A cancer of undetermined significance: Incidental thyroid carcinoma

Abstract

Introduction The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Methods Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Results Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non‐incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non‐complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). Conclusion ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases

“… 18 New investigation methods of thyroid nodules, such as elastography, PET/CT, biomarkers, and tumor markers are being investigated, but there is a consensus that USG-guided FNA is essential for the management of patients with thyroid nodules. 3 , 4 , 5 , 8 Nevertheless, the high occurrence of incidentalomas draws attention to the need for a more careful selection of thyroid sites to be biopsied. When only the LD results are compared with the preoperative diagnosis, it can be seen that the false-negative percentage in the Bethesda II category is 1.5% in this study, compatible with the error rate predicted for the method in the literature 0% to 3%.…”

“…In earlier stages, they have more favorable histopathological characteristics and a better prognosis. 8 Despite the more optimistic profile recorded in the literature, Maturo et al. 9 identified evidence of lymph node metastases in 57.7% of patients with incidental thyroid carcinomas.…”

Is Bethesda classification sufficient to predict thyroid cancer in endemic regions?

“…In our study, rate of incidental cancer was 18.2% of the whole series and 49.5% of all cancers were evaluated as incidental cancer. A study by Evranos et al detected incidental cancer in 326 (36 %) of 906 patients who were operated and determined to have a malignancy [12].…”

Oxidative Stress, Sensorineural Deafness Linked to Advancing Age - Presbycusis: Systematic Review

“…Few studies suggest that while screening in the general population does not appear to be useful, screening high risk groups by examination of the throat might be useful [22]. Incidental thyroid cancers are frequently determined in early stages with more favorable histopathological features and better prognosis [23].…”