[Cytomorphological characteristics of thyroid papillary carcinoma and their prognostic value].

Objective: The aim of this study was to determine cytomorphological characteristics of classic papillary carcinoma that could point to a higher likelihood of intraglandular or paraglandular dissemination of the disease.

Methods: Morphological characteristics of classic thyroid papillary carcinoma and the size and ultrasonography characteristics of thyroid nodules were semiquantitatively analyzed in 100 patients diagnosed with papillary carcinoma by cytology and verified by histology. Data on the presence of intraglandular and paraglandular dissemination, established by histologic examination of postoperative material, were collected and analyzed.

Results: There were 16 male and 84 female patients aged 4-78 (mean 48.8) years. Polymorphism, multinucleation, intranuclear inclusions, psammoma bodies, presence of follicles, Hürthle like cells and connective tissue elements were present in 31%, 62%, 88%, 19%, 16%, 26%, 10% of cases, respectively. Thyroid nodule size was 4-80 mm (mean 14.5 mm) and up to 10 mm in 50% of cases; 76% of nodules were hypoechoic, 96% had irregular margins, and calcifications were present in 71% of nodules. Intraglandular dissemination and neck lymph node metastases were found in 16% of patients. Paraglandular dissemination was observed in 15% of cases. Statistical analysis showed no significant cytologic characteristic that would imply a higher or lower likelihood of intraglandular dissemination. Older age was found to be a risk factor for paraglandular but not intraglandular dissemination, while nodule size and neck lymph node metastases were not important for the presence of intraglandular or paraglandular dissemination.

Conclusion: Since no marker that could indicate a higher or lower likelihood of intraglandular and/or paraglandular dissemination of thyroid papillary carcinoma has yet been identified, it is advisable to perform total thyroidectomy when papillary carcinoma is diagnosed by cytologic examination, irrespective of the nodule size or tumor subtype.