Background: Thyroid microcarcinoma (TMC) incidence has significantly increased in recent decades. The rates of lymph node metastasis extrathyroidal extension have been significantly different in patients with TMC ≤5 mm versus those with size >5 mm. The current analysis aimed to examine the clinicopathologic features of TMC measuring <5 mm and to compare them with those of TMC ≥5 mm.
Methods: A total of 273 patients with TMC confirmed by histological examination from December 2020 to May 2021 were enrolled in Bach Mai Hospital, Hanoi, Vietnam. Unconditional logistic regression models were used to determine the association between clinicopathological factors and tumor size, central lymph node metastasis and extrathyroidal extension.
Results: We found 212/273 patients (77.7%) were diagnosed incidentally. The majority of patients were female (87.5%) and had a mean age of 44.2 years. The mean tumor size (±standard deviation (SD)) was 5.72 ± 2.33 mm. Most of the patients were also diagnosed with papillary TMC. Multifocal and bilateral lesions accounted for 13.2% and 12.1%, respectively. The extrathyroidal invasion was observed in 14.7% (40 patients), while 24.5% (67 patients) were those with central lymph node metastases. The rate of extrathyroidal extension in patients with tumor size ≥5 mm was significantly higher than in patients with tumor size <5 mm (odds ratio (OR) = 4.98; 95% confidence interval (CI): 1.48-16.70; = 0.004). Patients with body mass index (BMI) <23 kg/m were found to be protected against the odds of extrathyroidal extension (OR = 0.38, 95% CI: 0.19-0.75; = 0.004) compared to those with BMI ≥23 kg/m. In univariable mode, central lymph node metastasis was positively associated with the odds of the presence of extrathyroidal extension (OR = 2.70, 95% CI: 1.34-5.45; = 0.004). In the multivariable model, central lymph node metastasis was also associated with the presence of extrathyroidal extension (OR = 2.507, 95% CI: 1.194-5.264; = 0.017). Univariate analysis demonstrated that tumor size ≥5 mm (OR = 2.04; 95% CI: 1.01-4.17; = 0.047) and extrathyroidal extension (OR = 2.71; 95% CI: 1.34-5.45; = 0.004) were risk factors of central cervical lymph node metastasis. In multivariable models, the extrathyroidal extension was associated with central lymph metastasis.
Conclusions: TMC <5 mm tumor size is less likely to have aggressive characteristics, including extrathyroidal extension, than a TMC ≥5 mm. Long-term follow-up studies are thus warranted to investigate the factors in the prognosis of TMC.
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http://dx.doi.org/10.24976/Discov.Med.202436180.20 | DOI Listing |
Am J Otolaryngol
December 2024
Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Technion, Haifa, Israel.
Objective: Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs), accurate risk stratification is valuable to optimize management: active surveillance (AS) vs. hemithyroidectomy (HT). BRAF positive lrPTMC is associated with increased recurrence risk; hence, AS was suggested for mutation-negative lrPTMC.
View Article and Find Full Text PDFGland Surg
November 2024
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background: Thyroid cancer is one of the most common endocrine tumors and preoperative diagnosis of thyroid follicular neoplasm (FN) is challenging. Commonly used examination methods have difficulty in distinguishing thyroid cancer from other follicular lesions. At the same time, with the recently released World Health Organization (WHO) guidelines, the risk classification of FNs of the thyroid is a new enlightenment for clinicians in the diagnosis and treatment.
View Article and Find Full Text PDFActive surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings.
View Article and Find Full Text PDFEndocr Connect
December 2024
S Xu, Endocrine and Diabetes Center, Nanjing University of Chinese Medicine, Nanjing, China.
Objective: To evaluate the therapeutic effects of microwave ablation (MWA) versus surgery in treating low-risk papillary thyroid microcarcinoma (PTMC), and to assess recurrence-free survival (RFS) in patients with and without the BRAFV600E mutation.
Methods: Totally 158 patients with low-risk PTMC treated with MWA and 288 patients who underwent surgical treatment were retrospectively analyzed. Local tumor progression (LTP), RFS, and adverse events associated with both treatments were monitored.
Arch Clin Cases
December 2024
Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
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