Although papillary thyroid carcinoma is the most common form of thyroid malignancy, it is considered to be an indolent disease that progresses slowly and has an excellent prognosis. Patients, therefore, may be monitored on a regular basis rather than undergo a surgical procedure at the outset. But results from a new large-scale study show that in nearly 20 percent of patients, papillary thyroid tumors less than 1 cm in size had pathological signs of more aggressive disease that increased the risk that these patients might develop distant metastasis (spread of the disease to other areas of the body away from the primary site of cancer). The study demonstrates the need for developing sophisticated tests that will find patients with these pathological signs early on and for them to be counseled on all treatment options, including immediate surgical removal of part or all of the thyroid gland. The research study appears in an "article in press" on the Journal of the American College of Surgeons website in advance of print.
Thyroid carcinoma is the most common malignancy of the endocrine system, and the papillary form of the disease accounts for 70 to 90 percent of these malignancies. Papillary thyroid microcarcinoma (PTMC) is a specific subgroup of papillary thyroid carcinoma that accounts for 30 percent of all papillary thyroid malignancies.
The prognosis for patients with PTMC is good; the disease is responsible for only 3 percent of all deaths from thyroid cancer and 5 percent of deaths of patients with papillary thyroid carcinoma. The indolent course of the disease is shown by the relatively high prevalence of PTMC in autopsies of individuals who died of other causes (3 to 36 percent) and comparable clinical outcomes for patients whether they underwent an operation or not. The American Thyroid Association's 2015 guidelines for treatment of PTMC support surgical removal of the thyroid gland of patients with PTMC. The guidelines also, however, discuss active surveillance or regular intensive monitoring and repeat testing, and at least one clinical trial recommended observation of patients with PTMC.
Patients with suspected PTMC typically have preoperative ultrasound or biopsy. However, pathological features of aggressive disease can be found only on a full examination of tissue removed at the time of surgery.
In general, PTMC tumors are not aggressive and not likely to affect overall survival. However, there are subsets within the patient population who may develop more serious cancers that could be life-threatening. With that in mind, we looked specifically at the risk of distant metastasis and the pathological profiles of patients with PTMC." Zaid Al-Qurayshi, MD, MPH, lead author of the study, Department of otolaryngology-head and neck surgery, University of Iowa Hospitals and Clinics, Iowa City Related Stories
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