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Background: The incidence of thyroid cancer is increasing globally due to the increase in detection of subclinical, low volume papillary thyroid microcarcinomas (PTMC) (<1 cm). Several international groups have recommended an active surveillance approach for this low‐risk disease. In contrast to many other countries, the United Kingdom's (UK's) approach to thyroid nodules is to avoid detection of incidental lesions where appropriate. Objective: This study aims to establish the proportion of patients with thyroid cancer in the UK that would benefit from active surveillance. Design, participants, and outcome measures: Individuals with PTMC in NHS Lothian from 2009–2020 were reviewed from a local thyroid cancer database. The mode of detection of PTMC and proportion of patients who might benefit from active surveillance were established. Results: From 651 individuals with differentiated thyroid cancer managed over 12‐year period, 185 individuals with PTMC were identified (28.4%). The majority of PTMC 151/185 (81.6%) were either diagnosed post‐operatively following thyroidectomy for benign disease or with nodal disease. Only 24 individuals with PTMC were identified following palpable thyroid nodule, incidental finding on imaging, and surveillance screening. Therefore, when the indication for surgery was considered, only 24/651 (3.7%) patients were identified pre‐operatively and would, therefore, be realistic candidates for active surveillance. Conclusion: Less than 4% of patients with thyroid cancer in the UK would be appropriate for active surveillance. Rather than developing programmes to deal with this minority of patients, focus should be maintained on minimising detection of these low‐risk cases. [ABSTRACT FROM AUTHOR]

Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aims of this study were to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p = 0.65), tumor size >2 cm (OR 1.45, p = 0.34), aggressive PTC histology (OR 0.55, p = 0.15), and age at diagnosis (OR 0.90, p = 0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27 [95% confidence interval], p = 0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and nontreated patients (p = 0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease. [ABSTRACT FROM AUTHOR]

Summary Background Papillary thyroid carcinoma (PTC) is the main type of the well-differentiated thyroid carcinomas. Multifocality is regarded as a poor prognostic factor for PTC. Methods Documents of 777 patients who underwent thyroidectomy were reviewed retrospectively. A total of 305 PTC patients were included. Patients with multifocal PTC were included in Group 1, and patients with unifocal PTC were included in Group 2. Results There were 165 patients (54.0%) in Group 1 and 140 patients (46%) in Group 2. The pathological mixed variant of PTC was significantly higher in Group 1 (p = 0,005). Lymph node metastasis (LNM) was detected at 9.6% and 3.5% in Group 1 and Group 2, respectively (p = 0,028). Micro PTC rates were 28.4% and 40.7% in Group 1 and Group 2, respectively (p = 0,017). Tumor size and pathologically mixed-type and fine-needle aspiration biopsy (FNAB) results were significantly different between multifocal and unifocal Micro PTC (p < 0.05). Conclusions Multifocality is more frequent in patients with tumors ≥1 cm and mixed-type tumors. LNM is found more often in multifocal tumors. The presence of micropapillary tumors can be predicted preoperatively by ultrasound-guided FNAB. Mixed-type pathology is also a predictive factor for multifocality. [ABSTRACT FROM AUTHOR]

Aim: There is no consensus regarding the recommended surgical approach in the treatment of micropapillary thyroid carcinoma (MTC) or whether additional treatment with radioactive iodine is necessary or not. The aim of this study was to investigate the surgical findings and pathological results of micropapillary thyroid cancer with tumor size of ≤5 mm or >5 mm and also in the presence of unifocal or multifocality. Material and Method: We enrolled 209 patients with MTC who underwent surgery at the Diskapi Training and Research Hospital between 2008 and 2012, in a retrospective study design. We divided patients into two groups according to whether tumor size of ≤5 mm or >5 mm and also categorized based on the presence of unifocal or multifocality. Results: One hundred and three patients (13 male, 90 female) with tumor size of ≤5 mm were categorized as group 1 and 106 patients (12 male, 94 female) with tumor size of >5 mm were categorized as group 2. Central lymph node dissection was more often performed in group 2 ( 40 (43.5%) to 20 (22.2%), p:0.002). Capsule invasion were identified in 6 (6%) of the patients in group 1 and in 20 (19.4%) of the patients in group 2 (p = 0.004). There was no statistically significant difference between the two groups regarding the presence of multifocality (24 (%23.8) patients in group 1 and 33 (%32) patients in group 2; p=0.18). Lymph node metastasis was more common in group 2 when compared to group 1 (4 (%4) to 13 (%12.6), p=0.027). Five patients (5%) with microscopically positive surgical margins were found group 2 however, none of the patients in group 1 had microscopically positive surgical margins (p:0.025). Conclusion: Although all tumors lower than 1cm categorized as micropapillary cancer, the recurrence of the disease is may more common in the presence of tumor greater than 5 mm. [ABSTRACT FROM AUTHOR]

Introduction: Lymph node (LN) metastases in papillary thyroid microcarcinomas (microPTCs) are common. The lymph node ratio (LNR) has been proposed as a risk factor for recurrence in papillary thyroid cancer. However, its relevance in microPTC is undetermined., Methods: Patients who underwent resection of their microPTC with concomitant LN clearance between 2005 and 2018 were identified. The LNR was calculated as the ratio of positive LNs to the total number of LNs., Results: Data on 50 patients (36 female [72%]; median age 47 years [range: 19-84]) who underwent LN clearance (28 central [56%] vs 22 central + lateral [44%]) were analysed. Positive LNs were found in over two-thirds of the patients ( n = 34; 68%). After a median follow-up of 61 months, 14 patients (28%) had developed recurrence. Positive LNs were not found to impact recurrence-free survival; extranodal extension and an LNR ≥ 0.26 were found to significantly increase the risk of recurrence on unadjusted analyses ( p < 0.05)., Conclusions: LN metastases are frequent among patients with microPTC. A higher LNR seems to be associated with recurrence. Additional studies are needed to further clarify these findings and to assess the possible role of LNR in treatment and surveillance.

Purpose: According to American Thyroid Association (ATA) guideline, papillary thyroid cancer (PTC) with minimal extrathyroidal extension (mETE) is classified at "intermediate risk" of persistent/recurrent disease. However, the impact of mETE per se on patients' outcome is not fully understood. The aim of our study was to evaluate the prognostic significance of mETE in patients with PTC not submitted to therapeutic or prophylactic lymph node dissection, according to tumor size and other prognostic factors., Patients and Methods: We retrospectively evaluated a total of 514 PTC patients: 127 (24.7%) had mETE (pT3Nx) and 387 (75.3%) had negative margins (pT1-2Nx). At a median follow-up of 9.1 years, patients were divided in two groups: patients with "good outcome" (no evidence of disease) and patients with "poor outcome" (persistent structural disease or recurrent disease or tumor-related death)., Results: The rate of patients with "poor outcome" was significantly higher in patients with mETE compared with patients with negative margins (11.8 versus 5.1%; OR 2.4576, 95% CI 1.2178-4.9594, p = 0.01). However, mETE was significantly associated with poor outcome only in patients with tumors larger than 1.5 cm., Conclusions: mETE is an unfavorable prognostic factor in tumors larger than 1.5 cm, suggesting that, in the absence of other unfavorable characteristics, smaller tumors with mETE should be classified and managed as "low risk" tumors.