Endocrine Abstracts (2011) 26 P467

Differences between incidental and preoperatively diagnosed papillary thyroid microcarcinomas. Review of the last decade

M Paja1, A Oleaga1, A Ugalde2, A Expósito3, C Moreno1, M Sánchez-Goitia1, A J Izuzquiza1 & J R Elorza1

1Endocrinology, Hospital de Basurto, Bilbao, Spain; 2Pathology, Hospital de Basurto, Bilbao, Spain; 3Endocrine Surgery, Hospital de Basurto, Bilbao, Spain.

Increasing incidence of papillary thyroid microcarcinoma (PTMC) is due to accurate histological study of surgical specimens (incidental, INC) or to improved preoperative diagnostic techniques (preoperatively diagnosed, PD). We evaluate the differences between both groups of PTMC from 2000 to 2009.

We reviewed data of patients diagnosed of PTMC (<10 mm) during the last decade with complete follow-up since surgery. Demographic data, tumour size, histological features (variant, extra capsular involvement (ECI), number of foci), lymph node disease (LND), treatment and clinical course were recorded.

Eighty-seven patients included 50 INC and 37 PD; 29 between 2000 and 2004 (18 INC, 62%) and 58 between 2005 and 2009 (32 INC, 55%). Main features are showed:

Size (mm)Age (years)≥2 foci (%)ECI (%)NX/NO/N1 LNDHigh riskaReQxbI131 (%)Curec
aHigh risk – patients with stage≥III (pT3 and/or N+ over 45 years).
bReoperation – thyroidectomy completion/compartmental dissection (LND). Two cases of 12 INC, showed new PTMC foci.
cCure, undetectable thyroglobulin (Tg) levels and normal cervical sonography in last evaluation. Seven not cured INC comprised 4 without radioiodine and minimal residual stable Tg levels (3–7 years after surgery), one treated with I131 and stimulated Tg:2.6 ng/ml without foci (9 years after surgery), plus two patients with positive antiTg Ab not radiated. In PD there was one metastatic patient, died of AMI 4 years after surgery, and other with ECI and LND in surgery, with stimulated level of Tg:2.8 ng/ml and normal sonography two years after surgery.

The incidence of PTMC shows an increasing trend in our series. INC tumours occur in older patients, are more frequently unifocal, without ECI and without LND, but they can display a high risk stage and require treatment as PD and larger tumours.

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