Sipok, Arkadii1; Sardi, Armando1; Sittig, Michelle1; Eskay, Victoria1; Gushchin, Vadim1
1 The Institute for Cancer Care at Mercy, Department of Surgical Oncology, Baltimore, Maryland, USA
Background: Incidental papillary carcinoma (IPC) is often diagnosed as incidental histologic finding after thyroidectomy for benign reasons. IPC incidence has been increasing and its impact on treatment patterns is unclear.
Our objective was to investigate the incidence of IPC in patients with other chronic thyroid disease, considered benign and whether the diagnosis led to additional treatments.
Methods: A retrospective review of 309 patients who underwent surgical treatment for various benign thyroid conditions from 2005 to 2016at a single institution was conducted. Indication, surgical procedure, tumor localization, size, and, histology of IPCs were documented. FNA results of “follicular lesion of undetermined significance,” “suspicious for carcinoma,” “carcinoma,” and “non-diagnostic” were excluded.
Results: IPC was diagnosed in 57 of 309 patients (18%), 49 (86%) were female.Total thyroidectomy was performed in 47 patients (82%). The most common indications in patients with IPC were multinodular goiter (MNG), single thyroid nodule, and Grave’s disease. MNG was associated with highest frequency of IPC (n=38, 67%). FNA results were benign in 45 patients (79%). Median tumor size was 3mm. Multi-focality was observed in 21of patients (37%). Thirty-six patients (63%) had papillary carcinoma and the rest had a follicular variant of papillary carcinoma. Forty patients (77%) had Stage I, 4 (7%) stage II, and 6 (11%) stage III disease; 7 patients were not staged. Seventeen patients (30%) required adjuvant therapy with radioactive iodine therapy.
Conclusions: IPC is a common diagnosis in patients who underwent thyroid surgery for benign disease. In these patients almost one-third required an alternate treatment plan.
- Asioli S, Odasso C, Macri L, Palestini N, Bussolati G. Merits of the PMiT (papillary microtumor) terminology in the definition of a subset of incidental papillary microcarcinomas of the thyroid. Int J Surg Pathol. 2009;17(5):378-83.
- Kaliszewski K, Strutynska-Karpinska M, Zubkiewicz-Kucharska A, Wojtczak B, Domoslawski P, Balcerzak W, et al. Should the Prevalence of Incidental Thyroid Cancer Determine the Extent of Surgery in Multinodular Goiter? PLoS One. 2016;11(12):e0168654.