Increasing prevalence of papillary thyroid carcinoma in recent years in Greece: the majority are incidental

Pathogenesis of cancers derived from thyroid follicular cells

The genomic simplicity of differentiated cancers derived from thyroid follicular cells offers unique insights into how oncogenic drivers impact tumour phenotype. Essentially, the main oncoproteins in thyroid cancer activate nodes in the receptor tyrosine kinase-RAS-BRAF pathway, which constitutively induces MAPK signalling to varying degrees consistent with their specific biochemical mechanisms of action. The magnitude of the flux through the MAPK signalling pathway determines key elements of thyroid cancer biology, including differentiation state, invasive properties and the cellular composition of the tumour microenvironment. Progression of disease results from genomic lesions that drive immortalization, disrupt chromatin accessibility and cause cell cycle checkpoint dysfunction, in conjunction with a tumour microenvironment characterized by progressive immunosuppression. This Review charts the genomic trajectories of these common endocrine tumours, while connecting them to the biological states that they confer.

An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma.

CASE PRESENTATION

We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx.

CONCLUSION

To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.

Evaluation of the Diagnostic Performance of EU-TIRADS in Discriminating Benign from Malignant Thyroid Nodules: A Prospective Study in One Referral Center

BACKGROUND

Several thyroid societies have endorsed ultrasound (US) malignancy risk stratification systems for thyroid nodules and the recently released European Thyroid Imaging Reporting and Data System (EU-TIRADS) needs large prospective studies for validation.

OBJECTIVE

The purpose of our study was to evaluate the performance of EU-TIRADS in identifying thyroid nodules for fine-needle aspiration biopsy (FNAB) and its ability to reduce the number of unnecessary biopsies.

METHODS

This was a single-center prospective study. From August 2017 to September 2018, 783 consecutive patients with 1,000 thyroid nodules underwent US examination and US-guided FNAB. A total of 741 patients (median age 50 years; range, 15-87 years; 649 females, 92 males) with 942 nodules (median largest diameter 14 mm; range, 4-96 mm) met the following inclusion criteria: (1) nodules with benign or malignant cytology - categories II and VI of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC); (2) nodules with non-diagnostic and indeterminate cytology (BSRTC I, BSRTC III, and BSRTC IV), or suspicious for malignancy (BSRTC V), if postoperative histology was present; (3) nodules classified as BSRTC I and BSRTC III with a repeat FNAB and conclusive cytology.

RESULTS

Of 942 nodules, 839 (89.1%) were benign and 103 (10.9%) were malignant. Nodules were classified as follows: EU-TIRADS 2 - 4.8%, EU-TIRADS 3 - 37.4%, EU-TIRADS 4 - 25.2%, and EU-TIRADS 5 - 32.6%. The malignancy rate in categories 2 to 5 was 0, 0, 3.8, and 30.6%, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EU-TIRADS with a cut-off set at category 5 were 91.3, 74.6, 30.6, 98.6, and 76.4%, respectively. Diagnostic performance other than sensitivity and NPV was superior in nodules ≥10 mm. FNAB number would be reduced by 53.4% if FNAB criteria were strictly applied. When the indication for FNAB was applied as test positivity, the estimated sensitivity, specificity, PPV, and NPV of EU-TIRADS were 69.9, 56.3, 16.4, and 93.8%, respectively.

CONCLUSION

EU-TIRADS provides effective malignancy risk stratification that can guide the selection of thyroid nodules for biopsy. The application of the guidelines criteria for FNAB in the clinical practice might reduce significantly the number of unnecessary FNAB.

A shift to more targeted thyroidectomies increased the detection of thyroid cancer and in particular low-risk papillary tumors in Southwestern Greece the decade 2007 to 2016

OBJECTIVES

Data regarding thyroid cancer (TC) epidemiology in Greece in the last decade are scarce, so we investigated the trends in TC detection during 2007 to 2016.

METHODS

We retrospectively studied 2040 pathology reports of total thyroidectomies performed at our institution from 2007 to 2016.

RESULTS

A number of 478 cases of TC were identified in the studied decade. The overall incidence of TC among thyroidectomies rose over the years. The proportion of papillary T1 tumors among thyroidectomies increased in the second period of our study (2012-2016), while that of papillary T2 to T4 tumors and other TC subtypes remained unchanged. Papillary T1 tumors represented 63.6% of all TC cases and 75.3% of them were low-risk microcarcinomas (papillary thyroid microcarcinoma). The strategy of fine needle aspiration (FNA) prior to surgery in the management of thyroid nodules was adopted by more clinical endocrinologists in the area of Southwestern (SW) Greece in the second period of our study (2012-2016:29.7% vs 2007-2011:18.4%, P < .001). Consequently, the indication for thyroidectomy was set by FNA more frequently in 2012 to 2016 than in 2007 to 2011 (42.5% vs 26.4% of cases, P < .001).

CONCLUSIONS

The wider use of FNA in the triage of thyroid nodules led to increased rates of TC in thyroidectomies performed in SW Greece during the decade 2007 to 2016; low-risk, small papillary tumors represented the majority of TC cases.

Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected

OBJECTIVE

To determine the prevalence of lymph node (LN) metastasis and extrathyroidal extension (ETE) in patients with papillary thyroid microcarcinoma (PTMC) in Cyprus and to evaluate the role of preoperative ultrasound (U/S) examination.

METHODS

A retrospective study of 102 patients who underwent thyroidectomy for PTMC in a 2-year period. Preoperatively, all patients had a thyroid and neck U/S examination with LN mapping. Tumor size according to the largest diameter, number of foci, LN metastasis, and ETE data was collected from the histopathological report and was compared to the preoperative U/S reports.

RESULTS

LN metastasis was present in 23.5% of patients. 15.7% had central, 3.9% had lateral, and 3.9% had both central and lateral LN metastasis. ETE was present in 27.5% of patients. 21.6% had multifocal disease, and in this group, 40.9% had LN metastasis and 36.4% had ETE. Multifocality (p = 0.03), size of tumor (p = 0.05), and ETE (p ≤ 0.001) were significantly associated with LN metastasis. The prevalence of LN metastasis in multifocal PTMC ≤5 mm was the same with multifocal PTMC >5 mm. The preoperative U/S sensitivity for the suspicious lateral neck and central LN was 100%, and the specificity was 100%. The preoperative U/S sensitivity for nodules suspicious for ETE was 53.6%, and the specificity was 100%.

CONCLUSION

The presence of LN metastasis and ETE in our PTMC patients in Cyprus is frequent. Neck U/S mapping is a highly reliable and accurate tool in identifying metastatic nodes. LN metastasis is associated with ETE and multifocality. Suspicious subcentimeter nodules should undergo FNA irrespective of size when multifocality is suspected.

Papillary Thyroid Cancer: Genetic Alterations and Molecular Biomarker Investigations

Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all cancers of the thyroid. It is also one of the few cancers with a rapidly increasing incidence. PTC is usually contained within the thyroid gland and generally biologically indolent. Prognosis of the cancer is excellent, with less than 2% mortality at 5 years. However, more than 25% of patients with PTC developed a recurrence during a long term follow-up. The present article provides an updated condensed overview of PTC, which focuses mainly on the molecular alterations involved and recent biomarker investigations.

Papillary thyroid carcinoma of the isthmus: Total thyroidectomy or isthmusectomy?

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most common histological type of differentiated thyroid malignancy. Although the majority of PTC is located in the thyroid lobes, a small minority arise from the thyroid isthmus. The reported incidence of PTC arising in the thyroid isthmus ranges from 1% to 9.2%, probably reflecting variation in the study populations.

PURPOSE

This review aimed to analyze the data about the optimal management of PTC arising in the isthmus.

DATA SOURCES

We performed a systematic review of PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials to identify eligible studies analyzing surgical management strategies and published outcomes of isthmic PTC.

RESULTS

Most reports support that papillary thyroid carcinomas originating in the isthmus are more likely to have multiple foci, invasion of thyroid capsule and adjacent tissues with increased rate of central node involvement, compared to carcinomas located in other parts of the thyroid.

CONCLUSIONS

The extent of the surgical resection, the role of prophylactic central neck dissection and the extent of central neck dissection in surgery for isthmic PTC remain highly controversial. However, total thyroidectomy and central node dissection may be an appropriate treatment for these patients.

No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period

Background

The prevalence of papillary thyroid microcarcinoma (PTMC) is continuously increasing but its clinical significance and management is still debatable. The aim of this study was to investigate possible changes in the clinical presentation, tumor characteristics, treatment modalities and long-term outcome during the last three decades in patients with PTMC.

Methods

We studied 335 patients with PTMC who were followed up for at least 5 years, from 1982 to 2015, and treated in accordance with the current literature or guidelines at each time-period. Patients were classified according to year of diagnosis into two time periods, TP1 from 1982–2000 and TP2 from 2001–2010.

Results

The mean follow-up of the whole cohort was 10.6 ± 5.3 (median 9) years. No change was noted in the mean age at diagnosis or the female to male ratio during the two time periods. In regard to tumor characteristics, multifocality and non-encapsulated follicular variant of PTMC was more often present while classic PTMC was less common in patients in the TP2, compared to patients in the TP1 (p = 0.007, p < 0.001 and p = 0.043 respectively). The prevalence of incidental PTMC was high but similar in both time periods (84.6 vs 80 %, p = 0.286). The majority of patients in TP2 underwent a total or near total thyroidectomy compared to patients in TP1 (91.7 vs 80 %, p = 0.001). However, more patients underwent thyroidectomy for toxic multinodular disease and less for Graves’ disease during TP1 compared to patients in the TP2 (p = 0.02 and 0.043 respectively). A significant percentage of patients underwent adjuvant radioiodine ablation, yet no difference was found between the two time periods (73.8 vs 79.5 %, p = 0.228). The rate of persistence was very low and not significant (3.1 vs 6.6 %, p = 0.165), while disease recurrence was observed in only 2 (0.6 %) patients, one from each time period.

Conclusions

We did not observe any important changes regarding the clinical presentation or tumor characteristics of PTMCs during a 30-year period. With applied interventions a favorable course was confirmed in the majority of patients without differences in recurrence or persistence during the last three decades.

Trends of Thyroid Cancer in Israel: 1980-2012

OBJECTIVES

Thyroid cancer incidence is increasing worldwide, while mortality from thyroid cancer is stable or decreasing. Consequently, survival rates are rising. We describe time trends in the incidence, mortality, and 5-year survival of thyroid cancer in Israel in 1980-2012, in light of the global trends.

METHODS

Israel National Cancer Registry database provided information regarding thyroid cancer incidence and vital status, which enabled computation of survival rates. The Central Bureau of Statistics database provided information on thyroid cancer mortality. Incidence and mortality rates were age-adjusted and presented by population group (Jews/Arabs) and gender. Relative 5-year survival rates which account for the general population survival in the corresponding time period were presented by population group and gender. Joinpoint analyses were used to assess incidence trends over time.

RESULTS

In 1980-2012 significant increases in the incidence of thyroid cancer were observed, with an annual percent change (APC) range of 3.98-6.93, driven almost entirely by papillary carcinoma (APCs 5.75-8.86), while rates of other types of thyroid cancer remained stable or decreased. Furthermore, higher rates of early detection were noted. In 1980-2012, a modest reduction in thyroid cancer mortality was observed in Jewish women (APC -1.07) with no substantial change in Jewish men. The 5-year relative survival after thyroid cancer diagnosis has increased to ≥90% in both population groups and both genders.

CONCLUSIONS

The Israeli secular trends of thyroid cancer incidence (increasing), mortality (mostly stable), and survival (modestly increasing) closely follow reported global trends.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010

INTRODUCTION

An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades.

OBJECTIVE

To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade.

METHODS

Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process.

RESULTS

An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas.

CONCLUSION

There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status

BACKGROUND

The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy.

METHODS

322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded.

RESULTS

From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology.

CONCLUSION

The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.

A descriptive study of the characteristics of differentiated thyroid cancer in Catalonia during the period 1998-2012. The CECaT registry

INTRODUCTION

The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC).

PATIENTS AND METHODS

The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012).

RESULTS

In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p<0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion.

CONCLUSIONS

Patient characteristics analyzed are similar to those reported in other parts of the world.

Papillary thyroid carcinomas in patients under 21 years of age: clinical and histologic characteristics of tumors ≤10 mm

OBJECTIVE

To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) ≤10 mm in patients ≤21 years old with larger ones and with microcarcinomas in adults.

STUDY DESIGN

Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected.

RESULTS

Patients ≤21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC ≤10 mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors ≤10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC ≤10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups ≤15, 15-18, and >18 to ≤21 years old, respectively; P = .016). Mean tumor size was larger (6.8 ± 2.7 vs 5.8 ± 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients ≤21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019).

CONCLUSIONS

The frequency of PTC ≤10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable.

Evolution of differentiated thyroid cancer: a decade of thyroidectomies in a single institution

BACKGROUND

Numerous studies have shown an increase in the incidence of thyroid cancer (TC) in recent years.

OBJECTIVES

In this paper, we reviewed the incidence of TC in a series of patients undergoing thyroid surgery at a single institution over a 10-year period.

PATIENTS AND METHODS

The cohorts were divided into two periods (2001-2005 and 2006-2010) with the purpose of comparing various clinicopathologic variables.

RESULTS

A total of 1,263 patients were included. A significant increase in the number of malignancies was shown in the second period, namely 90 cases in 2001-2005 (15.2% of all interventions) compared to 163 cases in 2006-2010 (24.3%) (p < 0.001). These differences were attributed to an increase in papillary thyroid carcinoma (PTC), as there were 66 PTC cases in the first period (11.13% of thyroidectomies performed) compared to 129 cases in the second period (19.25%). There were no clinicohistological differences among PTC cases in these two periods.

CONCLUSIONS

Over the last decade, there has been an increase in the incidence of TC in patients undergoing thyroid surgery. This increase is exclusively due to increases in PTC. Our study verifies the existence of this trend in our geographical area, similar to that noted in other parts of the world.

Clinical features and prognosis of patients with benign thyroid disease accompanied by an incidental papillary carcinoma

PURPOSE

To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with a background of benign disease.

METHOD

A total of 709 patients with papillary thyroid carcinoma undergoing surgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroid disease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examination of surgical specimens but were not detected by preoperative imaging studies. In the other group, according to the pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified as concomitant PTC and 309 cases were clarified as dominant PTC.

RESULTS

Incidental PTC was more common in women, about 85.7%, the mean age was 47.6±11.3 years old. Average tumor diameter was 4.4±2.2 mm, multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147). After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), there was no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10 and 14 year respectively.

CONCLUSION

Incidental PTC with a background of benign lesions is common, and the generally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperative finding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, but with a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomy or immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unless lymphadenectasis is present.

Obesity and thyroid cancer: epidemiologic associations and underlying mechanisms

The incidence of thyroid cancer has been rising over the past few decades along with a parallel increase in obesity. Observational studies have provided evidence for a potential association between the two. By contrast, clinical data for a link between type 2 diabetes mellitus, a condition strongly associated with obesity, and thyroid cancer are limited and largely not supportive of such an association. Obesity leads to hypoadiponectinemia, a pro-inflammatory state, and insulin resistance, which, in turn, leads to high circulating insulin and insulin-like growth factor-1 levels, thereby possibly increasing the risk for thyroid cancer. Thus, insulin resistance possibly plays a pivotal role in underlying the observed association between obesity and thyroid cancer, potentially leading to the development and/or progression of thyroid cancer, through its interconnections with other factors including insulin-like growth factor-1, adipocytokines/cytokines and thyroid-stimulating hormone. In this review, epidemiological and clinical evidence and potential mechanisms underlying the proposed association between obesity and thyroid cancer risk are reviewed. If the association between obesity and thyroid cancer demonstrated in observational studies proves to be causal, targeting obesity (and/or downstream mediators of risk) could be of importance in the prevention and management of thyroid cancer.

Should patients with remnants from thyroid microcarcinoma really not be treated with iodine-131 ablation?

Remnant ablation by radioiodine is generally not recommended in patients presenting uni- or multifocal cancer <1 cm, in the absence of other higher risk features. We retrospectively studied low-risk patients (pts) with differentiated thyroid cancer (DTC) less than 1 cm recruited for radioiodine therapy (RAI).

METHODS

91 pts (79 women, age 48.4 ± 12 yrs) with DTC were enrolled for RAI. Patients underwent pre-therapy ultrasonography (US), those with suspected/ambiguous lymph-nodes were excluded and proposed for cytology. Treated pts underwent post-therapeutic whole body scan (WBSt) completed by neck/chest SPECT/CT, when necessary (e.g. evidence of uptake outside of thyroid bed). A target lesion on SPECT/CT was defined as an identifiable lymph-nodal site presenting a matched significant iodine uptake. The patients were followed up for 14 ± 2 months thereafter.

RESULTS

All pts/cancers were pT1. The mean histological diameter was 0.68 ± 0.23 cm. Six patients were excluded because of suspected nodal involvement at US. Thirty (35 %) out of 85 pts had suspicious WBSt as per lymph-nodal involvement which was confirmed at the subsequent SPECT/CT acquisition in most part of pts (26/30; 86 %). Overall detected target lesions was 34, and nine (26 %) had interim positive fine needle cytology.

CONCLUSIONS

a significant part of low risk DTC patients, for whom RAI is not recommended, presents an incidental suspicion of lymph-nodal involvement at WBSt confirmed by subsequent SPECT/CT. Such setting would have not been treated by I-131.

Rising Incidence of Small Size Papillary Thyroid Cancers with No Change in Disease-Specific Survival in Finnish Thyroid Cancer Patients

Background:

The aim of this study was to investigate trends in the incidence, diagnostics, treatment and survival of thyroid cancer in Tampere University Hospital (TAUH) region in recent decades.

Material and Methods:

New thyroid cancer cases from 1981 to 2002 were ascertained from the Finnish Cancer Registry. Follow-up data was collected from medical records of TAUH. Differentiated thyroid cancer (DTC; consisting of papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC)) patients' data was analyzed and divided into two equal time periods (1981–1991 and 1992–2002).

Results:

The total amount of thyroid cancer cases was 553, of which 427 (77%) were papillary and 72 (13%) follicular. Thyroid cancer was four times more common in females than in males and the median age at the time of diagnosis was 52 years. The incidence of DTC was 4.5/100 000 in the earlier group and 6.0/100 000 in the later group (IRR 1.33, CI 1.11–1.60). The proportion of papillary thyroid cancer rose from 81% to 89% (p = 0.02) in two study periods. Median tumour size became smaller, from 25 mm to 15 mm (p < 0.001). Surgery became more radical as total thyroidectomies were performed almost exclusively on the later group (p < 0.001). Median cumulative dose of radioiodine (I131) therapy was higher in the later group (p = 0.04). There was no difference in number of cancer recurrences (p = 0.54). The prognosis of DTC was good; 10-year disease-specific survival was 92% in the earlier group and 94% in the later group (p = 0.43).

Conclusions:

The incidence of thyroid cancer has risen and proportion of papillary cancer has increased, however, median size of tumour has decreased. No difference was seen in either all-cause or disease-specific survival.

Changes in TNM stage, reoperation and 131-I ablation rate during the use of newer methods for the preoperative diagnosis of differentiated thyroid carcinoma

OBJECTIVE

To define and discuss the changes of important risk factors and TNM staging over the last 40 years in patients operated on for differentiated thyroid carcinoma (DTC), resulting from the introduction of newer sensitive diagnostic procedures in the preoperative evaluation of thyroid nodules.

PATIENTS

We reviewed the medical records of 1251 patients with postoperative diagnosis of DTC who had undergone initial diagnosis, before surgery, at our unit, between 1971 and 2010. According to the period of diagnosis, the patients were divided into four groups (I, II, III, IV) corresponding to the four decades.

RESULTS

The mean age at diagnosis was unchanged over time for both papillary (PTC) and follicular thyroid cancer (FTC). A decrease in the proportion of FTC (group I vs group IV P < 0·01) and a concomitant increase in PTC/FTC ratio was observed particularly in group IV. The significant decrease in the proportion of tumour size of PTC (group I vs group IV, P < 0·01), the increase in the proportion of microcarcinomas, from 22·4% in group I to 53·0% in group IV, P < 0·001, and the decrease in the number of cases with features of aggressiveness have changed the TNM stage towards stages I and II. The overall frequency of patients at high risk was significantly decreased, from 8·0% in group I to 1·8% in group IV. The number of patients who underwent reoperation for the completion of tumour resection and/or radioiodine therapy significantly decreased over time.

CONCLUSIONS

The evaluation of thyroid nodules using the newer diagnostic methods was useful in identifying DTC early. Consequently, the reoperation and thyroid remnant ablation rates were reduced.

Follicular thyroid carcinoma

Follicular thyroid carcinoma is being diagnosed less and less frequently despite the increasing incidence of well-differentiated thyroid carcinomas everywhere. This review will discuss the reasons underlying such an observation focusing on the evolution of the morphological and immunohistochemical diagnostic criteria of follicular thyroid tumors. It will address the differential diagnosis between follicular carcinoma and three tumor types--follicular adenoma, follicular variant of papillary carcinoma and poorly differentiated carcinoma--as well as the problems raised by the newly described categories of follicular tumors: follicular tumor of uncertain malignant potential, well-differentiated tumor of uncertain malignant potential and well-differentiated carcinoma, not otherwise specified. Finally, the prognostic and therapeutic significance of some promising molecular biomarkers will be discussed within the frame of the aforementioned histopathological classification.

Primary hyperparathyroidism and incidental multifocal metastatic papillary thyroid carcinoma in a man

Co-existence of primary hyperparathyroidism (PHPT) and non-medullary thyroid carcinoma has been previously reported in sporadic case reports and some surgical series, but the majority of cases concerned women with occult papillary carcinomas without cervical lymph node involvement. We present a 71-year man with PHPT and multinodular goiter who was subjected to surgery for single parathyroid adenoma and was found to have synchronous multifocal papillary thyroid carcinoma (PTC) with cervical lymph node involvement. Review of the literature retrieved only a few similar cases. Ultrasonography of both thyroid and parathyroid glands might be considered in patients with hyperparathyroidism. Given that there are no specific guidelines for the management of patients with synchronous PHPT and PTC, they should be managed like the cases of single PTC.