A new paradigm in low-risk papillary microcarcinoma: active surveillance

Bibliometric insights in advances of papillary thyroid microcarcinoma: Research situation, hot points, and global trends

BACKGROUND

Thyroid cancer has been on the rise over the last decade. Papillary thyroid microcarcinoma (PTMC) accounts for more than half of all thyroid cancers. Micropapillary carcinoma of the thyroid is a common but non-fatal form of thyroid cancer. To better comprehend, nearly two decades of scientific outputs were analyzed and summarized using bibliometric methods in this study.

METHODS

Approximately 1098 publications from 2000 and 2021 were included in WoS database through systematic retrieval. The general information was characterized, and developmental skeleton and research frontiers were explored. CiteSpace, VOSviewer, and R, Tableau were used to evaluate and visualize the results.

RESULTS

A total of 1098 publications from across 75 countries were identified. The annual number of publications showed an increasing trend in the past 21 years. China, Korea, the United States of America (USA), Italy, and Japan made remarkable contributions to the research of PTMC. Thyroid was the most productive journal. Miyauchi Akira published maximum articles. The utmost productive institution was the University of Ulsan. Risk stratification, active surveillance, and thermal ablation garnered the attention of researchers leading to novel approaches in the clinical diagnosis and treatment of micropapillary thyroid carcinoma.

CONCLUSIONS

This bibliometric study provides a comprehensive analysis of global productivity, collaboration, and research hotspots within PTMC field, which will aid in directing research toward PTMC in the coming years.

Impact of the new guidelines of the American Thyroid Association on the treatment of the differentiated thyroid tumor in an Italian center with medium-high volume thyroid surgery

Background

The therapy for differentiated thyroid tumors is currently built upon two cornerstones: the stage of the disease and the new guidelines of the American Thyroid Association, jointly converging to lobohystmectomy for selected cases that meet certain criteria. The aim of the study was to relate these guidelines to the activity of an Italian center with a medium-high volume of thyroidectomies in a region with a high rate of endemic disease of the thyroid.

Methods

In order to conduct the analysis, the clinical records of the last 3 years, including 194 cases of total thyroidectomy and 3 lobohystmectomy, were taken into consideration. There were 46 cases of differentiated thyroid cancer (18 incidental tumors were found during thyroidectomies for benign diseases). Postoperative complications, patient characteristics and the stage of the tumor were assessed in relation to the new ATA guidelines.

Results

All patients underwent total thyroidectomy, with 2 of them also undergoing lymphadenectomy. The incidence of transient hypoparathyroidism was 19% with 1 case of permanent deficit. No cases of recurrent nerve injury were reported. Twenty-five out of the 28 patients with cancer preoperatively diagnosed were found with more nodules and in 15 of them the nodule had a diameter bigger than 1 cm. All the parameters suggested lobohystmectomy only for one case.

The treatment for the differentiated thyroid tumor is still widely discussed. Above all, differences between populations, screening methods and surveillance programs are still evident.

Conclusions

The ATA guidelines applied to our cases, even if limited, have shown limited applicability to our study, mainly due to the high incidence of multinodularity and the size of the nodule: typical characteristics of a region with a high rate of endemic thyroid pathology.

Papillary Thyroid Microcarcinoma: Reclassification to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): a Retrospective Clinicopathologic Study

Papillary thyroid microcarcinoma (PTMC) accounts for nearly 50% of newly diagnosed PTC cases. There is considerable debate in literature about the clinicopathologic features and prognostic significance of PTMC and whether it should be treated as a separate entity. Due to lack of agreement and supportive data, the consensus study group that established the criteria for non-invasive thyroid neoplasm with papillary-like features (NIFTP) kept its size above 1 cm i.e., excluding PTMC from this new group. As a result, to date, some patients diagnosed with PTMC get aggressive treatments such as partial or total thyroidectomy and even radioactive iodine ablation. We retrospectively studied clinicopathologic features and long-term follow-up of 48 cases of papillary thyroid microcarcinoma. Of these, 7 cases (15%) had capsular invasion, 2 cases (4%) had extrathyroidal extension, 1 case (2%) had lymphovascular invasion, 5 cases (25%) had lymph node metastases, no case (0%) had any distant metastases, and 1 case had recurrence after long-term follow-up (mean 13.7 years, range 1-21 years). Upon slide review, 8 cases fulfilled the criteria for NIFTP and were sub-classified under this new category. These 8 cases had no recurrence after long-term follow-up (mean 12.1 years, range 7-19 years). In this study, we confirmed the previous published reports exhibiting indolent nature of PTMC and also suggested that PTMC cases that fulfill all the criteria for NIFTP can be sub-classified under this term in order to avoid unnecessary aggressive treatment.