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Incidental Papillary Thyroid Carcinoma: Diagnostic Findings in a Series of 287 Carcinomas

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Abstract

The recent increase in the detection of papillary thyroid carcinoma (PTC) has been influenced by the finding of incidental tumours. To this group, carcinomas measuring less than 1 cm (the so-called microcarcinomas) as well as those above 1 cm belong. Analyzing a case series from our own experience, this paper focuses on the current pre-operative diagnostic challenges that can lead to PTC incidental discovery. For this retrospective study, 287 patients with a PTC diagnosis were selected. For each, the following variables were analysed: sex, age, ultrasound (US) appearance, number of thyroid nodules, PTC size, PTC variants and presence of other associated pathology. Pre-operative fine needle aspiration (FNA) results were classified according to the five-tiered SIAPEC system. For 281 patients, the US-guided FNA results were available. Cytohistological correlation was evaluated in terms of FNA sensitivity and false negative rate. An incidental PTC was found in 45.2 % of patients. The majority of these were due to unsuccessful US detection of malignant nodules (103 cases); incorrect cytological diagnosis was responsible for the other 24 cases. The most powerful clinical confounding factors were: multinodular background versus single nodule presentations (p < 0.001) and histotype (follicular vs conventional variant, p < 0.05). Of course, tumour size remains a strongly influential feature on pre-operative diagnosis, with greater difficulties arising for carcinomas <5 mm. Moreover, FNA sensitivity was lower also in large PTCs (>2 cm) due to tumour heterogeneity. Although with limitations related to the tumour’s intrinsic features and the thyroid background, US-guided FNA, especially if performed by a dedicated multidisciplinary team, is a powerful diagnostic tool for detecting malignant thyroid nodules. To the state of the art, we propose a practical clinical-pathological cut-off for this procedure, setting it at 5 mm.

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Authors and Affiliations

  1. Department of Surgery and Translational Medicine, Section of Pathology, University Milan Bicocca, San Gerardo Hospital, 20900, Monza, Italy

    Fabio Pagni, Marta Jaconi & Francesca Bono

  2. Department of Surgery, San Gerardo Hospital, Monza, Italy

    Alberto Delitala, Mattia Garancini, Matteo Maternini & Alessandro Giani

  3. Department of Health Sciences, University Milan Bicocca, Milan, Italy

    Andrew Smith

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  1. Fabio Pagni
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  2. Marta Jaconi
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  3. Alberto Delitala
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  4. Mattia Garancini
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  5. Matteo Maternini
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  6. Francesca Bono
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  7. Alessandro Giani
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  8. Andrew Smith
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the San Gerardo Hospital collaborators group

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Correspondence to Fabio Pagni.

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The San Gerardo Hospital collaborators group: Manuela Colombo MD, Maurizio Capra MD, Rita Perego MD, Angela Ida Pincelli MD (Endocrinology); Davide Leni MD, Francesco Vacirca MD (Radiology); Marcella Scardilli MD, Giovanni Colombo MD (Surgery); Paolo Giannobi MD (Otolaryngology); Giuseppe Isimbaldi MD, Ambrogio Brenna MD (Pathology)

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Pagni, F., Jaconi, M., Delitala, A. et al. Incidental Papillary Thyroid Carcinoma: Diagnostic Findings in a Series of 287 Carcinomas. Endocr Pathol 25, 288–296 (2014). https://doi.org/10.1007/s12022-014-9323-x

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