PAPILLARY
THYROID MICROCARCINOMA (PTMC) – A COMMON CLINICAL ENTITY, BUT NOT ALWAYS ‘INNOCENT’
PTMC is
defined as papillary thyroid cancer (PTC) measuring less than 1 cm in size. PTMCs
are very common and are detected in up to 30 % in autopsy studies. In the past,
PTMCs were more commonly incidentally diagnosed during histological examination
of the specimen following thyroidectomy even for a presumably benign disease (in
up to 15 – 20 % of patients), but they are now increasingly detected by
high-resolution ultrasonography. PTMCs have excellent prognosis, with 10-year
or even 15-year disease specific survival rates exceeding 99 %. However, PTMCs
may occasionally have a more aggressive clinical behavior and 0.5 % of patients
will die of the disease. Recognized risk factors of mortality from a PTMC
include:
1.Age older
than 45 years
2.Male sex
3.African
American or minority race
4.Lymph node
metastases (no uncommon, in up to 50 % of patients, usually microscopic)
5.Extrathyroidal
extension
6.Distant
metastases
7.Intraglandular
spread or multifocality
8.BRAF
positivity
The presence
of 2 or more risk factors is strongly associated with cancer-related mortality
and can help to identify patients who should be considered for more aggressive
management.
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