Session: SAT 270-310-Thyroid Neoplasia (posters)
Poster Board SAT 293
The incidence of thyroid cancer has tripled over the past 40 years while the mortality rate has remained constant. The escalating incidence is largely due to detection of small papillary thyroid cancers (PTCs). The most commonly discussed cause is widespread imaging. We speculate that an important contributor to the rising incidence of PTC is the pathological findings of incidental, non-index papillary thyroid microcarcinomas (PTMCs) associated with benign thyroid surgery.
We performed a retrospective study of consecutive patients who underwent thyroid surgery from 2007 to 2014 at a single academic institution. Medical records were reviewed to identify thyroid cancers and the nature by which they were diagnosed. Cancers were categorized as incidental if the surgery was done for anticipated benign disease or the index nodule was confirmed to be benign on fine needle aspiration (FNA). This study was approved by the Institutional Review Board.
There were 1306 patients who underwent thyroid surgery during the study period. Thyroid cancer was diagnosed in 377 patients (28.8%). Among those patients with thyroid cancer, 181 (47.7%) had index cancers and 196 (51.9%) had incidental papillary thyroid cancers. Among the incidental papillary thyroid cancers, 4 (2.0%) were in patients with a benign FNA, and 20 (10.2%) had a FNA that revealed a follicular neoplasm or suspicious for follicular neoplasm. One hundred and thirty four of these incidental cancers (68.3%) were PTMCs and 2 of these were associated with lymph node metastasis. The mean size of the incidental papillary carcinomas was 0.90 cm.
We found that incidental papillary thyroid cancer represents 51% of the cancers diagnosed at our institution; PTMCs constitute 68.3% of the total incidental PTCs discovered on review of surgical specimens from thyroid surgery for benign conditions. Incidental cancers are common and increased pathologic scrutiny may therefore be contributing to the epidemic of thyroid cancer. Incidental PTMCs are less likely to have lateral compartment nodal metastases than clinically presenting cancers. However, central compartment nodes are at least sometimes involved.
Nothing to Disclose: GK, JWG, WSD, DJT
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