Endocrine Abstracts

Introduction: Recently, the incidence of thyroid carcinoma (TC) has been increasing rapidly worldwide and caused with significant increase in detection of papillary thyroid microcarcinomas (PTMC), especially among young women. Most authors associate the high incidence of microcarcinomas with improved quality of diagnosis and medical supervision of population. The clinical course of microcarcinomas can be different, which gives rise to many controversies regarding their diagnosis and treatment.

Objective: The aim of the study was to assess the experience of diagnosis and management of patients with PTMC in Republican Clinical Oncological Dispensary (RCOD) of the Ministry of Health of the Republic of Tatarstan (Kazan, Russia) in the period from 2020 to 2022.

Materials and Methods: 42 patients with PTMC, treated in RCOD between 2020 and 2022, were included in this study. This accounted for 4.35% of total number of patients, operated for TC over these years (966 people).

Results: There were 36 women (85.7%), aged from 21 to 83 years and 6 men (14.3%), aged from 28 to 67 years. Patients aged 45 and older accounted for 57.1% (24), fertile-age female patients - for 41.7% (15). PTMC was an accidental finding during thyroid ultrasound in most cases with EU-TI-RADS 4 and 5 in 78.6% of patients. Thyroid cytopathology reported Bethesda V and VI in 75.5% of patients. 15 patients (33.3%) underwent hemithyroidectomy with isthmusectomy, including one with central lymph node dissection (LND). Thyroidectomy was performed in 27 patients (66.7%), including 15 patients with LND (55.5%): 13 - with central, 2 - with central and lateral. Papillary thyroid cancer was verified histologically in 100% of cases, including follicular variant in 3 patients (7.4%). Capsular invasion was found in 15 patients (35.7%), regional metastases – in 8 (19%). Combination of capsular invasion with regional lymph node metastases was diagnosed in 5 of 8 patients (62.5%). No distant metastases were detected. Tumor size up to 0.5 cm was detected in 4.7% (2), from 0.6 cm to 1 cm – in 95.3% (40) of cases. Multifocal tumor growth occurred in 6 patients (14.3%). In two of them (33.3%), multifocal microcarcinoma growth was combined with regional lymph node metastases. 12 patients (28.6%) underwent radioiodine therapy. All patients are alive without disease recurrence.

Conclusion: PTMC often affects fertile-age women (41.7%). 19% of patients had regional lymph node metastases, 35.7% - capsular invasion, 14.3% - multifocal tumor growth. Papillary microcarcinoma requires timely diagnosis and radical treatment.