Background:
The incidence of micropapillary thyroid carcinoma (mPTC) has increased in the last decade. Active surveillance (AS) has been proposed as an alternative management for low-risk mPTC based on preoperative Kuma criteria. Controversy still exists on how to appropriately manage this group of patients, as some low-risk mPTC may harbor some postoperative features associated with disease recurrence as described in the 2015 American Thyroid Association (ATA) guidelines.
Methods:
We retrospectively reviewed 108 patients with histopathologic diagnosis of mPTC after surgery at a third level hospital in Mexico City from 2000 to 2018. Demographic and clinicopathologic data were analyzed as predictors for disease recurrence and/or metastatic disease (lymph node or distant). Comparison between group stratification based on preoperative Kuma criteria and postoperative 2015 ATA guidelines risk criteria for disease recurrence was performed. Measures of diagnostic accuracy were obtained for preoperative risk features according to the Kuma criteria.
Results:
Of 108 patients, 79 (73%) were classified as preoperative high-risk mPTC and 29 (27%) as low risk based on the Kuma criteria. Of these 79 high-risk patients, 38 (48%) were reclassified as low risk for disease recurrence, 12 (15%) as intermediate risk, and 29 (37%) remained as high risk based on the 2015 ATA risk criteria. Of the 29 preoperative low-risk patients, 19 (65.5%) remained as postoperative low risk for disease recurrence, 2 (7%) as intermediate risk, and 8 (27.5%) as high risk. Higher accuracy of preoperative risk features was obtained for lymph node and distant metastases, 84.2% and 97.2%, respectively. After multivariate analysis, age <40 years and microscopic extrathyroidal extension (ETE) were associated with higher risk for metastatic disease (lymph node or distant) in our cohort.
Conclusions:
Patients with mPTC under 40 years old and microscopic ETE are more prone to develop metastatic disease (lymph node or distant). One-third of our patients stratified as low-risk mPTC according to the Kuma criteria for AS had histopathologic features associated with a more aggressive clinical behavior or structural recurrence. In addition, lymph node and distant metastases are the preoperative risk features with the highest diagnostic accuracy for preoperative risk stratification.
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【Preoperative and Postoperative Risk Stratification of Thyroid Papillary Microcarcinoma: A Comparative Study Between Kuma Criteria and 2015 American Thyroid Association Guidelines Risk Stratification.].
【甲状腺乳头状微癌的术前和术后风险分层：Kuma标准与2015年美国甲状腺协会指南风险分层之间的比较研究。】
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DOI：10.1089/thy.2019.0698文章类型：杂志文章
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背景：
在最近十年中，微乳头状甲状腺癌（mPTC）的发病率有所增加。已提出基于术前Kuma标准的主动监视（AS）作为低风险mPTC的替代管理方法。关于如何适当地治疗该组患者仍存在争议，因为某些低风险的mPTC可能具有2015年美国甲状腺协会（ATA）指南中所述的与疾病复发相关的一些术后特征。
方法：
我们回顾性分析了2000年至2018年在墨西哥城三级医院接受手术治疗的108例mPTC的组织病理学诊断。分析了人口统计学和临床病理学数据，作为疾病复发和/或转移性疾病（淋巴结或远处）的预测指标。根据术前Kuma标准和术后2015 ATA指南疾病复发风险标准对组分层进行了比较。根据Kuma标准获得了术前风险特征的诊断准确性测量。
结果：
根据库玛标准，在108例患者中，有79例（73％）被归为术前高危mPTC，29例（27％）被归为低危。根据2015年ATA风险标准，在这79例高危患者中，有38例（48％）被重新分类为低疾病复发风险，12例（15％）被分类为中度风险，29例（37％）仍然被分类为高风险。在29例术前低危患者中，有19例（65.5％）仍为术后疾病复发的低风险，2例（7％）为中度风险，8例（27.5％）为高风险。淋巴结和远处转移的术前风险特征的准确性更高，分别为84.2％和97.2％。经过多变量分析，年龄<40岁和镜下甲状腺外扩展（ETE）与我们队列中转移性疾病（淋巴结或远处）的较高风险相关。
结论：
40岁以下的mPTC和镜下ETE的患者更容易发生转移性疾病（淋巴结或远处）。根据Kuma AS的标准，我们三分之一的患者被归为低危mPTC，其组织病理学特征与更积极的临床行为或结构复发相关。此外，淋巴结转移和远处转移是术前危险分层，对术前危险分层的诊断准确性最高。
背景：
在最近十年中，微乳头状甲状腺癌（mPTC）的发病率有所增加。已提出基于术前Kuma标准的主动监视（AS）作为低风险mPTC的替代管理方法。关于如何适当地治疗该组患者仍存在争议，因为某些低风险的mPTC可能具有2015年美国甲状腺协会（ATA）指南中所述的与疾病复发相关的一些术后特征。
方法：
我们回顾性分析了2000年至2018年在墨西哥城三级医院接受手术治疗的108例mPTC的组织病理学诊断。分析了人口统计学和临床病理学数据，作为疾病复发和/或转移性疾病（淋巴结或远处）的预测指标。根据术前Kuma标准和术后2015 ATA指南疾病复发风险标准对组分层进行了比较。根据Kuma标准获得了术前风险特征的诊断准确性测量。
结果：
根据库玛标准，在108例患者中，有79例（73％）被归为术前高危mPTC，29例（27％）被归为低危。根据2015年ATA风险标准，在这79例高危患者中，有38例（48％）被重新分类为低疾病复发风险，12例（15％）被分类为中度风险，29例（37％）仍然被分类为高风险。在29例术前低危患者中，有19例（65.5％）仍为术后疾病复发的低风险，2例（7％）为中度风险，8例（27.5％）为高风险。淋巴结和远处转移的术前风险特征的准确性更高，分别为84.2％和97.2％。经过多变量分析，年龄<40岁和镜下甲状腺外扩展（ETE）与我们队列中转移性疾病（淋巴结或远处）的较高风险相关。
结论：
40岁以下的mPTC和镜下ETE的患者更容易发生转移性疾病（淋巴结或远处）。根据Kuma AS的标准，我们三分之一的患者被归为低危mPTC，其组织病理学特征与更积极的临床行为或结构复发相关。此外，淋巴结转移和远处转移是术前危险分层，对术前危险分层的诊断准确性最高。
