Battistella Enrico, Pomba Luca, Toniato Riccardo, Piotto Andrea, Toniato Antonio
Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy.
School of Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
J Pers Med. 2025 Jul 18;15(7):324. doi: 10.3390/jpm15070324.
: Papillary thyroid microcarcinoma (PTMC), a subtype of papillary thyroid carcinoma ≤ 1 cm in diameter, has shown a marked increase in incidence in recent decades, largely due to the widespread use of neck ultrasonography and fine needle aspiration cytology. Despite its generally indolent course, optimal management of PTMC remains controversial, with treatment strategies ranging from active surveillance to total thyroidectomy. : This retrospective study analyzes five years of experience at a single tertiary care center, including 130 patients diagnosed with PTMC following thyroid surgery between July 2018 and December 2023. Clinical, cytological, and pathological data were collected and analyzed to identify factors influencing surgical decision-making and postoperative outcomes. Patients underwent either total thyroidectomy or hemithyroidectomy, with central and lateral lymph node dissection performed as indicated. Follow-up included clinical and biochemical surveillance for a mean duration of 3 years. : Total thyroidectomy was performed in 89.3% of patients, while hemithyroidectomy was limited to 10.7%. Multifocality was observed in 26.1% of cases, with bilateral involvement in 17.7%. Occult lymph node metastases were found in 14.6% (central compartment) and 3.8% (lateral neck). Postoperative radioactive iodine therapy was administered in 23.8% of patients. At final follow-up, 90.7% were disease-free. No significant predictors of recurrence or adverse outcomes were identified, though multifocality and lymph node involvement influenced surgical planning. : Our findings support a risk-adapted surgical approach to PTMC, favoring total thyroidectomy in patients with suspicious or multifocal disease to avoid reoperation. While active surveillance and minimally invasive techniques are emerging, total thyroidectomy remains a safe and effective strategy in selected cases. Prospective, multicenter studies are needed to further refine management guidelines for this increasingly common thyroid malignancy.
甲状腺微小乳头状癌（PTMC）是直径≤1cm的乳头状甲状腺癌的一种亚型，近几十年来其发病率显著上升，这主要归因于颈部超声检查和细针穿刺细胞学检查的广泛应用。尽管其病程通常较为惰性，但PTMC的最佳治疗方案仍存在争议，治疗策略从积极监测到全甲状腺切除术不等。
本回顾性研究分析了一家三级医疗中心五年的经验，包括2018年7月至2023年12月期间130例甲状腺手术后诊断为PTMC的患者。收集并分析临床、细胞学和病理数据，以确定影响手术决策和术后结果的因素。患者接受了全甲状腺切除术或半甲状腺切除术，并根据情况进行中央和侧方淋巴结清扫。随访包括平均为期3年的临床和生化监测。
89.3%的患者接受了全甲状腺切除术，而半甲状腺切除术仅占10.7%。26.1%的病例观察到多灶性，双侧受累占17.7%。隐匿性淋巴结转移在中央区为14.6%，侧颈部为3.8%。23.8%的患者术后接受了放射性碘治疗。在最后一次随访时，90.7%的患者无疾病。未发现复发或不良结果的显著预测因素，尽管多灶性和淋巴结受累影响了手术规划。
我们的研究结果支持对PTMC采取风险适应性手术方法，对于可疑或多灶性疾病患者倾向于全甲状腺切除术以避免再次手术。虽然积极监测和微创技术正在兴起，但在特定病例中全甲状腺切除术仍然是一种安全有效的策略。需要进行前瞻性、多中心研究以进一步完善这种日益常见的甲状腺恶性肿瘤的管理指南。
