期刊
AMERICAN JOURNAL OF SURGICAL PATHOLOGY
卷 44, 期 9, 页码 1161-1172出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PAS.0000000000001522
关键词
papillary microcarcinoma; papillary microtumor; Porto proposal; thyroid cancer; sex hormone receptors; BRAF
资金
- Instituto de Salud Carlos III
- State Research Agency (AEI)
- Ministry of Science and Innovation (Spain)
- European FEDER funds [PI15/01501, PI19/01316, BFU2016-76793-R]
Given the high incidence and excellent prognosis of many papillary thyroid microcarcinomas, the Porto proposal uses the designation papillary microtumor (PMT) for papillary microcarcinomas (PMCs) without risk factors to minimize overtreatment and patients' stress. To validate Porto proposal criteria, we examined a series of 190 PMC series, also studying sex hormone receptors andBRAF(V600E)mutation. Our updated Porto proposal (uPp) reclassifies as PMT incidental PMCs found at thyroidectomy lacking the following criteria: (a) detected under the age of 19 years; (b) with multiple tumors measuring >1 cm adding up all diameters; and (c) with aggressive morphologic features (extrathyroidal extension, angioinvasion, tall, and/or hobnail cells). PMCs not fulfilling uPp criteria were considered true PMCs. A total of 102 PMCs were subclassified as PMT, 88 as PMC, with no age or sex differences between subgroups. Total thyroidectomy and iodine-131 therapy were significantly more common in PMC. After a median follow-up of 9.6 years, lymph node metastases, distant metastases, and mortality were only found in the PMC subgroup. No subgroup differences were found in calcifications or desmoplasia. Expression of estrogen receptor-alpha and estrogen receptor-beta, progesterone receptor, and androgen receptor was higher in PMC than in nontumorous thyroid tissue.BRAFmutations were detected in 44.7% of PMC, with no differences between subgroups. In surgical specimens, the uPp is a safe pathology tool to identify those PMC with extremely low malignant potential. This terminology could reduce psychological stress associated with cancer diagnosis, avoid overtreatment, and be incorporated into daily pathologic practice.
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