Papillary Thyroid Microcarcinoma (PTMC) in Thyroid Surgical Practice

Background/Objectives The rising incidence of papillary thyroid carcinoma (PTC) is largely attributed to increased detection of microcarcinomas. Disease mortality, however, remains unchanged, raising concerns about overdiagnosis and overtreatment. This led to de-escalation in disease management recommendations. Our study compares disease characteristics and outcomes of incidental vs non-incidental cases over ten years. Methods This is a single-center retrospective comparative analysis, utilizing a prospectively collected database of patients referred for thyroid surgery. Results PTC accounted for 86.7% of thyroid malignancies, with papillary thyroid microcarcinoma (PTMC) comprising 36.2% (137 patients). Incidental PTMC (IPTMC) represented 109 out of 1,012 patients undergoing surgery for benign thyroid disease (10.8%). Nonincidental PTMC (NIPTMC) was found in 28 patients (20.4%( without associated thyroid pathology. NIPTMCs were more frequently associated with high-risk features (75% vs. 10.1%, P = 0.004), including extrathyroidal extension (21.43% vs. 7.3% P 0.0015), positive central lymph nodes (21.43% vs. 2.8%, P = 0.0291), positive lateral lymph nodes (28.6% vs. 0 % P= 0.012), and lymphovascular invasion (3.6% vs. 0%). Multifocal PTMC was seen in 37 patients (27%), 27 with bilobar disease. Multifocal tumors were significantly larger compared to unifocal tumors (P = 0.0054) and had a higher likelihood of high-risk features (48.6% vs. 14%, P = 0.007). NIPTMC was a significant predictor of multifocality (P = 0.0098). All patients underwent surgery, with an increase in total thyroidectomies performed in the latter five years. None opted for active surveillance. Conclusion The findings suggest that NIPTMC often necessitates more aggressive surgery, driven by its association with high-risk features.