Background/Objectives: Given the high incidence and generally favorable prognosis of papillary thyroid microcarcinomas (PTMs), the Porto Proposal aims to refine the management of these tumors. It designates tumors lacking certain risk factors as papillary microtumors (PMTs) to avoid overtreatment and reduce patient stress. The updated Porto Proposal (uPp) suggests criteria for reclassifying incidental PTMs as PMTs. This study seeks to validate these criteria using data from a university hospital in Catalonia, Spain, and assess the clinical and pathological characteristics of PTMs.Methods: This retrospective study analyzed patients diagnosed with PTM (≤1 cm) at a university hospital from 2000 to 2024. The study examined variables, including lymph node positivity, incidental diagnosis, tumor location, histological type, treatment, multifocality, age at diagnosis, tumor size, and survival. The uPp criteria were applied to reclassify PTMs into PMTs or PMCs (true papillary microcarcinomas). Student’st-test and chi-square tests were used to evaluate the associations between these variables and the uPp classification.Results: The cohort comprised 107 patients, with 77 (72%) women and 30 men. The mean age at diagnosis was 54.5 years. Out of the total, 77 (72%) cases were reclassified as PMTs and 30 (28%) as PMCs according to the uPp criteria. PMC tumors were larger (mean size 4.5 mm vs. 3.3 mm for PMT,p= 0.014) and were significantly associated with multifocality (52.2%;p= 0.004). Most lymph node-positive cases were classified as PMCs (69.2%;p< 0.001) and were multifocal and bilateral more commonly. However, no significant differences in outcomes between PMCs and PMTs were found (p= 0.188). Follicular histology was significantly more common in PMTs (87.0%,p< 0.001) and rarely had lymph node metastases (4.6%;p= 0.047).Conclusions: The updated Porto Proposal (uPp) effectively identifies PTMs with minimal malignant potential, distinguishing between PMT and PMC. The findings support the protocol’s use in reducing unnecessary treatments and psychological stress for patients. The study highlights significant clinical and pathological differences between PTM subtypes, reinforcing the protocol’s applicability in daily pathological practice.
**背景/目的：** 鉴于甲状腺微小乳头状癌的高发病率及总体良好的预后，波尔图提案旨在优化此类肿瘤的管理。该提案将缺乏特定风险因素的肿瘤定义为微小乳头状肿瘤，以避免过度治疗并减轻患者压力。更新版波尔图提案提出了将偶发性甲状腺微小乳头状癌重新分类为微小乳头状肿瘤的标准。本研究旨在利用西班牙加泰罗尼亚地区一所大学医院的数据验证这些标准，并评估甲状腺微小乳头状癌的临床与病理特征。 **方法：** 这项回顾性研究分析了2000年至2024年间在一所大学医院诊断为甲状腺微小乳头状癌（≤1 cm）的患者。研究考察了包括淋巴结阳性、偶发性诊断、肿瘤位置、组织学类型、治疗方式、多灶性、诊断年龄、肿瘤大小和生存情况在内的变量。应用更新版波尔图提案标准将甲状腺微小乳头状癌重新分类为微小乳头状肿瘤或真性微小乳头状癌。采用Student's t检验和卡方检验评估这些变量与更新版波尔图提案分类之间的关联。 **结果：** 队列共纳入107例患者，其中女性77例（72%），男性30例。诊断时平均年龄为54.5岁。根据更新版波尔图提案标准，总计77例（72%）被重新分类为微小乳头状肿瘤，30例（28%）被分类为真性微小乳头状癌。真性微小乳头状癌的肿瘤更大（平均大小4.5 mm vs. 微小乳头状肿瘤的3.3 mm，p=0.014），且与多灶性显著相关（52.2%；p=0.004）。大多数淋巴结阳性病例被分类为真性微小乳头状癌（69.2%；p<0.001），且更常见为多灶性和双侧性。然而，真性微小乳头状癌与微小乳头状肿瘤在预后方面未发现显著差异（p=0.188）。滤泡型组织学在微小乳头状肿瘤中显著更常见（87.0%，p<0.001），且极少发生淋巴结转移（4.6%；p=0.047）。 **结论：** 更新版波尔图提案能有效识别恶性潜能极低的甲状腺微小乳头状癌，区分微小乳头状肿瘤与真性微小乳头状癌。研究结果支持该方案可用于减少不必要的治疗和患者的心理压力。本研究强调了甲状腺微小乳头状癌亚型间显著的临床与病理差异，进一步证实了该方案在日常病理实践中的适用性。
肿瘤(癌症)患者之家