Background/Objectives: With evolving guidelines favoring de-escalation in the management of papillary thyroid microcarcinoma (PTMC), options such as active surveillance and minimally invasive procedures are now considered for patients with low-risk disease. However, a subset of PTMCs—particularly non-incidental cases—may exhibit aggressive behavior. This study compares disease characteristics and outcomes between incidental and non-incidental PTMCs over a 10-year period. Methods: This is a single-center retrospective comparative analysis utilizing a prospectively collected database of patients referred for thyroid surgery. Results: Papillary thyroid carcinoma accounted for 86.7% of thyroid malignancies, with PTMC comprising 36.2% (137 patients). Incidental PTMC represented 109 out of 1012 patients undergoing surgery for benign thyroid disease (10.8%). Non-incidental PTMC (NIPTMC), diagnosed preoperatively and presenting clinically without coexisting thyroid disease, was identified in 28 patients (20.4%). 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%), of which 27 had bilobar disease. Multifocal tumors 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, none opted for active surveillance.Conclusions:NIPTMC is more often associated with high-risk features and multifocality, necessitating more extensive surgery. These findings emphasize the need for careful preoperative risk stratification to guide individualized management.
背景/目的：随着指南的演变，甲状腺微小乳头状癌（PTMC）的治疗策略倾向于降阶梯处理，对于低风险患者，目前可考虑主动监测或微创手术。然而，部分PTMC——特别是非偶发性病例——可能表现出侵袭性行为。本研究比较了10年间偶发性和非偶发性PTMC的疾病特征及临床结局。方法：本研究为单中心回顾性比较分析，利用前瞻性收集的甲状腺手术患者数据库。结果：甲状腺乳头状癌占甲状腺恶性肿瘤的86.7%，其中PTMC占36.2%（137例）。在1012例因良性甲状腺疾病接受手术的患者中，偶发性PTMC占109例（10.8%）。非偶发性PTMC（NIPTMC）指术前诊断、临床发现且不伴有其他甲状腺疾病的病例，共28例（20.4%）。NIPTMC更常伴有高风险特征（75% vs. 10.1%，p=0.004），包括甲状腺外侵犯（21.43% vs. 7.3%，p=0.0015）、中央区淋巴结阳性（21.43% vs. 2.8%，p=0.0291）、侧颈淋巴结阳性（28.6% vs. 0%，p=0.012）以及淋巴血管侵犯（3.6% vs. 0%）。多灶性PTMC见于37例患者（27%），其中27例为双侧叶病变。多灶性肿瘤更易出现高风险特征（48.6% vs. 14%，p=0.007）。NIPTMC是多灶性的显著预测因素（p=0.0098）。所有患者均接受手术治疗，无患者选择主动监测。结论：NIPTMC更常伴有高风险特征及多灶性，需进行更广泛的手术切除。这些发现强调术前需进行细致的风险分层，以指导个体化治疗。
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