Defining Papillary Carcinoma of the Thyroid

Abstract

Objectives To review how changes in the pathologic definitions for papillary tumors of the thyroid during recent decades have affected outcomes for patients with these tumors. Methods Forty-nine previous reports or studies involving collectively 53,606 patients were reviewed, and new analyses were performed on the data to include analyses of agreement, incidence, survival, and diagnostic categories. Results The past emphasis on cytologic features to define papillary tumors has not resulted in ideal pairwise agreement between pathologists and has produced incidence and survival data suggesting overdetection and overdiagnosis. Most recently, tissue patterns have been reemphasized. Conclusions With the recent reemphasis on diagnostic tissue patterns (over cytologic criteria), agreements between pathologists for the diagnosis of papillary tumors should improve, and the incidence of papillary carcinoma should decline. Nevertheless, updated survival analyses demonstrate excellent long-term survival for most of those diagnosed with papillary carcinomas.