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Observational Study
. 2025 Nov 18;110(12):e4196-e4204.
doi: 10.1210/clinem/dgaf190.

Prospective Validation of ATA Risk Score for Papillary Thyroid Microcarcinoma: An ITCO Real-World Study

Simone De Leo  1 , Giulia Brigante  2 , Silvia D'Elia  3 , Simona Censi  4 , Bruno Madeo  2 , Silvia Morelli  5 , Alice Nervo  6 , Andrea Repaci  7 , Clotilde Sparano  8 , Ilaria Stramazzo  9 , Camilla Virili  9 , Francesco Bertagna  10 , Francesco Dondi  10 , Efisio Puxeddu  5 , Edoardo Talpacci  5 , Maria Chiara Zatelli  11 , Maria Rosaria Ambrosio  11 , Francesco Felicetti  6 , Alessandro Piovesan  6 , Luisa Petrone  8 , Virginia Adornato  8 , Matteo Trevisan  1 , Laura Fugazzola  1 , Chiara Mele  12 , Marco Zavattaro  12 , Erica Solaroli  13 , Nicola Salituro  13 , Mattia Rossi  14 , Loredana Pagano  14 , Alessandra Colapinto  7 , Cristina Basso  7 , Graziano Ceresini  15 , Michela Marina  15 , Umberto Crocetti  16 , Michela Massa  16 , Maurilio Deandrea  17 , Francesca Retta  17 , Giovanna Spiazzi  18 , Nicoletta Rolli  18 , Rocco Bruno  19 , Antonella Carbone  19 , Mario Rotondi  20 , Flavia Magri  20 , Poupak Fallahi  21 , Maria Grazia Chiofalo  22 , Maria Giulia Santaguida  9 , Salvatore Monti  23 , Tommaso Porcelli  24 , Roberto Castello  25 , Alfonso Sagnella  26 , Cristina Clausi  4 , Giulia Di Dalmazi  27 , Dario Tumino  28 , Andrea Palermo  29 , Antonio Brunetti  30 , Andrea Lania  31 , Andrea Liverani  32 , Cosimo Durante  33 , Umberto Ferraro Petrillo  3 , Marco Alfo'  3 , Sebastiano Filetti  33 , Giorgio Grani  33
Affiliations
Observational Study

Prospective Validation of ATA Risk Score for Papillary Thyroid Microcarcinoma: An ITCO Real-World Study

Simone De Leo et al. J Clin Endocrinol Metab. .

Abstract

Context: The risk of recurrence of papillary thyroid carcinoma (PTC) smaller than 1 cm (microPTC) is low. Predictors of disease persistence in microPTC are still unclear.

Objective: To compare the clinical and pathological characteristics of microPTCs with macrocarcinomas (PTC > 1 cm), identifying the predictors of biochemical and structural incomplete response 1 year after initial treatment in microPTC.

Methods: We included patients consecutively enrolled in the Italian Thyroid Cancer Observatory (NCT04031339), and selected patients with a histological diagnosis of PTC for whom complete pathological, clinical, treatment information, and results at the 1-year follow-up visits were available.

Results: Among 5038 patients in the cohort, 2345 (46.5%) had a microPTC. Patients with microPTCs had tumors with more indolent pathological features: only 3% of patients were classified as high risk according to the American Thyroid Association (ATA) risk stratification system for persistent or recurrent disease and 1% had distant metastases at diagnosis. MicroPTCs had a significantly better outcome: only 5% had a biochemical response and 2.3% a structural incomplete (SIR) response. Distant metastases at diagnosis were the best predictor of SIR in microPTCs (OR 5.13, 95% CI 1.11-23.73, P = .04). In a subgroup of 925 patients treated by total thyroidectomy and radioiodine treatment, the best predictor of SIR was the ATA high risk (OR 5.47, 95% CI 1.42-21.04, P = .01).

Conclusion: Our study confirms the favorable initial outcome of microPTC in a large series. We demonstrate that the ATA risk classification is reliable in predicting biochemical and structural persistence in patients with microPTC. Distant metastases, although rare, remain the best predictor of structural persistence at 1-year follow-up. These findings underscore the importance of tailored management strategies based on comprehensive risk stratification, rather than solely on tumor size.

Keywords: microcarcinoma; outcome; papillary thyroid carcinoma; predictors; thyroid cancer.

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Figures

Figure 1.
Figure 1.
Flowchart of the participants.
See this image and copyright information in PMC

References

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