‘Incidental thyroid cancer’ is not synonymous with ‘overdiagnosis’

We read with great interest the paper by Cosme and co-workers about the differences between incidentally (ITC) and non-incidentally (NITC) diagnosed papillary thyroid carcinoma (PTC) (1). We congratulate the authors for the excellent work-up of the study cohort that comprised 122 ITCs and 103 NITCs. Intriguingly, the study revealed no significant difference between ITC and NITC groups regarding the pTNM staging, American Thyroid Association (ATA) recurrence risk, proportion of aggressive PTC subtypes, frequency of radioactive iodine (RAI) prescription, and RAI activity. Moreover, the diagnostic modality (incidental vs symptomatic) had no impact on disease persistence at the 5-year follow-up both on univariate and on multivariate analyses. Although ITCs were smaller and of lower pT status than NITCs (which was expected given the definition of the groups), a considerable proportion of ITCs (36%) were yet larger than 2 cm in size.