Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES)

Iacobone, Maurizio; Jansson, Svante; Barczyński, Marcin; Goretzki, P. E.

doi:10.1007/s00423-013-1145-7

Cited by 79 publications

(76 citation statements)

References 99 publications

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“…However, more data are required regarding the long-term therapeutic outcomes of multifocal PTC in microcarcinoma or larger tumors, as well as how unilateral or bilateral tumors and the number of tumors in multifocal carcinoma may affect treatment outcomes [1, 17]. Our study response to the consensus report of the European Society of Endocrine Surgeons suggests that prognosis might be impaired in clinical multifocal PTC, but the effect might be less or none in tumors < 1 cm [18]. Our results showed that multifocal papillary microcarcinoma had a lower relapse rate than larger tumors; however, there were no statistically significant differences in cancer and overall mortality after a mean follow-up of 7.1 ± 5.3 years.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Outcomes of Patients with Multifocal Papillary Thyroid Microcarcinomas and Larger Tumors

Kuo

Chen

et al. 2017

International Journal of Endocrinology

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A retrospective review of 626 patients with multifocal papillary thyroid carcinoma (PTC) including 147 patients (23.5%) with multifocal papillary thyroid microcarcinoma (PTMC) from a total of 2,536 patients with PTC who visited the Chang Gung Medical Center in Linkou, Taiwan, was performed. A comparison of the clinical features between 626 multifocal and 1,910 solitary PTC cases showed that patients in the multifocal PTC group were older and had a smaller mean tumor size, a more advanced tumor-node-metastasis (TNM) stage, and a higher percentage of nonremission status compared to patients in the solitary PTC group. Of the 626 patients with multifocal PTC, the group with larger tumors showed a more advanced TNM stage, a higher percentage of lymph node metastasis and soft tissue invasion, and a higher nonremission rate compared to the multifocal PTMC group. Of the 626 patients with multifocal PTC, 25 patients (4%) died during a mean follow-up period of 7.1 ± 5.3 years. Kaplan-Meier survival curves showed a significantly lower survival rate associated with multifocal PTMC compared to that with solitary PTMC.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Outcomes of Patients with Multifocal Papillary Thyroid Microcarcinomas and Larger Tumors

Kuo

Chen

et al. 2017

International Journal of Endocrinology

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“…Therefore, our findings cannot justify total thyroidectomy for all of the patients with solitary PTC on ultrasound. However, because the patients in our series had clinically advanced PTC, some of the occult nodules could be the source of recurrence, reported as multiple synchronous tumors or intrathyroidal metastasis (Mazzaferri & Jhiang 1994, Hay et al 2002, Bilimoria et al 2007, Iacobone et al 2014. Problems inherent to current diagnostic modalities (ultrasound and fine-needle aspiration cytology) complicate decisions regarding the extent of the initial thyroid surgery and underscore the need to identify clinicopathologic parameters predictive of multifocal disease.…”

Section: Discussionmentioning

confidence: 99%

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma

Park¹,

Jung²,

Ryu³

et al. 2015

Endocrine-Related Cancer

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We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11-8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68-15.08) and extrathyroidal extensions (OR, 3.03; 95% CI,) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients.

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“…According to a consensus report of the European Society of Endocrine Surgeons, they recommended bilateral prophylactic CLND for patients with total tumor diameter (sum of the largest diameter of all foci) greater than 1 cm, because the frequency of subclinical CLNM is higher in multifocal PTC. Combining literatures on multifocal PTC and our study, we believe TT should be considered for UMPTMC, especially with male gender and total tumor diameter greater than 1 cm [6]. …”

Section: Discussionmentioning

confidence: 71%

“…Total thyroidectomy (TT) is performed when the nodule is preoperatively confirmed to be malignant in bilateral lobes by FNAC [5]. Nevertheless, as the 17–87% of PTC were multifocal [6], there were different opinions on how to manage the unilateral multifocal PTMC (UMPTMC). Most surgeons prefer to proceed with TT, which would be associated with the lowest risk of locoregional recurrence.…”

Section: Introductionmentioning

confidence: 99%

Total thyroidectomy may be more reasonable as initial surgery in unilateral multifocal papillary thyroid microcarcinoma: a single-center experience

et al. 2017

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BackgroundThe extent of surgery in patients with unilateral multifocal papillary thyroid microcarcinoma (UMPTMC) remains to be controversial. Aimed to improve surgical management of UMPTMC, this study was performed to identify the recurrence of UMPTMC and analyze its predictive factors.MethodsThis study was approved by the Ethical Committee of The First Hospital of the Jilin University, and written informed consent was given by participants for their clinical records to be used in this study. We retrospectively analyzed a total of 97 consecutive patients who underwent initial surgery for the treatment of UMPTMC at The First Hospital of Jilin University, between October 2005 and October 2006.ResultsAltogether, 97 patients of UMPTMC have been enrolled in our study, in which 57 cases were performed with hemithyroidectomy (HT) while other 40 cases with total thyroidectomy (TT). The sum diameter of all tumors >1 cm was more frequent in HT group than in TT group (40.35 vs 20%; p = 0.046). Positive central lymph nodes were found more frequently in the TT patients than in the HT patients (80 vs 59.65%; p = 0.046). Tumor recurrence was seen more frequently in the HT cases than in the TT cases (26 vs 5%; p = 0.007). The disease-free survival period was significantly shorter for the HT patients than for the TT patients (p = 0.0059 by the log-rank test). The disease-free survival rates at 5 and 10 years were 91.23 and 73.68%, respectively, in the HT group and 100 and 92.5%, respectively, in the TT group. Univariate analysis by Cox’s proportional hazards method showed male gender, sum diameter of all tumors >1 cm, and central lymph node metastases (CLNM) to be risk factors for recurrence of HT patients. Male gender and sum diameter >1 cm were factors identified for multivariate analysis by Cox’s proportional hazards method which yielded risk ratios of 3.037 [CI 1.026–8.988; p = 0.045] and 5.475 [CI 1.389–21.572; p = 0.015] in the HT group.ConclusionsIn summary, with an increased risk of recurrence, TT may be more reasonable as initial surgery in UMPTMC, especially with male gender and total tumor diameter greater than 1 cm.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-017-1130-7) contains supplementary material, which is available to authorized users.

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Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES)

Cited by 79 publications

References 99 publications

Therapeutic Outcomes of Patients with Multifocal Papillary Thyroid Microcarcinomas and Larger Tumors

Therapeutic Outcomes of Patients with Multifocal Papillary Thyroid Microcarcinomas and Larger Tumors

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma

Total thyroidectomy may be more reasonable as initial surgery in unilateral multifocal papillary thyroid microcarcinoma: a single-center experience

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