Comparison of the clinicopathologic features and prognosis of bilateral versus unilateral multifocal papillary thyroid cancer: An updated study with more than 2000 consecutive patients

Wang, Weibin; Su, Xingyun; He, Kuifeng; Wang, Yanli; Wang, Haiyong; Zhao, Yihang; Zhao, Wenqiang; Zarnegar, Rasa; Fahey, Thomas J.; Teng, Xiaodong; Teng, Lisong

doi:10.1002/cncr.29689

Cited by 69 publications

(58 citation statements)

References 33 publications

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“…Analysis of the contralateral lobe for occult carcinoma is another potential benefit of total thyroidectomy. Rates as high as 47 per cent have been reported and are of relevance, given that bilateral PTC has consistently been shown to be associated with a more aggressive course than unilateral disease.…”

Section: Discussionmentioning

confidence: 95%

Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy

et al. 2019

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Background Low‐risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy. Methods Patients with PTC treated over 5 years (2013–2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high‐volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy. Results Of 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required. Conclusion Although many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low‐risk 1–4‐cm PTC in the hands of high‐volume thyroid surgeons who can demonstrate low complication rates.

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Section: Discussionmentioning

confidence: 95%

Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy

et al. 2019

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“…However, preoperative diagnosis of multifocal PTC including the location and number of tumors may be important information for surgical strategy and decision-making [16]. A recent study showed that bilateral multifocal PTC had a worse prognosis than unilateral multifocal PTC [5]. Lymph node dissection may be indicated in cases of multifocal PTC [19].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, multifocal PTMC with extrathyroidal extensions is categorized as an intermediate-risk group. Bilateral multifocal PTMC has a worse prognosis than unilateral PTMC [5, 6]. Multifocal PTC may be diagnosed as “incidental” in the final histopathology examination or “nonincidental” if it is diagnosed before or during thyroid surgery [7, 8].…”

Section: Introductionmentioning

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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“…Although PTC can spread to regional lymph nodes bilaterally, most bilateral LNMs (BLNMs) occur after intrathyroidal metastases . LNMs of PTCs in one lobe first occur ipsilateral to the primary lesion, with BLNMs rarely detected, even in advanced cases.…”

Section: Introductionmentioning

confidence: 99%

“…Although PTC can spread to regional lymph nodes bilaterally, 3,6 most bilateral LNMs (BLNMs) occur after intrathyroidal metastases. 7,8 LNMs of PTCs in one lobe first occur ipsilateral to the primary lesion, with BLNMs rarely detected, even in advanced cases. Although several studies have reported predictive factors associated with ipsilateral LNM in PTC, few studies have analysed the clinicopathological factors contributing to BLNM from PTCs limited to one lobe.…”

Section: Introductionmentioning

confidence: 99%

Lateral neck metastases in the ipsilateral and contralateral compartments of papillary thyroid carcinoma located in one lobe

Kim

Chang

et al. 2019

ANZ Journal of Surgery

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Background Papillary thyroid carcinoma (PTC) frequently involves lymph nodes in the lateral compartment, but PTC located in one lobe rarely metastasizes to bilateral lateral nodes. This study was designed to evaluate the clinicopathological features of patients with PTC limited to one lobe but with bilateral lateral neck metastasis (LNM). Methods Between January 2009 and December 2013, 698 patients with unilateral PTC with LNM were analysed. Of these patients, 651 had unilateral LNM (ULNM) and 47 had bilateral LNM (BLNM). The clinicopathological characteristics of the two groups were analysed. Results There were no significant between‐group differences in age, extrathyroidal extension, multifocality in one lobe, thyroiditis or psammomatous calcification. Male sex (51.1% versus 29.8%; P = 0.002), central compartment metastasis (91.5% versus 78.6%, P = 0.035), aggressive subtype of PTC (23.4% versus 8.8%; P = 0.001) and Delphian node metastasis (36.2% versus 18.1% versus 36.2%, P = 0.002) were significantly more frequent, and mean primary tumour size (1.79 ± 1.12 cm versus 1.34 ± 0.83 cm, P = 0.010) significantly larger in the BLNM than in the ULNM group. Conclusions Although few patients with PTC located in one lobe have BLNM, the contralateral lateral compartment should be carefully evaluated for BLNM in males and in patients with a primary tumour size >2 cm, aggressive subtype of PTC, central node metastasis and Delphian node metastasis.

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Comparison of the clinicopathologic features and prognosis of bilateral versus unilateral multifocal papillary thyroid cancer: An updated study with more than 2000 consecutive patients

Cited by 69 publications

References 33 publications

Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy

Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy

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

Lateral neck metastases in the ipsilateral and contralateral compartments of papillary thyroid carcinoma located in one lobe

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