Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis

Abstract

Background:The clinicopathological characteristics and conclusive treatment modality for multifocal papillary thyroid microcarcinoma (mPTMC) have not been fully established.Methods:A retrospective study, systematic review, and meta-analysis were conducted to elucidate the clinicopathological significance of mPTMC. We investigated the multiplicity of 383 classical papillary thyroid microcarcinomas (PTMCs) and the clinicopathological significance of incidental mPTMCs. Correlation between tumor recurrence and multifocality in PTMCs was evaluated through a systematic review and meta-analysis.Results:Tumor multifocality was identified in 103 of 383 PTMCs (26.9%). On linear regression analysis, primary tumor diameter was significantly correlated with tumor number (R2=0.014, p=.021) and supplemental tumor diameter (R2=0.117, p=.023). Of 103 mPTMCs, 61 (59.2%) were non-incidental, with tumor detected on preoperative ultrasonography, and 42 (40.8%) were diagnosed (incidental mPTMCs) on pathological examination. Lymph node metastasis and higher tumor stage were significantly correlated with tumor multifocality. However, there was no difference in nodal metastasis or tumor stage between incidental and non-incidental mPTMCs. On meta-analysis, tumor multifocality was significantly correlated with tumor recurrence in PTMCs (odds ratio, 2.002; 95% confidence interval, 1.475 to 2.719, p<.001).Conclusions:Our results show that tumor multifocality in PTMC, regardless of manner of detection, is significantly correlated with aggressive tumor behavior.

A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: a retrospective individual risk factor-matched cohort study

“…Most patients with PTMC demonstrated excellent clinical outcomes, and all PTMC patients with recurrences could reach a disease-free state after re-operation. These findings are consistent with previous studies (5,6,7,8,10,11,12). In multivariate analyses, younger age, male gender, multifocality and cervical LN metastasis were related to recurrence of PTMC, as previously reported (5,6,9,10,11,12,13,14).…”

“…Disease-specific mortality rate of patients with PTMC who underwent treatment is less than 1%, loco-regional recurrence rate is 2-4% and distant recurrence rate is 1-2% (5,6,7,8). The prognostic factors for recurrence in patients with PTMC were known such as age, large primary tumor size (>0.5 cm), presence of extrathyroidal extension, multifocal tumor and the presence of cervical lymph node (LN) metastasis (5,6,9,10,11,12,13,14).…”

The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study

“…There was a difference statically significant between group A and group B in terms of neck hematoma (0.5% vs 3.7%), temporary hypoparathyroidism (11.4% vs 21.4%) and temporary unilateral nerve injury (1.5% vs 6.4%). According to Literature data, the recurrence rate in central lymph nodes compartment in patients aged over 65 years was higher compared to series of younger patients and was associated with a higher tumor staging and an increased rate of tumor multifocality [ 5 , 43 , 44 ]. Considering the patient stratified by age, the Authors reported a double rate of central lymph nodes compartment recurrence in over 75 years old patients, without statistically significant difference with patients aged 65–74 years.…”

Application of Ultrasonography in the Diagnosis and Management of Papillary Thyroid Microcarcinoma

“…Hong et al [25] confirmed that PTMC with age≤45, irregular morphology, and microcalcification was more likely to have CLNM. Pyo et al [37] found that multifocality in PTMC was significantly associated with aggressive behavior of the tumor. Jeon et al [38] found that male patients <50 years of age, tumors located in the upper or subcapsular, and microcalcification had a higher risk of LLNM (Fig.…”