Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma

Min Wuk Lee M.D.; Tae Kwun Ha M.D.; Sung Mock Ryu M.D.; Sang Hyo Kim M.D.

doi:10.16956/kjes.2010.10.1.24

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M.D., M.D., M.D., and M.D.: Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma

Review Article

Korean J Endocrine Surg 2010;10(1):24-28.

Published online: 18 March 2010

DOI: https://doi.org/10.16956/kjes.2010.10.1.24

Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma

Min Wuk Lee M.D., Tae Kwun Ha M.D., Sung Mock Ryu M.D., Sang Hyo Kim M.D.

Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer.

Methods:

A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups.

Results:

The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15∼77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P＜0.001), ETE (P＜0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality.

Conclusion:

The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with post-operative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC. (Korean J Endocrine Surg 2010;10:24-28)

Keywords: Papillary thyroid carcinoma, Multifocality, Lymph node metastasis

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Table 1.

Clinicopathologic characteristics of 624 patients with solitary & multifocal papillary thyroid carcinoma

	Total (n=624)	Solitary (n=395)	Multifocal (n=229)	P value
Gender Female	565 (90.5%)	359 (90.9%)	206 (90.0%)
Male	59 (9.5%)	36 (9.1%)	23 (10.0%)	0.702
Mean age	46	44.66	48.26
＜45	294 (47.1%)	205 (51.9%)	89 (38.9%)
≥45	330 (52.9%)	190 (48.1%)	140 (61.1%)	0.025
Tumor size mean	1.15 cm	1.11 cm	1.22 cm
≤1 cm	317 (50.8%)	214 (54.2%)	103 (45.0%)
＞1 cm	307 (49.2%)	181 (45.8%)	126 (55.0%)	0.027
Capsular invasion	72 (11.5%)	45 (11.4%)	27 (11.8%)	＜0.001
ETE	161 (25.8%)	81 (20.5%)	80 (34.9%)	＜0.001
Cervical lymph node metastasis	226 (36.2%)	125 (31.6%)	101 (44.1%)	0.002
TNM (SI/SII/SIII/SIV)		312/2/69/12	144/3/71/11	0.004
Local recurrence	12 (1.9%)	4 (1.01%)	8 (3.5%)	0.03
Distant metastasis	0	0	0
Dissected lymph node	5.82±5.55	5.27±4.99	6.78±6.33
Surgery
TT/CND	361 (57.8%)	205 (51.9%)	156 (68.1%)
TT/MND	46 (7.4%)	23 (5.8%)	23 (10.0%)
Lobectomy/CND	217 (34.8%)	167 (42.3%)	50 (21.9%)

ETE = extra-thyroidal extension; TNM = Tumor-Node-Metastasis; SI = stage I; SII = stage II; SIII = stage III; SIV = stage IV; TT = total thyroidectomy; CND = central neck dissection; MND = modified neck dissection.

Table 2.

Multivariate analysis of related factors between solitary and multifocal papillary thyroid carcinoma

	Odds ratio	P value
Lymph node metastasis	1.782	0.024
Age (45<)	1.565	0.01
Extrathyroidal extension	1.518	0.005
Tumor size	1.201	0.303
Capsular invasion	1.183	0.535

Table 3.

Comparison of cervical lymph node metastasis between solitary and multifocal papillary thyroid carcinoma

	Cervical lymph node metastasis		P value	Cervical lymph node metastasis (n=226)		P value
	LN (−)	LN (＋)	P value	N1a	N1b	P value
Solitary Multifocal	270/395 (68.4%) 128/229 (55.9%)	125/395 (31.6%) 101/229 (44.1%)	0.002	102/125 (81.6%) 78/101 (77.2%)	23/125 (18.4%) 23/101 (22.8%)	0.517

LN = lymph node; N1a = metastasis to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes); N1b = metastasi to unilateral, bilateral, or contralateral cervical or superior mediastinal lymph nodes.

Table 4.

Characteristics of patients with recurrence

	Gender	Age (yr)	Tumor size (cm)	Tumor foci	Initial op	Time to recurrence Re op (month)	Recurrence site
Case 1	M	41	1.2	2	TT/CND	B.MND 31	B.level III
Case 2	M	37	1.4	2	TT/CND	B.MND 12	B.level III, IV
Case 3	F	58	2.5	2	TT/CND	I.MND 9	Level III
Case 4	F	57	0.9	1	RL/CND	Completion/CND 56	Level VI
Case 5	F	22	3	2	TT/CND	I.MND 25	Level IV
Case 6	F	35	2.2	2	TT/CND	I.MND 15	Level III, IV
Case 7	F	36	0.8	2	TT/CND	I.MND 18	Level II, III
Case 8	F	42	1.6	2	TT/CND	I.MND 18	Level III, IV
Case 9	F	25	2.0	1	RL/CND	Completion/CND 35	Level VI
Case 10	F	44	1.9	1	LL/CND	Completion/CND 23	Level VI
Case 11	F	42	0.8	1	RL/CND	Completion/CND 19	Level VI
Case 12	F	21	2.6	2	TT/CND	I.MND 11	Level IV

TT = total thyroidectomy; RL = right lobectomy; LL = left lobectomy; CND = central neck dissection; B.MND = both modified nec dissection; I.MND = ipsilateral modified neck dissection.

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