Skip to main content

Advertisement

SpringerLink
Log in

Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Although multifocality is common in patients with papillary thyroid cancer, its effects on lymphatic metastasis and the necessity of central dissection in the presence of multifocality are still controversial. In our clinic, 258 patients who underwent thyroidectomy between 2015 and 2020 and were found to have papillary thyroid cancer in postoperative pathology reports were analyzed. The tumor characteristics contributing to central lymph node metastasis positivity were evaluated. Lymph node metastases were not significantly increased in the presence of multifocality. In cases with bilateral multifocal tumors, compared to cases with unilateral multifocal tumors, capsular invasion (p = 0.02), vascular invasion (p = 0.01) and cervical lymphatic metastasis (p = 0.004) were observed to increase. Bilateral multifocal tumors have more aggressive clinicopathological features than unilateral tumors. We found that the risk of central lymph node metastasis increased significantly in bilateral multifocal tumors in our study. Prophylactic central lymph node dissection may be considered in patients with no preoperative or intraoperative lymph node metastasis but thought to have a multifocal tumor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  PubMed  Google Scholar 

  2. Markovina S, Grigsby PW, Schwarz JK et al (2014) Treatment approach, surveillance, and outcome of well-differentiated thyroid cancer in childhood and adolescence. Thyroid 24(7):1121–1126. https://doi.org/10.1089/thy.2013.0297

    Article  PubMed  Google Scholar 

  3. He Q, Zhuang D, Zheng L et al (2012) The surgical management of papillary thyroid microcarcinoma: a 162-month single-center experience of 273 cases. Am Surg 78(11):1215–1218

    Article  PubMed  Google Scholar 

  4. Lee YS, Lim YS, Lee JC, Wang SG, Kim IJ, Lee BJ (2010) Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg 34:2558–2563

    Article  PubMed  Google Scholar 

  5. Degroot LJ, Kaplan EL, McCormick M, Straus FH (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–24

    Article  CAS  PubMed  Google Scholar 

  6. Kim HJ, Sohn SY, Jang HW, Kim SW, Chung JH (2013) Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg 37(2):376–384. https://doi.org/10.1007/s00268-012-1835-2

    Article  PubMed  Google Scholar 

  7. Lin JD, Chao TC, Hsueh C, Kuo SF (2009) High recurrent rate of multicentric papillary thyroid carcinoma. Ann Surg Oncol 16(9):2609–2616. https://doi.org/10.1245/s10434-009-0565-7

    Article  PubMed  Google Scholar 

  8. Pitt SC, Sippel RS, Chen H (2009) Contralateral papillary thyroid cancer: does size matter? Am J Surg 197(3):342–347. https://doi.org/10.1016/j.amjsurg.2008.09.011

    Article  PubMed  PubMed Central  Google Scholar 

  9. Koo BS, Lim HS, Lim YC, Yoon YH, Kim YM, Park YH et al (2010) Occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma. Ann Surg Oncol 17:1101–1105

    Article  PubMed  Google Scholar 

  10. Elisei R, Molinaro E, Agate L et al (2010) Are the clinical and pathological features of differentiated thyroid carcinoma truly changed over the last 35 years? Study on 4187 patients from a single Italian institution to answer this question. J Clin Endocrinol Metab 95(4):1516–1527. https://doi.org/10.1210/jc.2009-1536

    Article  CAS  PubMed  Google Scholar 

  11. Wang W, Wang H, Teng X et al (2010) Clonal analysis of bilateral, recurrent, and metastatic papillary thyroid carcinomas. Hum Pathol 41(9):1299–1309. https://doi.org/10.1016/j.humpath.2010.02.008

    Article  CAS  PubMed  Google Scholar 

  12. Silver CE, Owen RP, Rodrigo JP, Rinaldo A, Devaney KO, Ferlito A (2011) Aggressive variants of papillary thyroid carcinoma. Head Neck 33(7):1052–1059. https://doi.org/10.1002/hed.21494

    Article  PubMed  Google Scholar 

  13. Ito Y, Miyauchi A, Kihara M, Kobayashi K, Miya A (2014) Prognostic values of clinical lymph node metastasis and macroscopic extrathyroid extension in papillary thyroid carcinoma. Endocr J 61(8):745–750. https://doi.org/10.1507/endocrj.ej14-0138

    Article  PubMed  Google Scholar 

  14. Pelizzo MR, MeranteBoschin I, Toniato A et al (2008) Diagnosis, treatment, prognostic factors and long-term outcome in papillary thyroid carcinoma. Minerva Endocrinol 33(4):359–379

    CAS  PubMed  Google Scholar 

  15. Wang W, Zhao W, Wang H et al (2012) Poorer prognosis and higher prevalence of BRAF (V600E) mutation in synchronous bilateral papillary thyroid carcinoma. Ann Surg Oncol 19(1):31–36. https://doi.org/10.1245/s10434-011-2096-2

    Article  PubMed  Google Scholar 

  16. Karatzas T, Vasileiadis I, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G (2013) Bilateral versus unilateral papillary thyroid microcarcinoma: predictive factors and associated histopathological findings following total thyroidectomy. Hormones (Athens) 12(4):529–536

    Article  PubMed  Google Scholar 

  17. Suh YJ, Kwon H, Kim SJ et al (2015) Factors affecting the locoregional recurrence of conventional papillary thyroid carcinoma after surgery: a retrospective analysis of 3381 patients. Ann Surg Oncol 22(11):3543–3549. https://doi.org/10.1245/s10434-015-4448-9

    Article  PubMed  Google Scholar 

  18. Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G (2020) Risk factors for lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 11:265. https://doi.org/10.3389/fendo.2020.00265

    Article  PubMed  Google Scholar 

  19. Qu N, Zhang L, Ji QH, Zhu YX, Wang ZY, Shen Q et al (2014) Number of tumor foci predicts prognosis in papillary thyroid cancer. BMC Cancer 14:914

    Article  PubMed  PubMed Central  Google Scholar 

  20. Qu N, Zhang L, Wu WL, Ji QH, Lu ZW, Zhu YX et al (2016) Bilaterality weighs more than unilateral multifocality in predicting prognosis in papillary thyroid cancer. Tumor Biol 37:8783–8789

    Article  CAS  Google Scholar 

  21. Giordano D, Valcavi R, Thompson GB et al (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22(9):911–917. https://doi.org/10.1089/thy.2012.0011

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Sakarya University Educational and Research Hospital, Sakarya, Turkey

    Kayhan Ozdemir, Ahmet Tarik Harmantepe & Emre Gonullu

  2. Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey

    Belma Kocer & Zulfu Bayhan

Authors
  1. Kayhan Ozdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Tarik Harmantepe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Gonullu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Belma Kocer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zulfu Bayhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zulfu Bayhan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Faculty of Medicine, Sakarya University Ethics Committee (No. 71522473/050.01.04/253; date: 01.06.2021) (Decision number: 253, Date: April 01, 2021).

Human participants and/or animals

This study was performed in line with the principles of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all patients for inclusion in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozdemir, K., Harmantepe, A.T., Gonullu, E. et al. Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?. Updates Surg 75, 701–706 (2023). https://doi.org/10.1007/s13304-023-01479-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-023-01479-7

Keywords

Search

Navigation