Metastatic neck disease in multifocal thyroid papillary cancer

Abstract

Aim: Multifocal papillary thyroid cancer (MPTC) has aggressive and poor prognosis. The main aim of this study was to evaluate the lymph node metastasis pattern in MPTC patients. Methods: We retrospectively investigated the records of 2530 patients who underwent thyroidectomy for papillary thyroid cancer between January 2010 and December 2017. The age, gender, tumor size, thyroid capsule invasion and neck metastatic disease were evaluated in 515 of these patients having MPTC. Results: We compared multifocal and unifocal papillary thyroid cancer patients considering papillary thyroid capsule invasion (29.9%/10.86%), mean tumor diameter (15.9 mm/16.1 mm), central lymph node metastasis (56.5%/18.3%) and lateral neck lymph node metastasis (23.1%/6.3%). Capsule invasion was associated with an increased risk of multifocal disease. The incidence of capsular invasion and central and lateral neck metastases in MPTC patients was statistically significantly higher than in patients with unifocal thyroid papillary cancer (p<0.001). Conclusion: We recommend bilateral total thyroidectomy and bilateral central neck dissection as primary surgical treatment in multifocal thyroid cancer patients.