Clinical Analysis Of Multifocal Papillary Thyroid Carcinoma

Background and objective:Papillary thyroid carcinoma(PTC)often present as multifocal tumors.It has been reported that multifocal tumors are associated with elevate risk of lymph node and distant metastases, regional recurrence after initial treatment.But the clinical significance of the multifocal PTC is not clear.This study was designed to investigate the clinical features,diagnosis and management of multifocal PTC.Methods:From January 1997 to December 2006,648 patients who underwent surgery and defined as PTC,168 patients were multifocal.Results:There were 49 men and 119 women with a mean age of 42 years old(range:14～78 years old).we compared the clinical features of 168 patients with multifocal PTC with those of 480 patients with solitary PTC. patients with multifocal PTC were characterized by a higher ratio of male(P=0.004)and family history of thyroid tumor(P=0.031).In addition, cervical lymph node metastasis(P=0.008)and local invasion(P=0.001) tended to be at a higher frequency in patients with multifocal PTC.No significant differences were found between the two groups in mean age(P=0.235)and largest tumor size(P=0.18).We also found that cervical lymph node metastasis was more frequent in patients with≥3 tumor foci than in those with 2 tumor foci(P=0.004).Conclusions:Multifocal PTC were more malignant than solitary PTC,so total or near total thyroidectomy for multifocal should be performed. central compartment nodal dissection was also needed for patients with multifocal PTC,especially those with≥3 tumor foci.Lateral nodal dissection was not underwent unless Clinical examination found lymph node metastasis.Adjunctive therapy after operation such as endocrine therapy and ¹³¹I radiotherapy could decrease recurrence and prolong life span.