Clinical Features And Lymph Node Metastasis Of Multifocal Thyroid Papillary Carcinoma

Objective:Comparison of multifocal papillary thyroid carcinoma(MPTC)with single focal papillary thyroid carcinoma(PTC)clinical pathological characteristics,to explore the risk factors of lymph node metastasis,number of lesions and lesions total diameter on the impact of lymph node metastasis,to provide reference for the establishment of surgical strategy.Methods:A retrospective study of 2259 patients with thyroid papillary carcinoma was diagnosed after the first surgery.The clinicopathologic features of single focal group and multifocal group,unilateral multifocal group and bilateral multifocal group and single focal group were compared.According to the number of lesions,and the differences between the two groups of MPTC patients were compared.According to the total diameter of the lesion,all PTC patients were divided into two parts.The clinicopathologic features were compared between two groups of patients.According to the presence of lymph node metastasis in central region was divided into two groups,compared with and without lymph node metastasis and clinical pathologic features,the relationship between and through central multiariable Logistic regression analysis of risk factors for lymph node metastasis.According to the presence of lateral neck lymph node metastasis was divided into two groups and compare the clinicopathological features between the two groups and analysis the risk factors of lateral neck lymph node metastasis by multiariable Logistic regression.Results:Among the 2259 patients with PTC,1765 female(78.1%),494males(21.9%)and average age was 43.1 years old,936 patients(41.4%)were over 45 years old.The patients with single focal PTC were 1268(56.1%)and 991 patients(43.9%)were multifocal PTC patients.The PTC patients with 2 foci in MPTC were 539(54.4%),with 452 patients(45.6%)with no less than 3 foci,and 322(32.5%)lesions on the single side with 669 cases(67.5%)on both sides.In these 669 patients with bilateral MPTC,493 cases(73.7%)were clearly diagnosed before surgery(73.7%).One side was clearly diagnosed as malignant on the side of 115 cases(17.2%);On one side,61 cases(9.1%)were diagnosed as malignant on the side,and bilateral MPTC patients were diagnosed by paraffin pathology after surgery.The incidence of lymph node metastasis in the multifocal group was significantly higher than that in the singlefocal group(P < 0.05).The mean lesion diameter,total diameter,number of lesions and lymph node metastasis were higher in the bilateral multifocal group than in the single focal group(P < 0.05).The incidence of lymph node metastasis in the central and lateral neck regions of the unilateral multifocal group was significantly higher than that in the single focal group(P < 0.05).The higher the number of lesions,the larger the total diameter of the lesion,the higher the incidence of lymph node metastasis(P < 0.05).After the total diameter of the lesion was divided into all PTC patients,there was no significant difference(P>0.05)in the incidence of capsular invasion and lateral cervical lymph node metastasis in the multifocal group.Lesions total diameter > 1cm PTC shifting risk was about lymph node in central region lesions in patients with 1.961 times of diameter ?1cm group(P < 0.05),while multifocal PTC central lymph node metastasis in patients with risk was about 1.410 times that of the single focal group(P < 0.05);Lesions total diameter > 1cm PTC lateral neck lymph node metastasis in patients with risk was about lesions 3.636 times of diameter ?1cm group(P < 0.05),while multifocal PTC lateral neck lymph node metastasis in patients with risk was about 1.404 times that of the single focal group(P <0.05).The ratio of lymph node metastasis in central and lateral cervical regions was higher in male PTC patients aged < 45 years(P < 0.05).Conclusion:1.MPTC had a higher risk of membrane invasion and lymph node metastasis than single-focal PTC.2.Compared with the number of lesions,the overall diameter of PTC had a greater effect on the risk of lymph node metastasis,and the larger the total diameter of the lesions,the higher the risk of lymph node metastasis in PTC patients.3.Male PTC patients with age < 45 years were more likely to have lymph node metastasis in central and lateral neck regions.4.Membrane invasion was an independent risk factor for lymph node metastasis in the central region but was not a risk factor for lymph node metastasis in the lateral neck region.5.Preoperative ultrasound diagnosis for patients with unilateral MPTC contralateral hidden potential lesions.