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Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?
Kayhan Ozdemir1, Ahmet Tarik Harmantepe1, Emre Gonullu1
1Department of General Surgery, Sakarya University Educational and Research Hospital, Sakarya, Turkey.
Updates in Surgery
|March 5, 2023
Summary
Multifocality in papillary thyroid cancer doesn't always increase lymph node metastasis. However, bilateral multifocal tumors show more aggressive features, suggesting prophylactic central lymph node dissection may be beneficial.
Area of Science:
- Endocrinology
- Surgical Oncology
Background:
- Multifocality is common in papillary thyroid cancer.
- The impact of multifocality on lymphatic metastasis and central lymph node dissection remains debated.
Purpose of the Study:
- To evaluate the relationship between tumor multifocality and central lymph node metastasis in papillary thyroid cancer.
- To determine if multifocality necessitates central lymph node dissection.
Main Methods:
- Retrospective analysis of 258 patients with papillary thyroid cancer who underwent thyroidectomy (2015-2020).
- Evaluation of tumor characteristics associated with central lymph node metastasis positivity.
Main Results:
- Multifocality did not significantly increase overall lymph node metastases.
- Bilateral multifocal tumors showed increased capsular invasion, vascular invasion, and cervical lymphatic metastasis compared to unilateral multifocal tumors.
- A significant increase in central lymph node metastasis risk was observed in bilateral multifocal tumors.
Conclusions:
- Bilateral multifocal papillary thyroid cancer exhibits more aggressive clinicopathological features.
- Prophylactic central lymph node dissection may be considered for patients with multifocal tumors, even without preoperative or intraoperative evidence of metastasis.
