Multicentric Papillary Thyroid Carcinoma and its Association With Lymph Node Metastases

Multicentric papillary thyroid carcinoma has been associated with adverse clinicopathologic features, but its prognostic significance remains controversial. This study investigates the relationship between multicentricity and lymph node metastases in a large cohort of patients with papillary thyroid carcinoma (PTC).

We conducted a retrospective analysis of 1037 consecutive patients with PTC who underwent total thyroidectomy at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, between 2000 and 2023. Clinical and histopathological variables including tumor multicentricity, capsule invasion, T stage, and cervical lymph node involvement were analyzed. Univariate associations were evaluated using χ² test and odds ratios with 95% confidence intervals.

Multicentric tumors were identified in 48.8% of the patients, with bilateral multicentricity documented in 1.3%. Lymph node metastases were present in 27.2% of the patients. Multicentricity was significantly associated with lymph node metastases (OR = 2.32, 95% CI: 1.75-3.08, P < 0.0001). Bilateral multicentricity showed a particularly strong association with nodal involvement (OR = 16.73, 95% CI: 3.72-75.25, P < 0.0001). Conversely, both N1a and N1b status were significantly associated with tumor multicentricity (OR = 1.97 and 2.69, respectively). Additional factors associated with multicentricity included T stage (particularly T1b and T3a) and capsule invasion (OR = 1.51, P = 0.0022).Multivariable analysis confirmed multicentricity as an independent predictor of lymph node metastases (adjusted OR = 2.19, 95% CI: 1.60-2.99, P < 0.0001), after adjustment for sex, age category, T stage, and thyroid capsule invasion.

Multicentric PTC shows a strong association with cervical lymph node metastases and capsule invasion. These findings support considering multicentricity as an important prognostic factor in risk stratification and treatment planning, particularly regarding the extent of thyroidectomy, prophylactic central neck dissection, and postoperative radioiodine therapy.