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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2013

01-03-2013 | Endocrine Tumors

Multifocality and Total Tumor Diameter Predict Central Neck Lymph Node Metastases in Papillary Thyroid Microcarcinoma

Authors: Qunzi Zhao, MD, Jie Ming, MD, Chunping Liu, MD, Lan Shi, MD, Xia Xu, MD, Xiu Nie, MD, Tao Huang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2013

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Abstract

Purpose

To identify the subgroup of high-risk papillary thyroid microcarcinoma (PTMC) inclined to lymph node metastasis (LNM).

Methods

Patients who underwent total thyroidectomy with central neck dissection and had a pathologic diagnosis of PTMC between 2003 and 2010 at Wuhan Union Hospital were identified. The frequency of LNM was retrospectively analyzed according to the clinicopathological features. For multifocal lesions, total tumor diameter (TTD) was calculated as the sum of the maximal diameter of each lesion. Last, a meta-analysis was performed with respect to multifocality and LNM in the PTMCs.

Results

The proportion of LNM was similar between multifocal PTMCs with TTD ≤ 1 cm and unifocal tumors with diameter ≤ 1 cm (37.5 vs. 30 %, P = 0.463). LNM frequency was also similar between multifocal PTMCs with 1 < TTD ≤ 2 cm (TTD greater than 1 cm but less than or equal to 2 cm) and unifocal tumors with 1 < diameter ≤ 2 cm (56.8 vs. 64.9 %, P = 0.330). However, LNM frequency was significantly higher in multifocal PTMCs with TTD > 1 cm than unifocal tumors with diameter ≤ 1 cm (60.4 vs. 30 %, P < 0.001). A meta-analysis of nine publications plus our own data with a total 1,586 PTMCs demonstrated that multifocality was significantly associated with LNM risk (odds ratio 1.9, 95 % confidence interval 1.5–2.4).

Conclusions

Multifocal PTMC with TTD > 1 cm has a similar risk of LNM as a clinical papillary cancer. Routine central neck dissection is recommended in this subgroup of patients.
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Metadata
Title
Multifocality and Total Tumor Diameter Predict Central Neck Lymph Node Metastases in Papillary Thyroid Microcarcinoma
Authors
Qunzi Zhao, MD
Jie Ming, MD
Chunping Liu, MD
Lan Shi, MD
Xia Xu, MD
Xiu Nie, MD
Tao Huang, MD, PhD
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2654-2

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