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Does total tumour diameter, multifocality, number of tumour foci, or laterality predict lymph node metastasis or recurrence in differentiated thyroid cancer?
, 2, 3
Affiliations- Clinics of Endocrinology and Metabolism, Sinop Ataturk State Hospital Central/Sinop, Sinop, Türkiye
- Infectious Diseases and Environmental Health Division, Sirnak Province Health Directory, Turkish Ministry of Health, Şırnak, Türkiye
- Department of Endocrinology and Metabolism, Marmara University, School of Medicine, Istanbul, Türkiye
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Abstract
Introduction: Data regarding laterality, focality, or total tumour diameter (TTD) in papillary thyroid cancer (PTC) are limited. We aimed to investigate the impact of focality, TTD, number of tumour foci, or laterality on aggressive features in PTC.
Material and methods: Patients were categorized based on maximum tumour diameter (MTD) (≤ 10 vs. > 10 mm), focality, laterality, or the number of tumour foci (1/2/ ≥ 3). We also categorized the patients as follows: Group 1, unifocal microcarcinoma (MTD ≤ 10/TTD ≤ 10 mm); Group 2, multifocal microcarcinoma (MTD ≤ 10/TTD ≤ 10 mm); Group 3, multifocal microcarcinoma (MTD ≤ 10/TTD > 10 mm); Group 4, unifocal macrocarcinoma (MTD > 10/TTD > 10 mm); Group 5, multifocal macrocarcinoma (MTD > 10/TTD > 10 mm).
Results: The mean diagnosis age (n = 511) was 44.7 (± 12.7) years, the majority of the patients were < 55 years old (n = 310) and female (n = 416). An increasing number of tumour foci were associated with a higher MTD or TTD, a higher ratio of extrathyroidal extension (ETE), vascular or lymphatic invasion, lymph node metastasis (LNM) or distant metastasis, or the need for radioactive iodine (RAI). There was no difference in the parameters between Group 3 and Group 2, or Group 4. Vascular invasion, American Thyroid Association high risk, LNM at diagnosis, and RAI total dose were higher in Group 5 than in Group 3. Microscopic or macroscopic ETE, T1b, and T4a were positive predictors for recurrence. Male sex, multifocality, number of tumour foci (≥ 3), MTD (> 10 mm), TTD (> 10 mm), Group 5, microscopic
or macroscopic ETE, lymphatic or vascular invasion, RAI need, T2, and T4b were positive predictors for LNM.
Conclusion: MTD and TTD increase the risk of LNM but not the recurrence in PTC. TTD, multifocality, and bilaterality can be considered risk factors in PTC staging systems and risk calculators.
Abstract
Introduction: Data regarding laterality, focality, or total tumour diameter (TTD) in papillary thyroid cancer (PTC) are limited. We aimed to investigate the impact of focality, TTD, number of tumour foci, or laterality on aggressive features in PTC.
Material and methods: Patients were categorized based on maximum tumour diameter (MTD) (≤ 10 vs. > 10 mm), focality, laterality, or the number of tumour foci (1/2/ ≥ 3). We also categorized the patients as follows: Group 1, unifocal microcarcinoma (MTD ≤ 10/TTD ≤ 10 mm); Group 2, multifocal microcarcinoma (MTD ≤ 10/TTD ≤ 10 mm); Group 3, multifocal microcarcinoma (MTD ≤ 10/TTD > 10 mm); Group 4, unifocal macrocarcinoma (MTD > 10/TTD > 10 mm); Group 5, multifocal macrocarcinoma (MTD > 10/TTD > 10 mm).
Results: The mean diagnosis age (n = 511) was 44.7 (± 12.7) years, the majority of the patients were < 55 years old (n = 310) and female (n = 416). An increasing number of tumour foci were associated with a higher MTD or TTD, a higher ratio of extrathyroidal extension (ETE), vascular or lymphatic invasion, lymph node metastasis (LNM) or distant metastasis, or the need for radioactive iodine (RAI). There was no difference in the parameters between Group 3 and Group 2, or Group 4. Vascular invasion, American Thyroid Association high risk, LNM at diagnosis, and RAI total dose were higher in Group 5 than in Group 3. Microscopic or macroscopic ETE, T1b, and T4a were positive predictors for recurrence. Male sex, multifocality, number of tumour foci (≥ 3), MTD (> 10 mm), TTD (> 10 mm), Group 5, microscopic
or macroscopic ETE, lymphatic or vascular invasion, RAI need, T2, and T4b were positive predictors for LNM.
Conclusion: MTD and TTD increase the risk of LNM but not the recurrence in PTC. TTD, multifocality, and bilaterality can be considered risk factors in PTC staging systems and risk calculators.
Keywords
thyroid; cancer; papillary; diameter; focality; laterality
About this articleTitle
Does total tumour diameter, multifocality, number of tumour foci, or laterality predict lymph node metastasis or recurrence in differentiated thyroid cancer?
Journal
Issue
Article type
Original paper
Pages
153-167
Published online
2023-03-24
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2113
Article views/downloads
345
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2023;74(2):153-167.
Keywords
thyroid
cancer
papillary
diameter
focality
laterality
Authors
Onur Elbasan
Can Ilgın
Dilek Gogas Yavuz
References (27)- Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016; 26(1): 1–133.
- Gallardo E, Medina J, Sánchez JC, et al. SEOM clinical guideline thyroid cancer (2019). Clin Transl Oncol. 2020; 22(2): 223–235.
- Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why? Thyroid. 2017; 27(6): 751–756.
- Feng JW, Pan H, Wang L, et al. Total tumor diameter: the neglected value in papillary thyroid microcarcinoma. J Endocrinol Invest. 2020; 43(5): 601–613.
- Manso J, Censi S, Roberti A, et al. Prognostic significance of the sum of the diameters of single foci in multifocal papillary thyroid cancer: the concept of new-old tumor burden. Ther Adv Endocrinol Metab. 2020; 11: 2042018820964326.
- Qu N, Zhang L, Ji Qh, et al. Number of tumor foci predicts prognosis in papillary thyroid cancer. BMC Cancer. 2014; 14: 914.
- Choi WRi, Roh JL, Gong G, et al. Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence. Oral Oncol. 2019; 94: 106–110.
- Feng JW, Qu Z, Qin AC, et al. Significance of multifocality in papillary thyroid carcinoma. Eur J Surg Oncol. 2020; 46(10 Pt A): 1820–1828.
- Gur EO, Karaisli S, Haciyanli S, et al. Multifocality related factors in papillary thyroid carcinoma. Asian J Surg. 2019; 42(1): 297–302.
- Kim HJ, Sohn SY, Jang HW, et al. Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg. 2013; 37(2): 376–384.
- Tam AA, Özdemir D, Çuhacı N, et al. Association of multifocality, tumor number, and total tumor diameter with clinicopathological features in papillary thyroid cancer. Endocrine. 2016; 53(3): 774–783.
- Tam AA, Özdemir D, Çuhacı N, et al. Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma? Oral Oncol. 2017; 65: 1–7.
- Lin JD, Chao TC, Hsueh C, et al. High recurrent rate of multicentric papillary thyroid carcinoma. Ann Surg Oncol. 2009; 16(9): 2609–2616.
- Pacini F, Schlumberger M, Dralle H, et al. European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006; 154(6): 787–803.
- Zheng X, Peng C, Gao M, et al. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients. Cancer Biol Med. 2019; 16(1): 121–130.
- Tuttle RM, Morris LF, Haughen BR. et al. Thyroid — Differentiated and Analastic Carcinoma. In: Amin MB. ed. AJCC Cancer Staging Manual. 8th ed. Springer, New York 2017.
- Gui CY, Qiu SL, Peng ZH, et al. Clinical and pathologic predictors of central lymph node metastasis in papillary thyroid microcarcinoma: a retrospective cohort study. J Endocrinol Invest. 2018; 41(4): 403–409.
- Tuttle RM, Ross DS, Mulder JE. Differentiated thyroid cancer: Radioiodine treatment. https://www.uptodate.com/contents/differentiated-thyroid-cancer-radioiodine-treatment?search=differentiated%20thyroid%20cancer%20radioactive%20iodine, &source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H23. (October 30, 2021).
- Shteinshnaider M, Muallem Kalmovich L, Koren S, et al. Reassessment of Differentiated Thyroid Cancer Patients Using the Eighth TNM/AJCC Classification System: A Comparative Study. Thyroid. 2018; 28(2): 201–209.
- Sapuppo G, Tavarelli M, Belfiore A, et al. Time to Separate Persistent From Recurrent Differentiated Thyroid Cancer: Different Conditions With Different Outcomes. J Clin Endocrinol Metab. 2019; 104(2): 258–265.
- Iacobone M, Jansson S, Barczyński M, et al. Multifocal papillary thyroid carcinoma--a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg. 2014; 399(2): 141–154.
- Sciuto R, Romano L, Rea S, et al. Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann Oncol. 2009; 20(10): 1728–1735.
- Grigsby PW, Reddy RM, Moley JF, et al. Contralateral papillary thyroid cancer at completion thyroidectomy has no impact on recurrence or survival after radioiodine treatment. Surgery. 2006; 140(6): 1043–7; discussion 1047.
- Gan T, Huang B, Chen Q, et al. A comparison of different staging systems predictability of patient outcome. Thyroid carcinoma as an example. Cancer. 1997; 79(12): 2414–2423.
- Zhao Q, Ming J, Liu C, et al. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol. 2013; 20(3): 746–752.
- So YK, Kim MW, Son YI. Multifocality and bilaterality of papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol. 2015; 8(2): 174–178.
- Kuo SF, Lin SF, Chao TC, et al. Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol. 2013; 2013: 809382.
