Multifocality of papillary thyroid carcinoma with low risk of recurrence: Prevalence, predictive markers, prognostic significance and initial surgical treatment.

BACKGROUND AND

OBJECTIVE

The impact of multifocality on the prognosis of patients with papillary thyroid cancer is relevant when considering the choice of initial surgical treatment by hemithyroidectomy or total thyroidectomy. The aim of the study is to determine the prevalence of multifocality in our setting, its predictive markers and the rates of persistence, recurrence and mortality associated with papillary thyroid cancer with a low risk of recurrence in order to infer the most appropriate initial surgical treatment.

PATIENTS AND METHOD: Retrospective observational cross-sectional study of 85 total thyroidectomies.

RESULTS

Prevalences: unifocal carcinoma: 68.2%; multifocal: 31.8%. Predictive markers of multifocality: multinodular ultrasound pattern (OR:17.069, 95% CI:2.989-97.454) and non-incidental finding (OR:7.569, 95% CI:2.363-24.242). In 66.6% of multifocal cases there was bilateral involvement, all of them had a bilateral multinodular ultrasound pattern. Multifocal cases received postoperative radioiodine more frequently (p < 0.001). During the follow-up of 95.5 ± 32.2 months there was one case of persistence and one of recurrence, both in the multifocal group (p:ns), at 12 and 71 months of follow-up. There was no mortality.

CONCLUSIONS

This is the first study in our country to estimate the prevalence of multifocality in papillary carcinoma with a low risk of recurrence and to show an excellent prognosis, with no differences compared to unifocal cases, considering that all cases have been treated with total thyroidectomy, but multifocal cases with radioiodine more frequently. Hemithyroidectomy could offer a similar prognosis to total thyroidectomy in cases with an ultrasound pattern of a single or unilateral multinodular nodule, but not in cases of bilateral multinodular thyroid.