Abstract
ObjectiveThe aim of this study was to investigate risk factors of occult carcinoma in clinically solitary papillary thyroid carcinoma (PTC) patients, and to put emphasis on the predictive value of risk-scoring model to determine the optimal scope of surgeryMethodsA total of 573 clinically solitary PTC patients who underwent total thyroidectomy (TT) from two hospitals were retrospectively analyzed. Clinicopathological features were collected, univariate and multivariate analyses were performed to determine risk factors of occult carcinoma. The Cox proportional hazards model was used to analyze the risk factors of recurrence. A scoring model was constructed according to independent risk factors of contralateral occult carcinoma.Results19.2% of clinically solitary PTC patients had occult carcinoma, among which 3.7% patients had ipsilateral occult carcinoma and 15.5% patients had contralateral occult carcinoma. Factors such as male, the presence of benign nodule, and vascular invasion increase the risk of ipsilateral occult carcinoma. Tumor size >1 cm, the presence of benign nodule, extrathyroidal extension, central lymph node metastasis, lateral lymph node metastasis are independent predictors of contralateral occult carcinoma. Contralateral occult carcinoma is the independent predictor of recurrence. A 10-point risk-scoring model was established to predict the contralateral occult carcinoma in clinically solitary PTC patients.ConclusionLobectomy is sufficient for clinically solitary PTC patients with risk factors of ipsilateral occult carcinoma. For clinically solitary PTC patients with score ≥4, careful preoperative evaluations are required to rule out the contralateral occult carcinoma. Even if contralateral occult carcinoma is not detected preoperatively, TT is recommended for high-risk patients.
Highlights
Papillary thyroid carcinoma (PTC) is the most common endocrine malignant tumor worldwide, accounting for approximately 80.0% of thyroid malignant tumors [1, 2]
Patients were excluded from the study if they have any of following factors: [1] patients with preoperative clinical evidence of multiple PTCs or other pathologic types of thyroid malignancies; [2] patients with the single PTC had another suspicious lesion, but Fine needle aspiration (FNA) was not performed for the suspicious lesion; [3] nonPTCs or other subtypes than classic PTC; [4] patients did not undergo the TT; [5] patients had another malignancy before thyroidectomy; [6] patients with diffuse thyroid disease; [7] reoperation; [8] distant metastasis at diagnosis on pathological or clinical analysis; [9] history of neck radiation or familial cancer; [10] incomplete clinical data or missing follow-up
Tumor located in the upper portion of the thyroid gland was detected in 221 (38.6%) patients, and tumor located in the middle/lower lobe of thyroid was detected in 352 (61.4%) patients
Summary
Papillary thyroid carcinoma (PTC) is the most common endocrine malignant tumor worldwide, accounting for approximately 80.0% of thyroid malignant tumors [1, 2]. According to the 2004 World Health Organization “Thyroid and Parathyroid Diseases and Genetic Classification”, in addition to the most common classic PTC, there are 15 subtypes of PTC, among which highly aggressive PTC variants, such as diffuse sclerosing, tall-cell, insular, and poorly differentiated subtypes, exhibit heterogeneous clinical behavior and a wide range of mortality risk [3]. Considering the possibility of recurrent or persistent carcinoma in the remnant contralateral lobe, TT seems to be applicable for tumors confined to the unilateral lobe. Considering the high incidence of postoperative complications, the routine use of TT is not recommended for all patients with unilateral PTC. The ability of US to detect small malignant tumors would be significantly reduced when patients had diffuse thyroid disease [15]
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