Abstract

BackgroundBilateral lesions are common in papillary thyroid carcinoma (PTC). For patients with unilateral PTC, occult carcinoma that is not detected preoperatively, but pathologically after surgery, might remain in the contralateral lobe. In this situation, inadequate surgical extent could cause relapse and even lead to re-operation. Here, we explore the frequency and investigate the risk factors of contralateral occult PTC in unilateral PTC through a retrospective study conducted by our team and published articles online, respectively.MethodsWe collected the patients’ clinical data in our hospital, whose cancer was determined to be confined to the unilateral lobe by preoperative image examination (N = 204). These patients underwent initially total or near-total thyroidectomy and included their clinical data in the meta-analysis. We searched related literature in the PubMed, Embase, MEDLINE, Cochrane, and Web of Science databases until December 7, 2020, in order to perform a meta-analysis. The relevant articles were examined and the eligible studies were included to assess the association between clinicopathologic factors and contralateral occult PTC.ResultsThe meta-analysis included nine studies (involving 4347 patients). Of these, eight studies were from the databases, and one study was our retrospective data. The meta-analysis showed that the prevalence of contralateral occult PTC was 26.6% in all patients. A tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and central lymph node metastasis were significantly associated with contralateral occult PTC. In contrast, sex, age, ETE, capsular invasion, BRAF mutation, Hashimoto thyroiditis, and lateral lymph node metastasis were insignificantly associated with contralateral occult PTC.ConclusionThe meta-analysis identified a tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and CLNM as being significant risk factors for contralateral occult PTC. These findings may guide the extent of surgery in unilateral PTC patients.

Highlights

  • Thyroid carcinoma is the most frequent endocrine malignancy, accounting for approximately 2.9% of all newly diagnosed cancer [1]

  • 27 (13.2%) had contralateral occult carcinoma and 177 (13.2%) did not; 21 (10.3%) patients had ETE and 183 (89.7%) patients did not; 65 (31.9%) patients had central lymph node metastasis, 40 (19.6%) patients had lateral lymph node metastasis, and 99 (48.5%) patients were without lymph node metastasis (Table 1)

  • The analysis suggested no significant association between lateral lymph node metastasis (LLNM) and contralateral occult Papillary thyroid carcinoma (PTC) (Figure 4B)

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Summary

Introduction

Thyroid carcinoma is the most frequent endocrine malignancy, accounting for approximately 2.9% of all newly diagnosed cancer [1]. Papillary thyroid carcinoma (PTC), medullary thyroid carcinoma, follicular thyroid carcinoma, and anaplastic thyroid carcinoma are the four main types of thyroid carcinoma. PTC is the most common thyroid cancer type, accounting for approximately 80.0% of malignant thyroid tumors [3]. Papillary thyroid microcarcinoma (PTMC) is classified to PTC. Bilateral lesions are common in papillary thyroid carcinoma (PTC). For patients with unilateral PTC, occult carcinoma that is not detected preoperatively, but pathologically after surgery, might remain in the contralateral lobe. In this situation, inadequate surgical extent could cause relapse and even lead to re-operation. We explore the frequency and investigate the risk factors of contralateral occult PTC in unilateral PTC through a retrospective study conducted by our team and published articles online, respectively

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