Multifocality as an adverse histopathological factor in papillary thyroid carcinoma




multifocality, papillary thyroid carcinoma, lymphnode metastases


Papillary thyroid carcinoma (PTC) is characterized by various clinical and pathomorphological features, such as metastases to the locoregional lymph nodes and radioiodine resistance. It could also be diagnosed as a microcarcinoma coexisting with other benign thyroid pathologies or as multifocal growth. Of these, multifocality in PTC is considered an unfavourable pathomorphological feature. However, the research findings are controversial.

Objective — to investigate and evaluate the clinical and pathohistological features of multifocal PTC (mPTC) in comparison with unifocal (single nodule) PTC.

Materials and methods. Among the patients who underwent operative treatment at the clinical bases of the Department of Surgery, Institute of Biology, and Medicine at Taras Shevchenko National University of Kyiv, 91 were diagnosed with PTC and were included in the study.

Results. Out of the 91 patients, 31 (34%) had mPTC and 60 (66%) had PTC. Bilateral mPTC was diagnosed in 23 (74%) patients, which is in line with other studies. It is also worth mentioning, that 5 (16%) patients were diagnosed with multifocal growth only at the stage of histopathology section, without preoperative or intraoperative evidence of multifocality. A significantly higher frequency of locoregional metastasis was found in the mPTC group in 17 (55%) patients as compared to 18 (30%) patients with PTC (p=0.025). Lateral neck dissection was performed in 13 (42%) patients with mPTC, and in 13 (22%) patients with PTC (р=0.0525). Frozen section pathology was performed in 17 (24 patients with mPTC, and in 4 (10%) patients with PTC (р >0,05).

Conclusions. A higher frequency of locoregional metastasis and a higher propensity for performing a lateral neck dissection are both indicators of a higher biological aggressiveness of the carcinoma in PTC multifocal growth.


Author Biographies

A. Dinets, Taras Shevchenko National University of Kyiv, ESC «Institute of Biology and Medicine»; Verum Expert Clinic, Kyiv

MD, PhD, Associate Professor, Department of Surgery

M. Gorobeiko, Taras Shevchenko National University of Kyiv, ESC «Institute of Biology and Medicine»

MD, PhD, Head Of Department of Surgery

Y. Pysmenna, Taras Shevchenko National University of Kyiv, ESC «Institute of Biology and Medicine»

MD, PhD, Assitant Professor, Department of Fundamental Medicine

A. Lovin, Taras Shevchenko National University of Kyiv, ESC «Institute of Biology and Medicine»

MD, Assistant Professor, Department of Surgery

K. Abdalla, Verum Expert Clinic, Kyiv

MD, Intern, Department of Surgery

V. Hoperia, Taras Shevchenko National University of Kyiv, ESC «Institute of Biology and Medicine»;

MD, PhD, Prof., Head of Department of Fundamental Medicine


Huda B, Kovalenko A, Bolhov M, Ostafiichuk M. Rezultaty khirurhichnoho likuvannia khvorykh z dyferentsiiovanym rakom shchytopodibnoi zalozy u khirurhichnii klinitsi uprodovzh 20 rokiv. Klin khirurhiia. 2019;86(7):57-62. Ukrainian.

Dinets AV, Hulchii MV, Oliinyk OB, Tsymbaliuk SM. Papiliarna mikrokartsynoma shchytopodibnoi zalozy na foni folikuliarnoi adenomy: klinichne znachennia poiednanoi patolohii. Problemy endokrynnoi patolohii. 2012;2:20-5. Ukrainian.

Dinets AV, Hulchii MV, Fomin PD ta in. Kliniko-patomorfolohichni osoblyvosti papiliarnoi mikrokartsynomy shchytopodibnoi zalozy u poiednanni z khronichnym limfotsytarnym tyreoidytom. Problemy endokrynnoi patolohii. 2012;4:24-9. Ukrainian.

Dinets AV, Hulchii MV, Tsymbaliuk SM, Oliinyk OB. Papiliarna mikrokartsynoma shchytopodibnoi zalozy: suchasni pidkhody do diahnostyky ta likuvannia. Khirurhiia Ukrainy. 2012;(3):92-6. Ukrainian.

Dinets A, Fomin P, Hulchii M, Oliinyk O, Tsymbaliuk S, Belan M. Kliniko-morfolohichni osoblyvosti papiliarnoi mikrokartsynomy shchytopodibnoi zalozy na foni khvoroby Hreivsa. Ukrainskyi medychnyi chasopys. 2012(3):136-8. Ukrainian.

Karachentsev YuI, Vynnyk YuA, Khaziiev VV, Korkelia AH. Patohistolohichni osoblyvosti papiliarnoho raku shchytopodibnoi zalozy. Eksperymentalna i klinichna medytsyna. 2020;81(4). Ukrainian.

Sichinava R, Larin O, Cherenko S, Horobeiko M. Alhorytm nadannia medychnoi dopomohy patsiientam z vulovymy novoutvorenniamy shchytopodibnoi zalozy. Problemy viiskovoi okhorony zdorov’ia. 2014;42(1):401-8. Ukrainian.

Cherenko S, Horobeiko M, Vasko V, Larin S, Ivanov M. Vybir ta obhruntuvannia optymalnoi taktyky pry khirurhichnomu likuvanni raku shchytopodibnoi zalozy. Klin Khirurhiia. 2000;(8):50-53. Ukrainian.

Cui L, Feng D, Zhu C, Li Q, Li W, Liu B. Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol. 2022;7(4):1224-34.

Dinets A, Gorobeiko M, Hoperia V, Lovin A, Tarasenko S. Papillary thyroid carcinoma coexisting with benign thyroid and parathyroid pathology: clinical and pathomorphological features. International journal of endocrinology (Ukraine). 2023;19(4):274-8.

Dinets A. Molecular aspects of Post-Chornobyl and sporadic papillary thyroid carcinoma. Stockholm, Sweden: Karolinska Institutet; 2013.

Feng JW, Qu Z, Qin AC, Pan H, Ye J, Jiang Y. Significance of multifocality in papillary thyroid carcinoma. Eur J Surg Oncol. 2020;46(10 Pt A):1820-8.

Gorobeiko M, Dinets A, Hoperia V, Abdalla K. Improved intraoperative verification of parathyroid glands by determining their autofluorescence in the infrared spectrum. International journal of endocrinology (Ukraine). 2021;17(6):465-71.

Gorobeiko M, Dinets A, Pominchuk D, Abdalla K, Prylutskyy Y, Hoperia V. Challenges of Differential Diagnosis Between Primary Hyperparathyroidism and Bone Metastases of Breast Cancer. Clin Med Insights Case Rep. 2022;15:11795476221125136.

Gorobeiko M, Dinets A. Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases. J Med Case Rep. 2021;15(1):414.

Guda B, Gulevaty S, Tronko M. Modern approaches for the determination of radioiddiagnostics and radioid-therapy in a patient with promoted of thyroid papillary carcinoma. Endocrinology. 2019;24(2):109-15.

Guda B, Kovalenko A, Bolgov M, Pushkarev V, Tronko M. Multifocal differentiated thyroid cancer. Oncology. 2019;21(2):125.

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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.

Kim H, Kwon H, Moon BI. Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021;147(10):847-54.

Lloyd R, Osamura R, Klöppel G. Other encapsulated follicular-patterned thyroid tumours. Classification of tumours of endocrine organs 4th ed Lyon, France: World Health Organization. 2017:75-80.

Machens A, Lorenz K, Dralle H. Metastatic risk profile of microscopic lymphatic and venous invasion in papillary thyroid cancer. Clin Otolaryngol. 2022;47(3):440-6.

Omi Y, Haniu K, Kamio H, Fujimoto M, Yoshida Y, Horiuchi K, et al. Pathological multifocality is not a prognosis factor of papillary thyroid carcinoma: a single-center, retrospective study. World J Surg Oncol. 2022;20(1):394.

Ozdemir K, Harmantepe AT, Gonullu E, Kocer B, Bayhan Z. Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer? Updates Surg. 2023;75(3):701-6.

Shaha AR, Poorten VV, Tuttle RM. Multifocality in papillary thyroid carcinoma-An unresolved controversy. Eur J Surg Oncol. 2020;46(10 Pt A):1777-8.

Tronko M, Zelinska H, Bozhok YM, Kvachenyuk A, Gulevatyi S, Kulinichenko H, et al. Tsytolohichni chynnyky prohnozu pisliaoperatsiinoho metastazuvannia ta radioiodrezystentnosti papiliarnoho raku shchytopodibnoi zalozy. Endocrinology. 2021;26(4):326-35. Ukrainian.

Wang Z, Gui Z, Huang J, He L, Dong W, Zhang D, et al. Clinical and ultrasonic risk factors for high-volume central lymph node metastasis in cN0 papillary thyroid microcarcinoma: A retrospective study and meta-analysis. Clin Endocrinol (Oxf). 2023;98(4):609-21.

Wu K, Shi L, Wang J, Xie L. Association between papillary thyroid carcinoma and lymphocytic thyroiditis: A retrospective study. Oncol Lett. 2023;25(4):148.

Zhang T, He L, Wang Z, Dong W, Sun W, Zhang P, et al. Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer. Front Oncol. 2022;12:1003336.






Original Research