Background: Papillary thyroid carcinoma [PTC] is the most common malignant thyroid tumor, making up over 85% of cases in regions with adequate iodide intake. It can manifest as a solitary nodule or as multiple non-contiguous foci within the thyroid gland.
The aim of the work: This study aims to investigate the correlation between the presence of multiple foci and cervical lymph node metastasis in PTC, taking into consideration the size of the malignant nodules discovered in the removed thyroid gland.
Patients and Methods: In this study, 60 patients diagnosed with PTC were prospectively enrolled. The diagnosis was confirmed using neck ultrasonography, fine-needle aspiration cytology [FNAC], or true-cut biopsy from thyroid nodules or suspicious lymph nodes. All patients underwent total thyroidectomy and central neck dissection. Based on the pathological evaluation after surgery, the patients were divided into two groups: Group I included those with a single thyroid nodule, while Group II comprised patients with multiple thyroid nodules.
Results: The size of the largest thyroid foci in the study ranged from 0.5 to 8 cm, with an average size of 2.8 ± 1.69 cm. For patients with multiple thyroid foci, the sum of their sizes ranged from 0.7 to 10 cm, with an average size of 3.8 ± 2.2 cm. The radiological size of the largest thyroid foci ranged from 1 to 5.2 cm, with an average size of 2.58 ± 1.17 cm. The results demonstrated a significant correlation between the incidence of malignancy recurrence and the presence of multiple foci. Additionally, there was a statistically significant relationship between the involvement of lymph nodes with malignancy and the presence of multiple nodules, with a p-value of less than 0.05.
Conclusion: Multifocal PTC is more aggressive than unifocal PTC so it needs aggressive treatment and restrictive follow up.