Review Article

Langenbeck's Archives of Surgery

, Volume 399, Issue 2, pp 141-154

Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES)

  • Maurizio IacoboneAffiliated withMinimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua Email author 
  • , Svante JanssonAffiliated withDepartment of Surgery, Sahlgrenska University Hospital
  • , Marcin BarczyńskiAffiliated withDepartment of Endocrine Surgery, Jagiellonian University, Medical College
  • , Peter GoretzkiAffiliated withDepartment of Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss

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Abstract

Background

Multifocal papillary thyroid carcinoma (MPTC) has been reported in literature in 18–87 % of cases. This paper aims to review controversies in the molecular pathogenesis, prognosis, and management of MPTC.

Methods

A review of English-language literature focusing on MPTC was carried out, and analyzed in an evidence-based perspective. Results were discussed at the 2013 Workshop of the European Society of Endocrine Surgeons devoted to surgery of thyroid carcinoma.

Results

Literature reports no prospective randomized studies; thus, a relatively low level of evidence may be achieved.

Conclusions

MPTC could be the result of either true multicentricity or intrathyroidal metastasis from a single malignant focus. Radiation and familial nonmedullary thyroid carcinoma are conditions at risk of MPTC development. The prognostic importance of multifocal tumor growth in PTC remains controversial. Prognosis might be impaired in clinical MPTC but less or none in MPTC <1 cm. MPTC can be diagnosed preoperatively by FNAB and US, with low sensitivity for MPTC <1 cm. Total or near-total thyroidectomy is indicated to reduce the risk of local recurrence. Prophylactic central node dissection should be considered in patients with total tumor diameter >1 cm, or in cases with high number of cancer foci. Completion thyroidectomy might be necessary when MPTC is diagnosed after less than near-total thyroidectomy. Radioactive iodine ablation should be considered in selected patients with MPTC at increased risk of recurrence or metastatic spread.

Keywords

Papillary thyroid carcinoma Multifocality Thyroidectomy