We read the article ‘Should Multifocality be an indication for prophylactic neck dissection in papillary thyroid cancer’ by Ozdemir K et al. [1] with great interest.

We congratulate the authors for discussion on this very pertinent study on an issue of multifocality of Papillary thyroid cancer (PTC) which has been a matter of great debate even today.

Many previous studies and meta-analyses [2,3,4] have established that Multifocality as a known risk factor for lymph nodal metastasis and aggressive disease, however, the present study has made a commendable attempt to prove that multifocality can be used as a prognosticator to guide management in PTC by proving the correlation of bilateral multifocality and central lymph node metastasis and thereby if multifocality detected pre operatively shall help the surgeon plan prophylactic Central compartment lymph node dissection.

We have a few comments and queries to make which may interest future readers:

  1. 1.

    Since majority of the study population was female (78%), did the authors find any correlation between gender specific multifocality and central compartment lymph node (CCLN) metastasis?

  2. 2.

    Previous studies have also shown that some variants of PTC are associated with aggressive disease [5]. Was any attempt made to correlate the aggressive variants of PTC with multifocality and central lymph node metastasis?

  3. 3.

    Since patients with Papillary Thyroid Microcarcinoma (PTMC) formed a substantial proportion of the study population (48.4%), what was the proportion of PTMC patients undergoing prophylactic CCLN dissection and thereby having CCLN metastasis?

Thanks for comment on these issues.

Sarrah Idrees.

Sabaretnam Mayilvaganan.