Unit of General Surgery, Parma University Hospital, Parma, Italy.
a:1:{s:5:"en_US";s:83:"Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital";}.
Acta Biomed. 2021 Nov 3;92(5):e2021017. doi: 10.23750/abm.v92i5.11897.
Background Multifocality is usually detected afterwards surgery for papillary thyroid cancer (PTC) and has been reported in 18-87% of PTC. Methods This is a retrospective single-center study involving a series of 238 patients that underwent thyroidectomy or lobectomy after preoperative fine needle aspiration (FNA) diagnosis of Thyr 5 or Thyr 6, according to Bethesda classification, from January 2015 to December 2019 at the General Surgery Unit of the University - Hospital of Parma. We divided patients into two main groups: patients with multifocal papillary thyroid cancer at postoperative diagnosis and patients with unifocal papillary thyroid cancer. The aim of the study is to identify demographic or preoperative radiological risk factors for the presence of multifocal PTC and to verify the presence of cyto-histological features of greater aggressiveness in multifocal tumors than in unifocal ones. Results Out of our sample, 176 patients were females (73,9%) and 62 males (26,1%) with a mean age of 50,45 ±14,41. Preoperative cytological diagnosis resulted Thyr 5 in 47 cases (19,7%) and Thyr 6 in 191 cases (80,3%). Multifocal cancer was reported in 35,8% of the females and in 32,3% of the males. Older age was significatively related to the presence of multifocal papillary carcinoma (p<0.05). Preoperative bilateral thyroid nodules were associated with a higher finding of multifocal disease at histological examination (p<0.05). The presence of multifocal disease was related with a higher soft tissue invasion at the histological specimen (p<0.05). Tumor size was not related to multifocal PTC in our study. Conclusions Older age of patient and preoperative bilateral thyroid nodules are significantly associated to multifocal thyroid cancer. In add to this, multifocal disease is related to higher finding of perithyroidal tissue invasion at histological exam. In case of predictive factors for multifocal PTC, surgeons should take total/near-total thyroidectomy always into consideration.
多灶性通常在甲状腺乳头状癌（PTC）手术后被发现，其发生率为 18-87%。
这是一项回顾性单中心研究，纳入了 2015 年 1 月至 2019 年 12 月期间，在帕尔马大学医院普外科行术前细针穿刺（FNA）诊断为 Thyr 5 或 Thyr 6 后行甲状腺切除术或腺叶切除术的 238 例患者。我们将患者分为两组：术后诊断为多灶性甲状腺乳头状癌的患者和单灶性甲状腺乳头状癌的患者。本研究的目的是确定多灶性 PTC 存在的人口统计学或术前影像学危险因素，并验证多灶性肿瘤与单灶性肿瘤相比，是否具有更高侵袭性的细胞-组织学特征。
在我们的样本中，176 例患者为女性（73.9%），62 例为男性（26.1%），平均年龄为 50.45±14.41 岁。术前细胞学诊断为 Thyr 5 的有 47 例（19.7%），Thyr 6 的有 191 例（80.3%）。女性多灶性癌的检出率为 35.8%，男性为 32.3%。年龄较大与多灶性甲状腺癌的存在显著相关（p<0.05）。术前双侧甲状腺结节与组织学检查中多灶性疾病的发现率较高相关（p<0.05）。多灶性疾病与组织学标本中甲状腺周围组织侵犯程度较高相关（p<0.05）。肿瘤大小与本研究中的多灶性 PTC 无关。
患者年龄较大和术前双侧甲状腺结节与多灶性甲状腺癌显著相关。此外，多灶性疾病与组织学检查中甲状腺周围组织侵犯程度较高相关。在多灶性 PTC 的预测因素方面，外科医生应始终考虑行全/近全甲状腺切除术。
