MULTIFOCAL PAPILLARY THYROID MICROCARCINOMA WITH A TOTAL TUMOR DIAMETER> 1 CM INDICATE POOR BIOLOGICAL BEHAVIOR? - THE EVIDENCE IS INSUFFICIENT

Objective: Multifocal cancer is not uncommon in papillary thyroid microcarcinoma (PTMC) . Our aim was to investigate the correlation between multifocal PTMC, total tumor diameter (TTD) and clinicopathological features. Methods: In total, 206 patients were included and grouped as stage cT1a or cT1b. The primary tumor diameter (PTD) and TTD (the sum of the maximal diameter of each focus) were calculated. These patients were further subgrouped as TTD ≤1 cm or 1 cm<TTD ≤2 cm. The relationships of clinicopathological features between these groups were analyzed. Results: Multifocal cancer was more likely to occur with stage cT1a than stage cT1b (p=0.028). Stage cT1b PTC was more prone to central lymph node metastasis (CLNM) (p=0.001) and capsular invasion (p<0.001) than stage cT1a. There was no difference in clinicopathological factors, such as sex (p=0.448), age (p=0.227), CLNM (p=0.739), number of CLNMs (p=0.142), capsular invasion (p=0.804), BRAF mutation (p=0.905) or recurrence (p=0.789), between the multifocal PTMC and TTD>1 cm and PTD+ TTD≤1 cm groups. For the comparison of stage cT1a and cT1b tumors with a 1 cm<TTD≤2 cm, the multivariate analysis, stage cT1b tumors were more prone to capsular invasion than stage cT1a tumors (p=0.006), with an OR of 19.013 (95% CI: 2.295-157.478), but there was no significant correlation with CLNM. Conclusions: Tumors in stage cT1b are more prone to capsular invasion and CLNM than those in stage cT1a. For multifocal PTMC, calculating the TTD to evaluate adverse biological behavior is insufficient and limited, and further research is needed. Abbreviations: PTC = Papillary thyroid carcinoma; PTMC = Papillary thyroid microcarcinoma ; ETE = Extrathyroidal extension; ATA = American Thyroid Association; CLNM = Central lymph node metastasis; TTD = Total tumor diameter; CLND = Central lymph node dissection; DTC =Differentiated thyroid carcinoma ; US = Ultrasound; CT = Computed tomography; PTD = Primary tumor diameter ; Tg = Thyroglobulin ; Anti-Tg = Anti-thyroglobulin antibody ; FNA = Fine needle aspiration; SD = Standard deviation; OR = Odds ratio; CI = Confidence interval.