甲状腺多灶性乳头状癌临床病理特征分析及相关因素研究OA

OBJECTIVE To investigate the clinicopathological features of multifocal papillary thyroid carcinoma(MPTC),analyze differences between micro-MPTC(dominant tumor≤1.0 cm)with non-micro-MPTC(dominant tumor>1.0 cm)screen for independent predictors of contralateral occult microcarcinoma,and guide individualized clinical decision-making.METHODS A retrospective analysis was performed on 295 patients with MPTC who underwent surgery at Beijing Tongren Hospital,Capital Medical University from April 2021 to April 2024.Patients were stratified by the maximum diameter of the dominant tumor into micro-MPTC(≤1.0 cm,n=148)and non-micro-MPTC(>1.0 cm,n=147)groups,and by the maximum diameter of contralateral tumors into≤0.3 cm(n=98)and>0.3 cm(n=153)groups.From this cohort,142 patients with no or only≤0.3 cm contralateral nodules on preoperative ultrasound were further stratified by final pathology into a group with no carcinoma(n=44)and a group with contralateral carcinoma(n=98).Univariate analysis,multivariate logistic regression,and receiver operating characteristic(ROC)curve analysis were performed.RESULTS Significant differences were observed between the micro-and non-micro-MPTC groups in sex,preoperative thyroid-stimulating hormone(TSH)level,BRAF V600E mutation status,central lymph node metastasis(level VI),tumor-capsule relationship,and the size of contralateral tumors(all P<0.05).Between the contralateral≤0.3 cm and>0.3 cm tumor groups,only the size of the dominant tumor was significantly different(P<0.05).Hashimoto's thyroiditis(HT)and ultrasound findings were independent predictive factors for contralateral occult carcinoma≤0.3 cm(both P<0.05).The combination of HT and ultrasound features achieved an area under the ROC curve(AUC)of 0.698 in predicting contralateral occult carcinoma≤0.3 cm.CONCLUSION Micro-MPTC and non-micro-MPTC differ significantly in biological behavior.The size of the dominant lesion is correlated with that of the contralateral carcinoma focus.The coexistence of HT and ultrasonographically suspicious nodules are independent predictors for the presence of a contralateral occult microcarcinoma≤0.3 cm.Their combined use improves the accuracy of preoperative assessment and aids in determining the optimal surgical strategy for MPTC.