Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma?

• Published in: Oral oncology Vol. 65; pp. 1 - 7
• Main Authors: Tam, Abbas Ali, Özdemir, Didem, Çuhacı, Neslihan, Başer, Hüsniye, Dirikoç, Ahmet, Aydın, Cevdet, Yazgan, Aylin Kılıç, Ersoy, Reyhan, Çakır, Bekir
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2017
• Subjects: Adult; Aggressive behavior; Carcinoma, Papillary - diagnosis; Carcinoma, Papillary - pathology; Diagnosis, Differential; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Multifocality; Otolaryngology; Papillary thyroid microcarcinoma; Primary tumor diameter; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - pathology; Total tumor diameter; Tumor diameter ratio; Multifocality; Tumor diameter ratio; Total tumor diameter; Aggressive behavior; Primary tumor diameter; Papillary thyroid microcarcinoma
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2016.12.004

•The ratio of primary tumor diameter to total tumor diameter (TDR) in PTMC was evaluated.•TDR was lower in patients with capsular and lymphovascular invasion, ETE and LNM.•TDR might be helpful for the detection of aggressive behavior in multifocal PTMCs. In this study, we aimed to evaluate the usefulness of a new parameter –ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC). The diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined. Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features. Decreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs.