الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Papillary thyroid cancer (PTC) is the most common malignancy in thyroid gland and may be unifocal or multifocal. This study compares between unifocal and multifocal PTC to clarify which type has an aggressive behavior.
This retrospective and prospective cross-sectional study was done on one hundred PTC patients who underwent papillary thyroid cancer management. The unifocal and multifocal groups each one contains 50 patients. The study was done in the period between January 2015 to January 2018. Other types of cancer thyroid and distant metastatic thyroid cancer were excluded from the study. All patients underwent follow up for one year.
All patients were subjected to ;thorough history taking, clinical examination to assess the thyroid gland and enlarged cervical lymph nodes and to which group they belong, Ultrasonographic examination, pathology of fine needle aspiration cytology ( FNAC) and the postoperative histopathology of excised specimen .
Total thyroidectomy and central neck dissection for all PTC patients with bilateral or unilateral modified neck dissection.
Histopathological assessment of received surgical specimens for tumor size that was assessed by measuring the greatest dimension of focus in unifocal while in multifocal PTC by measuring the greatest dimension of the largest focus and by summation of greatest dimensions of all foci which will be referred as total tumor diameter (TTD). Other pathological parameters were assessed which include number of positive cervical dissected lymph nodes, capsular invasion and lymphovascular embolization. There are significant differences between unifocal and multifocal PTC regarding to age, the number of positive lymph nodes, history of multinodular goiter (MNG) and capsular invasion. The capsular invasion in multifocal increase the recurrence rate.
Multifocality occurrence associated with history of MNG and associated with high number of metastatic LN and recurrence.
Capsular invasion occurae with high percentage with multuifocalty and accounts for high rate of recurrence.
During follow up period, multifocal PTC patients developed regional LN recurrence while in unifocal PTC patients no recurrence detected.
When using the largest foci to assess the multifocal PTC sometimes downgrade the T staging in thyroid cancer while summation of foci leads to more advance the T stage that was significant.
The percentage of capsular invasion was higher in a positive recurrence group than in negative recurrence group. So this indicates the importance of capsular invasion assessment.
Lastly we conclude what multifocal PTH is more aggressive than unifocal PTC so it needs aggressive treatment and restrictive follow up.