Multicentric Papillary Thyroid Carcinoma: Stratification for Treatment

Tumor stage is the main prognosticator of differentiated thyroid carcinomas, but it needs further stratification for multicentric neoplasms (most frequently papillary thyroid carcinomas, PTC), which frequently present as foci smaller than 1cm and are considered by default as high-risk tumors. Not all cases of multicentric PTC should be considered of high risk and they should be stratified to avoid unnecessary radioiodine ablation in selected cases. Currently, there are known variables for this stratification: size and number of tumor foci, clonal patterns, and specific markers of aggressive behaviour (infiltrative growth, BRAF mutation). In a near future, the identification of a gene expression pattern associated with a higher risk of recurrence would allow us to focus more aggressive treatment appropriately.