Temporal distribution of aggresive variants of papillary throid carcinoma and their relationship with clinicopathological parameters

Objective: Papillary thyroid carcinoma is the most common histological type of thyroid malignancy and generally has a favorable prognosis. However, significant differences in clinical behavior are observed depending on its histopathological variants. In particular, subtypes such as tall cell, hobnail, diffuse sclerosing, columnar, and solid are defined as "aggressive variants." This study aims to retrospectively examine the pathology reports of patients diagnosed with papillary thyroid carcinoma and operated between 2012 and 2024 at the Department of Otorhinolaryngology, Gaziantep University Faculty of Medicine; to determine the temporal distribution of aggressive subtypes, analyze their relationship with clinicopathological parameters, and derive implications for patient management and treatment planning based on the findings. Materials and Methods: A total of 673 patients were included in the study. Based on the date of surgery, the cases were grouped into three periods (2012–2016, 2016–2020, 2020–2024) for comparative analysis. Aggressive and non-aggressive variants were compared in terms of demographic data, tumor size, capsular invasion, multifocality, extrathyroidal extension, lymph node metastasis, distant metastasis, local recurrence, and disease stage. Results: A marked increase in the proportion of aggressive variants over time was observed. The rate of aggressive subtypes increased from 16.1% in the first period to 36.5% in the last period. Aggressive variants were found to be associated with higher rates of lymph node metastasis, capsular and vascular invasion, local recurrence, distant metastasis, and extrathyroidal extension. Additionally, the rate of radioactive iodine administration was significantly higher in patients with aggressive variants. Conclusion: These findings highlight the strong association between aggressive variants and poor prognostic parameters, as well as the increasing frequency of these subtypes over time. Therefore, histological variant information should be taken into account in both preoperative and postoperative patient management and follow-up; particularly in aggressive subtypes, more careful monitoring and personalized treatment approaches should be adopted. Keywords: Aggressive variant, extrathyroidal extension, lymph node metastasis, papillary thyroid carcinoma,