背景:接受甲状腺全切除术治疗多结节性甲状腺肿的患者通常有很长的临床病史。他们经常因压迫症状而来手术,没有肿瘤疾病的怀疑。对于这些患者来说,微癌的发病率很高,尽管我们知道这不会影响后续治疗和长期生存。另一方面,当真正的偶发癌存在时,患者需要特定的治疗和长期随访.该研究的目的是确定甲状腺肿高发区的偶发癌的发生率,肿瘤的临床病理特征,以及治疗意义。
方法:这是一项回顾性研究,从2010年1月至2020年12月,在1435例甲状腺肿全甲状腺切除术中。所有患者术前诊断为良性疾病。性别,平均年龄,评估了从最初诊断甲状腺肿开始的平均持续时间以及进行细针穿刺的次数和频率。根据组织学检查,然后评估偶发癌的发生率(直径≥10mm)以及微小癌的发生率(直径<10mm),病理特征(多焦点,囊侵犯),以及随后的处方疗法。
结果:偶发癌患者编号为41(2.8%),34名女性和7名男性。平均年龄为53.5岁,而诊断为微癌的患者为88例(6.1%)。从最初诊断开始,该疾病的平均持续时间为7.8年。平均而言,这些患者在疾病过程中接受了1.8次细针穿刺,几乎只在前四年。肿瘤的平均直径为1.35cm(±0.3)。6名患者出现多病灶,而只有一名患者出现包膜侵犯。在耶茨校正后的偶然诊断方面,卡方检验对性别有显著依赖性(chi-stat=5.064;p=0.024),强调女性人口中发病率较高。所有患者随后接受代谢放疗。平均随访时间为6.3年,在35例患者中,没有显示任何疾病复发。
结论:偶发癌在因甲状腺肿行全甲状腺切除术的患者中并不少见。由于其治疗意义和患者的随访,必须将其与微癌区分开。统计分析表明,唯一显著的变量是性别。在甲状腺肿的区域,需要对患者进行仔细的监测,以突出即使在初次诊断后数年仍可能出现的可疑临床仪器方面.
BACKGROUND: Patients undergoing a total thyroidectomy for multinodular goiter typically have a long clinical history of the disease. They often come to surgery for compression symptoms, with no suspicion of neoplastic disease. For these patients, the incidence of microcarcinomas is high, even though we know that this does not affect subsequent therapies and long-term survival. On the other hand, when a true incidental carcinoma is present, the patient requires specific therapy and long-term follow-up. The purpose of the study was to identify the incidence of incidental carcinomas in the high prevalence region of goiter, the clinical-pathological characteristics of the tumor, and the therapeutic implications.
METHODS: This is a retrospective study, from January 2010 to December 2020, on a case series of 1435 total thyroidectomies for goiters. All patients had a preoperative diagnosis of a benign disease. Gender, mean age, and mean duration from the initial diagnosis of goiter were evaluated along with the number and frequency of fine needle aspirations carried out. On the basis of the histological examination, the incidence of incidental carcinoma was then assessed (diameter ≥ 10 mm) as well as the incidence of microcarcinoma (diameter < 10 mm), the pathological characteristics (multifocality, capsular invasion), and the subsequent prescribed therapies.
RESULTS: Patients with incidental carcinoma numbered 41 (2.8%%), 34 women and 7 men. The mean age was 53.5 years, while the patients diagnosed with microcarcinoma were 88 (6.1%). The mean duration of the disease from initial diagnosis was 7.8 years. On average, these patients underwent 1.8 fine needle aspirations during the course of the disease, almost exclusively in the first four years. The mean diameter of the tumor was 1.35 cm (±0.3). Multifocality was present in six patients, while only one patient presented capsular invasion. The chi-square test delivered a significant dependence on gender in terms of the incidental diagnosis after Yates correction (chi-stat = 5.064; p = 0.024), highlighting a higher incidence in the female population. All patients underwent subsequent metabolic radiotherapy. The mean follow-up was 6.3 years and in the 35 patients examined, none displayed any recurrence of the disease.
CONCLUSIONS: Incidental carcinoma is not uncommon in patients who have undergone total thyroidectomy for goiters. It must be differentiated from microcarcinoma for its therapeutic implications and the follow-up of the patient. Statistical analysis has shown that the only significant variable is gender. In a goiter area, the careful monitoring of patients is required to highlight suspicious clinical-instrumental aspects that may appear even several years after the initial diagnosis.