Malignant Tumors of Thyroid Gland

Česká verzia

Authors: B. Uhliarová ^1,2; G. Bugová ¹; A. Hajtman ¹
Authors place of work: Klinika otorinolaryngológie a chirurgie hlavy a krku JLF UK a UN Martin, Slovenská republika ¹; Otorinolaryngologické oddelenie, FNsP F. D. Roosevelta Banská Bystrica, Slovenská republika ²
Published in the journal: Klin Onkol 2015; 28(2): 121-129
Category: Původní práce
doi: https://doi.org/10.14735/amko2015121

Summary

Aim:
The incidence of thyroid cancer has been increasing. The aim of this work was to determine risk factors, diagnostic methods and extent of surgical treatment of malignant goiter.

Material and Methods:
The authors retrospectively analyzed patients who were surgically treated for thyroid disease at the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, Teaching Hospital in Martin, Slovakia, from the January 1^st, 2006 to December 31^st, 2013, for thyroid disease. The incidence, risk factors of malignant thyroid tumors, indication for surgery and its complications were evaluated.

Results:
A total of 1,620 adult patients were surgically treated for thyroid disease at the Department of ENT, Head and Neck Surgery, CU JMF, UH in Martin, Slovakia, between 2006– 2013. Malignant tumors were identified in 238 patients (15%). Microcarcinoma (incidentally detected malignant tumor ≤ 1 cm) occurred in 78 cases (5%). Malignant thyroid tumor was more common in younger patients (p = 0.002). Newly created and larger nodules positively correlated with the occurrence of malignancy (p = 0.003, p = 0.041, resp.). Gender, family history of thyroid disorder, previous radiation therapy, and previous malignancy did not affect the incidence of malignant tumor of thyroid gland. High sensitivity and specificity in the diagnosis of malignant thyroid nodule was observed using aspiration cytology (75%, 97%, resp.) and intraoperative histopathological examination (88%, 100%, resp.).

Conclusion:
Malignant tumor of thyroid gland is more common in younger patients with newly developed nodule. The risk factors of malignancy increase with the size of the thyroid nodule. Aspiration cytology and peroperative histopathology have high sensitivity and specificity in the diagnosis of malignant thyroid tumor; therefore, they should be a standard method in the diagnosis of nodular goiter. The method of choice in the treatment of thyroid malignancy is total thyroidectomy.

Key words:
neoplasm – thyroid gland – risk factors – aspiration cytology – intraoperative histology – thyroidectomy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
1. 12. 2014

Accepted:
20. 1. 2015

Zdroje

1. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22(6): 901– 911. doi: 10.1016/ j.beem.2008.09.019.

2. Eng ChY, Quraishi MS, Bradley PJ. Management of thyroid nodules in adult patients. Head Neck Oncology 2010; 2: 11. doi: 10.1186/ 1758‑ 3284‑ 2‑ 11.

3. McDougall IR (ed.). Management of thyroid cancer and related nodular disease. London: Springer – Verlag 2006: 397.

4. Wartofsky L, Van Nostrand D (eds). Thyroid Cancer. A comprehensive guide to clinical management. Totowa: Humana Press 2006: 709.

5. Dušková J. Nový systém pro sjednocené hodnocení tenkojehlových aspiračních biopsií štítné žlázy – Bethesda2010. Cesk Patol 2011; 47(1): 8– 14.

6. Jackson MB, Guttenberg M, Hedrick H et al. Multiple endocrine neoplasia type 2A in a kindred with C634Y mutation. Pediatrics 2005; 116(3): 468– 671.

7. Grigsby PW, Gal‑ or A, Michalski JM et al. Childhood and adolescent thyroid carcinoma. Cancer 2002; 95(4): 724– 729.

8. Pacini F, Vorontsova T, Demidchik EP et al. Post‑Chernobyl thyroid carcinoma in Belarus children and adolescents: comparison with naturally occurring thyroid carcinoma in Italy and France. J Clin Endocrinol Metab 1997; 82(11): 3563– 3569.

9. Cohen A, Rovelli A, Merlo DF et al. Risk for secondary thyroid carcinoma after hematopoietic stem‑ cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol 2007; 25(17): 2449– 2454.

10. Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. Oncologist 2008; 13(2): 105– 112. doi: 10.1634/ theoncologist.2007‑ 0212.

11. Fuhrer D, Bockish A, Schmid KW. Euthyroid goiter with and without nodules – diagnosis and treatment. Dtsch Arztebl Int 2012; 109(29– 30): 506– 515.

12. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med 2005; 142(11): 926– 931.

13. Mehanna HM, Jain A, Morton RP et al. Investigating the thyroid nodule. BMJ 2009; 338: 705– 709. doi: 10.1136/ bmj.b733.

14. Mazzaferri EL. Current concepts: management of a solitary thyroid nodule. N Engl J Med 1993; 328(8): 553– 559.

15. Kamran SC, Marqusee E, Kim MI et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013; 98(2): 564– 570. doi: 10.1210/ jc.2012‑ 2968.

16. Mehta RS, Carty SE, Ohori NP et al. Nodule size is an independent predictor of malignancy in mutation‑ negative nodules with follicular lesion of undetermined significance cytology. Surgery 2013; 154(4): 730– 736. doi: 10.1016/ j.surg.2013.05.015.

17. Sands NB, Karls S, Amir A et al. Thyroid nodule size (MTNS): „rating the risk“, a novel predictive scheme for cancer risk determination. J Otolaryngol Head Neck Surg 2011; 40 (Suppl 1): S1– S13.

18. Bauer AJ. Thyroid nodules and differentiated thyroid cancer. Endocr Dev 2014; 26: 183– 201. doi: 10.1159/ 000363164.

19. Papini E, Guglielmi R, Bianchini A et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color‑ doppler features. J Clin Endocrinol Metab 2002; 87(5): 1941– 1946.

20. Campanella P, Ianni F, Rota CA et al. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and metaanalysis. End J Endocrinol 2014; 170(5): R203– R211. doi: 10.1530/ EJE‑ 13‑ 0995.

21. Batawil N, Alkordy T. Ultrasonographic features associated with malignancy in cytologically indeterminate thyroid nodules. Eur J Surg Oncol 2014; 40(2): 182– 186. doi: 10.1016/ j.ejso.2013.11.015.

22. Leenhardt L, Hejblum G, Franc B et al. Indications and limits of ultrasound‑ guided cytology in the management on nonpalpable thyroid nodules. J Clin Endocrinol Metab 1999; 84(1): 24– 28.

23. Čáp J, Ryška A. Aspirační cytologie štítne žlazy. Odolena Voda: Nukleus HK 2003: 178.

24. Raab SS, Vrbin CM, Grzybicki DM et al. Errors in thyroid gland fine‑ needle apiration. Am J Clin Pathol 2006; 125(6): 873– 882.

25. Podoba J, Králik R, Borovičová F et al. Štandardné postupy v manažmente karcinómu štítnej žľazy v Onkologickom ústave sv. Alžbety v Bratislave. Onkológia (Bratisl.) 2008; 3(3): 152– 163.

26. Lin JD, Chao TC, Huang BY et al. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine‑ needle asporation cytology. Thyroid 2005; 15(7): 708– 717.

27. Peli M, Capalbo E, Lovisatti M et al. Ultrasound guided fine‑ needle aspiration biopsy of thyroid nodules: guidelines and recommendations vs clinical practice; a 12- month study of 89 patients. J Ultrasound 2012; 15(2): 102– 107. doi: 10.1016/ j.jus.2011.12.004.

28. Sugitani I, Fujimoto Y. Management of low‑ risk papillary thyroid carcinoma:Unique conventional policy in Japan and our efforts to improve the level of evidence. Surg Today 2010; 40(3): 199– 215. doi: 10.1007/ s00595‑ 009‑ 4034‑ 5.

29. Famakinwa OM, Roman SA, Wang TS et al. ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States? Am J Surg 2010; 199(2): 189– 198. doi: 10.1016/ j.amjsurg.2009.04.022.

30. Cisco RM, Shen WT, Gosnell JE. Extent of surgery for papillary thyroid cancer: Preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncology 2012; 13(1): 1– 10. doi: 10.1007/ s11864‑ 011‑ 0175‑ z.

31. Brychta I. Papilárny karcinóm štítnej žľazy – kontroverzie pokračujú. Slov Chir 2012; 9(3): 98– 101.

32. Hirsch D, Levy S, Tsvetov G et al. Total versus hemithyroidectomy for small unilateral papillary thyroid carcinoma. Oncology Letters 2014; 7(3): 849– 853.

33. Marchesi M, Biffoni M, Faloci C et al. High rate of recurrence after lobectomy for solitary thyroid nodule. Eur J Surg 2002; 168(7): 397– 400.

34. Esnaola NF, Cantor SB, Sherman SI et al. Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis. Surgery 2001; 130(6): 921– 930.

35. Ito Y, Miyauchi A, Inoue H et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. Worl J Surg 2010; 34(1): 28– 35. doi: 10.1007/ s00268‑ 009‑ 0303‑ 0.

36. Králik R, Straka V, Marek V et al. Centrálna krčná disekcia lymfatických uzlín v liečbe diferencovaného karcinómu štítnej žľazy – naše skúsenosti. Rozhl Chir 2008; 87(3): 149– 153.

37. Moo TA, McGill J, Allendorf J et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 2010; 34(6): 1187– 1191. doi: 10.1007/ s00268‑ 010‑ 0418‑ 3.

38. Caglia P, Zappula E, Costa S et al. Differentiated thyroid cancer: role of the lymph node dissection. G Chir 2010; 31(6– 7): 293– 295.

39. Carling T, Carty SE, Ciarleglio MM et al. American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 2012; 22(3): 237– 244. doi: 10.1089/ thy.2011.0317.

40. Forest VI, Clark JR, Ebrahimi A et al. Central compartment dissection in thyroid papillary carcinoma. Ann Surg 2011; 253(1): 123– 130. doi: 10.1097/ SLA.0b013e3181fc9644.