Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

Famà, Fausto; Sindoni, Alessandro; Cicciù, Marco; Polito, Francesca; Piquard, Arnaud; Saint‐Marc, Olivier; Gioffré-Florio, Maria; Benvenga, Salvatore

doi:10.20945/2359-3997000000017

Cited by 19 publications

(18 citation statements)

References 65 publications

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“…A recent systematic review involving 10,743 patients with GD and 3336 non-GD patients with hyperthyroidism showed that the pooled prevalence of incidental thyroid carcinoma was 7.0% [51], which is comparable to the incidence of coincidental thyroid carcinoma of about 10% in patients who underwent thyroid surgery for any kind of benign goiter [56][57][58][59][60]. The presented series of 1808 cases showed a much lower risk with an incidental thyroid carcinoma prevalence of only 0.05%.…”

Section: Discussionmentioning

confidence: 61%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

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Section: Discussionmentioning

confidence: 61%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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“…In the end, Histopathologic examination provides a definitive diagnosis. 5,6 Previous study estimated that thyroid cancer would be the third most common cancer among women in 2019 in the USA. 6 This cross-sectional study was conducted to identify thyroid disease histopathological patterns in patients who underwent thyroid operations in our center.…”

Section: Introductionmentioning

confidence: 99%

<p>An Investigation of the Histopathological Pattern of Thyroid in Patients Undergoing Thyroid Operations: A Cross-Sectional Study</p>

Al‐wageeh¹,

Ahmed²,

Nikbakht³

et al. 2020

OAS

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Background: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland, or both. This study was designed to determine thyroid histopathological patterns in patients who underwent thyroid operation. Materials and Methods: This retrospective study was carried out at Sana'a University Hospital over two years, from January 1, 2014, to December 30, 2015. All 260 patients who underwent thyroid surgery were included in this study. Factors such as age, sex, residency, fine needle aspiration biopsy (FNAB) result, and post-operative histopathological patterns were recorded. Patients who only underwent FNA were excluded. Results: The mean age of participants was 40.06±13.18 years. Females were most commonly affected by thyroid diseases (90%) in comparison to males (10%). Histopathologic patterns were nodular colloid goiter (63.1%), adenoma (4.6%), papillary thyroid neoplasms (20.4%), follicular thyroid carcinoma (3.8%), medullary thyroid carcinoma (1.9%), thyroiditis (5.4%) and anaplastic thyroid carcinoma (0.8%). Papillary thyroid cancer was the most common thyroid cancer, with a prevalence of 53 (20.4%). The accuracy of FNAB and final histopathology in combine was 88.07%. However, FNAB was not precise enough in the preoperative diagnosis of follicular carcinoma (40%). FNAB sensitivity ranged from 70.8% to 88.8%, while FNAB specificity ranged from 97.1% to 99.9%. Conclusion: Nodular colloid goiter is the most prevalent thyroid disease, while papillary thyroid carcinoma is the most frequent cancer seen in this study. We recommend further studies with a larger population to validate our study.

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“…They reported a mean age of 55 ± 10 years for thyroid malignancies in patients undergoing thyroidectomy for MNG. 16 The current study revealed an incidence of 8% carcinoma in MNG specimens. The incidence of thyroid malignancy in thyroidectomy specimens has been variously reported in the local data.…”

Section: Discussionmentioning

confidence: 45%

Frequency of Incidental Carcinoma in Thyroids Operated for Multinodular Goiter

Zahid

Usman²,

Tauseef³

et al. 2021

J Islamabad Med Dental Coll

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Background: Multinodular goiter (MNG) is a common disease in Pakistan. However, malignancy can be found occasionally on histopathological examination of resected goiter specimens. The objective of this study was to determine the frequency of malignant lesions on histopathological examination in thyroid specimens operated for multinodular goiter.Material and Methods: A total of 154 patients undergoing thyroid surgery with preoperative diagnosis of multinodular goiter (MNG) at Al Nafees Medical College and Hospital Islamabad, Pakistan were included in this study. The preoperative diagnosis of MNG was made upon physical examination of thyroid and ultrasound (n=62 cases) and FNAC (n=43 cases) was done in selected cases. Gross examination was done and sections were taken from areas of thyroid with varied appearances including hemorrhagic, solid, firm, white, gray, gelatinous as well as necrotic areas. Qualitative variables, were calculated in terms of percentages and mean and standard deviation were used for quantitative variables.Results: Of the 154 patients with preoperative diagnosis of MNG, there were 139 (90%) female and only 15 (10%) male patients. The age range was 14-60 years with a mean age of 36 ± 10 years The incidence of thyroid carcinoma in patients operated for clinical diagnosis of MNG was 8% (n=12). Papillary thyroid carcinoma was the most frequent type of malignancy (83.3%; n=10). Multifocality (60%; n=6), bilaterality (33.3%; n=4) and left lobe involvement (80%; n=8) of thyroid were more common. Microcarcinoma (measuring 1cm or less) was found in 50% (n=5) of these PTC. Histological type of papillary carcinomas greater than 1 cm were follicular variant (n=3; 30%) and conventional (n=2; 20%) types. The maximum measurement of the tumor was 2 cm. In all cases of PTC, rest of the thyroid showed MNG on histopathology.Conclusions: Incidental finding of thyroid malignancy in clinically diagnosed cases of MNG is not unusual. Papillary carcinoma of thyroid is the most common incidental malignant finding in these cases. Multilocularity in thyroid is not an indicator of benign disease process.

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Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

Cited by 19 publications

References 65 publications

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

<p>An Investigation of the Histopathological Pattern of Thyroid in Patients Undergoing Thyroid Operations: A Cross-Sectional Study</p>

Frequency of Incidental Carcinoma in Thyroids Operated for Multinodular Goiter

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