Zdon M J, Fredland A J, Zaret P H
Department of Surgery, Finch University of Health Sciences/The Chicago Medical School at Mount Sinai Hospital Medical Center, Illinois 60064, USA.
Am Surg. 2001 Sep;67(9):880-4.
Follicular neoplasms of the thyroid present a therapeutic challenge. Initial limited thyroidectomy may result in some patients requiring completion thyroidectomy for malignancy. In the current study we examined age, gender, race, time from nodule discovery to operation in months, history of radiation exposure, tumor size (cm), and cell type in patients with follicular neoplasms identified at the time of thyroidectomy in two socioeconomically diverse settings from 1993 through 2000 to identify possible factors associated with a greater chance of malignancy. Of 36 follicular lesions identified in 35 patients seven (19%) were malignant on permanent section. Hurthle cell histology was present in six of 36 lesions. Mean age of patients with benign lesions was 47 +/- 13 versus 50 +/- 15 in malignant cases (P > 0.05). Benign lesions measured 2.6 +/- 1.2 cm versus 3.1 +/- 1.7 cm in malignant (P > 0.05). Other factors found not to be significant included gender and time nodule was present (12.8 +/- 19 months benign vs 11.8 +/- 20 months malignant) (P > 0.05). Hurthle cell histology was associated with a 50 per cent malignancy rate (three of six) versus 13 per cent (four of 30) with non-Hurthle cell histology (P < 0.05). Two patients with exposure to radiation fallout had malignancies in lesions of one and 2 cm (P < 0.05). Patients from a socioeconomically disadvantaged setting had a malignancy rate of 50 per cent (six of 12) compared with a malignancy rate of 3 per cent (one of 24) from a socioeconomically affluent population (P < 0.05). In conclusion Hurthle cell histology and exposure to radiation fallout were associated with significantly higher rates of malignancy in follicular neoplasms and should be taken into account when deciding on the initial extent of thyroidectomy. The difference in malignancy rates observed between socioeconomic settings while significant requires further investigation.
甲状腺滤泡性肿瘤带来了治疗挑战。最初进行有限的甲状腺切除术可能会导致一些患者因恶性肿瘤而需要进行甲状腺全切术。在本研究中，我们调查了1993年至2000年间在两个社会经济背景不同的地区接受甲状腺切除术时确诊为滤泡性肿瘤患者的年龄、性别、种族、从发现结节到手术的时间（月）、辐射暴露史、肿瘤大小（厘米）以及细胞类型，以确定可能与更高恶性几率相关的因素。在35例患者中发现的36个滤泡性病变中，7个（19%）在永久切片上为恶性。36个病变中有6个为许特莱细胞组织学类型。良性病变患者的平均年龄为47±13岁，而恶性病变患者为50±15岁（P>0.05）。良性病变大小为2.6±1.2厘米，而恶性病变为3.1±1.7厘米（P>0.05）。其他无显著意义的因素包括性别和结节存在时间（良性为12.8±19个月，恶性为11.8±20个月）（P>0.05）。许特莱细胞组织学类型的恶性率为50%（6个中的3个），而非许特莱细胞组织学类型的恶性率为13%（30个中的4个）（P<0.05）。两名有放射性沉降物暴露史的患者，其1厘米和2厘米大小的病变为恶性（P<0.05）。来自社会经济条件较差地区患者的恶性率为50%（12个中的6个），而来自社会经济条件富裕人群的恶性率为3%（24个中的1个）（P<0.05）。总之，许特莱细胞组织学类型和放射性沉降物暴露与滤泡性肿瘤的恶性率显著升高相关，在决定甲状腺切除术的初始范围时应予以考虑。社会经济背景之间观察到的恶性率差异虽显著，但需要进一步研究。
