Pacini F, Elisei R, Capezzone M, Miccoli P, Molinaro E, Basolo F, Agate L, Bottici V, Raffaelli M, Pinchera A
Department of Endocrinology and Metabolism, University of Pisa, Italy.
Thyroid. 2001 Sep;11(9):877-81. doi: 10.1089/105072501316973145.
Total (or near-total) thyroidectomy (TT) is considered by many as the most adequate treatment for papillary thyroid carcinoma (PTC). In patients who have undergone lobectomy, the necessity of performing a completion thyroidectomy (CT) is still discussed. The aim of this retrospective study was to evaluate tumor bilaterality in patients initially treated with partial thyroidectomy for PTC and who then underwent CT. We studied 182 patients treated with CT after lobectomy and/or isthmectomy for PTC diagnosed from 1969-1998. Mean age at diagnosis was 40+/-14.5 years and mean interval between partial thyroidectomy and CT was 19.8+/-56.8 months. At CT, 80 of 182 patients (44%) had one or more foci of tumor in the remaining thyroid lobe, always of the same papillary histotype, associated with ipsilateral lymph node metastases in 22 cases. In addition, 10 patients with no tumoral foci in the thyroid specimen had evidence of lymph node metastases. The rate of bilateral tumor was not different when patients were analyzed according to the classification of "low-" or "high-risk." Among several clinical features, the presence of lymph node metastases at the first surgical treatment and time interval between first treatment and CT were correlated with higher frequency of bilaterality (p = 0.033 and p = 0.044, respectively). The postsurgical 131I whole-body scan revealed the presence of persistent lymph node metastases or diffuse micronodular lung metastases in 7 and 6 patients, respectively. In conclusion, PTC was frequently bilateral in our series and this bilaterality was independent from the "low-" or "high-risk" classification. On these bases, we believe that PTC should be treated with TT when diagnosed before surgery and submitted to CT, if partial surgery was the initial intervention.
全（或近全）甲状腺切除术（TT）被许多人视为乳头状甲状腺癌（PTC）最适当的治疗方法。对于接受过甲状腺叶切除术的患者，是否有必要进行甲状腺全切术（CT）仍存在争议。这项回顾性研究的目的是评估最初接受PTC部分甲状腺切除术然后接受CT的患者的肿瘤双侧性。我们研究了1969年至1998年间因PTC接受甲状腺叶切除术和/或峡部切除术并随后接受CT的182例患者。诊断时的平均年龄为40±14.5岁，部分甲状腺切除术与CT之间的平均间隔为19.8±56.8个月。在CT检查时，182例患者中有80例（44%）在剩余的甲状腺叶中有一个或多个肿瘤病灶，均为相同的乳头状组织学类型，其中22例伴有同侧淋巴结转移。此外，10例甲状腺标本中无肿瘤病灶的患者有淋巴结转移的证据。根据“低风险”或“高风险”分类分析患者时，双侧肿瘤的发生率没有差异。在几个临床特征中，首次手术治疗时存在淋巴结转移以及首次治疗与CT之间的时间间隔与双侧性频率较高相关（分别为p = 0.033和p = 0.044）。术后131I全身扫描显示，分别有7例和6例患者存在持续性淋巴结转移或弥漫性微小结节性肺转移。总之，在我们的系列研究中，PTC经常是双侧性的，并且这种双侧性与“低风险”或“高风险”分类无关。基于这些依据，我们认为，如果术前诊断为PTC且最初的干预是部分手术，则应在手术前进行TT治疗，并在必要时进行CT。
