Burgess John R, Tucker Paul
Department of Endocrinology, Royal Hobart Hospital, University of Tasmania, Tasmania.
Thyroid. 2006 Jan;16(1):47-53. doi: 10.1089/thy.2006.16.47.
Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy. The reported incidence of PTC has more than doubled in many countries during the past half century. In Tasmania, an island state of the Commonwealth of Australia the incidence has increased by 24.7% per annum during the last two decades.
Using the Tasmanian population as a model, this study sought to determine the relationship between changes in PTC incidence and trends for utilization of thyroid surgery and thyroid fine-needle aspiration biopsy (FNAB) cytology.
Hospital and pathology services in Tasmania provided data relating to all thyroid surgical, cytologic, and histopathology procedures undertaken between 1988 and 1998. The accuracy of PTC case ascertainment by the Tasmanian Cancer Registry was validated and the relationship between thyroid procedures and PTC incidence assessed.
A total of 3452 individuals underwent a thyroid procedure, comprising 1968 surgical and 1756 FNAB cytologic procedures. Of these, 184 patients were diagnosed with thyroid carcinoma, of whom 121 (65.8%) had PTC. Thyroidectomy and thyroid FNAB increased by 7.0% and 49.7% per annum, respectively. The likelihood of diagnosing PTC in thyroidectomy specimens increased by 99.7% per year in those patients preoperatively assessed by FNAB, compared to 10.1% per year in those for whom a preoperative FNAB was not performed. PTC incidence increased independently of PTC tumor size, although the greatest increase occurred for PTC 1 cm or less with a history of preoperative FNAB.
These results suggest increasing PTC incidence is largely attributable to greater diagnosis of small PTC, many of which are likely to have been asymptomatic, identified by neck ultrasonography and subsequent FNAB. However, the incidence of PTC larger than 1 cm in patients without history of preoperative FNAB has also risen, suggesting the occurrence of clinically relevant tumors may also have increased.
甲状腺乳头状癌（PTC）是最常见的内分泌恶性肿瘤。在过去半个世纪中，许多国家报告的PTC发病率增加了一倍多。在澳大利亚联邦的一个岛屿州塔斯马尼亚，过去二十年中发病率每年增加24.7%。
以塔斯马尼亚人群为模型，本研究旨在确定PTC发病率变化与甲状腺手术和甲状腺细针穿刺活检（FNAB）细胞学检查利用趋势之间的关系。
塔斯马尼亚的医院和病理服务部门提供了1988年至1998年间所有甲状腺手术、细胞学和组织病理学检查的数据。验证了塔斯马尼亚癌症登记处对PTC病例确诊的准确性，并评估了甲状腺检查与PTC发病率之间的关系。
共有3452人接受了甲状腺检查，包括1968例手术和1756例FNAB细胞学检查。其中，184例患者被诊断为甲状腺癌，其中121例（65.8%）为PTC。甲状腺切除术和甲状腺FNAB分别每年增加7.0%和49.7%。在术前接受FNAB评估的患者中，甲状腺切除标本中诊断为PTC的可能性每年增加99.7%，而未进行术前FNAB的患者中这一比例为每年10.1%。PTC发病率独立于PTC肿瘤大小而增加，尽管最大的增加发生在术前有FNAB史的1cm或更小PTC中。
这些结果表明，PTC发病率的增加很大程度上归因于对小PTC的更多诊断，其中许多可能是无症状的，通过颈部超声检查和随后的FNAB发现。然而，在没有术前FNAB史的患者中，大于1cm的PTC发病率也有所上升，这表明临床相关肿瘤的发生率可能也有所增加。
