Ito Yasuhiro, Higashiyama Takuya, Takamura Yuuki, Miya Akihiro, Kobayashi Kaoru, Matsuzuka Fumio, Kuma Kanji, Miyauchi Akira
Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-Dori, Chuo-ku, Kobe City 650-0011, Japan.
Anticancer Res. 2007 Mar-Apr;27(2):1039-43.
The recent prevalence of ultrasonography and fine-needle aspiration biopsy (FNAB) has facilitated the detection and diagnosis of papillary thyroid carcinoma. However, there are still cases that are preoperatively misdiagnosed and treated as benign nodules because ultrasonographic and FNAB findings do not provide sufficient evidence for a malignant diagnosis. In this study, we investigated the clinical outcomes of patients with papillary carcinoma that had not been recognized preoperatively.
We investigated the prognoses of 56 patients with papillary carcinoma who underwent thyroidectomy without node dissection under a diagnosis of benign nodules.
None of the patients underwent further surgery such as completion total thyroidectomy and node dissection after the pathological diagnosis of papillary carcinoma was established. However, to date, only 3 patients (5.3%) showed recurrence 116, 133 and 148 months after the initial surgery, respectively. Two patients showed recurrence in the remnant thyroid and one showed recurrence in the bone. None of the patients have died of thyroid carcinoma.
Papillary carcinomas misdiagnosed as benign nodules on ultrasonography and FNAB are indolent and very slow-growing. Immediate further surgery is not needed for such cases, even if they were resected as benign nodules at the initial surgery.
最近超声检查和细针穿刺活检（FNAB）的普及促进了甲状腺乳头状癌的检测和诊断。然而，仍有一些病例术前被误诊并当作良性结节治疗，因为超声检查和FNAB结果没有提供足够的恶性诊断证据。在本研究中，我们调查了术前未被识别的甲状腺乳头状癌患者的临床结局。
我们调查了56例诊断为良性结节而接受甲状腺切除术且未行淋巴结清扫的甲状腺乳头状癌患者的预后。
在甲状腺乳头状癌病理诊断确立后，无一例患者接受进一步手术，如甲状腺全切术和淋巴结清扫术。然而，迄今为止，仅3例患者（5.3%）分别在初次手术后116、133和148个月出现复发。2例患者在残余甲状腺复发，1例在骨中复发。无一例患者死于甲状腺癌。
超声检查和FNAB误诊为良性结节的甲状腺乳头状癌生长缓慢且惰性。即使这些病例在初次手术时作为良性结节切除，也无需立即进行进一步手术。
