Section of Endocrine Surgery, Division of General Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
Surgery. 2010 Sep;148(3):516-25. doi: 10.1016/j.surg.2010.01.020. Epub 2010 Mar 24.
Because no clinical parameter can establish the final status of a cytologically indeterminate thyroid nodule (ITN) or nodal-metastases in case of malignancy, the initial surgical strategy should define an oncologically adequate procedure with low morbidity.
The prognostic relevance of sex, age, tumor sizes, multifocality, thyroid function, and recurrence was analyzed in 156 consecutive patients according to the presence of malignancy and nodal metastases. The accuracy of frozen sections to reveal malignancy was determined. Clinical parameters were compared with regard to their ability to identify malignancy and nodal metastases in an ITN to determine an appropriate initial operative strategy.
One hundred and eighteen (75.6%) patients underwent (total) thyroidectomy, 37 (23.7%) patients underwent hemithyroidectomy, and 1 patient underwent isthmus resection. Fifty-five (35.3%) patients showed malignancy. First step lymphadenectomy (lymph node dissection along the recurrent laryngeal nerve before removing the thyroid lobe) was performed in 142 patients documenting 10 nodal metastases. Comparing benign and malignant ITN, no association was found for sex (P = .17), age (P = 1.0), tumor sizes (P = .33, P = .12, P = .19 for < or =30 mm, < or =40 mm, and < or =50 mm, respectively), or thyroid function (P = .26). The determination of malignancy by frozen section showed a sensitivity of 30.9% and a specificity of 100%. No permanent hypoparathyroidism or recurrent laryngeal nerve palsy was observed postoperatively.
Because of the failure of available clinical parameters to predict malignancy in cytologically ITN, hemithyroidectomy in unilateral goiter and thyroidectomy in bilateral goiter is recommended. Ipsilateral "first step central neck dissection" on the side of ITN offers the advantages of oncologically adequate resection and staging with a low morbidity, as well as avoids reoperation.
由于没有临床参数可以确定细胞学不确定的甲状腺结节（ITN）或恶性肿瘤时的淋巴结转移的最终状态，因此初始手术策略应确定具有低发病率的肿瘤学上充分的手术方法。
根据恶性肿瘤和淋巴结转移的存在，对 156 例连续患者的性别、年龄、肿瘤大小、多灶性、甲状腺功能和复发情况的预后相关性进行了分析。确定了冰冻切片显示恶性肿瘤的准确性。比较了临床参数，以确定它们在 ITN 中识别恶性肿瘤和淋巴结转移的能力，从而确定适当的初始手术策略。
118 例（75.6%）患者接受了（全）甲状腺切除术，37 例（23.7%）患者接受了甲状腺叶切除术，1 例患者接受了峡部切除术。55 例（35.3%）患者显示恶性肿瘤。在 142 例患者中进行了第一步淋巴结切除术（在切除甲状腺叶之前沿喉返神经清扫淋巴结），并记录了 10 例淋巴结转移。比较良性和恶性 ITN，发现性别（P=0.17）、年龄（P=1.0）、肿瘤大小（P=0.33，P=0.12，P=0.19，分别为≤30mm、≤40mm 和≤50mm）或甲状腺功能（P=0.26）之间无相关性。冰冻切片确定恶性肿瘤的敏感性为 30.9%，特异性为 100%。术后未观察到永久性甲状旁腺功能减退或喉返神经麻痹。
由于现有的临床参数无法预测细胞学 ITN 中的恶性肿瘤，因此建议在单侧甲状腺肿中进行甲状腺叶切除术，在双侧甲状腺肿中进行甲状腺切除术。在 ITN 侧进行同侧“第一步中央颈部淋巴结清扫术”具有肿瘤学充分切除和分期的优势，发病率低，并且避免了再次手术。
