Botrugno Ivan, Lovisetto Federico, Cobianchi Lorenzo, Zonta Sandro, Klersy Catherine, Vailati Alberto, Dionigi Paolo, Jemos Vassili
Department of General Surgery, Fondazione I.R.C.C.S. Policlinico S. Matteo of Pavia, University of Pavia, Italy.
Am Surg. 2011 Nov;77(11):1553-8.
The aim of the study was to analyze the frequency of incidental thyroid carcinoma (unknown tumor smaller than or equal to 10 mm) in a consecutive series of 462 total thyroidectomies for multinodular goiter and to investigate the clinical risk factors for this type of malignancy. A retrospective, single-center study of outcome data collected from patients with preoperative diagnosis of multinodular goiter who underwent total thyroidectomy at the General Surgery Unit of Pavia (Italy) between January 2000 and December 2008 was performed. Possible risk factors for malignancy were: gender, age, time of evolution of goiter, presence of a dominant nodule in multinodular goiter, hyperthyroidism, history of radiation to the neck, residence in an area of endemic goiter, prior thyroid surgery, calcifications in the goiter detected by neck ultrasound or chest X-rays, and a family history of thyroid diseases. In a 9-year period, 462 patients underwent total thyroidectomy. We found 41 cases of incidental thyroid carcinoma; the most common histopathological type was papillary. The multivariable analysis demonstrated that the clinical variables associated with occult carcinoma were a personal history of radiation therapy to the neck, the presence of calcifications detected by ultrasound or neck X-rays, and a family history of thyroid diseases; residence in an area of endemic goiter was a protective factor. A personal history of radiation to the neck, detection of calcifications by ultrasound or by neck X-rays, and a family history of thyroid diseases should be considered clinical risk factors for malignancy in multinodular goiter.
本研究的目的是分析在462例因多结节性甲状腺肿而接受全甲状腺切除术的连续病例中意外甲状腺癌（肿瘤未知且小于或等于10毫米）的发生率，并调查这类恶性肿瘤的临床风险因素。对2000年1月至2008年12月期间在意大利帕维亚综合外科接受全甲状腺切除术的术前诊断为多结节性甲状腺肿患者的结局数据进行了一项回顾性单中心研究。恶性肿瘤的可能风险因素包括：性别、年龄、甲状腺肿的病程、多结节性甲状腺肿中优势结节的存在、甲状腺功能亢进、颈部放疗史、居住在地方性甲状腺肿流行地区、既往甲状腺手术史、颈部超声或胸部X线检查发现甲状腺肿内有钙化以及甲状腺疾病家族史。在9年期间，462例患者接受了全甲状腺切除术。我们发现41例意外甲状腺癌病例；最常见的组织病理学类型是乳头状癌。多变量分析表明，与隐匿性癌相关的临床变量是颈部放疗个人史、超声或颈部X线检查发现钙化以及甲状腺疾病家族史；居住在地方性甲状腺肿流行地区是一个保护因素。颈部放疗个人史、超声或颈部X线检查发现钙化以及甲状腺疾病家族史应被视为多结节性甲状腺肿恶性肿瘤的临床风险因素。
