Department of Endocrine Surgery, Narayana Medical College and Super Speciality Hospital, Chinthareddypalem, Nellore, 524002, Andhra Pradesh, India.
Ir J Med Sci. 2013 Mar;182(1):37-40. doi: 10.1007/s11845-012-0822-9. Epub 2012 Apr 11.
Ultrasound-guided fine-needle aspiration cytology (FNAC), intraoperative frozen section, elastography and molecular markers have been tried to predict malignancy in indeterminate thyroid lesions. However, only histopathological evidence of capsular and vascular invasion can confirm malignancy. The aim of this study is to determine the effectiveness of hemithyroidectomy (HT) as an adequate surgical intervention in patients having cytologically proven follicular neoplasm limited to one lobe of the thyroid in a resource-limited country like India.
A retrospective study was conducted. The data of all patients operated for FNAC-proven follicular neoplasm (2008-2011) were analysed.
A total of 123 cases had FNAC-proven follicular neoplasm. Fourteen were male and 109 female. Forty-six patients with multiple nodules involving both lobes (MNG) underwent total thyroidectomy (TT), whereas 77 who had solitary thyroid nodule (STN) underwent HT. Among patients who had HT (n = 77), histopathology revealed malignancy in 3.6% (n = 3). Patients who needed completion thyroidectomy (CT) were older females (p = 0.02) with higher TSH levels (p = 0.0001), shorter duration of goitre (p = 0.01) and smaller nodules (p = 0.04).
Hemithyroidectomy is an adequate initial surgical procedure for FNAC-proven follicular neoplasm. The incidence of carcinoma is 3.9%. Older subjects with high normal TSH are likely to have malignancy. Routine employment of intraoperative frozen section, elastography and molecular markers is not necessary if locally unavailable, since the incidence of malignancy in FNAC-proven follicular neoplasm is low.
超声引导下细针穿刺细胞学检查（FNAC）、术中冷冻切片、弹性成像和分子标志物已被尝试用于预测不确定甲状腺病变的恶性程度。然而，只有包膜和血管侵犯的组织病理学证据才能确认恶性肿瘤。本研究旨在确定在印度等资源有限的国家，对细胞学证实的局限于一叶甲状腺的滤泡性肿瘤患者行半甲状腺切除术（HT）作为充分手术干预的效果。
本研究为回顾性研究。分析了所有因 FNAC 证实的滤泡性肿瘤（2008-2011 年）而行手术的患者的数据。
共有 123 例患者因 FNAC 证实的滤泡性肿瘤接受手术。男 14 例，女 109 例。46 例双侧多结节性甲状腺肿（MNG）患者行甲状腺全切除术（TT），77 例单发甲状腺结节（STN）患者行 HT。在行 HT 的 77 例患者中，组织病理学发现恶性肿瘤占 3.6%（n=3）。需要行补充甲状腺切除术（CT）的患者为年龄较大的女性（p=0.02），促甲状腺激素（TSH）水平较高（p=0.0001），甲状腺肿持续时间较短（p=0.01），结节较小（p=0.04）。
HT 是 FNAC 证实的滤泡性肿瘤的一种充分初始手术方法。恶性肿瘤的发生率为 3.9%。TSH 正常偏高的老年患者可能有恶性肿瘤。如果局部不可用，常规使用术中冷冻切片、弹性成像和分子标志物是不必要的，因为 FNAC 证实的滤泡性肿瘤恶性肿瘤的发生率较低。
