Lee Young Chan, Eun Young Gyu, Sohn Yu-Mee, Rhee Sang Youl, Hong Il Ki, Chon Suk, Oh Seung Joon, Kim Deog Yoon
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea.
World J Surg. 2015 Jul;39(7):1736-41. doi: 10.1007/s00268-015-3024-6.
The surgical extent and indication for treatment in patients with papillary thyroid microcarcinoma (PTMC) remain a controversial issue. The aim of this study was to investigate the predictive factor for contralateral occult carcinoma in patients with unilateral PTMC by preoperative ultrasonographic and pathological features.
Of the total patients who underwent thyroidectomy, 455 patients with PTMC confined to one unilateral lobe as diagnosed using preoperative ultrasonography (US) were enrolled in the study. Occult contralateral carcinoma was defined as tumor foci in the contralateral lobe that was not detected preoperatively, but was detected pathologically. All patients underwent preoperative US review to investigate the US features of PTMC such as laterality, location, size, internal component, echogenicity, margin, calcification shape, multifocality, bilaterality, extrathyroidal extension, and location with respect to the trachea. Clinicopathological data were also analyzed.
Of the total of 455 patients who underwent total thyroidectomy for preoperatively detected unilateral PTMC, 71 patients (15.6 %) had contralateral occult carcinoma. Clinicopathological characteristics did not significantly differ between patients with and without contralateral occult carcinoma. Multivariate analysis showed that the absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US images.
We demonstrated that an absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US. The prediction of contralateral occult carcinoma in unilateral PTMC using preoperative US features could be useful for determining the optical extent of surgery.
甲状腺微小乳头状癌（PTMC）患者的手术范围和治疗指征仍是一个有争议的问题。本研究的目的是通过术前超声和病理特征，探讨单侧PTMC患者对侧隐匿性癌的预测因素。
在接受甲状腺切除术的所有患者中，纳入455例术前超声（US）诊断为局限于单侧叶的PTMC患者。隐匿性对侧癌定义为术前未检测到，但病理检查发现的对侧叶肿瘤病灶。所有患者均接受术前超声检查，以研究PTMC的超声特征，如侧别、位置、大小、内部成分、回声、边界、钙化形态、多灶性、双侧性、甲状腺外侵犯以及相对于气管的位置。还分析了临床病理数据。
在455例因术前检测到的单侧PTMC而接受全甲状腺切除术的患者中，71例（15.6%）有对侧隐匿性癌。有和没有对侧隐匿性癌的患者临床病理特征无显著差异。多因素分析显示，术前超声图像中，单侧PTMC患者对侧隐匿性癌的独立预测因素为边界不清和对侧叶存在可能为良性的结节。
我们证明，术前超声检查中，边界不清和对侧叶存在可能为良性的结节是单侧PTMC患者对侧隐匿性癌的独立预测因素。利用术前超声特征预测单侧PTMC患者的对侧隐匿性癌，可能有助于确定最佳手术范围。
