Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom.
Laryngoscope. 2018 May;128(5):1099-1102. doi: 10.1002/lary.26927. Epub 2017 Oct 8.
OBJECTIVES/HYPOTHESIS: There is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid.
Ambispective cohort study.
All patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues.
Seventy-nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%-76.1%) and the negative predictive value was 100% (95% CI: 92.7%-100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%-100%), and the negative predictive value was also 100% (95% CI: 93.5%-100%).
This study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI.
目的/假设：在全喉切除术期间，几乎没有证据支持切除甲状腺组织。尽管肿瘤的控制是首要任务，但甲状腺切除术会导致甲状腺功能减退和甲状旁腺功能减退。本研究旨在测试术前计算机断层扫描在预测甲状腺组织学侵袭方面的有用性。
前瞻性队列研究。
纳入 2006 年至 2016 年期间在一家中心接受全喉切除术的所有鳞状细胞癌患者。数据作为患者标准护理的一部分进行前瞻性记录，但作为回顾性资料进行整理，使本研究具有前瞻性设计。甲状腺侵袭的组织学报告被视为金标准。计算机断层扫描报告根据肿瘤侵犯分为喉内、喉软骨受累和喉外组织。
共纳入 79 例患者。9 例患者的组织学检查有甲状腺受累，该人群的发病率为 11.29%。计算机断层扫描对软骨受累的阳性预测值为 52.9%（95%置信区间[CI]：28.5%-76.1%），阴性预测值为 100%（95%CI：92.7%-100%）。计算机断层扫描对喉外扩散的阳性预测值为 100%（95%CI：62.9%-100%），阴性预测值也为 100%（95%CI：93.5%-100%）。
本研究表明，术前计算机断层扫描是一种排除甲状腺侵犯的有效方法。在计算机断层扫描上未发现喉外扩散是最有用的发现，具有高阴性预测值和狭窄的 95%置信区间。
4。喉镜，128：1099-1102，2018 年。
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