Sahbaz Nuri A, Tutal Firat, Aksakal Nihat, Acar Sami, Aksu Kadir I, Barbaros Umut, Erbil Yesim
Am Surg. 2017 Dec 1;83(12):1390-1393.
Retrosternal goiter prevalence is 5 to 40 per cent according to classifications in goiter series. Goiters with mediastinal extension were reported to be related with higher cancer rates. In our study, we aimed to investigate whether cancer incidence increased in retrosternal goiters compared with the cervical ones. Three hundred and ninety consecutive patients, who had surgery because of retrosternal goiter in Istanbul University Medical Faculty Department of General Surgery between 2005 and 2015 were included in the study (Group 1). Control group included 880 patients who had surgery because of nontoxic multinodular goiter in the same period (Group 2). Preoperative ultrasonography (USG) was performed to each patient. Fine-needle aspiration biopsy was performed in suspicious nodules and results were recorded. Carcinomas in histopathological examination were classified as intrathorasic and extrathorasic. Diagnostic rates of USG results were compared with histopathologic cancer results. Papillary carcinoma was diagnosed in 76 patients with retrosternal goiter (19%) and in 200 patients in the control group (22%). No statistically significant difference was detected between groups regarding the tumor rates (P > 0.05). One hundred and forty-four tumoral foci were detected in 76 patients with papillary carcinoma in retrosternal goiter patients. Three hundred and seventy tumoral foci were detected in 200 patients with papillary carcinoma in the control group. In the retrosternal goiter group, 104 carcinoma lesions of 144 papillary carcinomas were intrathorasic (72%). No statistically significant difference was detected between intrathorasic (2.1 ± 1 cm) and extrathorasic regiones (1.9 ± 0.8 cm) regarding the tumor size P > 0.05. When patients with and without cancer in the retrosternal goiter group were compared regarding familial thyroid cancer history, radiation to the neck, and cervical adenopathy, no statistically significant difference was detected. Cancer incidence of retrosternal goiters was not higher than that of the cervical ones. Yet, cancer foci of retrosternal goiters were commonly located in the intrathorasic area and were not detected with USG. Depending on these findings, we suggest that all retrosternal goiters should be surgically treated.
根据甲状腺肿系列分类，胸骨后甲状腺肿的患病率为5%至40%。据报道，伴有纵隔延伸的甲状腺肿与较高的癌症发生率相关。在我们的研究中，我们旨在调查胸骨后甲状腺肿的癌症发生率与颈部甲状腺肿相比是否增加。本研究纳入了2005年至2015年间在伊斯坦布尔大学医学院普通外科因胸骨后甲状腺肿接受手术的390例连续患者（第1组）。对照组包括同期因非毒性多结节性甲状腺肿接受手术的880例患者（第2组）。对每位患者进行术前超声检查（USG）。对可疑结节进行细针穿刺活检并记录结果。组织病理学检查中的癌分为胸内癌和胸外癌。将USG结果的诊断率与组织病理学癌症结果进行比较。76例胸骨后甲状腺肿患者（19%）和200例对照组患者（22%）诊断为乳头状癌。两组之间的肿瘤发生率无统计学显著差异（P>0.05）。在76例胸骨后甲状腺肿乳头状癌患者中检测到144个肿瘤病灶。对照组200例乳头状癌患者中检测到370个肿瘤病灶。在胸骨后甲状腺肿组中，144例乳头状癌中的104例癌灶位于胸内（72%）。胸内（2.1±1cm）和胸外区域（1.9±0.8cm）的肿瘤大小无统计学显著差异（P>0.05）。比较胸骨后甲状腺肿组中有癌和无癌患者的家族性甲状腺癌病史、颈部放疗和颈部淋巴结病，未发现统计学显著差异。胸骨后甲状腺肿的癌症发生率不高于颈部甲状腺肿。然而，胸骨后甲状腺肿的癌灶通常位于胸内区域，且USG未检测到。基于这些发现，我们建议所有胸骨后甲状腺肿均应接受手术治疗。
