Karalus Miriam, Tamatea Jade Au, Conaglen Helen M, Meyer-Rochow Goswin Y, Conaglen John V, Elston Marianne S
Medical Student, Waikato Clinical Campus, University of Auckland, Hamilton.
Endocrinologist, Waikato Clinical Campus, University of Auckland, Hamilton.
N Z Med J. 2018 Jan 19;131(1468):69-74.
Previously the risk of concomitant thyroid cancer in multinodular goitre (MNG) has been reported as approximately 4%. Cancer risk in toxic MNG was often considered lower than for non-toxic MNG, due to a possible protective effect of TSH suppression. However, recent American data suggest an approximately 18% risk of occult malignancy in both toxic and non-toxic MNG.
To assess malignancy risk in a New Zealand population undergoing thyroidectomy for MNG.
Single-centre study of patients undergoing thyroidectomy for MNG from 1 December 2006 to 30 November 2016.
Six hundred and two patients underwent surgery for MNG (448 non-toxic and 154 toxic). Of these, 95/602 (16%) had thyroid cancer. After excluding patients operated for preoperative suspicion for cancer, 30/401 (8%) patients with non-toxic MNG and 15/151 (10%) with toxic MNG had unsuspected or occult thyroid cancer (p=0.358). Patients with toxic MNG were less likely to undergo preoperative fine needle aspiration than those with non-toxic MNG (34% vs 52%, respectively p=0.0001). Two-thirds of unsuspected thyroid cancers were incidental micropapillary carcinomas and unlikely to alter survival irrespective of therapy.
Malignancy rates in MNG are higher than historically reported, although most unsuspected cancers are unlikely to alter mortality even if diagnosis is delayed.
此前有报道称，多结节性甲状腺肿（MNG）患者合并甲状腺癌的风险约为4%。由于促甲状腺激素（TSH）抑制可能具有保护作用，毒性MNG的癌症风险通常被认为低于非毒性MNG。然而，最近美国的数据表明，毒性和非毒性MNG患者隐匿性恶性肿瘤的风险约为18%。
评估新西兰因MNG接受甲状腺切除术的人群中的恶性肿瘤风险。
对2006年12月1日至2016年11月30日因MNG接受甲状腺切除术的患者进行单中心研究。
602例患者因MNG接受手术（448例非毒性，154例毒性）。其中，95/602（16%）患有甲状腺癌。排除术前怀疑癌症而接受手术的患者后，30/401（8%）例非毒性MNG患者和15/151（10%）例毒性MNG患者患有未被怀疑或隐匿性甲状腺癌（p=0.358）。毒性MNG患者术前接受细针穿刺抽吸的可能性低于非毒性MNG患者（分别为34%和52%，p=0.0001）。三分之二未被怀疑的甲状腺癌为偶然发现的微小乳头状癌，无论治疗如何，都不太可能改变生存率。
MNG的恶性肿瘤发生率高于以往报道，尽管大多数未被怀疑的癌症即使诊断延迟也不太可能改变死亡率。
