Christakis I, Dimas S, Kafetzis I D, Roukounakis N
Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford , UK.
Department of Endocrine Surgery, Mediterraneo Hospital , Athens , Greece.
Ann R Coll Surg Engl. 2018 May;100(5):357-365. doi: 10.1308/rcsann.2018.0017. Epub 2018 Feb 27.
Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
引言 本研究的目的是评估术前诊断为良性的甲状腺手术中意外分化型甲状腺癌的发生率，确定相关危险因素，并根据2015年美国甲状腺协会（ATA）指南对癌症患者进行风险分层。材料与方法 本研究是对一家机构（2004年1月至2009年1月）进行的所有甲状腺切除术的回顾性研究。我们排除了术前诊断为甲状腺恶性肿瘤的患者。结果 在1369例患者中有282例（21%）被诊断为意外分化型甲状腺癌。意外组男性患者数量显著更多（19%对14%，P = 0.033），有甲状腺炎组织病理学证据的患者数量也更多（35%对25%，P = 0.004）。意外组存在的淋巴结数量更多，但未达到统计学意义（17%对13%，P = 0.079）。ATA低风险组有270例（96%），ATA中风险组有12例（4%）。ATA中风险的患者包膜侵犯、甲状腺外扩展和血管侵犯的数量在统计学上显著更高（分别为P < 0.001、P < 0.001和P < 0.001）。总体而言，22%的意外分化型甲状腺癌患者应考虑接受放射性碘131I治疗。美国癌症联合委员会I期的191例患者中有29例（15%）应考虑接受放射性碘治疗。结论 男性和患有甲状腺炎的患者发生意外分化型甲状腺癌的风险更高。每五名被诊断为癌症的患者中就有一人需要放射性碘治疗，即使是一些I期疾病的患者。
