Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Head Neck. 2018 Aug;40(8):1812-1823. doi: 10.1002/hed.25165. Epub 2018 Apr 6.
The impact of oncogene panel results on the surgical management of indeterminate thyroid nodules (ITNs) is currently unknown.
Surgical management of 649 patients consecutively evaluated from October 2008 to April 2016 with a single nodule biopsied and indeterminate cytology (193 evaluated with and 456 without oncogene panels) was assessed and compared. Histological features of 629 consecutively resected ITNs (164 evaluated with and 465 without oncogene panels) were also characterized and compared.
Oncogene panel evaluation was associated with higher rates of total thyroidectomy (45% vs 28%; P = .006), and central lymph node dissection (19% vs 12%; P = .03) without increasing the yield of malignancy or decreasing the rate of completion thyroidectomy. Most malignancies (64%), including 83% of those with driver mutation identified, were low-risk cancers for which a lobectomy could have been sufficient initial treatment.
Current oncogene panel results seem insufficient to guide the surgical extent of solitary ITNs.
目前尚不清楚癌基因检测结果对不确定甲状腺结节（ITNs）的手术管理的影响。
评估了 2008 年 10 月至 2016 年 4 月连续评估的 649 例患者的手术管理情况，这些患者的单个结节均进行了活检且细胞学检查结果不确定（193 例接受了癌基因检测，456 例未接受癌基因检测），并对这些患者的结果进行了比较。还对 629 例连续切除的 ITN 的组织学特征（164 例接受了癌基因检测，465 例未接受癌基因检测）进行了描述和比较。
癌基因检测组的甲状腺全切除术（45%比 28%；P =.006）和中央淋巴结清扫术（19%比 12%；P =.03）的比例更高，而恶性肿瘤的检出率或完成甲状腺切除术的比例并未增加。大多数恶性肿瘤（64%），包括 83%确定存在驱动基因突变的恶性肿瘤，为低危癌症，初始治疗仅行部分甲状腺切除术可能就足够了。
目前的癌基因检测结果似乎不足以指导单发 ITN 的手术范围。
