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分化型甲状腺癌病例中甲状腺全切术的必要性。

The Need for Completion Thyroidectomy in Cases of Differentiated Thyroid Cancer.

作者信息

Veyseller Bayram, Yenigun Alper, Aksoy Fadlullah, Meric Aysenur, Ozturan Orhan

机构信息

1Department of Otorhinolaryngology, Faculty of Medicine, Acibadem University, Istanbul, Turkey.

2Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blvd. Vatan Street, 34093 Fatih/Istanbul, Turkey.

出版信息

Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(Suppl 1):82-87. doi: 10.1007/s12070-017-1083-8. Epub 2017 Feb 17.

Abstract

There are no definitive criteria for the presence of malignancy in the opposite lobe in cases of unilateral lobectomy due to a thyroid mass in which the malignancy was diagnosed histologically. Study design is retrospective, cross sectional study. The present study included patients who underwent a lobectomy in our clinic between 2001 and 2016 with an initial diagnosis of atypia with undetermined significance or suspected malignancy according to fine-needle aspiration biopsy and adult patients who received a thyroidectomy based on thyroid cancer detected in pathological examinations. Tumor histopathological diagnosis, tumor size, and capsular, vascular, or lymphatic invasion were assessed in patients who received thyroid lobectomy. The presence of a multifocal tumor (52.3%) significantly increased the risk of malignancy in the opposite lobe over the risk association with a unifocal tumor (8.9%;  < 0001). In patients with a tumor diameter greater than 4 cm (83.3%), the risk of malignancy in the opposite lobe was higher than that in patients with a tumor diameter less than 4 cm (22.3%;  < 0.001). Significant differences were not observed between groups with and without vascular or capsular invasion of the opposite lobe ( = 0.913 and  = 0.840, respectively). We determined risk factors for the presence of multifocal disease in unilateral lobectomy materials; an aggressive tumor subtype and a size larger than 4 cm are the most important factors that increase the risk of malignancy in the opposite lobe. Level 4-Case-control studies.

摘要

对于因甲状腺肿块行单侧甲状腺叶切除术且经组织学诊断为恶性肿瘤的病例,目前尚无明确标准来判断对侧叶是否存在恶性肿瘤。研究设计为回顾性横断面研究。本研究纳入了2001年至2016年间在我们诊所接受叶切除术的患者,这些患者最初根据细针穿刺活检诊断为意义未明的非典型病变或疑似恶性肿瘤,还纳入了成年患者,这些患者在病理检查中发现甲状腺癌后接受了甲状腺切除术。对接受甲状腺叶切除术的患者评估肿瘤组织病理学诊断、肿瘤大小以及包膜、血管或淋巴管侵犯情况。多灶性肿瘤(52.3%)患者对侧叶发生恶性肿瘤的风险显著高于单灶性肿瘤患者(8.9%;P<0.001)。肿瘤直径大于4 cm的患者(83.3%)对侧叶发生恶性肿瘤的风险高于肿瘤直径小于4 cm的患者(22.3%;P<0.001)。对侧叶有或无血管或包膜侵犯的两组之间未观察到显著差异(分别为P = 0.913和P = 0.840)。我们确定了单侧叶切除术标本中多灶性疾病存在的危险因素;侵袭性肿瘤亚型和直径大于4 cm是增加对侧叶发生恶性肿瘤风险的最重要因素。4级——病例对照研究。

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