15 年来比利时中心甲状腺手术管理的演变。

Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center.

机构信息

Department of Endocrinology, Clinique du Sud Luxembourg, Arlon, Belgium.

, Vivalia Arlon, avenue des déportés 137, Arlon, 6700, Belgium.

出版信息

BMC Surg. 2024 Jun 15;24(1):188. doi: 10.1186/s12893-024-02471-7.

DOI:10.1186/s12893-024-02471-7

PMID:38877435

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11179191/

Abstract

BACKGROUND

Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis.

BACKGROUND

Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer.

METHODS

In this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020.

RESULTS

Respectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007-2010, 2011-2015 and 2016-2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011-2015 period) to 81% (2016-2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases.

CONCLUSIONS

Over a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.

摘要

背景

甲状腺手术指南的发展反映了医学知识的进步，降低了低危甲状腺癌的过度诊断率。我们的目标是分析手术甲状腺管理的变化及其对甲状腺癌诊断的影响。

背景

甲状腺手术指南的发展反映了医学知识的进步，降低了低危甲状腺癌的过度诊断率。我们的目标是研究长期以来术前和术后管理的演变及其对组织学癌症诊断的影响，特别是对微小癌的影响。

方法

在这项回顾性队列研究中，我们纳入了 2007 年至 2020 年间连续 891 例接受甲状腺手术的患者。

结果

在 2007-2010 年、2011-2015 年和 2016-2020 年三个时期，分别有 305、290 和 266 例患者接受手术。在所有三个时期，女性约占人群的 70%，平均年龄为 54 岁（范围：67）。大多数手术（90%）为甲状腺全切除术。研究期间，术前细针穿刺抽吸（FNA）的比例从 13%增加到 55%，p<0.01。共有 116 例患者发现癌症：2007-2010 年期间 35 例（11%），2011-2015 年期间 50 例（17%），2016-2020 年期间 32 例（12%）（p=0.08）。对于所有三个时期，甲状腺乳头状癌（PTC）是最常见的，约占 80%。T1a 以上甲状腺癌的比例从 37%（2011-2015 年）显著增加到 81%（2016-2020 年），p=0.001。接受放射性碘治疗的患者相对稳定（约 60%），但更频繁地接受低剂量放射性碘（p<0.01）和重组人促甲状腺激素（p<0.01）治疗。除低危 T1a PTC 病例外，所有病例的手术甲状腺重量均随时间减少。