Yamashita H, Noguchi S, Watanabe S, Uchino S, Kawamoto H, Toda M, Murakami N, Nakayama I, Yamashita H
Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan.
Surg Today. 1997;27(6):495-9. doi: 10.1007/BF02385801.
We evaluated the incidence of thyroid cancer in patients with adenomatous goiter and investigated the clinical factors distinguishing patients with occult thyroid cancer, defined as a tumor size smaller than or equal to 10 mm, from those with clinical thyroid cancer, defined as a tumor size larger than 10 mm. Of 835 patients with histologically confirmed adenomatous goiter, 256 (30.7%) also had thyroid cancer, being occult in 137 patients and clinical in 119 patients. There was no correlation between the maximum size of the thyroid cancer tumor and the age of the patient, and the percentage of patients with thyroid cancer in each group was not influenced by age. There were no significant differences in age, sex, the serum concentrations of free triiodothyronine, free thyroxine, thyrotropin, and thyroglobulin, or the urinary iodine creatinine ratio. The frequency of calcified lesions being detected by ultrasonography (US) and/or neck X-ray in the patients with clinical thyroid cancer was significantly greater than that in those with occult cancer at 83% vs 57%, respectively (P < 0.0001). This study disclosed a high prevalence of thyroid cancer associated with adenomatous goiter, and the results suggest that a considerable number of associated carcinomas remain occult. The detection of calcification in the thyroid gland is one of the surgical indications for patients with adenomatous goiter.
我们评估了腺瘤性甲状腺肿患者中甲状腺癌的发病率，并调查了区分隐匿性甲状腺癌（定义为肿瘤大小小于或等于10毫米）患者与临床甲状腺癌（定义为肿瘤大小大于10毫米）患者的临床因素。在835例经组织学确诊为腺瘤性甲状腺肿的患者中，256例（30.7%）也患有甲状腺癌，其中137例为隐匿性癌，119例为临床癌。甲状腺癌肿瘤的最大尺寸与患者年龄之间无相关性，且每组中甲状腺癌患者的百分比不受年龄影响。在年龄、性别、血清游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素和甲状腺球蛋白浓度或尿碘肌酐比值方面无显著差异。临床甲状腺癌患者通过超声（US）和/或颈部X线检测到钙化病变的频率显著高于隐匿性癌患者，分别为83%和57%（P<0.0001）。本研究揭示了与腺瘤性甲状腺肿相关的甲状腺癌的高患病率，结果表明相当数量的相关癌仍为隐匿性。甲状腺钙化的检测是腺瘤性甲状腺肿患者的手术指征之一。
