Chen H, Nicol T L, Zeiger M A, Dooley W C, Ladenson P W, Cooper D S, Ringel M, Parkerson S, Allo M, Udelsman R
Department of Surgery, The Johns Hopkins Medical Institutions and The Johns Hopkins Thyroid Tumor Center, Baltimore, Maryland, USA.
Ann Surg. 1998 Apr;227(4):542-6. doi: 10.1097/00000658-199804000-00015.
To determine if any preoperative or intraoperative factors can reliably predict malignancy in patients with Hürthle cell neoplasms.
Most experienced surgeons recommend total thyroidectomy for Hürthle cell carcinomas and reserve thyroid lobectomy for Hürthle cell adenomas. However, delineation between Hürthle cell adenoma versus carcinoma often cannot reliably be made either before or during surgery.
Medical records from 57 consecutive patients who underwent thyroid resections for Hürthle cell neoplasms between October 1984 and April 1995 at The Johns Hopkins Hospital were analyzed to determine if any factors were predictive of malignancy.
Of the 57 patients with Hürthle cell neoplasms, 37 had adenomas and 20 had carcinomas, resulting in a 35% prevalence of malignancy. Patients with adenomas did not differ from those with carcinoma with respect to age, sex, or history of head and neck irradiation. However, patients with Hürthle cell carcinomas had significantly larger tumors (4.0 +/- 0.4 cm vs. 2.4 +/- 0.2 cm, p < 0.005). Furthermore, although the incidence of malignancy was only 17% for tumors 1 cm or less and 23% for tumors 1 to 4 cm, tumors 4 cm or greater were malignant 65% of the time (p < 0.05). Both fine-needle aspiration and intraoperative frozen section analysis had low sensitivities in the detection of cancer (16% and 23%, respectively). With up to 9 years of follow-up, there has been no tumor-related mortality.
These data demonstrate that the size of a Hürthle cell neoplasm is predictive of malignancy. Therefore, at the time of initial exploration for large Hürthle cell neoplasms (>4 cm), definitive resection involving both thyroid lobes should be considered because of the higher probability of malignancy.
确定术前或术中的任何因素是否能够可靠地预测许特莱细胞肿瘤患者的恶性情况。
大多数经验丰富的外科医生建议对许特莱细胞癌患者行甲状腺全切术，而对许特莱细胞腺瘤患者则行甲状腺叶切除术。然而，在手术前或手术过程中，通常无法可靠地区分许特莱细胞腺瘤和癌。
分析1984年10月至1995年4月在约翰霍普金斯医院连续接受甲状腺切除术的57例许特莱细胞肿瘤患者的病历，以确定是否有任何因素可预测恶性情况。
57例许特莱细胞肿瘤患者中，37例为腺瘤，20例为癌，恶性患病率为35%。腺瘤患者与癌患者在年龄、性别或头颈部放疗史方面无差异。然而，许特莱细胞癌患者的肿瘤明显更大（4.0±0.4 cm对2.4±0.2 cm，p<0.005）。此外，虽然直径1 cm或更小的肿瘤恶性发生率仅为17%，直径1至4 cm的肿瘤为23%，但直径4 cm或更大的肿瘤65%为恶性（p<0.05）。细针穿刺活检和术中冰冻切片分析在检测癌症方面的敏感性都很低（分别为16%和23%）。随访长达9年，无肿瘤相关死亡病例。
这些数据表明，许特莱细胞肿瘤的大小可预测恶性情况。因此，在初次探查发现大型许特莱细胞肿瘤（>4 cm）时，由于恶性可能性较高，应考虑行包括双侧甲状腺叶的根治性切除术。
