Abstract
To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with a background of benign disease. A total of 709 patients with papillary thyroid carcinoma undergoing surgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroid disease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examination of surgical specimens but were not detected by preoperative imaging studies. In the other group, according to the pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified as concomitant PTC and 309 cases were clarified as dominant PTC. Incidental PTC was more common in women, about 85.7%, the mean age was 47.6±11.3 years old. Average tumor diameter was 4.4±2.2 mm, multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147). After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), there was no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10 and 14 year respectively. Incidental PTC with a background of benign lesions is common, and the generally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperative finding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, but with a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomy or immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unless lymphadenectasis is present.
Highlights
There has the fastest-growing incidence for thyroid carcinoma in recent years (Qian et al, 2005; Davies and Gilbert, 2008; Alevizaki et al, 2009), according to the United States 1989-2008 annual statistical data, its incidence have increased by 6.2% per year, new cases of papillary thyroid carcinoma (PTC) accounting for 85 -90%, especially the tiny carcinoma less than 1 cm in diameter
Pathological findings All 709 cases were papillary carcinoma, 312 cases accompanied by nodular goiter, 58 cases were Hashimoto’s disease, 16 cases were diagnosed as hyperthyroidism, 12 cases with follicular adenoma, in which there were 53 cases accompanied by two or more benign lesions
Follow-up The follow-up ended in July 2011, all patients were followed up for more than 4 years and 6 months. During this period after radical resection 71 cases recurrd, 66 cases received the second surgical resection, 5 patients with distant metastases. 13 patients died after radical resection, one patient with IPC died in 102 month for cerebrovascular accident, one suicide after 5 months in the concomitant group, the other cases were due to the tumor-related death
Summary
There has the fastest-growing incidence for thyroid carcinoma in recent years (Qian et al, 2005; Davies and Gilbert, 2008; Alevizaki et al, 2009), according to the United States 1989-2008 annual statistical data, its incidence have increased by 6.2% per year, new cases of papillary thyroid carcinoma (PTC) accounting for 85 -90%, especially the tiny carcinoma less than 1 cm in diameter. Thyroid nodules come to clinical attention when noted by the patients, or as an incidental finding during routine physical examination, or image procedure, which are present in 4% to 7% of the population (the incidence incresaes with increasing age) and 30% to 50% by ultrasonography (US) (Hagag et al, 1998; Lin et al, 2005; Pang and Chen, 2007). Stoffer et al (1960) reported that 13% of the glands resected in the thyroid operations for any reason contained carcinoma in 1960, 21.2% nodular goitres contained malignant foci from 2002 to 2004 (Pang and Chen, 2007). Wilhelm reported 41 cases of other malignancies with incidental thyroid nodules, therein 20 cases received surgical resections, and thyroid carcinoma accounted for 16 cases (Wilhelm et al, 2007). Stoffer et al (1960) reported that 13% of the glands resected in the thyroid operations for any reason contained carcinoma in 1960, 21.2% nodular goitres contained malignant foci from 2002 to 2004 (Pang and Chen, 2007). Arora et al (2009) believed there exist some differences between the occasional thyroid
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