Abstract
BackgroundThe most appropriate surgical procedure for multinodular goiter (MNG) remains under debate. Incidental thyroid carcinoma (ITC) is often identified on histopathological examination after thyroidectomy performed for presumed benign MNG.Aim of the studyThe aim of the study was to determine the value of radical surgery for MNG patients considering the prevalence of ITC diagnosed postoperatively.Materials and MethodsWe conducted retrospective analysis of the medical records of 2,306 patients surgically treated for MNG between 2008 and 2013 at one center. None of the patients presented with any suspicion of malignancy, history of familial thyroid cancer, multiple endocrine neoplasia syndrome or previous head or neck radiation exposure.ResultsAmong the 2,306 MNG patients, ITC was detected in 49 (2.12%) (44 women and 5 men, with average ages of 52.2 (21–79) and 55.6 (52–62), respectively). Papillary thyroid carcinoma was significantly more frequently observed than other types of ITC (p<0.00001). Among the MNG patients, 866 (37.5%) underwent total/near total surgery, 464 (20.1%) received subtotal thyroidectomy, and 701 (30.3%) received the Dunhill operation. The remaining 275 (11.9%) patients underwent a less radical procedure and were classified as "others." Among the 49 (100%) patients with ITC, 28 (57.1%) underwent radical surgery. Another 21 (42.9%) patients required completion surgery due to an insufficient primary surgical procedure. A total of 21 (2.42%) patients in the total/near total surgery group were diagnosed with ITC, as well as 16 (2.48%) in the subtotal thyroidectomy group and 12 (1.71%) in the Dunhill operation group; 21 (100%), 4 (25%) and 3 (25%) of these patients, respectively, underwent radical surgery; thus, 0 (0%), 12 (75%) and 9 (75%) required completion surgery. The prevalence rates of ITC were comparable between the radical and subtotal surgery groups (2.42% and 3.44%, respectively, p = 0.4046), and the prevalence was higher in the radical surgery group than in the Dunhill operation group (2.42% and 1.71%, respectively, p = 0.0873). A significant difference was observed between the group of patients who underwent total/near total surgery, among whom all of the patients with ITC (100%) received primary radical surgery, and the groups of patients who received the subtotal and Dunhill operations, among whom only 25% of the patients with ITC in each group received primary radical surgery (p<0.0001).ConclusionsMore radical procedures for MNG result in a lower risk of reoperation for ITC. The prevalence of ITC on postoperative histopathological examination should determine the extent of surgery in MNG patients. In the future, total/near total thyroidectomy should be considered for MNG patients due to the increased prevalence of ITC to avoid the necessity for reoperation.
Highlights
The prevalence of incidental thyroid cancer (ITC) in multinodular goiter (MNG) has been previously estimated to be 5–10% [1,2,3]; recent studies have reported higher ITC prevalence rates, ranging from 8.6 to 22% [4,5,6,7]
Papillary thyroid carcinoma was significantly more frequently observed than other types of ITC (p
The prevalence of ITC on postoperative histopathological examination should determine the extent of surgery in MNG patients
Summary
The prevalence of incidental thyroid cancer (ITC) in multinodular goiter (MNG) has been previously estimated to be 5–10% [1,2,3]; recent studies have reported higher ITC prevalence rates, ranging from 8.6 to 22% [4,5,6,7]. The detection rate of ITC on autopsy examination has been reported to be steadily rising, with an estimated increase from 6% in 2003 to 20% in 2012 [8] This perceived increase might have been a consequence of the high prevalence of thyroid nodules detected in the autopsy series of 50% [5,6,7]. A common clinical scenario is the incidental finding of thyroid carcinoma (TC) during histopathological examination after strumectomy performed for presumed benign MNG. Incidental thyroid carcinoma (ITC) is often identified on histopathological examination after thyroidectomy performed for presumed benign MNG
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