Incidence Of Thyroid Gland Invasion Research Articles

Thyroidectomy in laryngectomy-rationale and extent

<p><strong>Background:</strong> To study the incidence of thyroid gland invasion by laryngeal carcinoma (LC) and the risk factors that may predispose to thyroid gland involvement, aiding the surgeons to develop an evidence-based plan for the management of the thyroid gland during total laryngectomy.</p><p><strong>Methods:</strong> A retrospective analysis of patients with carcinoma larynx treated at government Royapettah hospital, Chennai between January 1, 2013, and December 31, 2020, was done. The total number of final pathology reports retrieved from our hospital system for patients who met the inclusion criteria within the specified time frame was 43.</p><p><strong>Results:</strong> The thyroid gland was found to be invaded by LC in 13 patients (30.2%). Three patients (3/13) had only microscopic involvement while 9 patients showed gross extension. Four pathological features were found to have Statistically significant association with the incidence of thyroid gland invasion by laryngeal carcinoma. Patients with primary tumor pathological stage T4a were 30/43, with 11 patients showing thyroid gland invasion. 20 patients had subglottic invasion by the LC, with 10 patients showing thyroid gland invasion. Poorly differentiated carcinoma incidence was 13, with 9 patients showing thyroid gland infiltration.</p><p><strong>Conclusions:</strong> Several risk factors are associated with higher incidence of invasion of the thyroid gland by laryngeal carcinoma. Identification of these factors can help surgeons develop a surgical strategy for the management of the thyroid gland during total laryngectomy.<strong></strong></p>

Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial

BackgroundWe investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methodsThis study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. ResultsThere was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. ConclusionThe incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control.

P-169 The Incidence of Thyroid Gland Invasion in Advanced Stage Laryngeal Cancers with Emphasis on Risk Factors and Its Impact on Survival

P-169 The Incidence of Thyroid Gland Invasion in Advanced Stage Laryngeal Cancers with Emphasis on Risk Factors and Its Impact on Survival

The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy

Introduction: Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods: This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p>0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.

Incidence and predictors of thyroid gland invasion by laryngeal carcinoma: a 7-year experience review

BackgroundStudy the incidence of thyroid gland invasion by laryngeal carcinoma and the risk factors that may predispose to this condition. Aiding surgeons develop an evidence-based plan for the management of the thyroid gland during total laryngectomy.ResultsRetrospective analysis of the available medical records for patients who had total laryngectomy together with total thyroidectomy or hemithyroidectomy in the same procedure. Associated pathological features were also investigated. Patients who had laryngeal carcinoma managed by total laryngectomy with total thyroidectomy or hemithyroidectomy between January 1, 2011, and December 31, 2017.Three hundred seventy-seven records were retrieved. The incidence of thyroid gland invasion by the laryngeal carcinoma was 24 (6.4%). Three patients showed microscopic extension (3/356; 0.8%). Six patients had malignant pathology other than squamous cell carcinoma (SCC). Two over six had invasion of the thyroid gland; OR (95% CI): 7.9 (1.4-45.4). Patients who had primary tumor stage of T4a were 244. 23/244 had thyroid gland invasion, 13.7 (1.8-102.9). Poorly differentiated tumors had significant incidence of thyroid gland invasion (4/15), 6.2 (1.8-21.3). Patients who had subglottic extension by the primary tumor were 177 with 20 patients having thyroid gland invasion (20/177), 6.2 (2.1-18.6).ConclusionSeveral risk factors are associated with higher incidence of invasion of the thyroid gland by laryngeal carcinoma. Identification of these factors can help surgeons develop a surgical strategy for the management of the thyroid gland during total laryngectomy.

Incidence of thyroid gland invasion in advanced laryngeal cancers and its impact on disease-specific survival; a retrospective review at a tertiary care center

Background: Incidence of thyroid gland invasion in advanced laryngeal cancers is low. Ipsilateral or total thyroidectomy along with total laryngectomy has been controversial and there has been no consensus over the management of thyroid gland in advanced laryngeal cancers.Objective: To determine the frequency of thyroid gland invasion in locally advanced laryngeal squamous cell carcinoma and the risk factors associated with it.Material and methods: A retrospective review of patients with laryngeal squamous cell carcinoma operated at our center between January 2011 and December 2018 was carried out. Patients undergoing upfront or salvage laryngectomy with or without neck dissection along with hemi or total thyroidectomy were included. Histopathology reports were reviewed to record the involvement of thyroid gland.Results: Invasion of thyroid gland by squamous cell carcinoma larynx was seen in 10 (10.9%) patients out of 92. All of the cases showed direct extension of the tumor. Trans-glottic, subglottic, and tumors with extra laryngeal spread were found to be significantly associated with thyroid gland invasion. Patients with thyroid gland invasion showed higher rate recurrence.Conclusion and significance: Incidence of thyroid gland invasion in squamous cell carcinoma larynx is low, allowing us not to address thyroid routinely in patients undergoing total laryngectomy for laryngeal carcinoma.

The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma

IntroductionInvasion of the thyroid gland is not a general feature of advanced laryngeal carcinoma. There is no need for performing thyroidectomy in all total laryngectomy cases. ObjectivesTo evaluate the frequency of the thyroid gland invasion in patients with advanced laryngeal squamous cell carcinoma submitted to total laryngectomy and thyroidectomy and to determine whether clinical and pathological characteristics of laryngeal carcinoma can predict glandular involvement. MethodsA retrospective case series with chart review, from March 2009 to January 2018, was undertaken in the the Princess Norah Oncology Center, King Abdul-Aziz Medical City, Jeddah/KSA. An inception cohort of 56 patients with laryngeal squamous cell carcinoma was considered. Nine cases were excluded. All patients had advanced stage cancer of the larynx (clinically T3‒T4) and underwent total laryngectomy in association with thyroidectomy. Total thyroidectomy was performed in all bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. The frequency of thyroid gland invasion was calculated and analysis of demographic, clinical and pathological characteristics associated with thyroid gland invasion was performed. ResultsIn all, 47 patients underwent total laryngectomy (40 treated with primary laryngectomy and seven treated with salvage laryngectomy following radiation failure or chemoradiation failure). Hemithyroidectomy was performed in 42 patients and the total thyroidectomy was performed in five patients. The overall frequency of invasion of the thyroid gland was 4.3%. Glandular involvement was seen in one advanced transglottic squamous cell carcinoma and one subglottic. In spite of thyroid cartilage invasion in 25.5% of cases detected in the preoperative radiological imaging, only one case demonstrated microscopic thyroid gland invasion. ConclusionsThyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.

Incidence of thyroid gland invasion in locally advanced laryngeal carcinoma

Incidence of thyroid gland invasion in locally advanced laryngeal carcinoma

Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance.

Intraoperative management of thyroid gland in laryngeal and hypopharyngeal cancer is controversial. The objectives of this study were to determine the incidence of thyroid gland invasion in patients undergoing surgery for laryngeal or hypopharyngeal carcinoma, to assess predictive factors and to assess the prognosis in patients with and without thyroid gland invasion. One hundred and thirty-three patients who underwent surgery for carcinoma larynx and hypopharynx from 2006 to 2010 were reviewed retrospectively. Surgical specimens were examined to determine the incidence of thyroid gland invasion and predictive factors were analysed. The recurrence rate and the survival in patients with and without thyroid gland invasion were also analysed. Out of the 133 patients with carcinoma larynx and hypopharynx who underwent surgery, histological thyroid gland invasion was observed in 28/133 (21%) patients. Significant relationship was found between histological thyroid gland invasion and preoperative evidence of thyroid cartilage erosion by CT scan and also when gross thyroid gland involvement observed during surgery. There is significant association between thyroid gland invasion when there is upper oesophageal or subglottic involvement. After analysing the retrospective data from our study, we would like to suggest that thyroid gland need not be removed routinely in all laryngectomies, unless there is advanced disease with thyroid cartilage erosion and gross thyroid gland involvement or disease with significant subglottic or oesophageal involvement.

Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

Clinical effectiveness of thyroidectomy on the management of locally advanced laryngeal cancer

The incidence of thyroid gland invasion in patients with advanced laryngeal cancer was reported to be 0-50%. However there is a controversy in necessity and extent of routine thyroidectomy in these patients due to the difficulty in diagnosis of tumor invasion to thyroid gland and the risk of possible postoperative hypothyroidism and hypocalcemia. The medical files of 47 patients who underwent thyroidectomy as part of surgical treatment for advanced laryngeal cancer were reviewed. Fourty-four (93.6%) patients underwent hemithyroidectomy, 3 (6.3%) patients underwent total thyroidectomy. Thyroid gland invasion was found in 2 (4.2%) patients. Hypothyroidism occurred in 15 (31.9%) patients, and their hormone levels were regulated with medical treatment during follow-up. Hypocalcemia was not found in any patients. We recommend that at least a hemithyroidectomy should be performed in patients with advanced laryngeal cancer, if they have any predictive factor (subglottic extension more than 1cm, invasion of paraglottic space, thyroid cartilage, cricoid cartilage and prelaryngeal tissue detected by radiological examination) for thyroid gland invasion.

Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta‐analysis of the English literature

Advanced laryngeal and hypopharyngeal squamous cell carcinomas carry an inherent risk of invading thyroid parenchyma leading to the incorporation of a hemithyroidectomy or total thyroidectomy as part of a total laryngectomy. In some centres, thyroid gland removal occurs routinely during surgery for T3 and T4 laryngopharyngeal carcinoma. However, the incidence of invasion is low, and therefore, thyroid-sparing surgery must be considered for select cases. The primary goal of the review is to assess the true incidence of thyroid gland invasion in laryngopharyngeal carcinoma. Utilising this data we aim to identify risk factors and clinical predictors of thyroid gland invasion to facilitate in a more targeted approach in the surgical management of advanced laryngopharyngeal carcinoma. A systematic review and meta-analysis of all published data and review of case series at Newcastle upon Tyne Hospitals (NuTH). MEDLINE (1946-2012) and EMBASE (1980-2012) were searched. A single reviewer conducted the systematic review with a follow-up ancestry search. Studies publishing case series of T3 and T4 laryngeal and hypopharyngeal carcinoma treated by total laryngectomy or laryngopharyngectomy and partial or total thyroidectomy, with pathological assessment for thyroid gland invasion rates were selected. Articles published prior to 1977 were excluded due to the advent of whole organ sectioning. The literature search identified 16 studies suitable for inclusion, with 1180 cases. The NuTH case series identified 107 patients. The overall pooled incidence of thyroid gland invasion in 1287 patients is 10.7% (95% CI 7.6-14.2). Patients with primary subglottic tumours (relative risk 7.5; 95% CI 4.3-13.0) and disease extension into the subglottis (relative risk 4.3; 95% CI 2.5-7.2) have a significantly higher relative risk of thyroid gland invasion. Radiorecurrent tumours and hypopharyngeal tumours did not have an increased risk of thyroid gland invasion. Advanced laryngeal and hypopharyngeal carcinomas involving the subglottis carry a significantly elevated risk of thyroid gland invasion compared with those that spare this subsite. The overall incidence of thyroid gland invasion is low, and therefore, thyroidectomy should be reserved for cases considered to be at risk as opposed to a being a routine measure for all total laryngectomies.

The Role of Thyroidectomy in Advanced Laryngeal and Pharyngolaryngeal Carcinoma

Total thyroidectomy or hemithyroidectomy together with a total laryngectomy (TL) or pharyngo laryngectomy (TPL) for (pharyngo) laryngeal cancer often renders the patient hypothyroid and commits them to life-long thyroid hormone replacement. To determine the incidence of thyroid gland invasion (TG) in patients undergoing TL or TPL with total thyroidectomy (TThy) or lobectomy (HThy) for advanced laryngeal or hypo pharyngeal cancer and to assess predicative factors. Retrospective analysis of 35 patients from 2007 to 2010. Specimens were examined to determine the incidence of TG invasion and relevant predicative factors such as histological grade and subglottic extension. Pre-operative imaging was reviewed to assess for radiological evidence of TG invasion. TL and TThy was performed in 13 patients. TL and HThy was performed in four patients and TPL and TThy was performed in 18 patients. Surgery was performed for primary and recurrent cancer in 29 and six patients, respectively. Histological evidence of invasion of the TG was found in three patients. Relationship was found between TG invasion and subsite of primary carcinoma and the presence of subglottic extension. No relationship was found between TG invasion and patient's sex, stage of primary disease at surgery, degree of differentiation. In addition, no significant relationship was found between the presence of TG invasion and recurrent disease. Invasion of the TG in patients undergoing a TL or TPL is a rare event and limits the need for a TTHy in most cases.

Necessity of routine ipsilateral hemithyroidectomy during laryngopharyngectomy for pyriform sinus cancer

PurposeThe aim of this study was to revisit the role of hemithyroidectomy in the treatment of pyriform sinus cancer by determining the incidence of thyroid gland invasion by the tumor. Materials and MethodsMedical records of 27 patients with pyriform sinus cancer who underwent laryngopharyngectomy with ipsilateral hemithyroidectomy from 1999 to 2010 at a National Cancer Institute–designated comprehensive cancer center were retrospectively reviewed. Computed tomographic scans of the neck, operative notes, and surgical specimens were examined to determine the presence of thyroid gland invasion by imaging, clinical appearance, and pathology. ResultsThere were 19 male and 8 female patients (age range, 44-79 years; mean, 59.9 years). Most of the cases (85%) had advanced-stage disease. Extralaryngeal spread of tumor with thyroid cartilage invasion was noted in the computed tomographic scans of 5 patients; however, there was no radiologic evidence of thyroid gland invasion in any patient. No gross thyroid gland invasion by the tumor was appreciated in any patient during surgery. No histologic evidence of tumoral invasion of the thyroid gland was found in any of 27 surgical specimens. ConclusionsResults of this study suggest that thyroid gland invasion by pyriform sinus cancer is not common. Therefore, a routine ipsilateral hemithyroidectomy may not be necessary in the treatment of every patient with pyriform sinus cancer, unless there is evidence of thyroid gland invasion.

Thyroid Gland Management in Total Laryngectomy: Meta-analysis

Objective 1. Review the incidence of thyroid gland invasion by squamous cell laryngeal carcinoma in the literature. 2. Correlate thyroid gland invasion with anatomical characteristics of the laryngeal tumor. Do laryngeal tumors which invade the thyroid gland share certain characteristics which can aid in determing the management of the thyroid gland during total laryngectomy? Methods Systematic review of MEDLINE (1967–2007) and EMBASE (1980–2007) for all total laryngectomy series which commented on thyroid gland invasion according to tumor subsite and pathological characteristics. These results were supplemented with 61 patients from our centers who underwent total laryngectomy with hemi- or total thyroidectomy. Eleven series in total (n = 535) were included in the meta-analysis (fixed effects model). Results Thyroid gland invasion was present in 47 laryngectomy specimens (9%); the main method of invasion of the gland was by direct extralaryngeal extension. Subglottic extension > 10mm (OR 6.27 [2.16 to 18.19]; p = 0.0007), subglottic subsite (OR 4.32 [1.53 to 12.19]; p = 0.006), and transglottic subsite (OR 4.10 [1.75 to 9.57]; p = 0.001) were significantly correlated with thyroid gland invasion. Cartilagenous invasion by tumor was not a significant predictor of thyroid gland invasion (p>0.05). Conclusions Thyroid gland invasion is not a general feature of squamous cell laryngeal carcinoma. When present, it is strongly associated with anteroinferior spread of laryngeal tumors. Thyroidectomy should only be performed during total laryngectomy for transglottic tumors, subglottic tumors, and tumors with subglottic extension >10mm. In these cases, total thyroidectomy is warranted to maximize locoregional control.

Management of thyroid gland invasion in laryngopharyngeal cancer

Background and objectives The incidence of thyroid gland involvement in laryngopharyngeal cancer ranges from 0 to 23%. Therefore, ipsilateral hemithyroidectomy and isthmusectomy are routinely performed with total laryngectomy in many clinics. Hemithyroidectomy causes hypothyroidism in 63% of patients, and if combined with radiotherapy, the incidence increases to 89% of patients. But there is no consensus about using thyroid surgery in the treatment of laryngopharyngeal cancer. The purpose of this study was to identify criteria to use in the decision of whether, in cases of laryngopharyngeal cancer, hemithyroidectomy should be performed with total laryngectomy. Materials and methods The study group consisted of 28 patients with a mean age of 63.2 years (range 42–77 years). All patients were treated by thyroidectomy with total laryngectomy. We evaluated the incidence of thyroid gland invasion, clinical predisposing factors, pathologic features, and prognosis in cases of laryngopharyngeal cancer. Results The incidence of thyroid gland invasion was 14% (4/28). Subglottic extension was the only statistically significant factor in thyroid invasion. All cases of laryngopharyngeal cancer that invaded the thyroid gland had vocal cord fixation, anterior commissure invasion, and were advanced stage. The most common mechanism of spread to the thyroid was by direct extension through thyroid cartilage and anterior commissure. While the prognosis of patients with thyroid gland invasion was worse than that of patients with no invasion, the difference was not statistically significant. Conclusion Prophylactic thyroidectomy should be performed in cases of laryngopharyngeal cancer where there is subglottic extension of the tumor.