Surgical Experience in the Management of 125 Patients with Thyroid Masses in Kashmir
Affiliation(s)
1 Associate Professor of ENT, Government Medical College Srinagar, Kashmir, India. 2 Medical Interne, Women’s Medical College Hospital, Uttara Model Town, Dhaka, Bangladesh. 3 Externe, Women’s Medical College, Dhaka, Bangladesh.
1 Associate Professor of ENT, Government Medical College Srinagar, Kashmir, India. 2 Medical Interne, Women’s Medical College Hospital, Uttara Model Town, Dhaka, Bangladesh. 3 Externe, Women’s Medical College, Dhaka, Bangladesh.
ABSTRACT
Results of surgical treatment in 125 patients with thyroid masses who attended to a Unit of the Department of ENT, Head and Neck Surgery of Govt. Medical College associated SMHS Hospital Srinagar in the first decade of this century are presented. Age of the patients ranged from 17 to 68 years peaking in the fourth decade of life (Figure 1 and Figure 2). Near 85% of the patients with thyroid masses were female and most of the cases (76%) euthyroid at the time of presentation. Depending upon the expertise of the pathologist, the FNA cytology has a good role in the preoperative diagnosis of thyroid masses especially the malignant types (Figure 3 and Figure 4). The specificity of FNA cytology in detecting malignant thyroid tumors in this study was 100% and the sensitivity was 73.08%. The overall diagnostic accuracy was 83.20%. 45.60% of the thyroid masses proved on excision biopsy to be malignant of which papillary carcinoma continued to be the most common malignant thyroid tumor followed by the medullary, the follicular and the undifferentiated types. Radionuclide scanning gave equivocal results in distinguishing between the benign and the malignant thyroid nodules in this study, but it was useful in evaluating indeterminate cases of FNA cytology. Magnetic resonance imaging of neck was used as an adjunctive imaging modality in assessing the extent of the primary malignant thyroid lesion, its direct extra-thyroidal spread and regional nodal metastases (Figure 5 and Figure 6). Different surgical techniques utilized in dealing with the thyroid masses included partial thyroidectomies and total thyroidectomy with or without modified neck dissection and the results are discussed.
Results of surgical treatment in 125 patients with thyroid masses who attended to a Unit of the Department of ENT, Head and Neck Surgery of Govt. Medical College associated SMHS Hospital Srinagar in the first decade of this century are presented. Age of the patients ranged from 17 to 68 years peaking in the fourth decade of life (Figure 1 and Figure 2). Near 85% of the patients with thyroid masses were female and most of the cases (76%) euthyroid at the time of presentation. Depending upon the expertise of the pathologist, the FNA cytology has a good role in the preoperative diagnosis of thyroid masses especially the malignant types (Figure 3 and Figure 4). The specificity of FNA cytology in detecting malignant thyroid tumors in this study was 100% and the sensitivity was 73.08%. The overall diagnostic accuracy was 83.20%. 45.60% of the thyroid masses proved on excision biopsy to be malignant of which papillary carcinoma continued to be the most common malignant thyroid tumor followed by the medullary, the follicular and the undifferentiated types. Radionuclide scanning gave equivocal results in distinguishing between the benign and the malignant thyroid nodules in this study, but it was useful in evaluating indeterminate cases of FNA cytology. Magnetic resonance imaging of neck was used as an adjunctive imaging modality in assessing the extent of the primary malignant thyroid lesion, its direct extra-thyroidal spread and regional nodal metastases (Figure 5 and Figure 6). Different surgical techniques utilized in dealing with the thyroid masses included partial thyroidectomies and total thyroidectomy with or without modified neck dissection and the results are discussed.
KEYWORDS
Thyroid Masses, Fine Needle Aspiration Cytology, Thyroid Scintiscan, Magnetic Resonance Imaging, Thyroidectomy, Excision Biopsy, Prognosticators
Thyroid Masses, Fine Needle Aspiration Cytology, Thyroid Scintiscan, Magnetic Resonance Imaging, Thyroidectomy, Excision Biopsy, Prognosticators
Cite this paper
Sheikh, M. , Bunafsha, S. and Afshan, S. (2015) Surgical Experience in the Management of 125 Patients with Thyroid Masses in Kashmir. International Journal of Otolaryngology and Head & Neck Surgery, 4, 381-393. doi: 10.4236/ijohns.2015.45063.
Sheikh, M. , Bunafsha, S. and Afshan, S. (2015) Surgical Experience in the Management of 125 Patients with Thyroid Masses in Kashmir. International Journal of Otolaryngology and Head & Neck Surgery, 4, 381-393. doi: 10.4236/ijohns.2015.45063.
References
[1] Schottenfeld, D. and Gershman, S.T. (1978) Epidemiology of Thyroid Cancer. CA: A Cancer Journal for Clinicians, 28, 66-86.
http://dx.doi.org/10.3322/canjclin.28.2.66 [2] Davies, L. and Welch, H.G. (2006) Increasing Incidence of Thyroid Cancer in the United States, 1973-2002. JAMA, 295, 2164-2167.
http://dx.doi.org/10.1001/jama.295.18.2164 [3] Cibas, E.S. and Ali, S.Z. (2009) Bethesda System for Reporting Thyroid Cytopathology. American Journal of Clinical Pathology, 132, 658-665.
http://dx.doi.org/10.1309/AJCPPHLWMI3JV4LA [4] Stell, P.M. and Maran, A.G.D. (2000) Surgical Treatment of the Differentiated Thyroid Cancer. Text Book of Head & Neck Surgery, 4th Edition, CRC Press, Florida, 470. [5] Cooper, D.S., Doherty, G.M., Haugen, B.R., et al. (2009) Revised American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 11, 1-16. [6] Mazzaferri, E.L. (1993) Management of a Solitary Thyroid Nodule. The New England Journal of Medicine, 328, 553-558.
http://dx.doi.org/10.1056/NEJM199302253280807 [7] Shapiro, J.S., Nathan, B., Friedman, S.L., et al. (1970) Incidence of Thyroid Carcinoma in Grave’s Disease. Cancer, 26, 1261-1271.
http://dx.doi.org/10.1002/1097-0142(197012)26:6<1261::AID-CNCR2820260613>3.0.CO;2-P [8] Messaris, G., Kyriakou, K., Vasilopoulus, P., et al. (1974) The Single Thyroid Nodule and Carcinoma. British Journal of Surgery, 61, 943-944.
http://dx.doi.org/10.1002/bjs.1800611204 [9] Afroze, N., Kayani, N. and Hassan, S.H. (2002) Role of Fine Needle Aspiration Cytology in the Diagnosis of Palpable Thyroid Lesions. Indian Journal of Pathology and Microbiology, 45, 241-246. [10] Kessler, A., Gavriel, H., Zahav, S., et al. (2005) Accuracy and Consistency of Fine Needle Aspiration Biopsy in the Diagnosis and Management of Solitary Thyroid Nodules. Israel Medical Association Journal, 7, 371-373. [11] Gupta, M., Gupta, S. and Gupta, V.B. (2010) Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule. Journal of Thyroid Research, 2010, Article ID: 379051.
http://dx.doi.org/10.4061/2010/379051 [12] Gharib, H. and Goellner, J.R. (1993) Fine-Needle Aspiration Biopsy of the Thyroid: An Appraisal. Annals of Internal Medicine, 118, 282-289.
http://dx.doi.org/10.7326/0003-4819-118-4-199302150-00007 [13] Amrikachi, M., Ramzy, I., Rubenfeld, S., et al. (2001) Accuracy of Fine Needle Aspiration of Thyroid. Archives of Pathology & Laboratory Medicine, 125, 484-488. [14] Mehanna, R., Murphy, M., Mccarthy, J., O’Leary, G., Tuthill, A., Murphy, M.S. and Sheahan, P. (2013) False Negatives in Thyroid Cytology: Impact of Large Nodule Size and Follicular Variant of Papillary Carcinoma. Laryngoscope, 123, 1305-1309. [15] Ashcraft, M.W. and Van Herle, A.J. (1981) Management of Thyroid Nodules II. Scanning Techniques, Thyroid Suppressive Therapy, and Fine Needle Aspiration. Head and Neck Surgery, 3, 297-322.
http://dx.doi.org/10.1002/hed.2890030406 [16] Brooks, J.R. (1973) The Solitary Thyroid Nodule. The American Journal of Surgery, 125, 477-481.
http://dx.doi.org/10.1016/0002-9610(73)90086-X [17] Ibanez, M.D., Russell, W.O., Aboves-Scavedva, J., et al. (1966) Thyroid Carcinoma: Biologic Behavior and Mortality. Cancer, 19, 1039-1052. [18] Silverberg, S.G., Hutter, R.V.P. and Foote, F.W. (1970) Fatal Carcinoma of the Thyroid: Histology, Metastases and Causes of Death. Cancer, 25, 792-801.
http://dx.doi.org/10.1002/1097-0142(197004)25:4<792::AID-CNCR2820250408>3.0.CO;2-P [19] Cady, B. and Rossi, R. (1988) An Expanded View of Risk Group Definition in Differentiated Thyroid Carcinoma. Surgery, 104, 947-953. [20] Greene, R. (1956) Discerete Nodules of the Thyroid Gland with Special Reference to Carcinoma. Huntarian Lecture Delivered on 29th November, 1956. [21] Hundahl, S.A., Flemming, I.D., Fremgen, A.M., et al. (1998) A National Cancer Data Base Report on 53, 856 Cases of Thyroid Carcinoma Treated in the US, 1985-1995. Cancer, 83, 2638-2648.
http://dx.doi.org/10.1002/(SICI)1097-0142(19981215)83:12<2638::AID-CNCR31>3.0.CO;2-1 [22] Hay, I.D., Hutchinson, M.E., Gonalez-Losada, T., et al. (2008) Papillary Thyroid Microcarcinoma: A Study of 900 Cases Observed in a 60 Year Period. Surgery, 144, 980-988.
http://dx.doi.org/10.1016/j.surg.2008.08.035 [23] Nixon, I.J., Ganlly, I., Patel, S.G., et al. (2012) Thyroid Lobectomy for Treatment of Well Differentiated Intrathyroid Malignancy. Surgery, 151, 571-579.
http://dx.doi.org/10.1016/j.surg.2011.08.016 [24] Merdad, M., Eskander, A., De Almeida, J., et al. (2014) Current Management of Papillary Thyroid Microcarcinoma in Canada. Journal of Otolaryngology—Head and Neck Surgery, 43, 32.
http://dx.doi.org/10.1186/s40463-014-0032-8 [25] Wu, A.W., Wang, M.B. and Nguyen, C.T. (2010) Surgical Practice Patterns in the Treatment of Papillary Thyroid Microcarcinoma. Archives of Otolaryngology—Head and Neck Surgery, 136, 1182-1190.
http://dx.doi.org/10.1001/archoto.2010.193 [26] Lee, J., Park, J.H., Lee, C.R., et al. (2013) Long Term Outcomes of Total Thyroidectomy versus Thyroid Lobectomy for Papillary Thyroid Microcarcinoma: Comparative Analysis after Propensity Score Matching. Thyroid, 23, 1408-1415.
http://dx.doi.org/10.1089/thy.2012.0463 [27] Russell, W.O., Ibane, M.L., Clark, L.C. and White, E.C. (1963) Classification, Intraglandular Dissemination, and Clinicopathological Study Based upon Whole Organ Sections of 80 (Thyroid) Glands. Cancer, 16, 1425-1458.
http://dx.doi.org/10.1002/1097-0142(196311)16:11<1425::AID-CNCR2820161106>3.0.CO;2-E [28] Clark, O.H. (1982) The Treatment of Choice for Patients with Differentiated Thyroid Cancer. Annals of Surgery, 196, 361-370.
http://dx.doi.org/10.1097/00000658-198209000-00016 [29] Stael, A.P.M., Plukker, J.M., Rouwe, C.W., et al. (1995) Total Thyroidectomy in the Treatment of Thyroid Carcinoma in Childhood. British Journal of Surgery, 82, 1083-1085.
http://dx.doi.org/10.1002/bjs.1800820825 [30] Flemming, J.B., Lee, J.E., Bouvet, M., et al. (1999) Surgical Strategy for the Treatment of Medullary Thyroid Carcinoma. Annals of Surgery, 230, 697-707. [31] Tubiana, M., Schlumberger, M., Rougier, P., et al. (1985) Long Term Results and Prognostic Factors in Patients with Differentiated Thyroid Carcinoma. Cancer, 55, 794-804.
http://dx.doi.org/10.1002/1097-0142(19850215)55:4<794::AID-CNCR2820550418>3.0.CO;2-Z [32] Bouvet, M., Schultz, P.N., Sharman, S.I., et al. (1970) Surgical Strategy for the Treatment of Medullary Thryroid Carcinoma. Annals of Surgery, 230, 697-707. [33] Lima, N., Cavaliere, H., Tomimori, E., et al. (2002) Prognostic Value of Serial Thyroglobulin Determinations after Total Thyroidectomy for Differentiated Thyroid Cancer. Journal of Endocrinological Investigation, 25, 110-115.
http://dx.doi.org/10.1007/BF03343973 [34] Polachek, A., Hirch, D. and Tzvetov, G. (2011) Prognestic Values of Post Thyroidectomy Thyroglubulin Levels in Patients with Differentiated Thyroid Cancer. Journal of Endocrinological Investigation, 34, 855-860. [35] Mazzaferri, E.L. and Jhiang, S.M. (1994) Long Term Impact of Initial Surgical and Medical Therapy on Papillary and Follicular Thyroid Cancer. The American Journal of Medicine, 97, 418-428.
http://dx.doi.org/10.1016/0002-9343(94)90321-2 [36] Geissinger, W.T., Horsley, J.S., Parker, F.P., et al. (1974) Carcinoma of the Thyroid. Annals of Surgery, 179, 734-739.
http://dx.doi.org/10.1097/00000658-197405000-00028 [37] Gilliland, F.D., Hunt, W.C., Morris, D.M., et al. (1997) Prognostic Factors for Thyroid Carcinoma. Cancer, 79, 564-573.
http://dx.doi.org/10.1002/(SICI)1097-0142(19970201)79:3<564::AID-CNCR20>3.0.CO;2-0
[1] Schottenfeld, D. and Gershman, S.T. (1978) Epidemiology of Thyroid Cancer. CA: A Cancer Journal for Clinicians, 28, 66-86.
http://dx.doi.org/10.3322/canjclin.28.2.66 [2] Davies, L. and Welch, H.G. (2006) Increasing Incidence of Thyroid Cancer in the United States, 1973-2002. JAMA, 295, 2164-2167.
http://dx.doi.org/10.1001/jama.295.18.2164 [3] Cibas, E.S. and Ali, S.Z. (2009) Bethesda System for Reporting Thyroid Cytopathology. American Journal of Clinical Pathology, 132, 658-665.
http://dx.doi.org/10.1309/AJCPPHLWMI3JV4LA [4] Stell, P.M. and Maran, A.G.D. (2000) Surgical Treatment of the Differentiated Thyroid Cancer. Text Book of Head & Neck Surgery, 4th Edition, CRC Press, Florida, 470. [5] Cooper, D.S., Doherty, G.M., Haugen, B.R., et al. (2009) Revised American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 11, 1-16. [6] Mazzaferri, E.L. (1993) Management of a Solitary Thyroid Nodule. The New England Journal of Medicine, 328, 553-558.
http://dx.doi.org/10.1056/NEJM199302253280807 [7] Shapiro, J.S., Nathan, B., Friedman, S.L., et al. (1970) Incidence of Thyroid Carcinoma in Grave’s Disease. Cancer, 26, 1261-1271.
http://dx.doi.org/10.1002/1097-0142(197012)26:6<1261::AID-CNCR2820260613>3.0.CO;2-P [8] Messaris, G., Kyriakou, K., Vasilopoulus, P., et al. (1974) The Single Thyroid Nodule and Carcinoma. British Journal of Surgery, 61, 943-944.
http://dx.doi.org/10.1002/bjs.1800611204 [9] Afroze, N., Kayani, N. and Hassan, S.H. (2002) Role of Fine Needle Aspiration Cytology in the Diagnosis of Palpable Thyroid Lesions. Indian Journal of Pathology and Microbiology, 45, 241-246. [10] Kessler, A., Gavriel, H., Zahav, S., et al. (2005) Accuracy and Consistency of Fine Needle Aspiration Biopsy in the Diagnosis and Management of Solitary Thyroid Nodules. Israel Medical Association Journal, 7, 371-373. [11] Gupta, M., Gupta, S. and Gupta, V.B. (2010) Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule. Journal of Thyroid Research, 2010, Article ID: 379051.
http://dx.doi.org/10.4061/2010/379051 [12] Gharib, H. and Goellner, J.R. (1993) Fine-Needle Aspiration Biopsy of the Thyroid: An Appraisal. Annals of Internal Medicine, 118, 282-289.
http://dx.doi.org/10.7326/0003-4819-118-4-199302150-00007 [13] Amrikachi, M., Ramzy, I., Rubenfeld, S., et al. (2001) Accuracy of Fine Needle Aspiration of Thyroid. Archives of Pathology & Laboratory Medicine, 125, 484-488. [14] Mehanna, R., Murphy, M., Mccarthy, J., O’Leary, G., Tuthill, A., Murphy, M.S. and Sheahan, P. (2013) False Negatives in Thyroid Cytology: Impact of Large Nodule Size and Follicular Variant of Papillary Carcinoma. Laryngoscope, 123, 1305-1309. [15] Ashcraft, M.W. and Van Herle, A.J. (1981) Management of Thyroid Nodules II. Scanning Techniques, Thyroid Suppressive Therapy, and Fine Needle Aspiration. Head and Neck Surgery, 3, 297-322.
http://dx.doi.org/10.1002/hed.2890030406 [16] Brooks, J.R. (1973) The Solitary Thyroid Nodule. The American Journal of Surgery, 125, 477-481.
http://dx.doi.org/10.1016/0002-9610(73)90086-X [17] Ibanez, M.D., Russell, W.O., Aboves-Scavedva, J., et al. (1966) Thyroid Carcinoma: Biologic Behavior and Mortality. Cancer, 19, 1039-1052. [18] Silverberg, S.G., Hutter, R.V.P. and Foote, F.W. (1970) Fatal Carcinoma of the Thyroid: Histology, Metastases and Causes of Death. Cancer, 25, 792-801.
http://dx.doi.org/10.1002/1097-0142(197004)25:4<792::AID-CNCR2820250408>3.0.CO;2-P [19] Cady, B. and Rossi, R. (1988) An Expanded View of Risk Group Definition in Differentiated Thyroid Carcinoma. Surgery, 104, 947-953. [20] Greene, R. (1956) Discerete Nodules of the Thyroid Gland with Special Reference to Carcinoma. Huntarian Lecture Delivered on 29th November, 1956. [21] Hundahl, S.A., Flemming, I.D., Fremgen, A.M., et al. (1998) A National Cancer Data Base Report on 53, 856 Cases of Thyroid Carcinoma Treated in the US, 1985-1995. Cancer, 83, 2638-2648.
http://dx.doi.org/10.1002/(SICI)1097-0142(19981215)83:12<2638::AID-CNCR31>3.0.CO;2-1 [22] Hay, I.D., Hutchinson, M.E., Gonalez-Losada, T., et al. (2008) Papillary Thyroid Microcarcinoma: A Study of 900 Cases Observed in a 60 Year Period. Surgery, 144, 980-988.
http://dx.doi.org/10.1016/j.surg.2008.08.035 [23] Nixon, I.J., Ganlly, I., Patel, S.G., et al. (2012) Thyroid Lobectomy for Treatment of Well Differentiated Intrathyroid Malignancy. Surgery, 151, 571-579.
http://dx.doi.org/10.1016/j.surg.2011.08.016 [24] Merdad, M., Eskander, A., De Almeida, J., et al. (2014) Current Management of Papillary Thyroid Microcarcinoma in Canada. Journal of Otolaryngology—Head and Neck Surgery, 43, 32.
http://dx.doi.org/10.1186/s40463-014-0032-8 [25] Wu, A.W., Wang, M.B. and Nguyen, C.T. (2010) Surgical Practice Patterns in the Treatment of Papillary Thyroid Microcarcinoma. Archives of Otolaryngology—Head and Neck Surgery, 136, 1182-1190.
http://dx.doi.org/10.1001/archoto.2010.193 [26] Lee, J., Park, J.H., Lee, C.R., et al. (2013) Long Term Outcomes of Total Thyroidectomy versus Thyroid Lobectomy for Papillary Thyroid Microcarcinoma: Comparative Analysis after Propensity Score Matching. Thyroid, 23, 1408-1415.
http://dx.doi.org/10.1089/thy.2012.0463 [27] Russell, W.O., Ibane, M.L., Clark, L.C. and White, E.C. (1963) Classification, Intraglandular Dissemination, and Clinicopathological Study Based upon Whole Organ Sections of 80 (Thyroid) Glands. Cancer, 16, 1425-1458.
http://dx.doi.org/10.1002/1097-0142(196311)16:11<1425::AID-CNCR2820161106>3.0.CO;2-E [28] Clark, O.H. (1982) The Treatment of Choice for Patients with Differentiated Thyroid Cancer. Annals of Surgery, 196, 361-370.
http://dx.doi.org/10.1097/00000658-198209000-00016 [29] Stael, A.P.M., Plukker, J.M., Rouwe, C.W., et al. (1995) Total Thyroidectomy in the Treatment of Thyroid Carcinoma in Childhood. British Journal of Surgery, 82, 1083-1085.
http://dx.doi.org/10.1002/bjs.1800820825 [30] Flemming, J.B., Lee, J.E., Bouvet, M., et al. (1999) Surgical Strategy for the Treatment of Medullary Thyroid Carcinoma. Annals of Surgery, 230, 697-707. [31] Tubiana, M., Schlumberger, M., Rougier, P., et al. (1985) Long Term Results and Prognostic Factors in Patients with Differentiated Thyroid Carcinoma. Cancer, 55, 794-804.
http://dx.doi.org/10.1002/1097-0142(19850215)55:4<794::AID-CNCR2820550418>3.0.CO;2-Z [32] Bouvet, M., Schultz, P.N., Sharman, S.I., et al. (1970) Surgical Strategy for the Treatment of Medullary Thryroid Carcinoma. Annals of Surgery, 230, 697-707. [33] Lima, N., Cavaliere, H., Tomimori, E., et al. (2002) Prognostic Value of Serial Thyroglobulin Determinations after Total Thyroidectomy for Differentiated Thyroid Cancer. Journal of Endocrinological Investigation, 25, 110-115.
http://dx.doi.org/10.1007/BF03343973 [34] Polachek, A., Hirch, D. and Tzvetov, G. (2011) Prognestic Values of Post Thyroidectomy Thyroglubulin Levels in Patients with Differentiated Thyroid Cancer. Journal of Endocrinological Investigation, 34, 855-860. [35] Mazzaferri, E.L. and Jhiang, S.M. (1994) Long Term Impact of Initial Surgical and Medical Therapy on Papillary and Follicular Thyroid Cancer. The American Journal of Medicine, 97, 418-428.
http://dx.doi.org/10.1016/0002-9343(94)90321-2 [36] Geissinger, W.T., Horsley, J.S., Parker, F.P., et al. (1974) Carcinoma of the Thyroid. Annals of Surgery, 179, 734-739.
http://dx.doi.org/10.1097/00000658-197405000-00028 [37] Gilliland, F.D., Hunt, W.C., Morris, D.M., et al. (1997) Prognostic Factors for Thyroid Carcinoma. Cancer, 79, 564-573.
http://dx.doi.org/10.1002/(SICI)1097-0142(19970201)79:3<564::AID-CNCR20>3.0.CO;2-0