Follicular Thyroid Carcinoma: Clinicopathologic Features, Prognostic Factors, and Treatment Strategy

PURPOSE: Follicular thyroid carcinoma (FTC) is a relatively rare form of thyroid carcinoma that often presents at a more advanced stage of disease with a higher incidence of distant metastases because of its propensity for vascular invasion. However, FTC and papillary thyroid carcinoma (PTC) have similar prognoses when they are matched for age and stage. Therefore, this study was conducted to evaluate the useful prognostic factors and determine the optimal management of FTC. METHODS: This study was conducted on 216 patients with FTC who underwent thyroidectomy at our institutions between April 1986 and August 2006. The patients included 174 women and 42 men with a mean age of 41 (4~87) years, and patients underwent follow-up evaluation for a mean period of 114 (6~253) months. The potential risk factors for treatment outcome were calculated using multivariate analysis, and the prognostic accuracy of UICC/AJCC pTNM staging, AMES, AGES, MACIS, and Degroot classification for predicting survival were compared. RESULTS: During the follow-up period, 13 (6.0%) patients developed locoregional recurrences and 8 patients (3.7%) showed distant metastases. In addition, cause specific mortality was seen in 8 patients (3.7%). The overall survival and cause-specific survival (CSS) rates at 10 years were 95.4% and 89.3%, respectively, and these cases were accurately predicted by the AMES and pTNM staging systems. The Cox proportional hazards revealed that gender (P=0.015), angioinvasion (P=0.013), invasion to adjacent structure (P=0.003), widely invasive carcinoma (P=0.028), and distant metastases at the time of presentation (P<0.001) were independent prognostic factors for survival. CONCLUSION: The extent of surgery in cases of FTC should be individualized based on the clinicopathologic findings; Conservative surgery should be adequate for cases of minimally invasive FTC without angioinvasion, however total or near-total thyroidectomy should be conducted in cases of widely invasive and minimally invasive FTC with angioinvasion.

Current Status of Endoscopic Thyroidectomy in Korea / 대한내분비외과학회지

PURPOSE: The endoscopic surgery has been widely used and developed in operations of the thyroid and parathyroid gland because of the cosmetic advantage and the development of laparoscopic instrument. Since the first endoscopic thyroid surgery in late 1990's, many endoscopic operations for thyroid tumors have been performed in Korea. The authors analyzed the current status of endoscopic thyroid surgery performed in Korea. METHODS: We have collected and analyzed the data of endoscopic thyroid operations using survey. RESULTS: The surgeons working in 16 hospitals answered the questions in survey. The total endoscopic thyroid operations were performed over 1,200 cases until the end of 2004. In the pathologic diagnosis, nodular hyperplasia was most frequent in 64.5%. The axillary approach was most frequently applied in 9 hospitals (56.2%). Most of endoscopic thyroid operations were performed in 2~3 hours. The operation time was decreased according to the experience. The endoscopic surgery for malignant tumors were also performed in 11 hospitals, The hospital stay was usually 3~4 days. The most common complications in endoscopic thyroid surgery were temporary recurrent laryngeal nerve paralysis and anteior chest wall discomfort or paresthesia. The most common reason for conversion to conventional surgery was the intraoperative diagnosis as for a malignancy. CONCLUSION: Endoscopic thyroid surgery has been perfomed in many hospitals not only special thyroid clinic in Korea. The operation cases are increasing rapidly in these days. According to the development of technique and instrument, the endoscopic surgery are applied to various neck disease involving malignancy. The safety and efficacy of endoscopic surgery for malignancy should be further evaluated with accumulation of experience of endoscopic operation and long term follow-up of thyroid cancer patients.