ABSTRACT
In most centers only selected patients with high risk thyroid nodules undergo thyroid surgery, and fine needle aspiration biopsy (FNA) is used to select patients for surgical treatment. The aim of the present study was to evaluate the impact of FNA on the management of thyroid nodules at our institution. A total of 872 patients who underwent FNA over a period of 7 years were retrospectively analyzed. There were 66 men and 806 women with a mean age of 40 +/- 15 years. Altogether 549 patients presented with a thyroid nodule and 323 with multinodular disease. The sensitivity and specificity of FNA were 90.0% and 99.8%, respectively. The positive and negative predictive values were 98% and 99%, respectively, and the accuracy was 99%. Our results are in agreement with those of other reports establishing that FNA of the thyroid is safe, reliable, and effective for differentiating benign from malignant nodules.
Subject(s)
Thyroid Neoplasms/pathology , Thyroid Nodule/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Sensitivity and Specificity , Thyroid Gland/pathology , Thyroid Neoplasms/surgery , Thyroid Nodule/surgery , Thyroidectomy , Treatment OutcomeABSTRACT
BACKGROUND: Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. OBJECTIVE: To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. MATERIALS AND METHODS: The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). RESULTS: Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). CONCLUSION: Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.
Subject(s)
Goiter, Nodular/surgery , Thyroidectomy , Adolescent , Adult , Aged , Biopsy, Needle , Carcinoma/diagnosis , Carcinoma/epidemiology , Carcinoma/surgery , Carcinoma, Medullary/diagnosis , Carcinoma, Medullary/epidemiology , Carcinoma, Medullary/surgery , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/epidemiology , Carcinoma, Papillary/surgery , Female , Goiter, Nodular/complications , Goiter, Nodular/epidemiology , Humans , Hypothyroidism/drug therapy , Hypothyroidism/etiology , Male , Mexico/epidemiology , Middle Aged , Postoperative Complications , Recurrence , Retrospective Studies , Thyroid Hormones/therapeutic use , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/surgery , Thyroid Nodule/diagnosis , Thyroidectomy/methods , Treatment OutcomeABSTRACT
BACKGROUND: Anaplastic thyroid carcinoma (ATC) is a highly aggressive tumor with a median survival rate of 6 months. AIM: To analyze presentation, treatment, morphology, immunohistochemistry, and nuclear DNA analysis of a cohort of patients with ATC. PATIENTS AND METHODS: Twelve patients with ATC (11 female) with a mean age of 65 years were seen at our hospital from 1970-1995. The data were obtained from the clinical records and the morphology, immunohistochemic studies and DNA pattern were performed in slides obtained from archival specimens. RESULTS: Previous or coexisting thyroide disease was documented in 10 patients (9 multinodular goiters and one Grave's). The most frequent presentation was a rapidly growing tumor associated with dysphagia, cervical pain, hoarseness and dyspnea. A cold thyroid nodule was detected by thyroid scan in 10 patients. The most frequent subtype was the spindle cell variety. Papillary thyroid carcinoma coexisted in eight cases, two of them corresponded to the tall cell variant. Reactivity for S-100 protein and vimentin was studied in six patients: all were positive for S-100 protein and vimentin, 5/6 for epithelial membrane antigen, half for carcinoembriogenic antigen, 2/6 for thyroglobulin and calcitonin, and one for neuronal specific enolase. These six tumors showed a diploid DNA pattern. Tumor resection was achieved in 2/11 and none survived six years after diagnosis. CONCLUSIONS: ATC is a highly aggressive tumor coexisting with thyroid pathologies. Spindle cell variant is the most frequent with positive reactivity for S-100 protein, vimentin and epithelial membrane antigen. Most tumors have a diploid DNA content.
