Surgical Management of Thyroid Carcinoma

2005 ◽  
Vol 3 (3) ◽  
pp. 458-466 ◽  
Author(s):  
Maria A. Kouvaraki ◽  
Suzanne E. Shapiro ◽  
Jeffrey E. Lee ◽  
Douglas B. Evans ◽  
Nancy D. Perrier
Keyword(s):  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Regional Lymph Node ◽  
Preoperative Staging ◽  
Disease Recurrence ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Regional Lymph Nodes ◽  
Regional Lymph Node Dissection ◽  
Cervical Surgery

Thyroid carcinoma has a unique biologic behavior characterized by early spread to regional lymph nodes and occasional extrathyroidal soft tissue extension but a low incidence of distant metastasis and infrequent disease-related death. Therefore, controversy exists over the proper extent of thyroidectomy and regional lymph node dissection in patients with differentiated thyroid carcinoma (DTC) and medullary thyroid carcinoma (MTC). The modest disease-specific mortality makes it unlikely that the extent of surgery will ever be the subject of a prospective randomized trial. Although more extensive cervical surgery may have only a limited effect on the duration of survival in patients with DTC, it may significantly improve quality of life by minimizing cervical recurrence. The high rates of cervical recurrence in patients with DTC and MTC have alerted physicians to the importance of fine-needle aspiration biopsy and ultrasonography for the diagnosis, preoperative staging, and follow-up of thyroid cancer. In patients with MTC, death caused by disease is uncommon in the absence of radiographically evident distant metastasis at the time of thyroidectomy. Cervical recurrence is even more common with MTC, and the need for compartment-oriented lymphadenectomy is accepted as standard surgical treatment to minimize disease recurrence. Postoperatively, calcitonin (CT) levels can be used to guide clinical management, but basal CT levels should not be used to direct the timing of prophylactic thyroidectomy in affected high-risk patients with familial MTC.

scholarly journals Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Weili Zhou ◽  
Yang Bai ◽  
Yangyang Yue
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Distant Metastasis ◽  
Regional Lymph Node ◽  
Invasion Depth ◽  
Regional Lymph Nodes ◽  
Adjacent Organ ◽  
Regional Lymph Node Dissection ◽  
Adjacent Organ Invasion ◽  
Organ Invasion

BackgroundThe safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied.MethodsA retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN−) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS).ResultsOf the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN−, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19–0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16–0.54, P<0.001) and OS (LN−, adjusted time ratio [TR] = 1.38; 95% CI, 0.82–2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73–4.14; P<0.001), although the effect of SLNB on OS was not significant within the LN− cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23–0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not.ConclusionsSLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN− cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

scholarly journals Diagnosis and Management of Thyroid Cancer

1995 ◽  
Vol 2 (2) ◽  
pp. 107327489500200
Author(s):  
Christopher L. Alexander ◽  
Roberto E. Izquierdo ◽  
James Figge ◽  
John Horton
Keyword(s):  
Thyroid Carcinoma ◽  
Radioactive Iodine ◽  
Imaging Techniques ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
The Past ◽  
Locally Recurrent ◽  
Improvement In Survival ◽  
Radioactive Iodine Ablation ◽  
Radionuclide Scanning

Thyroid carcinoma, which comprises the majority of endocrine malignancies, has a substantial annual morbidity and mortality based on age and other predisposing factors. Diagnosis of a growing thyroid nodule can be difficult, but ultrasonography, radionuclide scanning, and fine needle aspiration allow the majority of nodules to be properly characterized. Treatment of differentiated thyroid carcinoma remains controversial. Surgical resection continues to be the most important modality with long survival if the tumor is resected early. Newer imaging techniques have improved the diagnosis of locally recurrent or metastatic disease. Radioactive iodine ablation is indicated for patients with “high-risk” tumors or advanced age. Few patients respond to cytotoxic chemotherapy. In the past decade, advances in the screening and diagnosis of medullary thyroid carcinoma have led to earlier detection with improvement in survival.

scholarly journals Malar Bone Metastasis Revealing a Papillary Thyroid Carcinoma

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Ihsen Slim ◽  
Aida Mhiri ◽  
Imène Meddeb ◽  
Aida Goucha ◽  
Saïd Gritli ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Carcinoma ◽  
Papillary Thyroid ◽  
Malar Bone ◽  
Follicular Variant ◽  
Maxillofacial Region ◽  
Regional Lymph Nodes ◽  
Recorded Instance ◽  
Oral And Maxillofacial Region

Papillary thyroid carcinoma is the most common form of differentiated thyroid carcinoma. It is generally confined to the neck with or without spread to regional lymph nodes. Metastatic thyroid carcinomas are uncommon and mainly include lung and bone. Metastases involving oral and maxillofacial region are extremely rare. We described a case of malar metastasis revealing a follicular variant of papillary thyroid carcinoma, presenting with pain and swelling of the left cheek in a 67-years-old female patient with an unspecified histological left lobo-isthmectomy medical history. To our knowledge, this is the first recorded instance of a malar metastasis from a follicular variant of papillary thyroid carcinoma.

Lymph Node Metastases of Differentiated Thyroid Carcinoma: Does Serum Anti-Tg Antibodies or TSH Level Influence Tg measurement in Fine Needle Aspiration Washouts?

2021 ◽  
Author(s):  
Sara Donato ◽  
Joana Maciel ◽  
Paula Font ◽  
Helder Simões ◽  
Susana Prazeres ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Lymph Node Metastases ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Fine Needle ◽  
Node Metastases ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Thyroglobulin evaluation in the washout of fine-needle aspiration (FNA-Tg) is an accurate diagnostic method of lymph node metastases (LNM) of differentiated thyroid carcinoma (DTC). Serum anti-thyroglobulin antibodies (AATg) may cause falsely low serum Tg values, but their effect on FNA-Tg has not been well established. There are also concerns about the possibility that suppressed TSH results in false-negative FNA-Tg. Our objectives were to evaluate the effect of serum AATg and TSH level on FNA-Tg of LNM of DTC and to determine the presence of AATg on the washout of fine needle aspiration (FNA-AATg). Methods: Retrospective analysis of patients who underwent FNA-Tg assay in LNM of DTC. The sample was divided in two groups according to the presence of serum AATg at the time of FNA-Tg evaluation (Group 1: positive AATg, n =47; Group 2: negative AATg, n =50). Results: There was no significant difference in the FNA-Tg between the two groups ( p =0.066), although it was lower in Group 1 (1428 ng/mL) than in Group 2 (14842 ng/mL). FNA-Tg was able to identify 10.3% LNM of DTC that would not be diagnosed based solely on cytology. FNA-AATg evaluation was positive in 12.8% of the Group 1 patients and did not seem to interfere with FNA-Tg value ( p =0.732). There were no differences in the median FNA-Tg measurements between those on levothyroxine suppressive therapy and those on substitutive therapy ( p =0.800). Conclusion: FNA-Tg assay appears to be a good diagnostic tool even in patients with positive serum AATg and those under suppressive levothyroxine therapy.

Prognostic Value of Age and Distant Metastasis in Differentiated Thyroid Carcinoma Undergoing Salvage Surgery

2020 ◽  
Vol 40 (2) ◽  
pp. 1127-1133
Author(s):  
HIDENORI SUZUKI ◽  
DAISUKE NISHIKAWA ◽  
SHINTARO BEPPU ◽  
HOSHINO TERADA ◽  
MICHI SAWABE ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Prognostic Value ◽  
Salvage Surgery ◽  
Differentiated Thyroid Carcinoma
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