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The unexpected thyroid cancer: surgical attitude
R Van Hee1, D Ysebaert, G Roeyen
1Department of Surgery, Universitaire Instelling Antwerpen, Belgium.
Acta Chirurgica Belgica
|March 1, 1995
Summary
Unexpected well-differentiated thyroid cancers were found in 18 patients, often missed by preoperative tests. This highlights the need for revised surgical guidelines for thyroid tumors initially presumed benign.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Well-differentiated thyroid cancers are frequently diagnosed incidentally.
- Preoperative diagnostic methods often fail to detect these cancers in patients undergoing surgery for benign thyroid conditions.
Purpose of the Study:
- To present a series of patients with unexpected well-differentiated thyroid cancer.
- To evaluate the diagnostic accuracy of preoperative investigations.
- To propose therapeutic guidelines for managing incidentally discovered thyroid cancers.
Main Methods:
- Retrospective analysis of 18 patients with unexpected well-differentiated thyroid cancer.
- Review of preoperative investigations including thyroid function tests, ultrasound, scintigraphy, and fine needle aspiration biopsy.
- Analysis of intraoperative findings and histopathological results (frozen section and paraffin section).
Main Results:
- Unexpected thyroid cancer represented 6.5% of surgeries for "benign" thyroid disease and 44% of thyroid cancer surgeries.
- Preoperative investigations were not conclusive for malignancy in most cases.
- Paraffin section diagnosis led to reoperation in 8 out of 12 patients with unsuspected cancer.
Conclusions:
- There is a significant rate of incidentally discovered well-differentiated thyroid cancers.
- Current preoperative diagnostic tools have limitations in detecting these tumors.
- A clear therapeutic guideline is needed to differentiate between tumors requiring reoperation and those adequately treated by initial resection.