Management of thyroid cancers diagnosed histologically after surgery

Thirty-three patients with thyroid cancer diagnosed histologically after surgery from 1960 to 1987 were reviewed to delineate an acceptable treatment policy. The first group of 17 patients did not undergo a second operation, and five of these patients (29%) experienced local recurrence, metastasis and death during follow-up (minimum of 15 years). A second group of 16 patients underwent a second operation, and all remained healthy during the mean follow-up period of eight years. In 56% of the specimens obtained during the second operation, a histologic examination revealed residual cancerous foci in the remnant thyroid tissue or lymph node. This present study indicates that age, tumor grade, extent and size (AGES score), and the operative strategy used in the initial procedure are important factors affecting the prognosis. We suggest that patients whose tumors lose capsular integrity, show evidence of intraglandular metastases or have an AGES score of 3.1 or more should be considered as candidates for a second operation.