CARCINOMA OF THYROID: 51 PATIENTS WITH CARCINOMA

Abstract

The records of 51 patients operated for thyroid carcinoma, between January 1987 and June 1994, were reviewed retrospectively. Histologic distribution showed that papillary carcinoma accounted for 24 (47%) patients, folliculer carcinoma for 10 (19%), undifferentiated carcinoma for 8 (15.5%), medullary carcinoma for 5 (10%). The ultrasonographic and scintigraphic evaulation had no significant pathognomonic role as primary diagnostic tests for carcinoma. The fine-needle aspiration biopsy (FNAB) had sensitivity of 75.8%, a specificity of 96.2%, an accuracy of 92.6%, a false-negative rate of 4.2% and a false-positive rate of 3%. The diagnosis by using FNAB in routine preoperative evaluation led to a substantial reduction in the number of operations and an increase in the number of carcinomas. Incidence of the carcinoma before FNAB was in routine use was 3.8% (27/694) and after FNAB 8.9% (24/269) (p<0.05). Twenty four cases underwent total and near total thyroidectomy, 9 cases bilateral subtotal thyroidectomy, 6 cases thyroidectomy and neck dissection, three cases total lobectomy and five cases underwent only biopsy. Regional recurrences developed in two patients (8%) of total and near total thyroidectomies, in two (33%) patients of neck dissection, in one (11%) patient of bilateral subtotal thyroidectomy and one (3.3%) patient of total lobectomy (p>0.05).

In conclusion FNAB is found as the primary diagnostic test in diagnosing thyroid carcinoma. In preoperative evaluation, endocrinologist, cyto pathologist and surgeon should evaluate all diagnostic tests and physical findings together. Although the choice of operative procedure may differ in cases, total thyroidectomy on the tumor side and near total on the controlateral lobe seems to be the efficient procedure in managing thyroid carcinoma.