CARCINOMA INCIDENCE IN MULTINODULAR THYROID ENLARGEMENTS: A COMPARATIVE STUDY WITH SOLITARY NODULES

Abstract

The records of 558 patients with histologically proven nodular goitre treated by thyroidectomy since January 1390 to June 1994 were reviewed. There were 36 patients with thyroid carcinoma having the ratio of 6.4%. 292 patients were operated because of multinodular goitre (MNG) and 266 of single nodule (SN). Carcinoma incidence was 5.8% (17/292) in MNG, and 7.1% (19/262) in SN. Incidence of the carcinoma was lower in the MNG than in the SN but the difference was not significant (p>0.05). Patients with MNG had a history of swelling for a longer period than patients with SN (93.6 ± 4.7 and 50.214.2 respectively p<0.05). The ultrasonographic and the scintigraphic evaluation had no specific roles as primary diagnostic tests for the carcinoma. Fine needle aspiration biopsy (FNAB) in MNG had a sensitivity of 71%. a specificity of 95% and an accuracy of 95%. FNAB in SN had a sensitivity of 80%, a specificity of 91% and an accuracy of 91%. Tumour size in gross pathological evaluation was 22.2 ± 7.8 cm2 in patients with MNG and 11.2 ± 3.8 cm2 patients with SN(p>0.05). In histological evaluation, blood vessel invasion was found in two patients with MNG, capsular invasion in two, lymph node metastasis in two, muscular invasion in one. In patients with SN, blood vessel invasion was found in one patient, capsular invasion in one, lymph node metastasis in one. Three patients with MNG had multifocal tumor.

In conclusion, incidence of carcinoma was lower in MNG than SN but there was no statistical difference and patients with carcinoma in MNG had a history of swelling for a longer period than patients with SN. However, if there is any suspicion for cancer in a patient with MNG, the treatment should be radical operation.