Risk factors for malignancy in multinodular goitres
Introduction
Multinodular goitre (MNG) is the most prevalent thyroid pathology and accounts for a large volume of patients in surgery departments.1 The incidence of malignancy with this goitre ranges from 1 to 10%, and ruling it out is a objective in MNG management,1., 2., 3., 4., 5., 6., 7. since thyroid carcinoma must be operated on early and often requires postoperative radio-iodine. However, MNG without proven malignancy can be often managed conservatively. Partial thyroidectomy may lead to suboptimal management of an incidental carcinoma.
Several studies8 show that microcarcinomas may have a torpid evolution with local recurrence and may cause death, and also that aggressive histological variants may manifest themselves in MG, such as anaplastic carcinoma.2., 9.
The indicators of high risk of MNG-associated carcinoma are not well established.10 The aim of this manuscript is to study a series of patients with thyroid carcinoma associated with MG in order to determine the clinical risk factors for malignancy.
Section snippets
Patients and methods
Between 1974 and 1999, 672 patients with MNGs underwent surgery in our department, of which a subgroup of 59 patients with an associated thyroid carcinoma was analysed. The mean age of the patients was 46±14 years; most of them were female. Fifteen lived in areas of endemic goitre, nine had a family history of thyroid pathology, and three had received cervical radiation therapy for cutaneous angiomas. Eighteen were asymptomatic, and compressive symptoms and hyperthyroidism were the most common
Statistics
A descriptive statistical study was done of the characteristics of the carcinoma. This group with MG and associated carcinoma was compared to the rest of the patients in the series without carcinoma, using contingency tables analysed with the χ2 test complemented with an analysis of residues, and the Student's t test. For the multivariate analysis we used a logistic regression test including the variables, which in the bivariate analysis showed a statistically significant association. In all
Results
In the 59 carcinomas associated with goitre the mean tumour size was 1.3±1.3 cm (0.1–7 cm), of which 37 corresponded to a microcarcinoma (≤1 cm) and the other 22 to a macrocarcinoma (2.1±1; 1.1–7 cm). The most common histological type was papillary (n=48), followed by follicular (n=6), medullary (n=2), mixed or coincident (n=2) and anaplastic carcinoma in one case. The carcinoma was multifocal in 20 cases, and capsular involvement was observed in 16 patients, lymph node involvement in five and
Discussion
The incidence of carcinoma associated with MNG in our series is among the highest reported in the bibliography (8.8% vs. 2–3%),1., 2., 3., 4., 5., 6., 7., 8. although authors such as Yamashita et al.10 report rates of above 30%. It is difficult to differentiate, by palpation, ultrasound or gammagraphy, a goitre with a degenerated nodule from a benign goitre, since no symptom or sign is pathognomonic of malignancy.1 Furthermore, left to its natural evolution it is only detected when the
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2014, Biochimica et Biophysica Acta - Reviews on CancerCitation Excerpt :Although being a controversial topic, most studies, including large cohort studies, suggest that FNMTC is more aggressive than sporadic NMTC. As commented above, FNMTC has been associated with early age of onset, an increased incidence of multiple benign thyroid nodules, multifocality, bilaterality, nodal involvement, intraglandular dissemination, extrathyroidal invasion, lymph node metastasis, shorter disease-free survival period and recurrence [15,17,19,21,22,28–31]. In a study conducted in Japan containing records of 8422 patients treated by thyroidectomy between 1946 and 2000, 258 patients from 154 families were identified as having FNMTC [15].