Surgical Strategies For Thyroid Pathology

BackgroundThyroid disease is a common disease of the endocrine system. Benign thyroid diseasechanged little in recent years, the principle of clinical operations, according to the guide athome and abroad, surgical or less. The vast majority of thyroid patients with benign tumorsdo not require treatment takes6-12months were followed up for1. Although thyroid canceris relatively rare (accounting for2%of all cancers)[3], but it is the most common endocrinemalignancy in the past15to20years, its incidence is steadily rising[6]. In the last10years,female thyroid cancer incidence is rising rapidly, more than any other cancer, the rate ofincrease of male thyroid cancer incidence is also ranked third in[5]. The majority ofwell-differentiated thyroid cancer, slow growth, low degree of malignancy, surgicaltreatment, the first operation mode selection is correct or not the prognosis is particularlyimportant. Intraoperative frozen section is the most reliable method of diagnosis of thyroidcancer, the surgeon is often based on the results to determine the surgical approach. Butsometimes cause secondary surgery due to false negative frozen sections, or even treatmentfailure influence prognosis. How the results of the frozen section, combined with clinical andintraoperative conditions to make the right diagnosis and treatment has become the focus ofattention of the surgeon.ObjectiveSurgical strategy, particularly to discuss the pathological diagnosis of thyroid disease isnot clearly diagnosed cases, combination of clinical surgery coping strategies.MethodsHospital department in2011, all cases of thyroid disease surgery in2011, ourdepartment conducted a total of1580cases of thyroid surgery, of which854cases of thyroidbenign tumors,726cases of thyroid malignancy.Use of statistical methods of analysis ofintraoperative frozen section and paraffin pathology after the same time than the surgicalapproach.Results2011line in our hospital department1580cases of thyroid surgery, of which854casesof benign thyroid surgery,726cases of thyroid cancer surgery. Intraoperative frozen sectionand postoperative paraffin pathological diagnosis are basically the same cases of thyroid disease, thyroid disease diagnosis was98.8%total. Diagnosis was benign thyroid disease85499.1%, the diagnosis of thyroid malignancy was96.3%. According to the statisticalanalysis of this group of cases, thyroid surgery, frozen pathological sensitivity of97.4%,specificity100%, positive predictive value (PPV)100%, negative predictive value (NPV) of99.1%, accuracy99.5%. Therefore, intraoperative frozen section is a more reliable methodof diagnosis of thyroid cancer, the surgeon is often based on the results to determine thesurgical approach. Confirmed cases of this group are in accordance with the the ATA thyroidtumor surgery principles of treatment. The patients were18false negative cases, of whichabout15cases and one week after the second thyroid cancer radical surgery and neck lymphnode dissection. This group of cases of secondary thyroid cancer radical resection of residualdisease was44.4%, lymph node metastasis rate was66.7%. This group of patients21caseswere not clearly diagnosed cases, according to the preoperative neck ultrasonography,suggesting that the ultrasound characteristics of the cancer risk of cervical lymph nodessuspicious lymph nodes. And observation of the thyroid specimens cut surface gray, a littlesag, brittle and hard or brown, the central part of the dense foci or necrosis and othercharacteristics. Highly suggestive of malignant likely. Intraoperative thyroid cancer is radicalsurgery and neck lymph node dissection.19cases of postoperative paraffin pathologyreported as clear of papillary thyroid carcinoma lymph node metastasis rate of71.4%. Twocases return lymphocytic thyroiditis. For all cases, rapid pathology can not be confirmedcases in the positive predictive value (PPV) was90.5%.Conclusion1. An intraoperative frozen pathology and postoperative paraffin pathology is the goldstandard for diagnosis of thyroid tumors.2. false negative cases of secondary thyroid cancerand radical resection for residual tumor rate was44.4%. The first surgical procedure leavespart of the ipsilateral gland excision is the necessity of re-resection of the residual thyroidgland and neck lymph node dissection.3. intraoperative rapid pathological can not beconfirmed cases of the positive predictive value (PPV) was90.5%. For patients diagnosed as"suspicious thyroid cancer, thyroid cancer, radical mastectomy.4. Intraoperative rapidpathological and postoperative paraffin pathology can not be clearly diagnosed cases,immunohistochemical markers in the diagnosis and guidance to help. Papillary thyroidcancer is often over-expression of CK-19expression of Galectin-3. Positive for Calcitoninexpression of medullary thyroid cancer cells.