The Diagnosis And Surgical Treatment Of Thyroid Microcarcinoma (Report Of79Cases)

Objectives: Thyroid Carcinoma is a malignant neoplasm that mostlydevelops in the tissue of the thyroid gland in head and neck. The morbidity ofthyroid carcinoma is about1.5/10myriad yearly, which has become increasedat the highest speed since middle of1980s. Thyroid microcarcinoma (TMC)thyroid microcarcinoma is tumours measuring less than or equal to10mmlarge in diameter. With the widespread using of high resolution thyroidultra-sonography and advanceing technology of pathological diagnosis, thecase of discovered and reported all over the world is increasing year by year.However, the majority of the cases are discovered through surgery of thyroidaccidentally or postoperative pathological examination, which indicates thatprocess of clinical examination has a high misdiagnosed rate. TMC is uneasilyfound that it can stay as a state of subclinical without development for a longtime and involving with other thyroid diseases, which tends to be a sort ofoptimum pathological change. But not all TMC remain clinically occult, partof the pathological changes have phenomenon of metastatic lymphadenopathyand invasive tumor growth. The main rote of transform is lymphaticmetastasis, after that, TMC can show clinical symptoms and must be forclinical treatment. TMC is one of the few surgical treatments that can behealed absolutely. Thus, the treatments required healthcare to pay moreattention to surgery of thoroughness and correctness to reduce the incidence ofpatients with recurrence and metastasis. This paper discusses the clinicalcharacteristics of thyroid microcarcinoma, the lymphatic metastasis,preoperative diagnosis and the way of surgery. These will be contributed toprovide the reference for clinical diagnosis and treatment of thyroidmicrcocarcinoma.Methods: From January2010to January2013,79patients with TMC underwent thyroid surgery were retrospectively analyzed in otolaryngology,head and neck surgery of the Fourth Hospital of Hebei Medical University andrelative material.All cases accepted surgery, preoperative thyroid ultra-sonography anddiagnosis were confirmed by pathological examination.18male and61femalepatients，a media age of43.5years old.1All cases accepted preoperative thyroid ultra-sonography; CT(Computed tomogramphy) was2; FNA(Fine needle aspiration cytology) was3;radionuclide examination was1.2Methods of surgery: all cases, single thyroid nodule was61, multiplethyroid nodule was18, between of them with other benign lesions was43;total thyroidectomy was5, secondary total thyroidectomy was43, unilaterallobectomy was31;5of which is through expansion of two-stage operation.Selective neck dissection was60, level VI neck dissection was31, ipsilateralcervical lymph node dissection was11, level VI and ipsilateral cervical lymphnode dissection was18; among them selective bilateral cervical lymph nodedissection as a one-stage was7.64cases underwent frozen sections,52caseswere diagnosed during the operation, positive rate was81.2%.3Statistics analysis: SPSS13.0was applied to analyze the results ofexperiment. P<0.05was considered as statistical significantance. P<0.01indicating very significant difference.Results:1Preferred inspection method is high resolution thyroid ultra-sonographywhich has important significance for diagnosis of thyroid diseases anddiscovers TMC.2In all cases,64cases underwent frozen sections and12of these weremade in the postoperative pathological examination. The false negative ratewas18.8%.3In all cases, positive rate of lymphatic metastasis in level VI neckdissection was37.9%(30/79); positive rate of lymphatic metastasis inipsilateral cervical lymph node dissection was13.9%(11/79). There was very significant difference between the two groups(χ2=11.890, P=0.001);In all cases of level VI neck dissection, preoperative thyroidultra-sonography found positive rate of lymphatic metastasis and not foundwere62.9%(22/35) and32.0%(8/25), There was significant differencebetween the two groups(χ2=5.554, P=0.018).In all cases of ipsilateral cervical lymph node dissection, preoperativethyroid ultra-sonography found positive rate of lymphatic metastasis and notfound were55.6%(10/18) versus9.1%(1/11), There was significant differencebetween the two groups(Fisher probabilities, P=0.019).4In all cases, postoperative temporary low of parathyroid function was5,after2-6months to recover; no permanent discover recurrent laryngeal nerveparalysis low of parathyroid function.Conclusions:1TMC is often occult and difficult to preoperative diagnosis. Highresolution thyroid ultra-sonography is the main method of TMC ofpreoperative diagnosis. Most of them in clinical unplayable may be detectedby high resolution thyroid ultra-sonography.2Surgery is the first choice treatment of TMC. Unilateral lobectomy plusisthmusectomy may be recommended as treatment for single focus of TMC inunilateral lobe. Unilateral lobectomy plus isthmusectomy and the other sidepartial thyroidectomy may be recommended as treatment for multifocal focusof TMC in unilateral lobe. At the same time make ipsilateral level VI neckdissection; total thyroidectomy or secondary total thyroidectomy and bilaterallevel VI neck dissection as treatment for bilateral thyroid of TMC; the patientswith preoperative thyroid ultra-sonography don’t cervical lymph nodes,usually don’t do preventive ipsilateral cervical lymph node dissection.