[Post-operative examination of 2930 thyroid glands: observations on primary carcinoma. Incidental carcinoma and the preoperative diagnostic assessment of thyroidectomy for cancer].
The histological examinations performed in our Institute in the years 1985-1991 and concerning thyroid diseases pertain to 2930 patients. These were considered clinically benign in 2463 cases and malignant in 467. After histological control, the actually benign cases resulted to be 2335, whereas carcinomas were 588 (495 papillary, 61 follicular, 17 anaplastic, 15 medullary). Six lymphomas and 1 fibrosarcoma have been also observed. A comparison between clinical and morphological diagnosis for thyroids thought to be clinically benign has shown a diagnostic overlapping of 93.8%, with absolute agreement for Basedow's diseases, whereas thyroiditis is the disease most often not diagnosed preoperatively. Incidental carcinomas were 132, with an attendance related directly to the number of samples randomly taken from the surgical specimen. In 538 cases of carcinoma it has been possible to evaluate the intraglandular spread of the tumor: bilateral multifocal cases were 18.4%, with an incidence of latero-cervical metastases (41.4%) nearly twice as that observed in monolateral cases (24.2%). Post-surgical examination of the whole gland in 381 patients treated with a total thyroidectomy for carcinoma has discovered 20 false positive cases: 11 were operated on only according to clinical and instrumental examinations, 2 on the basis of just the cytological results, and 7 on the basis of cytologically positive evidence though refuted by intraoperative frozen sections. In the 381 cases taken into account, intraoperative frozen sections have been done 256 times: the results have been confirmed by the histological post-surgical examination of the whole gland in 94.5% of the cases. No false positive cases did occur. False negative cases were 7, due to inadequate sampling (in the operating room or in the pathology lab). Delayed diagnoses were 4, whereas truly false negative cases have been in all 3 (1.2%). The greater part of our data has been disaggregated in two different periods (1985-1988 and 1989-1991) to point out any change with time in the parameters under observation. The most relevant reflections relating to the time were the following: (1) per cent increase of bilateral multifocal carcinomas (13.9 vs. 21.8%), (2) per cent decrease of latero-cervical metastases in monolateral carcinomas (31.8 vs 17.7%), (3) frank decrease in the median value of incidental carcinomas' diameters (2.2 cm in the first vs. 0.6 cm in the last year), (4) frank decrease of false positive cases among patients operated on without prior cytological or histological verification (6/21 vs. 1/27), (5) remarkable improvement of the rate of correlation between intraoperative frozen section diagnosis and post-surgical histological examination (92.1 vs. 97.4%).(ABSTRACT TRUNCATED AT 400 WORDS)
Pingitore
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Istituto e museo di Anatomia e istologia patologica, Università di Pisa.
Vignati
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Bigini
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Ciancia
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D002648:Child; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000175:diagnosis / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000706:statistics & numerical data
L'esame post-operatorio di 2930 ghiandole tiroidee: osservazioni sul carcinoma primitivo. Il carcinoma incidentale e l'iter diagnostico pre-operatorio delle tiroidectomie per cancro.