title: The extent of surgery in thyroglossal cyst carcinoma.
abstract: OBJECTIVE
  The optimal management of thyroglossal cyst carcinoma, particularly the extent of surgery required is controversial. The aim of this study was to evaluate the need for routinely adding total thyroidectomy to Sistrunk's operation in the management of this condition.
  
  
  METHODS
  The clinical records of 19 patients with a diagnosis of thyroglossal cyst carcinoma encountered in an 11-year period (2004-2015) were reviewed. All patients underwent total thyroidectomy in addition to Sistrunk's procedure. The rate of concomitant thyroglossal cyst and thyroid carcinomas was calculated and cancers were staged according to the AJCC-TNM staging system. Patients were divided into two groups: those with thyroglossal cyst carcinoma only (group A) and those with a synchronous or metachronous thyroid carcinoma as well (group B). The need for radioactive iodine ablation in group A was assessed. The ability to omit total thyroidectomy based on thyroglossal cancer size and a negative thyroid ultrasound was also evaluated.
  
  
  RESULTS
  The rate of concomitant thyroid cancer was 63.2 % (12/19). Based on stage, three out of the seven patients in group A required radioactive iodine ablation. Total thyroidectomy was ultimately justifiable in 78.9 % (15/19) of cases. Omitting total thyroidectomy in T1 thyroglossal cyst cancers or based on a sonographically normal thyroid was associated with a 43 % risk of missing thyroid malignancy.
  
  
  CONCLUSIONS
  The routine addition of total thyroidectomy to Sistrunk's procedure seems to be appropriate for comprehensive loco-regional control especially that selecting a subset of patients in which it could be omitted is a difficult task.
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. sohail.bakkar@gmail.com.
authors.forename: Sohail
authors.initials: S
authors.lastname: Bakkar
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Biricotti
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Stefanini
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Carlo Enrico
authors.initials: CE
authors.lastname: Ambrosini
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D016609:Neoplasms, Second Primary; D013955:Thyroglossal Cyst / Q000473:pathology* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Papillary carcinoma; Sistrunk’s procedure; Thyroglossal cyst; Total thyroidectomy