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KMID : 0378019930360110015
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New Medical Journal
1993 Volume.36 No. 11 p.15 ~ p.29
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A Clinical Study of 450 Cases in Surgical Thyroid Nodules
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Abstract
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During of the 10 years of period, 450 patients with thyroid nodules, admitted and operated at Department of Surdgery, National Medical Center, from Jan. 1981 to Dec. 1990. And we represent the result of cases.
1. The benign nodules were prevalent in the second & third decade (27.4 & 22.1%) comparing with malignant nodules in the third & forth decade (24.3 & 21.9%). The sex distribution disclosed preponderance of female with ratio of 1 : 72.
2. Palpable mass was the most common clinical manifestation in most patients. Compression symptoms such as hoarseness and dyspnea were more common in malignancy than benign disease.
3. The right lobe was more common involved site than left. The incidence of bilateral involvement was 7.1% in benign and 14.2% in malignant tumor. The incidence of malignancy in solitary nodule was 33.8%.
4. The thyroid scanning,´3´ I uptake test and TFT were not sufficient for differential diagnosis between benign and _malignant nodules.
5. The FNA was underwent in 410 ´cases (91% of all cases). The sensitivity of this study was 71.2%, specificity was 97.9%, accuracy was 82.7%, false positive was 4.1% and false negative was 16.3%.
6. The pathologic distribution of thyroid nodules, 281 cases (62.4%) were benign and 169 cases (37.6%) were malignant : Among benign nodules, the incidence of adenomatous goiter was 48.1%, follicular adenoma was 41.3%, and diffuse hyperplasia was 10.3%. The papillary carcinoma was the most common type of malignancy and its incidence was 78.7% in malignancy.
7. The incidence of intrathyroidal cancer without extrathyroidal extension was 43.2% and lymphnode metastasis was 23.3%, the cancer with extrathyroidals extension was 56.8%, and lymphnode metastasis was 45.6%, the incidence of the distant metastasis was 3.6%.
8. The secondary degenerative change of the benign nodules was calcification (5%), cystic change (40.2%) and hemorrhagic change (9.6%). In malignant nodules, calcification (22.5%). cystic change (20.7%) and hemorrhagic change (13.6%) were also seen.
9. The incidence of the occult thyroid cancer was 2.2%. All of that. were noted in female patients, and the incidence of metastasis to cervical lymphnode of this cases was 20%.
10. The common surgical procedure was lobectomy (43.1%) in benign nodules. Subtotal thyroidectomy.(28.4%), near total thyroidectomy (27.8%) and total thyroidectomy
(21.3%) were common surgical procedure of malignant nodules. The incidence of neck dissection was 16.6% in malignant case.
11. The incidence of the postoperative complication was 14.2% in thyroid surgery. The incidence of hemorrhage or hematoma was 0.9%, hypoparathyroidism was 1.3% and injury of the recurrent laryngeal nerve was 1.3%.
12. The postoperative complication was related to size of the nodules, pathologic.findings, extent of the cancer, types of operation and duration of operation. 13. The incidence of recurrence of the malignancy was 11.2%.
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