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ABSTRACT: PURPOSE: Anaplastic thyroid cancer (ATC) is a lethal disease causing a global disproportionate number of thyroid cancer-related deaths. The American Thyroid Association (ATA) has recently produced clear and comprehensive guidelines to assist physicians treating ATC. METHODS: The recent ATA guideline publication was reviewed. A systematic review of studies indexed in Medline and Pubmed was also undertaken using search terms relevant to ATC. RESULTS: Patients with ATC have a median survival of 5 months and less than 20% survive 1 year. Early tumor dissemination results in 20-50% percent of patients having distant metastases and 90% having adjacent tissue invasion on presentation. This highlights the necessity for effective combined therapy. Stage IVA/ IVB, resectable disease may benefit from a multimodal (surgery, IMRT for loco regional control, and systemic therapy) approach. However, a majority of patients present with unresectable locoregional disease. Early palliative care involvement is inclusive of life-prolonging therapies. ATC management demands rapid, complex and integrated multidisciplinary decision making. CONCLUSION: In this article we discuss the multidisciplinary strategies that exist to optimize the management of these patients in accordance with the recent guidelines from The American Thyroid Association.
Oral Oncology 04/2013; · 2.86 Impact Factor
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ABSTRACT: Thyroid cancer metastasizes to regional lymph nodes early and often. The impact of these metastases on outcome depends on the histological subtype and the size, number and location of those metastases, as well as patient's age. Whilst clinically apparent lateral nodal metastases have a significant impact on both survival and recurrence, microscopic metastases to the central as well as lateral neck in well differentiated thyroid cancer (WDTC) do not affect outcome. In this review article we discuss the lymphatic drainage of the thyroid gland, and assessment of regional lymph nodes. We go onto describe the impact that nodal metastases have on outcome, before discussing the role of therapeutic and prophylactic neck dissection. Whilst all authors support the use of therapeutic neck dissection, there is considerable controversy over prophylactic central neck dissection. Despite a significant rate of occult disease in the central compartment of clinically negative necks, removal of this tissue results in morbidity without improving outcome. The role of the neck node metastases in decision making in relation to adjuvant radioactive iodine is discussed as is the process of post operative surveillance, and the role of observation in small volume persistent nodal disease. The focus of this article is WDTC, however the principles of management of the neck in medullary and anaplastic carcinoma are also discussed.
Oral Oncology 04/2013; · 2.86 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: Recent advances in the understanding of the biological basis for thyroid cancer have identified molecular changes in thyroid cancer cells. These changes form the basis for targeted therapies, which have been investigated with some success in patients with advanced, inoperable thyroid cancers and are the subject of this review. RECENT FINDINGS: For patients with advanced differentiated thyroid cancers, sorafenib, selumetinib, pazopanib and sunitinib have been investigated with promising results. In the setting of advanced medullary thyroid cancer, vandetanib now has FDA approval, whereas sorafenib, sunitinib and cabozantinib have shown activity in early studies. For patients with anaplastic thyroid cancer, no targeted therapy has been proven to be effective in vivo, although preclinical work on various kinase inhibitors has shown promise. Despite the potential for disease response, significant cardiac, gastrointestinal and skin-related side effects are reported for all therapies, limiting their application outside the setting of incurable disease. SUMMARY: Inoperable thyroid cancer still has a poor prognosis, however, the introduction of targeted therapies offers the hope of longer quality of meaningful life for this small group of patients.
Current opinion in otolaryngology & head and neck surgery 02/2013;
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ABSTRACT: An area of ongoing controversy in the management of patients with differentiated thyroid cancer is the role of prophylactic central neck dissection (pCND). This review describes the natural history of differentiated thyroid cancer and provides the limited data regarding the role of routine pCND. An evidence-based analysis was performed of the rationale for routine pCND was performed, including reduced rates of central neck recurrence, reduced morbidity with secondary central neck lymphadenectomy, improved rates of postoperative athyroglobulinemia, and improved stratification of radioactive iodine (RAI) dosage. A critical appraisal of the available literature demonstrates insufficient evidence to indicate that this extra procedure performed routinely leads to improvement in clinically meaningful end points.
Annals of Surgical Oncology 02/2013; · 4.17 Impact Factor
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Alfio Ferlito,
Robert P Takes,
Carl E Silver,
Primož Strojan,
Missak Haigentz,
K Thomas Robbins,
Eric M Genden,
Dana M Hartl, Ashok R Shaha,
Alessandra Rinaldo,
Carlos Suárez,
Kerry D Olsen
Archives of Oto-Rhino-Laryngology 01/2013; · 1.29 Impact Factor
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Archives of Oto-Rhino-Laryngology 01/2013; · 1.29 Impact Factor
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Tihana Ibrahimpasic,
Ronald Ghossein,
Diane L Carlson,
Natalya Chernichenko,
Iain Nixon,
Frank L Palmer,
Nancy Y Lee, Ashok R Shaha,
Snehal G Patel,
R Michael Tuttle,
Alfons Jm Balm,
Jatin P Shah,
Ian Ganly
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ABSTRACT: To describe the outcome of patients with poorly differentiated thyroid cancer (PDTC) presenting with gross extrathyroidal extension (ETE). After IRB approval we performed retrospective review of consecutive series of thyroid cancer patients treated by primary surgical resection with or without adjuvant therapy at MSKCC from 1986-2009. Out of 91 PDTC patients, 27 (30%) had gross ETE (T4a) and they formed the basis of our study. Of 27 patients, 52% were female. The median age was 70 (range 27-87). Ten patients (37%) presented with distant metastases; four to the bone, three to lung and three had both bone and lung metastases. All patients had extended total thyroidectomy except two who had subtotal thyroidectomy. 20 patients (74%) had central compartment neck dissection and 11 also had lateral neck dissection. Four patients had pN0, 6 (30%) pN1a and 10 (50%) pN1b neck disease. 21 patients (77%) had adjuvant therapy: 15 (55%) RAI only, 3 (11%) postoperative external beam radiation (PORT) only and 3 (11%) had both RAI and PORT. Overall survival (OS), disease specific survival (DSS), local recurrence free survival (LRFS) and regional recurrence free survival (RRFS) were calculated by the Kaplan Meier method. Median follow-up time was 57 months (range 1-197 months). The 5 year OS and DSS were 47% and 49% respectively. This poor outcome was due to distant metastatic disease; 10 patients had distant metastases at presentation and a further 6 developed distant metastases during follow up. Locoregional control was good with 5 year LRFS and RRFS of 70% and 62% respectively. Overall, 8 patients (30%) had recurrences: 2 had distant alone, 2 regional, 2 regional and distant, 1 local and distant, and 1 had local, regional and distant recurrence. Aggressive surgery in patients with PDTC showing gross ETE resulted in satisfactory locoregional control. Due to the small proportion of patients who received PORT (22%), it is not possible to analyze its benefit on locoregional control. Of significance is the observation that the majority of patients (60%) who presented with or subsequently developed distant metastases eventually died of distant disease. New systemic therapies to target distant metastatic disease are required for improvements in outcome.
Thyroid: official journal of the American Thyroid Association 01/2013; · 2.60 Impact Factor
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ABSTRACT: OBJECTIVES/HYPOTHESES: The Voice Handicap Index (VHI) is a simple, reliable, self-administered questionnaire that has been used to identify negative voice outcomes after thyroidectomy. This study provides an updated report of a multiyear study examining the predictive ability of the VHI to classify normal versus negative voice outcomes (VOs). STUDY DESIGN: Prospective observational, longitudinal study of the patient reported impact of voice changes after thyroidectomy using the VHI. Since the preliminary report, the sample size doubled and methods for classifying voice outcomes (VOs) were refined. METHODS: Ninety-one adults provided voice assessment data preoperatively (baseline) and at approximately 2 weeks postthyroidectomy. VO was defined according to endoscopic laryngeal examination, acoustic, auditory perceptual, and patient report parameters. The VHI was tested for its sensitivity and specificity for identifying VO. RESULTS: Twenty-two participants (24.2%) qualified as having adverse VOs during the early postoperative period. A change from baseline in VHI of 13-16 points had a diagnostic accuracy of 86% sensitivity and 88% specificity for classifying early VO and had 70% and 95% positive and negative predictive values, respectively. The Functional and Physical subscales of the VHI had higher predictive value than the Emotional subscale. Adjunctive analyses of a two-subscale version of the VHI and of the 10 items that comprises the VHI-10 also revealed high predictive value for differentiating groups by VO. CONCLUSIONS: Balanced sensitivity and specificity are achieved at a change in the total VHI score of 13-16. These results are generally consistent with several other studies examining voice problems over time. The VHI, as well as its alternate versions, appear to be useful and should be incorporated into the diagnostic process for identifying patients with voice problems after thyroidectomy.
Journal of voice: official journal of the Voice Foundation 01/2013; · 0.95 Impact Factor
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Eric J Sherman,
Yungpo Bernard Su,
Ashima Lyall,
Heiko Schoder,
Matthew G Fury,
Ronald A Ghossein,
Sofia Haque,
Donna Lisa, Ashok R Shaha,
R Michael Tuttle,
David G Pfister
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ABSTRACT: BACKGROUND: Historically, systemic therapy for radioactive iodine (RAI)-refractory thyroid cancer has been understudied. Available drugs have modest efficacy. Romidepsin is a histone deacetylase inhibitor with potent anti-tumor effects both in vitro and in vivo. In thyroid cancer cell lines, romidepsin increases expression of both thyroglobulin and the sodium iodide symporter (NIS) messenger RNAs, suggesting the possibility of improved iodine concentrating ability of RAI-resistant tumors. METHODS: This was a single institution Simon 2-stage Phase II clinical study. Eligible patients had progressive, RAI-refractory, recurrent/metastatic, non-medullary, non-anaplastic thyroid cancer. RECIST 1.0 measurable disease and adequate organ/marrow function were required. Romidepsin 13 mg/m2 IV was administered on days 1, 8, 15, every 28 days. The primary endpoint was response rate by RECIST (Response Evaluation Criteria In Solid Tumors) criteria; change in RAI avidity was a secondary endpoint. The study closed after the first stage due to the lack of response. RESULTS: 20 patients were enrolled: female-50%; median age-64 years; histology-papillary (8)/follicular (1)/Hürthle (11). Grade 4-5 adverse events possibly related to drug: grade 5 sudden death (1); grade 4 -pulmonary embolus (1). Twelve of 20 subjects had a reported adverse event. No RECIST major responses have been seen. Response per protocol: stable disease (13); disease progression (7). Restoration of RAI avidity was documented in 2 patients. Median overall survival and time on study was 33.2 (1-71+) and 1.7 (0.46-12) months, respectively. CONCLUSIONS: We observed preliminary signs of in vivo reversal of RAI resistance after treatment with romidepsin. However, no major responses were observed and accrual was poor after the grade 5 AE.
Thyroid: official journal of the American Thyroid Association 11/2012; · 2.60 Impact Factor
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ABSTRACT: INTRODUCTION: The incidence of well differentiated thyroid cancer (WDTC) is rising in the USA. The objective of this study is to present the changes in incidence, presentation, management and outcomes of WDTC within our institution over the past 8 decades. METHODS: 2797 patients managed between 1932-2005 at Memorial Sloan Kettering Cancer Center were identified from our institutional database. RESULTS: There has been an increase in the number of patients managed per decade. Although the median age was 45 years, patients managed post-1985 were more likely to be over 45 years (53% versus 44%, p<0.001). The percentage of women increased from 68% to 72% (p=0.026), and the percentage of papillary carcinomas also increased, from 78% to 92%, p<0.001. An increase in early stage tumors was observed with pT1 lesions increasing from 19% to 48%. Patients in the latter cohort were less likely to have thyroid lobectomy (29% versus 72%, p<0.001). There was a significant change in the use of RRA, with 8% of the early versus 44% of the latter group receiving post-operative RRA (p<0.001). Since the introduction of risk group stratification disease specific survival (DSS) has not changed significantly. With a median follow up of 90 months, 10 year DSS rates were below 90% in the cohort managed prior to the 1970s, which rose to >95% thereafter (p<0.001). CONCLUSIONS: Older patients with earlier stage disease present an increasing workload for surgical oncologists. Excellent outcomes remain unchanged despite increasingly aggressive surgical and medical management.
International journal of surgery (London, England) 11/2012;
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ABSTRACT: BACKGROUND: Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery. DATA SOURCES: PubMed literature searches were performed to identify original studies. CONCLUSIONS: Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.
American journal of surgery 10/2012; · 2.36 Impact Factor
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Primoz̆ Strojan,
Alfio Ferlito,
Jesus E Medina,
Julia A Woolgar,
Alessandra Rinaldo,
K Thomas Robbins,
Johannes J Fagan,
William M Mendenhall,
Vinidh Paleri,
Carl E Silver, [......],
Jochen A Werner,
Phillip K Pellitteri,
Remco de Bree,
Gregory T Wolf,
Robert P Takes,
Eric M Genden,
Michael L Hinni,
Vanni Mondin, Ashok R Shaha,
Leon Barnes
Head & Neck 09/2012; · 2.40 Impact Factor
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ABSTRACT: Distant metastases at presentation are rare in well-differentiated thyroid cancer (WDTC). The objective of this study was to report outcomes for patients presenting with distant metastases managed by thyroidectomy and radioactive iodine (RAI) therapy.
Fifty-two patients with distant metastases from thyroid cancer diagnosed before thyroid surgery (n=32) or on a postoperative RAI scan after thyroid surgery (n=20) were identified from a database of patients with WDTC treated between 1985 and 2005. The median age was 58 years (range 12-83 years), with a male-to-female ratio of 3:2. Forty-seven patients (90%) had total thyroidectomy and two (4%) had thyroid lobectomy, and three patients (6%) were found to be unresectable. Distant metastases were classified into pulmonary and extrapulmonary. Overall survival (OS), disease-specific survival (DSS), and locoregional recurrence-free survival were calculated by the Kaplan-Meier method. Factors predictive of the outcome were determined by univariate and multivariate analyses.
Thirty-nine patients (75%) were diagnosed with pulmonary metastases alone and 13 (25%) with extrapulmonary metastases. The sites of extrapulmonary metastases were bone in nine, mediastinum in one, pyriform sinus in one and skin in one, and one patient had synchronous lung, bone, and intracerebral metastases. After thyroid surgery, 47 patients (90%) were treated with RAI alone, and 2 patients had external beam radiation in addition to RAI. With a median follow-up after surgery of 78.5 months, the 5-year OS and DSS were 65% and 68%, respectively. Twenty-nine patients (56%) died during follow-up, of whom 24 (46%) died of thyroid cancer. Six patients (12%) developed recurrent disease in the lateral neck, and three patients (6%) developed recurrence in the thyroid bed. Over 45 years, follicular pathology and extrapulmonary metastases were predictive of lower 5-year DSS (56% vs. 100%, p<0.001; 50% vs. 70%, p=0.004; and 46% vs. 75%, p=0.013, respectively).
Approximately half of patients with WDTC presenting with distant metastases die of disease within 5 years of initial diagnosis despite thyroid surgery and RAI. Age over 45 years, extrapulmonary metastases, and follicular pathology were significant predictors of the poor outcome.
Thyroid: official journal of the American Thyroid Association 07/2012; 22(9):884-9. · 2.60 Impact Factor
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ABSTRACT: The overall prognosis in patients with differentiated thyroid cancer is excellent. The loco-regional recurrence and mortality are higher in patients with high-risk thyroid cancers. Patients initially presenting with locally aggressive and advanced thyroid cancer have a higher incidence of recurrent disease in the thyroid bed or nodal metastases. These patients also have a high incidence of distant metastases. Locally recurrent thyroid cancer may be seen in approximately 30% of patients with aggressive differentiated thyroid cancer. Recurrent disease in the thyroid bed can be a difficult problem to manage because of the proximity of the tumor to the recurrent laryngeal nerve, visceral structures in the central compartment, and occasional involvement of the trachea or larynx. External beam radiation therapy after surgery maybe important for better local control in the thyroid bed region especially in patients with poorly differentiated histology. The role of additional radioactive iodine remains undefined at this stage. Management of recurrent thyroid cancer requires a truly multidisciplinary approach. These patients require very close follow-up, with cross sectional imaging and PET scan in select individuals.
Endocrine Practice 07/2012; · 2.49 Impact Factor
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Ashok R Shaha
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ABSTRACT: To discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification.
Common risk factors associated with recurrent thyroid cancer are outlined, and appropriate management strategies are reviewed.
The overall prognosis in patients with differentiated thyroid cancer is excellent. Factors associated with recurrent thyroid cancer include extrathyroidal extension of the primary tumor, bulky nodal metastatic lesions, macroscopic local invasion, and aggressive histologic subtypes. The locoregional recurrence and mortality are higher in patients with high-risk thyroid cancers. Patients initially presenting with locally aggressive and advanced thyroid cancer have a higher incidence of recurrent disease in the thyroid bed or nodal metastasis. These patients also have a high incidence of distant metastatic lesions. Locally recurrent thyroid cancer may be seen in more than 25% of patients with aggressive differentiated thyroid cancer. Recurrent disease in the thyroid bed can be a difficult problem to manage because of the proximity of the tumor to the recurrent laryngeal nerve, visceral structures in the central compartment, and occasional involvement of the trachea or larynx. External beam radiation therapy after surgical treatment may be important for better local control in the thyroid bed region, especially in patients with poorly differentiated histologic features. The role of additional radioiodine therapy remains undefined at this stage.
Management of patients with recurrent thyroid cancer necessitates a true multidisciplinary approach. These patients require close follow-up, with cross-sectional imaging and positron emission tomographic scanning in selected individuals.
Endocrine Practice 07/2012; 18(4):600-3. · 2.49 Impact Factor
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ABSTRACT: Background Distant metastases at presentation are rare in well differentiated thyroid cancer (WDTC). The objective of this study is to report outcomes for patients presenting with distant metastases managed by thyroidectomy and radioactive iodine therapy. Methods 52 patients with distant metastases from thyroid cancer diagnosed prior to thyroid surgery (n=32) or on post-op RAI scan following thyroid surgery (n=20) were identified from a database of patients with WDTC treated between 1985-2005. The median age was 58 years (range 12-83 years), with a male to female ratio of 3:2. Forty-seven patients (90%) had total thyroidectomy, 2 (4%) thyroid lobectomy , and 3 patients (6%) were found to be unresectable. Distant metastases were classified into pulmonary and extrapulmonary. Overall survival (OS), disease specific survival (DSS) and locoregional recurrence free survival (LRRFS) were calculated by the Kaplan Meier method. Factors predictive of outcome were determined by univariate and multivariate analyses Results 39 patients (75%) were diagnosed with pulmonary metastases alone and 13 (25%) with extrapulmonary metastases. The sites of extrapulmonary metastases were bone in 9, mediastinum in 1, pyriform sinus in 1, skin in 1, and 1 patient had synchronous lung, bone and intracerebral metastases. Following thyroid surgery 47 patients (90%) were treated with RAI alone and 2 patients had external beam radiation in addition to RAI. With a median follow up after surgery of 78.5 months, the 5-year OS and DSS were 65% and 68% respectively. 29 patients (56%) died during follow up, of whom 24 (46%) died of thyroid cancer. 6 patients (12%) developed recurrent disease in the lateral neck and 3 patients (6%) developed recurrence in the thyroid bed. Age over 45yrs, follicular pathology and extrapulmonary metastases were predictive of lower 5yr DSS ( 56% vs 100%, p<0.001; 50% vs 70% , p=0.004 and 46% vs. 75%, p=0.013 respectively). Conclusion Approximately half of patients with WDTC presenting with distant metastases die of disease within 5 years of initial diagnosis despite thyroid surgery and RAI. Age over 45 years, extrapulmonary metastases and follicular pathology were significant predictors of poor outcome.
Thyroid: official journal of the American Thyroid Association 05/2012; · 2.60 Impact Factor
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Robert P Takes,
Alessandra Rinaldo,
Carl E Silver,
Missak Haigentz,
Julia A Woolgar,
Asterios Triantafyllou,
Vanni Mondin,
Daniela Paccagnella,
Remco de Bree, Ashok R Shaha,
Dana M Hartl,
Alfio Ferlito
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ABSTRACT: The incidence of distant metastasis in head and neck squamous cell carcinoma (HNSCC) is relatively low but remains a major determinant of prognosis and therefore an important factor in clinical decision making. The most frequently involved sites for distant metastasis are the lung (approximately 70% of cases), followed by bone and liver. There are often conflicting reports on which parameters are risk factors for distant metastasis, but the most important predictive factors appear to be the site of the primary tumor (hypopharynx in particular), advanced T- and N-classification, histological grade and the ability to achieve locoregional disease control. Metastasis results from a selection of tumor cells that have acquired the properties to withstand multiple and often unfavorable circumstances and settle in distant organs. Most of these processes involve interaction between tumor cells, their microenvironment and host factors. Increasing knowledge of the biology of distant metastasis may result in the development of diagnostic and therapeutic strategies targeted to this usually terminal stage for patients with HNSCC.
Oral Oncology 04/2012; 48(9):775-9. · 2.86 Impact Factor
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Remco de Bree,
Missak Haigentz,
Carl E Silver,
Daniela Paccagnella,
Marc Hamoir,
Dana M Hartl,
Jean-Pascal Machiels,
Vinidh Paleri,
Alessandra Rinaldo, Ashok R Shaha,
Robert P Takes,
C René Leemans,
Alfio Ferlito
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ABSTRACT: The detection of distant metastases is critical for prognostication and for the choice of treatment in patients with head and neck squamous cell carcinoma (HNSCC). Pretreatment screening for distant metastases should be conducted particularly for patients with high risk factors, prior to locoregional treatment decisions. Different diagnostic techniques are discussed. Unfortunately, most studies lack sufficient follow-up to reliably assess false-negative results. Moreover, the designs of most studies vary substantially with regard to homogeneity of groups (tumor types and stages), timing (pretreatment, follow-up) and definition of risk factors (patient selection). Therefore, only a few studies are comparable. The combination of F-18 fluoro-d-glucose-positron emission tomography (FDG-PET) and a dedicated CT (at least of the chest) is the most important imaging protocol at the present time. Eventually, whole-body-MRI (WB-MRI) may possibly replace PET-CT for screening patients for distant metastases.
Oral Oncology 04/2012; 48(9):780-6. · 2.86 Impact Factor
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ABSTRACT: Objective The optimal type of neck dissection in head and neck squamous cell carcinoma (SCC) with clinical cervical metastases has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients. Study Design Case series with planned data collection. Settings Single institution, cancer center. Methods and Subjects Patients with cervical lymph node metastases from mucosal cancers of the head and neck who were treated with SND from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, adjuvant treatments, locoregional control, and survival were recorded. Recurrence in the neck and disease-specific survival (DSS) were primary and secondary end points. Results One hundred eight patients underwent SND. Sixty-nine (64%) were male. Median age was 62 (20-89) years. The most common primary site was the oral cavity (71.3%). Ninety-five (88%) received adjuvant treatment. Median follow-up was 21 months. Six patients (5.5%) had isolated recurrence in the dissected neck. Patients with N2C disease had poorer neck recurrence-free survival. At the end of study, 64 (59.3%) patients had no evidence of disease, and 23 (21.3%) had died of disease. Two-year DSS was 76.9%. Number of positive nodes (P = .026) and positive surgical margins (P = .001), among others, were predictors of poorer DSS. Conclusion In a highly selected group of patients with cervical lymph node metastases from head and neck SCC, selective neck dissection is effective in controlling the disease in the neck when performed in the setting of a multimodality treatment, including adjuvant radiotherapy or radiochemotherapy.
Otolaryngology Head and Neck Surgery 04/2012; 147(4):707-15. · 1.72 Impact Factor
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ABSTRACT: Introduction:The role of fine-needle aspiration (FNA) and frozen section (FS) in the management of thyroid neoplasms continues to generate considerable controversy. We reviewed our recent experience to determine the clinical utility of FNA and FS in our surgical management and intraoperative decision-making.Methods:All patients who had operations for thyroid disease between January 1996 and June 1999 were identified in our prospective database. Completion and incidental thyroidectomies were excluded. Data obtained from the pathology files included FNA, FS, and the final histologic diagnosis.Results:Five hundred sixty-four patients, including 409 women (73%), with a median age of 50 years (range, 6–94) were identified, of whom 293 (52%) had cancer diagnosed on permanent sections. Three hundred twenty-nine patients (58%) had evaluable FNA, of which 91 (28%) were benign, 94 were malignant (28%), and 144 (44%) were suspicious (46% of these were malignant on final). Frozen section was performed in 397 (70%) patients; of these samples, 170 (43%) were found to be benign, 106 (27%) were malignant, and 121 (30%) were deferred (46% malignant on final). Fine-needle aspiration positively identified 51% of confirmed malignancies; 13% of patients with malignancy had a benign FNA result. Total thyroidectomy was performed in 64% of malignant tumors and 29% of benign thyroid disease (P < .001). Logistic regression revealed no association of extent of surgery with FNA results. A frozen section positive for malignancy was associated with total thyroidectomy (P < .001, RR 6 [CI 3–10]), and a negative frozen section report was associated with lobectomy (P < .05, RR 0.5 [CI 0.3–0.96]). Frozen sections results altered the preoperative plan in only 29 patients (5%).Conclusion:Results of preoperative FNA had no direct impact on the selection of the surgical procedure in this selected cohort. Intraoperative FS added very little to surgical management. The majority of thyroid operations at this institution are planned and performed based on known prognostic factors and intraoperative findings.
Annals of Surgical Oncology 04/2012; 8(2):92-100. · 4.17 Impact Factor
