ISSN:8756-0437    

DOI:10.1002/ssu.2980070202

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSince the incidence of cancer in nontoxic nodular goiter as reported by us in 1944 appeared high (17.1%), we made another study during the next four years and discovered an incidence almost identical (17.2%). Our figures on incidence of cancer in nontoxic nodular goiter appeared so high because we were the first authors to break down the goiters into the three different types and to discover that the incidence was high in only one type of goiter and not in the others. The incidence of cancer was only 4.6% in toxic nodular and toxic diffuse goiter added togetherFor decades, we have known that goiter is a geographic disease. It is possible that carcinoma of the thyroid is slightly geographical. At least it appears that there is a slightly geographical relationship in regard to the 16 patients we have observed in our clinic with cancer during 1944–1949; of these 16 patients, 11 had advanced malignant disease. We cannot have accurate figures on results regarding treatment of our cases until long‐term follow‐up is conc

ISSN:8756-0437    

DOI:10.1002/ssu.2980070203

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe first consideration in evaluating the thyroid nodule is whether it is functioning and causing hyperthyroidism. Autonomous nodules should be treated with either surgery or 1–31, with surgery favored due to the possibility, although small, of malignancy. Thyroid scans are no longer recommended during the initial evaluation of the thyroid nodule. Ultrasound is useful in determining the size of the nodule and whether it is multinodular thyroid disease, but it cannot detect thyroid cancer. Fine needle aspiration biopsy is currently the procedure of choice for evaluating all thyroid nodules. For accuracy of the cytological analysis, it is important that adequate tissue samples be obtained. False negative findings are of most concern to the clinician and occur in 2–10% of reported fine needle aspiration biopsy series. Nodules thought to be benign will need continued follow

ISSN:8756-0437    

DOI:10.1002/ssu.2980070204

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe rational treatment of thyroid diseases requires an understanding of the thyroid function and an accurate evaluation of its functional (endocrine), as well as it morphological alteration. There are several different imaging techniques which are available and are in use in the evaluation of thyroid diseases. In this article we present a protocol for the use of diagnostic imaging to evaluate a focal thyroid mass, a diffusely enlarged gland, regional, and distant metastatic disease. The current diagnostic applications of radionuclide scanning, ultrasound, computed tomography, and magnetic resonance imaging (MRI) will be discussed.

ISSN:8756-0437    

DOI:10.1002/ssu.2980070205

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractAs only 10% of thyroid nodules are malignant, the surgical oncologist is faced with the challenge of selecting for thyroidectomy only those patients likely to benefit therapeutically from surgery. Demonstration of nonfunction on scintigraphic thyroid scan increases the yield of cancer only by 15% to 20%. Aspiration cytology and needle biopsy are potent aids in selecting patients for thyroidectomy. In 1,504 patients for whom a benign or malignant cytological diagnosis was made prior to thyroidectomy, the sensitivity of this technique was 92.0%, specificity was 97.3%, and overall diagnostic accuracy 95.7%. Morbidity is minimal. The reliability of these techniques is dependent on proficient specimen procurement and the cytopathologist's expertise and experience. Differentiation of benign from malignant follicular and lymphocytic lesions is not possible with conventional cytology preparations; 28% of such “indeterminant” lesions prove to be cancer at thyroidectomy. Aspiration cytology is a simple, reliable technique for selection of patients with thyroid nodules for surg

ISSN:8756-0437    

DOI:10.1002/ssu.2980070206

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe clinical behavior and mortality rate of papillary carcinoma of the thyroid varies widely, and clinically insignificant microscopic foci of the disease are frequently found. Dietary iodine and radiation to the head and neck in childhood play a role in etiology. Needle aspiration cytology provides a highly accurate diagnosis. Ultrasound, radioactive iodine, and technetium scans are not specific and should only be used to complete diagnostic studies when aspiration cytology is negative for papillary carcinoma. The most important aspect of prognosis of an individual patient with papillary carcinoma of the thyroid is the age at which the disease is diagnosed, with an excellent prognosis, even in advanced primary disease or extensive lymph node involvement, in children and young adults. A multifactorial clinical risk group definition (AMES) is easy to use and reliably separates patients into low risk and high risk. Since 90% of patients with this disease rarely have metastases or late complications from the cancer, total or subtotal thyroidectomy is necessary in only 10% of cases for later use of postoperative radioactive iodine. More conservative surgical procedures are advised in low‐risk patients. Papillary carcinoma incidentally found during operation for other conditions such as Graves disease or thyroiditis and reported first on the permanent pathology reports are always clinically insignificant and completely cured by removal; total thyroidectomy should be completely avoided. Postoperatively, thyroid hormone supplementation may be unnecessary after relatively conservative surgery in selected low‐risk patients. Thyroid hormone must be maintained permanently after total or subtotal thyroidect

ISSN:8756-0437    

DOI:10.1002/ssu.2980070207

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractFollicular carcinoma deserves a careful preoperative evaluation and multidisciplinary therapy planning. Needle aspiration may be of less value than for other thyroid lesions. If the surgeon is suspicious of a carcinoma, a total lobectomy of the involved side and frozen section may be indicated. Lobectomy with or without isthmusectomy seems to be the minimal treatment for tumors confined to the lobe without nodal metastases. Total thyroidectomy is reserved for patients at high risk by nature of age, large lesions, angioinvasion, capsular invasion, or known metastatic disease where subsequent I‐131 therapy is considered likely. I‐131 scanning for metastatic disease is indicated in these high‐risk patients. I‐131 therapy is very valuable for treatment of metastatic disease; and in patients presenting with metastatic disease, total thyroidectomy may be indicated to maximize the therapeutic benefit of the I‐131. Judicious planning and care of these patients can result in a 50 to 70% total cure and as high as 85% long‐te

ISSN:8756-0437    

DOI:10.1002/ssu.2980070208

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractMedullary thyroid carcinoma (MTC) accounts for 5–10% of thyroid malignancies and occurs in either a sporadic or a familial form. The familial form is inherited in an autosomal dominant pattern, and expressed clinically as multiple endocrine neoplasia (MEN), types IIa and IIb, or as familial MTC alone. This neoplasm is derived from the parafollicular or C‐cells, and has the ability to secrete a variety of polypeptide hormones including calcitonin, which serves as a tumor marker for the presence of MTC. The development of a calcitonin radioimmunoassay and the screening of patients at risk for the familial forms of MTC allows the diagnosis of the neoplasm in an occult stage when total thyroidectomy results in virtually 100% cure. We will present our experience with the diagnosis, treatment, and postoperative follow‐up of our patients with this interesting neo

ISSN:8756-0437    

DOI:10.1002/ssu.2980070209

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractDecisions concerning the extent of surgical treatment for thyroid cancer remain controversial. Limited surgical procedures, designed to remove only the cancer that is clinically evident, can be successful since the primary determinants in survival are age, sex, and histologic type rather than number of positive nodes or other factors. A retrospective review of 339 patients who had surgical procedures for cancer of the thyroid at MDA hospital from 1975 to mid‐1989 did not show a conclusive advantage for any type of neck dissection. The operations were tailor‐made to include all evident clinical cancer. Secondary procedures such as surgery, radioactive iodine, or radiation therapy were successful in treating recurrences, which occurred in all surgical groups, whether limited or radi

ISSN:8756-0437    

DOI:10.1002/ssu.2980070210

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe incidence of thyroid cancer was analyzed based on data provided by cancer registration in Japan and also based on data for 11, 104 cases of thyroid cancer registered at the Japanese Committee for Registration of Malignant Neoplasm of Thyroid (JCR‐MNT) from 1977 through 1986Incidence rates for men and women gradually increased over the study period from 1959 through 1985. The age‐adjusted rates for 1985 showed 1.1 per 100,000 for men and 3.1 per 100,000 for women. The higher rates were observed in Hiroshima and Nagasaki cities. Male to female ratio was 1:6 in papillary and follicular carcinomas and 1:2 in medullary and anaplastic carcinomas. Papillary, follicular, and medullary carcinomas are more common in the fifth and sixth decades of life while anaplastic carcinoma is more common in the elderly. The age‐specific rates by histological classification showed no change over the study period of 1977 through 1986. The increased incidence could be attributed to improvements in diagnostic proce

ISSN:8756-0437    

DOI:10.1002/ssu.2980070211

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY