OP98 – Incidence of Malignancy within Intrathoracic Goitres (ITGs) – Evaluation and Clinical Implications

     

    Khosla, Shivun1, Simo, Ricard1, Nixon, Iain1, Tikka, Theofano1, Jeannon, Jean-Pierre1, Ngu, Rose1, Chandra, Ash1, Moonim, Muffadal1, Carroll, Paul1, Tharavaj, Selvam1
    1 Head and Neck and Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom

     

    Background: Ultrasound-guided fine needle aspiration (USS-FNAC) is now the gold standard tool for evaluating patients with thyroid nodules with a false-negative rate of < 3%. However, the utility of USS-FNAC in the evaluation of Intrathoracic Goitres (ITGs) remains controversial.

    Objectives: 
    To determine the value of USS-FNAC in the evaluation of ITG, to determine the incidence of cancer in ITG and establish the clinical implications of this diagnosis.

    Methods: 
    A review of 237consecutive patients undergoing surgery for ITG from 2004 to 2016 was undertaken. All patients were evaluated with USS-FNAC and cytology results of Thy3 or above were discussed in the thyroid multidisciplinary oncology meeting before surgery. Data on cytological and histological analysis was collected prospectively and analyzed.

    Results: 
    Nineteen patients were diagnosed with thyroid cancer. The rate of malignancy in ITG is 8.01%. Twelve patients had benign pre-operative benign cytology results and resulting in a rate of unexpected occult malignancy of 0.46%. 18 patients had Papillary Thyroid Cancer and 1 patient Medullary Thyroid Cancer. Of the 13 patients undergoing initial hemithyroidectomy, 7 underwent completion surgery due to multicentricity or tumour stage. The USS-FNAC had a sensitivity of 33% and specificity 93.3% to exclude cancer.

    Discussion & Conclusion: 
    Surgery for ITG is challenging. It requires accurate evaluation and a multidisciplinary approach by specialised teams. USS-FNAC has poor sensitivity (33%) but high specificity (93.3%) to exclude cancer in ITGs. Patients undergoing initial hemi-thyroidectomy and diagnosed of cancer may need to undergo completion thyroidectomy due to the stage of tumour.

 

Leave a Reply

  • Upcoming Events

     

    World Congress on Thyroid Cancer 3.5
    June 20 – 22, 2019
    Rome, Italy

    World Congress on Thyroid Cancer 4.0
    July 29 – August 1, 2021
    Boston, Massachusetts

     

  • WCTC3.5 Steering Committee:

     

    Rocco Bellatone, Co-Chair
    Celestino Lombardi, Co-Chair
    Gregory W. Randolph, MD
    Bryan McIver, MD
    Jeremy Freeman, MD
    Ian J. Witterick, MD
    Ashok R. Shaha, MD
    Jatin P. Shah, MD