TİROİDEKTOMİ SONRASI REZİDÜ DOKU TESPİT EDİLEN DİFERANSİYE TİROİD KARSİNOMLU HASTALARIN BAŞVURU ÖZELLİKLERİ, TEDAVİ VE TAKİP SONUÇLARI Presentations and Outcomes of Patients with Residual Tissue After

Yıl 2019, Cilt: 9 Sayı: 2, 120 - 126, 28.06.2019

Derya Çayır Bahadır Külah Mehmet Bozkurt

Öz

ÖZET

Amaç: Postoperatif radyoaktif iyot (RAI) ablasyonu, diferansiye tiroid karsinomlarında (DTK) tiroidektomi sonrası tamamlayıcı

tedavi seçeneklerinden birisidir. Tiroidektomi sonrası rezidü dokunun değerlendirilmesi, postoperatif RAI

ablasyonunun etkinliği açısından önemlidir. Çalışmamızda total tiroidektomi (TT) sonrası rezidü doku tespit edilmiş

DTK’lı olgularda başvuru özellikleri, tedavi ve takip sonuçlarını retrospektif olarak inceledik.

Hastalar ve Metod: Ocak 2014-Temmuz 2018 tarihleri arasında tiroidektomi sonrası patoloji sonucu DTK olarak

raporlanan, postoperatif sintigrafide rezidü tiroid dokusu tespit edilmiş 187 (165 kadın, 22 erkek) hasta çalışmaya

dahil edildi. Yaş, cinsiyet, ultrasonografi bulguları, ince iğne aspirasyon biyopsi (İİAB) sonuçları, yapılan cerrahi girişimin

tipi, tümör çapı, multifokalite, postoperatif serum tiroglobulin (Tg) düzeyi, tiroid sintigrafisi, RAI ablasyonu ve

lokorejyonel rekürrens gibi parametreler Windows için SPSS 18.0 programı ile Mann Whitney-U, Kruskal Wallis ve

ki-kare testleri kullanılarak değerlendirildi. P değeri < 0,05 ise anlamlı kabul edildi.

Bulgular: Tüm hastaların tiroidektomi spesimenlerinin histopatolojik değerlendirme sonucu DTK iken, ameliyat öncesi

sadece 44’ünde (%24) İİAB sonucu malign ya da malignite şüphesi olarak raporlanmıştı. 45 yaşından büyük

hasta grubunda papiller tiroid mikrokarsinomu (PTMK) anlamlı olarak daha sık gözlendi (p <0,05). Cerrahi girişimin

tipi 110 (%59) olguda TT, 77 (%41) olguda TT+santral lenf nodu diseksiyonu (SLND) şeklinde idi. Non-insidental olgularda

postoperatif rezidü doku anlamlı olarak düşük sıklıkta bulundu. Rezidü doku, preoperatif ultrasonografide

2 cm’den büyük çapta veya ikiden fazla nodül saptanan olgularda anlamlı olarak daha sık izlendi. Olguların 106’sına

(%57) RAI ablasyonu uygulandı. Olguların 11’inde (%14) lenf nodu metastazı (LNM), 8’inde (%4,3) kapsül invazyonu

ve 10’unda (%5) ekstratiroidal yayılım gözlendi.

Sonuç: Multinodüler guatr yada Graves hastalığı gibi benign nedenlerle tirodektomi geçirmiş, patoloji sonucu DTK

olarak bildirilmiş hastalarda rezidü tiroid dokusu varlığına anlamlı olarak sık rastlanılmaktadır. Preoperatif dönemde

İİAB sonucu malign yada malignite şüphesi olarak bildirilmiş olgularda, nodül çapının 2cm’den büyük olması ya da

nodül sayısının ikiden fazla olması halinde postoperatif rezidü tiroid dokusu varlığı riski anlamlı yüksek bulunmuştur.

Anahtar kelimeler: Tiroid karsinomu; Tiroidektomi; Sintigrafi

ABSTRACT

Aim: Postoperative radioactive iodine (RAI) ablation is one of the options for complementary treatment after

thyroidectomy of differentiated thyroid carcinoma (DTC). The evaluation of the residual tissue after thyroidectomy

is important for the effectiveness of RAI ablation. In our study, we evaluate the presentation and outcomes of the

patients with residual thyroid tissue and aimed to identify the risk factors related with the presence of the residual

thyroid tissue.

Patients and Methods: 187 (165 female, 22 male) patients, were reported as DTC and postoperative scintigraphy

revealed residual thyroid tissue between January 2014 and July 2018, were enrolled in the study. The parameters

including age, gender, ultrasonography findings, fine needle aspiration cytology (FNAC) reports, type of the surgery,

tumour diameter, multifocality, postoperative serum thyroglobulin (Tg) levels, thyroid scintigraphy, RAI ablation,

and locoregional recurrence were compared by Mann Whitney-U, Kruskal Wallis, and qi-square test in SPSS 18.0

for Windows software. P value is accepted as significant if below 0.05.

Results: Thyroidectomy specimens of all patients were reported as DTC, Preoperatively only in 44 (24%)

patients were reported as malign or suspicion of malignancy according to the results of FNAC. Papillary thyroid

microcarcinoma (PTMC) was significantly more common in the group of patients older than 45 (p <0.05). Surgical

intervention was performed as only TT in 110 (59%) cases, TT+central lymph node dissection (CLND) were done in

77 (41%) cases. Postoperative residual tissue was significantly more common in incidental cases. Residual tissue

was also significantly more common in cases with a nodule diameter longer than 2 cm and more than two nodules

on preoperative ultrasonographic evaluation.. RAI ablation was administered in 106 (57%) of the cases. Lymph

node metastasis (LNM) was observed in 11 (14%) cases, capsular invasion in 8 (4.3%) cases, and extrathyroidal

extension in 10 (5%) cases.

Conclusion: Risk of the presence of the residual thyroid tissue is found significantly high in patient with incidental

diagnosis. Patients have a thyroid nodul larger than 2cm or number of the thyroid nodules more than two carry a

significantly higher risk of the residual thyroid tissue

Keywords: Thyroid carcinoma; Thyroidectomy; Scintigraphy

Anahtar Kelimeler

TİROİDEKTOMİ SONRASI REZİDÜ DOKU TESPİT EDİLEN DİFERANSİYE TİROİD KARSİNOMLU HASTALARIN BAŞVURU ÖZELLİKLERİ

Kaynakça

• 1. Kaliszewski K, Zubkiewicz-Kucharska A, Kiełb P, Maksymowicz J, Krawczyk A, Krawiec O. Comparison of the prevalence of incidental and non-incidental papillary thyroid microcarcinoma during 2008-2016: a single-center experience. World J Surg Oncol. 2018;16(1):202. 2. Nikiforov YE, Steward DL, Robinson-Smith TM, Haugen BR, Klopper JP, Zhu Z, et al. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab. 2009;94(6):2092-8. 3. Ertorer ME, Tutuncu NB, Ozyilkan O. Incidental papillary microcarcinoma of the thyroid. Asian Pac J Cancer Prev. 2007;8(4):631-4. 4. Kaliszewski K, Wojtczak B, Strutyńska-Karpińska M, Łukieńczuk T, Forkasiewicz Z, Domosławski P. Incidental and non-incidental thyroid microcarcinoma. Oncol Lett. 2016;12(1):734-40. 5. Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahey TJ 3rd. Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid. 2009 May;19(5):473-7. 6. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214. 7. Khammash NF, Halkar RK, Abdel-Dayem HM. The use of technetium-99m pertechnetate in postoperative thyroid carcinoma. A comparative study with iodine-131. Clin Nucl Med. 1988;13(1):17-22. 8. Ozdemir D, Cuhaci FN, Ozdemir E, Aydin C, Ersoy R, Turkolmez S, et al. The role of postoperative Tc-99m pertechnetate scintigraphy in estimation of remnant mass and prediction of successful ablation in patients with differentiated thyroid cancer. Nucl Med Commun. 2016;37(6):640-5. 9. Ha S, Oh SW, Kim YK, Koo do H, Jung YH, Yi KH, et al. Clinical Outcome of Remnant Thyroid Ablation with Low Dose Radioiodine in Korean Patients with Low to Intermediate-risk Thyroid Cancer. J Korean Med Sci. 2015;30(7):876-81. 10. Rosario PW, dos Santos JB, Calsolari MR. Follow-up of patients with low-risk papillary thyroid carcinoma and undetectable basal serum thyroglobulin after ablation measured with a sensitive assay: a prospective study. Horm Metab Res. 2013;45(12):911-4.