Bekir UÇAN, Muhammed Erkam SENCAR, Muhammed KIZILGÜL, Mustafa ÖZBEK, İlknur ÖZTÜRK ÜNSAL, Erman ÇAKAL

Mikropapiller tiroid kanserlerinde tümör çapına ve tek odak-çoklu odak oluşuna göre operasyon bulgularının değerlendirilmesi

Amaç: Mikropapiller kanserlere önerilen cerrahi şekli veya radyoaktif iyot (RAİ) verilip verilmemesi konusunda görüş birliği yoktur. Bu çalışmadaki amaç, mikropapiller tiroid kanserlerinde, tümör çapı ≤5 mm veya>5 mm olanlarda, ayrıca tek odak ve çok odak varlığında öncelikle cerrahi bulguların ve patoloji sonuçlarının dökümante edilmesidir. Gereç ve yöntem: 2008-2012 yılları arasında Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Endokrinoloji polikliğine başvuran toplam 209 mikropapiller tiroid kanserli hasta retrospektif olarak taranıp çalışmaya dahil edildi. Hastalar öncelikle tümör çapı ≤5 mm ve >5 mm olacak şekilde gruplandırıldı, ayrıca tümörün tek odak ya da çoklu odak oluşuna göre de sınıflandırıldı. Bulgular: 209 hastadan 103 (13 erkek, 90 kadın) hastada tümör çapı ≤5 mm olup grup 1, 106 (12 erkek, 94 kadın) hastada tümör çapı >5 mm olup grup 2 olarak sınıflandırıldı. Grup 1 için 20 (%22.2) hastada santral lenf nodu diseksiyonu yapılırken, grup 2 için bu sayı 40 (%43.5) hastaydı (p=0.002). Kapsül invazyonu grup 1’de 6 (%6) hastada, grup 2’de 20 (%19.4) hastada tespit edildi (p=0.004). Çoklu odak varlığı açısından gruplar arasında anlamlı farklıklık saptanmadı (grup 1’de 24 (%23.8), grup 2’de 33(%32); p=0.18). Lenf nodu metastazı grup 1’de 4 (%4) hastada, grup 2’de 13 (%12.6) hastada mevcut olup iki grup arasında anlamlı farklılık mevcuttu (p=0.027). Grup 1’de hiçbir hastada cerrahi sınırda tümör tespit edilmemişken, grup 2’de 5 (%5.1) hastada cerrahi sınırda tümör tespit edildi (p=0.025) Sonuç: Operasyon ve patoloji sonuçları değerlendirildiğinde 1 cm’nin altındaki tümörler her ne kadar mikropapiller kanserler başlığı altında tek olarak değerlendirilse de,tümör boyutunun 5 mm’nin üzerinde olmasi veya tümör boyutundan bağımsız olarak multifokal tümör varlığında daha sık rekürrens görülmektedir.

Anahtar Kelimeler:

Mikropapiller tiroid kanseri, tümör boyutu, prognoz

Evaluation of surgical results of micropapillary thyroid cancers according to tumor size and focality

Aim: There is no consensus regarding the recommended surgical approach in the treatment of micropapillary thyroid carcinoma (MTC) or whether additional treatment with radioactive iodine is necessary or not. The aim of this study was to investigate the surgical findings and pathological results of micropapillary thyroid cancer with tumor size of ≤5 mm or >5 mm and also in the presence of unifocal or multifocality. Material and Method: We enrolled 209 patients with MTC who underwent surgery at the Diskapi Training and Research Hospital between 2008 and 2012, in a retrospective study design. We divided patients into two groups according to whether tumor size of ≤5 mm or >5 mm and also categorized based on the presence of unifocal or multifocality. Results: One hundred and three patients (13 male, 90 female) with tumor size of ≤5 mm were categorized as group 1 and 106 patients (12 male, 94 female) with tumor size of >5 mm were categorized as group 2. Central lymph node dissection was more often performed in group 2 ( 40 (43.5%) to 20 (22.2%), p:0.002). Capsule invasion were identified in 6 (6%) of the patients in group 1 and in 20 (19.4%) of the patients in group 2 (p = 0.004). There was no statistically significant difference between the two groups regarding the presence of multifocality (24 (%23.8) patients in group 1 and 33 (%32) patients in group 2; p=0.18). Lymph node metastasis was more common in group 2 when compared to group 1 (4 (%4) to 13 (%12.6), p=0.027). Five patients (5%) with microscopically positive surgical margins were found group 2 however, none of the patients in group 1 had microscopically positive surgical margins (p:0.025). Conclusion: Although all tumors lower than 1cm categorized as micropapillary cancer, the recurrence of the disease is more common in the presence of tumor greater than 5mm or multifocal tumor regardless of size.

Keywords:

Micropapillary thyroid cancer, tumor size, prognosis,

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