A modified neck dissection for carcinoma of the thyroid

Anterior neck dissection for carcinoma of the thyroid gland

Anterior neck dissection, a regional neck dissection in which the internal jugular chain of nodes is dissected completely but the posterior triangle is left undisturbed, has been developed by us. Metastases of carcinoma of the thyroid to cervical lymph nodes were studied clinically and pathologically in 54 patients who had undergone therapeutic total neck dissections in order to determine selection guidelines for anterior neck dissections. If the 7 patients in whom nodes in the posterior triangle of the neck were palpable preoperatively were eliminated, there were 47 evaluable patients for this portion of the study. Nine (19%) of the 47 patients had nonpalpable but histologically positive nodes in the posterior triangle. If these patients were divided into 4 groups, I, II, III, and IV in which the number of palpable nodes in each was 1, 2, 3, and 4 or more, respectively, the incidence of microscopically positive nodes in each group was 1/20 (5%), 2/11 (18%), 2/8 (25%), and 4/8 (50%), respectively. Twenty-one evaluable anterior neck dissections were performed and followed from 4 to 9 years postoperatively. In 18 patients, there was a single palpable node and in 3 patients, there were 2 palpable nodes. No nodal recurrence has occurred in the necks with a single palpable node, but there has been one recurrence in the group with 2 palpable nodes. We conclude that anterior neck dissection is beneficial to patients with a single palpable node in carcinoma of the thyroid in reducing cosmetic disfigurement and preserving function.

The solitary thyroid nodule: diagnosis and management of malignant disease

While few solitary thyroid nodules are carcinomatous, it is essential to identify and preferentially select those that are for surgery. Clinical, biochemical, serologic, radiographic, scintigraphic, sonographic, biopsy, and even therapeutic evaluation may be necessary to choose those patients with the greatest probability of malignancy. The benefits and limitations of each diagnostic modality are discussed, and the importance of fine-needle aspiration is stressed. After the operative confirmation of malignancy, the prognosis in any given case depends on 1) the histologic type of the neoplasm, 2) its size and extent, 3) the presence of angioinvasiveness, 4) the tendency toward multicentricity of the lesion, 5) the age and sex of the patient, and 6) whether distant metastases are present. These factors influence the extent of surgery required for well-differentiated carcinomas. Meticulous dissection and preservation of the recurrent laryngeal nerves and the parathyroid glands along with their blood supply are important if total thyroidectomy for papillary carcinoma is to be employed with an acceptable operative morbidity to optimize survival. The value of the adjunctive use of thyroid hormone and radioactive iodine is also discussed. Finally, the clinical behaviors and treatments of undifferentiated carcinomas, sarcomas, lymphomas, and neoplasms metastatic to the thyroid gland are reviewed.

Carcinoma of the thyroid gland in Iran

Of the 1698 cases of thyroid disease seen during the 17 years 1956-72 in the Taj Cancer Institute, Tehran, 398 were cases of carcinoma, an incidence of 23.4 per cent. The factors involved in this high incidence of malignancy are discussed and the treatment of these patients is described.

Thyroid cancer in young patients in Great Britain

Recent collective experience with thyroid cancer in children in Britain is reported. Fifteen out of 16 patients with papillary carcinoma treated in the years 1962–7 are still living at least 5–10 years later; the sixteenth patient died of an unrelated cause. Two patients with follicular carcinoma also survived. Seven deaths between 1957 and 1970 were due to anaplastic or medullary carcinomas and 1 death was caused by a papillary carcinoma.

These data emphasize that in the treatment of papillary carcinoma we should take account of its prolonged natural history. Radical operations which have serious associated morbidity do not appear to be indicated.