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INCREASING INCIDENCE OF THYROID CANCER IN RETROSTERNAL GOITRE
Author(s) -
Grodski S.,
Brown T.,
Gill A.,
Sywak M.,
Sidhu S.,
Delbridge L.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04118_11.x
Subject(s) - medicine , thyroid cancer , incidence (geometry) , thyroidectomy , thyroid , thyroid carcinoma , cancer , retrospective cohort study , surgery , gastroenterology , physics , optics
There has been a documented worldwide increase in the incidence of thyroid cancer attributed to increased surveillance. The aim of this study is to determine wether thyroid cancer incidence is also increasing in the group of patients with retrosternal goitre, who are not typically the subject of ultrasound surveillance. This is a retrospective clinical review of all patients undergoing thyroidectomy for retrosternal goitre over a 40 year period. Histology of all recorded thyroid cancers were reviewed by a single pathologist and reclassified according to current WHO criteria. Statistical analysis was performed using the chi‐square test. Between 1966 and 2005, 2026 patients were operated on for retrosternal goitre on a background of 13,793 thyroid procedures. While absolute numbers of retrosternal procedures remained stable, the rate as a percentage of all thyroid surgery dropped from 21% to 12% (p < 0.05). At the same time the percentage of retrosternal goitres with carcinoma increased from 3.6% to 8% (p < 0.05). However, if microcarcinomas (<10 mm) are excluded then the increase is only 2.9% to 4.3% (p = NS). Routine ultrasound surveillance is not relevant for patients with retrosternal goitre and hence the changes in thyroid cancer incidence in this study can not be attributed to this change in practice. This study has once again demonstrated an increasing incidence of thyroid cancer, however, there is no increase in the incidence of clinically significant cancers. This study removes surveillance as a confounding factor and has shown that the increasing incidence of thyroid cancer is due to increased reporting of microcarcinomas and that there is no increase in clinically significant cancers.