The Reason Of Misdiagnosis And Discussion About Reoperation Of Thyroid Carcinoma

Thyroid carcinoma is the frequent malignant tumor of cervical part, it accounts for roughly 1% of all malignant disease, about 4% in thyroid disease,the majority patients are female,the incidence is 1.49/100000.Majority of thyroid carcinoma are differentiated and have good prognosis,surgery is the main method for treatment.But thyroid carcinoma have not specificness symptom and examination,so the rate of diagnosis is very low,and usually need reoperation because misdiagnosis.The article retrospective analysis was performed on 27 patients with reoperation of thyroid carcinoma because of misdiagnosis,among the total,21 cases were other hospital′patients,6 cases were our hospital′patients , the proportion is 22.7% ( 27/119 ) in homochronous operation of thyroid carcinoma,the misdiagnosis rate is 6.1%(6/98) in our hospital.To analyze the reason of misdiagnosis and observe effect of reoperation. The mean age of 27patients(2 men,25women) was 38.3 years,below 40 years is 17.21 patients were performed on them first operation on the other hospital,19 cases had received nodule enucleating , 1 cases had received partial thyroidectomy,all didn't performed on frozen section, postoperation pathologic diagnosis is thyroid papillary carcinoma ; 1 cases preoperative diagnosis is tumor colli,performed on tumorectomy, postoperation pathologic diagnosis is metastatic carcinoma of lymph node,the origin is thyroid.6 patients was performed with them first operation on our hospital,preoperative diagnosis are nodular goiter or thyroid adenoma,all had received nodule enucleating or partial thyroidectomy,2 cases didn't performed on frozen section,2 cases's result of frozen section is benign tumor,2 cases hadn't make the diagnose of frozen section.Postoperation pathologic diagnosis is thyroid microcarcinoma or thyroid follcular carcinoma.Preoperative examination of the first operation only include physical examination,ultrasonic inspection and laboratory examination.21 patients who was performed with them first operation at the other hospital make the physical examination and ultrasonic inspection enter our hospital,10 case were discovered thyroid cancer remnants,10 case were discovered lymphadenectasis.The interval between two operation is from 5 day to 4 years,the interval below 1 month is 23 case.The second operation 23 case performed with lobectomy and isthmectomy plus opposite side subtotal thyroidectomy, among the total 5 cases were performed with neck dissection of the region II-IV,2 cases were performed with neck dissection of the region VI,total thyroidectomy was performed in 1 cases,1 cases was performed in total Thyroidectomy plus neck dissection of the region II-IV,VI,2 cases were performed with modified neck dissection.After reoperation the pathologic result confirm that 14 case have thyroid cancer remnants,among the total 12 cases were performed on first operation at the other hospital.the rate of thyroid cancer remnants is 51.9%.10 case were performed with selective neck dissection or modified neck dissection,pathologic result confirm that 4 case have lymph node metastasis of the region VI.After reoperation haven't complication.The following up time is 3-27month,no case find local recurrence,complication and no patient die.The reason of misdiagnosis have some aspect below:all cases by misdiagnosis are differentiated thyroid carcinoma,specific symptom and auxiliary examination which can make diagnose are very little so diagnose is very hard;the young doctor don't realize that the incidence of thyroid carcinoma rise and the patient become younger,especially for young female patient;method of preoperative diagnosis is unity,only by physical examination and ultrasonic inspection make the diagnose,didn't performed with any other examination;frozen section didn't performed in 23 case,2 case diagnose benign tumor,2 case cann't diagnose.Dis-appropriate operation can make thyroid cancer remnants,and reoperation is a energetic remedy measure.Before reoperation should make detailed examination,master the information of thyroid cancer remnants and lymph node metastasis.When reoperation should be expand the range of part that need to cut,include lobectomy and isthmectomy plus opposite side subtotal thyroidectomy,after sample being cut should perform with frozen section so that can make sure if cutting edge have cancer,if have remnants should perform with total Thyroidectomy.How to deal with the lymph node metastasis should be depend on the result of ultrasonic inspection,if have metastasis should choose the selective neck dissection or modified neck dissection;if havn't also should explore the lymph node of the region VI,when discover doubtful lymph node should resect.All case take operation according to the method with above.When operation we adopt the method that separation by follow fibrous capsule of thyroid gland,and expose recurrent laryngeal nerve so that can make it not to be injury.All operation's result is satisfactory,hasn't complication, after operation the following up time is 3-27month,no case find local recurrence.Above all, the rate of diagnosis of thyroid carcinoma before operation is low,the reason of misdiagnosis is versatility.and should increase the diagnosis level of clinician.For the patient being misdiagnosis should perform with reoperation,before reoperation should detailed examination,according to different condition perform with different treatment for every patient.Choose the reasonable modality of operation,and careful operation,the condition about reoperation should be good,recurrence rate and complication are low,the whole result is satisfactory.