Clinical Analysis Of Incidental Thyroid Nodules In Head And Neck Squamous Cell Carcinoma

ObjectivesCases of head and neck squamous cell carcinoma with incidental thyroid nodules were retrospectively analyzed, to determine the rate of malignancy in incidentally discovered thyroid nodules; to assess whether the presence of a pre-existing head and neck squamous cell carcinoma in a patient with a thyroid incidentaloma is associated with a higher rate of thyroid malignancy, to discuss the pathology distribution and surgery characteristics.Materials and MethodsCollect and analyze cases of patients with postoperative pathological report for head and neck squamous cell carcinomas in otolaryngology clinic, Qilu Hospital of Shandong University from March2003to March2014. Patients with incidentally discovered thyroid nodules and without neck surgical history were identified. Data of preoperative examinations, operation records, intraoperative and postoperative pathology reports were inspected and recorded to find information of primary tumor, surgery patterns, pathological results, postoperative recovery. Data analysis was performed using the excel software.Results25patients with incidentally discovered thyroid nodules were identified. There were22men and3women. The mean age for all patients was59.7±9.9years (range 41to75). The primary tumor included17cases of laryngeal cancer (supraglottic larynx cancer and glottis larynx cancer),6cases of hypopharynx cancer (including cancer involving cervical esophagus) and2cases of oropharynx cancer. The most common imaging modalities that discovered the incidental thyroid nodules were preoperative CT in22and physical exam in2. One patient had malignant thyroid nodule discovered after cervical surgery.21patients with thyroid nodules underwent surgery while4patients underwent observation. Thyroid surgical measures were similar to the conventional ones, including resection of thyroid nodules within the lobe, thyroid lobectomy, unilateral lobe with isthmus resection and total thyroidectomy. Final pathology showed thyroid adenoma in4, nodular goiter in13, thyroid malignant tumor (thyroid papillary carcinoma and follicular carcinoma) in3and other pathological type in1case. Only one patient had local infection of flap. Other complications, such as hemorrhage and fistula didn’t appear.ConclusionsThe detection rate of head and neck squamous cell carcinoma patients with incidentaloma was significantly lower than other literature report. It was also far lower than the regular physical examination detectione rate. In those patients, the malignant rate of thyroid nodules was12%which was similar to the patients with other pre-existing malignant tumor origin from digestive tract, breast and other organs or tissues. The malignant rate was significantly higher than common thyroid nodules (5%). The cervical enhanced CT scan in patients with head and neck carcinoma was the most important way to reveal thyroid incidentaloma. Surgery was the main treatment. The surgery of thyroid with other cervical maginant tumor had its own characteristics. So otolaryngologist should pay more attentions to head and neck squamous cell carcinoma with thyroid nodules and deal with those nodules during cervical surgery.