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Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease.

AIM
Aim of the study is to evaluate correlations between incidental thyroid carcinoma (ITC) and benign thyroid pathologies (BTP), to determine the most represented histotype and to point out the total thyroidectomy's possible advantages in terms of radicality, follow-up management and incidence of complications.


MATERIALS AND METHODS
During 10 years, 739 patients underwent thyroid surgery for BTP. Fine needle biopsy (FNAB) was negative in all cases; 503 total thyroidectomies (TT), 5 subtotal thyroidectomies (ST) and 231 emithyroidectomies (ET) were performed.


RESULTS
The specimens pathological examination revealed the presence of a ITC in 82 patients (11.1%); the prevalent histotype was the papillary one with a less than 1cm diameter in almost the totality of cases but with nodes metastasis in the 3.6% of cases. Complications were detected in 117 patients with a morbidity rate of 15.8%.


DISCUSSION
In our study the ITC prevalence was of 11.1% similar to literature with a higher incidence in patients affected by multinodular than uninodular goiter. No statistical significant differences were found between euthyroid and toxic pathologies. In our series hyperthyroidism doesn't seem to hold a protective role towards the ITC onset.


CONCLUSIONS
The ITC incidence is relevant; the prevalent histotype is papillary and nodes metastasis are present even if in a low percentage of cases. Besides, the complications of TT are similar to conservative procedures. The recurrence of goiter and ITC require a second surgical procedure, with a higher risk of complications. So we can claim that the standard surgical treatment of bilateral PBT would be represented by TT.