D. Ladurner

A Fourteen Year Practice With the Fine Needle Aspiration Biopsy of the Thyroid in an Endemic Area

In our institute from 1970 to 1983 12,829 fine needle aspiration biopsies (FNB) of the thyroid were cytologically examined. Cytologically unsatisfactory specimens were found in 17.7%. 2,709 patients with representative cytological findings were operated and histological examinations were performed. The cytological and histological findings were correlated. There was a false-negative rate of 2.0% and a false-positive rate of 18.4%. Furthermore we divided the results into two time periods (1970-1977 and 1978-1983) because of a change in the indication for surgery in the last years. Although the indication has changed, cytological findings of both time periods investigated were almost similar.

Das papilläre Schilddrüsencarcinom — Prognose und prognostische Faktoren

Summary90 papillary thyroid carcinomas (operated on between 1952 and 1977) were retrospectively analysed. The median follow-up is 5.29 years (range 0.08–29.42 years). After the primary operation only 68.9% of all patients may be classified as “tumor free”. The lethality rate from thyroid cancer is 28.9%, the cumulative survival rates at 10 and 20 years are 50.92% and 32.06%, respectively. Thus survival is not significantly different from the one of our follicular carcinomas. The whole material was characterized thoroughly by clinical and morphological parameters. The simultaneous examination of the variables as to their prognostic relevance was performed by means of a loglogistic regression model for survival data. Age, extension of primary tumor, vascular invasion and presence of colloid determined prognosis. For the histopathological practice a differentiation between vascular and lymphatic invasion is demanded.Zusammenfassung90 papilläre Schilddrüsencarcinome (Operation 1952-1977) wurden retrospektiv analysiert. Die mediane beobachtete Überlebenszeit beträgt 5,29 Jahre (Spannweite 0,08–29,42 Jahre). Nur 68,9% aller Patienten können nach der Erstoperation als „tumorfrei” klassifiziert werden. Die tumorbedingte Todesrate liegt bei 28,9%, die kumulative Überlebensrate nach 10 Jahren bei 50,92%, nach 20 Jahren bei 32,06%. Somit besteht kein signifikanter Unterschied zur Überlebensrate bei unseren folliculären Schilddrüsencarcinomen. Das Gesamtmaterial wurde durch klinische und morphologische Parameter ausgiebig charakterisiert. Die simultane Untersuchung der Variablen auf ihre prognostische Relevanz erfolgte mit einem regressionsanalytischen Modell, basierend auf einer log-logistischen Verteilung für die Überlebenszeit. Als prognosebestimmend erweisen sich Alter, Tumorstadium, Blutgefäßeinbrüche und Kolloidproduktion. Für die histopathologische Praxis wird die Differenzierung zwischen Blutgefäß- und Lymphgefäßeinbrüchen gefordert.

Die endemische Struma vor und nach der Kropfprophylaxe

Between 1952 and 1977 there has been a considerable change in the type of goitre operated on in the endemic area of the Austrian Tyrol. Iodine prophylaxis had proved significantly more effective in men: the consequences appear earlier and extend into the middle age groups. As a result, the type of surgical specimen is much more like that seen in non-endemic areas. The incidence of diffuse colloid goitre decreased, as that of adenomatous goitre increased. Among the adenomas, the number of the colloid-rich form has increased. Instead of diffuse or multinodular goitre one now frequently encounters the symptom-free, often uninodular, goitre. The total number of goitre operations has also decreased.

Endemic goitre before and after goitre prophylaxis.

Between 1952 and 1977 there has been a considerable change in the type of goitre operated on in the endemic area of the Austrian Tyrol. Iodine prophylaxis had proved significantly more effective in men: the consequences appear earlier and extend into the middle age groups. As a result, the type of surgical specimen is much more like that seen in non-endemic areas. The incidence of diffuse colloid goitre decreased, as that of adenomatous goitre increased. Among the adenomas, the number of the colloid-rich form has increased. Instead of diffuse or multinodular goitre one now frequently encounters the symptom-free, often uninodular, goitre. The total number of goitre operations has also decreased.

Endemic goitre before and after measures to prevent goitre.

Between 1952 and 1977 there has been a considerable change in the type of goitre operated on in the endemic area of the Austrian Tyrol. Iodine prophylaxis had proved significantly more effective in men: the consequences appear earlier and extend into the middle age groups. As a result, the type of surgical specimen is much more like that seen in non-endemic areas. The incidence of diffuse colloid goitre decreased, as that of adenomatous goitre increased. Among the adenomas, the number of the colloid-rich form has increased. Instead of diffuse or multinodular goitre one now frequently encounters the symptom-free, often uninodular, goitre. The total number of goitre operations has also decreased.

[Endemic goitre before and after goitre prophylaxis (author's transl)].

Between 1952 and 1977 there has been a considerable change in the type of goitre operated on in the endemic area of the Austrian Tyrol. Iodine prophylaxis had proved significantly more effective in men: the consequences appear earlier and extend into the middle age groups. As a result, the type of surgical specimen is much more like that seen in non-endemic areas. The incidence of diffuse colloid goitre decreased, as that of adenomatous goitre increased. Among the adenomas, the number of the colloid-rich form has increased. Instead of diffuse or multinodular goitre one now frequently encounters the symptom-free, often uninodular, goitre. The total number of goitre operations has also decreased.