FREQUENCY AND HISTOPATHOLOGICAL SPECTRUM OF MALIGNANCY IN NON-TOXIC MULTINODULAR GOITRE: A CROSS-SECTIONAL STUDY

Abstract

Objective:

To examine the histopathological range of thyroid malignancy and its frequency in patients with Non-Toxic Multinodular Goitre (NTMNG) undergoing surgery.

Material & Methods:

This descriptive cross-sectional study examined the sample population in the Surgical Unit II, Department of General Surgery, of Jinnah Postgraduate Medical Centre (JPMC), Karachi. The sample population included 113 patients with euthyroid NTMNG who underwent a clinically indicated thyroidectomy within six months of NTMNG surgery after obtaining ethical approval from the institution. Demographic and clinical details were entered. Data related to the procedure and the histopathology of the thyroid were also documented. The categorical variables, for which comparisons were required, were analyzed by using appropriate exact tests. A P-value of <0.05 was taken to indicate the presence of a significant relationship.

Results:

The average age of the study population was 44.3 (range, 35-52) years. There were 94 females (83.2% of the total population). 10.6% (n=12) (95% CI 6.2% to 17.6%) were diagnosed with malignancy after histopathological examination. Of those confirmed with malignancy (n=12), 10 cases (83.3%) were diagnosed with papillary carcinoma and 2 cases (16.7%) were diagnosed with follicular carcinoma. Multinodular goitre, which was bilateral (p=0.034), compressive goitre symptoms (p<0.001), and palpable cervical lymphadenopathy (p<0.001) were significantly associated with malignancy. Lymphadenopathy and the compressive symptom of goitre were also significantly associated with the nature of surgery (p=0.001). Family history of malignancy was not significantly associated with multinodular goitre.

Conclusion:

Approximately one in ten surgically managed patients with NTMNG had malignancy on final histopathology, most commonly papillary carcinoma. Cervical lymphadenopathy and suspicious clinical presentation should prompt careful preoperative risk stratification.