Thyroglossal Duct Carcinoma: A Case Series and Approach to Management

Manipadam, John Mathew; Manipadam, Marie Therese; Thomas, E; Michael, Rajiv C; Ramakant, Pooja; Abraham, Deepak Thomas; Paul, Mazhuvanchary Jacob

doi:10.5005/jp-journals-10002-1058

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…They recommended a total thyroidectomy with neck dissection only if lymph node metastases were found on ultrasound or during surgery; followed by radioiodine therapy (14). Some investigators have recommended that a total thyroidectomy must be performed in all patients with TGDC carcinoma, as it could decrease the risk of disease recurrence in future (15,16). In our experience, the benefit of performing a total thyroidectomy in addition to the Sistrunk procedure, in the absence of a suspicious thyroid lesion is questionable.…”

Section: Managementmentioning

confidence: 93%

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Mahajan,

Deokar,

Suryavanshi

et al. 2023

Front. Oncol.

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IntroductionThyroglossal duct cyst (TGDC) is the most frequently encountered developmental anomaly in thyroid genesis with a reported incidence of 7% in the adult population. The cyst is known to develop anywhere along the pathway of thyroid descent but is more frequently seen in the infrahyoid neck in the midline. The incidence of malignancy in a TGDC is approximately 1%; a majority of these are papillary carcinomas. This study was conducted at a single tertiary care centre which spanned over a decade which adds practice changing evidence-based knowledge to existing literature on this rare entity. A comprehensive study which conclusively establishes the imaging features predictive of malignancy in TGDC carcinomas (TGDCa), the protocol for optimal management, clinical outcome and long-term survival of these patients is not available. Although TGDC carcinoma is thought to have an excellent prognosis, there is not enough data available on the long-term survival of these patients. The aim of this study was to identify whether neck ultrasound (US) can serve as an accurate imaging tool for the preoperative diagnosis of TGDC carcinomas.MethodsWe accessed the electronic medical records of 86 patients with TGDC between January 2005 to December 2021. Of these, 22 patients were detected with TGDC papillary carcinoma on histopathologic examination. Relevant imaging, treatment and follow up information for all cases of TGDC carcinoma were retrospectively reviewed. We compared US characteristics predictive of malignancy across outcomes groups; malignant vs benign using the Chi-square test. Based on the results, a TGC-TIRADS classification was proposed with calculation of the percentage likelihood of malignancy for each category.ResultsCompared to benign TGDCs, malignant TGDCs were more likely to present with following US characteristics: irregular or lobulated margins (90.40 vs. 38.10%), solid-cystic composition (61.90 vs. 17.07%), internal vascularity (47.62 vs. 4.88 %), internal calcification (76.19 vs. 7.32 %) (each p value < 0.005). Calcifications and internal vascularity were the most specific while irregular/lobulated margins were the most sensitive feature for malignancy. AUC under the ROC curve was 0.88. Allpatients were operated and were disease free at the end of 5 years or till the recent follow up.DiscussionUS is the imaging modality of choice for pre-operative diagnosis of TGDC carcinoma. Thepre-operative diagnosis and risk stratification of thyroglossal lesions will be aided by the application of the proposed TGC-TIRADS classification, for which the percentage likelihood of malignancy correlated well with the results in our study. Sistrunk procedure is adequate for isolated TGDC carcinoma; suspicious neck nodes on imaging also necessitates selective nodal dissection. Papillary carcinomas have an excellent prognosis with low incidence of disease recurrence.

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Section: Managementmentioning

confidence: 93%

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Mahajan,

Deokar,

Suryavanshi

et al. 2023

Front. Oncol.

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“…Few studies in which the patient belongs to low risk group showed no recurrence after Sistrunk procedure [15]. Most literatures advocate minimum of total thyroidectomy as treatment of choice in view of possible multifocality of the tumour as well as clear surgical margin from Sistrunk procedure alone [13,15,16]. When nodal metastases are detected preoperatively, total thyroidectomy and regional neck dissection are recommended in addition to Sistrunk procedure.…”

Section: Incidental Carcinoma On Thyroglossal Cystmentioning

confidence: 99%