Bronchoscopic Diagnosis of Thyroid Cancer with Laryngotracheal Invasion

Hypothesis: Some controversy exists concerning the appropriate surgical management for patients with thyroid cancer invading the laryngotracheal wall. We have used shaving of the wall when cancer invasion was confined to the perichondrium, and extensive resection when it invaded further. Preoperative assessment of the depth and length of laryngotracheal invasion is important when choosing an appropriate surgical procedure.

Design: Prospective study.

Setting: A Japanese center for thyroid diseases, where about 1400 thyroid operations are performed each year.

Patients: Of 171 patients with thyroid cancer who were surgically treated between January 1, 2000, and July 30, 2000, 37 were suspected to have laryngotracheal invasion on preoperative magnetic resonance imaging or ultrasonography.

Intervention: We used bronchoscopy to examine the 37 patients suspected to have laryngotracheal invasion.

Main Outcome Measure: Bronchoscopic findings (localized mucosal redness, telangiectasia, mucosal elevation, mucosal edema, and mucosal erosion) were compared with pathological results in the 30 patients who underwent curative resections. Seven patients were excluded because of palliative resections.

Results: Of the 18 patients without localized mucosal changes, we performed shaving of the laryngotracheal wall in 4 patients because we found laryngotracheal invasion during surgery. Shaving of the laryngotracheal wall was performed successfully in terms of obtaining a cancer-free margin. Twelve patients with localized mucosal redness required extensive resections. Other mucosal changes were found depending on the depth of cancer invasion.

Conclusion: Surgeons should perform extensive resections when encountering localized mucosal redness on bronchoscopy.