12. Forgotten goiter (FG). Lession learned from a multicentric experience

S S83 Introduction: FG is a rare disease defined as mediastinal thyroid mass discovered after total thyroidectomy. We report a multi-institutional experience of 4 University Centers. Methods: Data of all patients diagnosed with FO between the years 2001 and 2013 were collected and reviewed. Patients who underwent a previous “less than total” thyroidectomy were excluded. Results: Eleven patients (female:male ratio 1⁄4 8:3) were found to have FG. Mean age was 56.5 years (range 34e71), mean time between first operation and diagnosis was 10.6 years (range 1 month e 25 years). Seven patients were symptomatic: 6 had hyperthyroidism (3 with associated dyspnea), 1 progressively increasing dyspnea. Preoperative imaging modalities were as follows: cervico-mediastinal CT scan alone in 6/11, CT scan + scintigraphy in 3/11, ultrasound exam + scintigraphy in 2/11. Nine of the 11 patients underwent re-operation, while two did not (l waiting for treatment, 1 not operated for contraindications due to overall morbidity). Surgical approach consisted in cervicotomy alone in 4 patients, direct thoracic approach in 4 other patients, cervicotomy + sternotomy in 1 patient. Two of the 9 patients (22%) had an invasive thyroid cancer. Inferior laryngeal nerve palsy occurred in 4/9 patients (44%). No hypoparathyroidism reported. Conclusions: FG is often diagnosed in case of hyperthyroidism in patients who had a previous “supposed” total thyroidectomy. Although scintigraphy may help confirmation, CT scan is the gold standard to identify it and helps the surgeon to decide the better surgical approach. Thoracic approach is often necessary and its use should be considered in case of trans-cervical attempt for FG. Morbidity is quite high (4 nerve palsies out of 9 patients). Accurate preoperative evaluation is always mandatory at the time of initial surgery and intraoperative findings should always be compared with preoperative imaging, especially in case of cervicomediastinal goiter, in order to avoid further operations. http://dx.doi.org/10.1016/j.ejso.2015.08.088 13. Neck hematoma after thyroidectomy. Do antiplatelet/anticoagulant drugs use or coagulopathies affect it? A case control study from a single center on 3150 patients G. Donatini, L. Lacoste, V. Goudet, D. Frasca, M. Boisson, J.L. Kraimps 1 Department of Endocrine Surgery, CHU Poitiers, Poitiers, France Department of Anesthesia, CHU Poitiers, Poitiers, France Introduction: Antiplatelet/anticoagulant drugs (A) and coagulopathies (B), are reported to be risk factors for neck hematoma requiring reoperation (NH) after thyroidectomy. We evaluate the role of A and B in NH. Methods: Between January 2008 and July 2014 data of all patients scheduled for thyroid surgery were collected, identifying patients to be included in group A/B. Analysis of postoperative course was performed, comparing the rate of NH in A/B and control (CG) groups. Within group A , subgroups were defined dependent from different type of drugs (Aspirin, Clopidogrel, Vitamine-K-Antagonist (VKA), prophylactic LMWH). Univariate analysis was performed. Results: There were 56 NH on 3150 patients (1.8%) in the study period. NH developed respectively in 38/2832 patients in CG (1.3%) and in 18/318 patients of A/B (5.7%). Subgroup analysis for NH in A reported: 2/116 Aspirin (1.7%), 2/63 Clopidogrel (3.1%), 13/97 VKA (13.4%), 0/28 prophylactic LMWH and 1/14 in group B (7.1%). Differences were statistically significant comparing CG versus whole A/B (p<0.00001) and CG versus subgroup VKA (p<0.00001). No differences (p 1⁄4 ns) were found comparing CG neither to Aspirin or Clopidogrel patients. Reoperation for NH was needed in CG and A/B respectively in 36/38 (95%) and 9/ 18 (50%) patients within the first 24 hours and 2/38 (5%) versus 9/18 (50%) patients after 24 hours (p<0.00001). Of the latter group, 8 patients were under VKA. Conclusions: The rate of NH after thyroidectomy is 4-fold increased in patients of A/B group. No significant differences for the subgroups of Aspirin (75 mg), Clopidogrel, prophylactic LMWH use and group B were reported. VKA subgroup reported a 10-fold higher incidence compared to CG. Half of the NH reported in group A/B developed after 24 hours from surgery. A strict post-operative and post-discharge surveillance is mandatory for A/B group patients, given the late NH occurrence. Outpatient surgery is contraindicated. http://dx.doi.org/10.1016/j.ejso.2015.08.089 14. Thyroid cancer e Is it picked up on pre-operative cytology? An audit of cases from 2014 in Newcastle upon Tyne Nicola Lynch, Sarah J. Johnson Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK Introduction: Thyroid FNA cytology is reported using RCPath “Thy” categories 1-5. Audit is recommended to monitor use of the categories and so local PPV of malignancy is known. The target is 100% PPV for malignancy of Thy5 cytology. The aim of this audit was to assess the cytology categories preceding histological diagnosis of thyroid cancer. No standard is provided so artificial standards were set: (1) all thyroid cancers should have had at least Thy3a cytology; (2) all non-follicular cancers should have had Thy5 cytology and all follicular carcinomas should have had Thy3f cytology. A secondary aim was to see if central review of externally reported cytology improved diagnosis. Methods: For all thyroid cancers reported on histology in Newcastle in 2014 the preceding cytology reports were reveiwed. Incidental microPTCs were excluded, also cases without cytology. Results: 32 Newcastle cases and 12 reviews were audited. The tumour types were 27 PTCs (6 presenting as neck lymph node masses), 7 follicular carcinomas and 10 other cancer types (1 DTC, 2 PDC, 2 ATC, 2 MTC, 1 MEC, 1 NEC, 1 NHL). 42 of 44 (95.5%) fulfilled the first artificial standard, having at least Thy3a cytology. Only 25 of 44 (56.8%) cases fulfilled the second artificial audit standard. For non-follicular cancers, 21/37 (56.8%) had Thy5/malignant cytology (including 6 PTC LN metastases), 12/37 had Thy4 (32.4%), 1/37 Thy3f (PTC), 2/37 Thy3a (PTC, ATC) and 1/37 Thy2 (PTC). For follicular carcinomas, 4/7 (57.1%) had Thy3f cytology, 2/7 Thy3a and 1/7 Thy1c. Central review of cytology at NUTH improved the cytology category in 6/12 cases (50%), three to Thy5 and three to Thy4. Conclusion: Although many thyroid cancers are accurately predicted on cytology, there is room for improvement in thyroid cytology reporting. Central cytology review adds value to local external reports for the diagnosis of thyroid cancer. http://dx.doi.org/10.1016/j.ejso.2015.08.090 15. Histopathological features and outcomes of poorly differentiated thyroid carcinoma Jay Goswamy, Jean-Pierre Jeannon, Johnathan Hubbard, Ash Chandra, Rose Ngu, Mufaddal Moonim, Edward Odell, Paul Carroll, Jake Powrie, Hosahalli Mohan, Mary Lei, Ricard Simo Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Introduction: Poorly differentiated thyroid carcinomas (PDTC) represent a rare group of thyroid cancers, often regarded as anaplastic carcinomas and therefore not treated with curative intent. Current literature is limited when reporting, histopathological features, treatment options and outcomes. The aim of this paper is to describe our experience of managing this group of patients and to provide evidence for an optimal treatment algorithm.