Bronchoscopic diagnosis of thyroid cancer with laryngotracheal invasion

Hypothesis: Some controversy exists concerning the appropriate surgical man agement 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. Preoperativ e assessment of the depth and length of laryngotracheal invasion is importa nt when choosing an appropriate surgical procedure. Design: Prospective study. Setting: A Japanese center for thyroid diseases, where about 1400 thyroid o perations are performed each year. Patients: Of 171 patients with thyroid cancer who were surgically treated b etween January 1, 2000, and July 30, 2000, 37 were suspected to have laryng otracheal invasion on preoperative magnetic resonance imaging or ultrasonog raphy. Intervention: We used bronchoscopy to examine the 37 patients suspected to have laryngotracheal invasion. Main Outcome Measure: Bronchoscopic findings (localized mucosal redness, te langiectasia, mucosal elevation, mucosal edema, and mucosal erosion) were c ompared 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 laryngo tracheal invasion during surgery. Shaving of the laryngotracheal wall was p erformed successfully in terms of obtaining a cancer-free margin. Twelve pa tients 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.