Risk of Malignancy in Long-Standing Goiters: A Retrospective Study at Khartoum Teaching Hospital, Sudan

TL;DR

This study found that nearly a third of long-standing goiters in Sudan had malignancy, with follicular carcinoma being the most common type, emphasizing the need for careful evaluation.

Contribution

The study provides new regional data on malignancy risk in long-standing goiters, highlighting the prevalence of follicular carcinoma in Sudan.

Findings

Malignancy was found in 32.5% of patients with long-standing goiters.

Follicular carcinoma was the most common subtype of thyroid cancer identified.

Nine percent of malignant cases were discovered incidentally during surgery.

Abstract

Background: Goiter is a common condition in Sudan, often presenting with a wide range of clinical features. While the risk of malignancy in long-standing goiters is generally considered low, it remains a clinical concern, especially with a prolonged disease duration. Surgical intervention should be considered in managing goiters of prolonged duration to mitigate this risk.

Aims: This study aims to evaluate the risk of malignancy and identify the subtypes of malignant transformation in patients with long-standing goiters undergoing thyroidectomy at Khartoum Teaching Hospital, Sudan.

Methods: This retrospective descriptive study was conducted at Khartoum Teaching Hospital, a major tertiary care center in Sudan, over 18 months from March 2017 to September 2018. A total of 160 patients aged 18 years and above with long-standing goiters scheduled for thyroidectomy were included. Data were collected from patient medical records, capturing demographic information, clinical characteristics, and histopathological findings, and compiled directly into a spreadsheet. Preoperative, intraoperative, and postoperative assessments included clinical examinations and thyroid function tests. Histopathological analysis of thyroid specimens determined the presence and type of malignancy. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with chi-square (χ²) tests applied to assess associations, and a p-value of <0.05 was considered statistically significant.

Results: The mean age of participants was 52.5 ± 14 years, with a male-to-female ratio of 1:4.5. Pressure symptoms were reported in 151 patients (94.4%), and 11 patients suffered from recurrent laryngeal nerve injury and five patients were found to have metastasis at the time of surgery. Histopathological examination revealed malignancy in 54 patients (32.5%), with follicular carcinoma being the most common subtype. Among the malignant cases, 44 were clinically suspected, while 10 (9%) were incidentally discovered. A significant association was observed between clinical diagnosis and histopathological confirmation of malignancy (P = 0.001).

Conclusion: This study found a significant rate of malignancy among patients with long-standing goiters undergoing thyroidectomy at Khartoum Teaching Hospital, with follicular carcinoma being the most common subtype. Many cases were incidentally discovered, highlighting the need for thorough preoperative evaluation and patient counseling in regions with endemic goiter.

Figures