Thorough gross examination and appropriate sampling of the thyroidectomy specimens are fundamental to the diagnosis and clinical risk management of patients. This study aims to investigate the frequency and clinical significance of initially unsampled microscopic thyroid carcinomas in total thyroidectomy specimens with presumed benign multinodular thyroid disease. Seventy-two total thyroidectomy specimens belonging to multinodular goiter patients were randomly selected and included in this prospectively designed study. Inclusion criteria were set as no suspicion of malignancy before surgery as well as lack of intra-parenchymal primary thyroid carcinoma after histopathological evaluation of slides generated from initial sampling. Subsequently, the remaining thyroidectomy specimens were submitted for microscopic examination and sign-outs were finalized following the microscopic examination of the entire thyroid tissue. Microcarcinomas, with a maximum diameter of 3.5 mm, were detected in 29 cases (40.2%) after the whole gland sampling. Although most of these tumors were low-risk papillary microcarcinomas confined to the thyroid, one specimen also showed a medullary microcarcinoma measuring 1.5 mm. Three had micrometastatic nodal disease. There was no local recurrence or distant metastatic disease during the follow-up (mean 51.4 months). This study further supports microscopic carcinomas, including papillary microcarcinoma, and medullary microcarcinoma might stay hidden in thyroidectomy specimens. Increased glandular weight, male gender, and advanced age were significant risk factors in the detection of microcarcinomas in this series. While each multinodular thyroidectomy specimen is unique, we recommend dynamic extensive sampling (rather than bare-minimum approach) strategy based on careful gross and initial histologic examination findings as well as by taking into consideration risk factors.

对甲状腺切除术标本进行彻底的大体检查和适当的取样是诊断和患者临床风险管理的基础。本研究旨在调查在假定为良性多结节性甲状腺疾病的全甲状腺切除术标本中最初未取样的微小甲状腺癌的频率和临床意义。属于多结节性甲状腺肿患者的 72 个全甲状腺切除术标本被随机选择并纳入这项前瞻性设计的研究中。纳入标准被设定为术前不怀疑恶性肿瘤以及在对初始取样产生的载玻片进行组织病理学评估后没有实质内原发性甲状腺癌。随后，将剩余的甲状腺切除术标本提交进行显微镜检查，并在对整个甲状腺组织进行显微镜检查后最终确定退出。29例（40.2%）全腺体取材后检出最大直径为3.5 mm的微小癌。尽管这些肿瘤中的大多数是局限于甲状腺的低风险乳头状微小癌，但一份标本也显示了 1.5 mm 的髓样微小癌。三人患有微转移性淋巴结病。随访期间（平均51.4个月）无局部复发或远处转移。该研究进一步支持微小癌，包括微小乳头状癌和微小髓样癌可能隐藏在甲状腺切除术标本中。腺体重量增加，男性，和高龄是检测该系列微小癌的重要危险因素。虽然每个多结节性甲状腺切除术标本都是独一无二的，但我们建议根据仔细的粗略和初始组织学检查结果以及考虑到风险因素，采用动态广泛取样（而不是最低限度方法）策略。