Is unicentric familial papillary thyroid microcarcinoma different from multicentric?

BACKGROUND: Familial papillary thyroid microcarcinoma (FPTMC) appears to be more aggressive than sporadic papillary thyroid microcarcinoma (SPTMC). However, there are authors who indicate that unicentric FPTMC has a similar prognosis to SPTMC. The objective is to analyze whether unicentric FPTMC has a better prognosis than multicentric FPTMC. DESIGN AND METHODS: Type of study: National multicenter longitudinal analytical observational study. STUDY POPULATION: Patients with FPTMC. STUDY GROUPS: Two groups were compared: Group A (unicentric FPTMC) vs. Group B (multicentric FPTMC). STUDY VARIABLES: It is analyzed whether between the groups there are: a) differentiating characteristics; and b) prognostic differences. STATISTICAL ANALYSIS: Cox regression analysis and survival analysis. RESULTS: Ninety-four patients were included, 44% (n = 41) with unicentric FPTMC and 56% (n = 53) with multicentric FPTMC. No differences were observed between the groups according to socio-familial, clinical or histological variables. In the group B a more aggressive treatment was performed, with higher frequency of total thyroidectomy (99 vs. 78%; p = 0.003), lymph node dissection (41 vs. 15%; p = 0.005) and therapy with radioactive iodine (96 vs. 73%; p = 0.002). Tumor stage was similar in both groups (p = 0.237), with a higher number of T3 cases in the group B (24 vs. 5%; p = 0.009). After a mean follow-up of 90 ± 68.95 months, the oncological results were similar, with a similar disease persistence rate (9 vs. 5%; p = 0.337), disease recurrence rate (21 vs. 8%; p = 0.159) and disease-free survival (p = 0.075). CONCLUSIONS: Unicentric FPTMC should not be considered as a SPTMC due to its prognosis is similar to multicentric FPTMC.

Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study.

PURPOSE: Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. METHODS: Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). RESULTS: Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). CONCLUSION: FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.

Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica / Sentinel lymph node biopsy in papillary thyroid cancer: Accuracy and application in clinical practice

Introducción La biopsia selectiva del ganglio centinela (BSGC) puede completar el estudio preoperatorio detectando adenopatías no visibles ecográficamente. De este modo, se puede estadificar a los pacientes y estratificar el riesgo de recidiva de forma más precisa y, por tanto, ayudar a definir el tipo de tratamiento tanto quirúrgico como con 131I que debemos realizar. El objetivo fue validar la BSGC para su utilización en el diagnóstico de la metástasis ganglionar por cáncer papilar de tiroides. Métodos Estudio observacional prospectivo de cohortes que incluye a 55 pacientes intervenidos por cáncer papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica, desde febrero de 2012 hasta febrero de 2015, con un seguimiento de entre 6 y 8 años. Se utilizó 99Tc con nanocoloide intratumoral y una sonda portátil de la gammacámara para la detección de los ganglios centinelas. Variables: edad, género, histológicas, analíticas y estadificación preoperatoria y postoperatoria. Se calculó la sensibilidad, la especificidad y los valores predictivos de la técnica. La validación se determinó calculando la detectabilidad y los falsos negativos de la prueba. Resultados En 53 de los 55 (96,36%) pacientes hubo detección del ganglio centinela. Los falsos negativos fueron 4 (7,5%) pacientes. Del resto, tras aplicar la BSGC, 24 (48,9%) se mantuvieron como N0, 14 (28,5%) pasaron a ser N1a y 11 (22,4%) se clasificaron como N1b. Las diferencias observadas en el estudio fueron significativas (p<0,05). La sensibilidad fue del 86,21%, la especificidad del 100%, el VPP del 100% y el VPN del 85,71%. La precisión diagnóstica fue del 92,45%. Conclusiones La BSGC es una técnica válida para su utilización en los pacientes afectos de cáncer papilar de tiroides, con una alta precisión diagnóstica (AU)

Introduction The presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with 131I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer. Methods Observational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used 99Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test. Results In 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P<.05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%. Conclusions The SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy (AU)

Adenomas Ectópicos de paratiroides. Sensibilidad y Valor de las pruebas diagnósticadas para el tratamiento quirúrgico / Ectopic parathyroid adenomas. Sensitivity and value of the diagnostic tests for surgical treatment

OBJETIVOS. Presentar las peculiaridades clínico-quirúrgicas de los adenomas ectópicos de paratiroides relacionándolas con las de los adenomas normotópicos. Determinar el valor de las pruebas diagnósticas para asegurar el éxito terapéutico. MATERIAL Y MÉTODOS. Estudio prospectivo de 158 pacientes intervenidos por hiperparatiroidismo primario (1998-2010). 83% mujeres. Edad media 62,8 años±13,7. Para el diagnóstico topográfico se usaron la gammagrafía con Tecnecio-sestaMIBI, ECO y TAC (ocasional) y para asegurar la exéresis quirúrgica, la monitorización intraoperatoria de PTH y, eventualmente en los ectópicos, la cirugía radioguiada. Se seleccionaron 15 pacientes (80% mujeres) con adenomas ectópicos y se compararon con 143 adenomas ortotópicos. Se evaluaron: sexo, edad, localización, clínica, diagnóstico bioquímico y topográfico, peso glandular, vías de abordaje quirúrgico, gradientes de descenso de PTH en la monitorización y resultados postoperatorios. Para la comparación de medias se utilizó la U de Mann-Whitney y para las variables cualitativas el test de Fisher aceptando valores de p≤0,05. RESULTADOS. Fueron ectópicos el 9,5% de los adenomas. 86,7% en paratiroides inferiores (4 mediastínicas) y 13,3% en superiores. La ectopia no modificó el comportamiento clínico de los adenomas (ambas series fueron similares). La sensibilidad diagnóstica de la gammagrafía, en los ectópicos, fue 100% y para los normotópicos 80,5%. La TAC alcanzó el 66,7%, en los ectópicos, y 48,6% en los normotópicos y la Ecografía el 36,4% y 54%, respectivamente. En el grupo de adenomas ectópicos se utilizó la cervicotomía bilateral en 12 pacientes (80%), el abordaje selectivo en 3 y la sonda radioisotópica en 4. Las glándulas ectópicas extirpadas fueron adenomas. En el grupo normotópico se eligió el abordaje selectivo en el 55%. La comparación de grupos no mostró diferencias de los parámetros evaluados, salvo en la localización de los adenomas, mayor en las paratiroides inferiores (86,7% vs 68%) (p<0,05), en la sensibilidad de la gammagrafía con MIBI, también mayor (100% vs 80,5%) (p<0,001) en el grupo de los ectópicos, y en el tipo de abordaje quirúrgico CONCLUSIONES: 1. Los adenomas ectópicos constituyeron el 9,5% y fueron más frecuentes en las glándulas inferiores (86,4%). 2. No hubo diferencias clínicas entre los ectópicos y normotópicos. 3. La gammagrafía fue la prueba más sensible (100%) para detectarlos (AU)

OBJECTIVES. To present the clinical-surgical peculiarities of ectopic parathyroid adenomas, comparing them to those of the normotopic adenomas. To determine the value of the diagnostic tests in ensuring therapeutic success. MATERIAL AND METHODS. Prospective study of 158 patients operated on for primary hyperparathyroidism (1998-2010), in which 83% were women, average age 62.8 years±13.7. For the topographic diagnostic, the gammagraph was used with Tecnecio-sestamibi, ultrasound and CAT (occasional) and to ensure the surgical exeresis, the intraoperative monitoring of PTH and, possible radio-guided surgery in the ectopic adenomas. Fifteen patients were selected (80% women) with ectopic adenomas and they were compared with 143 orthotopic adenomas. The following were evaluated: Gender, age, location, clinical symptoms, biochemical diagnosis, and topography, glandular weight, channels for surgical approach, degrees of decrease of PTH in the monitoring and postoperative results. For the comparison of means, the U of Mann-Whitney was used and the Fisher test was used for the qualitative variable, accepting values of p≤0.05. RESULT. Of the adenomas, 9.5% were found to be ectopic; 86.7% in inferior parathyroids (4 mediastinal) and 13.3% in superior parathyroids. The ectopia did not change the clinical behaviour of the adenomas (both series were similar). The diagnostic sensitivity of the gammagraphy, in the ectopic adenomas, was 100% and for the normotopic 80.5%. The CAT achieved 66.7% in the ectopic and 48.6% in the normotopic; and the ultrasound achieved 36.4% and 54%, respectively. In the group of ectopic adenomas, the bilateral cervicotomy was used on 12 patients (80%), the selective approach on 3 and the radioisotopic probe on 4. The removed ectopic glands were adenomas. In the normotopic group, the selective approach was chosen in 55%. The comparison of the groups did not show differences of the evaluated parameters, except in the location of the adenomas, greater in the inferior parathyroids (86.7% vs. 68%) (p<0.05), in the sensitivity of the gammagraph with MIBI also greater (100% vs. 80.5%) (p<0.001) in the group of ectopic adenomas, and in the type of surgical approach. CONCLUSIONS: 1. The ectopic adenomas constituted 9.5%. More frequent in the inferior glands (86.4%). 2. There were no clinical differences between the ectopic and normotopic adenomas. 3. The gammagraph was the most sensitive test (100%) for detecting them (AU)

Cirugía suprarrenal en España: resultados finales de una encuesta nacional / Adrenal Surgery in Spain: Final Results of a National Survey

Introducción Dada la disponibilidad del abordaje laparoscópico y la creciente detección de incidentalomas, las indicaciones de suprarrenalectomía pueden estar cambiando. La Sección de Cirugía Endocrina de la Asociación Española de Cirujanos diseñó una encuesta para analizar las indicaciones actuales de la suprarrenalectomía y sus resultados en los servicios de cirugía españoles. Material y métodos Se recogieron datos respecto al tipo de hospital y servicio, volumen de procedimientos, estudios de localización y preparación preoperatoria, indicaciones, técnica quirúrgica, instrumental utilizado, y resultados en términos de morbilidad y estancia hospitalaria. Se compararon los resultados de los centros en función de su volumen de actividad, utilizando las pruebas de Mann-Whitney para variables cuantitativas y de la chi al cuadrado para las cualitativas. Resultados Treinta y seis centros cumplimentaron el cuestionario e incluyeron 301 suprarrenalectomías realizadas en 2008. Las lesiones extirpadas más frecuentes fueron feocromocitoma (25,2%), adenoma no funcionante (16,2%), aldosteronoma (15,9%), adenoma de Cushing (11,2%), metástasis (10,3%), mielolipoma (5,6%) y carcinoma (4,9%) (..) (AU)

Introduction The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments.Material and methods Data were gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann–Whitney Test for the quantitative variables and chi squared for the qualitative ones. Results Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%).Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach (P=.019), and had a shorter overall hospital stay (P<.0001. Laparoscopic adrenalectomy was also associated with a shorter hospital stay (P<.0001).Conclusions Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay (..) (AU)