Differences in intraoperative and surgical outcomes between normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs) and hypertensive PPGLs: results from the PHEO-RISK STUDY.

PURPOSE: To compare the intraoperative and surgical outcomes of normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs), hypertensive PPGLs and non-PPGL adrenal lesions. METHODS: This a retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. A control group of histologically confirmed adrenocortical adenomas (non-PPGL group) was selected to compare intraoperative and surgical outcomes with of the normotensive PPGLs. RESULTS: Two hundred and ninety-six surgeries performed in 289 patients with PPGLs were included. Before surgery, 209 patients were classified as hypertensive PPGLs (70.6%) and 87 as normotensive PPGLs. A higher proportion of normotensive PPGLs than hypertensive PPGLs did not receive alpha presurgical blockade (P = 0.009). When we only considered those patients who received presurgical alpha blockers (200 hypertensive PPGLs and 76 normotensive PPGLs), hypertensive PPGLs had a threefold higher risk of intraoperative hypertensive crisis (OR 3.0 [95% 1.3-7.0]) and of hypotensive episodes (OR 2.9 [95% CI 1.2-6.7]) than normotensive PPGLs. When we compared normotensive PPGLs (n = 76) and non-PPGLs (n = 58), normotensive PPGLs had a fivefold higher risk of intraoperative complications (OR 5.3 [95% CI 1.9-14.9]) and a six times higher risk of postoperative complications (OR 6.1 [95% CI 1.7-21.6]) than non-PPGLs. CONCLUSION: Although the risk of intraoperative hypertensive and hypotensive episodes in normotensive PPGLs is significantly lower than in hypertensive PPGLs, normotensive PPGLs have a greater risk of intraoperative and postoperative complications than non-PPGL adrenal lesions. Therefore, it is recommended to follow the standard of care for presurgical and anesthetic management of PPGLs also in normotensive PPGLs.

[Diagnostic efficacy of fine needle aspiration biopsy in patients with thyroid nodular disease. Analysis of 510 cases]. / Eficacia diagnóstica de la punción-aspiración con aguja fina en pacientes con patología nodular tiroidea. Análisis de 510 casos.

INTRODUCTION: The prevalence of palpable thyroid nodules in the general population is 4%-7%. Although most are benign, 5% are carcinomas. This study aimed to assess the efficacy of fine needle aspiration biopsy (FNAB) of thyroid nodules to diagnose malignancy and know the benefit of repeating the FNAB in the same nodule. PATIENTS AND METHODS: A total of 510 patients (431 women and 79 men; mean age [standard deviation]: 47.6 [14.3] years) with surgery due to thyroid nodular condition between 1989 and 2002 and who had at least one FNAB prior to the surgery were studied. RESULTS: The first FNAB was benign in 312 patients (61.2%), malignant in 38 (7.5%), suspicious or indeterminate in 97 (19%) and insufficient in 63 (12.4%). Sensitivity and specificity in the first FNAB for malignancy diagnosis was 76% and 84%, respectively. Successive FNABs had a moderate concordance and significance. However, repeating the puncture did not improve diagnostic performance, since sensitive increased (84%), but specificity worsened (79%) and the area under the ROC curve was similar. In the group with suspicious or indeterminate FNAB, histology was benign in 70% and malignant in 30%. CONCLUSIONS: FNAB sensitivity and specificity for diagnosis of malignancy in thyroid nodules are high. Repetition of puncture on the same nodule does not improve diagnostic performance of the cytology. Among patients with suspicious FNAB, there is a high proportion of malignancy, which makes surgery necessary in these cases.

Eficacia diagnóstica de la punción-aspiración con aguja fina en pacientes con patología nodular tiroidea. Análisis de 510 casos / Diagnostic efficacy of fine needle aspiration biopsy in patients with thyroid nodular disease. Analysis of 510 cases

Introducción. La prevalencia de nódulos tiroideos palpables en la población general es del 4%-7%. Aunque la mayoría son benignos, un 5% son carcinomas. El objetivo de este estudio fue valorar la eficacia de la punción-aspiración con aguja fina (PAAF) de los nódulos tiroideos para diagnosticar malignidad y conocer el rendimiento de repetir la PAAF en el mismo nódulo. Pacientes y métodos. Se estudiaron 510 pacientes (431 mujeres y 79 varones; edad media [desviación estándar]: 47,6 [14,3] años) intervenidos quirúrgicamente por patología nodular tiroidea entre 1989 y 2002 y que tenían, al menos, una PAAF previa a la cirugía. Resultados. La primera PAAF fue benigna en 312 pacientes (61,2%), maligna en 38 (7,5%), sospechosa o indeterminada en 97 (19%) e insuficiente en 63 (12,4%). La sensibilidad y especificidad de la primera PAAF para el diagnóstico de malignidad fue del 76% y 84%, respectivamente. Las PAAF sucesivas tuvieron una concordancia moderada y significativa; sin embargo, la repetición de la punción no mejoró el rendimiento diagnóstico, ya que aumentó la sensibilidad (84%), pero empeoró la especificidad (79%) y el área bajo la curva ROC fue similar. En el grupo con PAAF sospechosa o indeterminada la histología fue benigna en el 70% y maligna en el 30%. Conclusiones. La sensibilidad y especificidad de la PAAF para el diagnóstico de malignidad en los nódulos tiroideos son elevadas. La repetición de la punción sobre el mismo nódulo no mejora el rendimiento diagnóstico de la citología. Entre los pacientes con PAAF sospechosa existe una proporción elevada de malignidad, lo que obliga a la intervención quirúrgica en estos casos

Introduction. The prevalence of palpable thyroid nodules in the general population is 4%-7%. Although most are benign, 5% are carcinomas. This study aimed to assess the efficacy of fine needle aspiration biopsy (FNAB) of thyroid nodules to diagnose malignancy and know the benefit of repeating the FNAB in the same nodule. Patients and methods. A total of 510 patients (431 women and 79 men; mean age [standard deviation]: 47.6 [14.3] years) with surgery due to thyroid nodular condition between 1989 and 2002 and who had at least one FNAB prior to the surgery were studied. Results. The first FNAB was benign in 312 patients (61.2%), malignant in 38 (7.5%), suspicious or indeterminate in 97 (19%) and insufficient in 63 (12.4%). Sensitivity and specificity in the first FNAB for malignancy diagnosis was 76% and 84%, respectively. Successive FNABs had a moderate concordance and significance. However, repeating the puncture did not improve diagnostic performance, since sensitive increased (84%), but specificity worsened (79%) and the area under the ROC curve was similar. In the group with suspicious or indeterminate FNAB, histology was benign in 70% and malignant in 30%. Conclusions. FNAB sensitivity and specificity for diagnosis of malignancy in thyroid nodules are high. Repetition of puncture on the same nodule does not improve diagnostic performance of the cytology. Among patients with suspicious FNAB, there is a high proportion of malignancy, which makes surgery necessary in these cases

[Epidemiological and clinicopathological study of thyroid cancer in east Madrid]. / Estudio epidemiológico y clinicopatológico del cáncer de tiroides en la zona este de Madrid.

OBJECTIVES: To analyze the incidence, clinical and histopathological manifestations, surgical complications, and prognostic factors of thyroid cancer in the east Madrid population. PATIENTS AND METHODS: Retrospective analysis of 141 consecutive diagnosed of thyroid cancer in our area between 1985 and 2001. Median follow-up was 4,5 years. RESULTS: The annual incidence rate was 4.74/100,000 inhabitants and the female:male proportion 3.5:1. The average age of patients at diagnosis was 44.5 years and nodular goiter was the principal type of clinical presentation (74.5%). The most frequent histological variant was papillary thyroid carcinoma (69%). Total thyroidectomy was carried out in 86% patients. 9.6% patients suffered permanent hypoparathyroidism and 3.3% paralysis of recurrent laryngeal nerve. Radioactive iodine ablation of remaining thyroid was carried out in 91 patients. Residual disease or local recurrence was observed on follow-up in 21% of patients, and metastasis at a distant site in 9%. 7.9% died along follow-up. The principal prognostic factors for metastasis or death were age, histological type, tumor size, local invasion and existence of metastasis at the time of diagnosis. CONCLUSIONS: The incidence of thyroid cancer in our population was high, especially in women. Although the proportion of postsurgical complications was elevated, global prognosis is good and some factors related to it have been identified. Increase of thyroglobulin plasma level at follow-up is a good recurrence indicator of the disease, especially with regard to distant metastases.

Estudio epidemiológico y clinicopatológico del cáncer de tiroides en la zona este de Madrid / Epidemiological and clinicopathological study of thyroid cancer in east Madrid

Objetivos. Analizar la incidencia, características clínicas e histopatológicas, complicaciones quirúrgicas y factores pronósticos del cáncer tiroideo en la población este de Madrid.Pacientes y métodos. Estudio descriptivo retrospectivo de 141 pacientes consecutivos diagnosticados de cáncer tiroideo en nuestra área entre 1985-2001. La mediana de seguimiento fue de 4,5 años. Resultados. La tasa de incidencia anual fue de 4,74/100.000 habitantes y la relación por sexos mujer:varón 3,5:1. La edad media al diagnóstico fue de 44,5 años y el bocio nodular supuso la principal forma de presentación (74,5%). La variante histológica más frecuente fue la papilar (69%). Se realizó tiroidectomía total en el 86% de los casos. El 9,6% de los casos tuvo hipoparatiroidismo permanente y el 3,3% parálisis del nervio laríngeo recurrente. En 91 pacientes se realizó ablación de restos tiroideos con radioyodo. Durante la evolución se observó enfermedad residual o recurrencia local en el 21% de los casos y metástasis a distancia en el 9%. El 7,9% fallecieron durante el seguimiento. Los principales factores pronósticos de metástasis o fallecimiento fueron la edad, el tipo histológico, el tamaño tumoral, la invasión local y la existencia de metástasis en el momento del diagnóstico. Conclusiones. La tasa de incidencia de cáncer tiroideo en nuestra población fue alta, especialmente en mujeres. Aunque la proporción de complicaciones postquirúrgicas fue elevada, el pronóstico global es bueno y se han identificado algunos factores relacionados con el mismo. La elevación de la tiroglobulina plasmática durante el seguimiento es un buen indicador de recurrencia de la enfermedad, especialmente de metástasis a distancia

Objectives. To analyze the incidence, clinical and histopathological manifestations, surgical complications, and prognostic factors of thyroid cancer in the east Madrid population. Patients and methods. Retrospective analysis of 141 consecutive diagnosed of thyroid cancer in our area between 1985 and 2001. Median follow-up was 4,5 years. Results. The annual incidence rate was 4.74/100,000 inhabitants and the female:male proportion 3.5:1. The average age of patients at diagnosis was 44.5 years and nodular goiter was the principal type of clinical presentation (74.5%). The most frequent histological variant was papillary thyroid carcinoma (69%). Total thyroidectomy was carried out in 86% patients. 9.6% patients suffered permanent hypoparathyroidism and 3.3% paralysis of recurrent laryngeal nerve. Radioactive iodine ablation of remaining thyroid was carried out in 91 patients. Residual disease or local recurrence was observed on follow-up in 21% of patients, and metastasis at a distant site in 9%. 7.9% died along follow-up. The principal prognostic factors for metastasis or death were age, histological type, tumor size, local invasion and existence of metastasis at the time of diagnosis. Conclusions. The incidence of thyroid cancer in our population was high, especially in women. Although the proportion of postsurgical complications was elevated, global prognosis is good and some factors related to it have been identified. Increase of thyroglobulin plasma level at follow-up is a good recurrence indicator of the disease, especially with regard to distant metastases