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1.
Anticancer Res ; 40(2): 1127-1133, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014964

RESUMEN

AIM: To investigate the association between survival outcomes and clinicopathological factors, including pathological restaging based on the UICC8th, among patients with recurrence differentiated thyroid carcinoma undergoing salvage surgery of local site. PATIENTS AND METHODS: A total of 54 patients who underwent salvage surgery of local site for recurrence differentiated thyroid carcinoma were enrolled. The optimal cutoff ages at salvage surgery for predicting death and cancer-specific death were determined by receiver operating curve analysis. Overall and cancer-specific survivals were determined using log-rank test and Cox's proportional hazards model. RESULTS: Univariate analysis showed that age and the presence of distant metastasis at salvage surgery were significantly associated with overall survival (p=0.01 and p<0.05, respectively) and cancer-specific survival (p=0.02 and p=0.01, respectively). The optimal cutoff age at salvage surgery for predicting the detection of both death (p=0.01) and cancer-specific death (p=0.02) was 65 years. Multivariate analysis showed that age ≥65 years and the presence of distant metastasis were significantly associated with shorter overall survival (p<0.01 and p=0.03, respectively) and shorter cancer-specific survival (p<0.01 and p=0.01, respectively). CONCLUSION: Older age and the presence of distant metastasis at salvage surgery of local site were identified as predictors for poor survival outcomes in recurrence differentiated thyroid carcinoma.


Asunto(s)
Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Curva ROC , Terapia Recuperativa , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto Joven
2.
BMJ ; 368: l6670, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31911452

RESUMEN

Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.


Asunto(s)
Neoplasias/diagnóstico , Medición de Riesgo/métodos , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo , Biopsia/métodos , Pruebas de Química Clínica , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología
3.
BMC Surg ; 20(1): 4, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907042

RESUMEN

BACKGROUND: To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. METHODS: Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher's linear discriminant analysis. RESULTS: The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher's linear discriminant analysis. CONCLUSIONS: NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher's linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.


Asunto(s)
Glándulas Paratiroides/diagnóstico por imagen , Espectrometría de Fluorescencia/métodos , Espectroscopía Infrarroja Corta/métodos , Cirugía Asistida por Computador/métodos , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Análisis Discriminante , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Curva ROC , Neoplasias de la Tiroides/diagnóstico
4.
Ann R Coll Surg Engl ; 102(2): e33-e35, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31530165

RESUMEN

Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.


Asunto(s)
Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Adolescente , Biomarcadores de Tumor/sangre , Biopsia con Aguja Fina , Calcitonina/sangre , Carcinoma Neuroendocrino/diagnóstico , Diferenciación Celular , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Secciones por Congelación , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos
5.
Ann R Coll Surg Engl ; 102(3): e63-e66, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31841033

RESUMEN

Calcitonin-negative medullary thyroid carcinoma is a rare, poorly understood primary neuroendocrine carcinoma of the thyroid characterised by classic medullary thyroid carcinoma morphology without raised serum calcitonin. A 24-year-old woman presented with a slow-growing, right-sided neck swelling. She underwent an ultrasound scan, cytopathological and histopathological examination, and tests for alternative diagnoses. The ultrasound showed a heterogeneous, hyperechoic nodule in the right thyroid lobe. Serum calcitonin was normal. Cytopathology and histopathology showed typical medullary thyroid carcinoma morphology but without calcitonin upon immunostaining and mRNA in situ hybridisation. A 'triple-negative' calcitonin-negative medullary thyroid carcinoma was diagnosed. A completion thyroidectomy with bilateral central lymph node dissection was performed. The patient remains well three-years post-surgery. When cytopathology suggests a medullary thyroid carcinoma, serum calcitonin, pro-calcitonin, carcinoembryonic antigen and calcitonin-gene-related peptide should be measured to identify cases of calcitonin-negative medullary thyroid carcinoma. They should also be measured post-treatment for monitoring purposes. This will aid future calcitonin-negative medullary thyroid carcinoma diagnoses and will inform prognostic stratification and influence treatment decisions.


Asunto(s)
Calcitonina/sangre , Carcinoma Neuroendocrino/sangre , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/sangre , Biomarcadores de Tumor/sangre , Biopsia , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/cirugía , Femenino , Humanos , Fenotipo , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto Joven
6.
Bioengineered ; 10(1): 383-389, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31791180

RESUMEN

Downregulation of lncRNA H19 (H19) expression is associated with an unfavorable prognosis in some cancers. However, little was known as to whether there was an association between H19 and minimally invasive follicular thyroid carcinoma (MI-FTC). In our study, we used quantitative real-time polymerase chain reaction (qRT-PCR) to determine H19 expression in 186 patients with MI-FTC who underwent initial surgery. Of the 186 patients with MI-FTC, 21 patients show distant metastasis (M+)at the initial operation established the diagnosis of MI-FTC. Of the 165 patients who did not show distant metastasis at diagnosis during the follow-up period (≥10 years), 28 patients undergone M+ and 137 patients has no distant metastasis(M-)after the initial operation. Low H19 expression was associated with large tumor size, vascular invasion, and distant metastasis. Univariate analysis showed that gender (male), age (45 years or older), primary tumor size (4 cm or more), vascular invasion and H19 level (<1.12) were significant prognostic factors related to postoperative distant metastases. Multivariate analysis showed that age, primary tumor size (4 cm or more) and vascular invasion was a significant prognostic factor for survival. Patients with low H19 expression showed a poorer outcome in MI-FTC patients. Receiver-operating characteristic (ROC) curve analysis demonstrated H19 could distinguish M+ from M- patientswith a value of area under the curve (AUC). Our findings suggest that H19 is a potential prognostic factor for evaluating prognosis and the metastatic potential of MI-FTC at an initial operation stage.


Asunto(s)
Adenocarcinoma Folicular/diagnóstico , Regulación Neoplásica de la Expresión Génica , ARN Largo no Codificante/genética , Neoplasias de la Tiroides/diagnóstico , Adenocarcinoma Folicular/genética , Adenocarcinoma Folicular/mortalidad , Adenocarcinoma Folicular/cirugía , Adulto , Anciano , Área Bajo la Curva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Pronóstico , ARN Largo no Codificante/sangre , Curva ROC , Estudios Retrospectivos , Factores Sexuales , Análisis de Supervivencia , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Carga Tumoral
7.
Medicine (Baltimore) ; 98(50): e18213, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852078

RESUMEN

We aimed to investigate the association between excess body mass index (BMI) and papillary thyroid cancer (PTC) in an operative population, and the impact of higher BMI on clinicopathological aggressiveness of PTC.Charts of 10,844 consecutive patients with thyroid nodules undergoing partial or total thyroidectomy between 1993 and 2015 were reviewed. Patients diagnosed with PTC were stratified in 4 groups: BMI < 18.5 (underweight), 18.5 ≤ BMI < 24 (normal-weight), 24 ≤ BMI < 28 (overweight) and BMI ≥ 28(obese). The impacts of high BMI on prevalence and clinicopathological parameters of PTC were retrospectively analyzed in both univariate and multivariate binary logistic regression analysis.For every 5-unit increase in body mass, the odds of risk-adjusted malignance increased by 36.6%. The individuals who were obese and overweight were associated with high risk of thyroid cancer [odds ratio (OR)= 1.982, P < .001; OR= 1.377, P < .001; respectively] compared to normal weight patients, and this positive association was found in both genders. Obesity was independent predictors for tumors larger than 1 cm (OR = 1.562, P < .001) and multifocality (OR = 1.616, P < .001). However, there was no difference in cervical lymph node (LN) metastasis among BMI groups. Crude analysis showed BMI was associated with advanced tumor-node-metastasis (TNM) stage (relative risk, approximately 1.23 per 5 BMI units, P < .001), but this association disappeared after adjusting for confounding factors.Obesity was significantly associated with the risk of PTC in a large, operative population. Higher BMI was significantly associated with larger tumor size and multifocal tumor.


Asunto(s)
Índice de Masa Corporal , Obesidad/complicaciones , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Tiroidectomía/métodos , Estudios de Casos y Controles , China/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Estudios Retrospectivos , Cáncer Papilar Tiroideo/etiología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/etiología , Neoplasias de la Tiroides/cirugía
8.
Chirurgia (Bucur) ; 114(5): 586-593, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31670634

RESUMEN

Background: All patients undergoing thyroid operations should be subjected to preoperative neck ultrasound (US) followed by fine needle aspiration cytology (FNAC) of suspicious lesions. In Western countries, thyroid surgeons routinely perform neck ultrasound. The role of prophylactic central neck dissection (PCND) remains a topic of debate. For treatment of papillary thyroid carcinoma (PTC), in 2014 we introduced two new adjuncts: PCND based on criteria of the European Society of Endocrine Surgeons (ESES) consensus group and surgeon-performed US (S-US). Methods: In order to better understand the role of these two adjuncts in our shift of strategy we aimed to evaluate the outcomes of our patients in two successive 5-year time periods based on a retrospective analysis of our prospectively maintained database (total of 286 patients were included in this study). Results: The two groups were similar regarding epidemiological and clinical data. FNAC was done in only 21.66% of all PTC cases. PTC diagnosis was done in the majority of suspicious cases by FS. S-US guided the selective lateral node dissections (LND), leading to more lymph node metastases detections and it also surpassed endocrinologist performed US (E-US) in terms of PPV. PCND rate of complications was significantly higher due only to transient hypoparathyroidism. Conclusions: Preoperative surgeon-performed ultrasonography is a useful tool in the arsenal of PTC treatment. The systematic preoperative FNAC diagnosis and intraoperative frozen sections in uncertain cases are mandatory. PCND is a safe method of treatment and staging in PTC.


Asunto(s)
Disección del Cuello/métodos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Humanos , Escisión del Ganglio Linfático/métodos , Estadificación de Neoplasias , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tiroidectomía , Resultado del Tratamiento , Ultrasonografía
9.
Chirurgia (Bucur) ; 114(5): 659-663, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31670642

RESUMEN

Anaplastic thyroid carcinoma (ATC) is a rare but almost invariably lethal disease. In this manuscript, we present a case where the dominant manifestation of ATC beside the goitre was elevated CRP values and a persistent low-grade fever. The patient underwent surgical removal of the tumour, chemotherapy and radiotherapy treatment. She is still alive and healthy 11 months after the surgery. We aim to demonstrate that ATC can be present with no specific symptoms or findings and to raise awareness towards an earlier diagnosis.


Asunto(s)
Proteína C-Reactiva/análisis , Fiebre/etiología , Carcinoma Anaplásico de Tiroides/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Femenino , Humanos , Carcinoma Anaplásico de Tiroides/sangre , Carcinoma Anaplásico de Tiroides/complicaciones , Carcinoma Anaplásico de Tiroides/terapia , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/terapia , Resultado del Tratamiento
10.
Medicine (Baltimore) ; 98(44): e17657, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689776

RESUMEN

New sonographic patterns have been recommended by the 2015 American Thyroid Association (ATA) to stratify nodules in terms of malignancy risk and help guide biopsy decision. This study aimed to compare the ultrasound part of the ATA guidelines and the Thyroid Imaging Reporting and Data System (TIRADS-Na).In 2013 to 2016, 708 thyroid nodules in 505 patients were confirmed by postoperative histopathology. Hypoechogenicity, solidity, microcalcification, irregular margin, and a taller-than-wide shape were considered features suggesting malignancy. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were obtained for the TIRADS and ATA guidelines.Of the 708 nodules, 341(48.2%) and 367(51.8%) were benign and malignant, respectively. Based on the ultrasound 2015 ATA guidelines, 62 nodules had nonspecific pattern (both malignant and benign features); malignancy rates of nodules with very low, low, intermediate, and high suspicion, and nonspecific pattern were 0, 17.7%, 57.9%, 90.0%, and 69.4%, respectively (P < .001). Malignancy rates of categories 2/3/4/5 nodules by TIRADS were 0, 8.1%, 67.0%, and 90.1%, respectively (P < .001). Based on pathological results, the AUC, sensitivity, specificity, NPV, and PPV were 0.926, 96.7%, 81.5%, 84.9%, and 95.9% for TIRADS, and 0.920, 93.5%, 82.4%, 85.1%, and 92.1% for ATA patterns, respectively. The TIRADS was generally more efficient than the 2015 ATA guidelines, especially for nodules >2 cm in diameter or those with nonspecific pattern.The TIRADS show a relative superiority over the ultrasound 2015 ATA guidelines, especially for nodules with >2 cm diameter or nonspecific pattern.


Asunto(s)
Índice de Severidad de la Enfermedad , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Sistemas de Datos , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Neoplasias de la Tiroides/diagnóstico , Ultrasonografía , Estados Unidos , Adulto Joven
11.
Pan Afr Med J ; 34: 33, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762901

RESUMEN

Adenoid Cystic Carcinoma of larynx is extremely rare location. We herein describe an unusual clinical and radiological presentation of ACCL and review recent literature. We report a case of a 38-year-old woman with history of asthma, presented to our department with acute inspiratory dyspnea that required an emergency tracheotomy. Physical examination revealed a large anterior cervical mass without any lymphadenopathy suspecting thyroid origin. Cervical Computed Scan showed a tumor process between the thyroid lobe, the left edge of the subglottic area and first tracheal rings filling all the lumen, discussing either a laryngo-tracheal or thyroid origin. The patient underwent a panendoscopy under general anesthesia that confirmed a subglottic extension of the tumor and multiples biopsies showed a malignant salivary origin of the mass. After multidisciplinary discussion, the patient underwent total laryngectomy and thyroidectomy with bilateral selective neck dissections (levels II- IV). Anatomopathological examination confirmed the laryngeal location of Adenoid Cystic Carcinoma classified pT4aN0R0. Adjuvant radiation therapy was indicated. In our knowledge, only 10 cases were reported in the literature with this unusual presentation. Moreover, the case we report is in the subglottic floor without invasion of neither vocal cords nor trachea. Total laryngectomy with neck dissection remains the recommended therapeutic procedure for locally advanced ACCL. Adverse features such as close or positive margins, T3-4, intermediate or high grade neural and perineural spread, lymphatic or vascular invasion or lymph node metastases should indicate adjuvant treatment to improve the outcome. The lack of randomized multicentric study, implies the management of ACCL by skilled multidisciplinary team, to suggest adequate personalized treatment.


Asunto(s)
Carcinoma Adenoide Quístico/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias Laríngeas/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Adulto , Carcinoma Adenoide Quístico/patología , Carcinoma Adenoide Quístico/terapia , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Laríngeas/terapia , Laringectomía , Grupo de Atención al Paciente/organización & administración , Neoplasias de la Tiroides/terapia , Tiroidectomía
12.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31775969

RESUMEN

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Asunto(s)
Laringoscopía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Parálisis de los Pliegues Vocales/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Disnea/etiología , Femenino , Ronquera/etiología , Humanos , Laringoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Factores Sexuales , Evaluación de Síntomas/métodos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Parálisis de los Pliegues Vocales/complicaciones
13.
Pathologe ; 40(Suppl 3): 342-346, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31705233

RESUMEN

BACKGROUND: Advances in diagnostic methods have led to an early detection of thyroid nodules with debatable malignant potential in numerous cases. This can result in a potential overtreatment of thyroid lesions with very good prognosis. OBJECTIVES: To avoid surgical overtreatment, an individualized, risk-adapted management is required that respects the different tumor biology of the underlying histological entities. METHODS: The current guidelines of the leading professional societies, the American Thyroid Association (ATA) and the German Association of Endocrine Surgeons (CAEK), were compared and critically studied, to describe risk-adapted, more conservative treatment options for certain types of thyroid neoplasms according to the 2017 WHO definition. RESULTS: The German CAEK recommends thyroidectomy as a routine operation in the case of thyroid carcinoma. Exceptions are papillary thyroid microcarcinoma and minimally invasive follicular thyroid carcinoma, which can be treated by lobectomy. The ATA proposes an "active surveillance" for papillary thyroid microcarcinoma and lobectomy in cases of differentiated thyroid carcinoma <4 cm in diameter in the absence of clearly predefined risk factors. CONCLUSIONS: The pre- or intraoperative pathological diagnosis of the underlying tumor entity is the key point, which allows for an adaption of the resection strategy for thyroid malignancy. Depending on the type of carcinoma, the current guidelines of international expert societies allow for parenchyma-sparing operations and, according to the ATA, even an "active surveillance."


Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Carcinoma , Diagnóstico Diferencial , Humanos , Uso Excesivo de los Servicios de Salud , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/patología , Nódulo Tiroideo/terapia , Tiroidectomía
14.
J Cancer Res Clin Oncol ; 145(11): 2751-2759, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31571010

RESUMEN

PURPOSE: Papillary thyroid carcinoma (PTC), the most common malignant tumor of the thyroid, has been criticized as overtreated by some researchers in recent years. Active surveillance (AS) was first proposed at Kuma Hospital in 1993, and popularized in other institutes ever since. We provide a brief review of low-risk PTC active monitoring studies to date, and discuss the advantages of AS and limitations of existing studies. RESULTS: Most papillary thyroid microcarcinomas do not show significant growth or new lymph node metastasis in a 10-year AS period. Patients who undergo delayed surgery during AS generally have a good prognosis. Tumor progression correlates with age, calcification pattern, and Ki-67 positivity. Serum thyroid stimulating hormone concentration and pregnancy might also influence tumor progression in some studies. CONCLUSION: Active surveillance for low-risk PTC has shown its safety and feasibility in certain populations. In the future, it is warranted to determine valuable tumor progression predictors and most suitable PTC patients for AS.


Asunto(s)
Vigilancia de la Población/métodos , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Espera Vigilante/métodos , Humanos , Cáncer Papilar Tiroideo/epidemiología , Neoplasias de la Tiroides/epidemiología
15.
Indian J Cancer ; 56(4): 325-329, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31607701

RESUMEN

BACKGROUND: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites. MATERIALS AND METHODS: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series. RESULTS AND CONCLUSION: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.


Asunto(s)
Venas Yugulares/patología , Neoplasias Faríngeas/diagnóstico , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tráquea/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Faríngeas/secundario , Tomografía de Emisión de Positrones , Embarazo , Estudios Retrospectivos , Trombosis , Cáncer Papilar Tiroideo/secundario , Neoplasias de la Tiroides/patología , Tiroidectomía , Tomografía Computarizada por Rayos X , Neoplasias de la Tráquea/secundario
16.
Indian J Cancer ; 56(4): 356-358, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31607708

RESUMEN

Papillary carcinoma of thyroid (PCT) commonly shows metastasis to central and lateral cervical compartment neck nodes. Submental nodes are rarely involved by PCT. Thus, its management is not clear. We report two young men who presented with submental nodal metastasis from PCT. Both underwent total thyroidectomy with central compartment neck dissection and modified radical neck dissection (MRND). Probable factors which might influence submental nodal metastasis are analyzed. We conclude that physicians should be aware of the possibility of submental nodal metastasis from PCT. A selective approach for neck dissection can be an alternative to MRND, reducing the morbidity in management of such cases.


Asunto(s)
Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Cáncer Papilar Tiroideo/diagnóstico , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Adulto , Biopsia con Aguja Fina , Humanos , Masculino , Disección del Cuello , Tiroidectomía , Adulto Joven
17.
Medicine (Baltimore) ; 98(42): e17588, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31626129

RESUMEN

In 2014/2015, tyrosine kinase inhibitors (TKIs) were introduced as a secondary treatment for refractory differentiated thyroid cancer (DTC) in Japan. While renal dysfunction is an adverse event of TKI, data on this adverse event in TKI-treated DTC remains insufficient. Here, we investigated renal function in patients undergoing TKI treatment for DTC and evaluated the efficacy of dose reduction/withdrawal for cases of renal dysfunction.A total of 73 cases of radioactive iodine-refractory DTC treated with sorafenib (n = 22) or lenvatinib (n = 51) were included. Patient data evaluated were TKI treatment period, estimated glomerular filtration rate (eGFR) before and after TKI therapy, incidence and degree (maximum value at time of TKI treatment) of proteinuria, and albumin levels before and after TKI therapy were compared.The mean ΔeGFR was -6.75% with lenvatinib and +5.90% with sorafenib. It was not significant (P = .15). The mean Δalbumin was -8.90% and -5.85% with lenvatinib and sorafenib, respectively; there was no significant difference between the lenvatinib and sorafenib groups (P = .77). According to our program of TKI dose reduction and withdrawal, all patients except 2 with diabetes were successfully continuing treatment.Overall, the present results demonstrated that renal function is negatively affected by long-term TKI treatment for RAI-refractory DTC. However, heightened proteinuria, decreased eGFR and albumin levels, and significant but apparently reversible renal dysfunction were more frequent with lenvatinib than sorafenib.


Asunto(s)
Tasa de Filtración Glomerular/fisiología , Radioisótopos de Yodo/uso terapéutico , Enfermedades Renales/etiología , Compuestos de Fenilurea/uso terapéutico , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Quinolinas/uso terapéutico , Sorafenib/uso terapéutico , Neoplasias de la Tiroides/terapia , Anciano , Sustitución de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Inhibidores de Proteínas Quinasas/uso terapéutico , Tolerancia a Radiación , Estudios Retrospectivos , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
18.
Artículo en Chino | MEDLINE | ID: mdl-31623037

RESUMEN

Objective:By retrospectively analyzing the results of ultrasound guided coarse needle biopsy(CNB) of thyroid nodules based on large samples, so as to evaluate its diagnostic value as first-line diagnostic tool for thyroid nodules. Method:From October 2015 to November 2017, a total of 508 nodules were studied from 474 patients who underwent CNB in general surgery department of tianjin first central hospital. The nondiagnostic rate, inconclusive rate, unnecessary surgery rate and complication rate of thyroid nodules diagnosed by CNB were calculated. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CNB in thyroid cancer diagnosis were analyzed. The correlation between inconclusive diagnostic results and ultrasonic findings like echogenicity, composition, margin, calcification type, blood supply and nodule size was analyzed. Result:The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CNB diagnosis were 97.27%, 99.17%, 99.07%, 99.45% and 99.36%, respectively. However, the nondiagnostic rate, the inconclusive rate, the conclusive rate and the unnecessary surgery rate of thyroid nodules diagnosed by CNB were 2.95%, 7.09%, 92.92% and 1.86%, respectively. Conclusion:Ultrasound guided coarse needle biopsy might be safe and reliable for the diagnosis of thyroid nodules, with relatively stable diagnostic effect. It is not only of high diagnostic value but also can significantly reduce diagnostic surgery. Therefore, CNB could be the preferred examinational method for nodules with suspicious ultrasonic findings.


Asunto(s)
Biopsia con Aguja , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Biopsia con Aguja Gruesa , Humanos , Estudios Retrospectivos , Sensibilidad y Especificidad , Ultrasonografía Intervencional
19.
J Vet Diagn Invest ; 31(6): 913-916, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31646945

RESUMEN

An 18-y-old female llama (Lama glama) in Saskatoon, Saskatchewan was examined during a routine herd check, and a mass was detected in the ventral cervical area just below the angle of the jaw. No clinical signs were evident except for the mass and chronic loss of body condition. Postmortem examination revealed bilateral enlargement of the thyroid gland with multiple cysts. Histopathology of the thyroid gland revealed follicular compact-cellular carcinoma lesions, with infiltration of neoplastic thyroid follicular cells in regional lymph nodes.


Asunto(s)
Adenocarcinoma Folicular/veterinaria , Camélidos del Nuevo Mundo , Neoplasias de la Tiroides/veterinaria , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patología , Animales , Resultado Fatal , Femenino , Saskatchewan , Células Epiteliales Tiroideas/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología
20.
Rev Med Suisse ; 15(665): 1752-1759, 2019 Oct 02.
Artículo en Francés | MEDLINE | ID: mdl-31580019

RESUMEN

The incidence of differentiated thyroid cancers has increased in the past 30 years, mainly due to overdiagnosis. It is therefore crucial to adapt diagnostic and therapeutic approaches to avoid overtreatment that exposes patients to unnecessary risks. Accordingly, international guidelines on the subject are regularly updated. Ultrasound and cytology guide the management for thyroid nodules. Some microcarcinomas can now be actively followed without immediate surgery, and some low-risk cancers can be adequately treated with lobo-isthmectomy. The indications for central neck dissection remain controversial. Technological advances allow minimizing specific complications of thyroid surgery and facilitate scarless surgery.


Asunto(s)
Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Humanos , Tiroidectomía , Ultrasonografía
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