RESUMO
The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.
RESUMO
Introducción: El objetivo del tratamiento del carcinoma diferenciado de tiroides con invasión traqueal es resecar satisfactoriamente la enfermedad conservando las funciones. Caso clínico: Mujer de 27 años, con masa tiroidea con compromiso traqueal evidenciado por tomografía computarizada. Se efectuó tiroidectomía total, linfadenectomía central y selectiva II-V bilateral, resección segmentaria y anastomosis traqueal. En el postoperatorio presentó dehiscencia de la anastomosis, requiriendo traqueostomía. Posteriormente, se efectuó traqueoplastia con evolución favorable. Discusión: La resección traqueal segmentaria es de elección en casos de compromiso local sin enfermedad a distancia. La traqueoplastia permite obtener un resultado funcional satisfactorio en estos casos en centros de alto volumen.
Introduction: The aim of surgery in well-differentiated thyroid cancer with tracheal invasion is to remove all the tumour while preserving functional structures. Clinical case: A 27 year old female presented with a thyroid mass with tracheal invasion on the computed tomography. She underwent total thyroidectomy, bilateral central compartment and selective II-V neck dissection, and tracheal resection with end-to-end anastomosis. She subsequently had anastomotic dehiscence, which required a tracheostomy. Tracheoplasty was later performed with good functional results. Discussion: Segmentary tracheal resection is the procedure of choice in differentiated thyroid cancer with local invasion and with no distant disease. Tracheoplasty, performed in highvolume centres, leads to a satisfying functional outcome.
