Publique un comentario 
Diagnóstico clínico, ultrasonográfico y citohistológico del carcinoma diferenciado del tiroides
Texto completo:
HTMLResumen
Introducción: el carcinoma diferenciado del tiroides representa la neoplasia maligna más frecuente en Endocrinología. Su presentación clínica y su diagnóstico se han modificado gracias a la disponibilidad de herramientas diagnósticas, tales como, el ultrasonido tiroideo y la biopsia aspirativa con aguja fina.
Objetivos: describir las características clínicas, ultrasonográficas y citohistológicas de los pacientes intervenidos quirúrgicamente por enfermedad tiroidea maligna, y evaluar en ellos la prevalencia de hipocalcemia crónica y el valor de la hormona estimulante del tiroides.
Métodos: se realizó un estudio descriptivo retrospectivo, en el cual se revisaron los informes consecutivos de Anatomía Patológica de todos los pacientes intervenidos quirúrgicamente por enfermedad tiroidea nodular en el Hospital General Provincial "Camilo Cienfuegos" en el periodo comprendido de enero de 2012 a diciembre 2014. La muestra estuvo conformada por 118 historias clínicas de pacientes operados por enfermedad tiroidea nodular que reunieron los criterios siguientes: datos clínicos, resultados según los criterios de Bethesda de la punción aspirativa con aguja fina, del ultrasonido del tiroides y la biopsia. A estos pacientes se les citó para una evaluación clínica y se les determinó en ayunas, la hormona estimulante del tiroides y en 2 días diferentes, la calcemia. Los pacientes fueron clasificados en portadores de: enfermedad tiroidea maligna (n= 39) y enfermedad tiroidea benigna (n= 79).
Resultados: clínicamente solo el 15,4 % de los pacientes con enfermedad tiroidea maligna presentaron dolor o molestia espontánea y/o a la palpación de la glándula del tiroides. La enfermedad tiroidea maligna se diagnosticó en todas las categorías del citodiagnóstico: I: 1/1 (100 %), II: 8/83 (9,6 %), III: 4/6 (66,7 %), IV: 2/2 (100 %), V: 18/20 (90 %), VI: 6/6 (100 %). El carcinoma papilar representó la neoplasia más frecuentemente diagnosticada (37/39 pacientes), el 33,3 % de estos enfermos mostraron cifras de hormona estimulante del tiroides por encima de 2,0 mU/L, y hubo un 46,15 % de hipocalcemia crónica.
Conclusiones: el carcinoma papilar fue la neoplasia más frecuentemente diagnosticada en los pacientes operados por enfermedad tiroidea maligna. La mayoría de estos pacientes tuvieron un comportamiento subclínico, un tercio de valores no óptimos de la hormona estimulante del tiroides y una prevalencia alta de hipocalcemia crónica.
Referencias
Agate L, Lorusso L, Elisei R. New and old knowledge on differentiated thyroid cancer epidemiology and risk factors. J Endocrinol Invest. 2012;35(6 sup):3-9.
Wartofsky L. Increasing world incidence of thyroid cancer: increased detection or higher radiation exposure? Hormones (Athens). 2010;9(2):103-8.
Dong W, Zhang H, Zhang P, Li X, He L, Wang Z, et al. The changing incidence of thyroid carcinoma in Shenyang, China before and after universal salt iodization. Med Sci Monit. 2013 Jan 14;19:49-53.
Udelsman R, Zhang Y. The epidemic of thyroid cancer in the United States: The role of endocrinologists and ultrasounds. Thyroid. 2014;24(3):472-9.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164-7.
Langsteger W, Koltringer P, Wolf G, Dominik K, Buchinger W, Binter G, et al. The impact of geographical, clinical, dietary and radiation-induced features in epidemiology of thyroid cancer. Eur J Cancer. 1993;29A(11):1547-53.
Blomberg M, Feldt-Rasmussen U, Andersen KK, Kjaer SK. Thyroid cancer in Denmark 1943-2008, before and after iodine supplementation. Int J Cancer. 2012;131(10):2360-6.
Valenciaga Rodríguez JL, Galán Álvarez Y, Turcios Tristá SE, Piña Rivera Y, Navarro Despaigne D, Barroso López O. Cáncer de tiroides en Cuba: estudio de 14 años. Rev Cubana Endocrinol [serie en Internet]. 2005 Dic [citado 8 de abril de 2016];16(3). Disponible en: http://scieloprueba.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532005000300002&lng=es
Durante C, Costante G, Filetti S. Differentiated thyroid carcinoma: defining new paradigms for postoperative management. Endocrine Rel Cancer. 2013;20(4):R141-54.
Turcios Tristá SE, Yanes Quesada M, Cruz Hernández JI, Rodríguez González JC. Actualización de la conducta diagnóstica en el nódulo de tiroides. Rev Cubana Endocrinol. 2010;21(3):333-9.
Turcios Tristá SE, Infante Amorós A, González Rivero L. Nódulo de tiroides. Rev Cubana Endocrinol. 2012;23(3):234-41.
Cooper D, Doherty G, Haugen B, Kloos R, Lee S, Mandel S, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-76.
Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, et al. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. Arq Bras Endocrinol Metab. 2013;57(4):240-64.
Misiakos EP, Margari N, Meristoudis C, Machairas N, Schizas D, Petropoulos K, et al. Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules. World J Clin Cases. 2016;4(2):38-8.
Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract. 2003;9(2):128-36.
Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid fine needle aspiration state of the science conference. Diagn Cytopathol. 2008;36(6):425-37.
Kitahara CM, Platz EA, Freeman LE, Hsing AW, Linet MS, Park Y, et al. Obesity and thyroid cancer risk among U.S. men and women: a pooled analysis of five prospective studies. Cancer Epidemiol Biomarkers Prev. 2011;20(3):464-72.
Leitzmann MF, Brenner A, Moore SC, Koebnick C, Park Y, Hollenbeck A, et al. Prospective study of body mass index, physical activity and thyroid cancer. Int J Cancer. 2010;126(12):2947-56.
Rinaldi S, Lise M, Clavel-Chapelon F, Boutron-Ruault MC, Guillas G, Overvad K, et al. Body size and risk of differentiated thyroid carcinomas: findings from the EPIC study. Int J Cancer. 2012;131(6):E1004-14.
Tai JD, Yang JL, Wu SC, Wang BW, Chang CJ. Risk factors for malignancy in patients with solitary thyroid nodules and their impact on the management. J Cancer Research Therapeutics. 2012;8(3):379-83.
Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clinical Endocrinol Metab. 2006;91(9):3411-7.
Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.
Wang HH. Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol. 2006;34(1):67-76.
Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-15.
Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of "follicular neoplasm": A gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol. 2002;26(1):41-4.
Wu HH, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol. 2006;34(2):93-6.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
Raab SS, Vrbin CM, Grzybicki DM, Sudilovsky D, Balassanian R, Zarbl RJ, et al. Errors in thyroid gland fine-needle aspiration. Am J Clin Pathol. 2006;125(6):873-82.
Faquin WC, Baloch ZW. Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow-up according to National Cancer Institute (NCI) recommendations. Diagn Cytopathol. 2010;38(10):731-9.
Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine needle aspiration of thyroid lesions according to the Bethesda System for reporting thyroid cytopathology. Am J Clin Pathol. 2010;134(3):450-6.
Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S. Implications of the proposed thyroid fine-needle aspiration category of "follicular lesion of undetermined significance": a five-year multi-institutional analysis. Diagn Cytopathol. 2009;37(10):710-4.
Luu MH, Fischer AH, Pisharodi L, Owens CL . Improved preoperative definitive diagnosis of papillary thyroid carcinoma in FNAs prepared with both ThinPrep and conventional smears compared with FNAs prepared with ThinPrep alone. Cancer Cytopathol. 2011;119(1):68-73.
Marchevsky AM, Walts AE, Bose S, Gupta R, Fan X, Frishberg D, et al. Evidence based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. Diagn Cytopathol. 2010;38(4):252-9.
Nayar R, Ivanovic M. The indeterminate thyroid fineneedle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute thyroid fine needle aspiration state of the science conference. Cancer. 2009;117(3):195-202.
Renshaw AA. Should "atypical follicular cells" in thyroid fine-needle aspirates be subclassified? Cancer Cytopathol. 2010;118(4):186-9.
Shi Y, Ding X, Klein M, Sugrue C, Matano S, Edelman M, et al. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category? Cancer. 2009;117(5):298-304.
Somma J, Schlecht NF, Fink D, Khader SN, Smith RV, Cajigas A. Thyroid fine needle aspiration cytology: follicular lesions and the gray zone. Acta Cytol. 2010;54(2):123-31.
Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC . The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid. 2009;19(11):1215-23.
Allen Ho, Evan S, Kunal J, Hangjun W, Iain J, Ashok S, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 2014;24(5):832-9.
Singh RS, Wang HH. Eliminating the "atypia of undetermined significance/follicular lesion of undetermined significance" category from the Bethesda System for reporting thyroid cytopathology. Am J Clin Pathol. 2011;136(6):896-902.
Clarke BL, Brown EM, Collins MT, Jüppner H, Lakatos P, Levine MA, et al. Epidemiology and diagnosis of Hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-99.
Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med. 2008;359(4):391-3.
Bilezikian JP, Khan A, Potts JT Jr., Brandi ML, Clarke BL, Shoback D, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011;26(10):2317-37.
De Sanctis V, Soliman A, Fiscina B. Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes Obes. 2012;19(6):435-42.
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg. 2014;101(7):307-20.
Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015;102(4):359-67.
Selberherr A, Scheuba C, Riss P, Niederle B. Postoperative hypoparathyroidism after thyroidectomy: efficient and cost-effective diagnosis and treatment. Surgery. 2015;157(2):349-53.
Giordano D, Valcavi R, Thompson GB. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012;22(9):911-7.
Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260(3):892-9.
Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology. 2008;247(3):762-70.
Salmaslioglu A, Erbil Y, Dural C, Issever H, Kapran Y, Ozarmagan S, et al. Predictive value of sonographic features in preoperative evaluation of malignant thyroid nodules in a multinodular goiter. World J Surg. 2008;32(9):1948-54.
Remonti LR, Kramer CK, Leitão CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25(5):538-50.
Unnikrishnan AG, Kalra S, Baruah M, Nair G, Nair V, Bantwal G, et al. Endocrine Society of India management guidelines for patients with thyroid nodules: A position statement. Indian J Endocrinol Metab. 2011;15(1):2-8.
Brophy C, Stewart J, O'Donovan N, McCarthy J, Murphy M, Sheahan P. Impact of Microcalcifications on Risk of Malignancy in Thyroid Nodules with Indeterminate or Benign Cytology. Otolaryngol Head Neck Surg. 2016;154(1):46-51.
Luciana RR, Kramer CK, Leitao CB, Pinto LCF, Gross JL. Thyroid Ultrasound Features and Risk of Carcinoma: A Systematic Review and Meta-Analysis of Observational Studies. Thyroid. 2015; 25(5):538-50.
Enlaces refback
- No hay ningún enlace refback.
Copyright (c) 2018 Emilio Bustillo Solano, María del Carmen Naranjo Guevara, Manuel Rivero Avella, Emilio Bustillo Madrigal
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.
La revista está: Certificada por el CITMA
La revista es de acceso abierto y gratuito.