Riesgo de recurrencia y factores de riesgo de invasión del cáncer diferenciado de tiroides / Risk of recurrence and risk factors for invasion of differentiated thyroid cancer

Introducción: El cáncer diferenciado de tiroides (CDT) se encuentra representado por el carcinoma papilar y el carcinoma folicular. Comprende la gran mayoría (>90%) de todos los cánceres de tiroides. Objetivos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Materiales y métodos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Resultados: El 87% fueron del sexo femenino. La edad media fue de 43±14 años. Predominó el riesgo de recurrencia bajo en el 49% de los pacientes, seguido del riesgo intermedio (33%) y riesgo alto (18%). El tamaño tumoral ˃1cm confiere mayor riesgo de ser estratificado como riesgo de recurrencia intermedio/alto (OR 5,7 IC 95% 3,6-9). El sexo masculino representó mayor riesgo de invasión ganglionar (OR 2,8 IC 95% 1,2-6,6); la edad ≥55 años lo fue en la invasión vascular (OR 2,1 IC 95% 1,1-4,1); el tamaño >1cm constituyó un mayor riesgo de manera significativa de invasión capsular (OR 10,5 IC 95% 6,5-17), invasión ganglionar (OR 10,2 IC 95% 3,8-26,9), invasión vascular (OR 30,7 IC 95% 4,2-224) e invasión de tejido peritiroideo (OR 5,2 IC 95% 3,3-8,2). Conclusión: El riesgo de recurrencia inicial más frecuente fue el riesgo bajo. El sexo masculino, la edad ≥55años y el tamaño >1cm constituyen factores de riesgo de invasión a estructuras vecinas.

Introduction: Differentiated thyroid cancer (DTC) is represented by papillary carcinoma and follicular carcinoma. It comprises the vast majority (> 90%) of all thyroid cancers. Objectives: Stratify the risk of initial recurrence of patients with DTC. Relate age, sex, and tumor size to the risk of recurrence, capsular, nodal, vascular, and perithyroid tissue invasion. Materials and methods: Observational, descriptive, retrospective, cross-sectional study with an analytical component. A total of 432 patients with a diagnosis of DTC from Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: 87% were female. The mean age was 43 ± 14 years. Low recurrence risk predominated in 49% of patients, followed by intermediate risk (33%) and high risk (18%). Male sex, age ≥55 years and tumor size ˃1cm confer a higher risk of being stratified as intermediate / high recurrence risk, but only size> 1cm was significantly (OR 5.7 95% CI 3.6-9). Male sex represented a higher risk of lymph node invasion (OR 3.1 95% CI 1.4-2.8) and vascular invasion (OR 2.3 95% CI 1.1-4.8); age ≥55 years was in the vascular invasion (OR 2.6 95% CI 1.4-4.9); size> 1cm constituted a significantly higher risk of capsular invasion (OR 10.7 95% CI 6.7-17.3), nodal invasion (OR 10.5 95% CI 4-27.7), vascular invasion (OR 33 95% CI 4.5-244) and invasion of perithyroid tissue (OR 5.1 95% CI 3.2-8.1). Conclusion: The most frequent initial recurrence risk was low risk. Male sex, age ≥55 years, and size> 1cm are risk factors for invasion of neighboring structures.

Role of CT in predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma / 中华放射学杂志

Objective:To investigate the value of CT tumor-thyroid marginal contact range (MCR) for predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma (PTC) with a diameter>1.0 cm and papillary thyroid microcarcinomas (PTMC) with a diameter ≤ 1.0 cm, and to evaluate the diagnostic efficacy of direct CT signs for lymph node metastasis.Methods:The CT data of 148 patients with PTC (>1.0 cm) and 193 patients with PTMC confirmed by surgery and pathology were retrospectively analyzed from January 2017 to April 2020 at Hangzhou First People′s Hospital. MCR was evaluated based on CT images and classified as<1/4 tumor circumference or ≥1/4 tumor circumference. Direct CT signs of cervical lymph nodes were observed, including cystic change, microcalcification, hyperenhancement, short/long diameter≥0.5, clustered lymph nodes or central area turbidity. The difference in the distribution of MCR between PTC (>1.0 cm) and PTMC was compared using the χ 2 test, and the efficiency of MCR and direct CT signs for diagnosing capsular invasion and lymph node metastasis was calculated using the pathological results as the gold standard. Results:In 148 PTC (>1.0 cm) and 193 PTMC patients, the pathological results showed capsular invasion in 88.5% (131/148) and 57.0% (110/193), and lymph node metastasis in 71.6% (106/148) and 44.0% (85/193), respectively. In PTC (>1.0 cm) patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=22.211, P<0.001) and lymph node metastasis (χ2=4.746, P=0.029), and the corresponding sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 84.7% (111/131) and 64.7% (11/17), 83.0% (88/106) and 33.3% (14/42), respectively. In PTMC patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=66.066, P<0.001) and lymph node metastasis (χ2=5.343, P=0.021), and its sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 87.3% (96/110) and 69.9% (58/83), 71.8% (61/85) and 44.4% (48/108), respectively. The sensitivity and specificity of direct CT signs for diagnosing lymph node metastasis in PTC (>1.0 cm) and PTMC were 89.6% and 73.8%, 69.4% and 76.9%, respectively. Conclusions:Both direct CT signs and MCR ≥ 1/4 tumor circumference can predict cervical lymph node metastasis in PTC patients, and the former had higher sensitivity and specificity. MCR≥1/4 tumor circumference has high efficiency for predicting capsular invasion in PTC patients.

The value of 18 MHz high-frequency linear array ultrasound probe in the diagnosis of thyroid anterior capsular invasion / 中华医学超声杂志（电子版）

Objective To investigate the value of 18 MHz high-frequency linear array ultrasound probe in the diagnosis of thyroid anterior capsular invasion,and compare it with the conventional high-frequency ultrasound probe.Methods Seventy-three nodules in 68 patients in Peking Union Medical College Hospital from December 2015 to March 2016 underwent conventional and 18 MHz high-frequency probes examination before operation and were compared with pathological results.The accuracy,sensitivity and specificity of the 18 MHz high-frequency linear array probe and the conventional high-frequency probe were determined.The consistency between the gold standard and the diagnosis by using two different frequency probes was measured using Kappa statistics.Additionally,diagnostic accuracy of different frequency probes was further evaluated according to the area under the ROC curve.Results The diagnostic consistency test of the total sample of 73 nodules:capsular abutment as the diagnostic criterion,the diagnostic consistency of 18MHz high-frequency probe was good (Kappa=0.803,P ＜ 0.01).The specificity,positive predictive value and accuracy were superior to the conventional high-frequency probe (90.7％ vs 69.8％,87.1％vs 68.3％,90.4％ vs 79.5％).The area under the ROC curve was 0.903,higher than that of the conventional high-frequency probe (0.816),which demonstrated that the former had better diagnostic accuracy.If the disruption of the perithyroidal echogenic line as another diagnostic criterion,the diagnostic consistency of the 18 MHz and conventional high-frequency probe was general,the Kappa value were 0.677 and 0.518.The sensitivity,positive predictive value,negative predictive value and accuracy of conventional high-frequency probe were inferior to the 18 MHz high-frequency probe (53.3％ vs 70.0％,74.5％ vs 82.0％,88.9％ vs 91.3％,78.1％ vs 84.9％).Conclusions The 18 MHz high frequency probe is a feasible tool for accurate prediction of the distance between tumor and thyroid anterior capsular and anterior capsular invasion,and it is helpful for the diagnosis of the preoperative staging and the prognosis of PTC.

Análisis de factores de agresividad de microcarcinoma papilar de tiroides / Features influencing aggressiveness of papillary thyroid microcarcinoma

Background: the risk factors determining the aggressiveness of papillary thyroid microcarcinoma (PTMC) are not well known. Aim: to determine if tumor size, along with other features of the tumor, influences its prognosis. Patients and Methods: we analyzed the medical records of 147 patients (age range 16-92 years, 93 percent women) at the Clinical Hospital of University of Chile who underwent thyroid surgery and in whom at least one focus of PTMC was found. We determined the association between different clinical characteristics and the presence of capsular invasion, lymph nodal extension or recurrence. Results: a tumor size over 5 mm, a follicular subtype and being aged more than 45 years, were significantly associated with the presence of capsular invasion. The latter two variables were protective. In the multivariate analysis, only a tumor size over 5 mm was significantly associated with thyroid capsule involvement. Conclusions: a tumor size over 5 mm is associated with capsular invasion in PTMC.

Introducción: los factores de riesgo que determinan una conducta agresiva de microcarcinoma papilar de tiroides (MCPT) no se conocen. Nuestra hipótesis es que el tamaño del tumor, posiblemente junto con otras características del cáncer puede influir en el pronóstico de esta patología. Material y Método: se analizaron las historias clínicas de 147 pacientes que se sometieron en nuestro hospital a cirugía de tiroides y en los cuales se encontró al menos un foco de MCPT. Resultados: se determinó la existencia de una correlación entre las diferentes características clínicas y la presencia de invasión capsular, la extensión ganglionar linfático o la recidiva. En el análisis univariado, el tamaño del tumor mayor de 5 mm, se correlacionó significativamente con la presencia de invasión capsular (p < 0,05). Entre las variables estudiadas, sólo un tamaño superior a 5 mm se asoció significativamente con el compromiso de la cápsula tiroidea en el análisis multivariado. Conclusiones: aunque en general el MCPT se comportan con baja agresividad, se encontró que aquellos que son mayores de 5 mm a menudo tienen invasión capsular, que se ha relacionado con aumento de la agresividad y recidiva. Se recomienda un tratamiento orientado según la presencia de factores de riesgo como las que se describen aquí.

Clinical Characteristics and Prognostic Factors of Papillary Microcarcinoma: Results from Retrospective Analysis of 176 Patients / 대한내분비외과학회지

PURPOSE: The clinical importance and characteristics of papillary thyroid microcarcinoma (PTC) are still under debate, and the criteria for appropriate treatment have yet to be established. In this study, we attempted to examine the appropriate extent of surgery and the desirability of prophylactic lymph node (LN) dissection through identification of factors influencing LN metastasis and capsular invasions. METHODS: We reviewed the medical records of 176 consecutive biopsy-proven PTC patients. The clinical and pathological prognostic factors including LN metastasis and capsular invasion were analyzed. Chi-square test and independent sample T-test were used for statistical analysis. RESULTS: The median age of patients was 47-years-of-age (range 23~80 years). Among 108 patients who underwent central LN dissection, 38 (35.8%) patients showed LN metastasis. Univariate analysis revealed that male patients showed significantly more LN metastasis than female patients and lymphovascular invasion significantly affected LN metastasis. Twenty-eight (14.8%) patients showed capsular invasion. Tumor size, especially tumors ≥5 mm in diameter, and tumor multiplicity were significantly associated with capsular Invasion. Lymphatic or venous invasion also affected the occurrence of capsular invasion. CONCLUSION: Patients who are male, have a tumor larger than 5 mm in diameter, or multiple tumors are more likely to develop LN metastasis or capsular invasions. These factors could help us to decide the extent of thyroidectomy and to select patients who need prophylactic LN dissection.

Papillary Thyroid Cancer: Clinicopathologic Characteristics and Factors of Contralateral Jugular Lymph Node Metastasis after Lymph Node Dissection / 대한내분비외과학회지

PURPOSE: Contralateral jugular lymph node metastasis (CJLNM) of papillary thyroid cancer (PTC) is rarely found during operative procedures. HoweverPTC is being diagnosed with increasing frequency and lymph node metastasis is now recognized as a factor of prognosis and recurrence. Therefore, this study was conducted to evaluate the clinical and histological characteristics of papillary thyroid cancer and to determine the factors that lead to CJLNM. METHODS: Two-hundred patients with PTC were treated in our hospital between March 2005 and October 2006. A retrospective analysis of the patient's clinical and histological features and lymph node metastasis was conducted. RESULTS: The total ratio of CJLNM to PTC was approximately 7.5%, the male to female ratio was 1:6.5, and the mean tumor size was 14.93 mm. In addition, the multiplicity was 53.3% and the bilatrality was 53.3%. Further, there were 4 cases involving benign thyroid disease combined with goiter. In addition, the capsule invasion was 100%. Age under 40 years, bilaterality and capsule invasion were found to be significant clinicopathologic factors of CJLNM induced by PTC. CONCLUSION: A contralateral jugular lymph node biopsy of PTC may be considered in cases involving patients under 40 years of age with, bilaterality and capsular invasion.