Manejo quirúrgico de tumores tiroideos en el Hospital General Docente Dr Agostinho Neto, Guantánamo 2016-2018 / Tratamento cirúrgico dos tumores da tiróide no Hospital Geral de Ensino Dr Agostinho Neto, Guantánamo 2016-2018 / Surgical management of thyroid tumors in the Teaching General Hospital Dr Agostinho Neto, Guantánamo 2016-2018

Introducción: en Guantánamo no está precisado el tratamiento quirúrgico de los pacientes con tumores del tiroides. Objetivo: precisar el tratamiento quirúrgico de los pacientes con nódulo tiroideo en el Servicio de Cirugía General del Hospital Dr Agostinho Neto durante el 2016-2018. Método: se realizó un estudio descriptivo, prospectivo y longitudinal. Se analizó: el resultado de la biopsia por parafina, clasificación del TIRADS (Thyroid Imaging Reporting and Data System), técnicas quirúrgicas y complicaciones posoperatorias. Resultados: fue más frecuente el carcinoma tiroideo (52,8 por ciento). El 29,1 por ciento de los pacientes se agrupó en la categoría TIRADS II. En la categoría TIRADS III fue más común el bocio multinodular (n=6); en la TIRADS IV, el carcinoma (n=4); todos los pacientes en las categorías V y VI presentaron carcinomas. La técnica más empleada fue la hemitiroidectomía con itsmectomía (47,2 por ciento). Se registraron complicaciones en 7 pacientes y la más común fue la parálisis recurrencial transitoria. Conclusiones: fue más frecuente el carcinoma del tiroides. Se revela la utilidad de la clasificación TIRADS para el manejo de estos pacientes. Fue bajo el registro de complicaciones(AU)

Introduction: Guantanamo does not specify the surgical treatment of patients with thyroid tumors. Objective: to specify the surgical treatment of patients with thyroid nodules in the General Surgery Department of the General Teaching Hospital Dr Agostinho Neto during the period 2016- 2018. Method: a descriptive, prospective and longitudinal study was made. The results of the paraffin biopsy, TIRADS classification (Thyroid Imaging Reporting and Data System), surgical techniques and postoperative complications were studied. Results: thyroid carcinoma was more frequent (52.8 per cent). 29.1 per cent of the patients were grouped in the TIRADS II category. In the TIRADS III category, multinodular goiter was more common (n=6); in TIRADS IV, the carcinoma (n=4); all patients in categories V and VI presented carcinomas. The most used technique was hemithyroidectomy with itsmectomy (47.2 per cent). Complications were recorded in 7 patients and the most common was transient recurrent paralysis. Conclusions: Thyroid carcinoma was more frequent. The usefulness of the TIRADS classification for the management of these patients is revealed. It was under the registry of complications(AU)

Introdução: Guantánamo não especifica o tratamento cirúrgico de pacientes com tumores da tireoide. Objetivo: especificar o tratamentocirúrgico de pacientes com nódulos tireoidianos no Departamento de Cirurgia Geral do Hospital Universitário Dr Agostinho Neto durante o período 2016-2018. Método: estudo descritivo, prospectivo e longitudinal. Foram estudados os resultados da biópsia de parafina, classificação TIRADS (Thyroid Imaging Reporting and Data System), técnicas cirúrgicas e complicações pós-operatórias. Resultados: o carcinoma de tireoide foi mais frequente (52,8 por cento). 29,1 por cento dos pacientes foram agrupados na categoria TIRADS II. Na categoria TIRADS III, o bócio multinodular foi mais comum (n=6); no TIRADS IV, o carcinoma (n=4); Todos os pacientes das categorias V e VI apresentaram carcinomas. A técnica mais utilizada foi a hemitireoidectomia com sua mectomia (47,2 por cento). As complicações foram registradas em sete pacientes e a mais comum foi a paralisia transitória recorrente. Conclusões: o carcinoma de tireoide foi mais frequente. A utilidade da classificação do TIRADS para o manejo desses pacientes é revelada. Foi sob o registro de complicações(AU)

Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB)

OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.

Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

ABSTRACT Objective To evaluate the clinical utility of 18F-FDG PET/CT in patients with high-risk DTC. Subjects and methods Single-center retrospective study with 74 patients with high-risk differentiated thyroid cancer (DTC), classified in 4 groups. Group 1: patients with positive sTg or TgAb, subdivided in Group 1A: negative RxWBS and no foci of metastases identified at conventional image (n = 9); Group 1B: RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level (n = 13); Group 2: patients with histological findings of aggressive DTC variants (n = 21) and Group 3: patients with positive RxWBS (n = 31). Results 18F-FDG PET/CT identified undifferentiated lesions and helped restage the disease in groups 1B and 2. The scan helped guide clinical judgment in 9/13 (69%) patients of group 1B, 10/21 (48%) patients of group 2 and 2/31 (6%) patients of group 3. There was no clinical benefit associated with group 1A. 18F-FDG PET/CT was associated with progressive disease. Conclusion 18F-FDG PET/CT is a useful tool in the follow-up of patients with high-risk DTC, mainly in the group of RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level and in those with aggressive DTC variants. Additionally, this study showed that 18F-FDG PET/CT was associated with progression and helped display undifferentiated lesions guiding clinical assessments regarding surgeries or expectant treatments.

Histological variants and prognostic factors of papillary thyroid carcinoma at the Colombian Instituto Nacional de Cancerología, 2006-2012 / Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012

Introduction: Thyroid cancer is the most common endocrine neoplasia and the papillary subtype is the most frequent; there are histological and clinical factors associated with a higher risk of recurrence and metastasis. Objective: The aim of this study was to examine the histological, prognostic and clinical characteristics of papillary thyroid carcinomas diagnosed at the National Cancer Institute of Colombia. Materials and methods: A retrospective cohort study was carried out on 619 patients with papillary thyroid carcinoma between 2006 and 2012; we analyzed the sociodemographic, histological, prognostic and clinical characteristics. Results: 87.7% of cases were women. The presence of two or more variants in the same case was considered a particular variant, which we called combined pattern. Combined pattern was then the most frequent (50.9%), followed by the follicular variant (23.4%) including subtypes encapsulated and unencapsulated, and the classic variant (22.1%). Mean tumor size was 20.8 mm. More than half of the cases had capsular invasion, extrathyroidal invasion and lymph node involvement. When compared with the other variants, the combined pattern carcinomas had a higher risk of invasion of the thyroid capsule, extraganglionar invasion and metastasis. Conclusions: Our results are in many aspects similar to those already reported. However, the presence of the combined pattern implied a higher risk for capsular invasion, nodal involvement, extranodal involvement and metastasis in comparison with those which had just one variant. Further studies are necessary to confirm these results.

Introducción. El cáncer de tiroides es la neoplasia más común y el subtipo papilar es el más frecuente; hay factores histológicos y clínicos asociados con un mayor riesgo de recidiva y metástasis. Objetivo. Examinar las características histológicas, clínicas y de pronóstico de los carcinomas papilares de tiroides diagnosticados en el Instituto Nacional de Cancerología de Colombia. Materiales y métodos. Se llevó a cabo un estudio de cohorte retrospectiva que incluyó a 619 pacientes con carcinoma papilar de tiroides entre 2006 y 2012; se analizaron las características sociodemográficas, histológicas, de pronóstico y clínicas. Resultados. El 87,7% de casos correspondió a mujeres. La presencia de dos o más variantes histológicas en un mismo caso se consideró como una variante a la cual se denominó patrón combinado; esta fue la más frecuente (50,9 %), seguida de la variante folicular (23,4 %), incluidos los subtipos encapsulados o no encapsulado y la variante clásica (22,1 %). El promedio del tamaño tumoral fue de 20,8 mm. En más de la mitad de los casos se evidenció invasión capsular, invasión extratiroidea y metástasis en ganglios linfáticos. Comparados con otras variantes histológicas, los carcinomas con patrón combinado presentaron mayor riesgo de invasión de la cápsula tiroidea, de invasión extraganglionar y de metástasis. Conclusión. En muchos aspectos los resultados fueron similares a los reportados previamente; sin embargo, se encontró que la presencia del patrón combinado aumentaba el riesgo de invasión capsular, metástasis en nódulos linfoides y extensión extratiroidea en comparación con los que tenían una sola variante. Sería necesario hacer estudios acerca del mecanismo biológico de la diferenciación en células cancerosas con el fin de ahondar sobre este fenómeno.

Spectrum of thyroid lesions on fine needle aspiration cytology.

The incidence of thyroid lesions is increasing significantly nowadays. Many a times, differentiation between physiological, inflammatory, autoimmune, hyperfunctioning and hypofunctioning of thyroid gland, benign and malignant tumor poses diagnostic difficulty. Fine needle aspiration cytology (FNAC) with clinical correlation, along with ultrasonography and thyroid function tests are done in relevant cases. Final diagnosis requires morphological examination of the lesions. FNAC is widely accepted and has become the cornerstone in evaluation of the thyroid lesions, as unnecessary surgery can be avoided. We studied a total of 251 cases in the age range of 3 years to 72 years, who presented with thyroid swelling over a period of one year and got a spectrum of thyroid lesions on cytology. Incidence was more in females 230 cases (91.63%) compared to males 21 cases (8.36%). Nodular goiter was the commonest disease constituting 127 cases (50.59%) followed by Hashimoto’s thyroiditis 93 cases (33.05%) and malignancy was reported in 7 cases (2.78%). USG guided FNAC for optimization of results is necessary for the location of target lesion. Careful searching for malignant cells and repeat FNAC are the key to a successful diagnosis and to plan a proper surgical procedure. Follow-up is necessary in case of a benign mass.

Is thyroid stunning clinically relevant? A retrospective analysis of 208 patients / O atordoamento da tireoide é clinicamente relevante? Análise retrospectiva de 208 pacientes

Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems / Níveis indetectáveis de tireoglobulina pré-ablação em pacientes com câncer de tireoide: nem sempre é o que parece

OBJECTIVE: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb- negative patients and to evaluate the outcome in the follow-up. SUBJECTS AND METHODS: We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow-up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. RESULTS: Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. CONCLUSIONS: U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement.

OBJETIVO: Estabelecer a frequência de U Tg (tireoglobulina indetectável pré-ablação) em pacientes com TgAb negativo e avaliar o prognóstico no seguimento. SUJEITOS E MÉTODOS: Foram analisados retrospectivamente 335 registros de pacientes. Vinte e oito pacientes (9%) tiveram U Tg. O acompanhamento médio foi de 42 ± 38 meses. Todos os participantes receberam uma tireoidectomia total, e os linfonodos foram positivos em 13 (46%) pacientes. Tg e TgAb foram medidos quatro semanas após a cirurgia pelo método IMA em estado de hipotireoidismo. A não evidência de doença (NED) foi definida como níveis indetectáveis (<1 ng/mL) de Tg estimulada com anticorpos anti-Tg negativos e/ou PCI negativo, com estudos de imagem normais. RESULTADOS: Dezessete pacientes (61%) foram considerados com NED. Quatro pacientes (14%) tiveram doença persistente (mediastino, n = 1, pulmão n = 2, n = desconhecido 1), e 7 (25%) apresentavam anticorpos anti-Tg detectáveis por outro método durante acompanhamento. CONCLUSÕES: U Tg geralmente indica uma cirurgia completa. No entanto, em uma pequena porcentagem de pacientes, pode estar relacionada com uma medida de Tg ou de anticorpos anti-Tg falsamente negativos.

Cáncer de tiroides: En búsqueda del tratamiento individualizado / Thyroid cancer: In search of individualized treatment

La incidencia de cáncer de tiroides, principalmente carcinoma papilar, aumentó exponencialmente en todo el mundo. Este incremento podría reflejar los efectos combinados de las prácticas de detección , sumados a cambios en los factores de riesgo. A pesar de este aumento, la mortalidad específica se mantuvo estable en las últimas tres décadas. Dado que los pacientes con carcinoma papilar de tiroides a menudo tienen un muy buen pronóstico, con elevada supervivencia en el seguimiento a largo plazo en comparación con otro tipo de carcinomas, no ha habido una necesidad de cambiar el tratamiento convencional por mucho tiempo. Los pilares del tratamiento, cirugía (tiroidectomía total o casi total) y la terapia con radioyodo (131I), se encuentran en este momento en el centro de discusión en los foros mundiales. La tendencia actual es garantizar el tratamiento más eficaz y menos deletéreo para el paciente. En este momento lo más importante es individualizar el enfoque terapéutico considerando cuál es el estadio tumoral y el riesgo de recurrencia, para determinar qué pacientes se beneficiarán de una terapia más agresiva y cuáles podrán ser tratados con un enfoque más conservador.

The incidence of thyroid cancer has increased exponentially around the world (mostly papillary thyroid carcinoma). This growth may reflect the combined effects of increased screening practices, together with changes in risk factors for thyroid cancer. In spite of this, disease specific mortality remained stable in the last three decades. Due to the fact that patients with papillary thyroid carcinoma often have a very good prognosis, with high survival in the long term follow-up compared with other types of carcinomas, there has been no need to change the standard treatment. The mainstays of thyroid cancer treatment are surgery (total or near-total thyroidectomy) with or without the additional administration of radioiodine (131I). These approaches are now in the center of discussion in all global forums. The current trend is to ensure the most effective and less harmful treatment and the most important issue at this point is to individualize patients according to tumor stage and risk of recurrence, to define which patients will benefit of more aggressive therapy and who could be handled with a more conservative approach.

Discriminating thyroid cancers from benign lesions based on differential expression of a limited set of miRNA using paraffin embedded tissues.

Background : Micro-RNAs (miRNAs) are expressed in a tissue-specific manner and are known to demonstrate differential expression even among the various subtypes of a given tumor. This differential expression has been harnessed successfully in the development of diagnostic assays for various malignant tumors. These assays have been found to be relevant and of value as additional diagnostic tools even among thyroid tumors, particularly with regard to thyroid carcinomas of follicular morphology. Materials and Methods : A limited set of miRNA have been assessed as part of this study in an effort to use minimal number of miRNA markers (miR-187, miR-221, miR-222, and miR-224) to differentiate the benign from the malignant thyroid tumors using miRNA derived from paraffin embedded material. Results : While miR-221 and miR-222 were found to provide good accuracy as individual markers (86% and 84%), a combination of the two provided slightly better accuracy (91%). Both miR-221 and 222 were able to significantly differentiate malignant tumors from the benign samples (P< 0.001) individually and as a combination of markers. However, inclusion of miR-187 and miR-224 in the panel did not provide any additional benefit. Conclusion : While a combination of miR-221 and 222 when used in a diagnostic panel could provide fairly good accuracy additional markers may need to be investigated to augment their diagnostic utility.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Carcinoma diferenciado de tiroides (CDT) en niños y adolescentes: Evolución clínica y factores pronósticos / Differentiated thyroid carcinoma in children and adolescents: Clinial outcome and prognostic factors

Si bien la forma de presentación del CDT es más agresiva en la edad pediátrica que en los adultos, la tasa de sobrevida es superior al 90%.Objetivo: analizar retrospectivamente las características clínico-patológicas,la evolución y los factores pronósticos en pacientes prepuberales (PP) y puberales (P) con diagnostico de CDT controlados en nuestro servicio. Resultados se incluyeron 43 pacientes seguidos por un tiempo X (±DS) de 5.99 años(a) (3.57) a, rango 1 -14 a. El tratamiento consistió en tiroidectomía con vaciamiento ganglionar, Iodo131 y levotiroxina en dosis inhibitoria de TSH. Al diagnóstico: edad cronológica (EC) X (±DS)10.9 (3.84) a, rango: 4.7 -17a, relación femenino /masculino 2.9. Diecinueve PP y 24 P. El 53.5% (n:23) presentó nódulos confinados a la glándula con o sin extensión ganglionar y el 46.5% (n:20) tenia un estadío tumoral más avanzado con invasión local y metástasis (MTS) pulmonar. Treinta y ocho pacientes (88.4%) tenían MTS ganglionar cervical y 16(37.2%) MTS pulmonar. El grupo PP comparado con el P tenía EC significativamente menor X (±DS) 7.25 (2.03) a vs 13.83a (p <0.001), estadío tumoral más avanzado 84.2 vs16.8% (p<0.001) y mayor ocurrencia de MTS pulmonar 68.4 vs 12.5% (p<0.003). La sobrevida global fue de 92% y libre de enfermedad 78%.Las variables predictoras de persistencia de enfermedad más significativas fueron presencia de MTS pulmonar al diagnóstico y niveles séricos de tiroglobulina superiores a 8.5 ng/ml posterior al tratamiento inicial. Conclusión: el CDT pediátrico tiene una presentación agresiva especialmente en los pacientes prepuberales. El pediatra debería incorporar el examen clínico del cuello para realizar un diagnóstico y tratamiento precoz (AU)

Children-DTC has been found to behave differently than in adults. At diagnosis, children present in a more aggressive way. However the overall survival rates is greater than 90%. The aim of this study was to perform a retrospective analysis of clinicopathologycal features at diagnosis, evolution and prognostic factors for DTC in pre-pubertal (PP)and pubertal (P)children treated at our centre. Results: 43 CDT patients were included. Mean follow up was X (±DS) 5.99 (3.57) years (y) range: 1 -14 y. Treatment consisted on total thyroidectomy with lymph node dissection, radioiodine therapy, and TSH suppressive therapy with L-thyroxine. At diagnosis: chronological age (CA) was (±DS) :10.9 (3.84) y, range: 4.7 - 17y,sex: female/male ratio: 32/11,nineteen were PP and 24 P. Twentythree ( 53.5%) presented intrathyroidal nodes with or without lymph node MTS, Twenty patients (46.5%) had advanced disease, with adjacent tissue invasion and lung MTS. Thirty-eight patients (88.4%) had cervical lymph node MTS, 16 (37.2%) lung MTS.PP group had significant less CA X (±DS) 7.25 (2.03) y vs 13.83 (1.95)y (p <0.001),advanced tumor stage 84.2 vs16.8% (p<0.001) and more lung MTS occurrence 68.4 vs 12.5% (p<0.003). Global survival rate was 92% and disease free survival rate was 78%.Lung metastases (MTS) and serum thyroglobuline levels greater than 8.5 ng\ml post initial treatment were the most significant prognostic factor related to persistent disease. Conclusion: CDT had a more aggressive presentation in children; especially in PP children. Pediatricians should be aware of this in order to realize a precocious diagnosis and treatment (AU)

Comparação das classificações dos nódulos de tireoide ao Doppler colorido descritas por Lagalla e Chammas / Comparison of color Doppler-evaluated thyroid nodule classifications as described by Lagalla and Chammas

OBJETIVO: Avaliar as classificações da vascularização dos nódulos de tireoide ao Doppler colorido descritas por Lagalla e cols. e Chammas e cols. MÉTODOS: Foram estudados 265 nódulos de tireoide com Doppler colorido e citopatologia. RESULTADOS: No diagnóstico de nódulos com citopatologia maligna, os padrões IV e V de Chammas mostraram sensibilidade de 16,7 por cento, especificidade de 97,6 por cento, valor preditivo positivo de 33,3 por cento, valor preditivo negativo de 94,1 por cento e acurácia de 92,1 por cento. O padrão III de Lagalla mostrou sensibilidade de 44,4 por cento, especificidade de 19,4 por cento, valor preditivo positivo de 3,9 por cento, valor preditivo negativo de 82,8 por cento e acurácia de 21,1 por cento. CONCLUSÃO: A classificação de Lagalla mostrou baixas sensibilidade e acurácia na detecção de nódulos com citopatologia maligna, enquanto a classificação de Chammas mostrou alta acurácia, porém baixa sensibilidade. O Doppler colorido mostrou-se insuficiente para substituir a punção com agulha fina e o estudo citopatológico no diagnóstico dos nódulos malignos da tireoide.

ABSTRACTOBJECTIVE: Evaluate the vascularization classification of thyroid nodules with color Doppler ultrasonography described by Lagalla and cols. and Chammas and cols. METHODS: A total of 265 thyroid nodules were studied with color Doppler and citopathology. RESULTS: In the diagnosis of nodules with malignant citopathology, Chammas's IV and V patterns showed sensibility of 16.7 percent, specificity of 97.6 percent, positive predictive value of 33.3 percent, negative predictive value of 94.1 percent and accuracy of 92.1 percent; Lagalla's III pattern showed sensibility of 44.4 percent, specificity of 19.4 percent, positive predictive value of 3.9 percent, negative predictive value of 82.8 percent and accuracy of 21.1 percent. CONCLUSION: Lagalla's classification showed low sensibility and accuracy in the detection of nodules with malignant citopathology, while Chammas's classification showed high accuracy, however, low sensibility. Color Doppler was also insufficient to substitute the small needle punction and the citopathologic study in the diagnosis of malignant thyroid nodules.

Ablación con yodo 131 en pacientes con cáncer diferenciado de tiroides en el Hospital Roberto Calderón / Ablation with iodine-131 in patients with differentiated thyroid cancer at the Hospital Roberto Calderón

Antecedentes: A pesar de las múltiples revisiones bibliográficas, metaanalisis y estudios de cohortes retrospectivo a largo plazo, persiste la controversia a cerca del uso de la ablación con yodo 131 en los pacientes con cáncer diferenciado de tiroides. Objetivo; Determinar la utilidad de la ablación con Yodo 131 como procedimiento terápéutico adyuvante en los pacientes con diagnóstico de cáncer diferenciado de tiroides en el Hospital ROberto Calderón G. Método: Estudio retrospectivo transversal de 83 pacientes con cáncer diferenciado de tiroides tratados integralmente de enero 2002 a diciembre 2007 en el Hospital Dr. Roberto Calderón, en quienes se analizaron los porcentajes de recurrencia en el grupo que recibió y en el que no recibió yodo131 como terapia ablativa post operatoria, identificándose además otros factores de mal positivo...

Association between different variants of papillary thyroid carcinoma and risk-group according to AMES (age, metastasis, extent and size) classification system.

OBJECTIVE: To study the association between cell variants of papillary carcinoma and AMES (Age, Metastasis, Extent and Size) risk classification. MATERIAL AND METHOD: One hundred and twenty-one cases of papillary thyroid carcinomas were subclassified for cell type and risk-groups according to AMES classification system. Correlations between both variables are evaluated RESULTS: Among different cell variants of papillary carcinoma, solid cell pattern has the highest proportion of high-risk tumor classified by the AMES criteria, comprising 75% followed by tall cell subtype with 33.3% of high risk patients. Conventional papillary carcinoma has only 8.3% of high-risk group. Follicular and encapsulated variants as well as microcarcinoma (< 1 cm) are all categorized as low-risk neoplasms. CONCLUSION: The present study indicates that there is association between cell variants and AMES prognostic index. The authors, therefore, emphasize the importance of cell variants in predicting the prognosis of papillary carcinoma.

clinicomorphological study of thyroid tumours in children and adolescents

This study was initiated to determine the clinicopathological aspects and frequency of various benign and malignant thyroid tumours in children and adolescents presenting with nodular and diffuse thyroid enlargement. Although numerous studies on thyroid tumours in adults are on record, data regarding thyroid tumors in children and adolescents in Pakistan is very scanty. Study design Descriptive cross sectional study. It was a 7-year retrospective study commencing from 1st July 1999 to 30th June 2006, conducted at the Department of Pathology, King Edward Medical University. Lahore, Pakistan. All thyroid specimens of children and adolescents aged 20 years and younger, submitted and reported at the Department of Pathology, King Edward Medical University, Lahore, Pakistan, during a 7-year period, were included in this study. Of the total 492 thyroid surgical specimens, 396 [80.48%] constituted of non-neoplastic lesions and 96 specimens [19.52%] were reported as tumours / neoplasms. Nearly all tumours were seen in the 2nd decade and girls outnumbered boys in a ratio of 5.4:1. Benign tumours constituted 86 [86.58%] cases and malignant constituted 10[10.42%] cases. The commonest benign tumour was Follicular Adenoma constituting 85 cases [98.54%] and Papillary Carcinoma was the commonest malignant tumour constituting 9 out of the 10 [90%] malignant cases. On clinical examination and scintiscans most of these tumours presented with cold solitary thyroid nodules. 3 cases of Papillary Carcinoma were associated with cervical lymph node metastases. There was a single case of Medullary Thyroid Carcinoma in a 12 year old boy with MEN 2 A syndrome. There was no case of Follicular Carcinoma in our study. Conclusions: Benign thyroid tumours far outnumber the malignant tumours in children and adolescents. The commonest tumour in this age group is Follicular Adenoma, followed by Papillary Carcinoma

value of fine needle aspiration cytology in the assessment of thyroid swellings at Queen Alia military hospital

To assess the accuracy of cytological examination of thyroid swellings and to evaluate the relationship between cytology and histopathology of fine needle aspiration at Queen Alia Military Hospital between 2002-2003. This study was carried out at Queen Alia Military Hospital between Jan.2002- Dec.2003. There were 251 FNAs of which 207 had subsequent excisional histopathological examination. All the records of histology and cytology were carefully reviewed and cases were identified and classified into six subsets: benign follicular lesions, thyroiditis, follicular neoplasm, suspicious of papillary carcinoma, malignant and non-diagnostic aspirate. Cases with no subsequent histopathological examination [n = 36] were excluded, also non-diagnostic aspirate [n = 8] were excluded. Only the medical records and histology of 207 cases were reviewed and correlated with the cytology results. There were 162 [75.3%] cases of benign aspirate, 31[12.3%] cases of follicular neoplasm, 8 [3.2%] cases of suspecious papillary carcinoma, 8 [3.2%] cases of non- diagnostic aspirate, 6 [2.4%] cases of papillary carcinoma. These 215 cases that underwent cytological and histopathological examinations, were classified as non-neoplastic and neoplastic [including follicular neoplasm and malignancy]. According to the postoperative histopathology and correlation that was carried out with preoperative cytology there were 145 true negative, 49 true positive, 11 false negative and 10 false positive. This gives a sensitivity of [81.7%], specificity of [93.5%], positive predictive value of [83%], negative predictive value of [93%] and accuracy of [90%]. The sensitivity and specificity of FNAs cytology in this study are similar comparatively with other published results, so FNA in experienced hands is a good screening test in the assessment of thyroid swellings, but one must be aware that a negative FNAs, doesnit exclude malignant lesions

Differentiated thyroid carcinoma referred for radioiodine therapy

The current work was conducted to study the disease status and treatment results of patients with differentiated thyroid carcinoma referred for radioactive iodine therapy. Retrospective review of 78 patients with differentiated thyroid carcinoma referred for radioiodine therapy in the Nuclear Medicine Unit, King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia. Analysis of the clinicopathologic characteristics, age correlation to different risk factors, treatment protocol and results were performed. Seventy seven% were female and the female to male ratio was 3.5:1. The age of patients ranged between 13-63 years with a median age of 36 years. Cervical lymph node involvement was detected in 22 patients [25%]. Papillary carcinoma was encountered in 78 patients [90%] and follicular carcinoma in 9 patients [10%]. Analysis of the clinicopathologic characteristics showed no statistically significant difference between patients in the different age groups except for extrathyroid extension and lymph node involvement. Patients older than 45 years had a statistically significant lower incidence of nodal involvement and higher incidence of extra thyroid extension [P<0.02]. In the current study we used a high dose method [Radioiodine-131 dose 75-100mCi] for thyroid remnant ablation after thyroidectomy [total or near total] in 67 patients. An Iodine 131 dose of 150 mCi was used in 12 patients with radioiodine-avid cervical lymph nodes and in 3 patients with gross residual tumor. In 4 patients with distant metastases an Iodine 131 dose of 200 mCi was used. For the whole study group the 5 year overall survival and disease-free survival was 96% and 88%. The current study, as with many other retrospective studies, concluded that despite the fact that differentiated thyroid carcinoma is among the most curable cancers, some patients are still at high risk for recurrent disease and associated mortality