In most centers only selected patients with high risk thyroid nodules undergo thyroid surgery, and fine needle aspiration biopsy (FNA) is used to select patients for surgical treatment. The aim of the present study was to evaluate the impact of FNA on the management of thyroid nodules at our institution. A total of 872 patients who underwent FNA over a period of 7 years were retrospectively analyzed. There were 66 men and 806 women with a mean age of 40 +/- 15 years. Altogether 549 patients presented with a thyroid nodule and 323 with multinodular disease. The sensitivity and specificity of FNA were 90.0% and 99.8%, respectively. The positive and negative predictive values were 98% and 99%, respectively, and the accuracy was 99%. Our results are in agreement with those of other reports establishing that FNA of the thyroid is safe, reliable, and effective for differentiating benign from malignant nodules.
Background: The incidence of micropapillary thyroid carcinoma (mPTC) has increased in the last decade. Active surveillance (AS) has been proposed as an alternative management for low-risk mPTC based on preoperative Kuma criteria. Controversy still exists on how to appropriately manage this group of patients, as some low-risk mPTC may harbor some postoperative features associated with disease recurrence as described in the 2015 American Thyroid Association (ATA) guidelines. Methods: We retrospectively reviewed 108 patients with histopathologic diagnosis of mPTC after surgery at a third level hospital in Mexico City from 2000 to 2018. Demographic and clinicopathologic data were analyzed as predictors for disease recurrence and/or metastatic disease (lymph node or distant). Comparison between group stratification based on preoperative Kuma criteria and postoperative 2015 ATA guidelines risk criteria for disease recurrence was performed. Measures of diagnostic accuracy were obtained for preoperative risk features according to the Kuma criteria. Results: Of 108 patients, 79 (73%) were classified as preoperative high-risk mPTC and 29 (27%) as low risk based on the Kuma criteria. Of these 79 high-risk patients, 38 (48%) were reclassified as low risk for disease recurrence, 12 (15%) as intermediate risk, and 29 (37%) remained as high risk based on the 2015 ATA risk criteria. Of the 29 preoperative low-risk patients, 19 (65.5%) remained as postoperative low risk for disease recurrence, 2 (7%) as intermediate risk, and 8 (27.5%) as high risk. Higher accuracy of preoperative risk features was obtained for lymph node and distant metastases, 84.2% and 97.2%, respectively. After multivariate analysis, age <40 years and microscopic extrathyroidal extension (ETE) were associated with higher risk for metastatic disease (lymph node or distant) in our cohort. Conclusions: Patients with mPTC under 40 years old and microscopic ETE are more prone to develop metastatic disease (lymph node or distant). One-third of our patients stratified as low-risk mPTC according to the Kuma criteria for AS had histopathologic features associated with a more aggressive clinical behavior or structural recurrence. In addition, lymph node and distant metastases are the preoperative risk features with the highest diagnostic accuracy for preoperative risk stratification.
Introduction Recurrence of papillary thyroid carcinoma after initial treatment is challenging. Surgical reintervention is recommended, but cure after surgery in uncertain and surgical morbidity may be high. This study evaluates the effect of compartment‐oriented lymph node dissection (LND) on clinical and biochemical cure rate as well as the related complications. Patients and methods All patients who underwent LND for recurrent papillary thyroid carcinoma between 2000 and 2015 were included. Demography, the extent of the initial surgery, usage of 131I, the pattern of recurrence, diagnosis, details of the surgical reintervention, histological findings, surgical morbidity, and clinical and biochemical outcomes were analyzed. Results There were 11 (12.7%) males and 75 (87.2%) females with a mean age of 42.8 ± 14.6 years. Seventy‐seven patients had undergone total thyroidectomy and in 67 (77.9%) some type of LN resection. In 76 (88.3%), 131I was administered after the initial surgery. We localized suspicious lymph nodes by US in all patients, and metastases were documented before surgery by FNA in 63. Seven (8.13%) patients underwent central LND, 63 (73.2%) lateral LND and 16 (18.6%) both, central and lateral LND. Major complications occurred in 6 patients (6.9%). Sixty‐two (72.0%) patients received 131I after surgery. A second surgical re‐exploration was performed in 30 (34.8%) patients, and 7 patients required 3 or more additional LND. In a mean follow‐up of 59.4 ± 39 months, 51 (59.3%) patients are clinically, radiologically and biochemically free of disease. Conclusions In this series, compartment‐oriented lymph node resection of recurrent papillary thyroid carcinoma leads to a final clinical and biochemical disease‐free status of 59.3% with 6.9% of major complications.
images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 356;26 www.nejm.org june 28, 2007 e27 A 72-year-old woman presented for evaluation of dyspnea. thirtyfive years earlier, she had noticed a painless, slowly enlarging anterior neck mass. Since she was otherwise asymptomatic and many in her community had the same "problem," she did not seek medical attention. For the past few years, however, she has had a sensation of suffocating a few minutes after falling asleep. Physical examination showed a goiter that was large, lobular, soft, and painless, with cyanosis and protrusion of the inferior lip (Panel A), which was probably related to chronic respiratory insufficiency. Serum thyrotropin and free thyroxine levels were normal. Computed tomography (Panel B) revealed a heterogeneous goiter, 16 cm by 7 cm, that was in contact with the trachea (arrow) and was displacing vascular structures (arrowheads). Cytologic examination of a specimen obtained by aspiration showed a colloid goiter. Surgical treatment was successfully accomplished early in 2007.
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