Multicentric papillary carcinoma of the thyroid: Study at the Hospital of San José de Bogotá

Carcinoma papilar multicéntrico del tiroides: Estudio en el Hospital de San José de Bogotá

Papillary thyroid carcinoma (TPC) is the most frequent endocrine neoplasia. Part of its characteristics is to be multicentric and have great predisposition for regional ganglion invasion. There is still controversy about the extension of the surgical procedure as the therapy of choice; Options vary from the resection of the compromised lobe to the completion of total thyroidectomy and central lymph node dissection. Those who support the former are based on the lower possibility of recurrent laryngeal nerve injury, while the latter seek better local control of the disease. We retrospectively reviewed the clinical histories and pathology reports of 202 patients diagnosed with CPT between 1994 and 2003, who underwent total thyroidectomy and central lymph node dissection at the Hospital de San José in Bogotá to determine if they were multicentric in the surgical specimens. Data from 168 (83%) women and 34 (17%) men were included, finding multiple foci in 91 (45%), lymph node metastases in 131 (64.85%) and combination of the former in 58 (28.7%). Recurrent laryngeal nerve injury was observed in three patients (1.48%), all of them men. The above data suggest that the performance of total thyroidectomy and central lymph node dissection allows a better control of the local disease with a low risk of recurrent laryngeal nerve injury. Abbreviations: CPT, papillary thyroid carcinoma; HSJ, Hospital de San José; BAAF, fine needle aspiration biopsy.

1. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53.856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer. 1998 Dec 15;83(12):2638-48.

2. Boone RT, Fan CY, Hanna EY. Well-differentiated carcinoma of the thyroid. Otolaryngol Clin North Am. 2003 Feb;36(1):73-90.

3. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988 Dec;104(6):947-53.

4. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987 Dec;102(6):1088-95.

5. Boyd LA, Earnhardt RC, Dunn JT, Frierson HF, Hanks JB. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules J Am Coll Surg. 1998 Nov;187(5):494-502.

6. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994 Nov;97(5):418-28. 148 Repertorio de Medicina y Cirugía. Vol. 15 No. 3• 2006

7. Beasley NJ, Lee J, Eski S, Walfish P, Witterick I, Freeman JL. Impact of nodal metastases on prognosis in patients with well-differentiated thyroid cancer. Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):825-8.

8. Ogren FP. Under most circumstances, thyroid lobectomy is appropriate for low-risk patients with papillary cancer of the thyroid. Arch Otolaryngol Head Neck Surg. 2001 Apr;127(4):461-2.

9. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am. 1990 Sep;19(3):545-76.

10. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988 Dec;104(6):947-53.

11. Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993 Dec;114(6):1050-7; discussion 1057-8.

12. Cohen EG, Tuttle RM, Kraus DH. Postoperative management of differentiated thyroid cancer. Otolaryngol Clin North Am. 2003 Feb;36(1):129-57.