Cancer de Tiroides e Indicaciones de Tiroidectomia.
Palabras clave:
Cáncer, bocio, incidencia, tiroides, tiroidectomía, yodo, sobrediagnóstico, Cancer, goiter, incidence, thyroid, thyroidectomy, iodine, overdiagnosisResumen
EXPERIENCIA DE 10 AÑOS EN EL DEPARTAMENTO DEL CAUCA, COLOMBIA, PERIODO 2004- 2013. INTRODUCCIÓN: El cáncer tiroideo es el cáncer endocrino más común de todos los diagnosticados en los Estados Unidos. El incremento en su frecuencia se debe al aumento en la incidencia del tipo papilar; su principal forma de presentación es en tumores pequeños. METODOLOGÍA: Se realizó una búsqueda manual exhaustiva de los registros de patología de individuos que fueron sometidos a tiroidectomía en dos centros de referencia en Popayán-Cauca, entre los años 2004 y 2013. Se realizó un análisis exploratorio para calcular las medidas de ocurrencia en enfermedad tumoral y no-tumoral. RESULTADOS: Se documentaron 463 tiroidectomías; 205 fueron por cáncer de tiroides y 258 fueron por patología distinta al cáncer de tiroides; 195 correspondieron a las diferentes variedades de carcinoma diferenciado (95,121%); 168 fueron para el tipo papilar clásico y sus variedades (81,95%); 22 fueron para carcinoma folicular (10,73%); 3 para carcinoma de células de Hürthle (1,46%); 2 se rotularon como mixtos (0,975%); 6 (2,92%) correspondieron a carcinoma pobremente diferenciado; 2 correspondieron a carcinoma medular (0,975%) y 2 fueron clasificados como anaplásicos (0,975%). CONCLUSIONES: El incremento en el número de cirugías en patología tiroidea tumoral y no-tumoral puede explicarse por un aumento real en la frecuencia –por un factor medioambiental explícito– (ingesta excesiva de sal yodada) y por un “sobrediagnóstico” originado por un mayor acceso a estudios de imágenes y una mayor frecuencia de ACAF. El incremento en los procedimientos en patología no-tumoral puede deberse principalmente a conductas, decisiones o creencias por parte del cirujano y del paciente. THYROID CANCER AND THYROIDECTOMY INDICATIONS A 10-YEAR EXPERIENCE IN CAUCA DEPARTMENT, COLOMBIA, DURING YEARS 2004-2013 ABSTRACT INTRODUCTION: Thyroid cancer is the most common endocrine cancer diagnosed in the United States. The increase in frequency is due to greater incidence of the papillary type, when seen as a small tumor. METHODOLOGY: We performed a comprehensive manual search of pathology records of individuals who underwent thyroidectomy at two reference centers in the city of Popayán, Cauca, between years 2004 and 2013. An exploratory analysis calculated the number of times thyroidectomy was done for tumor and for non-tumor disease. RESULTS: We documented 463 thyroidectomies; 205 were for thyroid cancer and 258 were for other conditions; 195 cases (95.121%) were classified as differentiated thyroid carcinoma; of these, 168 were classical papillary carcinoma and subtypes (81.95%); 22 were follicular carcinomas (10.73%); 3, Hürthle-cell carcinomas (1.46%); 2 were labeled as mixed (0.975%); 6 (2.92%) were poorly differentiated carcinomas, 2, medullary carcinomas (0.975%) and 2 were classified as anaplastic (0.975%). CONCLUSIONS: The increased number of surgeries in thyroid (tumor and non-tumor) disease can be explained by an actual increase in frequency-by a environmental explicit-factor (excessive intake of iodized salt) and moreover, can be explained by a “over-diagnosis” caused by increased access to imaging studies and a a larger number of fine-needle aspiration citologies (ACAF). The increase in thyroidectomies for non-tumoral pathology may be primarily due to a physician tendency to a surgical approach, decisions and beliefs by both surgeons and patients.Biografía del autor/a
Hernando Vargas Uricoechea, Universidad del Cauca, Popayán.
Jorge Herrera Chaparro, Universidad del Cauca, Popayán
Ivonne Meza Cabrera, Hospital Universitario San José
Valentina Agredo Delgado, Universidad del Cauca
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