Microcarcinoma papilar de la glándula tiroides: controversias y manejo actuales

  • Fernando López
    Servicio ORL y CCC. Hospital Universitario Central de Asturias. Oviedo. https://orcid.org/0000-0001-7019-9746 flopez_1981[at]yahoo.es
  • Patricia García-Cabo
    Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España https://orcid.org/0000-0003-2542-163X
  • Laura Fernández-Vañes
    Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España https://orcid.org/0000-0001-8196-9099
  • Andrés Coca-Pelaz
    1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España https://orcid.org/0000-0003-1363-8559
  • Juan Pablo Rodrigo
    1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España https://orcid.org/0000-0003-3063-0890
  • José Luis Llorente
    1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España https://orcid.org/0000-0001-7713-5526

Resumen

Introducción y objetivo: El número de pacientes con microcarcinoma papilar de la tiroides (mPTC) cada vez es más elevado. Las guías de práctica clínica han respaldado tanto la vigilancia activa como la cirugía como opciones de tratamiento para el (mCPT). En esta revisión nos planteamos como objetivo describir las opciones actuales de manejo del mCPT. Síntesis: La evidencia acumulada en los estudios realizados ha permitido conocer la historia natural y el comportamiento biológico de estos tumores. Mediante las extensas experiencias, se ha evidenciado que la gran mayoría de estos tumores muchas veces no presentan una variación significativa de su tamaño, o presentan tasas de crecimiento muy lentas, e incluso algunos presentan disminución de éste. La mayoría de mCPT son tumores de bajo riesgo clínico que no generarán morbilidad o mortalidad a pesar de no ser tratados. En los últimos años, la práctica clínica ha evolucionado hacia un tratamiento menos agresivo de estos mCPT para evitar la morbilidad derivada del tratamiento activo mediante cirugía y/o radioyodo y/o supresión hormonal. Los pacientes con tumores de alto riesgo deben ser manejados siguiendo los protocolos de los carcinomas papilares. Sin embargo, la vigilancia activa (VA) de pacientes con tumores de bajo riesgo ha mostrado excelentes resultados oncológicos sin aumentar la morbilidad y la mortalidad. Cuando se indica un tratamiento quirúrgico, la lobectomía es una opción válida para estos tumores. Los criterios de selección inicial para la idoneidad de ser manejados mediante VA deben tener en cuenta muchos aspectos, incluidas las características de los tumores y pacientes. En caso de alto riesgo de progresión deben ser sometidos a una cirugía inmediata en lugar de VA. Conclusiones: La VA ha surgido como una nueva alternativa terapéutica para estos tumores de bajo riesgo, con excelentes resultados oncológicos y menores tasas de complicaciones. No obstante, a pesar de los alentadores resultados de la VA, su implementación en la práctica depende de muchos aspectos entre los cuales se encuentran las características del tumor, las características clínicas del paciente y factores psicosociales.
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López, F., García-Cabo, P., Fernández-Vañes, L., Coca-Pelaz, A., Rodrigo, J. P., & Llorente, J. L. (2021). Microcarcinoma papilar de la glándula tiroides: controversias y manejo actuales. Revista ORL, 12(4), 325–340. https://doi.org/10.14201/orl.23924

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Biografía del autor/a

Fernando López

,
Servicio ORL y CCC. Hospital Universitario Central de Asturias. Oviedo.
FEA Otorrinolaringología y Cirugía de Cabeza y Cuello. Hospital Universitario Central de Asturias (Oviedo)Profesor Asociado (acreditado para Titular). Universidad de OviedoInstituto Universitario de Oncología del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de Asturias. CIBERONC - ISCIIIwww.servicioorlhuca.com

Patricia García-Cabo

,
Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España

Laura Fernández-Vañes

,
Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España
 

Andrés Coca-Pelaz

,
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
 

Juan Pablo Rodrigo

,
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
   

José Luis Llorente

,
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
 
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