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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El microcarcinoma papilar de tiroides &#40;MCPT&#41; es aquel carcinoma papilar cuyo tama&#241;o es igual o menor de 1<span class="elsevierStyleHsp" style=""></span>cm y su incidencia est&#225; aumentando considerablemente en los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La extensi&#243;n extratiroidea macrosc&#243;pica ha demostrado ser un factor de mal pron&#243;stico muy importante en el carcinoma papilar de tiroides<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2-8</span></a>&#44; pero en cuanto a la extensi&#243;n extratiroidea m&#237;nima o microsc&#243;pica &#40;EETm&#41; se refiere &#40;aquella que se produce al m&#250;sculo esternotiroideo o al tejido adiposo peritiroideo&#41;&#59; todav&#237;a no est&#225; claro qu&#233; papel desempe&#241;a en el pron&#243;stico de la enfermedad&#44; existiendo controversia en los distintos estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9-14</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seg&#250;n la European Thyroid Association<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#44; el carcinoma papilar de tiroides con EETm se considera de alto riesgo y seg&#250;n la American Thyroid Association<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> se considera de riesgo intermedio&#46; En cuanto al tratamiento con radioyodo &#40;I<span class="elsevierStyleSup">131</span>&#41;&#44; la European Thyroid Association<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> recomienda su uso cuando existe EETm&#44; mientras que la American Thyroid Association<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> recomienda considerarlo&#44; pero en tumores de peque&#241;o podr&#237;a estar justificado no administrarlo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; cada vez se tiende a no considerar la EETm como un factor pron&#243;stico desfavorable&#44; ya que se han publicado varios estudios donde la EETm no afecta a la supervivencia libre de enfermedad<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9-12</span></a>&#46; Adem&#225;s&#44; en la clasificaci&#243;n TNM del American Joint Committee on Cancer en su octava edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#44; la EETm no se considera&#44; clasificando el MCPT con EETm como T1 y no T3 como en la s&#233;ptima edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recientemente&#44; en un art&#237;culo publicado por Liu et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; la EETm podr&#237;a asociarse a una menor supervivencia global y a una menor supervivencia libre de enfermedad&#44; por lo que recomiendan una mayor discusi&#243;n e investigaci&#243;n para evaluar la omisi&#243;n de la EETm en la nueva clasificaci&#243;n TNM del American Joint Committee on Cancer en su octava edici&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Debido al incremento de la incidencia del MCPT&#44; es importante conocer los factores asociados a la EETm&#44; as&#237; como su impacto en el pron&#243;stico de la enfermedad&#44; para realizar un tratamiento adecuado y reducir las recurrencias y la mortalidad asociada a la enfermedad&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es analizar y comparar los factores asociados al MCPT en dependencia de la existencia de EETm&#44; as&#237; como su pron&#243;stico a largo plazo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n a estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; comparativo y retrospectivo cuya poblaci&#243;n a estudio la constituyen los pacientes con diagn&#243;stico histopatol&#243;gico de MCPT &#40;carcinoma papilar &#8804; 1<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#41; intervenidos durante el periodo comprendido entre los a&#241;os 1995 y 2015&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsit0130"><span class="elsevierStyleLabel">&#8211;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Disponibilidad de las muestras histopatol&#243;gicas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Seguimiento m&#237;nimo de 2 a&#241;os&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Criterios de exclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Cirug&#237;a tiroidea previa a la cirug&#237;a del diagn&#243;stico del MCPT&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Presencia de otras enfermedades tiroideas o extratiroideas neopl&#225;sicas malignas sincr&#243;nicas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Localizaci&#243;n ect&#243;pica del MCPT &#40;sublingual&#44; quiste tirogloso&#44; struma ovarii&#44; etc&#46;&#41;&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Grupos a estudio</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Grupo 1&#58;</span> MCPT sin extensi&#243;n extratiroidea&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Grupo 2&#58;</span> MCPT con EETm&#46; Se define la EETm como aquella que se produce m&#225;s all&#225; de la c&#225;psula tiroidea&#44; sobrepas&#225;ndola y llegando al m&#250;sculo esternotiroideo o al tejido adiposo peritiroideo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables a estudio</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sociopersonales</span><p id="par0085" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Edad&#46; Se mide en a&#241;os&#44; estableciendo como punto de corte los 45 a&#241;os&#44; como en la clasificaci&#243;n TNM del American Joint Committee on Cancer en su s&#233;ptima edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> y 55 a&#241;os como en la clasificaci&#243;n TNM del American Joint Committee on Cancer en su octava edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Sexo&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cl&#237;nicas</span><p id="par0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Antecedentes familiares de carcinoma papilar de tiroides&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8211;</span><p id="par0110" class="elsevierStylePara elsevierViewall">&#205;ndice de masa corporal&#46; Se mide en kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8211;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Funci&#243;n tiroidea&#58; eutiroidismo&#44; hipotiroidismo e hipertiroidismo&#46; El hipotiroidismo y el hipertiroidismo se consideran tanto si son cl&#237;nicos o subcl&#237;nicos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8211;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Valores anal&#237;ticos&#58;</p></li></ul></p><p id="par0125" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">a&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Tirotropina&#46; Se mide en &#956;UI&#47;mL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">b&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Tiroxina&#46; Se mide en ng&#47;dL&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Terap&#233;uticas</span><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8211;</span><p id="par0145" class="elsevierStylePara elsevierViewall">T&#233;cnica quir&#250;rgica&#58;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">a&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Tiroidectom&#237;a&#58; total vs&#46; lobectom&#237;a&#46; En pacientes tratados mediante lobectom&#237;a&#44; si la tiroidectom&#237;a se completa en los primeros 6<span class="elsevierStyleHsp" style=""></span>meses se considera como una tiroidectom&#237;a total&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">b&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Linfadenectom&#237;a cervical&#46;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8211;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Ablaci&#243;n de restos tiroideos con I<span class="elsevierStyleSup">131</span>&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Histopatol&#243;gicas</span><p id="par0175" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8211;</span><p id="par4415" class="elsevierStylePara elsevierViewall">Tama&#241;o&#46; El tama&#241;o se define por el di&#225;metro m&#225;ximo de la lesi&#243;n y se mide en mil&#237;metros&#46; En caso de tumores multifocales&#44; el tama&#241;o se define por el foco con mayor di&#225;metro m&#225;ximo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8211;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Focalidad&#46; El tumor se considera unifocal si tiene un solo foco o multifocal si tiene m&#225;s de un foco&#46; El di&#225;metro m&#225;ximo de cada uno los focos tumorales debe medir &#8804; 10<span class="elsevierStyleHsp" style=""></span>mm&#44; aunque la suma de todos los di&#225;metros m&#225;ximos de los focos sume m&#225;s de 10<span class="elsevierStyleHsp" style=""></span>mm&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8211;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Lateralidad&#46; El tumor se considera unilateral si solamente ocupa un l&#243;bulo tiroideo y bilateral si es multifocal y ocupa ambos l&#243;bulos tiroideos&#46; Cuando el tumor es multifocal y ocupa un l&#243;bulo tiroideo y el istmo se considera unilateral&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8211;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Variantes histol&#243;gicas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8211;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Presencia de adenopat&#237;as metast&#225;sicas&#46;</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Seguimiento</span><p id="par0180" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8211;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Recidivas&#46; Se define recidiva como la presencia de evidencia cl&#237;nica&#44; bioqu&#237;mica o radiol&#243;gica de enfermedad &#40;ecograf&#237;a&#44; TC&#44; gammagraf&#237;a de cuerpo completo con I<span class="elsevierStyleSup">131</span> o PET-TC&#41; a partir de los 6 meses siguientes a la cirug&#237;a&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8211;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Mortalidad asociada a la enfermedad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8211;</span><p id="par0350" class="elsevierStylePara elsevierViewall">Supervivencia global&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8211;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Supervivencia libre de enfermedad&#46;</p></li></ul></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">M&#233;todo estad&#237;stico</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los datos son recogidos en una base de datos&#46; Para variables categ&#243;ricas&#44; los datos se expresan mediante frecuencias y porcentajes&#44; y son comparados mediante el test de la chi al cuadrado de Pearson o el test exacto de Fisher cuando es apropiado&#46; Para variables cuantitativas continuas&#44; los datos son expresados como media &#177; desviaci&#243;n est&#225;ndar&#46; Se comprueba la distribuci&#243;n normal de las variables mediante el test de Kolmogorov-Smirnov&#46; Las variables cuantitativas de ambos grupos son comparadas mediante el test de la t de Student para datos independientes cuando siguen una distribuci&#243;n normal&#46; En el caso de que las variables cuantitativas no sigan una distribuci&#243;n normal&#44; se utiliza una prueba no param&#233;trica para su comparaci&#243;n&#44; el test de la U de Mann-Whitney&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante es realizado mediante una regresi&#243;n log&#237;stica binaria&#44; para evaluar las asociaciones independientes de todos los factores que fueron estad&#237;sticamente significativos en el an&#225;lisis bivariante&#46; Los resultados se presentan como odds ratio &#40;OR&#41; con un intervalo de confianza &#40;IC&#41; del 95&#37; y el valor de p&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">El m&#233;todo de Kaplan Meier es utilizado para analizar la supervivencia global y la supervivencia libre de enfermedad&#44; y el test log rank se usa para comparar la supervivencia entre grupos&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Un valor de p &#60; 0&#44;05 es considerado como estad&#237;sticamente significativo&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resultados</span><p id="par0205" class="elsevierStylePara elsevierViewall">De los 168 pacientes que conformaron la poblaci&#243;n a estudio&#44; 161 cumplieron los criterios de selecci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Grupos a estudio</span><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Grupo 1&#46;</span> En el 88&#44;8&#37; &#40;n &#61; 143&#41; no existi&#243; extensi&#243;n extratiroidea&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Grupo 2&#46;</span> En el 11&#44;2&#37; &#40;n &#61; 18&#41; se evidenci&#243; EETm&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">An&#225;lisis bivariante</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Diferencias sociopersonales y cl&#237;nicas</span><p id="par0220" class="elsevierStylePara elsevierViewall">Los pacientes con MCPT y EETm tuvieron una mayor edad media 45&#44;4 &#177; 13&#44;5 vs&#46; 52&#44;6&#177;8&#44;1 a&#241;os &#40;p &#61; 0&#44;003&#41; y correspond&#237;an en mayor proporci&#243;n al grupo de edad &#8805; 45 a&#241;os &#40;52&#44;4&#37; vs&#46; 77&#44;8&#37;&#59; p &#61; 0&#44;042&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Diferencias terap&#233;uticas</span><p id="par0225" class="elsevierStylePara elsevierViewall">Los pacientes con MCPT y EETm presentaron mayor frecuencia de linfadenectom&#237;as cervicales realizadas &#40;9&#44;8&#37; vs&#46; 44&#44;4&#37;&#59; p &#61; 0&#44;001&#41; y mayor frecuencia de ablaci&#243;n de restos tiroideos con I<span class="elsevierStyleSup">131</span> &#40;23&#44;1&#37; vs&#46; 100&#37;&#59; p &#60; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Diferencias histopatol&#243;gicas</span><p id="par0230" class="elsevierStylePara elsevierViewall">Los pacientes con MCPT y EETm tuvieron un mayor tama&#241;o tumoral medio &#40;5 &#177; 2&#44;7<span class="elsevierStyleHsp" style=""></span>mm vs&#46; 7&#44;9 &#177; 2&#44;3<span class="elsevierStyleHsp" style=""></span>mm&#59; p &#60; 0&#44;001&#41;&#44; mayor frecuencia de tama&#241;o tumoral &#8805; 8<span class="elsevierStyleHsp" style=""></span>mm &#40;20&#44;3&#37; vs&#46; 61&#44;1&#37;&#59; p &#61; 0&#44;001&#41;&#44; mayor presencia de bilateralidad &#40;11&#44;9&#37; vs&#46; 44&#44;4&#37;&#59; p &#61; 0&#44;002&#41; y mayor presencia de adenopat&#237;as metast&#225;sicas &#40;5&#44;6&#37; vs&#46; 38&#44;9&#37;&#59; p &#60; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lisis multivariante</span><p id="par0235" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; los factores de riesgo asociados a la presencia de EETm fueron&#58; la edad &#8805; 45 a&#241;os &#40;OR 4&#44;383&#44; IC del 95&#37;&#44; 1&#44;051-18&#44;283&#59; p &#61; 0&#44;043&#41;&#44; el tama&#241;o tumoral &#8805; 8<span class="elsevierStyleHsp" style=""></span>mm &#40;OR 5&#44;913&#44; IC del 95&#37;&#44; 1&#44;795-19&#44;481&#59; p &#61; 0&#44;003&#41;&#44; la bilateralidad &#40;OR 4&#44;430&#44; IC del 95&#37;&#44; 1&#44;294-15&#44;173&#59; p &#61; 0&#44;018&#41; y la presencia de adenopat&#237;as metast&#225;sicas &#40;OR 12&#44;588&#44; IC del 95&#37;&#44; 2&#44;919-54&#44;280&#59; p &#61; 0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Seguimiento</span><p id="par0240" class="elsevierStylePara elsevierViewall">Durante un seguimiento medio de 119&#44;8 &#177; 65 meses&#44; no existieron diferencias entre ambos grupos en cuanto a recurrencias &#40;grupo 1 &#91;0&#37;&#93; vs&#46; grupo 2 &#91;5&#44;6&#37;&#93;&#59; p &#61; 0&#44;112&#41; ni a supervivencia global &#40;grupo 1 &#91;124&#44;9 &#177; 5&#44;6 meses&#93; vs&#46; grupo 2 &#91;103&#44;1 &#177; 11&#44;7 meses&#93;&#59; p&#61;0&#44;088&#41;&#44; pero s&#237; en cuanto a la supervivencia libre de enfermedad se refiere&#44; siendo menor en el grupo 2 &#40;124&#44;9 &#177; 5&#44;6 vs&#46; 97&#44;4 &#177; 10&#44;3 meses&#59; p &#61; 0&#44;034&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discusi&#243;n</span><p id="par0245" class="elsevierStylePara elsevierViewall">La frecuencia y la importancia de la extensi&#243;n extratiroidea del carcinoma papilar de tiroides dependen de los criterios que se establezcan para definirla<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46; En la clasificaci&#243;n TNM del American Joint Committee on Cancer en su s&#233;ptima edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; la extensi&#243;n extratiroidea se divide en m&#237;nima o microsc&#243;pica &#40;p&#46; ej&#46;&#44; al m&#250;sculo esternotiroideo o al tejido graso peritiroideo&#44; presumiendo la incorporaci&#243;n del resto de m&#250;sculos pretiroideos en la definici&#243;n&#41; y significativa o macrosc&#243;pica &#40;al tejido subcut&#225;neo&#44; laringe&#44; tr&#225;quea&#44; es&#243;fago o nervio recurrente lar&#237;ngeo&#41;&#46; Seg&#250;n el College of American Pathologists en 2014&#44; la EETm incluye la presencia del carcinoma que se extiende en los tejidos peritiroideos&#44; incluida la infiltraci&#243;n del m&#250;sculo esquel&#233;tico&#44; as&#237; como la cercan&#237;a alrededor de estructuras vasculares considerables y nervios<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46; En la clasificaci&#243;n TNM del American Joint Committee on Cancer en su octava edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#44; la EETm no se considera y &#250;nicamente se eval&#250;a la extensi&#243;n extratiroidea macrosc&#243;pica a los m&#250;sculos pretiroideos &#40;T3b&#41;&#46; Por lo tanto&#44; en esta &#250;ltima clasificaci&#243;n el MCPT con EETm se clasifica como T1 y no T3 como en la s&#233;ptima edici&#243;n<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Debido a esta falta de consenso en cuanto a la definici&#243;n&#44; la EETm es una variable histopatol&#243;gica subjetiva en la enfermedad endocrina&#44; con gran variabilidad interobservador&#44; siendo la concordancia mayor cuando la EETm se produce a los m&#250;sculos pretiroideos y menor cuando se produce al tejido adiposo peritiroideo o se acerca a los vasos de pared gruesa o nervios<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">La EETm tiene lugar en el 9&#44;6-30&#44;9&#37; de los pacientes con MCPT seg&#250;n las series publicadas<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;21&#44;22</span></a>&#46; En este estudio supuso m&#225;s del 11&#37; de todos los casos&#46; Aunque cada vez existen m&#225;s estudios que analizan el valor pron&#243;stico de la EETm en el carcinoma papilar de tiroides o en el c&#225;ncer diferenciado de tiroides<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9-14</span></a>&#44; pocos son los estudios publicados que analizan los factores asociados y el valor pron&#243;stico de la EETm en el subgrupo del MCPT<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;21&#44;22</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Al analizar ambos grupos a estudio&#44; se observa que el MCPT con EETm tiene factores de riesgo de peor pron&#243;stico&#46; As&#237; pues&#44; se asocia a pacientes m&#225;s mayores &#40;edad &#8805; 45 a&#241;os&#41;&#44; si bien este factor no ha podido ser demostrado en otros estudios&#44; donde la EETm se ha asociado con la edad &#60; 45 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> o no se asoci&#243; a ning&#250;n grupo de edad<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Respecto a los factores histopatol&#243;gicos&#44; el MCPT de mayor tama&#241;o se asoci&#243; con la presencia de EETm&#44; hallazgo en concordancia con otros estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;22&#44;23</span></a>&#46; Por el contrario&#44; existen estudios que asocian la EETm solamente con el tama&#241;o tumoral &#62; 1<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Esto podr&#237;a explicarse porque cuando el MCPT se sit&#250;a en la periferia de la gl&#225;ndula tiroides&#44; si es de mayor tama&#241;o&#44; tiene m&#225;s probabilidad de invadir la c&#225;psula tiroidea&#44; sobrepas&#225;ndola e infiltrando la grasa peritiroidea o la musculatura pretiroidea&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Aunque la multifocalidad del MCPT no se asoci&#243; a la presencia EETm&#44; la presencia de bilateralidad s&#237;&#44; ya que todos los MCPT multifocales con EETm fueron bilaterales&#46; Sin embargo&#44; en la literatura cient&#237;fica&#44; la multifocalidad del MCPT&#44; ya sea unilateral o bilateral&#44; s&#237; se ha asociado con la presencia de EETm<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#46; Por lo tanto&#44; en pacientes con MCPT y EETm sometidos inicialmente a una lobectom&#237;a&#44; podr&#237;a estar indicado completar sistem&#225;ticamente la tiroidectom&#237;a para no dejar enfermedad residual en el l&#243;bulo tiroideo contralateral&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">La presencia de adenopat&#237;as metast&#225;sicas tambi&#233;n se ha asociado con la EETm del MCPT en los diferentes estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;21&#44;22</span></a>&#44; tal y como se muestra en este estudio&#44; lo que demuestra su mayor agresividad&#46; Por este motivo&#44; se deber&#237;a considerar la realizaci&#243;n de tratamientos m&#225;s intensivos m&#225;s all&#225; de la tiroidectom&#237;a total&#44; como la linfadenectom&#237;a cervical y la ablaci&#243;n de restos tiroideos con I<span class="elsevierStyleSup">131</span>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">El MCPT con EETm tiene un buen pron&#243;stico a largo plazo&#44; con escasas recidivas&#44; sin mortalidad asociada y sin diferencias respecto a la supervivencia global&#46; Esto puede ser debido a un tratamiento m&#225;s intensivo&#44; con mayor frecuencia de linfadenectom&#237;as cervicales y ablaci&#243;n de restos tiroideos con I<span class="elsevierStyleSup">131</span>&#46; El &#250;nico paciente con recidiva tuvo un MCPT con EETm y adenopat&#237;as metast&#225;sicas en el compartimento central&#46; Aunque en este trabajo no existieron diferencias en cuanto al n&#250;mero de recurrencias ni a supervivencia global entre ambos grupos&#44; la EETm se ha asociado a la recurrencia del MCPT en otros estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26-30</span></a>&#44; as&#237; como a una menor supervivencia global<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">En la literatura cient&#237;fica&#44; se han documentado resultados contradictorios en cuanto al significado pron&#243;stico de la EETm&#44; no afectando<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9-12</span></a> o s&#237;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14&#44;19</span></a> a la supervivencia libre de enfermedad&#46; Adem&#225;s&#44; en dependencia del tama&#241;o tumoral &#40;&#62; 1&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; se ha descrito que la EETm es un factor pron&#243;stico desfavorable<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; En este trabajo&#44; aunque no existieron diferencias en cuanto a la supervivencia global&#44; los pacientes con MCPT y EETm tuvieron una supervivencia libre de enfermedad significativamente menor&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Esta controversia en cuanto al pron&#243;stico de la enfermedad&#44; pudiera tener relaci&#243;n con la variabilidad interobservador en el diagn&#243;stico histopatol&#243;gico de la EETm&#46; Por este motivo&#44; deber&#237;a haber un consenso m&#225;s amplio en cuanto a la definici&#243;n de la EETm&#44; para disminuir la variabilidad interobservador&#44; realizar una mejor estadificaci&#243;n y valorar el impacto en el pron&#243;stico de la enfermedad de manera m&#225;s precisa<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#44; existen estudios que no recomiendan la administraci&#243;n de I<span class="elsevierStyleSup">131</span> en el carcinoma papilar de tiroides &#8804; 4<span class="elsevierStyleHsp" style=""></span>cm con EETm&#44; sin histolog&#237;a agresiva ni adenopat&#237;as metast&#225;sicas&#44; ya que &#250;nicamente presentan un 2&#44;2&#37; de recurrencias<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; Tampoco lo han recomendado en pacientes mayores de 45 a&#241;os y tumores &#8804; 4<span class="elsevierStyleHsp" style=""></span>cm&#44; ya que no afecta a la supervivencia<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; en este trabajo&#44; todos los pacientes con EETm recibieron terapia metab&#243;lica con I<span class="elsevierStyleSup">131</span>&#44; motivo quiz&#225;s por el cual hubo tan pocas recidivas&#46; Aun as&#237;&#44; la supervivencia libre de enfermedad fue menor en los pacientes con MCPT y EETm&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el MCPT con EETm se asocia a una mayor edad del paciente&#44; un mayor tama&#241;o tumoral&#44; la afectaci&#243;n tiroidea bilateral y la presencia de adenopat&#237;as metast&#225;sicas&#46; A su vez&#44; aunque presenta escasas recidivas&#44; ausencia de mortalidad asociada y una buena supervivencia global&#44; tiene una menor supervivencia libre de enfermedad&#46; Por todo ello&#44; deber&#237;a considerarse un factor de peor pron&#243;stico&#44; debiendo valorar tratamientos m&#225;s agresivos m&#225;s all&#225; de la tiroidectom&#237;a total&#44; como la linfadenectom&#237;a cervical y la ablaci&#243;n de restos tiroideos con I<span class="elsevierStyleSup">131</span>&#46; Adem&#225;s&#44; se deber&#237;an realizar m&#225;s estudios que analizaran el impacto de la EETm&#44; no solamente en el pron&#243;stico del MCPT&#44; sino tambi&#233;n en el carcinoma papilar de tiroides &#62; 1<span class="elsevierStyleHsp" style=""></span>cm&#44; ya que la evidencia cient&#237;fica es limitada y podr&#237;a ser un factor a tener muy en cuenta para el tratamiento de este tipo de tumores&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Financiaci&#243;n</span><p id="par0305" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ninguna beca espec&#237;fica de agencias de los sectores p&#250;blico&#44; comercial&#44; o sin &#225;nimo de lucro&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicto de intereses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aunque el microcarcinoma papilar de tiroides &#40;MCPT&#41; ha sufrido un incremento en la incidencia en las &#250;ltimas d&#233;cadas&#44; todav&#237;a no est&#225; claro qu&#233; papel desempe&#241;a la extensi&#243;n extratiroidea m&#237;nima &#40;EETm&#41; en su pron&#243;stico&#46; El objetivo de este estudio es analizar los factores asociados al MCPT con EETm y su pron&#243;stico a largo plazo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo cuya poblaci&#243;n a estudio la constituyen los pacientes con diagn&#243;stico histol&#243;gico de MCPT&#46; Se excluye a los pacientes con&#58; cirug&#237;a tiroidea previa&#44; otras enfermedades malignas sincr&#243;nicas&#44; localizaci&#243;n ect&#243;pica del MCPT o p&#233;rdida durante el seguimiento antes de los 2 a&#241;os&#46; Se comparan 2<span class="elsevierStyleHsp" style=""></span>grupos&#58; grupo 1 &#40;MCPT sin extensi&#243;n extratiroidea&#41; y grupo 2 &#40;MCPT con EETm&#41;&#46; Se realiza un an&#225;lisis multivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El 11&#44;2&#37; &#40;n &#61; 18&#41; de los pacientes presentaron MCPT con EETm&#46; En el an&#225;lisis multivariante&#44; la EETm se asoci&#243; con la edad &#8805; 45 a&#241;os &#40;OR&#58; 4&#44;383&#59; IC del 95&#37;&#58; 1&#44;051-18&#44;283&#59; p &#61; 0&#44;043&#41;&#44; el tama&#241;o tumoral &#8805; 8<span class="elsevierStyleHsp" style=""></span>mm &#40;OR&#58; 5&#44;913&#59; IC del 95&#37;&#59; 1&#44;795-19&#44;481&#59; p &#61; 0&#44;003&#41;&#44; la bilateralidad &#40;OR&#58; 4&#44;430&#44; IC del 95&#37;&#59; 1&#44;294-15&#44;173&#59; p &#61; 0&#44;018&#41; y las adenopat&#237;as metast&#225;sicas &#40;OR&#58; 12&#44;588&#59; IC del 95&#37;&#59; 2&#44;919-54&#44;280&#59; p &#61; 0&#44;001&#41;&#46; Durante un seguimiento medio de 119&#44;8 &#177; 65 meses&#44; una recurrencia fue detectada en el grupo 2 &#40;0&#37; vs&#46; 5&#44;6&#37;&#59; p &#61; 0&#44;112&#41;&#46; Ning&#250;n paciente falleci&#243; debido a la enfermedad&#46; La supervivencia libre de enfermedad fue menor en el grupo 2 &#40;124&#44;9 &#177; 5&#44;6 vs&#46; 97&#44;4 &#177; 10&#44;3 meses&#59; p &#61; 0&#44;034&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La EETm del MCPT es un factor de peor pron&#243;stico&#44; asociada a la presencia de adenopat&#237;as metast&#225;sicas y a una menor supervivencia libre de enfermedad&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Although the incidence of papillary thyroid microcarcinoma &#40;PTMC&#41; has increased in recent decades&#44; the role played by minimal extrathyroidal extension &#40;mETE&#41; in the prognosis of PTMC is still unclear&#46; The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective study on patients with a histological diagnosis of PTMC&#46; We excluded patients who had previously undergone thyroid surgery&#44; those who had other synchronous malignancies&#44; those with an ectopic location of the PTMC&#44; and those lost to follow-up within 2<span class="elsevierStyleHsp" style=""></span>years&#46; We compared group 1 &#40;PTMC without extrathyroidal extension&#41; to group 2 &#40;PTMC with mETE&#41; and performed a multivariate analysis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We observed PTMC with mETE in 11&#46;2&#37; &#40;n&#61;18&#41; of patients&#46; On the multivariate analysis&#44; mETE was associated with age &#8805;45 years &#40;OR&#58; 4&#46;383&#59; 95&#37; CI&#58; 1&#46;051-18&#46;283&#44; <span class="elsevierStyleItalic">p</span> &#61; &#46;043&#41;&#44; tumor size &#8805;8<span class="elsevierStyleHsp" style=""></span>mm &#40;OR&#58; 5&#46;913&#59; 95&#37; CL&#58; 1&#46;795-19&#46;481&#59; <span class="elsevierStyleItalic">p</span> &#61; &#46;003&#41;&#44; bilaterality &#40;OR&#58; 4&#46;430&#59; 95&#37; CI&#58; 1&#46;294-15&#46;173&#59; <span class="elsevierStyleItalic">p</span> &#61; &#46;018&#41; and metastatic lymph nodes &#40;OR&#58; 12&#46;588&#59; 95&#37; CI&#58; 2&#46;919-54&#46;280&#59; <span class="elsevierStyleItalic">p</span> &#61; &#46;001&#41;&#46; During a mean follow-up of 119&#46;8&#177;65 months&#44; one recurrence was detected in group 2 &#40;0&#37; vs&#46; 5&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; &#46;112&#41;&#46; No patients died of the disease&#46; Disease-free survival was lower in group 2 &#40;124&#46;9&#177;5&#46;6 vs&#46; 97&#46;4&#177;10&#46;3 months&#59; <span class="elsevierStyleItalic">p</span> &#61; &#46;034&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
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            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Criterios de selecci&#243;n de los pacientes del estudio&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Supervivencia libre de enfermedad de los pacientes con MCPT en dependencia de la presencia o no de extensi&#243;n extratiroidea m&#237;nima&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables sociopersonales&#44; cl&#237;nicas y diagn&#243;sticas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 1 &#40;n &#61; 143&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#8805; 55 a&#241;os</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">106 &#40;74&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10 &#40;55&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;098&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37 &#40;25&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;753&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">116 &#40;81&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;77&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;96&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41; &#40;media &#177; DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;1 &#177; 4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;8 &#177; 5&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Funci&#243;n tiroidea</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipotiroidismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eutiroidismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;69&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;83&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertiroidismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;19&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anal&#237;tica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiroxina &#40;ng&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;44 &#177; 0&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49 &#177; 0&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;856&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tirotropina &#40;&#956;UI&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;54 &#177; 1&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;93 &#177; 0&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2532828.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de variables sociopersonales y cl&#237;nicas en dependencia de la presencia o no de extensi&#243;n extratiroidea m&#237;nima del MCPT</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables terap&#233;uticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 1 &#40;n &#61; 143&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 2 &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervenci&#243;n quir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lobectom&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;7&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;614&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiroidectom&#237;a total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;92&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Linfadenectom&#237;a cervical</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;90&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;55&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;9&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ablaci&#243;n con I</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">131</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;76&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;23&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2532830.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de variables terap&#233;uticas en dependencia de la presencia o no de extensi&#243;n extratiroidea m&#237;nima del MCPT</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables histopatol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 1 &#40;n &#61; 143&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 2 &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o &#8805; 8 mm</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;79&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;38&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No &#40;n &#61; 72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237; &#40;n &#61; 89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;729&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;383 &#40;1&#44;051-18&#44;283&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;043&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o &#8805; 8 mm</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No &#40;n &#61; 121&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237; &#40;n &#61; 40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;777&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;913 &#40;1&#44;795-19&#44;481&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No &#40;n &#61; 136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;489&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;430 &#40;1&#44;294-15&#44;173&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Met&#225;stasis ganglionares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No &#40;n &#61; 146&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237; &#40;n &#61; 15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariante de los factores asociados a la extensi&#243;n extratiroidea m&#237;nima del MCPT</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Papillary thyroid microcarcinoma&#58; extrathyroidal extension&#44; lymph node metastases&#44; and risk factors for recurrence in a high prevalence of goiter area"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "C&#46; de Crea"
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                            0 => "J&#46;S&#46; Radowsky"
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                    0 => array:2 [
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ORIGINAL
DOI: 10.1016/j.rce.2019.12.010
Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo?
Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?
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J. Ruiz Pardoa,
Autor para correspondencia
josrp@hotmail.es

Autor para correspondencia.
, A. Ríos Zambudioa,b,c, J.M. Rodríguez Gonzáleza,b,c, M. Paredes Quilesa, V. Soriano Giméneza, M.I. Oviedo Ramírezd, A.M. Hernández Martíneze, P. Parrilla Paricioa,b,c
a Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
b Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España
c Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
d Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
e Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
Contenido relacionado
Microcarcinoma papilar de tiroides: no siempre indolente
Rev Clin Esp. 2021;221:157-910.1016/j.rce.2020.01.007
J. Ena, A. Gómez-Tierno

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