Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI

El carcinoma papilar de tiroides es el tipo de cáncer endocrino más común, siendo este el 85% de los tumores de tiroides, al momento del diagnóstico hasta el 45% de los pacientes tienen compromiso ganglionar el cual tiene gran influencia en la persistencia y recurrencia de la enfermedad y hasta el 6...

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2017
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Universidad Militar Nueva Granada
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Repositorio UMNG
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spa
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MUTACION BRAFV600E
CARCINOMA PAPILAR DE TIROIDES
VACIAMIENTO CENTRAL
ENFERMEDADES DE LA TIROIDES
CANCER
GANGLIOS LINFATICOS
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id UNIMILTAR2_274ff5d6140e070b694f3601e51ac594
oai_identifier_str oai:repository.unimilitar.edu.co:10654/20395
network_acronym_str UNIMILTAR2
network_name_str Repositorio UMNG
repository_id_str
dc.title.spa.fl_str_mv Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
dc.title.titleenglish.spa.fl_str_mv BRAFV600E mutation in preoperative thyroid cytology as an identifier of central compartment ganglion involvement in patients with papillary thyroid carcinoma Bethesda V and VI
title Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
spellingShingle Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
MUTACION BRAFV600E
CARCINOMA PAPILAR DE TIROIDES
VACIAMIENTO CENTRAL
ENFERMEDADES DE LA TIROIDES
CANCER
GANGLIOS LINFATICOS
title_short Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
title_full Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
title_fullStr Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
title_full_unstemmed Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
title_sort Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VI
dc.contributor.advisor.none.fl_str_mv cadena piñeros, enrique
dc.contributor.role.none.fl_str_mv Romero, alfredo
rojas, andres
dc.subject.keyword.spa.fl_str_mv MUTACION BRAFV600E
CARCINOMA PAPILAR DE TIROIDES
VACIAMIENTO CENTRAL
topic MUTACION BRAFV600E
CARCINOMA PAPILAR DE TIROIDES
VACIAMIENTO CENTRAL
ENFERMEDADES DE LA TIROIDES
CANCER
GANGLIOS LINFATICOS
dc.subject.decs.spa.fl_str_mv ENFERMEDADES DE LA TIROIDES
CANCER
GANGLIOS LINFATICOS
description El carcinoma papilar de tiroides es el tipo de cáncer endocrino más común, siendo este el 85% de los tumores de tiroides, al momento del diagnóstico hasta el 45% de los pacientes tienen compromiso ganglionar el cual tiene gran influencia en la persistencia y recurrencia de la enfermedad y hasta el 60 % del compartimiento central. El BRAF es una mutación que se presenta en la mitad de los carcinomas papilares de tiroides, altamente especifico y se correlaciona con la agresividad, recurrencia y mortalidad del carcinoma, lo que resalta la importancia de conocer el estatus de mismo en los pacientes. En paciente con carcinoma papilar de tiroides determinar la presencia de BRAF positivo llevara a la necesidad de vaciamiento central ganglionar. No hay estudios previos de la prueba de BRAF en citología y su correlación con ganglios positivos en el vaciamiento central en cuello.
publishDate 2017
dc.date.created.none.fl_str_mv 2017-11-28
dc.date.accessioned.none.fl_str_mv 2019-02-06T18:51:14Z
2019-12-30T18:58:36Z
dc.date.available.none.fl_str_mv 2019-02-06T18:51:14Z
2019-12-30T18:58:36Z
dc.type.spa.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.spa.spa.fl_str_mv Trabajo de grado
dc.type.dcmi-type-vocabulary.spa.fl_str_mv Text
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/10654/20395
url http://hdl.handle.net/10654/20395
dc.language.spa.fl_str_mv spa
dc.language.iso.spa.fl_str_mv spa
language spa
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.uri.spa.fl_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rights.creativecommons.spa.fl_str_mv Atribución-NoComercial-SinDerivadas
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/co/
Atribución-NoComercial-SinDerivadas
http://purl.org/coar/access_right/c_abf2
dc.format.spa.fl_str_mv pdf
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.coverage.spatial.spa.fl_str_mv Medicina
dc.publisher.spa.fl_str_mv Universidad Militar Nueva Granada
dc.publisher.department.spa.fl_str_mv Facultad de Medicina
dc.publisher.program.spa.fl_str_mv Cirugía Oncológica
institution Universidad Militar Nueva Granada
dc.source.bibliographicCitation.spa.fl_str_mv 1. Tang K-T, Lee C-H. BRAF mutation in papillary thyroid carcinoma: pathogenic role and clinical implications. J Chin Med Assoc. 2010;73(3):113-28.
2. Hwang J, Hee Shin J, Han B-K, Ko EY, Kang SS, Kim J-W, et al. Papillary thyroid carcinoma with BRAF V600E mutation: sonographic prediction. AJR Am J Roentgenol. 2010;194(5):425-30.
3. Kim SK, Woo J-W, Lee JH, Park I, Choe J-H, Kim J-H, et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11,569 cases from a single institution. J Am Coll Surg. 2016;222(5):853-64.
4. Lu J, Gao J, Zhang J, Sun J, Wu H, Shi X, et al. Association between BRAF V600E mutation and regional lymph node metastasis in papillary thyroid carcinoma. Int J Clin Exp Pathol. 2015;8(1):793.
5. Lee WS, Palmer BJA, Garcia A, Chong VE, Liu TH. BRAF mutation in papillary thyroid cancer: a cost-utility analysis of preoperative testing. Surgery. 2014;156(6):1569-78.
6. Ward LS, Morari EC, Leite JL, Bufalo NE, Guilhen ACT, Araujo PPCd, et al. Identifying a risk profile for thyroid cancer. Arquivos Brasileiros de Endocrinologia & Metabologia. 2007;51(5):713-22.
7. Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx. 2014;41(1):63-8.
8. Zuñiga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. 2009;135(11):1087-91.
9. Xing M. BRAF mutation in papillary thyroid cancer: pathogenic role, molecular bases, and clinical implications. Endocr Rev. 2007;28(7):742-62.
10. Kimura ET, Nikiforova MN, Zhu Z, Knauf JA, Nikiforov YE, Fagin JA. High prevalence of BRAF mutations in thyroid cancer. Cancer Res. 2003;63(7):1454-7.
11. Ugolini C, Giannini R, Lupi C, Salvatore G, Miccoli P, Proietti A, et al. Presence of BRAF V600E in very early stages of papillary thyroid carcinoma. Thyroid. 2007;17(5):381-8.
12. Xing M, Alzahrani AS, Carson KA, Viola D, Elisei R, Bendlova B, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA. 2013;309(14):1493-501
13. Park AY, Son EJ, Kim J-A, Youk JH, Park YJ, Park CS, et al. Associations of the braf v600e mutation with sonographic features and clinicopathologic characteristics in a large population with conventional papillary thyroid carcinoma. PloS one. 2014;9(10):e110868.
14. Brzezianska E, Pastuszak-Lewandoska D, Wojciechowska K, Migdalska-Sek M, Cyniak-Magierska A, Nawrot E, et al. Investigation of V600E BRAF mutation in papillary thyroid carcinoma in the Polish population. Neuro Endocrinol Lett. 2007;28(4):351-9.
15. Fugazzola L, Mannavola D, Cirello V, Vannucchi G, Muzza M, Vicentini L, et al. BRAF mutations in an Italian cohort of thyroid cancers. Clin Endocrinol (Oxf). 2004;61(2):239-43.
16. Kim TY, Kim WB, Rhee YS, Song JY, Kim JM, Gong G, et al. The BRAF mutation is useful for prediction of clinical recurrence in low‐risk patients with conventional papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2006;65(3):364-8.
17. Martín AM. Presencia de la mutación BRAFV600E en nódulos tiroideos, y su relación con el diagnóstico citológico y anatomopatológico de carcinoma de tiroides [Tesis]. Bogotá: Universidad Nacional de Colombia. Facultad de Medicina; 2015.
18. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9-29.
19. Zúñiga S, Sanabria Á. Complicaciones y recurrencia en el tratamiento del carcinoma papilar de tiroides Experiencia del Instituto Nacional de Cancerología. Rev Colomb Cir. 2007:166.
20. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
21. International Agency for Research on Cancer.The GLOBOCAN Project. 2012 [Internet]. [Revisado 28 de marzo de 2017]. Disponible en: http://globocan.iarc.fr/Default.aspx.
22. Thyroid T. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
23. American Cancer Society. Cáncer de tiroides. [Internet]; 2012. [Revisado 29 de marzo de 2017]. Disponible en: https://old.cancer.org/acs/groups/cid/documents/webcontent/002324-pdf.pdf.
24. Kondo T, Nakazawa T, Murata S-i, Kurebayashi J, Ezzat S, Asa SL, et al. Enhanced B-Raf protein expression is independent of V600E mutant status in thyroid carcinomas. Hum Pathol. 2007;38(12):1810-8.
25. Kim B-A, Jee H-G, Yi JW, Kim S-J, Chai YJ, Choi JY, et al. Expression Profiling of a Human Thyroid Cell Line Stably Expressing the BRAFV600E Mutation. Cancer Genomics Proteomics. 2017;14(1):53-67.
26. Calò PG, Pisano G, Medas F, Marcialis J, Gordini L, Erdas E, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment? World J Surg Oncol. 2014;12(1):152.
27. Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009;19(7):683-9.
28. Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. 2015;100(4):1316-24.
29. McHenry CR, Stulberg JJ. Prophylactic central compartment neck dissection for papillary thyroid cancer. Surg Clin North Am. 2014;94(3):529-40.
30. Baek S-K, Jung K-Y, Kang S-M, Kwon S-Y, Woo J-S, Cho S-H, et al. Clinical risk factors associated with cervical lymph node recurrence in papillary thyroid carcinoma. Thyroid. 2010;20(2):147-52.
31. Howell GM, Nikiforova MN, Carty SE, Armstrong MJ, Hodak SP, Stang MT, et al. BRAF V600E mutation independently predicts central compartment lymph node metastasis in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(1):47-52.
32. Joo J-Y, Park J-Y, Yoon Y-H, Choi B, Kim J-M, Jo YS, et al. Prediction of occult central lymph node metastasis in papillary thyroid carcinoma by preoperative BRAF analysis using fine-needle aspiration biopsy: a prospective study. J Clin Endocrinol Metab. 2012;97(11):3996-4003.
33. Fernandez IJ, Piccin O, Sciascia S, Cavicchi O, Repaci A, Vicennati V, et al. Clinical significance of BRAF mutation in thyroid papillary cancer. Otolaryngol Head Neck Surg. . 2013;148(6):919-25.
34. Yang Y, Chen C, Chen Z, Jiang J, Chen Y, Jin L, et al. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf). 2014;81(2):282-8.
35. Han PA, Kim HS, Cho S, Fazeli R, Najafian A, Khawaja H, et al. Association of BRAF V600E mutation and microRNA expression with central lymph node metastases in papillary thyroid cancer: A prospective study from four endocrine surgery centers. Thyroid. 2016;26:532-42.
36. Kurtulmus N, Ertas B, Saglican Y, Kaya H, Ince U, Duren M. BRAFV600E Mutation: Has it a role in cervical lymph node metastasis of papillary thyroid cancer. Eur Thyroid J. 2016;5(3):195-200.
37. Liu C, Chen T, Liu Z. Associations between BRAF V600E and prognostic factors and poor outcomes in papillary thyroid carcinoma: a meta-analysis. World J Surg Oncol. 2016;14(1):241.
38. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121(3):487-91.
39. Palestini N, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer. Langenbecks Arch Surg (2008) 393:693-698.
40. Dennis R, Medina A. Cálculo de tamaño de muestra. En: Ruíz A, Morillo L. Epidemiología Clínica. Investigación Clínica Aplicada. Bogotá: Editorial Médica Internacional; 2004. P.141-162
41. Roche PC, Hsi ED. Immunohistochemistry-Principles and Advances. Manual of Clinical Laboratory Immunology, 6th edition. In: NR Rose, ed. ASM Press; 2002.
42. Robinson TJ, Thomas S, Dinan MA, Roman S, Sosa JA, Hyslop T. How many lymph nodes are enough? assessing the adequacy of lymph node yield for papillary thyroid cancer. J Clin Oncol. 2016;34(28):3434-9.
43. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology: Springer; 2010.
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spelling cadena piñeros, enriqueRomero, alfredorojas, andresMogollon Reyes, Geannygeannym@hotmail.comEspecialista en Cirugía OncológicaMedicina2019-02-06T18:51:14Z2019-12-30T18:58:36Z2019-02-06T18:51:14Z2019-12-30T18:58:36Z2017-11-28http://hdl.handle.net/10654/20395El carcinoma papilar de tiroides es el tipo de cáncer endocrino más común, siendo este el 85% de los tumores de tiroides, al momento del diagnóstico hasta el 45% de los pacientes tienen compromiso ganglionar el cual tiene gran influencia en la persistencia y recurrencia de la enfermedad y hasta el 60 % del compartimiento central. El BRAF es una mutación que se presenta en la mitad de los carcinomas papilares de tiroides, altamente especifico y se correlaciona con la agresividad, recurrencia y mortalidad del carcinoma, lo que resalta la importancia de conocer el estatus de mismo en los pacientes. En paciente con carcinoma papilar de tiroides determinar la presencia de BRAF positivo llevara a la necesidad de vaciamiento central ganglionar. No hay estudios previos de la prueba de BRAF en citología y su correlación con ganglios positivos en el vaciamiento central en cuello.TABLA DE CONTENIDO pág. 1. INFORMACIÓN GENERAL DEL PROYECTO………………………………….3 1.1 TITULO GENERAL DEL PROYECTO…………………………………….……4 1.2 INVESTIGADOR PRINCIPAL…………………………………………..……….4 1.3 INVESTIGADORES SECUNDARIOS………………………………….……….4 2. RESUMEN EJECUTIVO…………………………………………………..……….4 2.1 PROBLEMA………………………………………………………………………..4 2.2 OBJETIVO GENERAL………………………………………………………...….5 2.3 MATERIALES Y MÉTODOS……………………………………………….…….5 3. PLANTEAMIENTO DEL PROBLEMA Y JUSTIFICACIÓN……………….……7 4. OBJETIVOS GENERALES Y ESPECÍFICOS…………………………….....….9 4.1 OBJETIVO GENERAL……………………………………………………………9 4.2 OBJETIVOS ESPECIFICOS………………………………………………..……9 5. MARCO TEÓRICO………………………………………………………………..10 5.1 ANTECEDENTES…………………………………………………………...…..10 5.2 TRATAMIENTO QUIRÚRGICO………………………………………………..13 6. METODOLOGÍA………………………………………………………….……….15 6.1 HIPÓTESIS OPERATIVAS……………………………………………………..15 6.2 DEFINICIÓN DE SUJETOS DE ESTUDIO…………………………………...15 6.3 CRITERIOS DE INCLUSIÓN…………………………………………………..15 6.4 CRITERIOS EXCLUSIÓN………………………………………………...…....16 6.5 TAMAÑO DE MUESTRA……………………………………………….………16 6.6. DESCRIPCIÓN DE LAS INTERVENCIONES………………………….……16 6.7. PROCEDIMIENTOS………………………………………………...………….17 6.8. PLAN DE ANÁLISIS………………………………………………...………….17 6.9 VARIABLES……………………………………………………….….………….18 7. CONDUCCIÓN DEL ESTUDIO………………………………………….………20 7.1. SITIO DE INVESTIGACIÓN………………………………………….………..20 7.2. MANEJO DE SUSTANCIAS O ESPECÍMENES BIOLÓGICOS…….…….20 7.3. ARCHIVO DE DATOS Y SISTEMATIZACIÓN…………………...………….20 7.4. CONSIDERACIONES ÉTICAS………………………….……………….……20 7.5. SEGURIDAD…………………………………………………………………….21 7.6. CONSIDERACIONES AMBIENTALES……………………….………………21 7.7. CONFIDENCIALIDAD………………………………………………………….21 7.8. ASEGURAMIENTO Y CONTROL DE LA CALIDAD………………………..22 8. RESULTADOS/PRODUCTOS ESPERADOS………………………...……….22 9. IMPACTO ESPERADO A PARTIR DEL USO DE LOS RESULTADOS…....24 10. REFERENCIAS……………………………………………………………….....25 11. CRONOGRAMA DE ACTIVIDADES…………………………………………..28 12. PRESUPUESTO DEL PROYECTO.............................................................30Papillary thyroid carcinoma is the most common type of endocrine cancer, with 85% of thyroid tumors, at the time of diagnosis, up to 45% of patients have lymph node involvement which has a great influence on the persistence and recurrence of the disease and up to 60% of the central compartment. BRAF is a mutation that occurs in half of papillary carcinomas of the thyroid, highly specific and correlates with the aggressiveness, recurrence and mortality of the carcinoma, which highlights the importance of knowing the status of same in patients. In patients with papillary thyroid carcinoma, determining the presence of positive BRAF will lead to the need for lymph node central emptying. There are no previous studies of the BRAF test in cytology and its correlation with positive lymph nodes in the central emptying of the neck.O carcinoma papilífero da tireoide é o tipo mais comum de câncer endócrino, com 85% dos tumores da tireóide, no momento do diagnóstico, até 45% dos pacientes apresentam comprometimento linfonodal, o que tem grande influência na persistência e recidiva dos tumores. doença e até 60% do compartimento central. O BRAF é uma mutação que ocorre em metade dos carcinomas papilares da tireoide, altamente específicos e correlacionados com a agressividade, recidiva e mortalidade do carcinoma, o que evidencia a importância do conhecimento do estado dos mesmos nos pacientes. Em pacientes com carcinoma papilífero da tireoide, a determinação da presença de BRAF positivo levará à necessidade de esvaziamento central do linfonodo. Não há estudos prévios do teste BRAF em citologia e sua correlação com linfonodos positivos no esvaziamento central do pescoço.pdfapplication/pdfspaspaUniversidad Militar Nueva GranadaFacultad de MedicinaCirugía Oncológicahttps://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadashttp://purl.org/coar/access_right/c_abf2Mutación BRAFV600E en citología tiroidea preoperatoria como identificador del compromiso ganglionar de compartimento central de los pacientes con carcinoma papilar de tiroides Bethesda V y VIBRAFV600E mutation in preoperative thyroid cytology as an identifier of central compartment ganglion involvement in patients with papillary thyroid carcinoma Bethesda V and VIinfo:eu-repo/semantics/bachelorThesisTrabajo de gradoTexthttp://purl.org/coar/resource_type/c_7a1fMUTACION BRAFV600ECARCINOMA PAPILAR DE TIROIDESVACIAMIENTO CENTRALENFERMEDADES DE LA TIROIDESCANCERGANGLIOS LINFATICOS1. Tang K-T, Lee C-H. BRAF mutation in papillary thyroid carcinoma: pathogenic role and clinical implications. J Chin Med Assoc. 2010;73(3):113-28.2. Hwang J, Hee Shin J, Han B-K, Ko EY, Kang SS, Kim J-W, et al. Papillary thyroid carcinoma with BRAF V600E mutation: sonographic prediction. AJR Am J Roentgenol. 2010;194(5):425-30.3. Kim SK, Woo J-W, Lee JH, Park I, Choe J-H, Kim J-H, et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11,569 cases from a single institution. J Am Coll Surg. 2016;222(5):853-64.4. Lu J, Gao J, Zhang J, Sun J, Wu H, Shi X, et al. Association between BRAF V600E mutation and regional lymph node metastasis in papillary thyroid carcinoma. Int J Clin Exp Pathol. 2015;8(1):793.5. Lee WS, Palmer BJA, Garcia A, Chong VE, Liu TH. BRAF mutation in papillary thyroid cancer: a cost-utility analysis of preoperative testing. Surgery. 2014;156(6):1569-78.6. Ward LS, Morari EC, Leite JL, Bufalo NE, Guilhen ACT, Araujo PPCd, et al. Identifying a risk profile for thyroid cancer. Arquivos Brasileiros de Endocrinologia & Metabologia. 2007;51(5):713-22.7. Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx. 2014;41(1):63-8.8. Zuñiga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. 2009;135(11):1087-91.9. Xing M. BRAF mutation in papillary thyroid cancer: pathogenic role, molecular bases, and clinical implications. Endocr Rev. 2007;28(7):742-62.10. Kimura ET, Nikiforova MN, Zhu Z, Knauf JA, Nikiforov YE, Fagin JA. High prevalence of BRAF mutations in thyroid cancer. Cancer Res. 2003;63(7):1454-7.11. Ugolini C, Giannini R, Lupi C, Salvatore G, Miccoli P, Proietti A, et al. Presence of BRAF V600E in very early stages of papillary thyroid carcinoma. Thyroid. 2007;17(5):381-8.12. Xing M, Alzahrani AS, Carson KA, Viola D, Elisei R, Bendlova B, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA. 2013;309(14):1493-50113. Park AY, Son EJ, Kim J-A, Youk JH, Park YJ, Park CS, et al. Associations of the braf v600e mutation with sonographic features and clinicopathologic characteristics in a large population with conventional papillary thyroid carcinoma. PloS one. 2014;9(10):e110868.14. Brzezianska E, Pastuszak-Lewandoska D, Wojciechowska K, Migdalska-Sek M, Cyniak-Magierska A, Nawrot E, et al. Investigation of V600E BRAF mutation in papillary thyroid carcinoma in the Polish population. Neuro Endocrinol Lett. 2007;28(4):351-9.15. Fugazzola L, Mannavola D, Cirello V, Vannucchi G, Muzza M, Vicentini L, et al. BRAF mutations in an Italian cohort of thyroid cancers. Clin Endocrinol (Oxf). 2004;61(2):239-43.16. Kim TY, Kim WB, Rhee YS, Song JY, Kim JM, Gong G, et al. The BRAF mutation is useful for prediction of clinical recurrence in low‐risk patients with conventional papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2006;65(3):364-8.17. Martín AM. Presencia de la mutación BRAFV600E en nódulos tiroideos, y su relación con el diagnóstico citológico y anatomopatológico de carcinoma de tiroides [Tesis]. Bogotá: Universidad Nacional de Colombia. Facultad de Medicina; 2015.18. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9-29.19. Zúñiga S, Sanabria Á. Complicaciones y recurrencia en el tratamiento del carcinoma papilar de tiroides Experiencia del Instituto Nacional de Cancerología. Rev Colomb Cir. 2007:166.20. 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The Bethesda system for reporting thyroid cytopathology: Springer; 2010.EspecializaciónMedicina y Ciencias de la Salud - Cirugía de Cabeza y CuelloORIGINALprotocolo final repositorio.pdftrabajo principalapplication/pdf726993http://repository.unimilitar.edu.co/bitstream/10654/20395/1/protocolo%20final%20repositorio.pdf06dc1794a93727a87a510646f5137181MD51LICENSElicense.txttext/plain2898http://repository.unimilitar.edu.co/bitstream/10654/20395/2/license.txt520e8f0b4e8d2d5c25366f2f78f584b0MD52THUMBNAILprotocolo final repositorio.pdf.jpgIM Thumbnailimage/jpeg4421http://repository.unimilitar.edu.co/bitstream/10654/20395/3/protocolo%20final%20repositorio.pdf.jpg031a4e48ef852ad5bb918cc41e7915aaMD5310654/20395oai:repository.unimilitar.edu.co:10654/203952019-12-30 13:58:36.611Repositorio Institucional UMNGbibliodigital@unimilitar.edu.coRWwgYXV0b3IgZGUgbGEgb2JyYSAodGVzaXMsIG1vbm9ncmFmw61hIG8gdHJhYmFqbyBkZSBncmFkbyksIGFjdHVhbmRvIGVuIG5vbWJyZSBwcm9waW8sIGhhY2UgZW50cmVnYSBkZWwgZWplbXBsYXIgcmVzcGVjdGl2byB5IGRlCnN1cyBhbmV4b3MgZW4gZm9ybWF0byBkaWdpdGFsIG8gZWxlY3Ryw7NuaWNvLgoKWSBhdXRvcml6YSBhIGxhIFVOSVZFUlNJREFEIE1JTElUQVIgTlVFVkEgR1JBTkFEQSwgcGFyYSBxdWUgZW4gbG9zIHTDqXJtaW5vcyBlc3RhYmxlY2lkb3MgZW46CgpMZXkgMjMgZGUgMTk4Mi0gTGV5IDQ0IGRlIDE5OTMtIERlY2lzacOzbiBBbmRpbmEgMzUxIGRlIDE5OTMtIERlY3JldG8gNDYwIGRlIDE5OTUgeSBkZW3DoXMgbm9ybWFzIGdlbmVyYWxlcyBzb2JyZSBsYSBtYXRlcmlhLAp1dGlsaWNlIHkgdXNlIHBvciBjdWFscXVpZXIgbWVkaW8gY29ub2NpZG8gbyBwb3IgY29ub2NlciwgbG9zIGRlcmVjaG9zIHBhdHJpbW9uaWFsZXMgZGUgcmVwcm9kdWNjacOzbiwgY29tdW5pY2FjacOzbiBww7pibGljYSwKdHJhbnNmb3JtYWNpw7NuIHkgZGlzdHJpYnVjacOzbiBkZSBsYSBvYnJhIG9iamV0byBkZWwgcHJlc2VudGUgZG9jdW1lbnRvLgoKUEFSw4FHUkFGTzogTGEgcHJlc2VudGUgYXV0b3JpemFjacOzbiBzZSBoYWNlIGV4dGVuc2l2YSBubyBzw7NsbyBhIGxhcyBmYWN1bHRhZGVzIHkgZGVyZWNob3MgZGUgdXNvIHNvYnJlIGxhIG9icmEgZW4gZm9ybWF0bwpvIHNvcG9ydGUgbWF0ZXJpYWwsIHNpbm8gdGFtYmnDqW4gcGFyYSBmb3JtYXRvIHZpcnR1YWwsIGVsZWN0csOzbmljbywgZGlnaXRhbCwgeSBjdXlvIHVzbyBzZSBkZSBlbiByZWQsIGludGVybmV0LCBleHRyYW5ldCwgaW50cmFuZXQsIGV0Yy4sCnkgZW4gZ2VuZXJhbCBlbiBjdWFscXVpZXIgZm9ybWF0byBjb25vY2lkbyBvIHBvciBjb25vY2VyLgoKRUwgRVNUVURJQU5URSAtIEFVVE9SLCBtYW5pZmllc3RhIHF1ZSBsYSBvYnJhIG9iamV0byBkZSBsYSBwcmVzZW50ZSBhdXRvcml6YWNpw7NuIGVzIG9yaWdpbmFsIHkgbGEgcmVhbGl6w7Mgc2luIHZpb2xhciBvIHVzdXJwYXIKZGVyZWNob3MgZGUgYXV0b3IgZGUgdGVyY2Vyb3MsIHBvciBsbyB0YW50bywgbGEgb2JyYSBlcyBkZSBleGNsdXNpdmEgYXV0b3LDrWEgeSB0aWVuZSBsYSB0aXR1bGFyaWRhZCBzb2JyZSBsYSBtaXNtYS4KClBBUsOBR1JBRk86IEVuIGNhc28gZGUgcHJlc2VudGFyc2UgY3VhbHF1aWVyIHJlY2xhbWFjacOzbiBvIGFjY2nDs24gcG9yIHBhcnRlIGRlIHVuIHRlcmNlcm8gZW4gY3VhbnRvIGEgbG9zIGRlcmVjaG9zIGRlIGF1dG9yCnNvYnJlIGxhIG9icmEgZW4gY3Vlc3Rpw7NuLCBFTCBFU1RVRElBTlRFIC0gQVVUT1IsIGFzdW1pcsOhIHRvZGEgbGEgcmVzcG9uc2FiaWxpZGFkLCB5IHNhbGRyw6EgZW4gZGVmZW5zYSBkZSBsb3MgZGVyZWNob3MgYXF1w60KYXV0b3JpemFkb3M7IHBhcmEgdG9kb3MgbG9zIGVmZWN0b3MgbGEgdW5pdmVyc2lkYWQgYWN0w7phIGNvbW8gdW4gdGVyY2VybyBkZSBidWVuYSBmZS4KCkFkZW3DoXMsIExBIFVOSVZFUlNJREFEIE1JTElUQVIgTlVFVkEgR1JBTkFEQSBjb21vIGluc3RpdHVjacOzbiBxdWUgYWxtYWNlbmEsIHkgcmVjb2xlY3RhIGRhdG9zIHBlcnNvbmFsZXMsIGF0ZW5kaWVuZG8KbG8gcHJlY2VwdHVhZG8gZW4gbGEgbGV5IDE1ODEgZGUgMjAxMiB5IGVsIERlY3JldG8gMTM3NyBkZSAyMDEzLCBxdWUgZGVzYXJyb2xsYW4gZWwgcHJpbmNpcGlvIGNvbnN0aXR1Y2lvbmFsIHF1ZSB0aWVuZW4gdG9kYXMgbGFzCnBlcnNvbmFzIGEgY29ub2NlciwgYWN0dWFsaXphciB5IHJlY3RpZmljYXIgdG9kbyB0aXBvIGRlIGluZm9ybWFjacOzbiByZWNvZ2lkYSBvLCBxdWUgaGF5YSBzaWRvIG9iamV0byBkZSB0cmF0YW1pZW50byBkZSBkYXRvcwpwZXJzb25hbGVzIGVuIGJhbmNvcyBvIGJhc2VzIGRlIGRhdG9zIHkgZW4gZ2VuZXJhbCBlbiBhcmNoaXZvcyBkZSBlbnRpZGFkZXMgcMO6YmxpY2FzIG8gcHJpdmFkYXMsIHJlcXVpZXJlIG9idGVuZXIgc3UgYXV0b3JpemFjacOzbiwKcGFyYSBxdWUsIGRlIG1hbmVyYSBsaWJyZSwgcHJldmlhLCBleHByZXNhLCB2b2x1bnRhcmlhLCB5IGRlYmlkYW1lbnRlIGluZm9ybWFkYSwgcGVybWl0YSBhIHRvZGFzIG51ZXN0cmFzIGRlcGVuZGVuY2lhcyBhY2Fkw6ltaWNhcwp5IGFkbWluaXN0cmF0aXZhcywgcmVjb2xlY3RhciwgcmVjYXVkYXIsIGFsbWFjZW5hciwgdXNhciwgY2lyY3VsYXIsIHN1cHJpbWlyLCBwcm9jZXNhciwgY29tcGlsYXIsIGludGVyY2FtYmlhciwgZGFyIHRyYXRhbWllbnRvLCBhY3R1YWxpemFyCnkgZGlzcG9uZXIgZGUgbG9zIGRhdG9zIHF1ZSBoYW4gc2lkbyBzdW1pbmlzdHJhZG9zIHkgcXVlIHNlIGhhbiBpbmNvcnBvcmFkbyBlbiBudWVzdHJhcyBiYXNlcyBvIGJhbmNvcyBkZSBkYXRvcywgbyBlbiByZXBvc2l0b3Jpb3MKZWxlY3Ryw7NuaWNvcyBkZSB0b2RvIHRpcG8gY29uIHF1ZSBjdWVudGEgbGEgVW5pdmVyc2lkYWQuCgpFc3RhIGluZm9ybWFjacOzbiBlcyB5IHNlcsOhIHV0aWxpemFkYSBlbiBlbCBkZXNhcnJvbGxvIGRlIGxhcyBmdW5jaW9uZXMgcHJvcGlhcyBkZSBsYSBVbml2ZXJzaWRhZCBlbiBzdSBjb25kaWNpw7NuIGRlIGluc3RpdHVjacOzbiBkZQplZHVjYWNpw7NuIHN1cGVyaW9yLCBkZSBmb3JtYSBkaXJlY3RhIG8gYSB0cmF2w6lzIGRlIHRlcmNlcm9zLgoKTGXDrWRvIGxvIGFudGVyaW9yLCAiQ29uc2llbnRvIHkgYXV0b3Jpem8gYSBsYSBVbml2ZXJzaWRhZCBNaWxpdGFyIE51ZXZhIEdyYW5hZGEgZGUgbWFuZXJhIHByZXZpYSwgZXhwcmVzYSBlIGluZXF1w612b2NhIHBhcmEgcXVlCm1pcyBkYXRvcyBwZXJzb25hbGVzIHNlYW4gdHJhdGFkb3MgY29uZm9ybWUgYSBsbyBwcmV2aXN0byBlbiBlbCBwcmVzZW50ZSBkb2N1bWVudG8iLgoK

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