Lacrimal gland pleomorphic adenoma: a narrative review / Adenoma pleomórfico de glândula lacrimal: uma revisão narrativa

ABSTRACT We present a literature review of 57 publications describing this pathology, published from the year 2012. In all these studies patients were reported to depict a slow-growing, motionless mass, which is painless at most times. All cases were managed by total excision, except for one report where adjuvant radiotherapy was applied. Among the several therapeutic strategies, the total tumor resection, preserving the tumor pseudocapsule intact, appears to be a consensus in treating the disease efficiently. Furthermore, fine-needle aspiration biopsy, including the assessment of genetic alterations, has proved to be a valuable tool in the diagnosis of challenging cases. Our literature survey also suggests that an incisional biopsy before the surgery may lead to the pseudocapsule disruption, thus considerably increasing the chances of adenoma recurrence, enabling its malignization. At present, genetics studies indicate that the molecular aberrations involved in the adenoma are similar to those represented in the salivary gland tumor pathogenesis. Further, in the recurrent cases, the pathology becomes difficult to treat and multiple surgeries may be required, occasionally, leading to radical surgery treatment.

RESUMO Uma revisão narrativa da literatura de 57 publicações que descrevem esta patologia, publicada a partir de 2012. Os pacientes têm uma massa de crescimento lento e imóvel, que na maioria das vezes é indolor. Todos os casos foram tratados por excisão total, com exceção de um relatório de radioterapia adjuvante. Entre as estratégias terapêuticas encontradas, a ressecção total do tumor, preservando a pseudocápsula tumoral intacta, parece ser um consenso. Alternativamente, a biópsia por aspiração de agulha fina incluindo a avaliação de alterações genéticas pode representar uma ferramenta valiosa nos casos diagnósticos desafiadores. Uma biópsia incisional antes da cirurgia não é recomendada, pois a ruptura da pseudocápsula aumenta consideravelmente a recorrência do adenoma, permitindo até mesmo sua malignização. Com relação à genética, estudos atuais indicam que as aberrações moleculares envolvidas no adenoma são semelhantes às da patogênese do tumor da glândula salivar. Para casos de recorrência, a patologia torna-se difícil de tratar e múltiplas cirurgias podem ser necessárias, às vezes levando a um tratamento cirúrgico radical.

Research progress of needle-free injection technology / 药学学报

Needle-free injection technology (NFIT) refers to the drug delivery systems in which drugs are propelled as high-speed jet streams using any of the pressure source to penetrate the skin to the required depth. NFIT is a promising drug delivery system as it enables the injection of liquids, powders, and depot/projectiles, and has the advantages of preventing needle stick accidents, improving drug bioavailability, eliminating needle-phobia, increasing vaccine immunity, simplifying operations and is convenient for patients to use. NFIT and its research background, the structure and classification of needle-free jet injectors (NFJI), drugs that can be delivered using NFJI and the factors affecting the injection effect are comprehensively reviewed in this paper. The limitations and potential development directions are summarized to provide a theoretical basis for the application and development of NFIT.

Application and development of endoscopic techniques in the diagnosis and treatment of liver diseases / 临床肝胆病杂志

Liver disease is one of the most important health problems around the world， and early diagnosis and timely intervention and treatment are the key to preventing liver-related morbidity and mortality rates. The development of endoscopic techniques has provided new diagnostic and intervention methods for liver diseases. This article reviews the application and development of endoscopic techniques in liver diseases from the following aspects： the technical advances and advantages of endoscopic ultrasound-guided liver biopsy； the application and development of endoscopic techniques in the treatment of portal hypertension caused by liver abscess/hepatic cyst and liver diseases， as well as interventional techniques in the treatment of liver tumors； the efficacy and prospects of the endoscopic techniques for weight loss， which are relatively new in China， in the treatment of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Endoscopic techniques may hold promise for wide clinical application and exploration in in liver-related diseases in China， so as to provide more options for patients and doctors.

Application value of two-dimensional shear wave elastography and serological models in the staging of liver fibrosis in patients with chronic hepatitis B / 临床肝胆病杂志

ObjectiveTo investigate the value of two-dimensional shear wave elastography （2D-SWE） or serological models used alone or in combination in determining the stage of liver fibrosis in patients with chronic hepatitis B. MethodsA retrospective analysis was performed for the clinical data of 327 patients with chronic hepatitis B who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from August 2020 to August 2022 and underwent 2D-SWE and liver histopathological examination， including sex， age， serological markers， and 2D-SWE results. According to the degree of liver fibrosis， they were divided into S0-S1， S≥2， S≥3， and S=4 groups， and the serological models were calculated based on serological markers. A Spearman correlation analysis was used to investigate the correlation of 2D-SWE and serological models with liver fibrosis stage； the receiver operating characteristic curve was plotted with the results of liver histopathology as the standard to compare the efficiency of each parameter used alone or in combination in determining the stage of liver fibrosis； the Delong test was used to investigate the difference between different methods. ResultsLiver stiffness measurement measured by 2D-SWE was strongly correlated with the stage of liver fibrosis （r=0.741， P<0.001）， and as for the serological model， six markers （APRI， FIB-4， GPR， GP， RPR， and S index）， other than AAR， were positively correlated with the stage of liver fibrosis （all P<0.001）. 2D-SWE had an area under the ROC curve （AUC） of 0.878， 0.932， and 0.942， respectively， in the diagnosis of S≥2， S≥3， and S=4 liver fibrosis （all P<0.001）， with an optimal cut-off value of 6.9 kPa， 7.9 kPa， and 9.4 kPa， respectively. Among the serological models， APRI had the largest AUC of 0.788 and 0.875， respectively， in the diagnosis of S≥2 and S=4 liver fibrosis， and S index had the largest AUC of 0.846 in the diagnosis of S≥3 liver fibrosis. In the diagnosis of S≥2， S≥3， and S=4 liver fibrosis， 2D-SWE combined with APRI increased the AUC values to 0.887， 0.938， and 0.950， respectively， and 2D-SWE combined with S index increased the AUC values to 0.879， 0.935， and 0.941， respectively， while there were no significant differences between 2D-SWE and the above combinations （P>0.05）. Conclusion2D-SWE has a better diagnostic efficacy than the above seven serological models in determining liver fibrosis stage. The serological models have a certain diagnostic value， among which APRI and S index have a relatively high diagnostic value. There is no significant difference between 2D-SWE and 2D-SWE combined with serological models， and such combinations cannot significantly improve diagnostic efficiency. Therefore， further studies are needed to explore new combinations of diagnostic methods.

Unilateral parotid gland Simultaneously primary two different pathological tumors: a case report and literature review / 口腔疾病防治

Objective@#To explore the clinical manifestations, histopathological characteristics, diagnosis, treatment, and prognosis of simultaneous unilateral primary tumors of different pathological types in the parotid gland.@*Methods@#A case of simultaneous unilateral primary parotid gland tumors, i.e., adenolymphoma and basal cell adenoma, was reviewed and analyzed in combination with the literature.@*Results@#The patient discovered a lump in the right parotid gland area one month prior to presentation, and a tumor was palpated in the shallow lobe of the right parotid gland before surgery. According to MR images, the initial diagnoses were tumors of the shallow and deep lobes of the right parotid gland. The tumors of the deep and shallow lobes were excised with part of the gland, and the facial nerves were dissected under general anesthesia. Postoperative pathology revealed an adenolymphoma in the shallow lobe of the right parotid gland and a basal cell adenoma with cystic transformation in the deep lobe. The surgical effect was good, with no complications, and there was no recurrence after 1 year of follow-up. A review of the relevant literature showed that multiple primary tumors of the parotid gland can manifest as the simultaneous presence of two or more types of tumors on both sides or on one side, and the disease is mainly treated with surgery.@*Conclusion@#Multiple unilateral primary parotid gland tumors are rare. Imaging examinations need to be combined with clinical evaluations to prevent missed diagnoses. Surgery is the first treatment option, and patients with benign tumors have a good prognosis.

Application of Magnetic Resonance Imaging and Transrectal Ultrasound Image Fusion Targeted Transperineal Biopsy Technique Using Electromagnetic Needle Tracking Under Local Anaesthesia / 肿瘤防治研究

Objective To explore the effect and safety of magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion targeted transperineal biopsy technique using electromagnetic needle tracking under local anesthesia. Methods We retrospectively analyzed the clinical and pathological data of 81 patients with mpMRI-TRUS image fusion targeted transperineal prostate biopsy using electromagnetic needle tracking under local anesthesia. Visual analog scale (VAS) and visual numeric scale (VNS) were used to evaluate the pain level and satisfaction of patients during prostate biopsy (VAS-1 and VNS-1), one hour after puncture (VAS-2 and VNS-2), and one day after surgery (VAS-3 and VNS-3). The perioperative clinical data and tumor positive rate of postoperative biopsy were recorded. Results The average prostate volume of 81 patients was 53.39±29.46 cm3. The PSA values of patients with PI-RADS scores of 2, 3, 4, and 5 were 9.14±2.31, 9.95±4.10, 14.77±6.36, and 32.17±24.39 ng/ml, respectively. The scores of VAS-1, VAS-2, and VAS-3 were 1.70±0.73, 1.16±0.58, and 0.53±0.55, respectively; the scores of VNS-1, VNS-2, and VNS-3 were 2.74±0.44, 3.69±0.46, and 3.84±0.37, respectively. The average surgical time was 17.47±3.44 minutes. Postoperative pathological results showed that the tumor positive rate of targeted prostate biopsy was 64.20%. According to the PI-RADS score for subgroup analysis, the tumor positive rates of patients with PI-RADS scores of 2, 3, 4, and 5 were 21.43%, 44.44%, 61.11%, and 96.77%, respectively. After transperineal prostate biopsy, gross hematuria occurred in 19.75% patients, and urinary retention occurred in 3.70%. The latter were relieved after symptomatic treatment. All patients did not experience complications, such as perineal puncture area hematoma, urinary tract infection, hematospermia, hematoma in perineal puncture area, urinary tract infection, hematospermia, vagus nerve reaction, or septic shock. Conclusion For suspected prostate cancer patients, mpMRI-TRUS image fusion targeted transperineal biopsy technique using electromagnetic needle tracking under local anesthesia is a feasible and easily tolerated surgical procedure. It has good safety and high tumor positive-detection rate, indicating that this technique is worthy of further clinical promotion and application.

Efectividad y seguridad de la biopsia hepática guiada porendosonografía en enfermedad hepática en un hospital públicode nivel III

La evaluación de la enfermedad hepática parenquimal suele comprender exámenes de laboratorio y de imagen; sin embargo, en algunos casos se puede requerir una biopsia hepática. La biopsia del hígado guiada por endosonografía se ha reportado como un procedimiento con un rendimiento diagnóstico entre 90 a 100% con un perfil bajo de eventos adversos; sin embargo, no existen estudios que reporten la experiencia y el tipo de técnica empleada en nuestro país. Objetivo: Determinar la efectividad y la seguridad de la biopsia hepática guiada por endosonografía en enfermedad hepática parenquimal. Materiales y métodos: Estudio prospectivo realizado en un hospital público de nivel de atención III-2 en Lima, Perú, el cual incluyó pacientes mayores de 18 años con sospecha de alguna enfermedad hepática parenquimal que fueron sometidos a una biopsia guiada por endosonografía desde marzo del 2018 a octubre del 2022. Resultados: El rendimiento diagnóstico de las biopsias fue de 77,02%, con una longitud media de la muestra obtenida de 13,98 mm (desviación estándar 7,34) y una mediana de 8 espacios porta completos (0-50). Cabe mencionar que solo un 31.25% de procedimientos se realizaron con aguja fina de biopsia (FNB), encontrándose una diferencia significativa entre el tipo de aguja y el rendimiento diagnóstico (p=0,01). El diagnóstico histopatológico más frecuente el de hepatitis autoinmune. Y existieron un 2,08% de complicaciones post procedimiento. Conclusiones: Las biopsias guiadas por endosonografía para el diagnóstico de enfermedad parenquimal hepática tienen una efectividad cercana al 80% en nuestro medio y con un perfil bajo de eventos adversos; sin embargo, se necesitan estudios prospectivos y con un mayor número de pacientes.

Parenchymal liver diseases are commonly evaluated by laboratory and imaging studies. However, in some cases a liver biopsy is required. Endoscopic ultrasonography-guided liver biopsy (EUS-LB) has been reported as a procedure with high diagnostic yield (90-100%) with low adverse event profile, but there are not studies which report about the experience and technique in our country. Objective: Determinate the effectiveness and the safety of endosonography-guided liver biopsy in liver parenchymal disease. Materials and methods: A prospective study was conducted at a III-2 level of care Public Hospital in Lima, Peru. It included patients over 18 years of age with suspicion of parenchymal liver disease who underwent EUS-LB for study hepatic parenchymal disease since March of 2018 to October of 2022. Results: The diagnostic yield of the biopsies was 77.02%, with a mean length of the sample of 13.98mm (standard deviation 7.34) and a median of 8 complete portal spaces (0-50). Only 31.25% of the procedures were performed with a fine needle biopsy (FNB), finding a significant difference between the type of needle and the diagnostic yield (p=0.01). The most common histopathological diagnosis was autoinmune hepatitis. There were 2.08% of post-procedure complications. Conclusions: EUS-LB for the diagnosis of liver parenchymal disease had a diagnostic yield close to 80% in our region with a low profile of adverse events. However, more prospectives studies with a larger number of patients are required.

Anaplastic (undifferentiated) carcinoma of pancreas, an uncommon variant: Diagnosed on endoscopic-guided fine needle aspiration

Anaplastic carcinoma of pancreas (ACP) are rare pancreatic neoplasms. They are well known to be associated with more aggressive tumor behavior and less favorable prognosis than usual pancreatic ductal adenocarcinoma. Endoscopic-guided fine needle aspiration (EUS-FNA) is now a widely accepted modality in diagnosis of pancreatic lesions. However, only a few reports are available describing cytological features of anaplastic carcinoma. Here, we report two cases of ACP diagnosed on EUS-FNA.

The Ganesh朑rewal cystitome maker � A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

The B-cell non-Hodgkin’s lymphoma: An enigma to diagnose

Non-Hodgkin’s lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T-cells, B-cells, or both. Sometimes, tuberculosis and lymphoma presentation can share common symptoms and features. In this case report, we present the case of a 28-year-old female patient who came with a chief complaint of swelling on the right side of the face for the past 6 months. Initially, it was not associated with pain but gradually developed severe pain over the region and reduced salivary flow. The patient was planned for surgery with a differential diagnosis of salivary gland pathology. Post-operatively, the histopathological report showed atypical cells which were diffusely positive for cluster of differentiation (CD)20. Focally positive for CD45 and CD3 which was positive in reactive T lymphocytes. Immunohistochemistry pattern favors the diagnosis of B-cell type NHL. Through this case report, we want to share our experience in treating an aggressive tumor that mimics salivary gland pathology.

Vacuum-assisted excision of breast lesions in surgical de-escalation: where are we? / Excisão assistida a vácuo de lesões mamárias no descalonamento cirúrgico: onde estamos?

Abstract Vacuum-assisted excision of breast lesions has come to be widely used in clinical practice. Increased acceptance and availability of the procedure, together with the use of larger needles, has allowed the removal of a greater amount of sample, substantially reducing the surgical upgrade rate and thus increasing the reliability of the results of the procedure. These characteristics result in the potential for surgical de-escalation in selected cases and gain strength in a scenario in which the aim is to reduce costs, as well as the rates of underestimation and overtreatment, without compromising the quality of patient care. The objective of this article is to review the technical parameters and current clinical indications for performing vacuum-assisted excision of breast lesions.

Resumo A excisão assistida a vácuo de lesões mamárias tem sido cada vez mais utilizada na prática clínica. A sua maior aceitação e disponibilidade, em associação ao uso de agulhas mais calibrosas, permitiu a retirada de quantidade maior de amostra, reduzindo substancialmente a taxa de subestimação diagnóstica e aumentando, assim, a confiabilidade final dos resultados do procedimento. Essas características resultam em potencial descalonamento cirúrgico, em casos selecionados, e ganham força em um cenário em que se visa a redução de custos, taxa de subestimação e tratamento excessivo, porém, sem comprometer a qualidade no cuidado com o paciente. O objetivo deste trabalho é revisar os parâmetros técnicos e as indicações clínicas atuais para realização de excisão assistida a vácuo em lesões mamárias.

Comparative Study on the Effects and Complications of Transverse Insertion of Two Fine Gauge Quincke’s Spinal Needles 26 and 29 G in Spinal Anesthesia

Introduction:Spinal anesthesia is one of the most commonly used techniques in modern anesthesia. Spinal needles have evolved over time to increase efficacy and decrease complications. Fine gauge spinal needles technically consume more time but are advisable in certain clinical conditions such as raised intracranial pressure and when patient well‑being and comfort are the priorities. Hence, we undertook this study to compare the effects and complication of transverse insertion of Quincke’s spinal needle 26 G (gauge) and 29 G. Materials and Methods: Hundred patients of age 18–40 years posted for lower abdominal and lower limb surgeries were allocated into two groups of 50 each to receive spinal anesthesia with 3 ml of 0.5% bupivacaine using 26 G or 29 G Quincke’s spinal needle. All the patients were evaluated for the time of drug administration, number of attempts, time to attain sensory blockade up to T8 level, time to attain motor blockade up to bromage Grade 3, and incidence of post‑dural puncture headache (PDPH) and post‑dural puncture backache. Results: Demographic data were comparable in both groups. The PDPH incidence on 3rd day for 29 G Quincke’s was 0% while for 26 G Quincke’s was 12%. There was statistically significant difference when 26 G Quincke’s was compared with 29 G Quincke’s for number of attempts, time of drug administration, time to attain motor and sensory block. Conclusion: 29 G Quincke’s spinal could be used to provide spinal anesthesia in young adult patients owing to adequate sensory and motor blockade with no incidence of PDPH and backache.

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

Application-of-the-proposed-sydney-system-in-reporting-of-the-lymph-node-cytopathology—a-retrospective-study

Introduction: Fine needle aspiration cytology (FNAC) is a widely accepted first line of investigation to diagnose the cause of lymphadenopathy. A standardized categorization and reporting system for lymph node cytology was proposed in 20th International Congress of Cytology at Sydney which consisted of 5 categories (L1, L2, L3, L4, L5) with management recommendations for each. Aims and Objective: To review the application of the Sydney system in achieving a uniform standardized approach for classifying and reporting lymph node cytology and to assess the risk of malignancy (ROM) for each category. : A 2 year single institute retrospective study. Clinical details were collectedMaterials and Methods from the patient records and cytology smears were reviewed by 2 cyto-pathologists as per the Sydney system. Histological correlation was done wherever possible. Statistical analysis was performed. 437 cases were re-Results: evaluated, with mean age of 39.66 years, slight male preponderance and cervical lymph node being the most common site. L2/Benign was the most common category with reactive lymphoid hyperplasia being the most common diagnosis and metastatic squamous cell carcinoma was the most common L5/malignant diagnosis. Histopathological correlation was available for 40 (9.1%) cases and the highest calculated risk of malignancy (ROM) was for L4 and L5 categories (100% each). The diagnostic accuracy of the proposed Sydney system in our study was 96.66%. TheConclusion: proposed Sydney system improves the diagnostic accuracy and standardizes the reporting of lymph node cyto- pathology. It improves the patient care by giving management recommendation to the clinicians.

Comparative study of atienuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Introduction: Needle prick pain is a distressing event for a pa?ent receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally trauma?zing for many pa?ents. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the prac?ce of giving injec?ons of local anaesthe?c or local applica?on of EMLA cream or patch at the site of spinal puncture beforehand for anaesthe?zing the skin and subcutaneous ?ssues. Methods: A prospec?ve cohort study was done. Those enrolled pa?ents were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed pa?ents either EMLA cream or regular standard lignocaine infiltra?on anaesthesia and labelled them as Group E and Group L respec?vely. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 pa?ents were enrolled in the study33 in Group E and 31 in Group L. Both groups had an almost similar number of pa?ents who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E pa?ents compared to that in Group L, p<0.001. The mul?variate analysis had similar findings a?er controlling confounding factors in mul?ple regression analysis. Conclusion: Local 2% lignocaine injec?on achieved significantly more pain reduc?on during spinal needle inser?on compared to the applica?on of an EMLA patch before spinal anaesthesia.

Evaluation of 18FDG PET-CT-positive mediastinal-hilar lymph nodes in extrathoracic malignancies by EBUS-TBNA; correlation of SUVmax, and short-axis diameter with the final diagnosis

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.

Utilización del sistema Bethesda para el diagnóstico citológico de nódulos tiroideos / Use of the Bethesda system for the cytologic diagnosis of thyroid nodules: en

Introducción: El nódulo tiroideo es un hallazgo común en la actualidad y, por sus características ecográficas, constituye una lesión distinta al parénquima glandular, con una prevalencia alta en la población general. Objetivo: Describir el uso del sistema Bethesda como método de diagnóstico de nódulos tiroideos y el grado de malignidad. Métodos: Se efectuó un estudio descriptivo y retrospectivo de 1771 pacientes con diagnóstico de nódulo tiroideo, a quienes se les realizó citología por aspiración con aguja fina en el Departamento de Anatomía Patológica del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba durante el cuatrienio 2016-2019. Resultados: En la serie predominó el grupo etario de 41-50 años y la edad media fue de 49,51±13,14 años. Asimismo, sobresalió la categoría II del sistema Bethesda (73,8 %); en tanto, de los 204 diagnosticados correspondientes a la categoría III, 111 fueron intervenidos quirúrgicamente y 29 de estos presentaron neoplasias malignas (27,6 %). El grado de malignidad osciló entre 22,8 y 36,0 %. Conclusiones: La aplicación del sistema Bethesda fue muy útil para el diagnóstico citopatológico de nódulos tiroideos y el grado de malignidad se correspondió con cifras adecuadas.

Introduction: The thyroid nodule is a common finding nowadays and, for its echographic characteristics, it constitutes a lesion different to the glandular parenchyma, with a high prevalence in the general population. Objective: To describe the use of the Bethesda system as diagnostic method of thyroid nodules and the degree of malignancy. Methods: A descriptive and retrospective study of 1 771 patients with diagnosis of thyroid nodule was carried out, who underwent fine needle aspiration cytology, in the Pathology Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during 2016-2019. Results: In the series there was a prevalence of the 41-50 age group and the mean age was of 49,51±13,14 years. Also, the category II of the Bethesda system was notable (73.8 %); as long as, of the 204 diagnosed corresponding to the category III, 111 were surgically intervened and 29 of them presented mlignancy (27.6 %). The degree of malignancy oscillated between 22.8 and 36.0 %. Conclusions: The application of the Bethesda system was very useful for the cytopathologic diagnosis of thyroid nodules and the degree of malignancy corresponded with appropriate figures.

Risk of malignancy in thyroid nodules classified as Bethesda categories III, III - subcategories and IV: 2.5 years study

Introduction: Thyroid fine-needle aspiration cytology (FNAC) has gained significance as a quick, safe, and relatively simple method to differentiate malignant from benign thyroid nodules and is regarded as the gold-standard first-line diagnostic test in the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid FNAC with each category having an implied cancer risk. However, the optimal management of thyroid nodules in the Bethesda III and IV categories is controversial, given the variable malignancy rates. Aims/Objectives: (1) Analysis of the cytomorphological characteristics of patients with categories III and IV of “TBSRTC.” (2) Assessment of risk of malignancy of TBSRTC category III, IV, and substratification of TBSRTC category III. Materials and Methods: A retrospective and prospective study of cases categorized under TBSRTC as category III and IV at a tertiary-care center. Cytological along with their histological results were compared. Results: We identified an overall malignancy rate of 33% for nodules belonging to Bethesda category III and a malignancy rate between 19% and 33% for Bethesda category IV. Also, a significantly higher risk of malignancy in subcategories with nuclear and architectural atypia (66.6%) than only architectural atypia (28.7%). Conclusion: Although surgery is recommended in most of these cases, cytomorphology helps to predict the final histopathological findings with greater accuracy. Substratification of category III into subgroups may help reduce the heterogeneity of the atypia of undetermined significance/follicular lesion of undetermined significance category and more.

Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters

ABSTRACT Objective: The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods: We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results: The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion: We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.

Needle visualization during ultrasound-guided puncture: image optimization / Visualização da agulha durante punção guiada por ultrassom: otimização de imagem

Abstract Background Obtaining an adequate image of the needle by ultrasound reduces complications resulting from punctures, increasing patient safety and reducing hospitalization costs. Objectives To verify human perception in relation to number of pixels, while also identifying the best puncture angle and which needle should be used, and to evaluate whether there is a difference if needle visualization software is used. Methods 20 images were analyzed by 103 students who classified them as being sufficient or insufficient and were compared with the quality observed using photoshop. We evaluated whether there were differences between puncture angles of less than 45º and more than 45º, between IV catheter and introducer needles, and between images obtained with and without visualization software. Results There was a higher percentage of sufficient ratings for images those that had more than 60 pixels and when the puncture angle was less than 45º, with significant associations between students' evaluations and each of these groups (p < 0.001). The percentages of images classified as sufficient were higher for images in which a IV catheter was used and also higher for those using the needle visualization software, with significant associations between the results for students' classifications and each of these groups (p < 0.001). Conclusions The human eye classifies an image as sufficient according to higher numbers of pixels. Images of punctures at angles smaller than 45º in relation to the surface, of punctures performed with a IV catheter, and when using specific visualization software are also better detected by the human eye.

Resumo Contexto A obtenção de uma imagem adequada da agulha pelo ultrassom diminui complicações decorrentes de punções, trazendo segurança para os pacientes e diminuindo custos com hospitalização. Objetivos Verificar a percepção do olho humano em relação aos pixels, identificar qual o melhor ângulo da punção e qual agulha deve ser utilizada e avaliar se há diferença com o uso de software de visualização de agulha. Métodos Vinte imagens foram analisadas por 103 alunos, que as classificaram como sendo suficientes ou insuficientes, e comparadas com a qualidade observada pelo photoshop. Avaliou-se se havia diferença entre punções com menos de 45º e mais de 45º, entre cateter EV e agulha introdutora e entre imagens obtidas com e sem software de visualização. Resultados Houve um percentual mais elevado de imagens suficientes entre aquelas que tinham mais de 60 pixels e quando o ângulo era menor que 45º, com associação significativa entre a classificação das avaliações pelos alunos e cada um desses grupos (p < 0,001). O percentual de imagens suficientes foi maior nas imagens realizadas com cateter EV e naquelas que utilizaram o software de visualização da agulha, ocorrendo associação significativa entre os resultados da classificação pelos alunos e cada um desses grupos (p < 0,001). Conclusões O olho humano classifica a imagem como sendo suficiente de acordo com a maior quantidade de pixels. Imagens puncionadas com ângulos menores que 45º em relação à superfície, realizadas com cateter EV e utilizando software específico de visualização também são mais bem detectadas pelo olho humano.