Improvement in specimen adequacy with ultrasound-guided Fine-Needle Aspiration Biopsy (FNAB) of Thyroid Nodules using Rapid On-site Evaluation (ROSE): A cross-sectional study

Background@#Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method to evaluate thyroid nodule for possible malignancy. However, an adequate specimen is required for proper examination by a pathologist. Rapid on-site evaluation (ROSE), a service typically provided by pathologists, is the real-time evaluation for adequacy of FNAB smears which can help improve adequacy rates by allowing the submission of additional thyroid samples when the submitted samples are inadequate. This study aims to investigate if ROSE done by trained Endocrinologists can improve specimen adequacy in our patients.@*Methods@#A total of 192 patients were included in this study and were divided in two groups: a ROSE group (n=96) and a non-ROSE group (n=96). In the ROSE group, the smear of thyroid aspirate was evaluated for adequacy by a trained Endocrinologist in real time. In the non-ROSE group, specimens are directly sent to the Pathologist.@*Results@#ROSE done by Endocrinologists had 94% sensitivity, 46% specificity and 82% accuracy compared to a Pathologist. The adequacy rate under the ROSE group was 84.38% and 81.25% in non-ROSE group.@*Conclusion@#Our study showed that ROSE can improve adequacy rate in our center. ROSE can also be used by physicians in the provinces who are performing FNAB of the thyroid without ultrasound guidance to improve specimen adequacy and lessen repeat biopsy.

Adenoma pleomorfo de la glándula submandibular: reporte de un caso y revisión de la literatura / Pleomorphic adenoma of the submandibular gland: report of a case and review of literature

Los tumores de las glándulas salivales constituyen alrededor de 5% de las neoplasias de cabeza y cuello. El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, representa aproximadamente 60% de todas las neoplasias salivales, está compuesto fundamentalmente por una proliferación de células mioepiteliales y por un amplio espectro de componentes de tejido epitelial y mesenquimal, rodeado por una nítida cápsula fibrosa. Alrededor de 80% de los adenomas pleomorfos aparecen en la parótida, 10% en la glándula submandibular y 10% en las glándulas salivales menores de la cavidad oral. La edad media de presentación es a los 46 años, pero la edad oscila entre la tercera y la quinta década de la vida. No obstante, ha sido encontrado en individuos de todas las edades, presentando una ligera predilección por el sexo femenino. Respecto a su sitio de origen, el adenoma pleomorfo es asintomático, de crecimiento lento y consistencia firme. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) son de gran utilidad para evaluar la extensión de la lesión, así como el compromiso de estructuras importantes. La biopsia por aspiración con aguja fina (BAAF) es un método útil para el diagnóstico de este tipo de neoplasias. El tratamiento de este tipo de lesiones consiste en la remoción quirúrgica de la tumoración junto con la glándula afectada. Menos de 1% de los casos de adenomas pleomorfos sufren transformación maligna, especialmente los que han presentado múltiples recidivas (AU)

The tumors of the salivary glands constitute about 5% of the neoplasms of the head and neck. The pleomorphic adenoma is the most frequent benign tumor of the salivary glands, represents approximately 60% of all salivary neoplasms, is composed mainly of a proliferation of myoepithelial cells and a wide spectrum of components of epithelial and mesenchymal tissue, surrounded by a sharp fibrous capsule. About 80% of pleomorphic adenomas appear in the parotid, 10% in the submandibular gland and 10% in the minor salivary glands of the oral cavity. The average age of presentation is 46 years, but age ranges between the third and fifth decade of life. However, it has been found in individuals of all ages, presenting a slight female predilection. Regarding its site of origin, the pleomorphic adenoma is asymptomatic, slow growing and firm consistency. Computed tomography (CT) and nuclear magnetic resonance (NMR) are very useful to evaluate the extent of the injury as well as the commitment of important structures. Fine needle aspiration biopsy (FNAB) is a useful method for the diagnosis of this type of neoplasm. The treatment of this type of injuries consists in the surgical removal of the tumor together with the affected gland. Less than 1% of cases of pleomorphic adenomas suffer malignant transformation, especially those that have presented multiple recurrences (AU)

Early diagnostic value of miR-191 and miR-494 from fine needle aspiration specimens and peripheral circulation for thyroid carcinoma / 中华内分泌代谢杂志

Objective To investigate the different expression levels of death-associated protein kinase ( DAPK) related miR-191 and phosphatase and tensin homolog deleted on chromosome ten ( PTEN) related miR-494 from fine-needle aspiration biopsy ( FNAB) samples and blood of both benign and malignant thyroid nodules, and to find new clinical molecular diagnostic markers. Methods FNAB specimens and peripheral venous blood were collected from 113 patients with thyroid nodules (48 cases of malignant and suspected malignant thyroid nodules, 38 cases of nodular goiter, and 27 cases of thyroid adenomas). The expression levels of miR-191 and miR-494 were detected by realtime fluorescence quantitative reverse transcription PCR ( qRT-PCR ) . qRT-PCR were applied to detect miR-191 and miR-494 expression level in 98 patients with thyroid nodules and peripheral circulation. Receiver operating characteristic curves ( ROC curves) were used to evaluate the sensitivity and specificity of miR-191 and miR-494 to diagnose malignant thyroid nodules. Results (1) The sensitivity of FNAB in diagnosing thyroid cancer was 91. 7％ (44/48) and the specificity was 90. 9％ (30/33),the diagnostic accuracy was 91. 35％. (2) In FNAB samples, as well as in peripheral circulation, the relative expression of miR-191 in thyroid cancer group is significantly lower than that of the benign group, while the relative expression of miR-494 in thyroid cancer group is significantly higher than that of the benign group (P<0. 05). (3) The sensitivity and specificity of miR-191 and miR-494 were acceptable (area under the ROC curve>0. 7). Sensitivity and specificity of miR-191 in FNAB and peripheral circulation were 76. 9％, 73. 5％ and 61. 5％, 64. 1％; miR-494 were 63. 6％,76. 5％ and 72. 7％, 84. 6％respectively. (4) In thyroid cancer FNAB samples and peripheral circulation, the differences between the relative expression level of miR-191 and miR-494, and the clinical characteristics of age, gender, nodule size, and calcification, with or without cervical lymph node enlargement, thyroid function and thyroid antibodies with or without abnormalities were not statistically significant(P>0. 05). Conclusion MiR-191 and miR-494 can be used as molecular diagnostic markers for early diagnosis of thyroid carcinoma with adjunctive FNAB.

Análisis de características clínicas y ecográficas de nódulos tiroideos con citología Bethesda III y su evolución / Analysis of Clinical and Ultrasound Features of Thyroid Nodules With Bethesda III Cytology and their Evolution

Introducción: Desde la implementación de la clasificación citológica de los nódulos tiroideos por el sistema Bethesda en 6 categorías, el grupo Bethesda III (BIII) es el que genera más controversias en cuanto a la conducta de seguimiento. Según la literatura corresponden a esta categoría entre el 4 y 20 % de los nódulos punzados y conllevan un riesgo de malignidad del 5-15 %. Objetivo: Determinar características clínicas y ecográficas de los nódulos tiroideos clasificados como BIII en nuestra población y analizar su evolución en el tiempo. Materiales y Métodos: Estudio descriptivo de todos los pacientes enviados a PAAF bajo guía ecográfica que resultaron BIII, entre febrero 2011 y diciembre 2013. Se describieron las características clínicas y ecográficas de dichos nódulos y su evolución. La mediana de seguimiento fue 24 meses (rango: 2 a 35 meses). Resultados: Fueron punzados 945 nódulos de 784 pacientes. Se clasificaron como BIII 85 nódulos (8,99 %) de 72 pacientes (69 mujeres y 3 varones), con una media de edad de 71,1 ±7,1 años. La mediana del diáme­tro mayor de los nódulos fue 18 mm (9 a 54 mm). El 76,1 % de los nódulos fueron sólidos, el 22,5 % mixtos y en 1 caso espongiforme. Según el patrón ecográfico: 36,7 % eran hipoecoicos, 54,4 % isoecoicos y 8,9 % hiperecoicos. El 8,33 % presentó microcalcificaciones y el 9,9 % márgenes irregulares. El 39,43 % presentó vascularización periférica, 4,23 % central y 56,34 % mixta. Evolución: De los 72 pacientes, 9 (12,1 %) se perdieron en el seguimiento, a 56 (77,8 %) se los siguió clínica y ecográficamente, y en 7 pacientes (9,7 %) se tomó conducta quirúrgica basándose en criterios clínicos y ecográficos sospechosos de malignidad, o por antecedentes familiares positivos, resultando 3 con carcinoma papilar (CP), y 4 con patología benigna. Durante el seguimiento, Fueron repunzados 40 nódulos de 35 pacientes (48,6 %) que resultaron: 2 BI, 23 BII, 14 BIII y 1 BV. De los 14 nódulos con segunda punción BIII, se operaron 7, 1 CP y 6 patología benigna. El nódulo BV resultó un CP a su cirugía. En total, fueron operados 16 pacientes con BIII (22,2 %) (7 de inicio y 8 luego de la segunda PAAF y 1 en el seguimiento clínico ecográfico), de los cuales 5 (31,25 %) resultaron CP y 11 (68,75 %) patología tiroidea benigna. Conclusión: Si bien para los nódulos tiroideos con categoría BIII se recomienda generalmente una repunción, en nuestra experiencia el hallazgo de características clínicas y ecográficas sospechosas de malignidad y/o antecedentes familiares de cáncer de tiroides permitiría en algunos pacientes optar por la cirugía tiroidea desde el inicio. Rev Argent Endocrinol Metab 52:14-21, 2015 Los autores declaran no poseer conflictos de interés.

Background: Since the implementation of the Bethesda System for cytology classification of thyroid nodules into 6 categories, the Bethesda III group (B III) has been the most controversial as regards follow-up management. Reported data shows that about 4 to 20 % of all biopsied nodules belong to this category, with the risk of malignancy being 5 to 15 %. Objective: To determine clinical and sonographic features of thyroid nodules classified as BIII in our population and analyze their evolution over time. Methods: We determined the clinical and ultrasonographic (US) features of all patients who had undergone fine needle aspiration biopsy (FNAB) in 2011-2013 at our Institution for Retirees and Pensioners. Descriptive study of all patients with nodules classified as BIII with a median follow-up time of 24 months (2 to 35 months). Results: Out of 945 nodules from 784 patients biopsied (age, mean ± SD:71.1±7.1 years), 85 (8.99 %) were classified as BIII. Six patients had received neck radiation, and 5 reported family history of thyroid cancer. The median (range) largest diameter of nodules was 18 mm (9-54 mm). Fifty-four nodules (76.1 %) were solid, 16 (22.5 %) mixed, and 1 spongiform. Based on echogenicity, 36.7 % were hypoechoic, 54.4 % isoechoic and 8.9 % hyperechoic. Twenty-two nodules (25.88 %) were taller than wider, 8.33 % had microcalcifications and 9.9 % had irregular margins. At Doppler evaluation, 39.43 % of nodules had peripheral vascularity, 4.23 % showed central vascularity and 56.34 % had mixed vascularity. In 7 out of 72 patients with BIII classification, surgery was indicated at the start based on suspicious clinical and US findings for malignancy, or family history of thyroid cancer. Out of these 7 patients, 3 were found to have papillary carcinoma (PTC), 1 follicular adenoma (FA), 1 colloid goiter (CG), 1 adenomatous nodule (AN) and 1 chronic lymphocytic thyroiditis (CLT). As regards the follow-up and evolution of the rest of the group, 9 were lost, 21 remained in observation and 35 (48.6 %) with 40 nodules underwent a second FNAB, with the following results: 2 BI, 23 BII, 14 BIII and 1 BV. Out of 14 nodules confirmed as BIII on repeat FNAB, 7 were operated on, resulting in: 2 CLT, 3 CG, 1 FA and 1 PTC. The BV nodule proved to be PTC. A total of 16 patients with BIII nodules underwent surgery (7 initially, 8 after a second FNAB, and 1 during clinical and US follow-up) and 5 (31.25 %) were PTC while 11 (68.75 %) were benign. Conclusion: Even though BIII thyroid nodules generally require a second FNAB, in our experience clinical and US findings suspicious for malignancy, or family history of thyroid cancer could allow some patients to be offered surgery at initial presentation. Rev Argent Endocrinol Metab 52:14-21, 2015 No financial conflicts of interest exist.

Avaliação da punção aspirativa por agulha fina (PAAF) em cavidade oral e região de cabeça e pescoço em diferentes técnicas de coloração / Evaluation of fine needle aspiration biopsy (FNAB) in oral cavity and head and neck region with different techniques stains

O presente estudo teve como objetivo avaliar a Punção Aspirativa por Agulha Fina (PAAF) em diferentes técnicas de coloração, em lesões nodulares de cavidade oral e região de cabeça e pescoço, quanto a sua sensibilidade, especificidade e acurácia, nas colorações de Panótico, Papanicolau e Hematoxilina-Eosina . Foram selecionados 46 pacientes consecutivamente que procuraram a Clínica da Disciplina de Estomatologia Clínica da FOUSP, portadores de lesões nodulares em cavidade oral e região de cabeça e pescoço. Como critérios de inclusão foram selecionados pacientes de ambos os sexos, todas as etnias, acima dos 5 anos de idade, sem restrição de comorbidades e que foram realizadas PAAF com confirmação diagnóstica pela biópsia. Como critérios de exclusão da pesquisa estão os pacientes abaixo dos 5 anos de idade e pacientes que foram somente submetidos a PAAF sem confirmação diagnóstica pela biópsia. O material obtido pela PAAF foi enviado em 6 lâminas diferentes, corados pelo método de Panótico, Papanicolau e Hematoxilina-Eosina a um mesmo patologista apenas com o diagnóstico clínico. Após a emissão do laudo da PAAF, o laudo do anátomo patológico era emitido, servindo como padrão ouro. Após os cálculos, o resultado da sensibilidade, especificidade e acurácia para o método de coloração com o Panótico foram de 28,6%, 76%, 15,4, respectivamente, para o método de coloração com o Papanicolau foram de 71,4%, 76,7%, 23,3%, respectivamente e para o método de coloração com a Hematoxilina-Eosina foram de 82,1%, 23,3%, 28,6%, respectivamente...

The present study aimed to evaluate the Fine Needle Aspiration Biopsy in different staining techniques in nodular lesions of the oral cavity and head and neck region, as their sensitivity, specificity and accuracy, staining with Panoptic, Papanicolaou and Hematoxylin-Eosin. 46 patients who sought the Clinic of the Discipline of Clinical Stomatology at FOUSP were selected consecutively, with nodular lesions in the oral cavity and head and neck region. Inclusion criteria were patients of both sexes, all ethnicities, above 5 years-old, with no restriction of comorbidities and FNAB performed with confirmation by biopsy. Exclusion criteria were patients under 5 years-old and patients who only underwent FNAB without confirmation by biopsy. The material obtained by FNAB was sent on 6 different slides, stained by the method of Panoptic, Papanicolaou and Hematoxylin-Eosin, to the same pathologist only with the clinical diagnosis. After the final report of FNAB, the biopsy report was issued, serving as gold standard. After the calculations, the results of sensitivity, specificity and accuracy for Panoptic staining were 28.6%, 76% and 15.4%, respectively...

In Thyroid Cancer Patients, Is Preoperative FNAB-C Reliable for Prediction of Lateral Cervical LN Metastasis? / 대한내분비외과학회지

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.

Comportamiento de la enfermedad nodular del tiroides en el Servicio de Cirugía General del Hospital Vladimir Iich Lenin de Holguín / Behavior of Thyroid Nodular Disease in General Surgery Service in Vladimir Ilich Lenin Hospital of Holguin

Introducción: la enfermedad nodular de la glándula tiroides es causa frecuente de atención en las consultas externas de los servicios de salud. Por esta razón, es importante conocer sus formas fundamentales de presentación, los exámenes complementarios necesarios para su diagnóstico y el seguimiento establecido para vigilar su evolución. Objetivo: caracterizar el comportamiento de la enfermedad nodular de la glándula tiroides en pacientes atendidos en el Servicio de Cirugía General del Hospital General Universitario Vladimir Ilich Lenin de la provincia Holguín. Métodos: se realizó un estudio descriptivo en pacientes con enfermedad nodular de la glándula tiroides atendidos en el Servicio de Cirugía General del Hospital General Universitario Vladimir Ilich Lenin de la provincia Holguín. El universo estuvo constituido por 931 pacientes que acudieron a consulta, la muestra estuvo constituida por 423 pacientes que padecían enfermedad nodular de la tiroides. Resultados: predominó el sexo femenino, así como, las edades entre 31 y 45 años. El aumento de volumen en la región anterior del cuello fue el motivo de consulta más frecuente. Como enfermedad asociada predominó la hipertensión arterial. El carcinoma papilar fue el más encontrado en los nódulos malignos. Prevalecieron los nódulos mayores de 15 mm para el lóbulo, únicos, unilaterales, de bordes regulares y contenido líquido con ganglios múltiples y calcificaciones. El lóbulo izquierdo fue el más afectado. En todos los pacientes se confirmó el diagnóstico mediante ecografía. Predominó el diagnóstico histológico no maligno de la glándula extirpada. Conclusiones: la hemitiroidectomía izquierda con istmectomía fue la resección más frecuente, sin accidentes quirúrgicos y evolución postoperatoria satisfactoria. La complicación más evidente en la cirugía tiroidea fue la disfonía transitoria y como secuela los queloides de la herida quirúrgica.

Introduction: nodular disease of the thyroid gland is a frequent cause of care in outpatient health services, so it is important to know the key features of presentation, any further examination and established monitoring. Objective: to characterize the nodular disease of the thyroid gland behavior in patients attended at General Surgery Service of Vladimir Ilich Lenin Hospital of Holguin. Methods: a descriptive study in patients with nodular thyroid gland, at General Surgery Service of Vladimir Ilich Lenin Hospital. The universe comprised 931 patients and 423 of them represented the sample. Results: papillary carcinoma was the most malignant one found. Nodules of more than 15 mm, unique, unilateral, of regular brink with liquid and multiple ganglia and calcification prevailed. The left lobule was the most affected one. The diagnosis was confirmed in all patients through echography. Non- malignant histologic removed gland predominated Conclusions: the left hemithyroidectomy with isthmectomy was the most frequent resection without postoperative surgical accidents and satisfactory progress. The most obvious complication in thyroid surgery was transient dysphonia as keloids sequel of the surgical wound.

False Negative Fine Needle Aspiration Biopsy Results in Primary Thyroid Lymphoma

Ultrasonography-guided fine needle aspiration biopsy (US-FNA) is one of the methods used to diagnose thyroid lymphoma, but it has a relatively high false-negative rate. The authors report a case of a primary thyroid lymphoma associated with underlying lymphocytic thyroiditis that was initially misdiagnosed as lymphocytic thyroiditis based on US-FNA findings.

Cytodiagnosis trends at the animal pathology laboratory of the University of Antioquia (Colombia) / Tendencias citodiagnósticas en el Laboratorio de Patología Animal de la Universidad de Antioquia (Colombia) / Tendências Cytodiagnosticas no laboratório de patologia animal da Universidade de Antioquia (Colômbia)

This retrospective study describes the cytology diagnoses conducted at the animal pathology laboratory of the University of Antioquia from years 1996 to 2009. Results were expressed as proportions. The studied traits were: animal species, cytological method used, affected system, and diagnosis. A total of 97.1% samples (1454/1497) corresponded to canine species. Cytology swab was the most common diagnostic method (64.6%, 939/1454). The female reproductive tract was the most affected system (45.6%, 663/1454). The most frequent diagnosis was inflammation (30.9%, 449/1454). A high proportion of samples failed to establish a specific diagnosis (21.3%, 309/1454). It is concluded that cytology was very useful for the diagnosis of inflammatory processes. The high proportion of non-specific diagnosis was mainly due to inadequate extraction and delivery of samples. This suggests there is a lack of knowledge on sample selection criteria, as well as sampling and delivery procedures necessary to confirm the clinical diagnosis. This article discusses the main difficulties found for proper cytology diagnosis in our region and proposes alternatives to optimize its results.

Con el objetivo de sistematizar y caracterizar los diagnósticos citológicos realizados en el Laboratorio de Patología Animal de la Universidad de Antioquia; se realizó un estudio descriptivo retrospectivo utilizando como fuente de información los registros de diagnóstico citológico y el material de archivo disponible en el laboratorio. Los resultados se expresaron como proporciones de acuerdo con las variables: especie, método citológico utilizado, sistema orgánico afectado y diagnóstico realizado. Las muestras evaluadas correspondieron en una mayor proporción a las especies canina 97.1% (1454/1497), el método citológico más empleado fue el hisopado 64.6% (939/1454), el sistema orgánico con mayor participación en el estudio fue el sistema reproductivo femenino 45.6% (663/1454), el diagnóstico más frecuente fue inflamación 30.9% (449/1454). En una alta proporción de las muestras no se logró establecer un diagnóstico específico 21.3% (309/1454). De estos resultados se concluye que la citología fue de gran utilidad para el diagnóstico de procesos inflamatorios. La alta proporción de diagnósticos inespecíficos se debe principalmente a una inadecuada obtención y remisión de las muestra, esto sugiere que existe desconocimiento en el medio sobre los criterios de selección, toma y envió de muestras adecuadas para realizar o confirmar el diagnóstico clínico. Este artículo discute las principales dificultades que se presentan para la realización de la citología en nuestro medio y propone alternativas para optimizar su valor diagnóstico.

Com o objectivo de sistematizar e descrever os diagnósticos citológicos realizados no Laboratório de Patologia Animal da Universidade de Antioquia, foi realizado um estudo retrospectivo utilizando a informação como fonte dos arquivos de diagnóstico citológico e material de arquivo no laboratório. Os resultados foram expressos como proporções, de acordo com as variáveis: espécie, método citológico utilizado, o sistema de órgãos afectados e diagnóstico feito. As amostras testadas em proporções mais elevadas corresponderam a espécie canina de 97,1% (1454/1497), o método mais comummente utilizado foi o esfregaço com o 64,6% (939/1454), o sistema orgânico com maior participação no estudo foi o sistema reprodutor feminino 45,6% (663/1454), o diagnóstico mais frequente foi a inflamação de 30,9% (449/1454). Em uma grande proporção das amostras não conseguiu-se estabelecer um diagnóstico específico em 21,3% (309/1454). A partir desses resultados conclui-se que a citologia foi muito útil para o diagnóstico de processos inflamatórios. A elevada proporção de diagnóstico não específica é devido principalmente à extracção inadequada e a entrega da amostra, isto sugere que há uma falta no meio dos critérios de selecção, recolha e envio de amostras necessárias para fazer ou confirmar o diagnóstico. Este artigo discute as principais dificuldades que surgem para a realização da citologia em meio ambiente e propõe alternativas para optimizar seu valor diagnóstico.

Bocio endotorácico / Endothoracic goiter

Se informa el caso de una paciente de 71 años de edad, con antecedentes de hipertensión arterial, que acude a consulta externa pues hace unos 5 años presenta aumento de volumen de la región inferior y lateral del cuello que se acompaña de decaimientos, palpitaciones y disfagia ocasional. Se realizaron los estudios de laboratorio para la valoración preoperatoria, además de los estudios de la función tiroidea, radiografías de tórax (vista anteroposterior), tomografía de tórax, ecografía de la tiroides y biopsia de aspiración con aguja fina. Se encontró un bocio endotorácico eutiroideo y se realizó tratamiento quirúrgico que consistió en hemitiroidectomía izquierda con istmectomía. El transoperatorio y el posoperatorio transcurrieron sin complicaciones, y el informe anatomopatológico reveló la presencia de un bocio coloide nodular(AU)

This is the case of a female patient aged 71 with a history of high blood pressure seen in external consultation since five years ago she presents a volume increase of lower and lateral region of the neck accompanied of weakness, palpitations and occasional dysphagia. Laboratory studies were conducted to preoperative assessment in addition to thyroid function studies, thorax X-rays (anteroposterior view), thorax tomography, thyroid gland echography and fine needle aspiration biopsy (FNAB). A euthyroid endothoracic goiter was present; surgical treatment was done consisting of left hemithyroidectomy with isthmectomy. In transoperative and postoperative periods there were not complications and the anatomic and pathologic report revealed the presence of nodular colloid goiter(AU)

Avaliação pré-operatória com PET-18F-FDG de nódulos de tireóide com citologia indeterminada / Preoperative evaluation of cytologically indeterminate thyroid nodules with 18F-FDG PET

Esse artigo tem o objetivo de discutir o papel da tomografia por emissão de pósitrons (PET) com 18F-FDG na avaliação pré-operatória de pacientes com nódulos de tireóide com citologia indeterminada. Para o cálculo da sensibilidade, foram selecionados todos os estudos com pacientes com carcinoma de tireóide. Para o cálculo da especificidade, foram selecionados apenas estudos desenhados para avaliação dos pacientes com nódulos com citologia indeterminada. O achado de captação focal na PET-18F-FDG relacionou-se com a presença de carcinoma de tireóide na maioria dos estudos. A sensibilidade do exame foi bastante alta na detecção de malignidade tireoidiana, porém sua especificidade variou de 0 por cento a 66 por cento, sendo de 39 por cento em estudo brasileiro. Concluindo, os estudos indicam que a PET-18F-FDG pode reduzir o número de tireoidectomias desnecessárias em pacientes com nódulos de tireóide com citologia indeterminada. Entretanto, o percentual relativamente elevado de resultados falso-positivos, o alto custo, a baixa disponibilidade do exame em países em desenvolvimento e a pouca experiência clínica ainda limitam o uso da PET-18F-FDG com essa finalidade.

The aim of this article is to discuss the role of 18F-FDG Positron Emission Tomography (PET) in the preoperative evaluation of patients with cytologically indeterminate thyroid nodules. All studies with patients with thyroid cancer were selected to the calculation of sensitivity. Only studies aiming to evaluate patients with thyroid nodules whose cytological result was indeterminate were selected to establish the specificity. The finding of focal 18F-FDG uptake at PET was associated with the presence of thyroid malignancy in most of the studies. The sensitivity of the exam to the detection of thyroid malignancy was extremely high, but the specificity varied from 0 to 66 percent. In our experience, the specificity was 39 percent. In conclusion, the studies suggest that 18F-FDG PET can reduce the number of unnecessary thyroidectomies performed in patients with cytologically indeterminate thyroid nodules. However, the relatively high percentage of false positive results, the high costs, the low availability of this exam in developing countries and the low clinical experience still restrict the use of 18F-FDG PET when recommended with this aim.

Accuracy of frozen-section combined with imprint and fine needle aspiration biopsy in thyroid nodules.

Thyroid malignancy can be found on 5% of thyroid nodules. In order to better managed of thyroid nodules, skills to differentiate benign from malignant cases were needed. Fine needle aspiration biopsy (FNAB) was done preoperatively while frozen section (FS) and imprint cytology (IC) should be done intra-operatively. The objective of this research paper is to evaluate the diagnostic accuracy of FNAB versus frozen section combined with imprint cytology (FS+IC) in thyroid nodules at the Anatomic-Pathology Department FMUI-CM Hospital, Jakarta. This diagnostic test, used data from clinico-pathological records in Anatomic Pathology Department, Faculty of Medicine University of Indonesia / Dr.Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during 1999-2003. Specimens with complete data of FNAB results, data of FS and slides of IC. All formalin fixed`specimens were reevaluated and used as the golden standard. Sensitivity, spesificity and accuracy of FS+IC were higher than FNAB (86.8% vs 73.7% ; 99.0% vs 83.9% ; 94.8% vs 80.5% respectively). If the results of FNAB were concordant with the result of FS+IC, the combined examination yields accuracy of 95.1%. The evaluation of frozen section combined with imprint cytology is very useful, because this examination significantly showed high accuracy in diagnosing thyroid malignancy.

Diagnostic Approach to Fine Needle Aspiration in a Breast Lesion / 대한세포병리학회지

Fine needle aspiration has been widely used to diagnose of breast lesions whether they are malignant or not. When applied by experienced and well-trained practitioners, its accuracy can approach that of histopathology, In order to make optimal use of FNAB in breast lesions, this article has reviewed the criteria for sample adequacy, the diagnostic terminology and the cytomorphologic approach to making a diagnosis and avoiding diagnostic pitfalls.

Extensive Hemorrhage after Ultrasound-guided Fine Needle Aspiration Biopsy of Thyroid Nodules in a Patient with Long-term Aspirin Therapy / 대한내분비외과학회지

Ultrasound-guided fine needle aspiration biopsy (USFNA) is a very useful procedure for the diagnosis and management of thyroid diseases. It is very safe procedure and complications have been rarely reported. We experienced a case of an extensive hemorrhage after USFNA of the thyroid nodule in a patient undergoing long-term aspirin therapy. We emphasize that it is very important to obtain a patient history carefully before performing a USFNA.

Ultrasound Guided Fine Needle Aspiration Biopsy of Abdominal Masses

Ultrasound guided fine needle aspiration biopsy of abdominal masses. Material Methods: 200 patients with abdominal lump were subjected to fine needle aspiration biopsy by a 20-22 G needle and smears prepared were stained with H & E and Papanicolaou stains. Histopathological specimens were processed and stained with H & E stain and a cytohistological correlative study performed. 128 (74%) were females and 72 (36%) were males. 83 cases (41.5%) had a mass in the hepatobiliary region, out of which 53 (63.9%) had a mass in the gall bladder. Malignant lesion constituted the commonest cytologic diagnostic category 115 cases (57.5%). Adenocarcinoma gall bladder was found in 31 cases (37.3%) followed by metastatic adenocarcinoma liver in 12 cases (14.5%) and hepatocellular carcinoma in 8 cases (9.6%). Adenocarcinoma stomach 8 cases (18.6%) was the commonest GI malignancy followed by adenocarcinoma intestine 7 cases (16.3%). Serous cystadenocarcinoma comprised the commonest ovarian cancer, 5 cases (12.5%) followed by mucinous cystadenocarcinoma, 2 cases (5.1%). Overall sensitivity of 94.11%, specificity of 100% and diagnostic accuracy of 95.7% was found in the present cytohistological correlative study.

Childhood Sarcoidosis

A case report of a young child who had presented with erythema nodosum, arthritis, uveitis, segmental lung lesion and was diagnosed as sarcoidosis has been projected, in which the role of fine needle aspiration biopsy has been highlighted.

Carcinoma papilar quístico y del tiroides: Estudio de 4 casos / Tryroid cyst papillary carcinoma: Study of four cases

Se presentaron 4 casos de carcinoma papilar quístico en el período de 4 años. Se realizó examen físico de todos los casos; se encontró una masa cervical firme en la cara anterior del cuello y en 2 de ellos, se palparon adenopatías cervicales. Se aplicaron técnicas de imagen (ecografía cervical y gammagrafía tiroidea); se completó el estudio con BAAF, que tuvo valor diagnóstico en el 75 % de los casos. Se realizó un estudio anatomopatológico de todas las piezas obtenidas. Se hizo la resección del quiste, biopsia intraoperatoria y si se confirmó el diagnóstico de carcinoma papilar quístico, se le realizó una tiroidectomía total y si fue necesario, linfadenectomía. Se completó el tratamiento con I131 a dosis ablativa y tratamiento hormonal supresor de la TSH. Se destacó el papel de la BAAF en el estudio preoperatorio.

4 cases of cyst papillary carcinoma in a period of 4 years were presented. All of them underwent physical examination. A firm cervical mass was found in the anterior side of the neck and cervical adenopathies were palpated in 2 of them. Imaging techniques (cervical echography and thyroid gammagram) were applied. The study was completed with FNAB, which had a diagnostic value in 75 % of the cases. An anatomopathological study of all the pieces obtained was conducted. Resection of the cyst and intraoperatory biopsy were performed. In those cases with confirmed diagnosis of cyst papillary carcinoma, total thyroidectomy was carried out and, if necessary, lymphadenectomy. The treatment was concluded with I131 at ablative doses and TSH -supressing hormonal treatment. The role of FNAB in the preoperative study was stressed.

Implantation Metastasis of Lung Cancer to Chest Wall after Percutaneous Fine-Needle Aspiration Biopsy / 결핵

The implatnation of malignant cells along the needle tract is an extremely rare complication after a percutaneous fine-needle aspiration biopsy(FNAB). However, it is very serious and may result in a change in the prognosis of lung cancer, especially in the curable early stage(T1-2,N0,M0). Recently, we experienced two cases of such complications. A 43 years old female underwent a fine needle aspiration biopsy and a right middle lobectomy with adjuvant chemotherapy due to an adenocarcinoma(T2N0M0). Two years later, a new tumor developed at the site of the needle aspiration biopsy. It had the same pathological findings as the previous lung cancer. Therefore, it was concluded to be an implantation metastasis, and she was treated successfully by a right pneumonectomy and a resection of the chest wall mall with adjuvant radiotherapy. In another case, a 62 years old man was diagnosed with squamous cell lung cancer by a fine needle aspiration biopsy and underwent a right upper lobectomy(T2N0M0) with adjuvant chemotherapy. eight months later, a protruding chest wall mass developed at the aspiration site. It showed the same pathological findings as the previous lung cancer. Consequently, a total excision of the mass with adjuvant radiotherapy was done. Two years after the second operation, although the right lung was intace a metachronous squamous cell lung cancer was found at the left lower lobe. The two patients were still alive 15 and 37 months after thenresection of the chest wall mass, respectively.

The Value of Routine Frozen Section Examination for Intraoperative Diagnosis of Thyroid Nodule / 대한이비인후과학회지

BACKGROUND: The value of routine frozen section examination for intraoperative diagnosis of thyroid cancer and determination of the extent of thyroidectomy is controversial and needs to be evaluated on an institution to institution basis. METHODS: Thyroidectomy with routine frozen section examination was carried out in 109 patients with nodular thyroid disease, who also underwent FNAB. And these patients were retrospectively studied. A direct comparison of the result of FNAB and frozen section examination with permanent pathologic finding was done. RESULT: The pathologic findings showed carcinoma in 32 patients, adenomatous hyperplasia in 57 patients, adenoma in 19 patients and a Hrthle cell adenoma in one patient. The sensitivity, specificity, and accuracy were 86%, 100%, and 97%, respectively, for frozen section examination, and 76%, 100% and 93%, respectively, for FNAR (p> 0.05). CONCLUSION: For patients who have undergone adequate FNAB, frozen section examination rarely affected the intraoperative decision making in thyroid surgery and its routine use proved neither cost effective nor time saving.

Fine Needle Aspiration Biopsy for Metastatic Cervical Lymphadenopathy / 대한암학회지

PURPOSE: This study was intended to evaluate the value of the FNAB in the diagnosis of the suspected metastatic cervical lymphadenopathy. MATERIALS AND METHODS: 221 patients diagnosed as metastatic cervical lymphadenopathy by FNAB from Jan., 1990 to Oct., 1994 were analyzed retrospectively. They represented 92.1% of metstatic cervical lymphadenopathy managed and 15.7% of 1,411 FNAB's performed during the same period. 33 cases with lymphoma were excluded in this study. RESULTS: In 107 patients with cervical lymphadenopathy who also received confirmatory node biopsy, the sensitivity, specificity, positive and negative predictive values of FNAB for the metastatic cervical lymphaenopathy were 79.3%, 100%, 100% and 44.1% respectively. In 76 (33.4%) patients the histopathologic types of the primary cancers were decided by information gained from FNAB alone. There were two kinds of tendency that GI cancers metastasized to left-sided cervical nodes (88.1%) and breast and lung cancers to ipsilateral supraclavicular nodes in high frequencies (94.1% and 86.8%, respectively). No complications were associated with FNAB. CONCLUSION: FNAB is a simple, rapid, inexpensive and highly specific diagnostic tool in the evaluation of suspected metastatic cervical lymphadenopathy. The sensitivity and negative predictive value, however, are relatively low. When the clinical findings strongly suggest metastatic lymphadenopathy, the negative FNAB should be followed by confirmatory biopsy. Information gained from it guides further diagnostic and therapeutic plans. Surrounding normal tissues are not damaged, and the theoretical hazards of local implantation of tumor cells and complication are negligible.