Aspectos actuales del carcinoma bien diferenciado de tiroides / Present-day aspects of Carcinoma well told apart of the thyroid

El carcinoma de tiroides ha aumentado su incidencia en los últimos años. Su diagnóstico rápido y consiguiente tratamiento son necesarios para una mayor sobrevida del paciente. El ultrasonido aun es la prueba diagnóstica de mayor utilidad. La biopsia por aspiración por aguja fina guiada por ultrasonido ha permitido disminuir los falsos negativos, así como incrementar la eficacia y sensibilidad de esta prueba. La cirugía es la mejor opción curativa que tiene la enfermedad, su extensión es aun controversial. El tratamiento en equipo multidisciplinario ha hecho avanzar en ello y optimizar el tiempo de diagnóstico, los métodos, así como el tipo de tratamiento a utilizar(AU)

Thyroidal carcinoma incidence has increased over recent years. Quick diagnosis and arranged treatment are necessary for the patient’s improved survival. Ultrasound continues to be the diagnostic test of greater usefulness. Ultrasound-guided aspiration biopsy has decreases the false-negative results, as well as this test’s efficacy and sensibility have increased. Surgery is the best healing choice against the disease, though its extension is even controversial. Treatment by multidisciplinary teams has prospered it optimized diagnosis time and methods, as well as the type of treatment to use(AU)

Marcadores moleculares en el cáncer de tiroides / Molecular markers for thyroid cancer

La importancia del estudio del nódulo tiroideo es excluir una lesión maligna, ya que, aunque la mayoría son lesiones benignas, existe un riesgo de malignidad de un 5-10 por ciento. La mayoría de estos son carcinomas bien diferenciados, que se originan del epitelio folicular. A pesar de que la mayoría de las lesiones son benignas, la distinción entre estas y los carcinomas, es crucial para un tratamiento y seguimiento apropiado. La biopsia por punción con aguja fina permite realizar el diagnóstico en la mayoría de los casos, sin embargo, esta presenta limitaciones, particularmente referidas al diagnóstico de las lesiones foliculares. En un esfuerzo por mejorar la precisión diagnóstica de la biopsia y ofrecer nuevos criterios para el diagnóstico, múltiples marcadores moleculares han sido propuestos, algunos de los cuales presentan gran aprobación, mientras que otros requieren aún validación para su implementación. En este artículo se realiza una revisión actualizada de los marcadores moleculares que presentan mayor número de evidencias, los que son metodológicamente más asequibles y potencialmente utilizables para el diagnóstico prequirúrgico del nódulo tiroideo(AU)

The importance of the study of the thyroid nodule lies in excluding the possibility of a malignant lesion because the majority of lesions are benign but there is a malignancy risk of 5 to 10 percent. Most of them are well differentiated carcinomas originating in the follicular epithelium. In spite of the fact that the majority are benign lesions, distinguishing them from carcinomas is crucial to treatment and adequate follow-up. Fine-needle biopsy allows making the diagnosis in most of cases. However, this method is restricted, particularly when diagnosing follicular lesions. In an effort to improve the diagnostic accuracy of biopsy and to provide new diagnosing criteria, a number of molecular markers have been put forward, some of which has wide range of approval whereas others still awaits to be validated for further implementation. This article presented an updated review of molecular markers with higher number of evidence, more accessible and potentially usable from a methodological viewpoint for diagnosis of the thyroid nodule before surgery(AU)

Linfoma no Hodgkin suprarrenal primario / Primary Non Hodgkin´s Lymphoma of the Adrenal Gland

El linfoma no Hodgkin primario de la glándula suprarrenal es una patología muy poco común. Su diagnóstico inicial es difícil siendo este histológico. El linfoma B difuso de células grandes es el tipo histológico más frecuente. Se presenta el caso mujer de 62 años a la que se le realiza tomografía axial computarizada abdominal que muestra una masa de 18 cms dependiente de la glándula suprarrenal y con características de carcinoma. Se realiza exéresis de la tumoración, siendo la anatomía patológica linfoma difuso de célula grande B. Este tipo de linfoma tiene mal pronóstico describiéndose supervivencias medias en torno a los 13 meses. No existe un régimen terapéutico bien definido; aunque el tratamiento más aceptado es el esquema R-CHOP. El papel de la radioterapia y de la exéresis tumoral no está claramente establecido. El linfoma suprarrenal primario debe tenerse en cuenta en el diagnóstico diferencial de pacientes que presentan una masa suprarrenal. Ante la sospecha de esta patología es preferible realizar una biopsia con aguja guiada por prueba de imagen para evitar una intervención quirúrgica innecesaria(AU)

Primary non- Hodgkin`s lymphoma of the adrenal gland is very rare. Its initial diagnosis is difficult and needs to be histological. Diffuse large B- cell lymphoma is the most common histological type. This is the report of a 62 years old woman, who was performed abdominal tomography to disclose a 18 cm tumor in the adrenal gland with carcinoma characteristics. The tumor was removed and the final pathologic diagnosis was diffuse large B-cell lymphoma. This type of lymphoma has poor prognosis since the average survival rates are roughly 13 months. There is no well-defined therapeutic regimen, although the most widely accepted treatment is R-CHOP scheme. The roles of radiotherapy and tumor resection are not clearly established. Primary adrenal lymphoma should be considered in the differential diagnosis of patients presenting with an adrenal mass. When this condition is suspected, then it is advisable to perform a imaging-guided needle biopsy to avoid unnecessary surgery(AU)

Enfoque terapéutico de algunas enfermedades del tiroides en Pediatría / Therapeutic approach to some thyroid diseases in pediatrics

Las enfermedades del tiroides ocupan un lugar importante, por su frecuencia y variedad, entre las afecciones endocrinas del niño y el adolescente, y aunque puedan padecer las mismas enfermedades tiroideas del adulto, presentan afecciones específicas de la edad, cuyo diagnóstico y tratamiento adecuado puede prevenir los efectos devastadores e irreversibles que estas pueden producir. Se presenta, con interés de actualizar y establecer consenso, el enfoque terapéutico de algunas tiroidopatías de la infancia, en orden de importancia y frecuencia, como es el nódulo de tiroides, el bocio y el hipertiroidismo(AU)

Thyroid diseases hold an important place because of their frequency and variety in the endocrine diseases affecting the child and the adolescent. Although both can suffer the same thyroid diseases as the adults, there are specific illnesses of the age, the diagnosis and treatment of which may prevent the devastating and irreversible effects that they can bring. For the purpose of updating information and reaching a consensus, this paper presented the therapeutic approach to some thyroid diseases of the childhood by order of importance and frequency, such as the thyroid nodule, the goiter and the hyperthyroidism(AU)

Biópsia aspirativa transtorácica por agulha fina guiada por TC de lesões pulmonares: resultados e complicações / Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

OBJETIVO: Analisar os resultados citológicos de biópsias aspirativas percutâneas por agulha fina guiada por TC de pulmão, demonstrar a viabilidade diagnóstica do método na investigação de lesões pulmonares e determinar as complicações do procedimento, avaliando sua segurança. MÉTODOS: Análise retrospectiva com 89 pacientes com tipos diversos de lesões pulmonares que foram submetidos a 97 procedimentos em um período de cinco anos. Os pacientes foram divididos em grupos de acordo com a indicação para o procedimento: suspeita de neoplasia pulmonar primária (estádios IIIB e IV); suspeita de neoplasia pulmonar (estádios I, II e IIIA) e contraindicações clínicas para cirurgia; suspeita de metástase pulmonar oriunda de outros órgãos; e lesões pulmonares com aspecto radiológico benigno. O método foi padronizado com agulha fina de 25 gauge. Todos os procedimentos foram guiados por TC helicoidal. O diagnóstico final foi confirmado por biópsias cirúrgicas e acompanhamento clínico/oncológico. Para a análise das complicações, foi considerado o número total de procedimentos. RESULTADOS: A principal indicação do procedimento foi a suspeita de neoplasia pulmonar primária avançada. O método apresentou acurácia de 91,5 por cento para lesões malignas. A lesão foi confirmada como neoplásica em 73 por cento dos pacientes. A principal complicação foi o pneumotórax (27,8 por cento), com necessidade de drenagem tubular em 12,4 por cento do total de procedimentos. CONCLUSÕES: A principal indicação para biópsia por agulha fina guiada por TC foi a suspeita de doença neoplásica pulmonar primária sem possibilidade de tratamento cirúrgico. O procedimento tem alta viabilidade diagnóstica para doenças pulmonares de origem neoplásica. A mais prevalente complicação foi o pneumotórax, sem necessidade de drenagem tubular na maioria dos casos. Não ocorreram óbitos relacionados ao procedimento.

OBJECTIVE: To analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. METHODS: A retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. RESULTS: The main indication for the procedure was suspicion of advanced-stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5 percent. The lesion was confirmed as cancer in 73 percent of the patients. The major complication was pneumothorax (27.8 percent), which required chest tube drainage in 12.4 percent of the procedures. CONCLUSIONS: The principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure.

Percutaneous interventional procedures in an era of liver transplantation / 대한간학회지

No abstract available.

Treatment and clinical outcome of needle-track seeding from hepatocellular carcinoma / 대한간학회지

BACKGROUND/AIMS: Needle-track seeding is a rare but important complication of diagnostic and therapeutic ultrasound (US)-guided procedures in hepatocellular carcinoma (HCC). We examined the frequency of needle-track seeding after US-guided percutaneous ethanol injection (PEI), fine-needle aspiration biopsy (FNAB), and percutaneous transhepatic biliary drainage (PTBD) in order to determine the appropriate treatment for needle-track seeding and its clinical outcome. METHODS: We analyzed the clinical characteristics and treatment outcomes in eight patients who experienced needle-track seeding from HCC after an US-guided procedure (FNAB, PEI, or PTBD) between January 1990 and July 2004. RESULTS: Seven (0.14%) of 5,092 patients who experienced needle-track seeding (2 after PEI, 4 after FNAB, and 1 after PTBD) during the study period and 1 other patient who experienced needle-track seeding recently were recruited for this study. Two of the eight patients underwent mass excision and the other six patients underwent en-bloc wide excision for the needle-track seeding. Tumors recurred in the needle-tracks in both patients who underwent mass excision but not in the six patients who underwent en-bloc wide excision. Mortality occurred in three patients who experienced the recurrence and progression of intrahepatic HCC. CONCLUSIONS: The incidence of needle-track seeding after US-guided procedures in HCC was 0.14%. En-bloc wide excision seems to be the optimal treatment for minimizing the probability of tumor recurrence due to needle-track seeding.

Punção aspirativa por agulha fina como método de coleta de material para a histopatologia no osteossarcoma canino / Fine-needle aspiration cytology as a sampling method for histopathology incanine osteosarcoma

Para a obtenção do diagnóstico definitivo do osteossarcoma realizam-se exames citopatológico e histopatológico. O material para exame citopatológico é coletado através de punção aspirativa por agulha fina (PAAF), já para a realização do exame histopatológico é necessário uma amostra de tamanho maior, geralmente conseguida através de biópsia incisional. Este trabalho tem como objetivo desenvolver uma técnica de coleta de material em cães com suspeita de osteossarcoma através de PAAF para a realização de exame histopatológico. Foram coletadas duas amostras de 12 cães suspeitos de osteossarcoma por PAAF. O material obtido pela primeira coleta foi utilizado para confirmar o diagnóstico através do exame citopatológico, enquanto que o material oriundo da segunda coleta foi fixado em formol a 10 por cento para a análise histopatológica. Quatro das 12 amostras (33,3 por cento) avaliadas histopatologicamente pela metodologia proposta obtiveram também o diagnóstico de osteossarcoma. Esses resultados apontam para uma possível adequação da técnica de coleta de material por PAAF para exame histopatológico.

Cytopathologic and histopathologic tests are important to obtain a definitive diagnosis of osteosarcoma. The sample for cytopathological exam is collected through fine-needle aspiration cytology (FNA). On the other hand, histopathological exams need a larger sample that is usually obtained by incisional biopsy. The objective of this article is to develop a FNA technique to biopsy and evaluate histopatologically samples of dogs with suspected osteosarcoma. Two FNS samples were collected from 12 such dogs. Samples obtained in the first procedure were examined cytologically. The material sampled at the second biopsy was fixed in 10 percent formalin and submitted to histopathological analysis. Four out of the 12 samples (33.3 percent) examined by the herein proposed method were diagnosed as osteosarcoma. These results indicate a possible adaptation of FNA for histopathological examination.

Predictive complication factors for ct-guided fine needle aspiration biopsy of pulmonary lesions

OBJECTIVE: Distinct aspects can influence the complication rates of computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions. The purpose of the current study is to determine the influence of radiological techniques and clinical characteristics in predicting complications from this procedure. SUBJECTS AND METHODS: A retrospective study was developed involving 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions between July 1996 and June 2004, using 22-gauge needles (CHIBA). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, co-morbidities, and aspects concerning the procedure were studied. RESULTS: The diameters of the lung lesions varied from 9 to 140 mm, with a mean of 51.5 ± 24.3 mm and median of 40mm. The depth of the lesions varied from 10 mm to 130 mm, with a mean of 44 ± 20.9mm, and median median of 52 mm. Complications occurred in 52 (14.4 percent) cases, pneumothorax being the most frequent, with 40 (11.1 percent) cases, followed by hemoptisis with 7 (1.9 percent) cases, and hematoma with 4 (1.1 percent) cases. Lesions that did not contact the pleura, with normal pulmonary tissue interposition between lesion and pleura, had higher complication rates, with 22 (22 percent) cases, than lesions that contact the pleura, with 6 (9 percent) cases, with a statistically significant difference (p = 0.03). CONCLUSIONS: CT-guided percutaneous fine needle aspiration biopsy of lung lesions had a lower rate of complications in our study and presented more rates of complications on lesions that lack pleural contact.

CT guided transthoracic Needle Aspiration biopsy; effect of size of the lesion on the rate of pneumothorax

To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, and correlating it with the size of the lesion. Descriptive study. Department of Radiology Mayo Hospital, Lahore. From June 2002 to April 2003, Seventy patients underwent CT guided FNA of the chest masses. Out of Seventy, 18 patients i.e.; 26% developed Pneumothorax. Lesion less than 1 cm, out of 6 patients 3 developed pneumothorax [50%], lesions 1-2 cm 5 out of 11 developed pneumothorax [45%], lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax [35%], lesions between 3-4 cm 2 out of 8 developed pneumothorax [25%], lesion sized 4-5 cm 1 out of 15 developed pneumothorax [6%], and lesion with more than 5 cm size 1 out of 16 developed pneumothorax [6%]. The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses increases as the size of the lesion decreases

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

OBJECTIVE: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. MATERIALS AND METHODS: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). RESULTS: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). CONCLUSION: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.

Computed tomography guided percutaneous transthoracic fine needle aspiration cytology in chest masses.

A retrospective, hospital based descriptive study was done to know the pathological spectrum of thoracic lesions and to correlate the radiological findings with cytological findings obtained from computed tomography guided percutaneous transthoracic fine needle aspiration of chest mass. The clinical, radiological and cytological data of 100 patients were studied who underwent CT guided FNAC from May, 2004 to May, 2007. Diagnostic accuracy of FNAC is 82%. Cytological examination showed that 51 cases were malignant and 31 cases were benign. Provisional diagnosis based on radiological findings were 50 and 32 cases of malignant and benign lesions respectively. Sensitivity and specificity, positive and negative predictive value of radiological findings in this study was 88%, 84%, 90% and 81% respectively. Post procedure complication were (a) pneumothorax in two cases and both the cases had to be hospitalized for active management (b) minimal perilesional hemorrhage and hemoptysis in three cases and (c) chest pain in six cases. CT guided FNAC is a simple and safe procedure with high diagnostic accuracy in the evaluation of focal chest lesions. Pneumothorax, perilesional hemorrhage, hemoptysis and chest pain are the usually encountered complications. Very few cases of complication require active management.

Experience of endoscopic ultrasound-guided fine needle aspiration in a regional teaching hospital.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was first reported in 1991 and 1992 for gastric submucosal tumor and pancreas cancer. Subsequently, the indications have expanded to mediastinal lesions, liver, spleen, adrenal gland, ascites, pleural effusion, intra-abdominal lymph nodes. We report our experience of EUS-FNA and the number of cases required during the learning curve. From May 2005 to December 2007, we did a retrospective analysis of 45 cases (median age: 68 [range] [37-87] years; 34 men and 11 women) of EUS-FNA punctures on solid masses. EUS-FNA was performed with linear echoendoscope (Olympus GF-UCT2000, EUC2000 unit) using 22 gauge needles (Olympus power-shot needle and Wilson Cook echo-tip needle). The procedure was done by a single endoscopist. Patients were divided into 2 groups, the first 30 patients (group A) and the last 15 patients (group B). The median size of tumor was 2.6 cm (range: 1-14 cm) in group A and 2 cm (range: 0.7-3.5 cm) in group B (p=0.023). The median number of punctures was the same in both groups, i.e. 2 (range: 1-4). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy in groups A and B were 55.1% vs. 85.7%, 100% vs. 100% 100% vs. 100%, 7.1% vs. 33.3%, 56.6% vs. 86.6% respectively. Group B patients had smaller tumor size, but with higher sensitivity and accuracy rates. Only one patient in group A needed 4 units of blood transfusion. EUS-FNA is a safe intervention; the sensitivity and accuracy rate can be improved after a learning curve of 30 cases.

Tissue effects of fine needle aspiration on salivary gland tumours.

Fine needle aspiration cytology (FNAC) is a widely used diagnostic procedure to evaluate lesions in the salivary glands. Though regarded as a safe and reliable procedure ,a variety of histological changes following FNAC have been reported. We studied the FNAC related tissue changes in 50 neoplasms of the salivary gland and the impact on subsequent histological evaluation. FNAC induced changes were found in 34% (17/50) with needle tract (10/50)and infarction (7/50) as the commonest changes .These changes did not interfere with the subsequent histological evaluation of the tumours. We conclude that knowledge of a previous FNAC and awareness of its effects on histology may avoid potential misdiagnosis, though the incidence of significant changes is small.

Per-cutaneous needle biopsy of intrathoracic masses [retrospect analysis of 38 cases]

The value of per-cutaneous needle biopsy [PCNB] either blind [B-PCNB] or CT guided [CTG-PCNB] in diagnosing intrathoracic masses is well established. It is one of the less invasive techniques used in the diagnosis of intrathoracic masses. In appropriate cases, per-cutaneous needle biopsy remains the method of choice as it is done under local anaeshesia and usually takes few minutes to perform. Blind biopsy If the cases are carefully selected has a diagnostic accuracy which is very close to CT guided biopsy with obvious money and time saving and with no exposure to radiation. In this retrospective study we report the high accuracy of blind needle biopsy compared to a smaller sample of CT guided biopsy. We report the low incidence of complications and report the frequency of various pathologies found. Positive diagnosis could be established in [88.8 percent and 82 percent] of patients of both groups respectively