Tratamiento quirúrgico de las neoplasias en la glándula parótida / Surgical treatment of the neoplasmsof the parotid gland

Objetivo: Caracterizar a pacientes con diagnóstico de neoplasias en glándula parótida, según el procedimiento quirúrgico efectuado, la técnica de identificación del nervio facial, y la relación de los hallazgos patológicos definitivos con los estudios de muestreo histológico preoperatorio. Métodos: Estudio multidisciplinario, multiinstitucional, descriptivo, cuantitativo y retrospectivo de 26 pacientes con diagnóstico de neoplasias en glándula parótida entre el año 2018 al 2023. Se dividieron de acuerdo a la histología en benignas y malignas. Las distintas frecuencias fueron expresadas en número y porcentaje. Se calculó la sensibilidad y especificidad de la punción con aguja fina como prueba de muestreo histológico. Resultados: Categoría benigna: 16 pacientes (61,5% %). El resto de la serie, diez pacientes, de la categoría de tumores malignos (38,5%). La lobectomía superficial parotídea fue el procedimiento más frecuente en las neoplasias benignas (75%) y malignas (60%). La técnica anterógrada de identificación del nervio facial fue la más común. Entre 25% a 30% de parálisis temporales en ambos grupos. La sensibilidad y especificidad de la punción con aguja fina para el diagnóstico de neoplasias benignas fue de 92,3% y 50%, el porcentaje de falsos negativos de 5,8%. Conclusión: La lobectomía superficial de la glándula parótida y la técnica anterógrada representaron el procedimiento quirúrgico y la técnica de identificación del nervio facial más frecuentemente realizado en ambas categorías. La baja especificidad de la punción con aguja fina y el porcentaje de falsos negativos representaron algunas de las dificultades a afrontar para decidir la extensión del tratamiento quirúrgico(AU)

Objective: To evaluate the surgical procedure, technique identification of nerve facial and correlate the pathological findings withthe preoperative histological sampling studies, in patients with neoplasms parotid underwent surgery. Methods: Study multi-institutiona, multi-disciplinary, descriptive y quantitative of 26 patients with neoplasm parotid between the years 2018 to 2023. We divided in two categories benign and malignant. The frequency was expressed in number and percentage. It was calculated the sensibility and specificity of the fine needle puncture. Results: Category benign: 16 patients (61,5% %). Malignant, ten patients (38,5%). The lobectomy superficial was the surgical procedure more frequent in the neoplasm benign (75%) and malignant (60%). The anterograde technique of identification of nerve facial was the more common. Between 25% and 30% presents facial palsytemporal. The sensibility and specificity of the fine needle puncture were 92,3% y 50%, the percentage of false negatives was 5,8%. Conclusion: In this study the lobectomy superficial and anterograde technique were the surgical procedure and technique of identification of nerve facial more frequent in both categories. The low specificity of fine needle puncture and the percentage of false negatives were some of the difficulties to affront in the decision of the surgery exten(AU)

Beyond the Recommendations of the Clinical Guidelines for Medullary Thyroid Cancer - A Case Report / Más allá de las recomendaciones de las guías clínicas de cáncer medular de tiroides - a propósito de un caso

Medullary thyroid cancer (MTC) is a rare disease from parafollicular C cells. Calcitonin has been suggested as a screening; its levels are proportional to the tumor size and predictive of metastatic disease. We present a case where an early action was taken with lower cut-off points. Male patient, 49 years old. Thyroid ultrasound (US) with a suspicious nodule. Fine Needle Aspiration Biopsy (FNAB) suggests MTC, with pre-operative serum calcitonin (CTN) of 591 pg/mL. Total thyroidectomy with central and bilateral dissection was performed. Biopsy: MTC in left nodule of 26 mm without lymph nodes (LN) metastases. Follow-up with undetectable CTN for six years. After that, CT was 4.7 pg/mL, and carcinoembryonic antigen (CEA) was 1.2 ng/mL. Neck US showed bilateral LN. FNAB of LN does not show recurrence. A progressive rise of markers with doubling time of CTN and CEA was 16 and 51.3 months, respectively. CTN raised until 112 pg/mL. Given the lack of cervical compromise, a neck and lung CT, liver MRI, and bone scintigraphy were ordered despite CTN levels < 150 pg/mL. MRI showed hypervascular hepatic lesions, contrasted with gadoxetic acid. PET Ga68-DOTATATE showed lesions with overexpression of somatostatin receptors in the liver. Surgery was done, and a biopsy confirmed metastases. Conclusions: The clinical guidelines may allow the management of cases; however, they should be used considering each case context. In our patient, if the guidelines had been strictly followed, it would not have been possible to detect liver metastases to achieve a surgical resection with curative intent.

Paciente masculino, 49 años. Ecografía tiroidea con nódulo sospechoso. Biopsia por aspiración con aguja fina (PAAF) sugiere cáncer medular de tiroides (CMT), calcitonina sérica preoperatoria (CTN) de 591 pg/mL. Se realizó tiroidectomía total con disección central y bilateral. Biopsia: CMT en nódulo tiroideo izquierdo de 2,6 cm sin metástasis en 29 ganglios linfáticos (GL). En el seguimiento, CTN sérica indetectable durante 6 años. Posteriormente CTN sérica de 4,7 pg/mL y antígeno carcinoembrionario (CEA) de 1,2 ng/mL. Ecografía cervical de control mostró GL subcentimétricos bilaterales en grupo IV. PAAF de GL sin evidencia de malignidad, con niveles de CTN indetectables en la muestra. El doblaje de CTN y CEA fue 16 y 51,3 meses respectivamente. Dado ausencia de compromiso cervical, se solicitó TC de cuello y tórax, RM hepática y gammagrafía ósea, a pesar de no presentar niveles de CTN > 150 pg/mL. La RM mostró 3 lesiones hepáticas hipervasculares; se complementa con un PET Ga-DOTATATE que mostró 2 lesiones focales con sobreexposición de receptores de somatostatina en el parénquima hepático, con SUVmáx de 6,8 y 7,3. Se realiza cirugía extirpando 5 lesiones; la biopsia confirmó metástasis de CMT. Conclusiones: Las guías clínicas pueden dar orientaciones generales y permitir el manejo de casos basados en la evidencia; sin embargo, siempre deben usarse considerando el contexto de cada caso en particular. Si se hubieran seguido estrictamente las pautas, no habría sido posible detectar las metástasis hepáticas dentro de la ventana de oportunidad para lograr una resección quirúrgica con intención curativa.

Hidatidosis subcutánea primaria / Primary subcutaneous hydatid disease: a case report

La hidatidosis o equinococosis quística es una zoonosis parasitaria endémica causada por el estadio larvario del cestode Echinococcus granulosus. El hígado y el pulmón son los órganos con afección más frecuente. Su ubicación subcutánea es una entidad rara, poco descrita, y por ende un reto diagnóstico. Describimos el caso de una mujer, de 18 años de edad, procedente de un área endémica, que presentó un quiste hidatídico primario supraclavicular.

Hydatid disease or cystic echinococcosis is an endemic parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus, the liver and lung being the most frequently affected organs. Its subcutaneous location is a rare entity, little described, and therefore a diagnostic challenge. We describe the case of an 18-year-old woman from an endemic area who presented with a primary supraclavicular hydatid cyst.

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.

Association of clinicodemographic factors and tissue biopsy results among patients with thyroid nodules at the Southern Philippines Medical Center

Objective@#To compare selected clinicodemographic factors of patients with thyroid nodules who underwent thyroid surgeries with their tissue biopsy results and determine any association between clinicodemographic factors and tissue biopsy results.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Government Training Hospital. Participants: 251 patients with thyroid nodules.@*Results@#Of 251 patients with thyroid nodules, the majority (218; 86.9%) were females while 33 (13.1%) were males. The average age in years was 41.5±13.3 The same population also had malignant outcomes at 79.3%. Most of the patients did not have family history of thyroid malignancy (54%) and had no palpable cervical lymph nodes at presentation (75.9%). Furthermore, there was no distant metastasis at presentation for both lungs (97.7%) and bones (98.9%). There were no significant differences in tissue biopsy results when correlated with age (df=249; t=-.144; p = .886), duration of goiter (df=249; t=-.829; p = .408), and distant metastasis at presentation for lungs (Z=-5.977; p = .052) and bones (Z=-.457; p = .648). Significant differences were only evident for clinicodemographic factors such as sex (Z=-2.570; p = .010), family history (Z=-2.239; p = .020), palpable cervical lymph nodes at presentation (Z=-5.977; p = .000), and the following comorbidities: pulmonary tuberculosis (Z=-2.388; p = .017) and bronchial asthma (Z=-2.148; p = .032) and smoking history (Z=-3.455; p=.001). Furthermore, having no palpable cervical lymph nodes at presentation were associated with malignant tissue biopsy results (B=3.616; p=.001). Patients without palpable cervical lymph nodes at presentation were 37.204 times [OR=37.204] more likely to have benign biopsy results [95% CI: 4.705 – 294.168].@*Conclusion@#There are greater odds of having benign biopsy results for patients without palpable cervical lymph nodes at presentation.

Diagnostic values of nuclear score combined with cyclin D1 immunocytochemistry in indeterminate thyroid follicular nodules in preoperative fine needle aspiration / 中华病理学杂志

Objective: To assess the feasibility of nuclear score combined with cyclin D1 immunocytochemistry in classifying indeterminate thyroid nodules with fine-needle aspiration (FNA) cytological diagnosis of Bethesda category Ⅲ-Ⅴ. Methods: A consecutive cohort of 118 thyroid FNA specimens with indeterminate diagnosis (TBSRTC category Ⅲ-Ⅴ) and available histopathologic follow-up data were collected between December 2018 and April 2022 at the Department of Pathology, Beijing Hospital, China. These cases were subjected to cytological evaluation and cyclin D1 immunocytochemistry. The optimal cut-off points of a simplified nuclear score and the percentage of cyclin D1-positive cells for the diagnosis of malignancy or low-risk neoplasm were determined using the receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of nuclear score and cyclin D1 immunostaining were evaluated from the crosstabs based on cut-off points. The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining was estimated using ROC curve analysis. Results: Nuclear grooves, intra-nuclear inclusions and chromatin clearing were more commonly found in malignancy/low-risk neoplasms than benign lesions (P=0.001, P=0.012 and P=0.001 respectively). A cut-off point of≥2 for the simplified nuclear score was sensitive for defining malignancy/low-risk neoplasm, and its PPV, NPV, sensitivity and specificity were 93.6%, 87.5%, 99.0% and 50.0% respectively. A positive cut-off point of 10% positive thyroid cells in cyclin D1 immunostaining demonstrated sensitivity of 88.5%, specificity of 100%, PPV of 100% and NPV of 53.8% for correctly detecting thyroid malignancy or low-risk neoplasm. The sensitivity and PPV of simplified nuclear score combined with cyclin D1 immunostaining were 93.3% and 100%, respectively. Both specificity and NPV were maintained at high levels (100% and 66.7%, respectively). The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining in detecting thyroid malignancy/low-risk neoplasm was increased to 94.1% compared to using either of them alone. Conclusions: Combing simplified nuclear score and cyclin D1 immunostaining on FNA cytology specimens can increase the diagnostic accuracy in classifying thyroid nodules of indeterminate cytological categories. Thus, this supplementary approach provides a simple, accurate, and convenient diagnostic method for cytopathologists so that may reduce unnecessary thyroidectomies.

Influencing Factors and Prediction Model of Performance of Needle Visualization in Fine Needle Aspiration of Thyroid Nodules / 中国医学科学院学报

Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules. Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction. Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P<0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI=0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation. Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.

Influencing Factors of Bethesda Ⅲ Results in Fine-Needle Aspiration Biopsy of Thyroid Nodules / 中国医学科学院学报

Objective To investigate the influencing factors of Bethesda Ⅲ results in fine-needle aspiration biopsy of thyroid nodules.Methods A total of 300 thyroid nodules with cytological diagnosis results were analyzed retrospectively,including 100 Bethesda Ⅲ nodules and 50 nodules of Bethesda Ⅱ,Ⅳ,Ⅴ,and Ⅵ categories,respectively.Univariate analysis and Logistic regression analysis were performed on the clinical data of patients and the ultrasound signs of thyroid nodules to clarify the factors influencing the diagnosis of Bethesda Ⅲ nodules.Results Univariate analysis showed that Bethesda Ⅲ nodules were mostly adjacent to the capsule(P<0.001),with no blood flow in the color Doppler assessment(P=0.011)and lack of blood supply(P=0.033)and maximum diameter ≤0.9 cm(P=0.038)as revealed by the contrast-enhanced ultrasound.Logistic regression showed that the position close to the capsule(OR=5.110,95%CI=2.153-12.130,P<0.001)and color Doppler without blood flow signal(OR=3.015,95%CI=1.094-8.311,P=0.033)were independent risk factors for the diagnosis of Bethesda Ⅲ nodules.Conclusions The puncture difficulty caused by the dangerous position of thyroid nodules close to the capsule and the aspiration difficulty caused by the absence of blood flow signal in color Doppler are the main factors influencing the diagnosis of Bethesda Ⅲ nodules.Therefore,corresponding avoidance measures should be taken during the aspiration process to reduce the diagnosis results of Bethesda Ⅲ nodules.

Asociación entre el diagnóstico de carcinoma mamario y la actividad de la enzima lactoperoxidasa sérica / Association between the diagnosis of mammary carcinoma and serum lactoperoxidase enzyme activity

Fundamento: La enzima lactoperoxidasa tiocianato es una proteína producida por células epiteliales en los acinos mamarios. Los carcinomas de la mama constituyen un tipo de cáncer que se origina por la transformación maligna de las células acinares de la mama y se caracterizan por el crecimiento y multiplicación descontrolado. Por tanto, podría existir una correlación entre el cáncer de mama y el aumento de la actividad sérica de la lactoperoxidasa. Objetivo: Determinar la asociación entre el diagnóstico de carcinoma mamario y la actividad aumentada de la enzima lactoperoxidasa sérica en muestras de pacientes que han sido atendidos en el Hospital Oncológico María Curie de Camagüey en el periodo de abril a agosto del 2022. Métodos: Se desarrolló un estudio correlacional en el Centro de Inmunología y Productos Biológicos de Camagüey, en el período de abril a agosto del 2022. Se empleó la citología por aspiración con aguja fina para el diagnóstico histopatológico del carcinoma mamario y se determinó la actividad de la enzima lactoperoxidasa sérica mediante el método del pirogalol salicilato. Se emplearon las pruebas t de student y chi-cuadrado para el análisis estadístico de los datos. Resultados: El carcinoma ductal infiltrante fue el subtipo de cáncer más frecuente con un 94,1 por ciento del total de las muestras. Se encontraron diferencias significativas entre los grupos de muestras analizadas p ( 0.000. De un total de 34 muestras positivas, 32 presentaron aumento de la actividad enzimática. Conclusiones: Hubo asociación entre el diagnóstico de carcinoma mamario y niveles aumentados de la enzima lactoperoxidasa sérica(AU)

Background: The enzyme lactoperoxidase thiocyanate is a protein produced by epithelial cells in the mammary acini. Breast carcinomas are a type of cancer that originates from the malignant transformation of the acinar cells of the breast and are characterized by uncontrolled growth and multiplication. Therefore, there could be a correlation between breast cancer and increased serum lactoperoxidase activity. Objective: To determine the association between the diagnosis of mammary carcinoma and the increased activity of the serum lactoperoxidase enzyme in samples of patients who have been treated at the Maria Curie Oncology Hospital in Camagüey from April to August 2022. Methods: A correlational study was developed at the Center for Immunology and Biological Products of Camagüey, from April to August 2022. Fine-needle aspiration cytology was used for the histopathological diagnosis of mammary carcinoma and the activity of serum lactoperoxidase enzyme by the pyrogallol salicylate method. Student's t and chi-square tests were used in the statistical analysis of the data. Results: Infiltrating ductal carcinoma was the most frequent subtype of cancer with 94,1 percent of the total samples. Significant differences were found between the groups of samples analyzed p ( 0,000. Of a total of 34 positive samples, 32 showed increased enzyme activity. Conclusions: There was an association between the diagnosis of mammary carcinoma and increased levels of the serum lactoperoxidase enzyme(AU)

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo en un centro universitario (Hospital de Clínicas) de Uruguay, diez años de experiencia / Performance of the Bethesda SYSTEM in the cytopathological diagnosis of the thyroid nodule in a university center (Hospital de Clínicas) in Uruguay, ten years of experience / Desempenho do sistema Bethesda no diagnóstico citopatológico de nódulos tireoidianos em um centro universitário (Hospital de Clínicas) no Uruguai, dez anos de experiencia

Resumen: Introducción: el estudio citológico por punción ecoguiada se caracteriza por ser rápido, confiable, mínimamente invasivo y rentable. Permite reducir procedimientos quirúrgicos innecesarios y clasifica apropiadamente a los pacientes con nódulos sospechosos o malignos para una intervención quirúrgica oportuna. Objetivo: el objetivo del presente estudio es evaluar la correlación citológica-anatomopatológica del sistema Bethesda en un centro universitario (Hospital de Clínicas) de Uruguay. Metodología: se realizó un estudio de tipo observacional, retrospectivo, descriptivo, basado el análisis de historias clínicas de pacientes sometidos a cirugía tiroidea en el Hospital de Clínicas, en el período comprendido entre enero de 2008 y diciembre de 2018. Resultados: del total inicial de 119 pacientes, 93 cumplieron los criterios de inclusión. El rango de edad de la muestra fue entre 15 y 79 años. Del total de puncionados 49,5% (46) fueron informados como benignos y 50,5% (47) como malignos. Se calculó en forma global una sensibilidad de 96% (0,96) con IC 1,0-0,90, especificidad de 98% (0,97) con IC 1,0-0,93, un VPP de 98% y VPN de 96%. La sensibilidad diagnóstica para la categoría IV, V y VI fue de 96%, con una especificidad de 100, 94 y 100% respectivamente. Conclusiones: el sistema Bethesda aplicado a las PAAF de nódulos tiroideos potencia la certeza diagnóstica y asiste en la decisión terapéutica. En nuestra institución contamos con una buena correlación citopatológica, similar a otros trabajos reportados en la literatura, lo que permite predecir adecuadamente el riesgo de malignidad y facilitar la toma de decisiones.

Summary: Introduction: the ultrasound-guided fine needle aspiration biopsy (FNAB) study is characterized by being fast, reliable, minimally invasive, and cost-effective. It reduces unnecessary surgical procedures and appropriately classifies patients with suspicious or malignant nodules for timely surgical intervention. Objective: the objective of this study is to evaluate the cytological-pathological correlation of the Bethesda System in a university center (Hospital de Clínicas) in Uruguay. Methodology: an observational, retrospective, descriptive study was carried out, based on the analysis of medical records of patients undergoing thyroid surgery at the Hospital de Clínicas, in the period between January 2008 and December 2018. Results: of the initial total of 119 patients, 93 met the inclusion criteria. The age range of the sample was between 15 and 79 years. Of the total of punctured, 49.5% (46) were reported as benign and 50.5% (47) as malignant. A sensitivity of 96% (0.96) with CI 1.0-0.90, specificity of 98% (0.97) with CI 1.0-0.93, a PPV of 98% and NPV of 96%. The diagnostic sensitivity for categories IV, V and VI was 96% with a specificity of 100, 94 and 100% respectively. Conclusions: the Bethesda system applied to FNA of thyroid nodules enhances diagnostic certainty and assists in the therapeutic decision. In our institution we have a good cytopathological correlation, similar to other works reported in the literature. This makes it possible to adequately predict the risk of malignancy and facilitate decision-making.

Resumo: Introdução: o estudo citológico por punção guiada por ultrassom caracteriza-se por ser rápido, confiável, minimamente invasivo e de baixo custo. Permite reduzir procedimentos cirúrgicos desnecessários e classificar adequadamente pacientes com nódulos suspeitos ou malignos para intervenção cirúrgica oportuna. Objetivo: avaliar a correlação citológico-patológica do Sistema Bethesda em um centro universitário (Hospital de Clínicas) no Uruguai. Metodologia: foi realizado um estudo observacional, retrospectivo, descritivo, baseado na análise de prontuários de pacientes submetidos à cirurgia de tireoide no Hospital de Clínicas, no período janeiro de 2008-dezembro de 2018. Resultados: do total inicial de 119 pacientes, 93 preencheram os critérios de inclusão. A faixa etária da amostra foi entre 15 e 79 anos. Do total de punções, 49,5% (46) foram relatadas como benignas e 50,5% (47) como malignas. No geral, uma sensibilidade de 96% (0,96) com IC 1,0-0,90, uma especificidade de 98% (0,97) com IC 1,0-0,93, um VPP de 98% e VPN de 96%. A sensibilidade diagnóstica para as categorias IV, V e VI foi de 96% com especificidade de 100, 94 e 100%, respectivamente. Conclusões: o sistema Bethesda aplicado à PAAF de nódulos tireoidianos aumenta a certeza diagnóstica e auxilia na decisão terapêutica. Em nossa instituição temos uma boa correlação citopatológica, semelhante a outros trabalhos relatados na literatura. Isso permite prever adequadamente o risco de malignidade e facilitar a tomada de decisão.

Grayscale, subjective color Doppler, combined grayscale with subjective color Doppler in predicting thyroid carcinoma: a retrospective analysis / Escala de cinza, doppler colorido subjetivo, combinação de escala de cinza com doppler colorido subjetivo na previsão de carcinoma da tireoide: uma análise retrospectiva

Abstract Introduction: Fine needle aspiration cytology is preferred for thyroid nodules preoperatively, but has disadvantages of false-negative and false-positive results. Objective: To compare the diagnostic performance of grayscale ultrasound, subjective color Doppler ultrasound, and combined features of grayscale ultrasound and subjective color Doppler ultrasound in predicting thyroid carcinoma, using results of the fine needle aspiration cytology as the reference standard. Methods: Data from gray-scale ultrasound images, subjective color Doppler ultrasound images, and the fine needle aspiration cytology of 325 nodules of 250 patients (age ≥ 18 years) were collected and analyzed. Hypo-echogenicity than adjacent strap muscle, micro-lobulated or irregular margins, micro- or mixed calcifications, and taller-than-wide shapes were considered as a suspicious malignant nodule in grayscale ultrasound. Marked vascularity was considered as a suspicious malignant nodule in color Doppler ultrasound. The Bethesda system for classification of thyroid nodules was used for cytopathology. Results: With respect to the results of fine-needle aspiration cytology for detecting suspicious malignant nodules, for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound, sensitivities were 0.564, 0.600 and 0.691, respectively and accuracies were 0.926, 0.919 and 0.959, respectively. Suspicious malignant nodules detectability for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound were 0.09-0.56 diagnostic confidence, 0.08-0.61 diagnostic confidence, and 0.063-0.7 diagnostic confidence, respectively. Conclusion: The combined gray-scale with subjective color Doppler ultrasound-guided fine-needle aspiration biopsies are recommended for the diagnosis of thyroid carcinoma. Level of Evidence: III.

Resumo Introdução: A citologia da punção aspirativa com agulha fina é preferida para nódulos tireoidianos no pré-operatório, mas apresenta desvantagens de resultados falso-negativos e falso-positivos. Objetivo: Comparar o desempenho diagnóstico da ultrassonografia em escala de cinza, do doppler colorido subjetivo e da combinação dos recursos da ultrassonografia em escala de cinza e do doppler colorido subjetivo na previsão do carcinoma da tireoide com os resultados da citologia da punção aspirativa com agulha fina como padrão de referência. Método: Dados de imagens de ultrassonografia em escala de cinza, imagens subjetivas da ultrassonografia com doppler colorido e citologia da punção aspirativa com agulha fina de 325 nódulos de 250 pacientes (idade ≥ 18 anos) foram coletados e analisados. A hipoecogenicidade da musculatura adjacente, as margens microlobuladas ou irregulares, as microcalcificações ou calcificações mistas e os formatos mais altos do que largos foram considerados como um nódulo maligno suspeito na ultrassonografia em escala de cinza. A vascularização acentuada foi considerada um nódulo maligno suspeito na ultrassonografia com doppler colorido. O sistema Bethesda para classificação de nódulos tireoidianos foi usado para a citopatologia. Resultados: Com relação aos resultados da citologia por punção aspirativa com agulha fina para detecção de nódulos malignos suspeitos, as sensibilidades foram de 0,564, 0,600 e 0,691 para a ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo, respectivamente, e as acurácias foram 0,926, 0,919 e 0,959, respectivamente. A detectabilidade de nódulos suspeitos malignos para ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo foram de 0,09-0,56, 0,08-0,61 e 0,063-0,7 de confiança diagnóstica, respectivamente. Conclusões: A ultrassonografia em escala de cinza combinada com o doppler colorido subjetivo e biópsias por punção aspirativa com agulha fina guiadas por ultrassonografia são recomendados para o diagnóstico de carcinoma da tireoide. Nível de evidência: III.

Criterios para la selección del tipo de tratamiento quirúrgicoen cáncer de tiroides / Criteria for the selection of surgical treatment in the thyroidcancer

Objetivo: evaluar los procedimientos disponibles para el manejo quirúrgico del cáncer de tiroides y los criterios para su selección. Pacientes y métodos: se evaluaron dieciocho pacientes con cáncer de tiroides a quienes se les realizaron procedimientos quirúrgicos como parte de su enfoque diagnostico y terapéutico. Resultados: el 83,3% de la serie se distribuyó por encima de los 45 años. No hubo etapa tumoral T1. Doce pacientes se catalogaron como de riesgo intermedio. Los estudios imagenológicos y la punción con aguja fina se usaron como método de diagnóstico preoperatorio. La tiroidectomía total en un solo tiempo, fue la cirugía más común y el reporte histológico definitivo más frecuente fue el de carcinoma papilar. El tamaño tumoral igual o mayor de 4cms, los cortes congelados y los hallazgos intraoperatorios como la presencia de adenopatías e infiltración a estructuras anatómicas adyacentes permitieron correlacionar el resultado de la punción con aguja fina y definir la conducta quirúrgica en dos tercios de la casuística. La disección cervical estuvo indicada en las adenopatías clínicamente evidentes. Conclusiones: La presencia de neoplasias iguales o mayores de 4cms, metástasis cervicales, infiltración a estructuras anatómicas adyacentes y los cortes congelados determinaron el tipo de intervención. La tiroidectomía total con o sin linfadenectomía fue el procedimiento más frecuente, otras intervenciones de rescate y paliativas representan parte de las opciones quirúrgicas de acuerdo a la etapa tumoral o la situación clínica preoperatoria. La crisis sanitaria que sufre el país ha determinado algunas dificultades en el proceso terapéutico de estos pacientes(AU)

Objective: to evaluate the procedure for the surgical management of the thyroid cancer and the criteria for the selection Patients and method: eighteen patients with cancer of thyroid programmed to surgical procedures. Results: the 83, 3% of the series was 45 years or more. No exist T1. Twelve patients were intermediate risk. Radiologic studies and the fine needle aspiration were the methods of evaluation preoperative. Total thyroidectomy was the most common surgery and the histology more frequent was papilar carcinoma. The neoplasies of 4cms or more, the frozen section and the findings in the operating room were be used to adapt the surgical plan in the 66,6% of the serie. Neck dissection was indicated in the clinics lymph nodes. Conclusions: the surgical extension depends of the tumoral size, the presence of cervical metastasis, the infiltration of adjacent structures and frozen sections. The thyroidectomy total with or without lymphadenectomy were the procedures more frequent, other intervention of salvage and palliative intention represents surgical options. The sanitary crisis determinates some problems in the therapeutic process(AU)

Intraoperative frozen section performance for thyroid cancer diagnosis

ABSTRACT Objective: A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Subjects and methods: To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results: In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion: Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated

Valor de la PAAF y el Sistema Bethesda en tumores de tiroides / TFNA VALUE AND THE BETHESDA SYSTEM IN THYROID TUMORS

Introducción: La punción aspiración con aguja fina (PAAF) de tiroides se fundamentó y desarrolló por completo en 1950. Los informes citológicos eran descriptivos, no sistematizados, no comparables y rara vez indicaban el manejo del paciente. En 2007, en el Instituto Nacional del Cáncer de los Estados Unidos en Bethesda, se realiza el manual de la Nomenclatura y Sistemática de elaboración de los informes de PAAF tiroidea (Sistema Bethesda). En la actualidad, es una herramienta diagnóstica imprescindible para la evaluación de nódulos tiroideos y útil para decidir conducta e indicar la intervención quirúrgica. Objetivos: determinar el valor de la citología por PAAF en el diagnóstico final de los tumores tiroideos y comparar con el estudio patológico intraoperatorio y definitivo. Diseño: Estudio retrospectivo observacional. Lugar de aplicación: Hospital Público de atención terciaria de oncología. Materiales y métodos: se evaluaron todos los pacientes operados por patología tiroidea de enero de 2018 a diciembre de 2020, con PAAF previa y estudio patológico intraoperatorio. Resultados: La PAAF tuvo una sensibilidad de 96% y una especificidad del 70% con 1 falso negativo (FN) y 6 falsos positivos (FP), un valor predictivo positivo (VPP) de 85% y un valor predictivo negativo (VPN) de 87%. El porcentaje de malignidad según categoría de Bethesda fue: 28% para la categoría IV, 91% para V y 100% para VI. El estudio patológico intraoperatorio (EPI) tuvo una sensibilidad de 97% y especificidad del 83,3%, con 1 FN y 1 FP, un VPP de 96% y un VPN de 86%. Conclusión: El estudio de los tumores de tiroides por medio de la PAAF y su informe mediante el Sistema de Bethesda demostró, en general, ser confiable para evaluar el riesgo de malignidad tiroidea y la adecuada indicación de tratamiento quirúrgico a los pacientes estudiados en el preoperatorio.

Background: Thyroid fine needle aspiration (FNA) was fully founded and developed in 1950. Cytological reports were descriptive, not systematized, and not comparable and rarely indicated patient management. The manual of the Nomenclature and Systematics of preparation of the thyroid FNA reports (Bethesda System) was created in 2007, at the National Cancer Institute of the United States. At present, it is an essential diagnostic tool for the evaluation of thyroid nodules and useful for deciding on the conduct and indicating surgical intervention. Objectives: to determine the value of FNA cytology in the final diagnosis of thyroid tumors and to compare it with the intraoperative and definitive pathological study. Design: Retrospective observational study. Setting: Public Hospital for tertiary care of tumors. Material and methods: all patients surgically intervened for thyroid pathology from January 2018 to December 2020, with previous FNA and intraoperative pathological study, were evaluated. Results: FNA had a sensitivity of 96% and a specificity of 70% with one false negative (FN) and six of them with false positives (FP), a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 87%. The percentage of malignancy according to Bethesda category was: 28% for category IV, 91% for V and 100% for VI. Intraoperative histologic study (HIS) had a sensitivity of 97% and a specificity of 83.3%, with 1 FN and 1 FP, a PPV of 96% and a NPV of 86%. Conclusions: The study of thyroid tumors using FNA and its report using the Bethesda System proved, generally, to be reliable in evaluating the risk of thyroid malignancy and the adequate indication of surgical treatment in preoperative studied patients.

Fetus in Fetu as a suprarenal mass in a neonate - a rare and perplexing entity

Fetus in fetu (FIF) is a rare entity in which a malformed vertebrate fetus is incorporated within its twin. This entity should be differentiated from a teratoma, which has more malignant potential. We describe a neonate with a heterogeneous calcified suprarenal mass. The aspiration cytology revealed a heterogeneous cell population with spindle cells and small round blue cells. Operative and histopathologic examination showed features consistent with a fetus in fetu. This case report describes a rare entity and discusses its clinical presentation, cytological features on fine-needle aspiration, and the difficulties posed in its differentiation from a teratoma.

Cervical Thymic Cyst with parathyroid tissue - a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.

Carcinoma medular esporádico de tiroides / Sporadic Medullary Thyroid Carcinoma

Introducción: El carcinoma medular de tiroides, representa aproximadamente entre el 5 - 10 por ciento de todos los carcinomas tiroideos, aparece con más frecuencia entre los 25 y 60 años y en el sexo femenino. Se distinguen dos tipos: el esporádico (no hereditario) y el familiar (hereditario). La localización más frecuente es la unión del tercio superior de lóbulo tiroideo con el tercio medio, que es la zona de mayor concentración de células C. Objetivo: Presentar el caso de paciente masculino operado de carcinoma medular de tiroides, tipo esporádico, en la provincia de Cienfuegos. Caso clínico: Paciente masculino de 60 años de edad, piel blanca, que acudió a la consulta; refiere aumento de volumen del cuello acompañado de disfonía y disfagia a los alimentos sólidos. Al examen físico se constató la presencia del nódulo tiroideo. Se le realizó ultrasonido que corrobora la presencia de un nódulo en el lóbulo derecho del tiroides. La biopsia por aspiración con aguja fina informó el nódulo como sospechoso de malignidad. Se le realizó tiroidectomía total, informándose por la biopsia por parafina de la pieza como un carcinoma medular del tiroides. En la actualidad lleva 6 meses de operado con evolución favorable. Conclusiones: El carcinoma medular de tiroides constituye una entidad rara y agresiva más frecuente en los pacientes mayores de 45 años, cuyo tratamiento de elección es la cirugía(AU)

Introduction: Medullary thyroid carcinoma accounts for approximately 5-10 percent of all thyroid carcinomas. It appears more frequently at ages 25-60 years and in females. Two types are distinguished: sporadic (nonhereditary) and familial (hereditary). The most common location is the union of the upper third of the thyroid lobe to the middle third, the area with the highest concentration of C cells. Objective: To present the case of a male patient operated on for medullary thyroid carcinoma, of sporadic type, in the Cienfuegos Province. Clinical case: A 60-year-old male patient of white skin attended consultation. He reported an increase in neck volume accompanied by dysphonia and dysphagia for solid food. The physical examination revealed the presence of the thyroid nodule. Ultrasound was performed, which confirmed the presence of a nodule in the right lobe of the thyroid. Fine needle aspiration biopsy reported the nodule as suspicious for malignancy. A total thyroidectomy was performed, after which, paraffin biopsy of the specimen permitted to report a medullary carcinoma of the thyroid. At present, he has been operating for six months, with favorable evolution. Conclusions: Medullary thyroid carcinoma is a rare and aggressive entity, more frequent in patients over 45 years of age, whose treatment of choice is surgery(AU)

Valor del estudio patológico intraoperatorio de tiroides. Comparación con la punción aspiración preoperatoria y la patología diferida / Value of the intraoperative pathology in thyroid surgery: comparison with preoperative aspiration puncture and deferred pathology

Resumen Para evaluar la utilidad diagnóstica del estudio patológico intraoperatorio (EPI) en cirugía tiroidea se realizó una revisión retrospectiva de sus resultados en 350 pacientes en comparación con la biopsia preoperatoria por punción con aguja fina (PAAF) y el est udio patológico diferido (EPD). Los resultados de la PAAF se clasificaron según el sistema de Bethesda en categoría II (91 casos, 26.0%), III (21 casos, 6.0%), IV (73 casos, 21.9%), V (54 casos, 15.4%) y VI (111 casos, 31.7%). El EPI mostró lesiones benignas en 137 casos (39.1%), malignas en 169 (48.2%), y resultados no definitivos en 44 (12.6 %). El EPD informó patología benigna en 161 casos (46%) y carcinoma en 189 (54%); se encontró carcinoma en 8 pacientes (5.8%) en quienes el EPI había informado lesión benigna y en 12 (27.2%) en quienes había informado no definitivo; 13 de estos 20 casos fueron microcarcinomas incidentales. El EPI no informó ningún falso positivo (especificidad 100%, sensibilidad 89.4%, valor predictivo positivo 100%, valor predictivo negativo 90.0%, exactitud 94.2%). Los resultados de malignidad con EPI y EPD, según categorías de Bethesda fueron respectivamente: II 3 (3.3%) y 7 (7.7%); III 8 (38.1%) y 10 (47.6%); IV 3 (4.1%) y 10 (13.7%); V 47 (87.0%) y 52 (96.3%); VI 108 (97.3%) y 110 (99.1%). El EPI no dio información adicional a la biopsia por PAAF en la mayoría de los casos ni detectó microcarcinomas en otros, por lo que no parece justificado indicarlo rutinariamente.

Abstract To evaluate the usefulness of intraoperative pathology (IP) in thyroid surgery, a retrospective review of its results in 350 patients was performed in comparison with the results of the preoperative fine-needle biopsy (FNB) and the surgical pathology report (SPR). The FNB was reported according to the Bethesda system as type II in 91 cases (26.0%), type III in 21 (6.0%), type IV in 73 (21.9%), type V in 54 (15.4%), and type VI in 111 (31.7%). The IP showed benign lesions in 137 cases (39.1%), malignancy in 169 (48.2%), and inconclusive results in 44 (12.6%). The SPR results were benign pathology in 161 cases (46%) and carcinoma in 189 (54%); carcinoma was found in 8 patients (5.8%) in whom the IP had reported benignity, and in 12 (27.2%) with IP inconclusive results; 13 of those 20 cases were incidental microcarcinomas. The IP did not report any false positive result (specificity 100 %, sensitivity 89.4%, positive predictive value 100%, negative predictive value 90.0%, and accuracy 94.2%). When discriminated by Bethesda types, the malignant lesions detected by IP and SPR were, respectively: II 3 (3.3%) and 7 (7.70%); III 8 (38.1%) and 10 (47.6%); IV 3 (4.1%) and 10 (13.7%); V 47 (87.0%) and 52 (96.3%); VI 108 (97.3%) and 110 (99.1%). In most cases, the IP did not provide additional information to the FNB report nor did it detect microcarcinomas in others, so it does not seem justified to perform it routinely.