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Resumen Como revisamos en la primera parte1 hay algunos conceptos que deben ser considerados para el adecuado manejo médico por parte del equipo clínico que recibe el reporte de patología, de esta misma manera existen aspectos por parte del patólogo que este debe conocer, los cuales tienen impacto terapéutico. En esta segunda parte queremos revisar algunos conceptos que son de importancia por parte del patólogo que aplican directamente sobre la interpretación del clínico, como: procesamiento macroscópico; estudio de la citología por aspiración con aguja fina (FNA) vs. biopsia trucut, utilidad de la biopsia por congelación y de la inmunohistoquímica, así como los métodos e imágenes diagnósticas.
Abstract As was reviewed in the first part, there are some concepts that should be considered for the appropriate medical management by the medical team that receives the pathology report. Similarly, there are some aspects that the pathologist should know, such as those that can have therapeutic impact. In this second part, a short review is presented on some of the concepts that are of importance to the pathologist that apply directly to the interpretation by the clinician, such as the macroscopic processing, the cytology study of the fine-needle aspirate (FNA) vs. "tru-cut" biopsy, the usefulness of the frozen biopsy, and immunohistochemistry, as well as diagnostic methods and diagnostic images.
Assuntos
Humanos , Doenças da Glândula Tireoide , Biópsia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Agulhas , Patologia , TerapêuticaRESUMO
Objective To evaluate the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in combination with flow cytometry (FCM) in lymphoma.Methods From January 2011 to December 2011,the cases of suspicious lymphoma with EUS-FNA examination at Shanghai Ruijin Hospital were retrospectively analyzed.The final diagnosis was according to pathological diagnosis of specimen from the surgery and follow up results.The sensitivity,specificity and accuracy of EUS-FNA combined with FCM in lymphoma diagnosis were initially analyzed.Results A total of 14 suspicious lymphoma patients were collected,eight cases were diagnosed as lymphoma by pathological examination of specimen from the surgery or.tissue from aspiration,four cases were non-lymphoma lesions and two cases still had no final diagnosis.The sensitivity and specificity of FCM alone in lymphoma diagnosis were 4/8 and 4/4 respectively.Six cases of lymphoma were detected by EUS-FNA with FCM.The sensitivity,specificity and accuracy of EUS FNA combined with FCM were 6/8,6/6 and 10/12 respectively.Conclusion EUS-FNA combined with FCM has better diagnostic value in lymphoma,especially for gastrointestinal lymphoma and those surrounding deep lesions.
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Objective To evaluate the diagnostic value of endoscopic ultrasonography-guided fineneedle aspiration(EUS-FNA)for pancreatic occupying lesion,especially pancreatic cancer.Methods From year of 2005,37 patients with suspected pancreatic cancer by means of uhrasound,CT or MRI received EUS-FNA.Amylase and tumor markers(CEA,CA19-9 and CA125)in cyst fluid were analyzed if applicable.The patients were followed up till July 2008,and the results of EUS-FNA were compared with those confirmed during the follow-up.Results The EUS-FNA yielded diagnosis of 16 cases of pancreatic duetal adenocarcinoma,1 metastatic:renal cancer,5 suspicious malignancy,6 atypia,6 normal pancreatic tissue,and 3 normal non-pancreatic tissue.During the follow-up,25 cases of pancreatic cancer and 10 benigh lesions,including 4 chronic panereatitis,4 cyst-adenoma and 2 pseudocyst,were confirmed,and the other 2 cases still remained un-determined.The sensitivity,specificity,positive predictive value and negative predictive value of EUS-FNA were 80.0%(95% CI:59.0-93.0),100.0%(95% CI:60.0-100.0),100.0%(95% CI:80.0-100.0),and 55.6%(95% CI:27.0-79.0),respectively.No severe procedurerelated complication was observed.Conclusion EUS-FNA is a safe and effective medality for diagnosis of pancreatic occupying lesions,especially pancreatic cancer.