Score system for cytological evaluation of fine-needle aspiration specimens to predict the diagnosis of papillary thyroid carcinomas.

INTRODUCTION: According to the World Health Organization's classification of endocrine tumors, papillary thyroid carcinoma (PTC) accounts for almost 90 % of malignant thyroid neoplasms. This study aimed to create a point system based on cytomorphological criteria for evaluating FNA products from thyroid nodules to predict the risk of papillary thyroid carcinomas. METHODS: This was an analytical observational study based on a retrospective analysis of cytological reports and surgical specimens from January 1, 2016, to December 31, 2021. Cytological slides were analyzed using the following ten variables: Nuclear Grooves; Intranuclear Pseudoinclusion; Cellularity; Colloid (Quantity); Clarified Chromatin; Overlapping nuclei; Irregular Nuclear Membrane; Multinucleated Giant Cells; Psamoma bodies; and Papillae. We categorized these variables quantitatively from zero to three points as follows: zero (absent), one (mild), two (moderate), and three (intense). RESULTS: Cytologies of 254 (4.9 %) cases were analyzed. The cut-off point was defined in this study as 6 ± 1 points. For the prediction of cases in benign, values < 5 points, malignant, values > 7 points and indeterminate, 5-7 points. Among the benign, there were 64 (69.5 %) cases <5 points, 17 (18.4 %) from 5 to 7 points and 11 (11.9 %) >7 points. Among the malignant ones, there were 12 (8.6 %) cases <5 points, 19 (13.6 %) from 5 to 7 points and 108 (77.6) >7 points. CONCLUSION: In this context, through the quantitative analysis of the ten suggested cytological variables, scored from 0 to 3, a final score > 7 is suspicious for malignancy, while a score < 5 is related to benign lesions.

Desfecho clínico de pessoas com diabetes infectadas pelo SARS-CoV-2 que desenvolveram Síndrome Respiratória Aguda Grave, Brasil / Clinical outcomes of SARS-CoV-2 infected people with diabetes who developed Severe Acute Respiratory Syndrome in Brazil

Objetivo: Comparar os desfechos clínicos de pessoas com e sem Diabetes Mellitus tipo 2 (DM 2), infectadas pelo SARS-CoV-2, que desenvolveram Síndrome Respiratória Aguda Grave (SRAG) no Brasil. Métodos: Trata-se de um estudo transversal realizado a partir de análise da ficha de notificação compulsória de Síndrome Respiratória Aguda Grave Hospitalizado, obtidas no DATASUS. Foram analisados homens e mulheres com e sem DM2, infectados pelo SARS-CoV-2 e notificados como SRAG no período de fevereiro de 2020 a maio de 2021. Foram identificados os desfechos: hospitalização, admissão em Unidade de Terapia Intensiva (UTI) e óbito. Em seguida, a porcentagem de cada desfecho entre pessoas com DM2 foi comparada com a de pessoas não-diabéticas infectadas no mesmo período, utilizando o teste de Qui-Quadrado, com intervalo de confiança de 95%. Resultados: De um total de 384.805 pacientes, 111.046 eram diabéticos e 273.759 não diabéticos. Entre os diabéticos, 98.2% foram hospitalizados, 43.7% admitidos em UTI e 44.6% evoluíram a óbito. Enquanto entre os não-diabéticos, 97.3% necessitaram de hospitalização, 37.2% foram admitidos em UTI e 35.7% evoluíram a óbito. Após a análise com o teste de Qui-Quadrado, nos desfechos analisados foi encontrada uma diferença estatística significante (p<0.001) entre os grupos. Conclusão: A presença de DM 2 esteve associada a um pior prognóstico da COVID-19, quando comparada a pessoas sem DM2 na população brasileira. Entretanto, são necessários mais estudos para estabelecer a causalidade e elucidar a fisiopatologia dessa associação (AU)

Objective: Compare the clinical outcomes of people with and without Type 2 Diabetes Mellitus (DM2), infected by SARS-CoV-2, who developed Severe Acute Respiratory Syndrome (SARS) in Brazil. Methodology: This is a cross-sectional study. The research was carried out by analyzing the compulsory notification form Severe Acute Respiratory Syndrome of hospitalized patients, obtained from DATASUS. Type 2 diabetic and non-diabetic men and women infected with SARS-CoV-2 and notified as SARS in the period February 2020 to May 2021 were analyzed. The outcomes were identified as: hospitalization, Intensive Care Unit (ICU) admission, and death. The percentage of each outcome among diabetic patients was compared with that of the infected non-diabetic patients in the same period using the Chi-square test, with a 95% confidence interval. Results: From a total of 384,805 patients, 111,046 were diabetic and 273,759 non-diabetic. Among the diabetic patients, 98.2% were hospitalized, 43.7% were admitted to the ICU, and 44.6% died. While among non-diabetics, 97.3% required hospitalization, 37.2% were admitted to the ICU, and 35.7% died. After the analysis with the Chi-square test, a statistically significant difference was found between the groups (p<0.001). Conclusion: The presence of DM2 was associated with a worse prognosis for COVID-19 compared to people without DM2, in the Brazilian population. However, further studies are needed to establish causality and elucidate the pathophysiology of this association (AU)

Thyroid FNA performed by cytopathologists accompanied by radiologists guiding the ultrasound provide high-level quality results: A retrospective observational study.

BACKGROUND: On thyroid cytology, false negative and false positive rates are considered parameters for quality control. Nevertheless, there are few studies about medical professional involved in this procedure. We conducted a 4-year cytohistological correlation of thyroid specimens in a single institution. To describe cytological and histological correlation where radiologists guide the ultrasound (US) and cytopathologists perform the thyroid fine needle aspiration (FNA). METHODS: Retrospective observational study of thyroid specimens in a Brazilian countryside setting. The ultrasound was performed by radiologists, and the FNA was performed by pathologists. All cases were reviewed by two pathologists following the Bethesda Reporting System for Reporting Thyroid Cytopathology and the World Health Organization's Classification of Tumours of Endocrine Organs. Clinical information, such as sex, age, location, and ultrasound data, was collected from our reports. RESULTS: From a total of 3265 patients, 3703 nodules (391 patients showed more than one nodule) were submitted to FNA. For correlation, there were 168 surgical thyroidectomy specimens. The risk of malignancy for the Bethesda system categories were: nondiagnostic/unsatisfactory = 0/4 (0%); benign = 1/38 (2.6%); atypia of undetermined significance or follicular lesion of undetermined significance = 2/20 (10.0%); follicular neoplasm or suspicious for follicular neoplasm = 3/16 (18.7%); suspicious for malignancy = 63/67 (94.0%); and malignant = 22/23 (95.6%). CONCLUSION: High-level quality results can be accomplished with cooperation between cytopathologists performing thyroid FNA accompanied by radiologists guiding the ultrasound.

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories.

OBJECTIVE: To compare the frequency of fine needle aspiration (FNA) cytological results between nodules 1 cm or less and nodules greater than 1 cm. METHODS: All FNAs performed between January 2016 and December 2019 at an institute in Brazil were analysed. For each nodule, at least two conventional slides were produced (one stained by Giemsa and the other by hematoxylin and eosin). All cases were reviewed by two cytopathologists and were reported following the Bethesda System. Clinical information (gender and age) and ultrasound data (nodule size and location) were collected. The magnitude of association was measured using the prevalence ratio (PR) with 95% confidence intervals (CIs) considering two groups of nodules: 1.0 cm or less, and greater than 1 cm. RESULTS: A total of 3703 nodules were analysed from 3265 patients (2906 women [88.48%], 359 men [11.51%], with a combined mean age of 52 years). Considering the prevalence ratio of Bethesda categories between these two groups of nodules, the nondiagnostic or unsatisfactory category (PR: 3.0, 95% CI: 2.2-4.2) and the suspicious for malignancy category (PR: 1.6, 95% CI: 1.1-2.4) were significantly associated with nodules measuring 1 cm or less. CONCLUSION: Our results demonstrated that nodules 1 cm or less are significantly associated with the nondiagnostic and suspicious for malignancy categories of the Bethesda System when compared to nodules greater than 1 cm.