Serum cholesterol levels are inversely associated with the risk of malignancy in subjects with Bethesda category IV thyroid nodules.

INTRODUCTION: Some epidemiological data suggest that there may be an inverse relationship between cholesterol levels and the risk of thyroid cancer in the overall population. The present study was aimed to evaluate the lipid profile specifically in subjects with Bethesda category IV thyroid nodules, and compare whether there were any differences between those with benign and malignant nodules. METHODS: Single-centre, retrospective study on 204 subjects treated by partial or total thyroidectomy for excision of a Bethesda category IV thyroid nodule, who had undergone a blood lipid profile test in the 12 months prior to surgery. In addition to lipid measures, other demographic, clinical, biochemical and ultrasound data were collected. RESULTS: Seventy-five subjects (36.8%) were diagnosed with thyroid carcinoma in the definitive histopathological examination. Patients with thyroid cancer had lower levels of total cholesterol, LDL-cholesterol and non-HDL-cholesterol than subjects with benign thyroid diseases. There were no differences in HDL-cholesterol, triglycerides or total cholesterol/HDL-cholesterol ratio. There were no differences either between groups in other clinical, biochemical and ultrasound variables, including the use of lipid-lowering drugs. In multivariate analysis, only LDL-cholesterol was independently associated with malignancy. Subjects with follicular carcinoma showed the lowest cholesterol levels, while those with papillary carcinoma had intermediate values between the group with follicular carcinoma and the group with benign thyroid diseases. CONCLUSIONS: In subjects with cytologically indeterminate Bethesda category IV thyroid nodules, levels of total cholesterol, non-HDL-cholesterol and, particularly, LDL-cholesterol are lower among those with malignant nodules.

Assessment of inflammatory parameters as predictive markers for malignancy in thyroid nodules: a study on the correlation with Bethesda classification.

OBJECTIVE: The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules. METHOD: Nine hundred and ninety-one patients with thyroid nodules who had undergone thyroid fine-needle aspiration biopsy were included and classified according to the Bethesda system. Neutrophil lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) values obtained from hemogram parameters were determined for each patient. The study examined the correlation between the Bethesda classification and NLR/SII levels. In addition, a comparison was made between the inflammatory parameters of the benign and malignant Bethesda groups. RESULTS: Five hundred and seventy-three patients were classified as Bethesda 2 (benign), 34 as Bethesda 6 (malignant). A correlation was observed between the Bethesda classification and NLR and SII levels (r: 0.230, p < 0.001; r: 0.207 p < 0.001, respectively). NLR and SII values were significantly higher in the malignant group (p < 0.001). The cutoff value for SII in predicting benign and malignant thyroid nodules was 489.86 × 103/mm3 with a sensitivity of 88.2% and a specificity of 63.7%. The cutoff value for NLR for the same prediction was 2.06 with a sensitivity of 82.4% and a specificity of 83.4%. CONCLUSIONS: The findings of this study indicate that SII and NLR may be valuable prognostic markers for predicting the malignancy of thyroid nodules.

OBJETIVO: Evaluar parámetros inflamatorios como posibles marcadores de malignidad en individuos con nódulos tiroideos. MÉTODO: Se incluyeron 991 pacientes con nódulos tiroideos que se sometieron a biopsia por aspiración con aguja fina y se clasificaron según el sistema de Bethesda. Se determinaron los valores de la relación neutrófilo-linfocito (NLR) y el índice de inflamación inmunitaria sistémica (SII). El estudio exploró la correlación entre la clasificación de Bethesda y los valores de NLR/SII, y comparó los parámetros inflamatorios de los grupos benignos y malignos de Bethesda. RESULTADOS: Se clasificaron 573 pacientes como Bethesda 2 (benigno) y 34 como Bethesda 6 (maligno). Se observó una correlación entre la clasificación de Bethesda y los valores de NLR y SII (r: 0.230; r: 0.207). Los valores de NLR y SII fueron mayores en el grupo maligno (p < 0.001). El valor de corte para SII en la predicción de nódulos tiroideos benignos y malignos fue de 489.86 × 103/mm3, con una sensibilidad del 88.2% y una especificidad del 63.7%; para NLR fue de 2.06, con una sensibilidad del 82.4% y una especificidad del 83.4%. CONCLUSIONES: El SII y el NLR pueden ser valiosos marcadores pronósticos para predecir la malignidad de los nódulos tiroideos.

Repetition of thyroid fine-needle aspiration cytology after an initial nondiagnostic result: Is there an optimal timing?

INTRODUCTION: It is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous procedure. This study evaluated the influence of the interval between 2 FNACs in a cohort with a previous non-diagnostic (ND) FNAC. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in the second FNAC, based on the intervals between procedures. PATIENTS AND METHODS: Retrospective study (2017-2020) including thyroid nodules with a ND result, subjected to another FNAC. Demographic, clinical and echographic data, interval between FNACs and their results were collected. We considered the intervals: ≤/>3 months and ≤/>6 months. Second FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda categories). RESULTS: Included 190 nodules (190 patients - 82.1% women, mean age 60±13.7 years) with a first ND FNAC. The second FNAC results were: ND in 63 cases, AUS/FLUS in 9 and diagnostic in 118 cases. There were no statistical differences in FNAC results performed≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs >3 months (50 ND, 7 AUS/FLUS, 99 diagnostic; p=0.71). Similarly, there were no statistical differences considering a longer time interval: ≤6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs >6 months (31 ND, 6 AUS/FLUS, 59 diagnostic; p=0.61). CONCLUSIONS: Time interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS.

Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography.

OBJETIVE: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

Efectividad y seguridad de la biopsia hepática guiada porendosonografía en enfermedad hepática en un hospital públicode nivel III

La evaluación de la enfermedad hepática parenquimal suele comprender exámenes de laboratorio y de imagen; sin embargo, en algunos casos se puede requerir una biopsia hepática. La biopsia del hígado guiada por endosonografía se ha reportado como un procedimiento con un rendimiento diagnóstico entre 90 a 100% con un perfil bajo de eventos adversos; sin embargo, no existen estudios que reporten la experiencia y el tipo de técnica empleada en nuestro país. Objetivo: Determinar la efectividad y la seguridad de la biopsia hepática guiada por endosonografía en enfermedad hepática parenquimal. Materiales y métodos: Estudio prospectivo realizado en un hospital público de nivel de atención III-2 en Lima, Perú, el cual incluyó pacientes mayores de 18 años con sospecha de alguna enfermedad hepática parenquimal que fueron sometidos a una biopsia guiada por endosonografía desde marzo del 2018 a octubre del 2022. Resultados: El rendimiento diagnóstico de las biopsias fue de 77,02%, con una longitud media de la muestra obtenida de 13,98 mm (desviación estándar 7,34) y una mediana de 8 espacios porta completos (0-50). Cabe mencionar que solo un 31.25% de procedimientos se realizaron con aguja fina de biopsia (FNB), encontrándose una diferencia significativa entre el tipo de aguja y el rendimiento diagnóstico (p=0,01). El diagnóstico histopatológico más frecuente el de hepatitis autoinmune. Y existieron un 2,08% de complicaciones post procedimiento. Conclusiones: Las biopsias guiadas por endosonografía para el diagnóstico de enfermedad parenquimal hepática tienen una efectividad cercana al 80% en nuestro medio y con un perfil bajo de eventos adversos; sin embargo, se necesitan estudios prospectivos y con un mayor número de pacientes.

Parenchymal liver diseases are commonly evaluated by laboratory and imaging studies. However, in some cases a liver biopsy is required. Endoscopic ultrasonography-guided liver biopsy (EUS-LB) has been reported as a procedure with high diagnostic yield (90-100%) with low adverse event profile, but there are not studies which report about the experience and technique in our country. Objective: Determinate the effectiveness and the safety of endosonography-guided liver biopsy in liver parenchymal disease. Materials and methods: A prospective study was conducted at a III-2 level of care Public Hospital in Lima, Peru. It included patients over 18 years of age with suspicion of parenchymal liver disease who underwent EUS-LB for study hepatic parenchymal disease since March of 2018 to October of 2022. Results: The diagnostic yield of the biopsies was 77.02%, with a mean length of the sample of 13.98mm (standard deviation 7.34) and a median of 8 complete portal spaces (0-50). Only 31.25% of the procedures were performed with a fine needle biopsy (FNB), finding a significant difference between the type of needle and the diagnostic yield (p=0.01). The most common histopathological diagnosis was autoinmune hepatitis. There were 2.08% of post-procedure complications. Conclusions: EUS-LB for the diagnosis of liver parenchymal disease had a diagnostic yield close to 80% in our region with a low profile of adverse events. However, more prospectives studies with a larger number of patients are required.

Tumores parotídeos: correlación entre estudios de imagen, punción aspiración con aguja fina y los hallazgos histopatológicos / [Parotid tumors: correlation between imaging studies, fine needle aspiration and histopathological findings]

Introducción y objetivo: Nuestro objetivo es establecer la rentabilidad del diagnóstico citológico mediante punción aspiración con aguja fina (PAAF) y la utilidad del estudio de imagen preoperatoria en el manejo de masas parotídeas. Método: Se realizó un estudio retrospectivo de una muestra de 142 pacientes con tumoración parotídea intervenidos por el Servicio de Otorrinolaringología del HUPR en los últimos 10 años, con diagnóstico preoperatorio radiológico (ecografía, TC, RNM) y citológico, mediante PAAF. Los resultados de ambas pruebas se han clasificado como positivos o negativos para malignidad y se compararon con el diagnóstico anatomopatológico. Resultados: La edad media fue de 56 años, el 61,3% eran hombres. La PAAF presentó una sensibilidad para detectar malignidad del 75% y una especificidad del 100%; con valores predictivos positivo y negativo (VPN) de 100 y 97%, respectivamente. La sensibilidad del estudio radiológico fue de 25%, y la especificidad del 99%. El valor predictivo positivo para malignidad fue de 80%, y el valor predictivo negativo, de 89%. Conclusiones: La PAAF es una prueba sencilla, pero de utilidad limitada para la orientación diagnóstica debido a su baja sensibilidad y elevados falsos negativos; sin embargo, su alta especificidad y elevado VPN hacen de la misma una prueba con mayor precisión frente a un resultado benigno o negativo. El estudio radiológico previo es útil en el diagnóstico de extensión y características tumorales, aunque se ve limitado por sí solo en el diagnóstico diferencial de malignidad. La RM se ha convertido en la modalidad de imagen de elección. (AU)

Introduction and objective: Our aim is to establish the profitability of cytological diagnosis by fine needle aspiration (FNA) and the usefulness of preoperative imaging in the management of parotid masses. Method: A retrospective study of a sample of 142 patients with parotid tumors operated on by the HUPR Otorhinolaryngology Service in the last 10 years, with preoperative radiological (ultrasound, CT, MRI) and cytological diagnosis, by FNA, was carried out. The results of both tests have been classified as positive or negative for malignancy and were compared with the pathological diagnosis. Results: The average age was 56, 61.3% were men. FNA had a sensitivity to detect malignancy of 75% and a specificity of 100%; with positive and negative predictive values (NPV) of 100 and 97%, respectively. The sensitivity of the radiological study was 25%, and the specificity 99%. The positive predictive value for malignancy was 80%, and the negative predictive value was 89%. Conclusions: FNA is a simple test, but of limited utility for diagnostic orientation due to its low sensitivity and high false negatives; however, its high specificity and high NPV make it a more accurate test against a benign or negative result. The previous radiological study is useful in the diagnosis of tumor extension and characteristics, although it is limited by itself in the differential diagnosis of malignancy. MRI has become the imaging modality of choice. (AU)

Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions / Bloques celulares obtenidos de la punción-aspiración con aguja fina ecoguiada: rendimiento diagnóstico en una serie de 51 lesiones dermatológicas

The generation of cell blocks (CB) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated (AU)

La generación de bloques celulares (CBs) obtenidos a partir de punción-aspiración con aguja fina guiada por ultrasonido (USFNAB), es una técnica bien establecida en patología mamaria y tiroidea, pero rara vez se utiliza en dermatología. Revisamos los CBs obtenidos por USFNAB de lesiones cutáneas, que se clasificaron como tumores cutáneos malignos, tumores cutáneos benignos, tumores cutáneos inflamatorios o enfermedades cutáneas por depósito. El rendimiento diagnóstico de cada categoría se comparó con la histopatología. La USFNAB de 51 lesiones cutáneas se procesó en CBs. Hubo concordancia global entre la histopatología y los CBs en el 84,31% de los casos. La concordancia entre histopatología y CBs para lesiones cutáneas benignas, malignas e inflamatorias y por depósito fue del 69,2, 93,7 y 86,3%, respectivamente. La generación de CBs a partir de USFNAB de lesiones cutáneas debe considerarse como parte del arsenal diagnóstico dermatológico. Se necesita más experiencia para comprender mejor para qué tipos de lesiones dermatológicas estaría claramente recomendado (AU)

[Artículo traducido] Bloques celulares obtenidos de la punción-aspiración con aguja fina ecoguiada: rendimiento diagnóstico en una serie de 51 lesiones dermatológicas / Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions

La generación de bloques celulares (CBs) obtenidos a partir de punción-aspiración con aguja fina guiada por ultrasonido (USFNAB), es una técnica bien establecida en patología mamaria y tiroidea, pero rara vez se utiliza en dermatología. Revisamos los CBs obtenidos por USFNAB de lesiones cutáneas, que se clasificaron como tumores cutáneos malignos, tumores cutáneos benignos, tumores cutáneos inflamatorios o enfermedades cutáneas por depósito. El rendimiento diagnóstico de cada categoría se comparó con la histopatología. La USFNAB de 51 lesiones cutáneas se procesó en CBs. Hubo concordancia global entre la histopatología y los CBs en el 84,31% de los casos. La concordancia entre histopatología y CBs para lesiones cutáneas benignas, malignas e inflamatorias y por depósito fue del 69,2, 93,7 y 86,3%, respectivamente. La generación de CBs a partir de USFNAB de lesiones cutáneas debe considerarse como parte del arsenal diagnóstico dermatológico. Se necesita más experiencia para comprender mejor para qué tipos de lesiones dermatológicas estaría claramente recomendado (AU)

The generation of cell blocks (CB) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated (AU)

Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions.

The generation of cell blocks (CB) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated.

Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions. / [Artículo traducido] Bloques celulares obtenidos de la punción-aspiración con aguja fina ecoguiada: rendimiento diagnóstico en una serie de 51 lesiones dermatológicas.

The generation of cell blocks (CBs) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated.

Ultrasonographic measurement of the effect of physical training on ligament injuries / Medição ultrassonográfica do efeito do treinamento físico nas lesões ligamentares / Medición ecográfica del efecto del entrenamiento físico en las lesiones de ligamentos

ABSTRACT Introduction: The ankle joint is the most load-bearing joint of the human body. The health consciousness of people is increasing day by day, the probability of ankle sports injuries is also increasing. Objective: Analyze the applying sports medicine ultrasound value to rehabilitate anterior talofibular tendon injury. Methods: Seventy- two patients with anterior talofibular injury in a particular hospital were divided into control and observation groups to observe the effect of recovery, recovery time, and degree of ligament injury during rehabilitation treatment. Results: In the observation group, the complete recovery rate was 91.67%, incomplete recovery (8.33%), recovery time was (2.36±0.9) months. The complete recovery rate of the control group is (77.78%), the incomplete recovery (22.2%), the recovery time (3.58±0.42) months. Patients in the experimental group had a higher grade of ligament injury III than those in the control group during each rehabilitation period; the difference was statistically significant (P<0.05). Conclusions: Sports medical ultrasound can determine the degree of anterior talofibular ligament rupture after injury, providing a basis for the clinical formulation of the treatment plan. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução: A articulação do tornozelo é a articulação do corpo humano que mais suporta carga. A consciência da saúde das pessoas está aumentando de dia para dia, a probabilidade de lesões esportivas no tornozelo também está aumentando. Objetivo: Analisar o valor de aplicação do ultra-som de medicina esportiva para a reabilitação de lesão no tendão talofibular anterior. Métodos: Setenta e dois pacientes com lesão talofibular anterior em um determinado hospital foram divididos em grupos de controle e observação para observar o efeito da recuperação, o tempo de recuperação e o grau de lesão ligamentar durante o tratamento da reabilitação. Resultados: No grupo de observação, a taxa de recuperação completa foi de 91,67%, a recuperação incompleta (8,33%), o tempo de recuperação foi de (2,36±0,9) meses. A taxa de recuperação completa do grupo de controle é de (77,78%), a recuperação incompleta (22,2%), o tempo de recuperação (3,58±0,42) meses. Os pacientes do grupo experimental tiveram maior grau de lesão ligamentar III do que os do grupo controle durante cada período de reabilitação, a diferença foi estatisticamente significativa (P<0,05). Conclusões: A ultra-sonografia médica esportiva pode determinar o grau de ruptura do ligamento talofibular anterior após a lesão, fornecendo uma base para a formulação clínica do plano de tratamento. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: La articulación del tobillo es la que más carga soporta del cuerpo humano. La conciencia de la salud de las personas aumenta día a día, la probabilidad de lesiones deportivas en el tobillo también aumenta. Objetivo: Analizar el valor de la aplicación de ultrasonidos en medicina deportiva para la rehabilitación de la lesión del tendón talofibular anterior. Métodos: Setenta y dos pacientes con lesión talofibular anterior en un hospital particular fueron divididos en grupos de control y de observación para observar el efecto de la recuperación, el tiempo de recuperación y el grado de lesión del ligamento durante el tratamiento de rehabilitación. Resultados: En el grupo de observación, la tasa de recuperación completa fue del 91,67%, la recuperación incompleta (8,33%), el tiempo de recuperación fue de (2,36±0,9) meses. La tasa de recuperación completa del grupo de control fue (77,78%), la recuperación incompleta (22,2%), el tiempo de recuperación (3,58±0,42) meses. Los pacientes del grupo experimental tuvieron un mayor grado de lesión del ligamento III que el grupo de control durante cada periodo de rehabilitación, la diferencia fue estadísticamente significativa (P<0,05). Conclusiones: La ecografía médico-deportiva puede determinar el grado de rotura del ligamento talofibular anterior tras la lesión, proporcionando una base para la formulación clínica del plan de tratamiento. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Diagnostic yield of computed tomography guided fine-needle aspiration for pancreatic cancer / Rendimiento diagnóstico de la aspiración con aguja fina guiada por tomografía computarizada para el cáncer de páncreas

Abstract Fine-needle aspiration (FNA) for the histological diagnosis of occupying lesions in the pancreas as opposed to tru-cut needle biopsy to obtain tissue for analysis has been associated with a lower incidence of post-procedure complications, with almost immediate recovery and no need for hospital stay. Nev ertheless, the question of the diagnostic effectiveness of percutaneous computed axial tomography (CT)-guided FNA in solid pancreatic lesions has been raised. The aim of this study was to confirm the diagnostic effectivity of percutaneous CT-guided FNA in pancreatic space-occupying lesions and to assess short-term complications. All percutaneous CT-guided FNA with real-time monitoring, performed between April 2010 and December 2015, were retrospectively analyzed. In all cases 21-gauge needles were used. All FNA were performed in the pres ence of a pathologist who immediately stained and reported as adequate for analysis in all cases. The diagnosis was confirmed by histopathological evaluation. Of 54 FNA performed, final histopathological evaluation revealed neoplastic cells compatible with adenocarcinoma in 52 patients (96%) and was negative for neoplastic cells in two patients (4%). The sensitivity was 94%, and the specificity 100%. Post-FNA morbidity was observed in four patients, consisting of epigastric pain in two and abdominal wall hematoma in two other patients. Percutaneous CT-guided FNA of pancreatic space-occupying lesions was found to be a good, minimally invasive and safe method with low morbidity. The presence of the pathologist in the procedure allowed for immediate cytological diagnosis.

Resumen El uso de la punción-aspiración con aguja fina (PAAF) en el diagnóstico histológico de lesiones ocupantes de páncreas es una alternativa frente al uso de agujas tru-cut en la obtención de tejido para su análisis, con una incidencia más baja de complicaciones y una recuperación casi inmediata sin necesidad de internación. El objetivo fue valorar la efectividad diagnóstica de las PAAF de lesiones ocupantes pancreáticas guiadas por tomografía axial computada (TAC) por vía percutánea, y su tasa de complicaciones a corto plazo. Se analizaron de forma retrospectiva todas las PAAF realizadas mediante guía tomográfica por vía percutánea con control en tiempo real, entre abril 2010 y diciembre 2015. Todas las PAAF se realizaron en presencia de un patólogo que inmediatamente tiñó e informó como adecuado para el análisis. La confirmación diagnóstica se hizo con el análisis anatomopatológico diferido. De las 54 PAAF realizadas, el diagnóstico anatomopatológico informó positivo para células neoplásicas compatible con adenocarcinoma en 52 pacientes (96%) y en otros dos (4%) como negativo para células neoplásicas. La sensibilidad del método fue 94% y la especificidad del 100%. Se registraron 4 casos de morbilidad post punción (2 dolores epigástricos y 2 hematomas de pared abdominal). Las punciones percutáneas de lesiones ocupantes pancreáticas guiadas por TC pueden considerarse un buen método diagnóstico mini invasivo, seguro, con una morbilidad post punción baja. La presencia del patólogo en el procedimiento permitió el diagnóstico citológico inmediato.

Ecoendoscopia con punción-aspiración intermitente en el diagnóstico de lesiones sólidas pancreáticas. Estudio piloto / Intermittent endoscopic ultrasound guided fine-needle aspiration for the diagnosis of solid pancreatic lesions. A pilot study

Antecedentes y objetivo: la ecoendoscopia con punción-aspiración con aguja fina (USE-PAAF) es el método de elección para la toma de muestras de lesiones sólidas pancreáticas. Sin embargo, existe una heterogeneidad significativa en cuanto a la técnica utilizada. La aspiración intermitente no ha sido evaluada en lesiones sólidas pancreáticas y podría mejorar el rendimiento diagnóstico.Métodos: estudio piloto de no inferioridad, simple ciego. Se incluyeron de forma prospectiva pacientes con lesiones sólidas pancreáticas e indicación de USE-PAAF. Los pacientes fueron asignados aleatoriamente para el método de aspiración intermitente (AI) o continua (AC). Se evaluaron el rendimiento diagnóstico, la celularidad, la contaminación hemática y el número de pases necesarios para llegar al diagnóstico.Resultados: treinta y tres pacientes fueron asignados a AC (16 pacientes) o AI (17 pacientes). El rendimiento diagnóstico fue del 87,5 % en AC y del 94,1 % en AI (OR 2,29, IC 95 %: 0,19-27,99, p = 0,51). En el grupo de AI las muestras tuvieron mayor celularidad (OR 1,83, IC 95 %: 0,48-6,91, p = 0,37) y menor contaminación hemática (OR 0,38, IC 95 %: 0,09-1,54, p = 0,18). El número de pases necesarios para llegar al diagnóstico fue de 2,12 en AC y 1,94 con AI (p = 0,64). Se obtuvo citología líquida en el 73,3 % de AI y en el 61,5 % de AC (OR 1,72, IC 95 % 0,35-8,50).Conclusiones: la técnica de AI no fue inferior a la AC en términos de precisión diagnóstica, con tendencia a obtener mayor celularidad, menor contaminación hemática y frecuente presencia de bloque celular en la evaluación de lesiones sólidas pancreáticas. (AU)

Papel da arquitetura nuclear no manejo do carcinoma de tiroide / Role of nuclear architecture in the management of thyroid carcinoma

One of the biggest dilemmas facing a cytopathology slide is the differential diagnosis of follicular thyroid lesions, grouped as follicular pattern lesions, which include goiter, follicular adenoma and follicular carcinoma, follicular variant of papillary thyroid carcinoma and non-invasive follicular thyroid neoplasm with papillary like nuclear features. Such lesions share many characteristics, which makes the proper identification of malignant follicular lesions a challenge. The cytology obtained through fine needle aspiration puncture is the most effective standard method for diagnosis of thyroid nodules, but its diagnostic efficacy clearly decreases in lesions of thyroid follicular pattern. Thus, a series of auxiliary tools for diagnoses, such as morphometry and nuclear texture analysis, have been increasingly used in the pathologist's practice, as an objective and reproducible tool. These are techniques, which depend on the incorporation of software to digital image analysis and can add accuracy to classical morphological analysis and immunohistochemistry in the evaluation of follicular pattern lesions. In addition to immunocytochemistry and molecular techniques, morphometry allows the estimation of parameters identified in individual cells and represents a tool that, based on quantitative parameters, translates reliable parameters for objective classification of the malignancy. This study aims to review the nuclear characteristics and their role in the diagnosis of follicular thyroid lesions.

Um dos maiores dilemas diante de uma lâmina de citopatologia é o diagnóstico diferencial de lesões foliculares da tiroide agrupadas como lesões de padrão folicular e que incluem; bócio, adenoma e carcinoma foliculares, carcinoma papilífero variante folicular e a neoplasia folicular não invasiva com características nucleares papilares (Uno de los mayores dilemas que presenta una muestra de citopatología es el diagnóstico diferencial de las lesiones foliculares tiroideas reunidas como lesiones de patrón folicular, que incluyen: bocio, adenoma folicular, carcinoma folicular, variante folicular del carcinoma papilar y la neoplasia folicular no invasiva con características nucleares de tipo papilar). Tais lesões compartilham muitas características, o que faz com que a identificação adequada de lesões foliculares malignas represente um desafio. A citologia obtida através de punção aspirativa por agulha fina é o método padrão mais efetivo para diagnóstico em nódulos de tiroide, mas sua eficácia diagnóstica diminui nitidamente em lesões de padrão folicular da tiroide (La citología por punción y aspiración con aguja fina es el método estándar más eficaz para el diagnóstico de los nódulos tiroideos, pero su eficacia diagnóstica se ve notablemente reducida en las lesiones de patrón folicular de la tiroides). Assim, uma série de ferramentas auxiliares ao diagnóstico, como a morfometria e a análise de textura nuclear, têm sido utilizadas cada vez mais na prática do patologista, como ferramenta objetiva e reproduzível. São técnicas que dependem da incorporação de softwares para análise digital de imagens e podem agregar acurácia à análise morfológica clássica e à imunohistoquímica na avaliação de lesões de padrão folicular (para el análisis de imágenes digitales y puede agregar precisión al análisis morfológico clásico y la inmunohistoquímica en la evaluación de lesiones de patrón folicular). Somando-se à imunocitoquímica e às técnicas moleculares, a morfometria permite a estimativa de parâmetros identificados em células individuais e representam uma ferramenta que, a partir de parâmetros quantitativos, traduz parâmetros confiáveis para classificação objetiva de malignidade. O objetivo deste estudo é rever as características nucleares e seu papel no diagnóstico de lesões foliculares da tiroide (es revisar las características nucleares y su papel en el diagnóstico de las lesiones foliculares tiroideas).

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.

Safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate in suspicious parathyroid adenomas.

OBJECTIVE: To evaluate the safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate (PTH-FNA) in patients with primary hyperparathyroidism and suspicious parathyroid adenomas. METHODOLOGY: A retrospective observational study was performed in 47 patients (57.7 ±â€¯11.2 years of average age, 74% women) attending an endocrinology clinic for primary hyperparathyroidism (average calcemia: 11.6 ±â€¯1.6 mg/dl and PTH: 276 ±â€¯477 pg/mL) in which PTH-FNA was made. Sensibility, specificity, positive predictive value and negative predictive value were calculated in all surgical patients. RESULTS: Forty-seven lesions were punctured (mean adenoma maximum diameter: 1.8 ±â€¯2.6 cm): negative image in the sestamibi scan (26 patients); the discordance between ultrasonography and the sestamibi scan (6 patients); possible intrathyroidal adenomas (4 patients); a positive sestamibi scan in 2 or more localizations (4 patients); ectopic adenoma (3 patients); persistent primary hyperparathyroidism (2 patients) and atypical adenomas (2 patients). Mean PTH-FNA was 2853 ±â€¯3957 pg/mL and 68% were considered positive (PTH-FNA ≥ 100 pg/mL). No complications were detected during or after the puncture. Thirty-seven patients were operated on, 95% were cured and no parathyromatosis cases were detected. PTH-FNA ≥ 100 pg/mL as a diagnostic test had a sensitivity of 93.7%, a specificity of 100%, a positive predictive value of 100% and an negative predictive value of 71.4%. CONCLUSION: PTH-FNA is an easy and safe diagnostic test and has a high sensitivity and specificity for differentiating between parathyroid adenomas and other cervical masses in patients with primary hyperparathyroidism.

Efectividad de la PAAF bajo guía ecográfica con la biopsia definitiva en los pacientes portadores de patología tiroidea, año 2016 - 2018

Resumen La neoplasia tiroidea impulsa la búsqueda de métodos diagnósticos para obtener un dictamen precoz y tratamiento oportuno que permitan mayor supervivencia y mejor calidad de vida, como objetivo se presentó en este trabajo la efectividad de la PAAF bajo guía ecográfica con la biopsia definitiva en los pacientes portadores de patología tiroidea, en el INCAN año 2016 - 2018, estudio observacional, descriptivo y retrospectivo, elaborado con historias clínicas de pacientes en quienes se realizó punciones (PAAF) para la citología, según el Sistema Bethesda, y con histopatología, para diagnosticar neoplasia tiroidea cuyos resultados fueron de los pacientes con patologías nodulares asistidos en la INCAN con mayor incidencia se constató en pacientes cuyas edades oscilaron entre 36 a 50 años con el 36%, se observó más afecciones en el sexo femenino con el 64%, las procedencias mayoritariamente fueron de áreas del interior del país en un 56%, según la citología por la clasificación de Bethesda se observó mayormente con el 49% pacientes con categoría II, según prevalencia de diagnósticos histológicos en el 26% se constató carcinoma folicular (CaF), se constató tumores malignos en 163 (39%) de los pacientes y en 252 (61) presentaron tumores benignos y los valores altos de la razón de verosimilitud positiva (LR +) y los valores bajos de la razón de verosimilitud negativa (LR-), le confieren a la citología por PAAF un valor diagnóstico muy confiable.

Abstract Thyroid neoplasia promotes the search for diagnostic methods to obtain an early opinion and timely treatment that allow for greater survival and better quality of life, as objective in this work the effectiveness of FNA under ultrasound guidance with the definitive biopsy in carrier patients was presented. of thyroid pathology, in INCAN 2016 - 2018, an observational, descriptive and retrospective study, prepared with clinical histories of patients who underwent punctures (FNA) for cytology, according to the Bethesda System, and with histopathology, to diagnose thyroid neoplasia whose results were from patients with nodular pathologies assisted in INCAN with higher incidence was found in patients whose ages ranged from 36 to 50 years with 36%, more conditions were observed in females with 64%, the origins were mostly of areas of the interior of the country in 56%, according to the cytology by the classification Bethesda fication was observed mostly with 49% patients with category II, according to prevalence of histological diagnoses in 26% follicular carcinoma (CaF) was found, malignant tumors were found in 163 (39%) of patients and in 252 (61 ) presented benign tumors and the high values ​​of the positive likelihood ratio (LR +) and the low values of the negative likelihood ratio (LR-), give the PAAF cytology a very reliable diagnostic value.

Elastografía cuantitativa en la evaluación de nódulos tiroideos / Quantitative Elastography in the Evaluation of Thyroid Nodules

Resumen: Objetivo. Evaluar retrospectivamente la capacidad diagnóstica de la elastografía cuantitativa para determinar la posibilidad de malignidad o benignidad de los nódulos tiroideos benignos y malignos, y determinar su utilidad para así decidir qué nódulos deberán ser sometidos a punción aspirativa con aguja fina (PAAF). Pacientes y métodos. Se analizaron 203 nódulos tiroideos de 195 pacientes remitidos por el Servicio de Endocrinología para estudio citológico durante el año 2018. A todos ellos se les realizó ecografía convencional, elastografía cuantitativa y PAAF. Se realizó un análisis estadístico mediante regresión logística, que pone en relación la probabilidad de que un nódulo sea sospecho de malignidad y el valor de la elasticidad medido en kilopascales (kPa) y el ratio elastográfico. Resultados. Existe una relación significativa y positiva entre el resultado citológico de Bethesda V/VI y los kPas/ratio elastográfico. Se recomienda realizar PAAF a aquellos nódulos con valores superiores a 25kPa y/o ratio elastográfico superior a 1,5. Conclusión. La elastografía cuantitativa es una herramienta útil que, junto a otros parámetros ecográficos, ayudaría a predecir o sospechar la malignidad de un nódulo tiroideo y a una mejor selección para la PAAF.

Abstract: Objective. To retrospectively assess the diagnostic capacity of quantitative elastography to determine the odds between benign and malignant thyroid nodules, and determine its usefulness in deciding which nodules should be subjected to fine needle aspiration puncture (FNA). Patients and methods. 203 thyroid nodules from 195 patients referred by the Endocrinology Service for cytological study during the year 2018 were analyzed. All of them underwent conventional ultrasound, quantitative elastography and FNA. A statistical analysis was performed using logistic regression that relates the probability that a nodule is suspected of malignancy and the elasticity value measured inkilopascals (kPa) and the elastographic ratio. Results. There is a significant and positive relationship between the cytological result of Bethesda V / VI and the kPas / elastographic ratio. FNA is recommended for those nodules with values greater than 25kPa and / or elastographic ratio greater than 1.5. Conclusion. Quantitative elastography is a useful tool that, together with other ultrasound parameters, would help to predict the malignancy of a thyroid nodule and to better select for FNA.

Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism.

OBJECTIVE: The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). METHODS: A retrospective observational study was designed in 195 patients (mean age: 59.2 ±â€¯13.0 years; 77% woman) with PHPT (calcium: 11,3 ±â€¯1,1 mg/dl and PTH: 218 ±â€¯295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULT: 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ±â€¯98 vs. 244 ±â€¯334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ±â€¯0,4 vs. 1,7 ±â€¯0,9 cm; p = 0,001 and volume: 0,36 ±â€¯0,43 vs. 1,7 ±â€¯4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ±â€¯0,5 vs. 1,9 ±â€¯1,1 cm; p = 0,008 and volume: 0,30 ±â€¯0,20 vs. 1,2 ±â€¯1,1 cm3; p < 0,001), less heavy (567 ±â€¯282 vs. 1470 ±â€¯1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46-22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22-29,16). CONCLUSIONS: One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.

Central papillary adenoma of the lung diagnosed in a bronchoscopy-guided FNA: Cytological and histological characterization of this rare entity.

Pulmonary papillary adenoma (PA) is an unusual tumor with only 32 reported cases to date. We present a case of a 69-year-old man, a smoker from the age of 12, with a central mass in the pulmonary left lower lobe identified in a PET-CT scan. Microscopical analysis of the Fine Needle Aspiration (FNA) samples showed fragments of a tumor comprised of abundant papillary structures lined by a monolayer of cytologically bland columnar to cuboidal epithelial cells. The immunohistochemical stains were positive for CK7, TTF-1 and EMA in the epithelial cells, and negative for MYC. Based on the imaging tests, histological features and immunohistochemical profile, the tumor was diagnosed as pulmonary PA. The cytologic and histologic features of this rare entity are described in detail and the value of FNA as an essential presurgical diagnostic procedure is emphasized.