Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings.

OBJECTIVES: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS: Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.

Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica / Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings

Objetivos: Conocer el rendimiento diagnóstico de la biopsia con aguja gruesa (BAG) ecoguiada en nódulos tiroideos con dos punciones aspirativas con aguja fina (PAAF) previas no diagnósticas. Evaluar complicaciones de la BAG. Analizar la fiabilidad de los diagnósticos obtenidos mediante BAG. Medir el impacto económico de evitar lobectomía tras BAG con resultado benigno. Material y métodos: Revisión retrospectiva de 195 BAG realizadas en 178 pacientes. Las referencias utilizadas para medir la fiabilidad de los resultados de la BAG fueron el análisis de la pieza quirúrgica tras una biopsia con malignidad o proliferación folicular (PF) y la estabilidad ecográfica superior a 1 año tras una BAG benigna. Se compararon costes directos de BAG más seguimiento ecográfico frente al que hubiera tenido realizar lobectomía sin complicaciones en los pacientes con estabilidad ecográfica superior a 1 año tras BAG benigna. Resultados: De los 195 nódulos sometidos a BAG, el resultado fue diagnóstico en 179 (91,7%), incluyendo 122 benignos (62,5%), 50 PF (25,6%) y 7 malignos (3,6%). No fue diagnóstico en 16 nódulos (8,3%). Hubo complicaciones menores en 4 pacientes (2%) y mayores en ninguno. La sensibilidad de la BAG para el diagnóstico de cáncer de tiroides fue baja (42,8%) por su incapacidad para detectar invasión capsular o vascular, aunque con especificidad y valor predictivo positivo (VPP) del 100%. Al considerar los diagnósticos de malignidad y PF como positivos, pues ambos obligan a resección quirúrgica, la sensibilidad ascendió al 97,5%, con descenso al 83,3% del VPP. Hubo 79 nódulos con seguimiento ecográfico superior a 1 año, 76 con BAG benigna (96,2%), de los cuales mostraron estabilidad 74 (97,3%). El valor predictivo negativo (VPN) para malignidad de los nódulos benignos fue del 98,6%, aunque no se detectó ninguna transformación maligna. Sin embargo, el análisis estadístico no permite recomendar la supresión del seguimiento ecográfico tras BAG benigna.(AU)

Objectives: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. Material and methods: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. Results: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed.(AU)

Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings. / Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica.

OBJECTIVES: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS: Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.

Diagnostic yield of endoscopic ultrasound with fine-needle aspiration in pancreatic cystic lesions. / Rendimiento diagnóstico de la punción mediante ultrasonografía endoscópica de las lesiones quísticas del páncreas.

INTRODUCTION: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. MATERIAL AND METHODS: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. RESULTS: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). CONCLUSION: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%.

Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. / Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada.

OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.

Diagnóstico de las afecciones nodulares del tiroides / Diagnosis of the thyroid nodular disorders

A pesar de los avances en los medios de diagnóstico, la identificación de los nódulos malignos del tiroides continúa siendo un reto para los patólogos, endocrinólogos y cirujanos. Aunque los factores pronósticos, la aplicación del método clínico y los estudios imagenológicos y funcionales pueden contribuir al diagnóstico; sus pilares fundamentales lo constituyen el estudio citológico mediante punción aspirativa con aguja fina, la biopsia intraoperatoria por congelación y la biopsia por inclusión en parafina. Al respecto, en el presente trabajo se ofrecen algunas consideraciones relacionadas con el diagnóstico del nódulo tiroideo.

In spite of the advances in the diagnosis means, the identification of the malignant nodules of the thyroid continues being a challenge for the pathologists, endocrinologist and surgeons. Although the prognosis factors, the use of the clinical method and the imagenological and functional studies can contribute to the diagnosis; their main key stone is constituted by the cytological study through fine needle aspiration, the frozen intraoperative biopsy and the paraffin inclusion biopsy. In this respect, some considerations related to the diagnosis of the thyroid nodule are offered in this work.

Diagnóstico de las afecciones nodulares del tiroides / Diagnosis of the thyroid nodular disorders

A pesar de los avances en los medios de diagnóstico, la identificación de los nódulos malignos del tiroides continúa siendo un reto para los patólogos, endocrinólogos y cirujanos. Aunque los factores pronósticos, la aplicación del método clínico y los estudios imagenológicos y funcionales pueden contribuir al diagnóstico; sus pilares fundamentales lo constituyen el estudio citológico mediante punción aspirativa con aguja fina, la biopsia intraoperatoria por congelación y la biopsia por inclusión en parafina. Al respecto, en el presente trabajo se ofrecen algunas consideraciones relacionadas con el diagnóstico del nódulo tiroideo(AU)

In spite of the advances in the diagnosis means, the identification of the malignant nodules of the thyroid continues being a challenge for the pathologists, endocrinologist and surgeons. Although the prognosis factors, the use of the clinical method and the imagenological and functional studies can contribute to the diagnosis; their main key stone is constituted by the cytological study through fine needle aspiration, the frozen intraoperative biopsy and the paraffin inclusion biopsy. In this respect, some considerations related to the diagnosis of the thyroid nodule are offered in this work(AU)

Punción aspirativa con aguja fina para el diagnóstico de tumores en anatomía patológica / Fine needle aspiration biopsy for the diagnosis of tumors in pathology

La punción aspirativa con aguja fina es un método de diagnóstico rápido, eficaz, sencillo de ejecutar, de bajo costo y apenas causante de complicaciones leves, por lo que ha devenido el estudio fundamental, pues además de permitir iniciar la secuencia diagnóstica de los tumores, garantiza que el patólogo o citopatólogo apoye y brinde información de valor al médico clínico para el adecuado tratamiento de pacientes con procesos tumorales. La morbilidad atribuible al procedimiento se considera insignificante y en series escandinava y estadounidense, en las cuales se estudió mediante cortes de tejidos la zona de la vía de entrada previamente marcada, no se halló siembra celular alguna en el trayecto de la aguja(AU)

Aspiration punction with fine needle is an easily obtained, low cost, quick, effective diagnosis method which hardly causes mild complications, so it has become the fundamental study, because besides allowing to begin the diagnostic sequence of tumors, it guarantees that the pathologist or cytopathologist supports and offers valuable information to the clinical doctor for the appropriate treatment of patients with tumoral disorders. The morbidity attributable to the procedure is considered insignificant and in Scandinavian and American series, in which the area of the previously marked entrance was studied by means of tissue cuts, cell seeding was not found in the needle route(AU)

Rol de la ultrasonografía endoscópica (USE) en el diagnóstico y estadificación del cáncer de páncreas / Role of endoscopic ultrasonography (EUS) in the diagnosis and staging of pancreatic cancer

Pancreatic cancer is currently a disease with an ominous natural evolution, showing, after 5 years, a survival of no more than 5 percent. We also know that the only curative therapy is surgical resection; however, no more than 20 to 30 percent is a candidate for potentially curative resection at diagnosis. This shows the importance of early and accurate diagnosis and staging in order to predict tumor resectability.Endoscopic ultrasonography is currently considered the best screening method for the diagnosis of pancreatic tumors, especially of small size and in which other diagnostic methods have been doubtful with a sensitivity of 96 percent and negative predictive value near 100 percent. Endoscopic ultrasonography and helical computed tomography are complementary in the staging of pancreatic cancer. Endoscopic ultrasonography is more accurate for T staging and assessment of vascular involvement. The possibility of obtaining material for cytological and histological study through fine-needle aspiration, gives endoscopic ultrasonography an advantage over other imaging methods, having a sensitivity of 90 percent and a specificity of 100 percent and with a very low rate of complications (1-2 percent).

El cáncer de páncreas es aún en la actualidad una patología con una evolución natural ominosa, con sobrevida a 5 años no mayor de 5 por ciento. Además, sabemos que la única terapia curativa es la resección quirúrgica, pero no más de 20 a 30 por ciento es candidato a una resección potencialmente curativa al momento del diagnóstico. De ello se desprende la importancia de realizar un diagnóstico precoz y un estadificación lo más precisa posible para lograr predecir la resecabilidad del tumor. La ultrasonografía endoscópica (USE) es considerada actualmente como el mejor método de exploración para el diagnóstico de los tumores del páncreas, especialmente los de tamaño pequeño y en los cuales otros métodos diagnósticos han sido dudosos. Posee una sensibilidad de 96 por ciento y un valor predictivo negativo cercano 100 por ciento. La USE y la tomografía computarizada (TC) helicoidal son complementarias en la estadificación de los cánceres de páncreas, pero la USE es más exacta en la estadificación T y en la evaluación del compromiso vascular. La posibilidad de obtener material para estudio citológico e histológico a través de la punción aspirativa con aguja fina (PAAF), le otorga a la USE una ventaja sobre los otros métodos de imágenes, poseyendo una sensibilidad de 90 por ciento y una especificidad de 100 por ciento, con una muy baja tasa de complicaciones (1-2 por ciento).

Valor diagnóstico de punción aspirativa con aguja fina en nódulo tiroideo: hospital Doctor Gustavo Fricke / Diagnostic value of puncture aspiration with fine needle in thyroide nodule: hospital Doctor Gustavo Fricke

Introducción: la punción aspirativa con aguja fina (PAAF) ha ido introduciéndose paulatinamente en la práctica clínica y constituye actualmente el método de elección en la aproximación diagnóstica del cáncer tiroideo. La PAAF ha contribuido a reducir el porcentaje de pacientes tiroidectomizados, 67 aumentando la cirugía por cáncer tiroideo del l5 porciento al 39 porciento. Objetivo: determinar el Valor diagnóstico de la PAAF en pacientes sometidos a tiroidectomía en el Hospital Doctor Gustavo Fricke (HGF), entre los71 años 2006-2007. Material y Método: estudio observacional descriptivo retrospectivo. Se utilizó el registro de pacientes sometidos a procedimiento quirúrgico por nódulo tiroideo, que hayan sido previamente estudiados con PAAF en policlínico de Endocrinología del HGF. Resultados: el valor diagnóstico de la PAAF, en el estudio pre-operatorio del nódulo tiroideo y su relación con la biopsia definitiva postoperatoria, alcanzó una sensibilidad de 7l porciento y una especificidad del 54,S porciento. Discusión: el rendimiento que alcanzó la PAAF de los nódulos tiroideos para excluir o confirmar carcinoma tiroideo fueron bajos en relación a estudios internacionales que poseen una sensibilidad del 83 porciento y una especificidad del 92 porciento.

Introduction: the flne-needle aspiration (FNA) has been gradually incorporated into the clinical practice and nowadays represents the method of choice in the diagnosis of the thyroid cancer. The FNA has helped to reduce the percentage of patients that undergo thyroidectomy, and it has increased the operation for thyroid cancer from 15 percent to 39 percent. Objetive: establish the diagnostic value ofthe FNA in patients submitted to thyroidectomy in Hospital Doctor Gustavo Fricke (HGF), between 2006 and 2007. Materials and Methods: this is a descriptive observational retrospective study. We used a register of patients submitted to surgical procedure for thyroid nodule that also have been studied with FNA in the clinic of Endocrinology of the HGF. Results: the diagnostic value of FNA in the preoperative study of the thyroid nodule and its relationship with the definitive surgical biopsy reaches a sensibility of 71 percent and a specificity of S4,8 percent. Discussion: the thyroid nodules FNA had a low performance for exclude or confirm thyroid carcinoma in thyroid nodules compared to international studies (sensibility 83 percent and specificity 92 percent).