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1.
Braz. j. otorhinolaryngol. (Impr.) ; 88(2): 220-227, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374730

ABSTRACT

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.


Subject(s)
Humans , Adolescent , Thyroid Neoplasms/pathology , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/pathology , Thyroid Nodule/diagnostic imaging , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle
2.
Arch. endocrinol. metab. (Online) ; 66(1): 50-57, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364302

ABSTRACT

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


Subject(s)
Humans , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Thyroid Nodule/surgery , Thyroid Nodule/diagnosis , Thyroid Nodule/pathology , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle/methods , Frozen Sections/methods
3.
Autops. Case Rep ; 12: e2021347, 2022. graf
Article in English | LILACS | ID: biblio-1355724

ABSTRACT

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.


Subject(s)
Humans , Female , Infant, Newborn , Teratoma/complications , Adrenal Glands , Biopsy, Fine-Needle , Fetus/abnormalities , Congenital Abnormalities/pathology
4.
Prensa méd. argent ; 108(4): 194-200, 20220600. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1381484

ABSTRACT

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.


Subject(s)
Humans , Adult , Middle Aged , Aged , Retrospective Studies , Thyroid Nodule/surgery , Thyroid Nodule/diagnosis , Cell Biology , Biopsy, Fine-Needle/methods
5.
Autops. Case Rep ; 12: e2021361, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360149

ABSTRACT

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.


Subject(s)
Humans , Male , Adolescent , Head and Neck Neoplasms/pathology , Mediastinal Cyst/pathology , Tomography, X-Ray Computed , Biopsy, Fine-Needle , Diagnosis, Differential
8.
Medicina (B.Aires) ; 81(4): 611-616, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346514

ABSTRACT

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.


Subject(s)
Humans , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Carcinoma , Thyroid Nodule/surgery , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle
9.
Oncol. (Guayaquil) ; 31(2): 155-163, 31 de agosto 2021.
Article in Spanish | LILACS | ID: biblio-1284458

ABSTRACT

Introducción: Los nódulos tiroideos se presentan entre el 4 al 8 % de la población, de los cuales hasta el 15% tienen etiología neoplásica. Las nódulos sospechosos de malignidad requieren la realización de punción, aspiración con aguja fina (PAAF) y la citología maligna reportada mediante sistema Bethesda tiene que ser corroborada con el estudio anatomopatólógico una vez realizada la excisión nodular. El objetivo del presente estudio es presentar la experiencia de un centro de referencia de pacientes con nódulos tiroideos. Metodología: Se realizó un estudio descriptivo, transversal, retrospectivo en el Servicio de Endocrinología del Hospital General del Norte de Guayaquil IESS CEIBOS, desde Junio 2017 a Julio 2019. El Universo estuvo compuesto por todos los casos con diagnóstico de nódulo tiroideo que requirieron PAAF. Se utiliza en sistema Bethesda para los reportes. Resultados: Fueron 349 casos de pacientes con nódulos tiroideos, mujeres (89%), edad entre 60 ­ 69 años (26%). 71 casos (21%) BETHESDA I; 220 casos (63%) BETHESDA II; 11 casos (3%) BETHESDA III; 15 casos (4%) BETHESDA IV; 15 casos (4%) BETHESDA V; y 17 casos (5%) BETHESDA VI. Malignidad de los nódulos tiroideos post en BETHESDA I 1%; de BETHESDA II 21%; BETHESDA III 56%, BETHESDA IV, 33%; BETHESDA V 71%; y BETHESDA VI 100%. Conclusión: La citología Benigna (Bethesda II) fue la más predominante, seguido de la Citología Insatisfactoria (Bethesda I) con un 21%.En la población estudiada el riesgo real de malignidad en los nódulos tiroideos que fueron intervenidos quirúrgicamente de las Categorías de diagnóstico citopa-tológicas BETHESDA II, IV, V y VI, confirmado por histopatología; fueron similares a lo esperado en-contrándose dentro del rango estimado por el Sistema Bethesda 2017. La categoría citopatológica Bethesda III (AUS/FLUS) presentó una tasa de malignidad más alta que el límite superior descrito por el Sistema Bethesda 2017, confirmando la necesidad de mayores estudios en este tipo de pacientes.


Introduction: Thyroid nodules occur between 4 to 8% of the population, of which up to 15% have neoplastic etiology. Nodules suspected of malignancy require puncture, fine needle aspiration (FNA) and the malignant cytology reported by the Bethesda system must be corroborated with the pathological study once the nodular excision has been performed. The objective of this study is to present the experience of a referral center for patients with thyroid nodules. Methodology: A descriptive, cross-sectional, retrospective study was carried out in the Endocriology Service of the General Hospital of the North of Guayaquil IESS CEIBOS, from June 2017 to July 2019. The Universe was made up of all the cases with a diagnosis of thyroid nodule that required PAAF. It is used in the Bethesda system for reports. Results: There were 349 cases of patients with thyroid nodules, women (89%), aged between 60 - 69 years (26%). 71 cases (21%) BETHESDA I; 220 cases (63%) BETHESDA II; 11 cases (3%) BETHESDA III; 15 cases (4%) BETHESDA IV; 15 cases (4%) BETHESDA V; and 17 cases (5%) BETHESDA VI. Post thyroid nodule malignancy in BETHESDA I 1%; of BETHESDA II 21%; BETHESDA III 56%, BETHESDA IV, 33%; BETHESDA V 71%; and BETHESDA VI 100%. Conclusion: Benign cytology (Bethesda II) was the most predominant, followed by Unsatisfactory Cytology (Bethesda I) with 21%. In the population studied, the real risk of malignancy in thyroid nod-ules that underwent surgery from the Diagnostic Categories cytopathological BETHESDA II, IV, V and VI, confirmed by histopathology; were similar to what was expected, and were within the range esti-mated by the 2017 Bethesda System. The Bethesda III cytopathological category (AUS / FLUS) pre-sented a higher malignancy rate than the upper limit described by the 2017 Bethesda System, con-firming the need for further studies in this type of patient.


Introdução: Os nódulos tireoidianos ocorrem em 4-8% da população, dos quais até 15% têm etiologia neoplásica. Os nódulos com suspeita de malignidade requerem punção, aspiração por agulha fina (FNA) e a citologia maligna relatada pelo sistema de Bethesda deve ser corroborada com o estudo patológico, uma vez que a excisão nodular tenha sido realizada. O objetivo deste estudo é apresentar a experiência de um centro de referência para pacientes com nódulos tireoidianos. Metodologia: Foi realizado um estudo descritivo, transversal e retrospectivo no Serviço de Endocrinologia do Hospital Geral do Norte de Guayaquil IESS CEIBOS, de junho de 2017 a julho de 2019. O Universo foi composto por todos os casos com diagnóstico de nódulo tireoidiano que exigia FNA. É usado no sistema Bethesda para relatórios. Resultados: Houve 349 casos de pacientes com nódulos tireoidianos, mulheres (89%), com idades entre 60-69 anos (26%). 71 casos (21%) BETHESDA I; 220 casos (63%) BETHESDA II; 11 casos (3%) BETHESDA III; 15 casos (4%) BETHESDA IV; 15 casos (4%) BETHESDA V; e 17 casos (5%) BETHESDA VI. Malignidade pós-nódulo tireoidiano em BETHESDA I 1%; de BETHESDA II 21%; BETHESDA III 56%, BETHESDA IV, 33%; BETHESDA V 71%; e BETHESDA VI 100%. Conclusão: A citologia benigna (Bethesda II) foi a mais predominante, seguida da Citologia Insatisfatória (Bethesda I) com 21%. Na população estudada, o risco real de malignidade em nódulos de tireoide operados das Categorias de Diagnóstico Citopático tológico BETHESDA II, IV, V e VI, confirmados por histopatologia; foram semelhantes ao esperado, e estiveram dentro da faixa estimada pelo Sistema Bethesda 2017. A categoria citopatológica Bethesda III (AUS / FLUS) apresentou uma taxa de malignidade superior ao limite superior descrito pelo Sistema Bethesda 2017, confirmando a necessidade de mais estudos nesse tipo de paciente.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Thyroid Neoplasms , Thyroid Nodule , Biopsy, Fine-Needle , Biopsy, Needle , Cross-Sectional Studies
10.
Braz. j. otorhinolaryngol. (Impr.) ; 87(4): 402-409, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285714

ABSTRACT

Abstract Introduction Ultrasound sonography provides a quick method for determining which nodule to sample for fine needle aspiration biopsy in thyroid nodules. On the other hand, the computed tomography examination is not restricted by echo attenuation and distinguishes between benign and malignant nodules. Objective To compare computed tomography examinations against ultrasound/fine needle aspiration biopsy in the differential diagnosis of thyroid nodules. Methods Data regarding computed tomography examinations, sonographic finding following fine needle aspiration biopsy, and tumor histology of 953 nodules from 698 patients who underwent thyroidectomy were collected and analyzed. The beneficial score for detection of the malignant tumor for each adopted modality was evaluated. Results Ultrasound images did not show a well-circumscribed solid mass in 89 nodules, and ultimately did not detect nodules in fine needle aspiration biopsies (false positive non-malignant nodules). Ultrasound images showed parenchymatous disease (false positive malignant nodules) in several nodules. Computed tomography examinations demonstrated higher difficulty in detection of malignant nodules of 1.0-2.0 cm size than ultrasound examination following fine needle aspiration biopsies; compared to tumor histological data, computed tomography examinations had a sensitivity of 0.879. Conclusion Computed tomography examinations are a more reliable method for differential diagnosis of thyroid nodules than ultrasound examinations followed by fine needle aspiration biopsy. Level of Evidence III.


Resumo Introdução A ultrassonografia é um método rápido para determinar de qual nódulo se deve coletar uma amostra para biópsia por aspiração com agulha fina. Por outro lado, o exame de tomografia computadorizada não é restringido pela atenuação do eco e distingue entre nódulos benignos e malignos. Objetivo Comparar exames tomográficos versus biópsia por ultrassonografia/aspiração por agulha fina no diagnóstico diferencial de nódulos tireoidianos. Método Dados sobre exames tomográficos, achados ultrassonográficos após biópsia por aspiração com agulha fina e histologia tumoral de 953 nódulos de 698 pacientes submetidos à tireoidectomia foram coletados e analisados. O escore de benefício para detecção do tumor maligno para cada modalidade adotada foi avaliado. Resultados As imagens de ultrassom não mostraram uma lesão sólida bem circunscrita em 89 nódulos; e na análise final não foram detectados nódulos nas biópsias por aspiração com agulha fina (nódulos não malignos falsos positivos). As imagens ultrassonográficas mostraram doença parenquimatosa (nódulos malignos falsos positivos) em vários nódulos. Os exames de tomografia computadorizada apresentaram grandes dificuldades na detecção de nódulos malignos de 1,0-2,0 cm de tamanho em comparação com o exame de ultrassonografia após biópsias por aspiração com agulha fina; comparados aos dados histológicos do tumor, os exames de tomografia computadorizada apresentaram sensibilidade de 0,879. Conclusão Os exames de tomografia computadorizada são um método mais confiável para o diagnóstico diferencial de nódulos tireoidianos do que os exames de ultrassonografia, seguidos por biópsia por aspiração com agulha fina.


Subject(s)
Humans , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle , Diagnosis, Differential
11.
Arch. endocrinol. metab. (Online) ; 65(3): 336-341, May-June 2021. tab
Article in English | LILACS | ID: biblio-1285154

ABSTRACT

ABSTRACT Objective: To determine sonographic features of malignancy in partially cystic thyroid nodules and assess the diagnostic efficacy of these features for differentiating between benign and malignant lesions in the nodules with indeterminate cytology. Subjects and methods: From January 2016 to December 2017, a total of 91 patients with 94 partially cystic thyroid nodules who had undergone ultrasound-guided fine-needle aspiration biopsy and thyroid surgery in our hospital were included in this study. The sonographic features of the thyroid nodules were analyzed to identify the predictive features of malignancy and assess the diagnostic efficacy of these features. Results: The features of hypoechogenicity, microcalcification, composition, and an eccentric solid component with an acute angle had statistically significant associations with malignant nodule (p<005) by univariable analysis. Binary logistic regression analysis showed that microcalcification and hypoechogenicity were significantly associated with malignancy. Using the combination of microcalcification, hypoechogenicity, and a solid component comprising of greater than or equal to 50% of the total volume, the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 97.6%, 32.7%, 53.9%, and 94.4%, respectively. In these nodules with indeterminate cytology, this combination also exhibited a high sensitivity of 92.3% and an NPV of 83.3%. Conclusion: This study demonstrated that microcalcification and hypoechogenicity were independently associated with malignancy in partially cystic thyroid nodules. The combination of microcalcification, hypoechogenicity, and a solid portion that is greater than or equal to 50% of the total volume will help guide clinical decisions in mixed cystic solid nodules.


Subject(s)
Humans , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Retrospective Studies , Ultrasonography , Sensitivity and Specificity , Biopsy, Fine-Needle
12.
Braz. j. otorhinolaryngol. (Impr.) ; 87(3): 338-345, May-Jun. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285684

ABSTRACT

Abstract Introduction Only 5%-15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy. Objective The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods. Methods A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed. Results Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%. Conclusion When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.


Resumo Introdução Apenas 5% a 15% das amostras cirúrgicas de tireoide são relatadas como malignas. A maioria das cirurgias é feita devido à suspeita de lesão maligna como resultado da biópsia por punção aspirativa com agulha fina. Entretanto, invasividade, resultados não diagnósticos e biópsias repetidas são desvantagens desse procedimento. Objetivo Investigar a eficácia do uso simultâneo da razão de compressão e do escore de elasticidade no diagnóstico diferencial de nódulos tireoidianos, bem como avaliar a compatibilidade desses dois métodos. Método Foram incluídos no estudo 144 nódulos. O diagnóstico histopatológico final foi usado como padrão de referência. A área sob a curva sensibilidade, especificidade e valores de corte da razão de compressão e do escore de elasticidade foram determinados com a análise da curva Receiver Operating Characteristic. A compatibilidade e comparação da razão de compressão e do escore de elasticidade também foram feitas. Resultados Eram malignos 28 nódulos (19,4%). Os resultados da razão de compressão e do escore de elasticidade foram significantemente bem-sucedidos em prever a lesão maligna de nódulos da tireoide (p < 0,001 para ambos). Além disso, as áreas sob a curva para a razão de compressão e o escore de elasticidade foram de 0,944 e 0,960, respectivamente. A acurácia diagnóstica escore de elasticidade foi superior à da razão de compressão, mas essa diferença não foi estatisticamente significante (p = 0,456). Quando a compatibilidade da razão de compressão e do escore de elasticidade foi examinada, as duas avaliações mostraram-se estatisticamente consistentes (Kappa = 0,767; p < 0,001). Quando a razão de compressão e o escore de elasticidade foram usados em conjunto, a especificidade de captar o diagnóstico correto aumentou de 84,5% para 93,1%. Conclusão Quando a razão de compressão e o escore de elasticidade foram usados juntos para o diagnóstico diferencial de nódulos tireoidianos, resultados mais precisos foram obtidos. Assim, o uso combinado dos dois métodos pode ser uma opção promissora à biópsia por punção aspirativa com agulha fina e evitar intervenções cirúrgicas desnecessárias para nódulos tireoidianos suspeitos.


Subject(s)
Humans , Thyroid Nodule/surgery , Thyroid Nodule/diagnostic imaging , Elasticity Imaging Techniques , Sensitivity and Specificity , Biopsy, Fine-Needle , Diagnosis, Differential
13.
Rev. cuba. med ; 60(1): e1399, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156554

ABSTRACT

RESUMEN Introducción: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina es una técnica novedosa para el diagnóstico de tumores y ganglios mediastínicos e hiliares. Objetivo: Evaluar la eficacia diagnóstica de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina como método de estudio de lesiones hiliares y mediastinales. Métodos: Se realizó un estudio descriptivo con carácter prospectivo en 49 pacientes a los que se le realizó ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina. Resultados: El diagnóstico se obtuvo mediante la histología y resultaron positivos 48 pacientes, de ellos 45 fueron positivos por el ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina y 4 negativos por este estudio. El resultado global de la investigación mostró una sensibilidad de 93,8 %, especificidad 100 %, valor predictivo positivo de 100 % y predictivo negativo 25 %. De esta manera, el índice de validez de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina fue de 93,8 %. El número de complicaciones fue mínimo. Conclusiones: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina constituye un método diagnóstico eficaz y seguro en el estudio de pacientes que presentan lesiones hiliares y mediastinales con alta sospecha de cáncer de pulmón y a su vez, una alternativa de acceder al mediastino de manera no cruenta para la estadificación ganglionar.


ABSTRACT Introduction: Linear endobronchial ultrasound with transbronchial fine needle aspiration is a novel technique for the diagnosis of tumors and mediastinal and hilar lymph nodes. Objective: To evaluate the diagnostic efficacy of linear endobronchial ultrasound with transbronchial fine needle aspiration as a method of studying hila and mediastinal lesions. Methods: A prospective descriptive study was carried out in 49 patients who underwent linear endobronchial ultrasound with transbronchial fine needle aspiration. Results: The diagnosis was obtained by histology and 48 patients were positive, 45 of them resulted positive by linear endobronchial ultrasound with transbronchial fine needle aspiration and 4 resulted negative by this study. The overall result of the investigation showed a sensitivity of 93.8%, specificity 100%, a positive predictive value of 100% and a negative predictive value of 25%. Thus, the validity index of linear endobronchial ultrasound with transbronchial fine needle aspiration was 93.8%. The number of complications was minimal. Conclusions: Linear endobronchial ultrasound with transbronchial fine needle aspiration is an effective and safe diagnostic method in the study of patients with hilar and mediastinal lesions with high suspicion of lung cancer and, consecutively, it is an alternative to access the mediastinum in a non- invasive approach for lymph node staging.


Subject(s)
Humans , Male , Female , Ultrasonics/methods , Bronchoscopy/methods , Biopsy, Fine-Needle/methods , Epidemiology, Descriptive , Prospective Studies
14.
Gac. méd. Méx ; 157(1): 19-24, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279068

ABSTRACT

Resumen Introducción: La elastografía por ondas de corte (SWE) ha demostrado ser predictiva de malignidad en nódulos tiroideos. Objetivo: Determinar mediante SWE, el punto de corte de la rigidez con mayor especificidad y sensibilidad para detectar nódulos tiroideos que requieren cirugía. Métodos: Estudio transversal de pacientes con nódulos tiroideos evaluados ultrasonográficamente en un periodo de tres años; se empleó la clasificación TI-RADS y mediante SWE se determinó la rigidez de los nódulos. Con el sistema Bethesda se clasificaron las muestras histopatológicas y mediante curva ROC se obtuvo el punto de corte de la rigidez con mayor especificidad y sensibilidad. Resultados: 41 % de los nódulos fue TI-RADS 5 y 59 %, TI-RADS 1-4. En los TI-RADS 5, la mediana de rigidez de los nódulos con categoría IV-VI del sistema Bethesda fue de 35.9 kPa y en los nódulos con TI-RADS 1-4, 21.6 kPa. En los nódulos TI-RADS 5, la rigidez > 32.5 kPa tuvo especificidad de 75 % y sensibilidad de 57 % para detectar los que requieren cirugía; en los TI-RADS 1-4, el valor de corte de 21.5 kPa tuvo especificidad de 63 % y sensibilidad de 51 %. Conclusión: La rigidez determinada por SWE es útil para detectar nódulos que requerirán exploración quirúrgica.


Abstract Introduction: Shear-wave elastography (SWE) has been shown to be predictive of malignancy in thyroid nodules. Objective: To determine, by SWE, the stiffness cutoff point with the highest specificity and sensitivity to detect thyroid nodules that require surgery. Methods: Cross-sectional study of ultrasonographically-evaluated patients for thyroid nodules over a period of three years; the TI-RADS classification system was used, and nodule stiffness was determined by SWE. Histopathological specimens were classified using the Bethesda system, and the stiffness cutoff point with the highest specificity and sensitivity was obtained using ROC curves. Results: Forty-one percent of the nodules were classified as TI-RADS 5, and 59 %, as TI-RADS 1-4. In TI-RADS 5 nodules, median stiffness of those in Bethesda system IV-VI categories was 35.9 kPa; in nodules with TI-RADS 1-4, 21.6 kPa. In TI-RADS 5 nodules, a cutoff point > 32.5 kPa had a specificity of 75 % and sensitivity of 57 % to detect those requiring surgery; in TI-RADS 1 to 4 nodules, a cutoff point of 21.5 kPa had a specificity of 63 % and sensitivity of 51 %. Conclusion: SWE-determined stiffness is useful to detect nodules that require surgical evaluation.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thyroid Nodule/diagnostic imaging , Elasticity Imaging Techniques/methods , Thyroid Gland/pathology , Thyroid Gland/diagnostic imaging , Cross-Sectional Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Biopsy, Fine-Needle/methods
16.
Rev. chil. endocrinol. diabetes ; 14(2): 77-80, 2021.
Article in Spanish | LILACS | ID: biblio-1283556

ABSTRACT

El carcinoma oculto de tiroides está poco reportado. Se presenta el caso de una mujer de 59 años. Durante un control por hipotiroidismo se solicitó ecografía cervical, la que mostró áreas hipoecogénicas en lóbulo derecho, una formación nodular hiperecogénica circunscrita no sospechosa de 8 mm y una adenopatía cervical periglandular derecha de 20 x 12 x 8 mm con áreas quísticas y microcalcificaciones, asociadas a hipervascularización. Se solicitó punción aspirativa por aguja fina del ganglio linfático, con resultado de citología negativa para células neoplásicas. El examen microscópico es compatible con tiroiditis, por lo que no es posible descartar metástasis. Se realizó biopsia del ganglio linfático, el que se informa como metástasis ganglionar linfática de 1.3 cm, histología de carcinoma papilar variedad folicular, sin invasión extracapsular. Se realizó tiroidectomía total y disección cervical derecha. El estudio anatomopatológico reportó una tiroiditis crónica de Hashimoto con un nódulo fibroso hialinizado de 0,4 cm negativo para tumor maligno y metástasis en 4 de 28 ganglios linfáticos, sin invasión extracapsular. El tamaño de la metástasis fue de 0,3 a 0,9 cm. Posteriormente se administró 100 mci de radioyodo. Actualmente, la paciente está en buenas condiciones y mantiene controles con ecografía y tiroglobulina periódicos.


Occult thyroid carcinoma is under-reported. The case of a 59-year-old woman is presented. During a check-up for hypothyroidism, a cervical ultrasound was requested, which showed hypoechogenic areas in the right lobe, an 8 mm nonsuspicious circumscribed hyperechogenic nodular formation and a 20 x 12 x 8 mm right cervical periglandular lymphadenopathy with cystic areas and microcalcifications, associated with hypervascularisation. Fine needle aspiration of the lymph node was requested, with negative cytology results for neoplastic cells. Microscopic examination was compatible with thyroiditis, so metastasis could not be ruled out. A biopsy of the lymph node was performed, which was reported as a 1.3 cm lymph node metastasis, histology of papillary carcinoma of the follicular variety, without extracapsular invasion. Total thyroidectomy and right cervical dissection were performed. The anatomopathological study reported chronic Hashimoto's thyroiditis with a 0.4 cm hyalinised fibrous nodule negative for malignant tumour and metastases in 4 of 28 lymph nodes, without extracapsular invasion. The size of the metastasis was 0.3 to 0.9 cm. Subsequently, 100 mci of radioiodine was administered. The patient is currently in good condition and maintains regular ultrasound and thyroglobulin monitoring.


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/secondary , Lymphatic Metastasis/pathology , Biopsy, Fine-Needle , Lymph Nodes/pathology
17.
Rev. chil. endocrinol. diabetes ; 14(3): 115-117, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1293385

ABSTRACT

La ecografía tiroidea es la principal herramienta diagnóstica en el manejo de los nódulos tiroideos, siendo la presencia de microcalcificaciones un signo de malignidad. Sin embargo, existen escasas publicaciones acerca de la presencia de microcalcificaciones en ausencia de nódulo identificable y su asociación con cáncer de tiroides. Presentamos un caso de una mujer de 26 años, que, tras hallazgo incidental de bocio, se describe en ecografía un tiroides con alteración difusa de su ecogenicidad e imágenes compatibles con microcalcificaciones sin claro nódulo definido en su polo inferior. Tras realización de punción aspiración con aguja fina de la lesión con resultado Bethesda categoría 5, se decide realizar tiroidectomía total, presentando estudio histológico con diagnóstico de carcinoma papilar de tiroides variante clásica con metástasis ganglionares p(T1bN1a). Tras una revisión sistemática, los estudios hasta hoy publicados sugieren que la presencia de microcalcificaciones aisladas sin nódulo identificable debe considerarse un importante factor de riesgo de cáncer de tiroides, especialmente en gente joven, y en aquellas asentadas sobre una tiroiditis de Hashimoto. Por ende, resulta imperativo mantener una alta sospecha ante el hallazgo de este tipo de lesiones, recomendando una valoración exhaustiva de las mismas con la realización de una punción aspiración con aguja fina a todas las lesiones con dichas características.


Thyroid ultrasound is the main diagnostic tool in the management of thyroid nodules, with the presence of microcalcifications being a sign of malignancy. However, there are few publications about the presence of microcalcifications in the absence of an identifiable nodule and its association with thyroid cancer. We present a case of a 26-year-old woman who, after an incidental finding of goiter, a thyroid with diffuse echogenicity alteration and images compatible with microcalcifications without a clear nodule defined in the lower pole of the lobe is described on the ultrasound. After performing a fine needle aspiration of the lesion resulting in a Bethesda category 5, a total thyroidectomy was performed, presenting in the histological study a diagnosis of a classic variant of a papillary thyroid carcinoma with lymph node metastases p (T1bN1a). After a systematic review, the studies previously published suggest that the presence of isolated microcalcifications without an identifiable nodule should be considered an important risk factor for thyroid cancer, especially in young people, and in those with a concomitant Hashimoto's thyroiditis. Therefore, it is imperative to maintain a high suspicion of the discovery of this type of lesion, recommending an exhaustive assessment of them with the performance of a fine needle aspiration to all lesions with these features.


Subject(s)
Humans , Female , Adult , Calcinosis/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Carcinoma/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroidectomy , Calcinosis/surgery , Calcinosis/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Carcinoma/surgery , Carcinoma/pathology , Ultrasonography , Thyroid Nodule/surgery , Thyroid Nodule/pathology , Biopsy, Fine-Needle
18.
Med. lab ; 25(3): 581-591, 2021. tabs, graf, ilus
Article in English | LILACS | ID: biblio-1343480

ABSTRACT

La aspiración con aguja fina (ACAF) es una técnica ampliamente utilizada por su alta seguridad y fácil uso. Sin embargo, al usarse en conjunto con la evaluación rápida de la muestra en el sitio de la toma (ROSE, del inglés, Rapid On- Site Evaluation), disminuyen los tiempos necesarios para la evaluación y el diagnóstico, mejora la calidad de la muestra, disminuye el número de punciones por procedimiento y limita la necesidad de repetir la prueba, lo que hace que el uso combinado de ambas técnicas sea de gran utilidad y cada vez más solicitado en los servicios de imágenes diagnósticas y patología. ROSE, además, permite una clasificación adecuada del material recolectado para cultivos, estudios de citometría de flujo y pruebas moleculares. Particularmente, en los pacientes con nódulos tiroideos, la realización de ROSE durante el procedimiento de evaluación ecográfica y punción, puede garantizar que la muestra extraída sea suficiente y adecuada para el diagnóstico, y, así mismo, permite evaluar la necesidad de estudios complementarios de manera inmediata, brindando un diagnóstico rápido y preciso, disminuyendo los costos relacionados con la repetición del procedimiento y la morbilidad asociada a complicaciones por punciones múltiples


Fine needle aspiration (FNA) is a widely used technique due to its high safety and ease of use. However, when used in combination with Rapid On-Site Evaluation (ROSE), there is a reduction in the time required for evaluation and diagnosis, as well as an improvement in the sample quality, a reduction in the number of needle passes and the need to repeat the test, which makes the combined use of both techniques very useful and increasingly requested in the diagnostic imaging and pathology services. ROSE also allows a proper classification of the collected material for cultures, flow cytometry studies and molecular tests. Particularly in patients with thyroid nodules, the performance of ROSE during the ultrasound evaluation and biopsy procedure can guarantee that the sample extracted is sufficient and adequate for the diagnosis, and, likewise, an immediate evaluation for the need for complementary studies can be achieved, providing a fast and accurate diagnosis, reducing the costs related to repeating the procedure, and the morbidity associated with complications from multiple biopsies


Subject(s)
Biopsy, Fine-Needle , Pathology , Specimen Handling , Thyroid Nodule , Diagnosis
19.
Clinics ; 76: e2126, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153950

ABSTRACT

OBJECTIVE: In our organization, it has been necessary in our organization to calculate the risk categories according to the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) classification systems for each patient, from the year 2019; these are also required to be registered in the database. This creates a barrier to medical collaboration in everyday radiological practice because using multiple rating systems can be confusing for both readers and patients. For the change in routine practice, this study aimed to compare diagnostic parameters of the ATA, AACE/ACE/AME, and ACR TIRADS classification systems for the detection of suspicious thyroid nodule(s) considering the results of fine-needle aspiration cytopathology as the reference standard. METHODS: Data on ultrasound characteristics (2,000 nodules) and fine-needle aspiration cytopathology (39 nodules) were included in the analysis. The decision making of fine-needle aspiration biopsies was evaluated from the ultrasound characteristics as per the ATA, AACE/ACE/AME, and ACR TIRADS classification systems. RESULTS: The ATA, AACE/ACE/AME, and ACR TIRADS recommended 26, 32, and 37 nodules for fine-needle aspiration biopsies, respectively. Considering the results of fine-needle aspiration cytopathology as the reference standard, the ATA, AACE/ACE/AME, and ACR TIRADS classification systems had 0.993, 0.996, and 0.998 sensitivity, respectively. The accuracies were 0.641, 0.795, and 0.923, respectively. CONCLUSION: The ACR TIRADS classification system is less invasive and can identify suspicious nodules more accurately than that of ATA and AACE/ACE/AME.


Subject(s)
Humans , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , United States , Cross-Sectional Studies , Ultrasonography , Biopsy, Fine-Needle
20.
Oncol. (Guayaquil) ; 30(3): 204-214, Diciembre 30, 2020.
Article in Spanish | LILACS | ID: biblio-1145722

ABSTRACT

Introducción: La citología de nódulos tiroideos es una técnica que, evita procedimientos quirúrgicos innecesarios por lo que se lo ha determinado como primera línea dentro del algoritmo de diagnóstico, el objetivo del estudio fue determinar la sensibilidad y la especificidad de la citología y biopsia por congelación frente al estudio histopatológico en el diagnóstico de nódulos tiroideos en pacientes atendidos en Solca desde el año 2009 -2017. Métodos: Es un estudio de tipo observacional, retrospectivo y de correlación diagnóstica; los datos fueron obtenidos de las historias clínicas de pacientes intervenidos quirúrgicamente por nódulos tiroideos con biopsia por congelación, a quienes se les realizó previamente un estudio citológico en el Departamento de patología de SOLCA de la ciudad de Cuenca, Ecuador. El cálculo del tamaño de la muestra fue de 324 casos. Resultados:324 casos fueron incluidos. El 8.3% correspondió a hombres y el 91.7% a mujeres. La media de la edad fue 51.8 años; la gran mayoría provenían de la provincia Azuay con el 64.8%. En los estudios citológicos el 34.6% (112 casos)corresponden a lesiones inflamatorias benignas; el 11.1% [36 casos]a patologías malignas y 14.2% (46 casos)fueron insatisfactorios. En la biopsia por congelación el mayor porcentaje estuvo concentrado en enfermedades benignas con un 62.6% y 35.5% a lesiones malignas. Hubo 6 casos con el 1.9% en donde fue diferido el criterio diagnóstico. En el histopatológico definitivo el 60.2% (195 casos)fueron patologías benignas y el 39.8% (129 casos)fueron lesiones malignas. La sensibilidad de la PAAF frente a histopatológico es alta con un 91.79%, pero la especificidad es baja con un 51.94%. La sensibilidad y la especificidad de la biopsia por congelación frente a histopatológico es alta con un 98.97% y 90.70% respectivamente lo que le confiere una metodología óptima. Conclusiones: La PAAF de tiroides demuestra ser una metodología útil en el diagnóstico de nódulos, siempre y cuando sea realizada y observada por personal capacitado. La biopsia por congelación constituye una técnica con alta sensibilidad y especificidad que nos permite discriminar lesiones benignas de las malignas. Palabras claves: Nódulo tiroideo, Biopsia con Aguja, Servicio de Patología en Hospital, Oncología Médica, Agencias Voluntarias de Salud, Biología Celular, Biopsia con Aguja Fina


Introduction:Cytology of thyroid nodules is a technique that avoids unnecessary surgical procedures and has therefore been determined as the first line within the diagnostic algorithm.General Objective:To determine the sensitivity and specificity of cytology and freezing biopsy versus histopathological study in the diagnosis of thyroid nodules in patients treated in Solca since 2009 -2017. Methods:This is an observational, retrospective and diagnostic correlation study; the data were obtained from the clinical histories of patients surgically treated by thyroid nodules with freeze biopsy, who underwent a cytological study in the Department of pathology of the city of Cuenca, Ecuador. The calculation of the sample size was 324 cases. Results:8.3% corresponded to men and 91.7% to women. The mean age was 51.8 years; The vast majority came from the province of Azuay with 64.8%. In cytological studies, 34.6% [112 cases]correspond to benign inflammatory lesions; 11.1% [36 cases]to malignant pathologies and 14.2% [46 cases]were unsatisfactory. In the freeze biopsy the greater percentage was concentrated in benign diseases with 62.6% and 35.5% to malignant lesions. There were 6 cases with 1.9% where the diagnostic criterion was deferred. In the definitive histopathological, 60.2% [195 cases]were benign pathologies and 39.8% [129 cases]were malignant lesions. The sensitivity of FNAB to histopathological is high with 91.79%, but the specificity is low with 51.94%. The sensitivity and specificity of freezing versus histopathological biopsy is high with 98.97% and 90.70% respectively, which gives it an optimal methodology. Conclusions: Thyroid PAAF proves to be a useful methodology in the diagnosis of nodules, as long as it is performed and observed by trained personnel. Freezing biopsy is a technique with high sensitivity and specificity that allows us to discriminate benign from malignant lesions. Key words:Thyroid Nodule; Biopsy, Needle;Pathology Department, Hospital; Medical Oncology; Voluntary Health Agencies; Cell Biology; Biopsy, Fine-Needle


Subject(s)
Humans , Pathology Department, Hospital , Biopsy, Needle , Thyroid Nodule , Voluntary Health Agencies , Cell Biology , Biopsy, Fine-Needle , Medical Oncology
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