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1.
Artículo en Chino | MEDLINE | ID: mdl-34628833

RESUMEN

Objective:To explore the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology(US-FNAC) for thyroid nodules ≥1 cm, and the effect of Hashimoto's thyroiditis(HT) on it. Methods:The clinical data of 1027 cases of thyroid nodules ≥ 1 cm were retrospectively analyzed. Two-dimensional ultrasound, US-FNAC and BRAFV600E gene testing were performed. The postoperative pathological results were used as the criterion. The two dimensional ultrasound examination, clinical characteristics, follow-up results, and BRAFV600E were used to diagnosis for unoperated patients. The diagnostic efficiency of US-FNAC in HT(+) group and HT(-) group was compared, and the factors affecting the diagnostic efficiency were analyzed. Results:Of the 1027 nodules, the cytological results were nondiagnostic/unsatisfactory in 73 nodules(7.1%), benign in 282(27.5%), atypia of undetermined significance/follicular lesion of undetermined significance in 230(22.4%), follicular neoplasm/suspicious for a follicular neoplasm in 20(1.9%), suspicious for malignancy in 120(11.7%), and malignant in 302(29.4%). 515 cases underwent surgery. Among them, 495 were malignant and 20 were benign. 512 cases continued to be followed up without surgery, and the BRAFV600E of them were wild type. Combined with the two dimensional ultrasound examination, clinical features, and follow-up results, they were judged to be benign. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and the false negative rate the of US-FNAC were 98.7%, 98.4%, 99.3%, 99.5%, 97.5%, 0.7% and 1.6%, respectively. The accuracy, sensitivity and negative predictive value of the HT(+) group were 95.5%, 95.4% and 82.8%, respectively, which were lower than that of HT(-) group (99.5%, 99.4%, 99.2% )(P=0.001, 0.018, P<0.001). The false negative rate of the HT(+) group was 4.6%, higher than 0.6% of the HT(-) group(P=0.018), and HT was an risk factor for increased FNR(OR=7.596, 95%CI: 1.452-39.740). Conclusion:US-FNAC is an effective method for the diagnosis of thyroid nodules and it has high sensitivity and specificity in ≥ 1 cm nodules. However, the combination of HT reduces the diagnostic accuracy and HT is a risk factor for increased false negative rate.


Asunto(s)
Enfermedad de Hashimoto , Nódulo Tiroideo , Biopsia con Aguja Fina , Enfermedad de Hashimoto/diagnóstico por imagen , Humanos , Estudios Retrospectivos , Sensibilidad y Especificidad , Nódulo Tiroideo/diagnóstico por imagen , Ultrasonografía Intervencional
2.
BMC Infect Dis ; 21(1): 1069, 2021 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-34654392

RESUMEN

BACKGROUND: Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. METHODS: We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. RESULTS: Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. CONCLUSIONS: Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections.


Asunto(s)
Burkholderia pseudomallei , Melioidosis , Biopsia con Aguja Fina , Niño , Humanos , Malasia/epidemiología , Melioidosis/diagnóstico , Melioidosis/epidemiología , Estudios Retrospectivos
3.
Pan Afr Med J ; 39: 220, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34630832

RESUMEN

Introduction: thyroid nodules are palpable in about 8% of adults. It is necessary to differentiate benign nodules from malignant ones by the non-invasive ultrasonography thereby reducing the frequency of the invasive fine needle aspiration cytology (FNAC). The study assessed the sonographic and FNAC patterns of thyroid nodules for benign and malignant features in a black African population. Methods: this was a hospital-based, cross-sectional study design over a 1-year period in which one hundred and seven (107) consenting patients between 15 to 80 years of age with palpable thyroid masses by convenience sampling, were consecutively recruited to have both thyroid ultrasound scan and FNAC of their thyroid mass sequentially. Frequency, percentages and two-by-two contingency table were employed for data analysis. Results: the sonographic features of the thyroid nodules varied from round 80 (74.8%) to oval 25 (23.4%) masses, the presence of thin peripheral halo 83 (77.6%), heterogeneous echo-pattern 104 (97.2%) with cystic component and peripheral vascularity 75 (70.1%). One hundred and five (98.1%) study participants showed benign features on sonography while two had features suspicious of malignancy; however FNAC result in the same group of patients was suggestive of benign masses in all 107 (100%) patients. Histology however confirmed malignancy in the 2 participants with ultrasound features suggestive of malignant thyroid nodules. Conclusion: ultrasonography is very sensitive in the characterization of thyroid nodules into benign or suspicious for malignancy in black African population.


Asunto(s)
Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Ultrasonografía , Adolescente , Adulto , Grupo de Ascendencia Continental Africana , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adulto Joven
4.
Pan Afr Med J ; 39: 133, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34527149

RESUMEN

Introduction: breast lump is the commonest presentation for both benign and maligant breast conditions. Both ultrasound guided and conventional fine needle aspiration cytology (FNAC) have been used for diagnosing of breast malignancy among patients with palpable breast lumps. This study compared diagnostic utility of ultrasound guided versus conventional FNAC in diagnosing breast malignancies among patients with palpable breast lumps at Bugando Medical Centre. Methods: this was a hospital based cross sectional study with a follow up component that combined both retrospective data (from January 2017 to June 2018) and prospective data (from July 2018 to June 2019). Results: during the study, total of 354 patients (male; female = 1: 32) were enrolled in the study. A total of 134 (37.9%) patients had malignant lesions while 220 (62.1%) of patients had benign lesions confirmed on histology. The diagnostic utility (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) for conventional FNAC was 86.7%, 95.7%, 93.5%, 91.1% and 92.0% with an 8% error margin versus ultrasound guided FNAC all were 100% with a 0% error margin respectively. Conclusion: both ultrasound guided and conventional FNAC show almost perfect agreement with histology. However, ultrasound guided FNAC has a higher diagnostic utility relative to conventional FNAC in diagnosing breast malignancies.


Asunto(s)
Biopsia con Aguja Fina/métodos , Neoplasias de la Mama Masculina/diagnóstico , Neoplasias de la Mama/diagnóstico , Ultrasonografía Intervencional/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama Masculina/patología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estudios Retrospectivos , Sensibilidad y Especificidad , Tanzanía , Adulto Joven
5.
World J Surg Oncol ; 19(1): 292, 2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34583723

RESUMEN

BACKGROUND: Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions METHODS: This is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. We calculated sensitivity, specificity, and accuracy of the methods. We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable. RESULTS: The most sensible method was US (0.59; 95% CI, 0.50-0.69), and the most specific was US coupled with FNAC (0.97; 95% CI, 0.92-0.99). Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC. CONCLUSIONS: Axillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.


Asunto(s)
Neoplasias de la Mama , Axila , Biopsia con Aguja Fina , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Estudios Transversales , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Metástasis Linfática , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Biopsia del Ganglio Linfático Centinela
6.
Anticancer Res ; 41(9): 4417-4422, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34475063

RESUMEN

BACKGROUND/AIM: Ovarian carcinoma is the fifth leading cause of cancer-related deaths in women in the United States. Serous papillary carcinoma is the most common histological type of ovarian carcinoma that often goes undetected until it has spread within the pelvis and abdomen leading to poor prognosis. Translation of next-generation sequencing (NGS) technology into personalized medicine and identification of new potential targets for therapeutic applications may be helpful. CASE REPORT: We report a case of a 59-year-old female who initially presented in the emergency department with increasing abdominal girth, and bloating. Computed tomography showed ascites and omental and pelvic masses. Fine needle biopsy of the omental mass showed high-grade papillary adenocarcinoma consistent with high-grade ovarian serous carcinoma. She was treated with chemotherapy followed by debulking surgery. Primary ovarian serous carcinoma and synchronous primary fallopian tube serous carcinoma with multiple leiomyomas were identified in the surgical specimen. Pleural biopsy was also positive for carcinoma. NGS and programmed death-ligand 1 (PD-L1) expression testing were performed in the ovarian serous carcinoma. The results showed mutations of breast cancer type 1 (BRCA1) and type 2 (BRCA2), tumor protein p53 (TP53) (c.524G>A at pR175H), and heat shock protein 90 alpha family class B member 1 (HSP90AB1) (p.R456C), as well as low RNA expression score of PD-L1. CONCLUSION: Identification of these mutations and PD-L1 abnormality at the diagnosis of ovarian carcinoma may shed light for clinicians to provide targeted therapy with poly (ADP-ribose) polymerase (PARP) inhibitors and immune checkpoint inhibitors for ovarian serous carcinoma. This is the first documented case of ovarian serous carcinoma to have found a HSP90AB1 (p.R456C) mutation.


Asunto(s)
Cistadenocarcinoma Seroso/genética , Neoplasias de las Trompas Uterinas/genética , Proteínas HSP90 de Choque Térmico/genética , Leiomiomatosis/genética , Neoplasias Primarias Múltiples/genética , Neoplasias Ováricas/genética , Biopsia con Aguja Fina , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/cirugía , Procedimientos Quirúrgicos de Citorreducción , Quimioterapia , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Leiomiomatosis/tratamiento farmacológico , Leiomiomatosis/patología , Leiomiomatosis/cirugía , Persona de Mediana Edad , Mutación , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/cirugía , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía , Análisis de Secuencia de ADN , Tomografía Computarizada por Rayos X , Estados Unidos
7.
JNMA J Nepal Med Assoc ; 59(239): 663-666, 2021 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-34508507

RESUMEN

INTRODUCTION: Lateral neck masses present clinically as neoplastic or non-neoplastic lesions of lymph nodes, salivary glands, and thyroid. Non-neoplastic lesions, if evaluated timely, may not transform into malignancy thus reducing clinical burden. A cytomorphological study using fine needle aspiration is a reliable method for the diagnosis of such masses. The aim of this study was to find out the prevalence of non-neoplastic lesions of lateral neck mass specimens received in the Department of Pathology in a tertiary care center. METHODS: This descriptive cross-sectional study was carried out in the Department of Pathology among lateral neck mass specimens of a tertiary care center from January 2019 to December 2020 after obtaining ethical approval from the Institutional Review Committee (Reference no: 155/19). A convenience sampling method was used and data analysis was done in Microsoft Excel 2019. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 300 lateral neck mass specimens, non-neoplastic lesions were found in 246 (82%) (77.7-86.3 at 95% Confidence Interval). The involvement of lymph nodes in 117 (47.6%) was the most common finding followed by thyroid 112 (45.5%). Among non-neoplastic lesions, the cytomorphological features of benign nodular goiter 93 (37.8%) was the most common lesion followed by reactive lymphoid hyperplasia 73 (29.7%). CONCLUSIONS: The study showed that the prevalence of non-neoplastic lesions was similar to that of other national and international studies.


Asunto(s)
Ganglios Linfáticos , Biopsia con Aguja Fina , Estudios Transversales , Humanos , Prevalencia , Centros de Atención Terciaria
8.
Rev Assoc Med Bras (1992) ; 67(4): 511-515, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34495053

RESUMEN

OBJECTIVE: Treatment and follow-up are controversial in patients whose thyroid fine needle aspiration biopsy (FNAB) is reported as atypia of undetermined significance and follicular lesion of uncertain significance (AUS/FLUS). We aimed the efficacy of the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) in preventing unnecessary thyroidectomies in patients with FNA cytology results as AUS/FLUS. METHODS: In Bolu Abant Izzet Baysal University General Surgery Clinic, case series between 2017 and 2020 were analyzed with thyroid operated. Grouping was made according to the result of postoperative pathology: those with benign results after postoperative pathology were classified as Group 1, and those with malignant results after postoperative pathology were classified as Group 2. RESULTS: As a result, 66 patients were found to be AUS/FLUS. A total of 28.8% of AUS/FLUS patients have been determined with cancer. In the statistical analysis of the ACR TI-RADS score between the groups, the ACR TI-RADS score in Group 1 patients (3.36) (SD 0.87) was significantly lower than that in Group 2 patients (4.11) (SD 1.04) (p=0.003). The distribution of the ACR TI-RADS scores of the patients in Group 2 was TR2: 2 (15.4%) patients, TR3: 3 (25%) patients, TR4: 5 (16.1%), TR5: 9 (90%) patients, respectively. CONCLUSION: The ACR TI-RADS score was statistically significant in predicting malignancy in AUS/FLUS patients whose follow-ups and treatments are controversial, and the ACR TI-RADS has a limited role in preventing unnecessary thyroidectomies in patients with AUS/FLUS.


Asunto(s)
Radiología , Neoplasias de la Tiroides , Nódulo Tiroideo , Biopsia con Aguja Fina , Humanos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/cirugía , Estados Unidos
9.
BMC Cancer ; 21(1): 964, 2021 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-34452609

RESUMEN

OBJECTIVE: The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making. METHODS: We retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated. RESULTS: Cytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809-0.953), 100% (95% CI: 0.561-1), 100% (95% CI: 0.938-1), 46.7% (95% CI: 0.223-0.726) and 90.9% (95% CI: 0.848-0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354-0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings. CONCLUSIONS: US-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer.


Asunto(s)
Toma de Decisiones Clínicas , Citodiagnóstico/métodos , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Biopsia del Ganglio Linfático Centinela/métodos , Ultrasonografía/métodos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Femenino , Estudios de Seguimiento , Humanos , Biopsia Guiada por Imagen/métodos , Metástasis Linfática/diagnóstico por imagen , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Neoplasias del Cuello Uterino/diagnóstico por imagen
10.
Medicina (Kaunas) ; 57(7)2021 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-34357003

RESUMEN

Background and Objectives: It is necessary to properly diagnose and manage axillary lymphadenopathy caused by a variety of diseases. This study aimed to evaluate the utility of ultrasound (US)-guided sampling in patients with axillary lymphadenopathy. Materials and Methods: Patients with axillary lymphadenopathy (excluding patients with newly diagnosed breast cancer) who underwent US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at a single center between February 2016 and September 2020 were retrospectively examined. The association between US imaging findings and malignancy was investigated and the diagnostic performance of US-guided sampling was assessed. Results: Fifty-five patients (including eight males) were included in the study; of these, 34 patients (61.8%) were finally diagnosed with a malignant lymph node lesion. Twenty-two patients (40.0%) had undergone FNA and 33 (60.0%) had undergone CNB. Larger short and long axis diameters, thicker lymph node cortex, and the absence of fatty hilum on the US were significantly associated with malignancy (p < 0.05). The diagnostic performance of FNA, CNB, and FNA + CNB was excellent (sensitivity, specificity, and accuracy of 0.909, 0.900, and 0.917 for FNA, 0.958, 1.000, and 0.970 for CNB, and 0.941, 0.952, and 0.945 for FNA + CNB, respectively). Conclusions: US-guided FNA and CNB play an important role in the diagnosis and management of patients with axillary lymphadenopathy.


Asunto(s)
Neoplasias de la Mama , Linfadenopatía , Biopsia con Aguja Fina , Biopsia con Aguja Gruesa , Neoplasias de la Mama/diagnóstico por imagen , Humanos , Linfadenopatía/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , Ultrasonografía Intervencional
11.
Turk J Pediatr ; 63(4): 721-726, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34449157

RESUMEN

BACKGROUND: True thymic hyperplasia (TTH) is characterized as a distinct increase in both size and weight of thymus, which retains normal microscopic and immunohistochemical appearances. Massive true thymic hyperplasia (MTTH) is an extremely rare but significant subtype of TTH in pediatric ages due to its potentially serious consequences. It was reported that the age of cases with MTTH was predominantly between 1 and 15 years, while those before 1 year rarely occurred. By presenting the diagnosis and treatment process of our case as well as reviewing the related literature, we aimed to analyze the clinical characteristics of MTTH for patients younger than 1 year. CASE: A 3-month-old male infant was admitted to our department with a chief complaint of gradually increasing polypnea over 9 days, whose preoperative imaging examination showed a large intrathoracic soft tissue shadow predominantly on the right side. The percutaneous fine-needle biopsy guided by ultrasonography was performed to identify its diagnosis. However, proliferating lymphocytes and Hassall`s corpuscles were seen microscopically in the biopsy tissues, which were immunohistochemically positive for CD3, CD19, CD20, CD99, TdT, PCK and Ki67 ( > 90%). Due to the aggravating symptoms, a second operation with total thymectomy was carried out successfully for this infant, which confirmed the diagnosis of TTH again by both morphological study and immunohistochemical staining from the surgical specimen. CONCLUSIONS: By reviewing the literature, there were only 10 cases with MTTH reported between 1975 and 2020 for children aged < 1 year of life, together with our present one. In MTTH patient`s sex had an obviously male predominance (70%). Nine out of 10 presented initial symptoms or signs related to respiratory system and 6 patients showed respiratory distress. All patients were successfully treated by surgical thymectomy without any postoperative complications. The prognosis of MTTH was very successful.


Asunto(s)
Enfermedades Linfáticas , Hiperplasia del Timo , Adolescente , Biopsia con Aguja Fina , Niño , Preescolar , Humanos , Lactante , Masculino , Pronóstico , Timectomía , Timo , Hiperplasia del Timo/diagnóstico , Hiperplasia del Timo/cirugía
12.
Acta Cytol ; 65(5): 393-402, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34343999

RESUMEN

OBJECTIVE: The aim of the study was to investigate the mutation status of multiple driver genes by RT-qPCR and their significance in advanced lung adenocarcinoma using cytological specimens. MATERIALS AND METHODS: 155 cytological specimens that had been diagnosed with lung adenocarcinoma in the Fourth Hospital of Hebei Medical University were selected from April to November 2019. The cytological specimens included serous cavity effusion and fine-needle aspiration biopsies. Among cytological specimens, 108 cases were processed by using the cell block method (CBM), and 47 cases were processed by the disposable membrane cell collector method (MCM) before DNA/RNA extraction. Ten drive genes of EGFR, ALK, ROS1, BRAF, KRAS, NRAS, HER2, RET, PIK3CA, and MET were combined detected at one step by the amplification refractory mutation system and ABI 7500 RT-qPCR. RESULTS: The purity of RNA (p = 0.005) and DNA (p = 0.001) extracted by using the MCM was both significantly higher than that extracted by using the CBM. Forty-seven cases of fresh cell specimens processed by the MCM all succeeded in multigene detections, while of 108 specimens processed by the CBM, 6 cases failed in multigene detections. Among 149 specimens, single-gene mutation rates of EGFR, ALK, ROS1, RET, HER2, MET, KRAS, NRAS, BRAF, and PIK3CA mutations were 57.71%, 6.04%, 3.36%, 2.68%, 2.01%, 2.01%, 1.34%, 0.67%, 0% and 0% respectively, and 6 cases including 2 coexistence mutations. We found that mutation status was correlated with gender (p = 0.047), but not correlated with age (p = 0.141) and smoking status (p = 0.083). We found that the EGFR mutation status was correlated with gender (p = 0.003), age (p = 0.015) and smoking habits (p = 0.007), and ALK mutation status was correlated with age (p = 0.002). CONCLUSION: Compared with the CBM, the MCM can improve the efficiency of DNA/RNA extraction and PCR amplification by removing impurities and enriching tumor cells. And we speculate that the successful detection rate of fresh cytological specimens was higher than that of paraffin-embedded specimens. EGFR, ALK, and ROS1 mutations were the main driver mutations in patients with advanced lung adenocarcinoma. We speculate that EGFR and ALK are more prone to concomitant mutations, respectively. Targeted therapies for patients with coexisting mutations need further study.


Asunto(s)
Adenocarcinoma/genética , Adenocarcinoma/patología , Biomarcadores de Tumor/genética , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Adulto , Anciano , Quinasa de Linfoma Anaplásico/genética , Biopsia con Aguja Fina , Humanos , Masculino , Persona de Mediana Edad , Proteínas Tirosina Quinasas/genética , Proteínas Proto-Oncogénicas/genética
13.
Acta Cytol ; 65(5): 368-376, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34350849

RESUMEN

INTRODUCTION: There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. MATERIALS AND METHODS: From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as "soft," "hard," or "hard with grittiness." The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. RESULTS: There was a significant correlation between puncture feeling and postoperative pathology (p < 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (p < 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size >1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (p < 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. CONCLUSION: Puncture feeling is of great value during US-FNAC. "Hard" and "hard with grittiness" were indicators for malignancy, while "soft" indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.


Asunto(s)
Punciones , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Biopsia con Aguja Fina/métodos , Citodiagnóstico/métodos , Técnicas Citológicas/métodos , Humanos , Biopsia Guiada por Imagen/métodos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Ultrasonografía/métodos
14.
Med Clin North Am ; 105(5): 827-837, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34391536

RESUMEN

Neck masses are common physical examination findings seen in the outpatient setting but identifying an underlying cause can be challenging. A careful medical history should be obtained, and a thorough physical examination should be performed, which will guide the need for follow-up examination with imaging, biopsies, and specialist referrals. The goal of this article is to provide a working framework to evaluate and manage some of the most common causes of adult neck masses.


Asunto(s)
Cuello/patología , Factores de Edad , Biomarcadores , Biopsia con Aguja Fina , Diagnóstico Diferencial , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Humanos , Cuello/diagnóstico por imagen , Examen Físico , Atención Primaria de Salud
15.
Kyobu Geka ; 74(9): 717-719, 2021 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-34446629

RESUMEN

We report a case of ectopic cervical thymoma that was difficult to differentiate from thyroid tumor. A 69-year-old woman was referred to our hospital with a tumor on the left side of the neck. Fine-needle aspiration cytology could not establish the diagnosis and the surgery was then performed for diagnosis and treatment. Since the intraoperative pathological diagnosis was also inconclusive, thymectomy was performed because of the macroscopic finding suggesting close relation to the thymus. The final pathological diagnosis was type AB thymoma.


Asunto(s)
Timoma , Neoplasias del Timo , Neoplasias de la Tiroides , Anciano , Biopsia con Aguja Fina , Femenino , Humanos , Timectomía , Timoma/diagnóstico por imagen , Timoma/cirugía , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía
16.
Medicina (B Aires) ; 81(4): 611-616, 2021.
Artículo en Español | MEDLINE | ID: mdl-34453804

RESUMEN

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.


Asunto(s)
Carcinoma , Neoplasias de la Tiroides , Nódulo Tiroideo , Biopsia con Aguja Fina , Humanos , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía
18.
Oncol. (Guayaquil) ; 31(2): 155-163, 31 de agosto 2021.
Artículo en Español | LILACS | ID: biblio-1284458

RESUMEN

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.


Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Tiroides , Nódulo Tiroideo , Biopsia con Aguja Fina , Biopsia con Aguja , Estudios Transversales
19.
J Am Soc Cytopathol ; 10(5): 504-509, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34229981

RESUMEN

INTRODUCTION: Cytopathology fellows are required to enter their fine-needle aspiration (FNA) case numbers in an online data collection system, the Accreditation Council for Graduate Medical Education (ACGME) Case Log system. This study reviewed this data to examine trends in FNA case numbers during fellowship training. METHODS: A retrospective review of the ACGME Accreditation Data System (ADS) FNA Case Log data was performed for academic years 2006-2019. For 2006-2016, total and average numbers of FNAs performed per academic year were available. After 2016, data also included the number of programs and trainees, national averages, standard deviation, minimum, median, maximum, and percentiles for the number of FNAs performed. RESULTS: The number of FNAs documented by cytopathology fellows has gradually increased from 2006 (average 10.9) to 2013 (average 18.6) and dramatically increased in 2014 (average 38.0). Averages have remained greater than 30 FNAs documented per academic year since 2014, with some variation. However, a decline was observed in 2019, likely due to the COVID-19 pandemic. CONCLUSIONS: FNA procedures reported in the ACGME Case Log System indicate vast differences in cytopathology fellowship educational experiences and settings. After logging FNAs becoming an ACGME requirement in 2013, the average number of FNAs has been greater than 30 per year and provides some guidance for programs with respect to the number of FNAs being reported by cytopathology fellows nationally.


Asunto(s)
Acreditación , Educación de Postgrado en Medicina , Internado y Residencia , Biopsia con Aguja Fina , COVID-19 , Becas , Femenino , Humanos , Masculino , SARS-CoV-2
20.
Diagn Interv Radiol ; 27(4): 511-518, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34313236

RESUMEN

PURPOSE: In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. METHODS: A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. RESULTS: Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. CONCLUSION: The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.


Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Biopsia con Aguja Fina , Humanos , Estudios Retrospectivos , Nódulo Tiroideo/diagnóstico por imagen , Ultrasonografía
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