Thyroid FNA cytology: Impact of the COVID-19 pandemic and vaccination in a Brazilian series.

BACKGROUND: The coronavirus disease 2019 pandemic prompted changes in medical practice, with a reduction in cytopathology volumes and a relative increase in the malignancy rate during lockdown and the initial postlockdown period. To date, no study has evaluated the impact of these changes on the volume of rapid on-site evaluation (ROSE) or on the frequency of cases according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories after vaccination. METHODS: Ultrasound-guided thyroid fine-needle aspiration (FNA) and ROSE assessments performed from January 2019 to May 2022 were evaluated retrospectively according to TBSRTC categories for three periods: prepandemic (period 1), from transmission to expansion (period 2), and after vaccination (period 3). RESULTS: There were 7531 nodules from 5815 patients. FNA cases increased throughout the pandemic despite a drop during lockdown. The frequency of TBSRTC categories changed. Nondiagnostic cases had an increase of 18.1% in period 2 and 76.2% after vaccination compared with prepandemic levels. Malignant cases increased from 2.3% to 4.2% in period 2 and to 5.1% in period 3, representing increases of 83.1% and 121.2%, respectively, compared with period 1. Data corrected by time showed increases in categories IV, V, and VI and a decrease in benign nodules during the two pandemic periods. ROSE was performed in 787 cases during the prepandemic period, and there were decreases of 29.4% and 22.8% in periods 2 and 3, respectively. The ROSE-to-category I ratio was reduced significantly after vaccination. CONCLUSIONS: Increased volume with sustained lower benign rates and higher malignant rates before and after vaccination indicate better selection of patients for FNA. A worse adequacy rate was correlated with a decrease in the number of ROSE assessments.

Aplicação e Contribuição do Sistema de Classificação de Bethesda no Diagnóstico de Nódulos de Tireoide Submetidos à Punção Aspirativa por Agulha Fina: uma revisão da literatura / Application and Contribution of the Bethesda Classification System for the Diagnosis of Thyroid Nodules Submitted to Fine Needle Aspiration: a review of the literature

câncer é um problema impactante na saúde pública com estimativa de mais de 20 milhões de casos no mundo para 2025, dentre os quais o de tireoide respondeu em 2012 por 298 mil novos casos, e em 2016, no Brasil, por 6960 casos. Sua principal manifestação é por meio de nódulos na tireoide, que devem ser abordados por PAAF e analisados citologicamente em situações específicas (nódulos frios e maiores que 1 cm) e suspeitas (história clínica favorável, exame físico e exames de imagem com alterações suspeitas) para diferenciar condições benignas (maioria dos nódulos) das malignas (dentre as quais se destacam os carcinomas bem diferenciados), selecionando os casos que merecem seguimento clínico e os que devem ser submetidos à intervenção cirúrgica. A presente revisão da literatura objetivou, nesse contexto, descrever, com base nos estudos vigentes, a aplicação do Sistema Bethesda, instituído em 2007 para uniformizar a nomenclatura citológica dos espécimes de tireoide utilizando critérios citomorfológicos e classificando os achados em categorias, bem como verificar sua contribuição no diagnóstico e na predição do risco de malignidades. Assim, detectou-se que outros sistemas de classificação têm sido utilizados ao redor do mundo, porém o Sistema Bethesda é o de maior aceitação e guarda grandes sensibilidade, especificidade e acurácia no diagnóstico citológico, quando comparado com o diagnóstico histopatológico, e tem boa reprodutibilidade. Diversos estudos demonstraram que os riscos estimados de malignidade nas categorias pelo sistema obtiveram correspondência com os resultados de avaliação dos espécimes cirúrgicos. Ademais a utilização do Sistema permitiu a padronização dos diagnósticos, facilitando a comunicação entre os diversos profissionais envolvidos no manejo das doenças da tireoide

Cancer is a striking public health problem with an estimated 20 million cases worldwide in 2025. In 2012, there were 298,000 new cases of thyroid cancer and, in 2016, there were 6,960 cases in Brazil. The main manifestation of this neoplasm isthyroid nodules, which must be approached by FNA and analyzed cytologically in specific situations (cold nodules and nodules greater than 1 cm) or suspicions conditions (favorable clinical history, physical examination and imaging with suspicious alterations), to distinguish benign conditions (most of the nodules) frommalignance (among which well differentiated carcinomas plays an important role). The cytological assessment is very useful for selecting cases that deserve surgical intervention from those that should undergo clinical follow-up. The present literaturereview aimed to describe, based on current studies, the application of the Bethesda System, instituted in 2007 to standardize the cytological nomenclature of thyroid specimens using cytomorphological criteria and classifying the findings into categories, as well as verifying their contribution to the diagnosis and risk prediction of malignancies. Even though other classification systems have been used around the world, but the Bethesda System is the one of better acceptance and keeps great sensitivity, specificity and accuracy in the cytological diagnosis, when compared withthe histopathological diagnosis. Futhermore this system has a good reproducibility. Several studies have shown that the estimated risk of malignancy predicted in Bethesda’s categories corresponded to the results of the surgical specimens evaluation. In addition, the use of the Bethesda System allowed the standardizationof the diagnoses, facilitating the communication between different professionals involved in the management of thyroid diseases

Gallbllader cancer: 10 years of experience at an Amazon reference hospital.

OBJECTIVE: To evaluate the epidemiological aspects of surgical patients with gallbladder cancer (GC) enrolled in a University Hospital in Bethlehem (State of Pará - PA), in the period 1999-2009. METHODS: observational, retrospective, descriptive and analytical study of secondary sources of patients with GC in the period 1999-2009. We analyzed 75 medical records, with 34 patients studied. The information collected was used for the TNM tumor staging of GC and to characterize the clinical and surgical population. RESULTS: 79% were female, mean age 66.2 ± 11 years and duration of symptoms was 10.8 ± 17.2 months, with no statistical relationship with the stage of disease. Pain in right upper quadrant, nausea and jaundice prevailed as signs / symptoms. Gallstones were present in 91% of cases and were positive in 100% of patients with stage I / II. The sensitivity of ultrasound to preoperatively suggest GC was 14.28%. The simplest operation performed was cholecystectomy, with the predominant intraoperative finding being hepatic invasion. Adenocarcinoma was the predominant histologic type, especially for stages III and IV. CONCLUSION: The present study showed high incidence of gallstone disease. Advanced stage adenocarcinoma was the most prevalent. This resulted in a low rate of operations with curative intent, in 30% of the patients, and a mortality rate of 21%. The appreciation of symptoms and early investigation by imaging could facilitate treatment in early stages of GC, providing a better prognosis for patients.

Câncer de vesícula biliar: experiência de 10 anos em um hospital de referência da Amazônia / Gallbllader cancer: 10 years of experience at an Amazon reference hospital

OBJETIVO: Analisar os aspectos epidemiológicos-cirúrgicos dos pacientes com câncer de vesícula biliar (CAVB) atendidos em um Hospital Universitário de Belém/PA, no período de 1999-2009. MÉTODOS: estudo observacional, retrospectivo, descritivo-analítico de fonte secundária dos pacientes com diagnóstico de CAVB, no período de 1999-2009. Foram analisados 75 prontuários, sendo 34 pacientes estudados. As informações coletadas foram utilizadas para o estadiamento tumoral TNM do CAVB e para a caracterização clínico-cirúrgica da população estudada. RESULTADOS: 79 por cento eram do sexo feminino, com média de idade de 66,2±11 anos e tempo de sintomatologia de 10,8±17,2 meses, não obtendo relação estatística com o estadio da doença. Dor no hipocôndrio direito, náuseas e icterícia predominaram como sinais/sintomas. A litíase biliar esteve presente em 91 por cento dos casos, sendo positiva em 100 por cento dos pacientes com estadios I/II. A sensibilidade ultrassonográfica para sugestionar o CAVB no pré-operatório foi 14,28 por cento. A operação mais executada foi a colecistectomia simples, tendo como achado intra-operatório predominante, invasão hepática. O adenocarcinoma foi o tipo histológico preponderante, com destaque para os estadios III e IV. CONCLUSÃO: A série estudada apresentou alta incidência de litíase biliar, o adenocarcinoma com estadio avançado foi o mais prevalente. acarretando um pequeno índice de operações com intenção curativa, 30 por cento dos pacientes operados, e uma taxa de mortalidade de 21 por cento. A valorização dos sintomas e a investigação precoce por exames de imagem poderiam favorecer o tratamento, em fases iniciais do CAVB, proporcionando um melhor prognóstico para os pacientes operados.

OBJECTIVE: To evaluate the epidemiological aspects of surgical patients with gallbladder cancer (GC) enrolled in a University Hospital in Bethlehem (State of Pará - PA), in the period 1999-2009. METHODS: observational, retrospective, descriptive and analytical study of secondary sources of patients with GC in the period 1999-2009. We analyzed 75 medical records, with 34 patients studied. The information collected was used for the TNM tumor staging of GC and to characterize the clinical and surgical population. RESULTS: 79 percent were female, mean age 66.2 ± 11 years and duration of symptoms was 10.8 ± 17.2 months, with no statistical relationship with the stage of disease. Pain in right upper quadrant, nausea and jaundice prevailed as signs / symptoms. Gallstones were present in 91 percent of cases and were positive in 100 percent of patients with stage I / II. The sensitivity of ultrasound to preoperatively suggest GC was 14.28 percent. The simplest operation performed was cholecystectomy, with the predominant intraoperative finding being hepatic invasion. Adenocarcinoma was the predominant histologic type, especially for stages III and IV. CONCLUSION: The present study showed high incidence of gallstone disease. Advanced stage adenocarcinoma was the most prevalent. This resulted in a low rate of operations with curative intent, in 30 percent of the patients, and a mortality rate of 21 percent. The appreciation of symptoms and early investigation by imaging could facilitate treatment in early stages of GC, providing a better prognosis for patients.