RESUMO
ABSTRACT Objective Ultrasound-guided fine-needle aspiration (US-FNA) biopsy has proven to be an accurate and efficient tool in thyroid nodule evaluation. We evaluated whether cell block adds to the diagnostic accuracy of US-FNA. Subjects and methods Three hundred twenty-eight consecutive patients underwent US-FNA, cytology and cell block evaluation. Six slides were prepared for each patient and stained by Papanicolaou and Giemsa techniques. The residual hemorrhagic aspirate in the syringe and needle was fixed in 10% formalin and paraffin-embedded (cell block). The histological sections were examined as a complementary diagnostic tool to US-FNA. Results The study population comprised 89% females and the mean age was 57.4 ± 13.7 years. The mean nodule size was 2.3 ± 1.2 cm. US-FNA cytological results were as follows: Bethesda I, 17.1% (n = 56); Bethesda II, 61.6% (n = 202); Bethesda III, 9.5% (n = 31); Bethesda IV, 5.8% (n = 19); Bethesda V, 2.4% (n = 8), and Bethesda VI, 3.6% (n = 12). Cell blocks were obtained in 100% of cases and were considered diagnostic in 89.6%. Combined cytological and cell block (cyto-cell block) results were as follows: unsatisfactory, 4.3% (n = 14); benign, 72.6% (n = 238); indeterminate, 11.3% (n = 37); follicular lesion, 5.8% (n = 19); suspicious for malignancy, 2.4% (n = 8), and malignant, 3.6% (n = 12). The sensitivity and specificity for cyto-cell block was 100% and 90%, respectively, and the accuracy was 94%. Cyto-cell block analysis reduced the rate of unsatisfactory samples (p < 0.001). Conclusions The cyto-cell block interpretation improved the efficiency of US-FNA. This simple, fast and low-cost technique should be used as an adjunctive test in thyroid nodule evaluation. Arch Endocrinol Metab. 2016;60(4):367-73.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Inclusão em Parafina/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Valores de Referência , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco/métodos , Reações Falso-Negativas , Reações Falso-Positivas , Células Epiteliais da Tireoide/patologiaRESUMO
A hipertensäo pulmonar primária é uma doença rara, caracterizada pelo aumento na resistência vascular pulmonar e na pressäo arterial com deterioraçäo progressiva da funçäo cardíaca e evoluçäo geralmente fatal. Sendo de etiologia desconhecida, seu diagnóstico poder ser firmado apenas após causas reconhecidas de hipertensäo arterial pulmonar terem sido excluídas. Doença pulmonar obstrutiva crônica, embolia pulmonar de repetiçäo, fibrose pulmonar, colagenoses, doenças cardíacas, cirrose hepática e persistência da circulaçäo fetal no recém-nascido säo as causas mais comuns de hipertensäo pulmonar secundária e devem sempre ser investigadas. Ao longo do presente trabalho, enfocou-se a hipertensäo pulmonar primária, buscando levantar, na bibliografia, uma visäo geral da doença, mecanismos responsáveis pelo seu surgimento, manifestaçöes clínicas e tratamentos indicados