Punção aspirativa de tireóide com agulha fina em um hospital geral: estudo de 754 punções

Abstract

A punção aspirativa com agulha fina (PAAF) é considerada o método diagnóstico inicial e o de melhor relação custo-benefício na avaliação da doença nodular da tireóide. Apesar das vantagens do procedimento, o sucesso do método depende da experiência do patologista e da habilidade técnica na obtenção de amostras adequadas. Neste trabalho avaliamos a eficácia do procedimento em um hospital geral de ensino. Foram realizadas 754 punções em um período de 3 anos. Cada nódulo palpável foi aspirado por médicos residentes de endocrinologia com agulha fina por 4 a 6 vezes. O material foi corado pelos métodos de Giemsa e de Papanicolaou. O resultado anatomopatológico foi obtido de 93 pacientes. A PAAF foi realizada em 663 pacientes (613F/50M), com idade média de 50±14 anos (12 a 93). Nos exames citopatológicos, os diagnósti-cos foram: bócio colóide (58,5%), neoplasia folicular ou suspeito (8,2%), tireoidite de Hashimoto (5,3%), carcinoma papilar (2,3%), carcinoma anaplásico (0,4%), carcinoma medular (0,1%) e insatisfatório (25,2% ABSTRACT ABSTRACTFine-needle aspiration (FNA) biopsy is considered the routine initial and the most cost-effective procedure in the evaluation of thyroid nodules. Notwithstanding the advantages of the procedure, it depends heavily on the pathologist's experience and on technical skills to obtain adequate smears. The aim of this paper is to evaluate the procedure efficacy in a general teaching hospital. Smears obtained from 754 FNA were examined over a 3-year period. Each palpable nodule was aspirated by an endocrinology resident with a fine-needle 4 to 6 times. Material were stained by Giemsa and Papanicolaou techniques. Histopathologic examination was done on 93 patients. FNA biopsy was performed in 663 patients (613F/50M), mean age of 50±14 years (range 12 -93). FNA results were: colloid nodule (58.5%), follicular neoplasm or suspicious (8.2%), Hashimoto's thyroiditis (5.3%), papillary carcinoma (2.3%), anaplastic carcinoma (0.4%), medullary carcinoma (0.1%), and unsatisfactory (25.2%). Neoplasias were detected in 41 (44%) of 93 surgeries undertaken, and most of the carcinomas were of papillary type (65.6%). There were 24% follicular carcinomas among the follicular neoplasms. The

Diagnostic accuracy between fine needle aspiration biopsy (FNA) and pathological examination of the thyroid

“…Regarding benign pathological findings, the colloid goiter was the most prevalent diagnosis, accounting for 57% of 182 patients belonging to this group, followed by follicular adenoma (33%), hyperplasia, thyroiditis and normal parenchyma, which accounted for 8% of patients. These results were similar to those yielded at a study carried out in 2001 in a hospital in Porto Alegre-RS (12) .…”

ROSE: Alternative for Cancelled and Inconclusive Cytopathologic Examinations, as Well as Professional Training at the UNESP-Botucatu Veterinary Hospital

“…Several Factors that may interfere and complicate the examination include: heterogeneous composition of tumors, incomplete clinical history, lack of standardization in the methodology, inter-observer variation, irregular distribution, cystic nature, small injuries, difficulties during the collection and presence of necrosis and inflammation [3] [4] [8]. As such, in about 5% to 15% of the cases, the Fine Needle Aspiration (FNA) biopsy did not reach a conclusive diagnosis, not because of the technique itself, but rather because of the inexperience of the pathologist or the characteristics of the injury [4] [8] [9]. Therefore, an alternative to increase quality in these cases is applying the ROSE (Rapid On-Site Evaluation) protocol, which consists in establishing standards to assure the sensitivity and specificity of the cytopathological exam without compromising its inherent quickness, considering all stages of the process, from requisition, collection, processing, reading and interpretation to issuing the diagnosis, as well as the determining of the previous classification of the injury [10].…”

Esclerose: uma opção de tratamento para os nódulos tireoidianos císticos

“…É conhecido que 5% a 7% da população têm um nódulo na tireóide e menos de 10% deles são malignos, os quais têm indicação cirúrgica (1)(2)(3)(4) . As formas convencionais e conservadoras de tratamento do nódulo tireoidiano (NT) benigno têm-se revelado frustrantes para produzir a sua redução e evitar os fenômenos compressivos locais ou mesmo estéticos que eles podem ocasionar (5) .…”