Avaliação ultra-sonográfica dos nódulos tireóideos: comparação com exame citológico e histopatológico

Abstract

RESUMOO objetivo deste estudo foi avaliar a nossa classificação ultra-sonográfi-ca dos nódulos tireóideos, baseada na ecoestrutura, ecogenicidade, calcificação, contornos e análise do restante do parênquima. De janeiro de 1998 a janeiro de 2002, 2468 pacientes portadores de nódu-los tireóideos foram encaminhados ao nosso serviço para realização de ultra-sonografia e punção aspirativa por agulha fina guiada pelo ultrasom (US-PAAF). De 1039 nódulos considerados benignos ao ultra-som, 998 (96,05%) também apresentaram citologia benigna, 37 (3,6%) tiveram citologia suspeita e somente 4 (0,4%) tiveram citologia maligna. De 153 nódulos considerados suspeitos ao ultra-som, 20 (13,1%) tiveram citologia suspeita e 88 (57,5%) tiveram citologia maligna. Dos 71 nódulos suspeitos ao ultra-som submetidos à cirurgia, 67 (94,3%) tiveram diagnóstico anatomopatológico maligno. Já, dos 58 nódulos considerados benignos, 56 (96,6%) tiveram diagnóstico anatomopatológico benigno. Concluímos que a US-PAAF deve ser realizada em nódulos classificados como indeterminados ou suspeitos ao ultra-som. Nódulos classificados como benignos podem ser acompanhados periodicamente. The purpose of this study was to evaluate our ultrasonographic classification of thyroid nodules, based on echo structure, echogenicity, calcification, margin and analysis of the surrounding parenchyma. From January 1998 to January 2002, 2,468 consecutive patients with thyroid nodules were referred for thyroid ultrasonography and ultrasound-guided fine needle aspiration biopsy (USFNAB) in our Thyroid Unit. Among 1,039 nodules classified as benign on ultrasound, 998 (96.1%) were also benign on cytology, 37 (3.6%) were suspicious and only 4 (0.4%) were malignant. On the other hand, among 153 nodules classified as suspicious on ultrasound, 20 (13.1%) were suspicious and 88 (57,5%) were malignant on cytology. Of the 71 nodules suspicious on ultrasound submitted to surgery, 67 (94.3%) were malignant and 56 (96.6%) of 58 nodules considered benign were benign on pathologic studies. In conclusion, we advocate USFNAB in nodules classified as indeterminate or suspicious. Nodules classified as benign may be followed up at periodic intervals.

Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: accuracy of TIRADS classification system in more than 1000 nodules

“…1 Almost 50% of these cancers consist of carcinomas smaller than 1.0 cm in diameter (microcarcinomas). [1][2][3][4][5][6][7][8][9][10][11] Increased detection of subcentimeter nodules is most likely due to the use of higher resolution ultrasound, whereas detection of microcarcinomas was augmented mainly because of pathological confirmation by fine needle aspiration biopsy (FNAB). [1][2][3]9 On the basis of ultrasound features, thyroid nodules may be categorized into three groups: low, intermediate and high malignancy risk.…”

Ultrasonographic assessment of thyroid volume in oldest-old individuals

“…Thyroid ultrasonography is considered an auxiliary method to identify the occurrence and prognosis of autoimmune thyroid diseases ( 10 - 12 ), and has an important role in identifying individuals at risk of these conditions in epidemiological studies ( 13 , 14 ). Thyroid glands affected with autoimmune disorders may show a hypoechoic pattern ( 15 , 16 ) caused by increased cellularity and a variable degree of lymphocytic infiltration ( 17 ).…”

Avaliação ultra-sonográfica da tiróide, excreção urinária de iodo em escolares de 6 a 14 anos e grau de iodação de sal, em diferentes regiões do estado de São Paulo

“…Assim, a análise da ecogenicidade no exame ultra-sonográfico de tiróide pode ser considerada uma ferramenta de auxílio no diagnóstico das doenças auto-imunes, sendo de grande valia para estudos populacionais (66)(67)(68) .…”