Punção de tireóide: valor da associação de duas técnicas

Abstract

Thyroid Biopsy: Value of the Association of Two Techniques. Thyroid nodules have a high incidence in the population. This study aims to observe the value of the association between the aspiration and nonaspiration biopsy and to compare the obtained cytology by these two techniques. Sixty-one patients with thyroid nodules were selected and underwent ultrasound-guided thyroid biopsies by both techniques. Quality of the obtained material was analyzed by two independent pathologists, according to five criteria. There was no difference between the techniques regarding the sum of the points of the criteria when they were analyzed together or separately (p>0.05). The kappa index between the techniques was very small (k=0.13). There was no significant difference between techniques when they were compared to the sum of the criteria according to the pathologists (p>0.05). The non-aspiration technique was superior to the aspiration one in the hyperechogenic nodules (p<0.05). The techniques provided similar quality material and the association of both techniques reduced the number of false diagnoses.

Comparison of Fine Needle Aspiration and Fine Needle Nonaspiration Cytology of Thyroid Nodules: A Meta-Analysis

“…The results included diagnostically inadequate and superior smears, diagnostic performance (accuracy, sensitivity, specificity, NPV, and PPV), average scores of each parameter, and average total scores of the five parameters of the Mair et al scoring system. Diagnostically inadequate smears collected using both techniques were reported in 12 studies [ 8 , 10 – 14 , 20 , 23 – 27 ], while superior smears collected using both techniques were reported in 11 studies [ 8 , 10 – 14 , 23 – 27 ]. The accuracy of both techniques as confirmed by histopathology was assessed in five studies [ 10 , 15 , 19 – 21 ]; among these, sensitivity, specificity, NPV, and PPV were extracted from four studies [ 10 , 15 , 19 , 21 ], the average score of each of the five parameters was measured for both techniques in five studies [ 8 , 10 , 13 , 24 , 28 ], and the average of the total scores was calculated in five studies [ 8 , 10 , 13 , 14 , 24 ].…”

“…The number of diagnostically superior smears collected via FNAC compared with FNNAC was assessed in 11 studies [ 8 , 10 – 14 , 23 – 27 ]. The proportion of diagnostically superior smears in the FNAC and FNNAC groups ranged from 14.6 to 78.8% and from 12.3 to 79.6% in 11 studies, respectively.…”

“…The proportion of diagnostically superior smears in the FNAC and FNNAC groups ranged from 14.6 to 78.8% and from 12.3 to 79.6% in 11 studies, respectively. Smears unsuitable for diagnosis were collected using both techniques in 12 studies [ 8 , 10 – 14 , 20 , 23 – 27 ]. The proportion of smears unsuitable for diagnosis ranged from 8.1 to 34.0% and from 8.1 to 38.0% in the FNAC and FNNAC groups, respectively.…”

Padrão citológico de punção aspirativa do tecido tireoidiano morfologicamente normal

“…Deve-se questionar o fato de haverem sido utilizadas duas técnicas para a obtenção do material: as punções aspirativa e não-aspirativa. No entanto, trabalhos na literatura mostram que não existe superioridade de uma técnica em relação à outra (23) . Além disso, o mesmo procedimento foi realizado em todos os casos.…”

“…Um outro questionamento que justifica a realização deste trabalho é que as células que vêm no interior da agulha, e servem para fazer o esfregaço, são obtidas pela pressão negativa que se imprime com o êmbolo. No entanto, essas células também são coletadas pelo princípio físico da capilaridade, onde o material aspirado ascende espontaneamente dentro da agulha, numa velocidade que é inversamente proporcional ao seu diâmetro (23) . Assim, ao se puncionar um nódulo tireoidiano situado mais posteriormente, a agulha percorrerá um longo trecho dentro da glândula e, ao chegar ao nódulo, células do tecido tireoidiano normal já estarão no interior da agulha e possivelmente estarão contaminando o material aspirado do nódulo.…”