RESUMEN
Cystic thyroid nodules are considered to be one of the major causes of nondiagnostic and false-negative results on conventional fine-needle aspiration biopsy, thus limiting the potential of this method for the evaluation of complex (solid-cystic) thyroid nodules. Although ultrasound-guided fine-needle aspiration biopsy has emerged as a highly effective diagnostic method for the assessment of nonpalpable and difficult to palpate nodules, its role in complex nodules has not yet been carefully evaluated. In this study, we report the efficacy of ultrasound-guided fine-needle aspiration biopsy in 124 complex nodules in 113 patients. This method proved to be highly effective, yielding a satisfactory specimen for cytological evaluation in 94% of the nodules, suggesting that it is an excellent modality for the evaluation of complex nodules and also for the reevaluation of those nodules with a nondiagnostic result on conventional fine-needle aspiration biopsy.
Asunto(s)
Biopsia con Aguja/instrumentación , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Nódulo Tiroideo/cirugía , UltrasonografíaRESUMEN
We report an uncommon case of a 20-year-old man, who noted a painless, growing mass in his neck, which appeared in a weekend, associated with moderate dysphagia and weakness. Laboratory examination revealed an elevated serum thyrotropin of 25 mU/L, normal serum triiodothyronine and thyroxine levels, and high titers of antithyroglobulin and antithyroid peroxidase antibodies. The neck lesion showed a depressed iodine uptake in the left thyroid lobe, which had an asymmetrical pseudocystic pattern associated with poor vascularization in the ultrasound scan. Cytologic examination showed a lymphocyte thyroiditis in association with lymphoma of large cell arising from mucosa-associated lymphoid tissue (MALT-lymphoma or maltoma). The patient underwent a left thyroid lobectomy while being treated with levothyroxine for Hashimoto's thyroiditis, and the surgical treatment was further complemented with chemotherapy using fludarabine. The histologic examination confirmed the cytologic findings and the immunohistochemistry showed a B-cell type maltoma. Additional investigation provided no evidence of disease in other tissues. The clinical course has been favorable in the first 2 years of follow-up, with no evidence of local or systemic recurrence of the disease.
Asunto(s)
Linfoma de Células B de la Zona Marginal/complicaciones , Neoplasias de la Tiroides/complicaciones , Tiroiditis Autoinmune/complicaciones , Vidarabina/análogos & derivados , Adulto , Antineoplásicos/uso terapéutico , Autoanticuerpos/sangre , Humanos , Yoduro Peroxidasa/inmunología , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/terapia , Masculino , Tiroglobulina/inmunología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapia , Tiroidectomía , Tiroiditis Autoinmune/diagnóstico , Tiroiditis Autoinmune/tratamiento farmacológico , Tirotropina/sangre , Tiroxina/sangre , Tiroxina/uso terapéutico , Triyodotironina/sangre , Vidarabina/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate the accuracy values of 276 fine needle aspriations (FNA) of breast lesions with a subsequent excisional biopsy diagnosis and to make a comparison between 25 studies of the literature using the same criteria to calculate those values. STUDY DESIGN: Cytologic findings were compared with the histologic diagnosis of each mass. The correlation of results was analyzed by a decision-analysis approach, and the following values concerning diagnostic accuracy were calculated in the present study and in 25 other reports: sensitivity, specificity, positive predictive value, negative predictive value, false positive fraction and false negative fraction. To calculate those values, we eliminated unsatisfactory results and assumed that suspicious and positive cytologic findings represented carcinoma of the breast. RESULTS: Comparing our results with the means in the literature (numbers in parenthesis), FNA detected cancer with a sensitivity of 92.1% (87.7%), specificity of 98.6% (94.7%), positive predictive value of 99.4% (92.8%), negative predictive value of 82.1% (90.7%), false positive fraction of 0.6% (7.1%) and false negative fraction of 17.9% (13.4%); in 6.2% of cases the material was unsatisfactory (13.4%). CONCLUSION: All the rates varied enormously between the studies and during the past 13 years. It seems that false positive and false negative fractions tended to diminish and stabilize in more recent years, and specificity and sensitivity underwent a slight increase. The differences between the rates of those studies suggest that FNA of the breast has some unavoidable limitations.
Asunto(s)
Biopsia con Aguja , Enfermedades de la Mama/patología , Neoplasias de la Mama/patología , Femenino , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The objective of the present investigation was to study the evolution of untreated inflammatory disease of the colon as compared to disease treated with an elemental diet plus glutamine, with 5-ASA and with a combination of the three. A total of 120 female Wistar-Tecpar rats aged 180 days and weighing on average 290 g were studied. Inflammatory disease of the colon was induced with 10% acetic acid and the animals were divided at random into four groups of 30 rats each. Group A, which received a standard diet and no type of treatment, was used as control. Group B received an elemental diet supplemented with glutamine. Group C received a standard diet and daily 5-ASA enemas, 15 mg/ml. Group D received an elemental diet supplemented with glutamine plus daily 5-ASA enemas. Ten animals were picked at random from each group and sacrificed on the 7th, 14th and 21st days of treatment after intravenous injection of Evans blue for visualization of the damaged areas. Changes in weight and the macroscopic aspects of the abdominal cavity and the colon were evaluated and the involved segment was resected for macroscopic and microscopic analysis. The highest weight loss occurred in group D animals on the 14th and 21st days. The number of complications was larger in group A animals, with intestinal perforation, peritonitis and death (P = 0.0053). Complications were of equal intensity in groups B and C and no complications were detected in group D. Macroscopic evaluation showed a lower frequency of ulcers on the 7th day in group B (P = 0.0113) and D (P = 0.0294). Group D animals showed a significantly reduced frequency of ulcers on the 14th day (P = 0.0140). Microscopic examination showed a better evolution in groups B (P = 0.0113) and D (P = 0.0294) on the 7th day and in group D on 14th day (P = 0.0105) compared to A. We conclude that the combination of an elemental diet containing glutamine and treatment with 5-ASA leads to more rapid healing of the colon lesions induced by 10% acetic acid in rats.
Asunto(s)
Colitis Ulcerosa/terapia , Alimentos Formulados , Glutamina/uso terapéutico , Hidroxibenzoatos/uso terapéutico , Animales , Femenino , Mucosa Intestinal/patología , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
To evaluate the accuracy of the smear technique in the rapid diagnosis of lesions of the central and peripheral nervous system, intraoperative diagnoses made on cytologic preparations in 307 consecutive cases were compared with the final paraffin section diagnoses. In 92.2% of cases the final diagnosis obtained on paraffin preparations was similar to that made on smears. In this group there were neuroglial tumors, meningiomas and medulloblastomas, among others. In the cases in which the cytologic diagnoses were not confirmed by paraffin sections, the majority of the cases were unlikely to affect immediate neurosurgical management, while in only 0.7% of all cases (n = 2) an incorrect smear diagnosis might have affected the neurosurgical procedure. The cytologic diagnostic criteria are discussed together with the main difficulties in interpretation with this valuable approach to a rapid neurosurgical diagnosis.
Asunto(s)
Neoplasias del Sistema Nervioso/patología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Técnicas de Preparación Histocitológica , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neoplasias del Sistema Nervioso/diagnóstico , Manejo de EspecímenesRESUMEN
We studied 198 cases of neuroepithelial tumours with intra-operative diagnosis made by smears comparing the accuracy rates with the final paraffin section diagnosis. In 90.6% of cases the final diagnosis obtained on paraffin preparations was similar to that made on smears. In the group of cases with cytological diagnosis not confirmed by paraffin sections the majority of cases were unlike to affect immediate neurosurgical management, and represent mainly differences in grading of astrocytomas and mixed gliomas. The cytological diagnostic criteria are discussed together with the main difficulties for the interpretation of this valuable approach to intra-operative neurosurgical diagnosis.