Article

Nódulos de tireóide: valor da ultra-sonografia e da biópsia por punção aspirativa no diagnóstico de câncer

Revista da Associação Médica Brasileira (Impact Factor: 0.93). 06/2003; 49(2). DOI: 10.1590/S0104-42302003000200031
Source: DOAJ

ABSTRACT

Os nódulos de tireóide são um problema clínico comum e a punção aspirativa por agulha fina (PAAF) é o principal exame utilizado para seu diagnóstico diferencial. Recentemente, foi demonstrado que algumas características ultra-sonográficas dos nódulos estão associadas a um maior risco de câncer. Entretanto, não encontramos estudos que avaliassem o desempenho dos dois exames de forma comparativa e/ou complementar. OBJETIVO: Avaliar o desempenho da ultra-sonografia (US), da PAAF e de sua combinação no diagnóstico de câncer em nódulos de tireóide. MÉTODOS: Oitenta pacientes com nódulos únicos ou dominantes, com indicação cirúrgica, foram selecionados dentre 289 pacientes com nódulos tireoidianos atendidos entre março de 1995 e julho de 1997. Os pacientes foram submetidos à PAAF e à US de tireóide por um dos autores. A PAAF foi considerada positiva quando os achados citológicos eram suspeitos ou diagnósticos de câncer. A US foi considerada positiva quando os nódulos apresentavam pelo menos um dos seguintes achados: microcalcificações, hipoecogenicidade ou halo ausente. PAAF e US foram combinados em paralelo (o resultado positivo em qualquer um dos dois exames era considerado indicativo de malignidade) e em série (somente o resultado positivo de ambos os testes indicava presença de malignidade). RESULTADOS: A sensibilidade e a especificidade da PAAF na detecção do câncer em nódulos de tireóide foram, respectivamente, 87% e 62%, e a sensibilidade e a especificidade da US foram, respectivamente, 81% e 70%. A combinação em série dos dois exames (PAAF e US) resultou em sensibilidade de 69% e especificidade de 91%, e a combinação em paralelo (PAAF ou US) apresentou sensibilidade de 94% e especificidade de 52%. CONCLUSÃO: A US pode ser útil na avaliação dos nódulos de tireóide, alternativamente ou em combinações com a PAAF. Como o resultado da US depende da experiência do operador e das características do equipamento, são necessários estudos em diferentes centros para o seu uso na prática clínica.

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Available from: Mauro Antonio Czepielewski, Nov 23, 2015
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