Article

The National Cancer Institute Thyroid Fine-Needle Aspiration State-of-the-Science Conference

Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Cancer (Impact Factor: 4.89). 05/2008; 114(2):71-3. DOI: 10.1002/cncr.23343
Source: PubMed
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    ABSTRACT: Artículo original Patología 2011;49(4):243-250 RESUMEN Antecedentes: la biopsia por aspiración de tiroides es una herramienta diagnóstica útil para la evaluación de nódulos tiroideos, permite normar la conducta terapéutica más adecuada. Las lesiones foliculares representan la "zona gris" de la citopatología tiroidea y constituyen un reto diagnóstico, ya que son diversos los factores que influyen para su correcta identificación. Objetivo: establecer que la falta de correlación citohistológica se debe a error de interpretación del citopatólogo y a sobreposición de criterios citológicos. Material y método: se elaboró un estudio retrospectivo de cinco años con pacientes con diagnóstico citológico de lesión folicular, a los que posteriormente se les realizó una tiroidectomía. Se estableció la correlación citohistológica, el análisis de casos discordantes y la descripción de las causas de error diagnóstico. Resultados: se encontraron 212 casos con diagnóstico citológico de lesión folicular; en 46 de éstos se realizó estudio histopatológico. La concordancia fue de 69.6% y la mayoría correspondía a neoplasias malignas. El 57.2% de los casos discordantes se diagnosticó histoló-gicamente como carcinoma papilar, seguido de carcinoma medular (14.3%), carcinoma anaplásico (14.3%), carcinoma poco diferenciado (7.1%) y tiroiditis de Hashimoto (7.1%). Conclusiones: la falta de correlación citohistológica se debió a error de interpretación del citopatólogo en 85.7% de los casos y a sobre-posición de criterios citológicos en 14.3%. No identificamos errores por mala calidad del material. El error de muestreo es difícil evaluarlo por falta de datos clínicos. Palabras clave: lesión folicular, neoplasia folicular, biopsia por aspiración de tiroides, correlación citohistológica. ABSTRACT Background: Fine needle aspiration of thyroid is a useful diagnostic procedure for the evaluation of thyroid nodules. It is necessary for deciding the most appropriate treatment. Follicular lesions represent the "gray zone" of thyroid cytopathology and constitute a diagnosis challenge because of different factors that influence its correct identification.
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    ABSTRACT: BACKGROUND: Fine-needle aspiration remains the primary diagnostic intervention for the evaluation of most thyroid nodules larger than 1-1.5 cm. Although most aspirates provide diagnostic cytology, approximately 15-25% will be classified indeterminate (often referred to as follicular neoplasm, suspicious for carcinoma, or atypical). In such cases, abnormal cellular findings preclude interpretation of benignity, although only a minority will prove cancerous upon final histopathology. Nonetheless, patients with indeterminate aspirates are commonly referred for consideration of hemi- or near-total thyroidectomy. Recently, improved understanding and novel investigation of clinical, radiological, cytological, and molecular factors has allowed improved stratification of cancer risk. CONCLUSION: Although surgery continues to be commonly recommended, strategies for such patients should increasingly seek to define treatment based on the estimation of an individual's thyroid cancer risk in comparison with associated operative risk and morbidity. In doing so, the rate of unnecessary surgical procedures and associated complications can be reduced.
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