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- ItemAcesso aberto (Open Access)Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica(Universidade Federal de São Paulo (UNIFESP), 2017-12-21) Reuter, Kassia Blauth [UNIFESP]; Biscolla, Rosa Paula Mello [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; http://lattes.cnpq.br/3864261034300240; http://lattes.cnpq.br/5447491571580985; http://lattes.cnpq.br/8884909593035829; Universidade Federal de São Paulo (UNIFESP)Prior to the Bethesda System for Reporting Thyroid Cytopathology, there was no standard classification and no reproducible cytological reporting applied for thyroid nodule FNA results. The Bethesda system proposed the classification of cytological results in 6 categories with the aim of standardizing the findings described by different inter-observers while also reporting malignancy rates and a different approach for each category. In this study, the incidence of each cytological category was in accordance with that proposed by the Bethesda classification and literature [3,13]: 11% nondiagnostic (2-20% by literature), 59.8% benign (55-74% by literature), and 7.1% AUS/FLUS (up to 7% by the Bethesda system and 2-18% by literature). The incidences of FN/SFN and SM, compared with the literature, were 8.5% (2-25%) and 5.1% (1-6%), respectively [3,13], but these frequencies are not reported by the Bethesda system [11,12]. The incidence of malignant FNA found in this study (8.2%) was higher than that observed in the literature (2-7%), but this can be expected, as the study was carried out in a thyroid reference center. The Bethesda system proposes that nondiagnostic nodules should be submitted to a second FNA at an appropriate interval and, in many cases (50 to 88%) [11,12], this second FNA allows them to be reclassified in a distinct category. In this study, 27/108 (25%) of nondiagnostic nodules were submitted to a second FNA and 20/27 (74%) were reclassified in a different category: 70% (14/20) benign (41.7% to 87.5% by literature), 20% (4/20) AUS/FLUS, 5% (1/20) FN/SFN and 5% (1/20) SM. Seven of 27 (25.9%) nodules remained classified as nondiagnostic after a second FNA, which is in accordance with the literature (1.2% to 47.9%) [15-18]; however, this finding is higher than that suggested by the Bethesda classification (7-10%) [11,12]. In this study, the comparatively low percentage of nondiagnostic nodules submitted to another FNA, 25% of the total, probably contributes to this result, which could be different if all nondiagnostic nodules had been submitted to a second procedure. Clinical follow-up is recommended for nodules classified as benign. If significant growth or sonographic changes are observed, another FNA should be performed [11, 12]. In this study, 12/587 (2%) benign nodules were submitted to a new FNA: 10/12 (83.3%) remained benign and 2/12 (16.6%) were reclassified as FN/SFN. In the literature, Yang et al. performed a second FNA in 11.7% of benign nodules, with 82.1% remaining benign and 9.1% reclassified in a different category [15]. According to the Bethesda system, AUS/FLUS nodules should be submitted to another FNA at an adequate interval, with the majority of them reclassified in another category [11]. In this study, 50% of AUS/FLUS nodules were reclassified as benign after a second FNA, in accordance with the literature (42.7% to 73.1%), which allows a clinical follow-up approach instead of a surgical procedure [15,21-23]. On the other hand, 9% of AUS/FLUS nodules submitted to a second FNA remained in the same category. This result was in accordance to that proposed by the Bethesda classification (approximately 20%) [11,12] and literature (3.8% to 38.5%) [15,21-23]. In this study, the malignancy rates obtained in each cytological category were in accordance with those proposed by the Bethesda classification and literature: 6% in benign nodules (0-3% by the Bethesda system and 1-10% by literature), 12% in AUS/FLUS (5-15% by the Bethesda system and literature),20.8% in FN/SFN (15-30% by both the Bethesda system and literature), 72.5% in SM (60-75% by both the Bethesda system and literature) and 97.3% in the malignant category (97-99% by both the Bethesda system and literature) [3,11-18,23]. The malignancy rate obtained in the nondiagnostic category was 25.7%, with 67% of the cases being microcarcinomas. This result was in accordance to previous studies published in the literature (10% to 35%) [13-16] but was higher than that proposed by Bethesda system (1 to 4%) [11,12]. One possible reason for this finding is that the majority of nondiagnostic nodules were submitted to surgery before performing a second FNA, due to the presence of other suspicious nodules in the gland or a nodule size greater than 3 cm. If those nodules had been submitted to a second FNA, they probably would have been reclassified in the suspicious category. In conclusion, this study found that the Bethesda system can be applied to the Brazilian population since the frequency of each category and malignancy rates were similar to those described by the classification. However, a higher malignancy rate was observed in a nondiagnostic cytological category. In the presence of a multinodular goiter with a nondiagnostic result and another nodule greater than 3.0 cm or with another suspicious cytological nodule, the occurrence of multifocal tumors should be carefully evaluated.
- ItemAcesso aberto (Open Access)Incidência de malignidade na doença nodular da tiróide com baixa suspeita clínica: estudo observacional prospectivo por dois anos numa coorte de 50 pacientes(Sociedade Brasileira de Endocrinologia e Metabologia, 2004-04-01) Yamazaki, Claudia A. [UNIFESP]; Mamone, Maria da Conceição de Oliveira Carneiro [UNIFESP]; Ikejiri, Elza Setsuku [UNIFESP]; Hidal, Jairo Tabacow [UNIFESP]; Matsumura, Luiza Kimiko [UNIFESP]; Hojaij, Flávio Carneiro [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Abrahão, Márcio [UNIFESP]; Furlanetto, Reinaldo Perrone [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: To study the frequency of malignant lesions in patients with clinically benign thyroid nodules and the value of the repetition of fine needle aspiration biopsy (FNAB). METHODS: Observational and prospective 2-year study in a cohort of 50 patients with clinically benign thyroid nodules. Patients were initially submitted to clinical examination, ultrasound (US) and FNAB1 patients, followed by a second FNAB and US. RESULTS: Palpation is not a good test for diagnosis and follow-up of thyroid nodules. On the other hand, the initial consideration that these patients should harbor benign lesions is a very useful parameter, since 47/50 patients (94%) did not present malignant lesions during the follow-up. FNAB1 and FNAB2 were concordant in 33/39 patients when FNAB1 was negative (85%); 11 patients were operated, 8 by suspicious FNAB and 3 due to nodule growth. We observed 2 patients with non-invasive papillary microcarcinoma and 1 patient with papillary carcinoma outside of the main nodules. CONCLUSION: there was concordance between initial clinical benign diagnosis, FNAB and the follow-up. In one case there was a papillary carcinoma. In addition, ultrasonography should be considered for all patients with suspected thyroid nodules. Finally, we demonstrated that a second cytology usually confirms the result of the first cytology in benign thyroid nodules.
- ItemAcesso aberto (Open Access)Injeção percutânea de etanol no tratamento de nódulos tiroidianos sólidos, císticos e autônomos(Sociedade Brasileira de Endocrinologia e Metabologia, 2003-10-01) Bianchini, Elizabeth X. [UNIFESP]; Ikejiri, Elza S. [UNIFESP]; Mamone, Maria Conceição [UNIFESP]; Paiva, Elias R. [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Furlanetto, Reinaldo P. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Percutaneous ethanol injection (PEI) guided by ultrasound has been used for the treatment of cystic, solid and autonomous thyroid nodules. We present our experience in the treatment of 50 patients with thyroid nodules: 26 solid, 17 cystic and 7 autonomous (AN). Patients were evaluated 1 week, 1, 3, and 6 months and 1 year after PEI. After one year, solid nodules showed a mean 74% volume reduction, and cysts a volume reduction of 92%, with no recurrences. After one year, 5 patients with AN reached clinical and laboratory euthyroidism; the other 2 also became euthyroid, but with subnormal TSH. Recurrence of thyrotoxicosis was not observed and mean nodular reduction was 66%. The procedure was well tolerated by all patients. The results confirm that PEI is a good therapeutic alternative for reduction of solid and cystic thyroid nodules and for the treatment of autonomous nodules.
- ItemSomente MetadadadosMethylation levels of sodium-iodide symporter (NIS) promoter in benign and malignant thyroid tumors with reduced NIS expression(Humana Press Inc, 2013-02-01) Galrao, Ana Luiza Resende; Sodre, Ana Karina de Melo Bezerra; Camargo, Rosalinda Yossie Asato de; Friguglietti, Celso Ubirajara; Kulcsar, Marco Aurelio Vamondes; Lima, Erika Urbano de; Medeiros-Neto, Geraldo; Rubio, Ileana Gabriela Sanchez de [UNIFESP]; Universidade de São Paulo (USP); Santa Catarina Hosp; ICESP; Universidade Federal de São Paulo (UNIFESP)DNA methylation regulates gene expression. Aberrant methylation plays an important role in human tumorigenesis. We have previously detected reduced NIS mRNA expression in thyroid tumors as compared to non-tumor tissues. Thus, in this study we investigated whether the methylation of the CpG-island located in the NIS gene promoter was associated with reduced mRNA expression in thyroid tumors. Methylation levels of 30 pairs of samples from 10 benign and 20 malignant thyroid tumors (T) along with matched non-tumor (NT) areas were determined by semiquantitative methylation specific-PCR. NIS methylation was detected in all samples. Methylation levels and frequencies did not differ between the groups and were not associated with BRAF mutational status. Highest methylation levels and frequencies were detected in the 5' region of the CpG-island decreasing toward the 3' end. Intraindividual analysis (T versus NT) showed high tumor methylation levels in 40 % of the samples in the benign group and 30 % in the malignant group, associated with low NIS mRNA expression. No quantitative correlation was detected between methylation levels and mRNA expression in any the groups. the results of this study showed that methylation of NIS promoter is a very frequent event in both benign and malignant tumors as well as in their surrounding tissues, and characterized a non-homogeneous methylation pattern along the CpG island. Therefore, further investigations involving other sites that may be implicated in methylation regulation of NIS expression are warranted.
- ItemAcesso aberto (Open Access)Nódulos de tireóide e câncer diferenciado de tireóide: consenso brasileiro(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-07-01) Maia, Ana Luiza; Ward, Laura S.; Carvalho, Gisah A.; Graf, Hans; Maciel, Rui Monteiro de Barros [UNIFESP]; Maciel, Léa M. Zanini; Rosário, Pedro W.; Vaisman, Mario; Sociedade Brasileira de Endocrinologia e Metabologia Departamento de Tireóide; Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre Serviço de Endocrinologia; Universidade Estadual de Campinas (UNICAMP); Universidade Federal do Paraná Serviço de Endocrinologia e Metabologia; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Santa Casa de Belo Horizonte Serviço de Endocrinologia Departamento de Tireóide; Universidade Federal do Rio de Janeiro Faculdade de Medicina Hospital Universitário Clementino Fraga FilhoThyroid nodules are a common manifestation of thyroid diseases. It is estimated that ~10% of adults have palpable thyroid nodules with the frequency increasing throughout life. The major concern on nodule evaluation is the risk of malignancy (5-10%). Differentiated thyroid carcinoma accounts for 90% of all thyroid malignant neoplasias. Although most patients with cancer have a favorable outcome, some individuals present an aggressive form of the disease and poor prognostic despite recent advances in diagnosis and treatment. Here, a set of clinical guidelines for the evaluation and management of patients with thyroid nodules or differentiated thyroid cancer was developed through consensus by 8 member of the Department of Thyroid, Sociedade Brasileira de Endocrinologia e Metabologia. The participants are from different reference medical centers within Brazil, to reflect different practice patterns. Each committee participant was initially assigned to write a section of the document and to submit it to the chairperson, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. All committee members further revised and refined the document. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information.
- ItemAcesso aberto (Open Access)Risco de malignidade e acurácia diagnóstica da punção aspirativa por agulha fina nos nódulos tiroidianos com 4 centímetros ou mais(Universidade Federal de São Paulo (UNIFESP), 2020-11-26) Barcelos, Rafaela Norbim [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Martins, João Roberto Maciel [UNIFESP]; http://lattes.cnpq.br/4098629441198157; http://lattes.cnpq.br/3864261034300240; http://lattes.cnpq.br/4464243764865412; Universidade Federal de São PauloIntrodução: O risco de malignidade e a acurácia diagnóstica da punção aspirativa por agulha fina(PAAF) de nódulos tiroidianos (NT) com diâmetros maiores ou iguais a 3-4 cm permanecem controversos naliteratura. No entanto, alguns grupos têm indicado tratamento cirúrgico nesses pacientes, independentementedos resultados da PAAF. Objetivo: Nosso objetivo foi avaliar a acurácia diagnóstica da PAAF em NT ≥4 cm ese o risco de malignidade for maior nesses pacientes. Pacientes e métodos: Avaliamos retrospectivamente138 pacientes (142 nódulos) que apresentavam NT com diâmetro ≥4 cm e que foram operadosconsecutivamente. Resultados: Os resultados da PAAF foram não diagnósticos em 2,1% dos casos ebenignos em 51,4%. Indicaram atipia de significado indeterminado em 23,9% dos casos, neoplasia folicularem 9,2%, suspeita de malignidade em 8,5% e malignidade em 4,9%. A prevalência de câncer de tiroide, deacordo com a PAAF, foi não diagnóstico ou insatisfatório em 0% dos casos, benigno em 4,1%, atipia designificado indeterminado ou lesão folicular de significado indeterminado em 17,6%; neoplasia folicular oususpeita de neoplasia folicular em 7,7%, suspeita de malignidade em 33,3% e malignidade em 100%. Odiagnóstico global de malignidade foi de 14,8% (n = 21). No entanto, a taxa de falsos negativos para PAAF foibaixa (4,1%). Conclusão: Mostramos que o risco de malignidade em nódulos com diâmetros ≥4 cm foi maiorem comparação com o risco de câncer de tiroide em NT em geral. No entanto, encontramos uma taxa baixade resultados citológicos falso-negativos; portanto, nossos dados não justificam a orientação de ressecção derotina para esses nódulos maiores.