Luiz Martins Collaço

Value of Fine Needle Aspiration in the Diagnosis of Breast Lesions

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.

Estudo das atipias indeterminadas em relação à prevalência e ao percentual de discordância nos casos do Programa de Prevenção do Câncer Uterino do Paraná

BACKGROUND: The Bethesda Pap Smear System introduced two categories of undetermined atypias: atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). The objective of this study is to report the prevalence and the disagreement percentile of ASCUS and AGUS as diagnosed by the Cervical Cancer Screening Program of Parana and revised by the Unit for External Monitoring of Cytology Quality (UEMCQ). METHODS: The UEMCQ revised 65,753 cervical smears during 25 months and all undetermined atypias were selected. These cases were classified according to their agreement or not and then prevalence was obtained. RESULTS: Before the UEMCQ review, the number of undetermined atypias was 4,067 (5.45%); this number decreased to 3,584 after revising the data. Considering the whole sample, the ASCUS rate was 4.91% (3,235) and AGUS corresponded to only 0.51% (338). Most of the reclassified cases presented negative diagnoses (57.32%). The primary grouped diagnoses, including CIN I and HPV, was responsible for 51.1% of undetermined atypias after reclassification. DISCUSSION AND CONCLUSION: Undetermined atypias were the second most frequent among disagreement diagnosis groups.

Câncer de tireóide na infância e adolescência: relato de 15 casos

Thyroid tumors are rare in childhood and adolescence. A retrospective analysis was done of fifteen patients (8 female) with thyroid carcinoma attended in the Pediatric Endocrinology Unit of the HC-UFPR, from February 1988 to March 2003. The most frequent initial complaint was an anterior cervical nodule. Ten patients were papillary carcinoma (PTC) bearers, four had medullary carcinoma (MTC; three of them with MEN-2B) and one had follicular carcinoma. Two patients with MEN-2B have de novo proto-oncogene RET mutation (Met918Thr). Fine needle aspiration (FNA) was performed in ten patients and was malignancy positive in only five of them. All patients underwent total thyroidectomy. Adjuvant radioiodine (131I) therapy was made in ten patients. Two patients died from unrelated diseases. Nine patients presented no clinical or laboratorial evidence of disease; one (PTC) developed recurrence 5 years after initial treatment and three (1 PTC, 2 MTC) have disease evidence yet. Our prognosis and clinical manifestations data are according to the literature. However, MTC prevalence (27%), sex distribution and FNA results differ from the majority of published casuistics, that can be atributed to the number of cases reported here.

Valor da repunção aspirativa na doença nodular benigna de tireóide

This study aimed to verify whether a new fine needle aspiration (FNA) biopsy should be performed in patients who have already been submitted to the procedure with a cytopathologic diagnosis of benign thyroid nodular disease. Forty-one patients with clinical and biochemical diagnosis of nodular goiter were submitted to two fine needle aspiration biopsies with an interval of at least six months, and compared as to their final results and cytopathologic characteristics. Apart the aspiration biopsies the following characteristics were observed (mean±SD): age= 44.3±13.1y; time from initial detection= 5.1±8.1y (median= 2.0 y); nodule volume= 18.6±21.6ml (median= 33.5ml); thyroid volume= 42.8±30.8ml (median= 33.5ml), both based on echography; 24h 131I thyroid uptake= 13.2±5.4%; triiodothyronine (T3)= 142.0±34.5ng/dl; thyroxine (T4)= 8.6±1.5µg/dl; thyrotropin (TSH)= 1.7±1.0mUI/L; thyroglobulin (TG)= 59.3±47.8ng/ml. The study showed the predominance of female (40/41), mixed (23/41) and cold nodules (29/41), with a multinodular pattern (23/41). On cytopathologic evaluation, the second result was identical to the initial one in 40 out of 41 patients (97.6%), in spite of distinct biopsy characteristics in 39 of the 41 patients studied (95.1%), pointing to the heterogeneity of the colloid nodule. We conclude that FNA is a safe procedure for the diagnosis of benign thyroid nodular disease. Differences in the cytopathologic details of the sequential biopsies reveal the large heterogeneous spectrum of the colloid nodule.

A ação dos ácidos graxos de cadeia curta na cicatrização de anastomoses colônicas: estudo experimental em ratos

Short-chain fatty acids (SCFA) derive from the fermentation of fibbers ingested in the diet and act as a cell substrate of the colonic mucosa. The object aim of the present study was to evaluate the action of SCFA in colonic wound healing .Sixteen female rats were used, divided into 2 groups of 8 animals each. In the control group (HC) the animals underwent Hartmann procedure and post-operative infusion of isotonic saline solution per rectum for 7 days. In the experimental group (HA) saline solution was replaced by isomolar solution with SCFA. In the animals of the control group, the average bursting pressure of the rectal stump was 128.37 mm Hg, and 137.25 mm Hg in the experimental group (p=0.5693). Histologic evaluation with hematoxicilin and eosin was similar in both groups studied. The collagen densitometry analysis showed a significantly greater concentration of the mature collagen (type I) in the experimental group when compared with the control group (p=0.0094). Greater concentration of total collagen was found in the experimental group when compared to the control group (p=0.0371). It was concluded that rats who underwent intraluminal infusion of SCFA have greater concentration of mature and total collagen in the suture line of the rectal stump, when compared with to the control group.

Diagnóstico citopatológico de tumores neuroepiteliais pela técnica do esfregaço

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 oases with cytclogical 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.

TRANEXAMIC ACID ACTION ON LIVER REGENERATION AFTER PARTIAL HEPATECTOMY: EXPERIMENTAL MODEL IN RATS

ABSTRACT Background: Different lesions may affect the liver resulting in harmful stimuli. Some therapeutic procedures to treat those injuries depend on liver regeneration to increase functional capacity of this organ. Aim: Evaluate the effects of tranexamic acid on liver regeneration after partial hepatectomy in rats. Method: 40 rats (Rattus norvegicus albinus, Rodentia mammalia) of Wistar-UP lineage were randomly divided into two groups named control (CT) and tranexamic acid (ATX), with 20 rats in each. Both groups were subdivided, according to liver regeneration time of 32 h or seven days after the rats had been operated. The organ regeneration was evaluated through weight and histology, stained with HE and PCNA. Results: The average animal weight of ATX and CT 7 days groups before surgery were 411.2 g and 432.7 g, and 371.3 g and 392.9 g after the regeneration time, respectively. The average number of mitotic cells stained with HE for the ATX and CT 7 days groups were 33.7 and 32.6 mitosis, and 14.5 and 14.9 for the ATX and CT 32 h groups, respectively. When stained with proliferating cell nuclear antigen, the numbers of mitotic cells counted were 849.7 for the ATX 7 days, 301.8 for the CT 7 days groups, 814.2 for the ATX 32 hand 848.1 for the CT 32 h groups. Conclusion: Tranexamic acid was effective in liver regeneration, but in longer period after partial hepatectomy.

O tocoginecologista, o patologista e o exame de Papanicolaou

O câncer do colo (CC) uterino, por se tratar de uma doenca de distribuicao mun-dial e de grande prevalencia entre os paises menos desenvolvidos, tem sido considerado como um dos indicadores de desenvolvimento da saude de um povo. Isto porque, sendo o colo uterino um orgao de facil acesso ao exame especular, considera-se inadmissivel o diagnostico tardio desta doenca, sendo a proporcao de casos invasores um parâmetro da qualidade do servico de saude da populacao

Efeito do ultrasom terapêutico nas anastomoses colônicas. Estudo experimental em ratos

Objetivou-se conhecer a influencia do ultra-som na cicatrizacao colonica em ratos e avaliar os fios de aco e nailon na vigencia desta terapia. Utilizou-se 64 ratos machos Wistar divididos em protocolos. Protocolo 1 com 32 ratos submetidos a anastomose colonica com fio de nailon divididos em 2 grupos C (controle), e T (terapeutico). O grupo T realizou a terapia com ultra-som de alta frequencia, na regiao dorsal. O subgrupo sacrificado no 3o dia, recebeu ultra-som no 1o e 2o dias pos-operatorio. E o no 7o, terapia no 4o, 5o e 6o P.O. No Protocolo 2 anastomoses com aco, subdivididos da mesma forma. E no Protocolo 3 comparou-se os grupos T do nailon e aco. Avaliou-se pressao de ruptura a insuflacao (PRI) e estudo histologico. Resultados: Protocolo 1 no 3o dia a PRI foi maior no grupo T (p=0,001) e no 7o dia nao houve diferenca (p=0,0950). No Protocolo 2 no 3o dia nao houve diferenca na PRI (p=0,3060) e no 7o dia a PRI foi maior no C (p=0,0010). No Protocolo 3 no 3o dia a PRI foi maior no NailonT (p=0,0010) e no 7o dia nao houve diferenca (p=0,3100). Concluiu-se que o ultra-som nao influencia a cicatrizacao de anastomoses feitas com nailon e nao compromete a viabilidade das feitas com aco.

Evaluation of the cicatrization of left colon anastomoses in the presence of peritonitis: an experimental study on rats

To monitor the evolution of anastomoses performed on the distal colon in a situation of experimental peritonitis, 37 Wistar-Tecpar male rats aged 114 to 130 days and weighing on avarage 298 g were divided into two lots: group S (control, N = 18) and group P (experimental, N = 19). P rats were submitted to laparotomy and peritonitis was induced by perforating the cecum with a needle, and S rats were only submitted to manipulation of the cecum. Twenty-four hours later animals were resubmitted to laparotomy and distal colectomy was performed 1.5 cm to the peritoneal reflection. End-to-end anastomosis was performed on a single extramucosal plane using 8 separate stitches with 5-0 polypropylene sutures. The anastomoses were checked on the 3rd and 7th postoperative day. Upon opening the peritoneal cavity, the presence of alterations such as peritonitis or abscesses, adhesions, organs involved, fistulas or dehiscences was reorded. A 4.0 cm segment of the colon containing the anastomosis was resected and rupture pressure was measured. Epithelialization of the mucosal wound was evaluted and the material was studied histopathologically for inflammatory reaction and scar condition. Upon relaparotomy, peritonitis was detected in all P animals and fibrin was observed in the cavity of all animals. Adhesions were present in 2 groups, without significant differences between them. Mean rupture pressure was 108.7 mm Hg in group S and 112.0 mm Hg in group P on the 3rd day and 205.0 mm Hg in group S and 206.6 mm Hg in group P on the 7th day, with no significant difference between groups. Microscopic evolution was similar in the two groups. These results permit us to conclude that peritonitis induced by this method does not modify the healing process of distal colon anastomoses in rats.