Teresa Cristina Santos Cavalcanti

Adequacy and Diagnostic Accuracy of Aspiration vs. Capillary Fine Needle Thyroid Biopsies

Thyroid nodules can be biopsied by fine needle aspiration (FNA) or fine needle capillary (FNC) biopsies. However, there is controversy on whether one technique is superior to another. In a randomized cytopathologist-blinded cross-sectional study, 260 patients (238 females, age 43.2 ± 12.6) with nodular (82.7%) and diffuse goiter (17.3%) underwent 520 FNAs and 520 FNCs (not guided by ultrasound). Smears were scored for sample adequacy, and diagnosed as malignant, benign, suspicious, or nondiagnostic. Diagnostic accuracy was calculated based on the histological findings of 58 patients submitted to surgery. Intra-technique diagnostic accuracy and sample adequacy was seen in all samples. FNA and FNC provided similar cytological diagnosis, respectively (benign: 75.8% vs. 74.2%, p = 0.600; malignant: 3.8% vs. 3.8%, p = 0.871; suspicious: 10.4% vs. 10.8%, p = 0.913; and nondiagnostic: 10.0% vs. 11.2%, p = 0.598). Adequacy scores were similar by FNA (7.94 ± 2.84) and FNC (7.96 ± 2.81, p = 0.909). The same proportion of adequate or superior samples was seen in both techniques (91.6%). Sensitivity was equal to 85.7% for FNA and 100% for FNC. Similarly, specificity was 100% for both techniques. FNA and FNC provide the similar sample adequacy and diagnostic accuracy. The choice of technique should be based on the operator’s personal preferences and experience.

TSH levels are associated with increased risk of thyroid carcinoma in patients with nodular disease

INTRODUCTION Several studies have shown an increased risk of thyroid malignancies in patients with elevated TSH levels, even if these levels fell within the normal range. The aim of this study was to evaluate the relationship between TSH and risk of malignancy in patients with thyroid nodules. MATERIAL AND METHODS We included 622 patients with thyroid nodules evaluated by fine needle aspiration and/or thyroidectomy and diagnosed by cytology or histology. Clinical and laboratory data, such as gender, weight, ultrasound findings, serum TSH, and free T4, were obtained from medical records or collected during each patients first visit to our centre, prior to any intervention. RESULTS Thyroid cancer was more prevalent in males (p = 0.012) and in patients with a solitary nodule (p < 0.01). Malignant tumours were predominantly solid, whereas benign tumours were solid or mixed (p = 0.053). The carcinoma risk in patients with thyroid nodules increased with increasing serum TSH concentration, with a significant elevation in patients with serum TSH levels above 1.64 mU/L (p < 0.001). This relationship persisted even when the subgroup of patients undergoing thyroidectomy was analysed separately. Patients with follicular lesions presented with significantly higher TSH levels compared to patients with benign cytology (p < 0.001). We also found correlation between elevated TSH and tumour size (p = 0.005). CONCLUSIONS Our results suggest that in patients with nodular thyroid disease the carcinoma risk rose in parallel with serum TSH concentration, with significant increases evident in patients with serum TSH greater than 1.64 mU/L.

Application of genetic testing to define the surgical approach in a sporadic case of multiple endocrine neoplasia type 1

We report the use of a genetic test for therapeutic decision making in a case of primary hyperparathyroidism associated with Cushings disease (CD). A 20-year-old woman was evaluated for gradual weight gain, asthenia, muscle pain, and hypertension. Biochemical and radiologic tests confirmed CD and she underwent transsphenoidal surgery. Immunohistochemistry of the microadenoma was positive for adrenocorticotropic hormone (ACTH). On follow-up, hypercalcemia with high parathyroid hormone (PTH) levels was detected, associated with nephrolithiasis and low bone mineral density in the spine and hip. Parathyroid scintigraphy showed tracer uptake in the inferior region of the left thyroid lobe, and cervical ultrasound showed a heterogeneous nodule in the same area, suggestive of a parathyroid adenoma (PA). Genetic testing detected mutation in the MEN 1 gene and total parathyroidectomy with the implantation of a fragment of one gland in the forearm was performed. Pathology showed a PA and 3 normal parathyroid glands, without hyperplasia, despite the diagnosis of MEN 1. This case illustrates the role of genetic testing in defining the therapeutic approach for sporadic MEN 1.

Ploidy level determination and quantitative chromatin pattern description in pregnancy-associated breast cancers

The present study deals with the characterization of hormone-sensitivity in pregnancy-associated breast cancers (PBCs). Thischaracterization was carried out in 22 PBCs as opposed to 88non-pregnancy-associated breast cancers (NPBCs). For this study, we used thedigital cell image analysis of Feulgen-stained nuclei to assess the type ofhormone-sensitivity. In a previous study it was demonstrated that thechromatin pattern in breast cancers is related to the amounts of estrogenreceptors they contain. Our results demonstrated that the quantitative description of the chromatin pattern by means of 15 parameters (relating tomorphometric, densitometric, and textural features) made it possible toidentify typical cell nuclei populations in the PBC and NPBC groups. Theuse of specific statistical analyses (principal-components anddiscriminant) made it possible to quantify the proportion of each cellnucleus type in the PBCs. Furthermore, of the 22 PBCs under study, 13contained a large majority of cell nuclei whose chromatin pattern wascharacteristic of hormone-sensitive cells, while 5 cases contained a largemajority of typically hormone-insensitive ones. The remaining 4 casescontained a relatively similar proportion of typically hormone-sensitive and insensitive cell nuclei. The quantitative chromatin pattern descriptionthus made it possible to characterize the hormone-sensitivity level inPBCs, whereas DNA ploidy level determination did not enable any suchcharacterization to be carried out. The chromatin pattern assay describedhere, which enables hormone-sensitive pregnancy-associated breast cancersto be identified from hormone-insensitive ones independently frombiochemical assays, should help the physician regarding therapy adaptation.

Ação do bevacizumabe subconjuntival na neovascularização e re-epitelização corneana 25 dias após queimadura química

OBJETIVOS: Avaliar a acao do bevacizumabe subconjuntival em modelo experimental de neovascularizacao em cornea de coelho. Analisar se o modelo de avaliacao empregado e adequado e comparar entre os grupos a extensao dos vasos, inflamacao e re-epitelizacao da cornea. METODOS: Estudo experimental, prospectivo em 20 coelhos submetidos a trauma quimico com hidroxido de sodio a 1 N divididos em dois grupos, Imediatamente apos a queimadura, o grupo tratado recebeu injecao subconjuntival de 0,15 ml (3,75 mg) de bevacizumabe e o grupo controle, injecao subconjuntival de 0,15 ml de soro fisiologico a 0,9%. Apos 25 dias, foi realizada analise fotografica digital para avaliar a extensao e inflamacao/calibre dos vasos segundo criterio pre-estabelecido e estudo histopatologico da cornea, no qual foi avaliado o estado do epitelio e o numero de polimorfonucleares. RESULTADOS: A extensao dos neovasos corneanos foi menor no grupo estudo em relacao ao controle (p<0,001). Nao houve diferenca significativa entre os grupos na inflamacao/calibre dos vasos. A analise histopatologica mostrou que nao ocorreu diferenca entre os grupos nas variaveis estado do epitelio e numero de polimorfonucleares. A analise de concordância para a variavel extensao dos vasos e para a variavel inflamacao/calibre dos vasos teve uma estimativa do coeficiente de Kappa respectivamente de 0,705 e 0,500 indicando bom grau de concordância nas diferentes avaliacoes cegadas, validando o metodo empregado. CONCLUSOES: O modelo de avaliacao foi adequado e pode ser reproduzido para avaliar outras drogas na cornea. O bevacizumabe inibiu a neovascularizacao corneana, porem nao foi eficaz em reduzir o processo inflamatorio. A droga nao atrasou a re-epitelizacao da cornea.