Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica
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Data de Publicação: | 2017 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5280141 http://repositorio.unifesp.br/handle/11600/50750 |
Resumo: | Objetivos Geral: Avaliar O Comportamento Da Classificação De Bethesda Na População Brasileira, Utilizando Dados Do Ambulatório De Doenças Da Tiroide Da Universidade Federal De São Paulo - Centro De Referência De Doenças Tiroidianas No Brasil. Específico: Correlacionar Achados Citológicos E Histopatológicos Em Pacientes Submetidos À Cirurgia A Fim De Se Obter As Taxas De Malignidade Referentes A Cada Categoria Citológica De Bethesda, Comparando-As Aos Dados Reportados Na Literatura. |
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http://lattes.cnpq.br/3864261034300240http://lattes.cnpq.br/5447491571580985Reuter, Kassia Blauth [UNIFESP]http://lattes.cnpq.br/8884909593035829Universidade Federal de São Paulo (UNIFESP)Biscolla, Rosa Paula Mello [UNIFESP]Maciel, Rui Monteiro de Barros [UNIFESP]São Paulo2019-06-19T14:58:21Z2019-06-19T14:58:21Z2017-12-21Objetivos Geral: Avaliar O Comportamento Da Classificação De Bethesda Na População Brasileira, Utilizando Dados Do Ambulatório De Doenças Da Tiroide Da Universidade Federal De São Paulo - Centro De Referência De Doenças Tiroidianas No Brasil. Específico: Correlacionar Achados Citológicos E Histopatológicos Em Pacientes Submetidos À Cirurgia A Fim De Se Obter As Taxas De Malignidade Referentes A Cada Categoria Citológica De Bethesda, Comparando-As Aos Dados Reportados Na Literatura.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.Dados abertos - Sucupira - Teses e dissertações (2017)46 f.https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5280141http://repositorio.unifesp.br/handle/11600/50750porUniversidade Federal de São Paulo (UNIFESP)Nodulo tiroidianoClassificação de BethesdaCitologia tiroidianaPunçao aspirativa agulha finaRisco de malignidadeThyroid noduleBethesda rankingThyroid cytologyFine needle aspiration punctureRisk of malignancyAvaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológicaBethesda classification and cytohistological correlation of thyroid nodules in a Brazilian thyroid disease centerinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPEscola Paulista de MedicinaMedicina (Endocrinologia Clínica)TiróideTiróide: Fisiologia e FisiopatologiaORIGINALKASSIA BLAUTH REUTER PDF A.pdfKASSIA BLAUTH REUTER PDF A.pdfDissertação de mestradoapplication/pdf604178https://repositorio.unifesp.br/bitstreams/1701a5ef-fb9c-48b0-b549-dde1c3755936/download96bce91d20da79e132762e1c62634cecMD5111600/507502024-02-01 14:52:55.996oai:repositorio.unifesp.br/:11600/50750https://repositorio.unifesp.brRepositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652024-02-01T14:52:55Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.pt_BR.fl_str_mv |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
dc.title.alternative.en.fl_str_mv |
Bethesda classification and cytohistological correlation of thyroid nodules in a Brazilian thyroid disease center |
title |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
spellingShingle |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica Reuter, Kassia Blauth [UNIFESP] Nodulo tiroidiano Classificação de Bethesda Citologia tiroidiana Punçao aspirativa agulha fina Risco de malignidade Thyroid nodule Bethesda ranking Thyroid cytology Fine needle aspiration puncture Risk of malignancy |
title_short |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
title_full |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
title_fullStr |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
title_full_unstemmed |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
title_sort |
Avaliação retrospectiva de nódulos tiroidianos puncionados em serviço especializado baseada na classificação de Bethesda e correlação citohistológica |
author |
Reuter, Kassia Blauth [UNIFESP] |
author_facet |
Reuter, Kassia Blauth [UNIFESP] |
author_role |
author |
dc.contributor.advisor-coLattes.none.fl_str_mv |
http://lattes.cnpq.br/3864261034300240 |
dc.contributor.advisorLattes.none.fl_str_mv |
http://lattes.cnpq.br/5447491571580985 |
dc.contributor.authorLattes.none.fl_str_mv |
http://lattes.cnpq.br/8884909593035829 |
dc.contributor.institution.pt_BR.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Reuter, Kassia Blauth [UNIFESP] |
dc.contributor.advisor1.fl_str_mv |
Biscolla, Rosa Paula Mello [UNIFESP] |
dc.contributor.advisor-co1.fl_str_mv |
Maciel, Rui Monteiro de Barros [UNIFESP] |
contributor_str_mv |
Biscolla, Rosa Paula Mello [UNIFESP] Maciel, Rui Monteiro de Barros [UNIFESP] |
dc.subject.por.fl_str_mv |
Nodulo tiroidiano Classificação de Bethesda Citologia tiroidiana Punçao aspirativa agulha fina Risco de malignidade |
topic |
Nodulo tiroidiano Classificação de Bethesda Citologia tiroidiana Punçao aspirativa agulha fina Risco de malignidade Thyroid nodule Bethesda ranking Thyroid cytology Fine needle aspiration puncture Risk of malignancy |
dc.subject.eng.fl_str_mv |
Thyroid nodule Bethesda ranking Thyroid cytology Fine needle aspiration puncture Risk of malignancy |
description |
Objetivos Geral: Avaliar O Comportamento Da Classificação De Bethesda Na População Brasileira, Utilizando Dados Do Ambulatório De Doenças Da Tiroide Da Universidade Federal De São Paulo - Centro De Referência De Doenças Tiroidianas No Brasil. Específico: Correlacionar Achados Citológicos E Histopatológicos Em Pacientes Submetidos À Cirurgia A Fim De Se Obter As Taxas De Malignidade Referentes A Cada Categoria Citológica De Bethesda, Comparando-As Aos Dados Reportados Na Literatura. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017-12-21 |
dc.date.accessioned.fl_str_mv |
2019-06-19T14:58:21Z |
dc.date.available.fl_str_mv |
2019-06-19T14:58:21Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
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publishedVersion |
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https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5280141 |
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http://repositorio.unifesp.br/handle/11600/50750 |
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https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5280141 http://repositorio.unifesp.br/handle/11600/50750 |
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openAccess |
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46 f. |
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São Paulo |
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Universidade Federal de São Paulo (UNIFESP) |
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Universidade Federal de São Paulo (UNIFESP) |
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Repositório Institucional da UNIFESP |
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