Comparación entre la citología por aspiración con aguja fina y la biopsia por congelación en el diagnóstico de las neoplasias malignas de la glándula tiroides: un estudio prospectivo
DOI:
https://doi.org/10.30944/20117582.226Palabras clave:
neoplasias de la tiroides, biopsia con aguja fina, secciones por congelación, citología, diagnóstico, sensibilidad y especificidadResumen
Introducción. La citología obtenida mediante aspiración con aguja fina (cACAF) y la biopsia por congelación, se consideran actualmente pilares en el diagnóstico de las enfermedades nodulares de la glándula tiroides. El objetivo del presente estudio fue comparar su rendimiento en el diagnóstico de las neoplasias malignas de la glándula tiroides en la E.S.E. Hospital Universitario del Caribe.
Materiales y métodos. En forma prospectiva, entre abril de 2014 y junio de 2015, se compararon los resultados de cada una de las citologías y biopsias obtenidas por un radiólogo y un cirujano de cuello con los del estudio anatomo-patológico. Se calcularon la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, la precisión diagnóstica, y la frecuencia de falsos positivos y falsos negativos. Se utilizó el índice kappa de concordancia para comparar el rendimiento de las citologías y las biopsias.
Resultados. La población de estudio estuvo conformada por 85 pacientes, 92,9 % mujeres, con una edad promedio de 45,3 ± 14,7 años. Los resultados obtenidos para la citología obtenida mediante aspiración con aguja fina y la biopsia por congelación, respectivamente, fueron: sensibilidad, 80,0 % y 90,0 %; especificidad, 98,7 % y 100,0 %; valor predictivo positivo, 88,9 % y 100,0 %; valor predictivo negativo, 97,4 % y 98,7 %; precisión diagnóstica, 96,5 % y 98,8 %; porcentaje de falsos positivos, 1,2 % y 0,0 %, y porcentaje de falsos negativos, 2,4 % y 1,2 %; el índice kappa de concordancia fue de 0,952.
Conclusiones. La cACAF y la biopsia por congelación mostraron un índice de concordancia de 0,952 en el diagnóstico de las neoplasias malignas de la glándula tiroides. Dichos resultados no sugieren el uso rutinario de la biopsia por congelación; sin embargo, sí sugieren su implementación en el manejo intraoperatorio de los pacientes con diagnósticos citológicos “sospechosos de malignidad”, para disminuir la frecuencia de falsos positivos.
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https://doi.org/10.1159/000354537
4. NaÏm C, Karam R, Eddé D. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: Methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist. Can Assoc Radiol J. 2013;64:220-5.
https://doi.org/10.1016/j.carj.2012.03.003
5. Harvey AM, Mody DR, Amrikachi M. Thyroid fine-needle aspiration reporting rates and outcomes before and after Bethesda implementation within a combined academic and community hospital system. Arch Pathol Lab Med. 2013;137:1664-8.
https://doi.org/10.5858/arpa.2012-0366-OA
6. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: An appraisal. Ann Intern Med. 1993;118:282-9.
https://doi.org/10.7326/0003-4819-118-4-199302150-00007
7. Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid gland: A 12-year experience with 11,000 biopsies. Clin Lab Med. 1993;13:699-709.
https://doi.org/10.1016/S0272-2712(18)30434-7
8. Gharib H, Goellner JR. Fine-needle aspiration biopsy of thyroid nodules. Endocr Pract. 1995;1:410-7.
https://doi.org/10.4158/EP.1.6.410
9. Pedroza A. Manejo del nódulo tiroideo: revisión de la literatura. Rev Colomb Cir. 2008;43:257-71.
10. Román A, Restrepo L, Alzate C, Vélez A, Gutiérrez J. Nódulo tiroideo, enfoque y manejo. Revisión de la literatura. Iatreia. 2013;26:197-206.
11. Melo-Uribe MA, Sanabria Á, Romero-Rojas A, Pérez G, Vargas EJ, Abaúnza MC, et al. The Bethesda System for Reporting Thyroid Cytopathology in Colombia: Correlation with histopathological diagnoses in oncology and non-oncology institutions. J Cytol. 2015;32:12-6.
https://doi.org/10.4103/0970-9371.155224
12. Herrera F, Castañeda S, Contreras S, Fernández A, Pérez E. Rendimiento diagnóstico de la citología por aspiración con aguja fina en pacientes con nódulo tiroideo en la E.S.E. Hospital Universitario del Caribe. Rev Colomb Cir. 2014;29:313-8.
13. Jo VY, Stelow ES, Dustin SM, Hanley KZ. Malignancy risk for fine needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2010;134:450-6.
https://doi.org/10.1309/AJCP5N4MTHPAFXFB
14. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111:508-16.
https://doi.org/10.1002/cncr.23116
15. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111:306-15.
https://doi.org/10.1002/cncr.22955
16. Nayar R, Ivanovic M. The indeterminate thyroid fine‑needle aspiration: Experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute thyroid fine needle aspiration state of the science conference. Cancer 2009;117:195-202.
https://doi.org/10.1002/cncy.20029
17. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. J Cytol. 2013;30:94-9.
https://doi.org/10.4103/0970-9371.112650
18. Antic T, Taxy JB. Thyroid frozen section: Supplementary or unnecesary. Am J Surg Pathol. 2013;37:282-6.
https://doi.org/10.1097/PAS.0b013e318267aee6
19. Cibas ES, Syed ZA, Ali SZ. NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658-65.
https://doi.org/10.1309/AJCPPHLWMI3JV4LA
20. Bakhos R, Selvaggi SM, DeJong S, Gordon DL, Pitale SU, Herrmann M, et al. Fine-needle aspiration of the thyroid: Rate and causes of cytohistopathologic discordance. Diagn Cytopathol. 2000;23:233-7.
https://doi.org/10.1002/1097-0339(200010)23:4<233::AID-DC3>3.0.CO;2-L
21. Amrikachi M, Ramzy I, Rubenfeld S, Wheeler TM. Accuracy of fine-needle aspiration of thyroid. Arch Pathol Lab Med. 2001;125:484-8.
22. Khan I, Naz S, Mehmood A, Aziz N. Diagnostic accuracy of fine needle aspiration of thyroid nodule verses biopsy in thyroid lesions. J Ayub Med Coll Abbottabad. 2000;22:174-81.
23. Morgan JL, Serpell JW, Cheng MS. Fine-needle aspiration cytology of thyroid nodules: How useful is it? ANZ J Surg. 2003;73:480-3.
https://doi.org/10.1046/j.1445-1433.2003.02670.x
24. Ko HM, Jhu IK, Yang SH, Lee JH, Nam JH, Juhng SW, et al. Clinico-pathologic analysis of fine needle aspiration cytology of the thyroid. A review of 1,613 cases and correlation with histopathologic diagnoses. Acta Cytol. 2003;47:727-32.
https://doi.org/10.1159/000326596
25. Jogai S, Al-Jassar A, Temmim L, Dey P, Adesina AO, Amanguno HG. Fine needle aspiration cytology of the thyroid: A cytohistologic study with evaluation of discordant cases. Acta Cytol. 2005;49:483-8.
https://doi.org/10.1159/000326192
26. Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T. Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology. 2006;17:251-6.
https://doi.org/10.1111/j.1365-2303.2006.00397.x
27. Chih-En T, Chang-Kuo W, Chin-Sung K, Shih-Tang Y, PinFan C, Wei-Cheng L, et al. Fine needle aspiration cytology of thyroid nodules: Evaluation of diagnostic accuracy. Tzu Chi Med J. 2008;20:296-303.
https://doi.org/10.1016/S1016-3190(08)60054-3
28. Arrechedera-Pacheco C, Oviedo N, Linares Y, Sanabria E, Canozo L. La punción con aguja fina método de estudio diagnóstico en nódulos de la glándula tiroides. Rev Venez Oncol. 2009;21:77-84.
29. Seningen JL, Nassar A, Henry MR. Correlation of thyroid nodule fine-needle aspiration cytology with corresponding histology at Mayo Clinic, 2001-2007: An institutional experience of 1,945 cases. Diagn Cytopathol. 2012;40(Suppl.1):E27-32.
https://doi.org/10.1002/dc.21566
30. Tariq M, Zafar-Iqbal M, Zulifqar-Ali M, Anwar-Ch M, SulmanKhan R, Irum S. FNAC of thyroid nodule: Diagnostic accuracy of fine needle aspiration cytology (FNAC). Professional Med J. 2010;17:589-97.
31. Piana S, Frasoldati A, Ferrari M, Valcavi R, Froio E, Barbieri V, et al. Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18,000 FNAs reported at the same institution during 1998-2007. Cytopathology. 2011;22:164-73.
https://doi.org/10.1111/j.1365-2303.2010.00777.x
32. Sellami M, Tababi S, Mamy J, Zainine R, Charfi A, Beltaief N, et al. Interest of fine-needle aspiration cytology in thyroid nodule. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:159-64.
https://doi.org/10.1016/j.anorl.2011.01.003
33. Jammah A. Evaluation of the accuracy of fine-needle aspiration cytology in the diagnosis of thyroid nodules: A retrospective analysis of data from a tertiary care hospital in Saudi Arabia. Turk Jem. 2012;16:30-3.
https://doi.org/10.4274/Tjem.035135
34. Cheng MS, Morgan JL, Serpell JW. Does frozen section have a role in the operative management of thyroid nodules. ANZ J Surg. 2002;72:570-2.
https://doi.org/10.1046/j.1445-2197.2002.02474.x
35. Wong Z, Mothu C, Craik J, Carter J, Harman CR. Role of intraoperative frozen section in the management of thyroid nodules. ANZ J Surg. 2004;74:1052-5.
https://doi.org/10.1111/j.1445-1433.2004.03266.x
36. Huber GF, Dzieguelewski P, Matheus TW, Warshawski SJ, Kmat LM, Faris P, et al. Intraoperative frozen-section analysis for thyroid nodules: A step toward clarity or confusión? Arch Otolaryngol Head Neck Surg. 2007;133:874-81.
https://doi.org/10.1001/archotol.133.9.874
37. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwing LM, et al. The STARD statement for the reporting studies of diagnostic accuracy: Explanation and elaboration. Ann Intern Med. 2003;138:W1-12.
https://doi.org/10.7326/0003-4819-138-1-200301070-00012-w1
38. Prades JM, Querat C, Dumollard JM, Richard C, Gavid M, Timoshenko AA, et al. Thyroid nodule surgery: Predictive diagnostic value of fine-needle aspiration cytology and frozen section. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130:195-9.
https://doi.org/10.1016/j.anorl.2012.12.005
39. Knezevic-Usaj S, Eri Z, Panjkovic M, Klem I, Petrovic T, Ivkovic-Kapicl T, et al. Diagnostic relevance of the fine needle aspiration cytology in nodular thyroid lesions. Vojnosanit Pregl. 2012;69:555-61.
https://doi.org/10.2298/VSP1207555K
40. Haberal AN, Toru S, Özen Ö, Arat Z, Bilezikci B. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: Correlation with histopathology in 260 cases. Cytopathology. 2009;20:103-8.
https://doi.org/10.1111/j.1365-2303.2008.00594.x
41. Bista M, Toran KC, Regmi D, Maharjan M, Kafle P, Shrestha S. Diagnostic accuracy of fine needle aspiration cytology in thyroid swellings. J Nepal Health Res Counc 2011;9:14-6.
42. Mandal S, Bardman D, Mukerjee A, Mukherjee D, Saha J, Sinhas R. Fine needle aspiration cytology of thyroid nodules: Evaluation of its role in diagnosis and management. J Indian Med Assoc. 2001;109:258-61.
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2016-01-01
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Osorio , C. .; Fernández, A. .; Ensuncho, C. .; Redondo, K. .; Herrera, F. . Comparación Entre La citología Por aspiración Con Aguja Fina Y La Biopsia Por congelación En El diagnóstico De Las Neoplasias Malignas De La glándula Tiroides: Un Estudio Prospectivo. Rev Colomb Cir 2016, 31, 17-26.
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