Thesis (M.S.)--University of Michigan, 1950.

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 71-78). Also available in print.

Orientador: Pablo Agustin Vargas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-17T16:28:38Z (GMT). No. of bitstreams: 1 Diaz_KatyaPulido_M.pdf: 2360194 bytes, checksum: f255c5f05264cc8e79ed9c5fb11876ad (MD5) Previous issue date: 2011 / Resumo:A punção aspirativa por agulha fina (PAAF) é um método simples, seguro, rápido e eficaz, amplamente utilizado no diagnóstico citológico de lesões de glândulas salivares. O objetivo deste estudo foi analisar a eficácia e a reprodutibilidade do diagnóstico citológico das neoplasias de glândulas salivares obtidos com a PAAF, realizado através da correlação dos diagnósticos citológicos e histológicos dos espécimes cirúrgicos correspondentes, além de avaliar a concordância e a reprodutibilidade inter-observador dos diagnósticos citológicos. Foram analisados retrospectivamente 236 casos de neoplasias benignas e malignas oriundos do Departamento de Anatomia Patológica do Hospital das Clínicas de São Paulo-FMUSP entre 2000 e 2006. Os resultados encontrados foram submetidos à análise estatística pelo teste do Qui-quadrado de Pearson e a concordância inter-examinadores pelo teste de Kappa. Os valores foram considerados estatisticamente significantes quando o valor de p<0,05. A média de idade dos pacientes foi de 48,8±17,0 anos, com idade mínima e máxima de 13 e 94 anos, respectivamente. A quinta década de vida foi a mais acometida (23,73%) e o gênero feminino foi o mais acometido (60,59%). A glândula parótida foi a localização mais comum (77,54%) (p<0,05), e a neoplasia de glândula salivar mais frequente foi o adenoma pleomorfo (73,86%) (p<0,05). Dos 236 casos, 176 (74,58%) foram avaliados quanto aos aspectos citológicos e histopatológicos e 60 (25,42%) casos foram avaliados apenas quanto aos aspectos citológicos. Dos 176 casos, 9 (5.11%) foram excluídos da análise para a correlação cito-histopatológica, visto que não representaram benignidade ou malignidade no diagnóstico citológico final. Dos 167 casos restantes, detectamos 94,1% de sensibilidade, 100% de especificidade e uma acurácia diagnóstica de 99,4%. A análise da reprodutibilidade dos diagnósticos citológicos inter-observadores apresentou uma concordância estatisticamente significante (p<0,05). A partir dos resultados obtidos pôde-se concluir que a PAAF de neoplasias de glândulas salivares é uma ferramenta eficaz, de alta sensibilidade, especificidade e acurácia diagnóstica quando realizada por patologistas com experiência em citopatologia. O diagnóstico citológico prévio realizado por meio da PAAF possibilitou aos pacientes um melhor planejamento pré-cirúrgico e tratamento. / Abstract: The fine needle aspiration cytology (FNAC) is a simple, safe, fast and effective method widely used on cytologic diagnosis of salivary glands lesions. The objectives of this study were to assess the efficacy and reproducibility of the cytological diagnosis of the salivary glands tumors obtained using FNAC, to correlate the cytological and histological diagnosis of surgical specimens that correspond to each other, also to evaluate the concordance and reproducibility inter-observer of the cytological diagnosis. Two hundred and thirty six cases of benign and malignant salivary tumors were retrospectively analyzed from the files of the Division of Pathology of the Clinics Hospital of Sao Paulo between 2000 and 2006. The results obtained were submitted to statistical analysis by the "Qui-square" test of Pearson and the concordance inter-examining for Kappa. There were 93 male (39.4 %) and 143 female (60.6 %) patients (male to female ratio 1:1.5). Our 236 cases of salivary gland tumors showed a wide age range (13 to 94 years), with a mean of 48.9±17.0 years, and mainly affected the fifth decade of life (23.73%). The female gender was the most affected (60.59%) (p<0.05) and the parotid gland was the main location (77.54%) (p<0.05). Pleomorphic adenoma was the most frequent salivary gland neoplasm (73.86%) (p<0.05). Among the 236 cases analyzed, 176 (74.58%) where evaluated within the cytologic and histopathological aspects and 60 (25.42%) cases where only evaluated within the cytological aspects. Of the 176 cases, 9 (5.11%) counted with an inconclusive cytologic diagnosis and where excluded from the statistical analysis. The diagnostic correlation of 167 (70.76%) cases was carried out and found 94.1% of sensibility, 100% of specificity and 99.4% of diagnostic accuracy. The reproducibility analysis of the inter-observer cytological analysis presented a significant statistical concordance (p<0.05). From the obtained results it can be proved that the FNAC in salivary tumors is an effective tool, of high sensibility, specificity and diagnostic accuracy when applied by experienced pathologists. In the current study, the previous cytological diagnosis performed by the FNAC allowed a better pre-surgical planning and treatment. / Mestrado / Patologia / Mestre em Estomatopatologia

Abstract 1.1 Introduction The over-diagnosis and over-treatment of prostate cancer is a major public health concern, and in 2012 the United States Preventive Services Taskforce (USPSTF) recommended against prostate cancer screening. Prostate cancer is usually detected by performing a prostate biopsy. Previously, many men received a biopsy at the first sign of an elevated cancer risk identified by screening. Currently, physicians have more tools are their disposal to select men for biopsy who are likely to have clinically significant cancers, including repeat prostate specific antigen (PSA) testing, PSA density, PSA velocity, PSA free/total ratio, and age-specific cutoffs. These tests allow physicians to reduce the number of unnecessary biopsies performed on lower risk patients. One would expect that the use of these tests, in addition to more selective screening, would decrease the incidence of prostate biopsies in the population. I hypothesized that in the last 10 years in Ontario: 1) the incidence of prostate biopsy has decreased, 2) the proportion of biopsies that are malignant has increased, and 3) patients receiving biopsies are healthier. 1.2 Methods I performed a secondary analysis of population-based administrative databases. I validated the prostate biopsy procedure code in the Ontario Health Insurance Plan (OHIP) then used this code to create a cohort of Ontario men who received their first prostate biopsy between 1992 and 2012. Crude and age standardized incidence rates of prostate biopsy were determined for each study year. Era-specific inter-censal population estimates from Statistics Canada were used to establish the number of men at risk of biopsy each year. Changes over time in prostate biopsy incidence were examined using negative binomial regression by comparing the biopsy incidence of each year to a referent year expressed as incident density ratios. Similar analyses were performed to examine changes over time in the proportion of biopsies that are malignant and the health status of patients receiving biopsy. Health status was determined by calculating the Aggregated Diagnosis Group (ADG) score for each patient. 1.3 Results The sensitivity of the OHIP prostate biopsy code improved during the study period and was approximately 90% in recent years. The specificity for identifying the first prostate biopsy a patient received was estimated to exceed 95%. The crude and age standardized incidence of prostate biopsy in Ontario gradually increased between 1992 and 2007 and then dropped sharply in 2008 and 2012. Overall, 39% of biopsies were malignant but this proportion increased during the study period. The health status of patients receiving biopsy, as measured by the ADG score, improved over the study period. 1.4 Conclusions This is the first study to report crude and age standardized prostate biopsy incidence in a population. We found that previously rising biopsy rates decreased significantly in 2008 and 2012 in conjunction with changes to the perceived utility of prostate cancer screening. More years of follow up are required to determine if these changes were transient or the start of broad practice changes.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

The detection or exclusion of metastatic liver involvement is critical in the management and prognosis of patients with malignant disease. Noninvasive imaging modalities such as computed tomography, ultrasound, and technetium colloid liver scan are highly sensitive but nonspecific. Serum alkaline phosphatase is of similar value. A blind liver biopsy by the Menghini technique is often done to confirm the diagnosis, but its yield is low. We prospectively evaluated 74 patients using blind Menghini needle biopsy and concurrent Chiba fine-needle aspiration biopsy (FNAB) techniques. A positive diagnosis of malignancy was made in 30 patients (41%). In only 25 (34%) was the diagnosis made by Menghini biopsy, while Chiba FNAB confirmed the diagnosis in all 30 patients. Thus, concurrent use of both needles increased the diagnostic accuracy by 7%. Seven additional patients, considered to have one or more contraindications for the Menghini biopsy, underwent Chiba FNAB alone; the diagnosis was confirmed in all without complication. We conclude that FNAB alone or in combination with Menghini biopsy is valuable and safe in the diagnosis of metastatic liver disease.

No description available.

Abstract not available

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences