Objective: The incidence rate and mortality of breast cancer are increasing in Taiwan during recent years. The incidence rate of breast cancer is ranked number one among top ten female cancers, and the mortality of breast cancer is ranked fourth among cause of death for female cancer sufferers. The most common age group for breast cancer is between 40 and 50 years old. Breast cancer causes huge disease burdens for individual, family and society. The breast sonography and fine needle aspiration cytology (FNAC) are common screening methods for breast cancer diagnosis. Nevertheless, little study has focused on the benefits of combing these two methods in clinical application. This study aims to fill such research gap. Method: This study conducted medical chart reviews and collected 2,776 observations that were under breast sonography and FNAC examination from a regional hospital locates in southern Taiwan. The diagnosis categories for sonography include: malignant, benign, and probably benign tumor. The diagnosis categories for FNAC include: malignant, benign, and suspicious for malignant. Results: Among 2,776 observations, there were 555 observations (20%) had operation in the studied hospital. The operation results indicated that 205 (36.9%) observations were with malignant status, and 350 (63.1%) observations were with benign status. The diagnosis categories of both sonography and FNAC were significantly associated with the operation results (p<0.001). The FNAC had specificity in 100%, false positive ratio in zero, and positive predictive value in 100%. The Odds ratios for sonography diagnosis categories, age groups, and tumor sizes were OR=4.132 (95%CI: 1.5¡V11.6), OR=31.957 (95% CI: 3.7¡V272.4), OR=0.457 (95% CI: 0.1¡V1.5), respectively. When combining sonography and FNAC in parallel tests, the diagnosis accuracy was 89.2%, sensitivity was 90.2%, specificity was 88.6%, positive predictive value was 82.2%, and negative predictive value was 93.9%. When combining sonography and FNAC in serial testing, the diagnosis accuracy was 88.1%, sensitivity was 67.8%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 84.1%. Conclusion: Combining sonography and FNAC in breast cancer diagnosis can increase the accuracy, decrease false positive ratio and false negative ratio. These two methods can be conducted during outpatient visit and are fast, accurate and cost-effective tools for breast cancer diagnosis. These two methods particularly appropriate for younger female patients for early screening, early intervention, and may increase the survival rates.

Orientador: Ulisses Frederigue Júnior / Resumo: Realizou-se um estudo retrospectivo de 613 casos de lesões não palpáveis de mama submetidas a punção aspirativa por agulha fina, dirigida por ultra-sonografia (PAAF-US), arquivados em nosso serviço particular de diagnóstico por imagem. Todas as pacientes, antes de realizarem a PAAF-US, submeteram-se a ultra-sonografia mamária para que fossem detectadas e caracterizadas as lesões não palpáveis, a pedido do clínico ou cirurgião dessas pacientes. Antes de iniciarmos a PAAF-US, o imaginologista e o patologista discutiam o caso em questão, analisavam os exames de imagem (mamografia quando havia, e o US das mamas). Assim, no momento da punção, o patologista já estava ciente da impressão diagnóstica do imaginologista. A ultra-sonografia em tempo real orientava o patologista até que o mesmo estivesse com a agulha junto à lesão e começasse a colher o material para análise. Dessa forma, realizávamos a PAAF-US a "4 mãos". Observamos que o número de material considerado inadequado foi baixo, pois o patologista analisava a lâmina por ele mesmo preparada no ato da punção. Neste estudo foram excluídos dos cálculos estatísticos o único caso de material inadequado que representou 0,1% do total de 613 e os achados indeterminados da ultra-sonografia, da PAAF-US e da histologia. Em nosso trabalho, a Sensibilidade e a Especificidade da PAAF-US foi de 100% e não houve caso de falso-positivo ou de falso-negativo. Creditamos esses valores a diversos fatores, tais como a presença do patologista no ato da punção, realizando-a; o triplo diagnóstico onde clínica e imagem são do conhecimento do patologista e, finalmente, a ampla experiência em patologia mamária dos citopatologistas de nossa equipe. A ultrasonografia, em nossa opinião, é um bom método de escolha para orientar procedimentos invasivos de lesões não palpáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A retrospective study done in 613 cases of nonpalpable breast lesions submitted to a fine needle aspiration biopsy (FNAB) by ultrasonography is filed in our diagnosis by image service in a private clinic. All patients, before the FNAB were submitted to a breast ultrasonography so that we could detect and characterize the nonpalpable lesions, which was asked by those patients' physicians or surgeons. Before beginning US-guided fine-needle aspiration biopsy the roentgenologist and pathologist discussed the case in question, they analysed the exams through the image (mammography when there was one, and breast US). So, when the aspiration biopsy was beeing operated the pathologist was awave of the previous diagnosis opinion concluded by the roentgenologist. The ultrasonography in real time guided the pathologist until he had the needle in the lesion and could stard to collect the material for the analyses. In this way, we performed a "4 hand" USFNAB. We also could observe that the amount of material considered insufficient was low, thus the pathologist analysed the lamina by himself, which was prepared during biopsy. In this study we excluded from the statistics results the only case of insufficient material that represented a total of just 0,1% from these 613 patients, and the ones that were found indeterminated in the ultrasonography, from the citology and from histology. In our work, the US-FNAB sensitivity and specificity was 100% and there wasn't any case of false-positive or false-negative. We believe this fact is possible because of several factors, such as: the pathologist assistance during the biopsy, performing it; the triple diagnosis in which the clinic and image are known by the pathologist, and also from the broad experience our staff of cytopathologists have in breast. The ultrasonography, in our opinion, is a good choice... (Complete abstract, click electronic address below) / Mestre

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.

Metastatic carcinomas to the thyroid are quite rare in daily cytology practice. However, when present they may produce a diagnostic dilemma, particularly when they share some morphologic similarities with primary thyroid lesions and when occurring in patients with occult malignant history. Herein, we report a case of metastatic gastric signet ring cell carcinoma to the thyroid. Our patient presented with an isolated right thyroid nodule, which was clinically considered to be a primary thyroid neoplasm. Fine-needle aspiration (FNA) cytology of the nodule revealed a cellular specimen with cohesive fragments and scattered individual neoplastic cells. The neoplastic cells had enlarged nuclei, fine chromatin, and inconspicuous nucleoli. Nuclear crowding, molding, and grooving were prominent. Intranuclear inclusion-like clearance was identified. Some tumor cells also had eccentric nuclei, creating a signet ring cell appearance. The colloid was scant. These cytological features may be seen in cases of papillary thyroid carcinoma or signet ring cell follicular adenoma; however, the presence of the signet ring cells is unusual in primary thyroid lesions and raises the possibility of a metastatic lesion to the thyroid. In our case, the tumor cells were positive for AE1/AE3, mucicarmine, and periodic acid-Schiff, but negative for thyroglobulin and thyroid transcription factor-1. The patient was also found to have a 3.7-cm mass in the distal esophagus/proximal stomach. Biopsy of this mass showed an invasive signet ring cell carcinoma. The purpose of our study is to discuss the cytological features and the differential diagnosis of this unusual thyroid FNA case.

Diagnosis of two distinct malignant entities existing concurrently and at the same location (synchronous malignancy) by fine-needle aspiration (FNA) is unusual but may occur. Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) in particular is associated with an increased incidence of secondary tumor, likely due to associated immunodeficiency. Co-occurrence of some carcinomas such as squamous cell carcinoma (SCC), may show especially aggressive behavior. A 57-year-old Caucasian male presented with recurrent upper extremity lymphedema and diffuse lymphadenopathy ofthe axillary and cervical regions. FNA ofa large cervical lymph node was diagnostic for both atypical lymphocytic proliferation and SCC. Flow cytometric analysis showed the atypical lymphocytic proliferation to be positive for CD5, CD23, CD19, CD20, HLA-DR, CD38, and the population was kappa light chain restricted. These cells were negative for CD-10 and FMC-7 antigens, suggesting a phenotype of B-cell SLL/CLL. We report a rare occurrence of metastatic SCC to a lymph node infiltrated by SLL/CLL. The diagnosis was achieved by a combination of cytomorphologic examination of FNA smears, immunohistochemical staining of cell block material, and flow cytometry on the sample obtained by FNA. To the best of our knowledge, only three cases of SCC metastasis to SLL/CLL diagnosed by FNA have been reported in the English literature. Though rare, awareness of such a possibility and careful cytological examination under the appropriate clinical conditions is warranted.

Thesis (PhD)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Although transthoracic ultrasonography is a well established modality, it is still underutilised by chest physicians. The aim of this research project was to investigate the feasibility, diagnostic yield and safety of ultrasound(US)-assisted transthoracic biopsies performed by clinicians in various settings relevant to daily practice of respiratory medicine. We conducted four clinical trials which are summarised below: 1. In a prospective study on the feasibility of US-assisted transthoracic fine needle aspiration (TTFNA) of drowned lung secondary to a proximal mass lesion, a novel indication for US-assisted TTFNA was described. TTFNA passes >20mm from the visceral pleura had a sensitivity of 74.2% and were also more likely to contain malignant cells than more superficial passes. The surprisingly high yield and the fact that no serious complications were observed validated this approach, which may be an alternative to bronchoscopy. 2. In the largest single-centre study on US-assisted TTFNA with rapid on-site evaluation (ROSE) and cutting needle biopsy (CNB) in the setting of superior vena cava (SVC) syndrome ever reported, we were able to accurately diagnose 96% of all patients who presented with an associated mass lesion that abutted or infiltrated the chest wall. No pneumothoraces or major haemorrhage was caused. We also validated the single-session approach, and were able to conclude that US-assisted TTFNA (with ROSE) is the initial investigation of choice in suspected bronchogenic carcinoma, whereas both TTFNA and CNB need to be performed in all other cases. 3. We continued to validate the novel single-session sequential approach in a study on anterosuperior mediastinal masses. US-assisted TTFNA with ROSE was performed on 45 consecutive patients, immediately followed by CNB where a provisional diagnosis of epithelial carcinoma or probable tuberculosis (TB) could not be established. An accurate cytological diagnosis was made in 73.3%, and was more likely to be diagnostic in epithelial carcinoma and TB than all other pathology (p<0.001). CNB yielded a diagnosis in 88.2%. Overall 93.3% of patients were diagnosed by the single-session approach. No pneumothorax or major haemorrhage was observed. 4. In a prospective study, we compared US-assisted Abrams and Tru-Cut needle biopsies with regard to their yield for pleural TB. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 91.0% of cases and were diagnostic in 81.8%, whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 78.7% (p=0.015) and were diagnostic in 65.2% (p=0.022). In conclusion, we investigated the feasibility of US-assisted biopsies performed by respiratory physicians in various settings, and consistently found acceptable to very high diagnostic yields with minimal complications. Furthermore, we were able to validate a novel indication for US-assisted TTFNA (US-assisted TTFNA of drowned lung), validate the use of a single-session sequential approach (USassisted TTFNA with ROSE followed by CNB where indicated) in at least two clinical settings (SVC syndrome and anterosuperior mediastinal masses) and we were able to show that US-assisted Abrams needle biopsy is superior to Tru-Cut needles biopsy when histological confirmation of TB pleuritis is required. / AFRIKAANSE OPSOMMING: Alhoewel transtorakale ultrasonografie ‘n gevestigde modaliteit is, word dit onderbenut deur pulmonoloë. Die doel van hierdie navorsingsprojek was om die praktiese uitvoerbaarheid, diagnostiese opbrengs en veiligheid van sonargerigte transtorakale biopsies uitgevoer deur klinici in verskeie situasies relevant tot die alledaagse praktyk te ontleed. Ons het vier kliniese proewe uitgevoer wat hieronder opgesom word: 1. In ‘n prospektiewe studie oor die praktiese uitvoerbaarheid van sonargerigte transtorakale fyn naald aspirasie (TTFNA) van areas van obstruktiewe pneumonitis sekondêr tot proksimale massa letsels, is ‘n nuwe indikasie vir sonargerigte TTFNA beskryf. TTFNA aspirasies wat >20mm van die visserale pleura geneem is, het ‘n sensitiwiteit van 74.2% gehad en was meer geneig om maligne selle op te lewer as meer oppervlakkige aspirasies. Die verbasende hoë diagnostiese sensitiwiteit en afwesigheid van ernstige komplikasies het die praktiese waarde van hierdie benadering bevestig. 2. In die grootste studie nog oor sonargerigte TTFNA met spoedige in-teater evalusies (SITE) en sny-naald biopsie (SNB) in die teenwoordigheid van superior vena cava (SVC) sindroom, kon ons 96% van pasiënte wat presenteer het met ‘n geassosieerde massa letsel wat die borskaswand betrek, akkuraat diagnoseer. Geen pneumotoraks of major bloeding is waargeneem nie. Ons kon ook die praktiese uitvoerbaarheid van ‘n enkelsessie benadering bevestig en kon tot die gevolgtrekking kom dat sonargerigte TTFNA (met SITE) die aanvanklike ondersoek van keuse is waar bronguskarsinoom vermoed word, maar dat beide TTFNA en SNB noodsaaklik is in ander gevalle. 3. Ons het voortgegaan om die waarde van die nuwe enkel-sessie benadering te bevestig in ‘n studie oor antero-superior mediastinale massas. Sonargerigte TTFNA met SITE is uitgevoer op 45 pasiënte en in gevalle waar ‘n voorlopige diagnose van epiteliale karsinoom of waarskynlike tuberkulose (TB) nie bevestig kon word nie, is dit onmiddelik gevolg deur SNB. ‘n Akkurate sitologiese diagnose is gemaak in 73.3% van gevalle en meer algemeen in epiteliale karsinoom en TB as ander patologie (p<001). SNB was diagnosties in 88.2%. In 93.3% kon ‘n diagnose verkry word met die enkel-sessie benadering. Geen pneumotoraks of major bloeding is waargeneem nie. 4. In ‘n prospektiewe studie is sonargerigte Abrams naald en Tru-Cut naald biopsies se opbrengs vir pleurale TB met mekaar vergelyk. Pleurale biopsie monsters wat met ‘n Abrams naalde geneem is, het pleurale weefsel in 91.0% gevalle getoon en was diagnosties in 81.8%, vergeleke met Tru-Cut naalde wat slegs in 87.7% pleurale weefsel opgelewer het (p=0.015) en wat net in in 65.2% diagnosties was (p=0.022). Opsommend het ons die praktiese uitvoerbaarheid van sonargerigte biopsies uitgevoer deur pulmonoloë in veskeie kliniese situasies nagevors, en het deurlopend aanvaarbare tot hoë diagnostiese opbrengste gevind met minimale komplikasies. Verder kon ons ‘n nuwe indikasie vir sonargerigte TTFNA beskryf en evalueer (sonargerigte TTFNA van obstruktiewe pneumonitis); ‘n enkel-sessie sekwensiële benadering se waarde bevestig (sonargerigte TTFNA met SITE, gevolg deur SNB waar aangedui) in ten minste twee kliniese situasies (SVC sindroom en anterosuperior mediastinale massas); en was dit moontlik om te bewys dat UK-geleide Abrams naald biopsies superior tot Tru-cut naald biopsies is in die histologiese bevestiging van TB pleuritis.

Thesis (PhD (Pathology. Anatomical Pathology))--University of Stellenbosch, 2009. / Dissertation presented for a PhD degree in anatomical pathology at Stellenbosch University. / ENGLISH ABSTRACT: Expediting a diagnosis of tuberculosis in children, particularly those who are immunocompromised due to HIV/AIDS, is essential, as they are vulnerable to develop severe forms of disease due to their immature or compromised immune systems. A significant percentage of children (8 to 10%) with TB have TB lymphadenitis, in isolation, or in combination with other disease manifestations. Fine needle aspiration biopsy (FNAB) is a simple and minimally invasive procedure well tolerated by children. It may be performed as an outpatient procedure by clinicians as well as nurses, and excellent results can be achieved with training in the correct procedure. The aim of this dissertation was to demonstrate that FNAB may contribute significantly to the diagnosis of mycobacterial lymphadenitis, with particular reference to children TB suspects. We first established that TB lymphadenitis is a common clinical problem in children in TB endemic areas and that FNAB is an efficient simple and effective diagnostic modality in children with peripheral lymphadenopathy. We then proceeded to document the diagnostic yield and time to diagnosis of FNAB compared to conventional laboratory specimens collected in children. We investigated the value of additional diagnostic modalities such as autofluorescence in improving the ability of cytology to make a definitive diagnosis of mycobacterial infection based on cytomorphology and identification of the organism. In countries where organisms such as Mycobacterium bovis BCG and nontuberculous mycobacteria are prevalent, culture with subsequent speciation is essential. The amount of material harvested during FNAB is minuscule, and requires immediate bedside inoculation for optimal yields. We developed an inexpensive and effective transport medium to facilitate mycobacterial culture from FNAB, even if this is collected at an outside facility. It is ideally suited for use in clinics and rural hospitals as it is stable at room temperature, maintains viability of the organism for seven days, and the closed lid format reduces contamination. Mycobacterial culture even using liquid-based media, takes up to 6 weeks, and this delay is unacceptable particularly in children. We developed a Nucleic Acid Amplification Technique (NAAT) using High Resolution Melt Analysis and applied this novel technique to FNAB specimens submitted in transport medium. Although sensitivity remained suboptimal, the technique is highly specific, simple and rapid. Its use could be incorporated into routine microbiology laboratories, to assist with rapid diagnosis while cultures are pending. We collected a solid body of evidence, which will promote the use of FNAB in suspected mycobacterial lymphadenopathy, particularly in children in resource-limited countries. The utilisation of the diagnostic methods identified will expedite speciation and allow early and appropriate initiation of therapy. This is in keeping with Millennium Development Goal 6: to combat TB by early detection of new cases and effective treatment. / AFRIKAANSE OPSOMMING: Kinders met tuberkulose (TB), en veral diegene met gekompromiteerde immuniteit as gevolg van MIV/VIGS, het ‘n verhoogde neiging om ernstige siektebeelde te ontwikkel vanweë hul onvolwasse of gekompromiteerde immuunsisteme. ‘n Spoedige diagnose van TB in kinders is dus noodsaaklik. ‘n Betekenisvolle persentasie van kinders (8 tot 10%) met TB het TB limfadenitis met of sonder meegaande ander siekteverskynsels. Fynnaaldaspirasiebiopsie (FNAB) is ‘n eenvoudige en minimale indringende prosedure wat geredelik deur kinders aanvaar word. Geneeshere en verpleegkundiges wie toepaslike opleiding in die uitvoering van FNAB ontvang het, kan die prosedure op buitepasiënte uitvoer en uitstekende resultate behaal. Die doel van hierdie studie was om aan te toon dat FNAB betekenisvol kan bydra tot die diagnose van mikobakteriële limfadenitis in veral kinders met vermoedelike TB. Daar was eerstens bevestig dat TB limfadenitis ‘n algemene kliniese probleem is in kinders in TB endemiese areas en dat FNAB ‘n doeltreffende, eenvoudige en effektiewe diagnostiese modaliteit is in kinders met perifere limfadenopatie. Vervolgens was FNAB se diagnostiese opbrengs en die tydsverloop tot diagnose vergelyk met dié van konvensionele laboratoriummonsters wat in kinders verkry word. Die bydrae van verdere diagnostiese modaliteite soos outofluoressensie tot ‘n verbetering in sitologie se rol in die diagnose van mikobakteriële infeksie, soos gebaseer op sitomorfologie en identifisering van organismes, is ondersoek. In lande waar organismes soos Mycobacterium bovis BCG en nie-tuberkuleuse mikobakterië heersend is, is kultuur en spesiebepaling noodsaaklik. Die hoeveelheid materiaal wat met FNAB verkry word is baie min en vereis onmiddellike okulasie vir die beste resultate. Tydens hierdie studie is ‘n goedkoop en effektiewe vervoermedium ontwikkel om mikobakteriële kultuur van FNAB verkreë monsters te fasiliteer, selfs al is die monster vanaf ‘n buite fasiliteit bekom. Die vervoermedium is baie geskik vir gebruik in klinieke en plattelandse hospitale. Dit is stabiel by kamertemperatuur, handhaaf lewensvatbaarheid van organismes vir sewe dae, en die geslote dekselformaat verminder kontaminasie. Mikobakteriële kultuur neem tot ses weke, selfs met die gebruik van vloeistofgebaseerde mediums. Sodanige vertraging in die diagnose is veral in kinders onaanvaarbaar. Tydens hierdie studie is ‘n Nukleïnsuur Amplifikasietegniek ontwikkel deur die aanwending van Hoë Resolusie Smeltanalise en is hierdie nuwe tegniek toegepas op FNAB verkreë monsters wat in die vermelde vervoermedium versamel was. Alhoewel sensitiwiteit nie optimaal was nie, is die tegniek baie spesifiek, eenvoudig en vinnig. Dit kan in roetine mikrobiologie laboratoriums gebruik word om vinnige diagnose te bewerkstellig terwyl daar gewag word vir die kultuur se resultaat. Hierdie studie bied omvattende bewys ter ondersteuning van die gebruik van FNAB in veral kinders met vermoedelike mikobakteriële limfadenopatie in lande met beperkte hulpbronne. Die toepassing van die diagnostiese metodes wat in hierdie studie identifiseer is sal spesiebepaling bespoedig en vroegtydige en toepaslike behandeling verseker. Dit stem ooreen met Millennium Ontwikkelingsdoelwit 6: om TB te beveg deur vroeë opsporing van nuwe gevalle en effektiewe behandeling.

Made available in DSpace on 2014-06-11T19:26:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:54:35Z : No. of bitstreams: 1 castro_cacac_me_botfm.pdf: 1691917 bytes, checksum: 9decbdf91d5ccd20c3aedefc1b66c009 (MD5) / Realizou-se um estudo retrospectivo de 613 casos de lesões não palpáveis de mama submetidas a punção aspirativa por agulha fina, dirigida por ultra-sonografia (PAAF-US), arquivados em nosso serviço particular de diagnóstico por imagem. Todas as pacientes, antes de realizarem a PAAF-US, submeteram-se a ultra-sonografia mamária para que fossem detectadas e caracterizadas as lesões não palpáveis, a pedido do clínico ou cirurgião dessas pacientes. Antes de iniciarmos a PAAF-US, o imaginologista e o patologista discutiam o caso em questão, analisavam os exames de imagem (mamografia quando havia, e o US das mamas). Assim, no momento da punção, o patologista já estava ciente da impressão diagnóstica do imaginologista. A ultra-sonografia em tempo real orientava o patologista até que o mesmo estivesse com a agulha junto à lesão e começasse a colher o material para análise. Dessa forma, realizávamos a PAAF-US a “4 mãos”. Observamos que o número de material considerado inadequado foi baixo, pois o patologista analisava a lâmina por ele mesmo preparada no ato da punção. Neste estudo foram excluídos dos cálculos estatísticos o único caso de material inadequado que representou 0,1% do total de 613 e os achados indeterminados da ultra-sonografia, da PAAF-US e da histologia. Em nosso trabalho, a Sensibilidade e a Especificidade da PAAF-US foi de 100% e não houve caso de falso-positivo ou de falso-negativo. Creditamos esses valores a diversos fatores, tais como a presença do patologista no ato da punção, realizando-a; o triplo diagnóstico onde clínica e imagem são do conhecimento do patologista e, finalmente, a ampla experiência em patologia mamária dos citopatologistas de nossa equipe. A ultrasonografia, em nossa opinião, é um bom método de escolha para orientar procedimentos invasivos de lesões não palpáveis... / A retrospective study done in 613 cases of nonpalpable breast lesions submitted to a fine needle aspiration biopsy (FNAB) by ultrasonography is filed in our diagnosis by image service in a private clinic. All patients, before the FNAB were submitted to a breast ultrasonography so that we could detect and characterize the nonpalpable lesions, which was asked by those patients’ physicians or surgeons. Before beginning US-guided fine-needle aspiration biopsy the roentgenologist and pathologist discussed the case in question, they analysed the exams through the image (mammography when there was one, and breast US). So, when the aspiration biopsy was beeing operated the pathologist was awave of the previous diagnosis opinion concluded by the roentgenologist. The ultrasonography in real time guided the pathologist until he had the needle in the lesion and could stard to collect the material for the analyses. In this way, we performed a “4 hand” USFNAB. We also could observe that the amount of material considered insufficient was low, thus the pathologist analysed the lamina by himself, which was prepared during biopsy. In this study we excluded from the statistics results the only case of insufficient material that represented a total of just 0,1% from these 613 patients, and the ones that were found indeterminated in the ultrasonography, from the citology and from histology. In our work, the US-FNAB sensitivity and specificity was 100% and there wasn’t any case of false-positive or false-negative. We believe this fact is possible because of several factors, such as: the pathologist assistance during the biopsy, performing it; the triple diagnosis in which the clinic and image are known by the pathologist, and also from the broad experience our staff of cytopathologists have in breast. The ultrasonography, in our opinion, is a good choice... (Complete abstract, click electronic address below)

Made available in DSpace on 2014-06-11T19:31:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-23Bitstream added on 2014-06-13T21:02:19Z : No. of bitstreams: 1 cunha_gn_dr_jabo.pdf: 465416 bytes, checksum: e2fa65c0170bcd5725dafe063644725b (MD5) / O objetivo deste estudo foi avaliar histologicamente as biópsias testiculares de cães obtidas por punção aspirativa por agulhas fina (PAAF) e “tru cut”. Foram utilizados 40 cães, adultos, hígidos, distribuídos em 2 grupos: G1 - punção biópsia aspirativa; e G2 - biópsia com agulha “tru-cut”. Cada grupo foi dividido em quatro subgrupos (Ga, Gb, Gc e Gd) com cinco animais cada, sendo estes orquiectomizados 3, 7, 14 e 62 dias após as biópsias PAAF ou “Tru-cut”. O material colhido pela PAAF foi submetido à avaliação citológica, e o proveniente da biópsia “tru-cut” e orquiectomia submetidos à histopatologia. Foram avaliados os espermiogramas e mensuração de comprimento e largura do escroto e colhido o soro para pesquisa de anticorpo antiespermatozóides. Referente ao espermiograma e a mensuração do escroto não foram observados diferenças (p>0,05) significativas. A amostra direcionada para citologia e histologia obtida pelas duas técnicas foi considerada de quantidade suficiente para diagnóstico. Na histopatologia a PAAF apresentou menor área de lesão e reação inflamatória comparada a “tru cut”, no entanto esta última apresentou maior quantidade de material, preservando a arquitetura dos túbulos seminíferos e interstício. Não foi observado diferença (p>0,05) na produção de anticorpos anti-espermatozóides, após as biopsias. Concluímos que apesar das biópsias fornecerem material em qualidade e quantidade adequadas, e da PAAF ter se mostrado menos traumática, a escolha da técnica a ser empregada dependerá da finalidade para o qual o material se destina. / The aim of this study it was evaluate hystologicaly the testicular biopsies in dogs obtained by aspirative puncture by fine needle and “tru-cut”. Forty males dogs, adults, healthies were used, distributed in 2 groups: G1 – Fine Needle aspiration; and G2- biopsy by “Tru-cut”. Each group were shared in four groups (Ga, Gb, Gc e Gd) with 5 animals each, and all of then were orchiectomized after 3, 7, 14, 62 days after the biopsies by FNA and “tru-cut” being performed. The samples collected by FNA were submitted to cytology evaluate, and the sample from tru-cut biopsy and orchiectomy submitted to histopathology. The spermiograms were evaluated, the testicular length and with were measure, and the animal’s blood were collected to the anti-sperm antibody quantification. About the spermogram and measurement of scrotal bag any significative difference was observed (p>0,05). The sample to cytology and histology obtained from two techniques showed be in quantity enough to diagnostic. In histopathology, the biopsy FNA showed smaller damage area and inflammatory reaction compared to tru-cut, however this one showed biggest quantity of material, preserving the seminiferous tubules architeture and interstitium. It was not observed significative difference at anti-sperm antibodies production. We concluded that althought the biopsies provide material in quantity and quality appropriate, and the PAAF showed less traumatic, the choose of the technique to be used will depend the purpose for which the material is intended.

Accurate diagnosis of small‐cell carcinoma of the lung (SCLC) is clinically important because of the therapeutic implications. SCLC must be distinguished from non‐small‐cell carcinoma (NSCLC) and lymphoma. Paranuclear blue inclusions (PBIs) were recently described as a feature of metastatic SCLC on air‐dried Wright‐stained bone marrow aspirate smears. To determine the utility of PBIs in distinguishing SCLC from NSCLC and lymphoma, we evaluated air‐dried Diff‐Quik‐stained smears from 103 fine‐needle aspiration (FNA) specimens and 14 touch imprint specimens. PBIs were identified in 24 (89%) of 27 cases of SCLC, in 6 (9%) of 64 non‐small‐cell carcinomas (P < 0.00001), and in two (8%) of the 26 lymphoma cases (P < 0.00001). No PBIs were seen on any of the alcohol‐fixed Papanicolaou or hematoxylin‐eosin (HandE) stained smears examined. In conclusion, PBIs appear to be a feature of SCLC on air‐dried cytologic material stained with Romanowsky type stains. In the presence of cytologic features of SCLC, the identification of PBIs provides a useful diagnostic feature for diferentiating between SCLC and NSCLC carcinomas, and between SCLC and lymphomas in FNA specimens and touch imprints from surgical specimens.