Cómo mejorar la precisión de los diagnósticos I y III del Sistema Bethesda
Resumen Introducción y objetivo: La punción aspiración con aguja fina es el método de elección para el diagnóstico del nódulo tiroideo, permitiendo discriminar entre lesiones malignas y benignas en un alto porcentaje de pacientes. Sin embargo, las categorías diagnósticas I (No diagnóstico o insatisfactorio) y III (Atipia o Lesión folicular de Significado Incierto) del Sistema Bethesda suponen un reto en el manejo de los nódulos tiroideos. El objetivo del presente trabajo es exponer las opciones de que se disponen en el momento actual para intentar incrementar la rentabilidad de estos diagnósticos. Síntesis: En primer lugar, el abordaje multidisciplinar de los casos, la posibilidad de seguimiento, la repetición de la punción aspiración, la complementación del diagnóstico incorporando técnicas inmunohistoquímicas o moleculares, y finalmente la posibilidad de realizar una biopsiacilindro. Conclusiones: Estas alternativas son especialmente útiles en la categoría diagnóstica III, mientras que se prefiere la opción de seguimiento o repetición de PAAF en la categoría diagnóstica I.
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Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol [Internet]. 2012 [cited 2020 Oct 28];56(4):333–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22846422
Coorough N, Hudak K, Jaume JC, Buehler D, Selvaggi S, Rivas J, et al. Nondiagnostic fineneedle aspirations of the thyroid: Is the risk of malignancy higher? J Surg Res [Internet]. 2013;184(2):746–50. Available from: http://dx.doi.org/10.1016/j.jss.2013.02.018
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Nishino M, Wang HH. Should the thyroid AUS/FLUS category be further stratified by malignancy risk? Cancer Cytopathol. 2014;122(7):481–3.
Olson MT, Clark DP, Erozan YS, Ali SZ. Spectrum of risk of malignancy in subcategories of «atypia of undetermined significance.» Acta Cytol. 2011;55(6):518–25.
Jae Ryu Y, Seung Jung Y, Chul Yoon H, Jung Hwang M, Hyoung Shin S, Seong Cho J, et al. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res [Internet]. [cited 2020 Oct 29];109. Available from: http://dx.doi.org/10.4174/astr
Gopalakrishna Iyer N, Shaha AR. Management of Thyroid Nodules and Surgery for Differentiated Thyroid Cancer. [cited 2020 Oct 29]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806860/pdf/nihms508330.pdf
Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, et al. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Cytopathology. 2013;24(6):385–90.
Sosa JA, Hanna JW, Robinson KA, Lanman RB. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surg (United States) [Internet]. 2013;154(6):1420–7. Available from: http://dx.doi.org/10.1016/j.surg.2013.07.006
Saieg MA, Barbosa B, Nishi J, Ferrari A, Costa F. The impact of repeat FNA in non-diagnostic and indeterminate thyroid nodules: A 5-year single-centre experience. Cytopathology. 2018;29(2):196–200.
Lubitz CC, Nagarkatti SS, Faquin WC, Samir AE, Hassan MC, Barbesino G, et al. Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy. Thyroid. 2012;22(6):590–4.
Deniwar A, Hammad ARY, Ali DB, Alsaleh N, Lahlouh M, Sholl AB, et al. Optimal timing for a repeat fine-needle aspiration biopsy of thyroid nodule following an initial nondiagnostic fine-needle aspiration. Am J Surg [Internet]. 2017;213(2):433–7. Available from: http://dx.doi.org/10.1016/j.amjsurg.2016.04.010
Yang J, Recavarren RA, Houser PM. Potential pitfalls of needle tract effects on repeat thyroid fine-needle aspiration. Cancer Cytopathol. 2013;121(3):155–61.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.
Renshaw AA. Does a repeated benign aspirate change the risk of malignancy after an initial atypical thyroid fine-needle aspiration? Am J Clin Pathol. 2010;134(5):788–92.
Vanderlaan PA, Marqusee E, Krane JF. Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: Should repeated FNA be the preferred initial approach? Am J Clin Pathol. 2011;135(5):770–5.
He Y, Franco OE, Jiang M, Williams K, Love HD, Coleman IM, et al. Tissue-specific consequences of cyclin D1 overexpression in prostate cancer progression. Cancer Res. 2007;67(17):8188–97.
Tong R, Yang Q, Wang C, Bi F, Jiang B. OVCA1 expression and its correlation with the expression levels of cyclin D1 and p16 in cervical cancer and intraepithelial neoplasia. Oncol Lett [Internet]. 2017 May [cited 2020 Oct 2];13(5):2929–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28521400
Smalley KSM, Lioni M, Dalla Palma M, Xiao M, Desai B, Egyhazi S, et al. Increased cyclin D1 expression can mediate BRAF inhibitor resistance in BRAF V600E-mutated melanomas. Mol Cancer Ther [Internet]. 2008 Sep [cited 2020 Oct 2];7(9):2876–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18790768
Temmim L, Ebraheem AK, Baker H, Sinowatz F. Cyclin D1 protein expression in human thyroid gland and thyroid cancer. Anat Histol Embryol [Internet]. 2006 Apr [cited 2020 Oct 2];35(2):125–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16542178
Lantsov D, Meirmanov S, Nakashima M, Kondo H, Saenko V, Naruke Y, et al. Cyclin D1 overexpression in thyroid papillary microcarcinoma: its association with tumour size and aberrant beta-catenin expression. Histopathology [Internet]. 2005 Sep [cited 2020 Oct 2];47(3):248–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16115225
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