Valor da repunção aspirativa na doença nodular benigna de tireóide

Abstract

Resumo: O presente estudo teve por objetivo verificar se um novo exame de puncao aspirativa com agulha fina (PAAF) deve ser realizado em pacientes que ja foram submetidos a tal procedimento e tiveram o diagnostico citopatologico compativel com doenca nodular benigna de tireoide. Quarenta e um pacientes com o diagnostico clinico e laboratorial de bocio nodular foram submetidos a duas puncoes aspirativas com agulha fina, com intervalo minimo de seis meses, e comparados quanto aos seus laudos e caracteristicas citopatologicas. Alem do resultado das puncoes foram observadas as seguintes caracteristicas: idade (media = 44,3 }13,1 anos); inicio do aparecimento do nodulo (media = 5,1 + 8,1 anos e mediana de 2,0 anos); volume nodular (media = 18,6 } 21,6 ml e mediana de 9,6 ml) e volume tireoidiano (media = 42,8 } 30,8 ml e mediana de 33,5 ml), ambos a ecografia; captacao de 131I em 24 horas (media = 13,2 + 5,4 %); niveis de triiodotironina (T3) (media = 142,0 } 34,5 ng/dl), de tiroxina (T4) (media = 8,63 } 1,5 jxg/dl), de hormonio tireoestimulante (TSH) (media = 1,7 } 1,0 mUI/L) e de tireoglobulina (TG) (media = 59,3 ± 47,8 ng/ml). O estudo demonstrou predominancia do sexo feminino (40 de 41); nodulo misto (23 de 41) e frio (29 de 41), com padrao multinodular (23 de 41). Na avaliacao citopatologica o segundo laudo foi identico ao primeiro em 40 de 41 pacientes (97,56 %), embora houvessem caracteristicas citopatologicas distintas em 39 dos 41 pacientes estudados (95,12 %), apontando para a propria heterogeneidade do nodulo coloide. Concluimos que a PAAF e um metodo diagnostico seguro na doenca nodular de tireoide, nao existindo necessidade de repeticao do procedimento quando a puncao e satisfatoria. A nao concordancia nos detalhes citopatologicos das puncoes sequenciais revela a grande heterogeneidade da morfologia do bocio coloide.

Abstract: The aim of this study was to verify if a new fine needle aspiration (FNA) biopsy has to be realized in patients who have already been submitted to the procedure with cytopathologic diagnosis ofbenign thyroid nodular disease. Forty-one patients with clinical and laboratorial diagnosis of nodular goiter were submitted to two fine needle aspirative biopsies, in the interval of at least six months, and compared in relation to their final results and cytopathologycal characteristics. Apart the aspirative biopsies, the following characteristics were observed: age (mean rate = 44,3 + 13,1 years); nodule appearance (mean rate = 5,1 } 8,1 years and median of 2,0 years); nodular volume (mean rate = 18,6 } 21.6 ml and median of 33,5 ml) and thyroid volume (mean rate = 42,8 + 30,8 ml and median of 33,5 ml), both at ecography; 131I thyroid uptake in 24 hours (mean rate = 13,2 + 5,4 %); triiodothyronine (T3) (mean rate = 142,0 } 34,5 ng/dl), thyroxine (T4) (mean rate = 8.6 }1,5 ng/dl), thyrotropin (TSH) (mean rate = 1,7 } 1,0 mUI/L) and thyroglobulin (TG) (mean rate = 59,3 } 47,8 ng/ml) levels. The study showed the predominance of female (40 of 41); mixed (23 of 41) and cold nodules (29 of 41), with multinodular pattern (23 of 41). In the cytopathologycal evaluation the second result was identical to the first one in 40 of 41 patients (97,56 %), in spite of the distinct first biopsy characteristics in 39 of the 41 studied patients (95,12 %), showing the heterogeneity of the colloid nodule. We conclude that FNA is a safe method for the diagnosis of thyroid benign nodular disease, with no necessity to repeat the procedure when the first biopsy is satisfactory. The difference in the cytopathologycal details of the sequential biopsies reveals the large heterogeneity of the colloid nodule.