Fine needle aspiration biopsy of thyroid nodules.

BACKGROUND: Fine needle aspiration biopsy (FNA) is a routine diagnostic technique for evaluating thyroid nodules. Many reports in adults consider that FNA is superior to thyroid ultrasonography (USG) and radionuclide scanning (RS). Only five studies have been published on FNA of childhood thyroid nodules. AIMS: To investigate the reliability of FNA in the evaluation and management of thyroid nodules, and compare the results of FNA, USG, and RS with regard to final histopathological diagnosis. METHODS: FNA was performed in 46 children with thyroid nodules after USG and RS examination. We investigated the sensitivity, specificity, accuracy, and positive and negative predictive values of USG, RS, and FNA in their management. RESULTS: Six patients who had malignant or suspicious cells on FNA examination underwent immediate surgery. The other 40 patients received medical treatment according to their hormonal status. Fifteen of these nodules either disappeared or decreased in number and/or size. Surgery was performed in 25 patients who did not respond to therapy. Statistical analysis revealed sensitivity, specificity, accuracy, and positive and negative predictive values respectively as follows: 60%, 59%, 59%, 15%, and 92% for USG; 30%, 42%, 39%, 12%, and 68% for SC; 100%, 95%, 95%, 67%, and 100% for FNAB. CONCLUSION: FNAB is as reliable in children as in adults for definitive diagnosis of thyroid nodules. Using this technique avoids unnecessary thyroid surgery in children.     

Fine needle aspiration biopsy: diagnostic utility in resource-limited settings

BACKGROUND: Little information is available on the value of fine needle aspiration biopsy (FNAB) in routine paediatric practice in resource-limited settings. AIM: To provide an overview of all paediatric FNAB samples received at Tygerberg Hospital, Cape Town, South Africa over a 3-year period, including the determinants of sample adequacy and the diagnoses. METHODS: Samples were analysed from three locations: Tygerberg Hospital (TBH) where pathologists performed all the procedures, surrounding clinics where aspirates were mostly performed by doctors with no formal training in FNAB technique, and Queen Elizabeth Hospital, Blantyre, Malawi where FNABs were performed by trained nurse aspirators. RESULTS: A total of 830 aspirates were reviewed: 464 (56%) from TBH, 264 (32%) from local clinics and 102 (12%) from Blantyre. The main diagnoses at TBH were mycobacterial infection (31%), normal/reactive tissue (27%) and malignancy (14%); malignancy dominated (74%) in the select group from Blantyre. Sample adequacy rates were similar between pathologists and nurse aspirators [399/464 vs 82/102, odds ratio (OR) 1.4, 95% confidence interval (CI) 0.8-2.6]. Results were significantly better in the group who received formal training (TBH and Malawi) than in the clinics where clinicians had no formal training (481/566 vs 171/264, OR 3.1, 95% CI 2.2-4.4). CONCLUSIONS: FNAB provides a definitive tissue diagnosis in the majority of patients. Well-trained nurse aspirators perform as well as pathologists, indicating the feasibility of FNAB in resource-limited settings.     

甲状腺细针吸取细胞学检查对儿童甲状腺疾病的诊断价值

目的探讨细针吸取细胞学检查对儿童甲状腺疾病诊断的价值。方法甲状腺肿大患儿１６例，男２例，女１４例，用细针吸取甲状腺组织，放在玻片上经特殊染色后，于光学显微镜下观察细胞形态学的改变。结果１６例患儿共行２０次穿刺，１９次为一次穿刺成功。于光学显微镜下直接作出细胞组织学的诊断。２０次穿刺均无不良反应。结论细针吸取细胞学检查的方法同样可应用于儿童甲状腺疾病的诊断，而且这种方法操作简便，安全。     

Diagnostic value of fine-needle aspiration biopsy of thyroid nodules in children and adolescents

From 1971 to 2001, 188 fine-needle aspiration biopsies (FNAB) of the thyroid gland were performed in 169 children and adolescents with thyroid nodules. In 65.4% the results of FNAB were classified as benign. In 13.8% FNAB was considered insufficient for diagnosis, due to the absence or small number of cells. The results of FNAB were classified as suspicious or malignant in 17.6% (n = 33). Surgery was performed in 118 patients (69.8%) and the results of cytological evaluation and histopathology were compared. The accuracy of FNAB was 77.2%, specificity 63.6%, and sensitivity 78.9%, which is less than reported for adults. Histopathological evaluation showed 13 malignant tumors. In two of the 13 malignancies, FNAB was inadequate because of a lack of thyroid cells. Of the remaining 11 malignancies, seven were detected by FNAB but four of these were classified as benign. Because of the lower accuracy of FNAB, we suggest a more aggressive diagnostic and therapeutic approach in children and adolescents than for adults.     

Fine-needle aspiration biopsy in the management of thyroid nodules in children and adolescents

We reviewed the utility of fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules in 41 children and adolescents (35 girls; mean age, 13.3 years). Cytologic findings were benign in 30, malignant in 2, suspicious in 6, and insufficient in 3. The malignancy rate was 5%, with no false-negative results. Diagnostic accuracy for FNAB was 87% and inter-observer reliability was 88%. FNAB is safe and highly accurate in the evaluation of thyroid nodules in childhood.     

细针穿刺细胞学检查对小儿甲状腺疾病的诊断价值

自1992年7月至2001年12月对262例小儿甲状腺肿大性疾病进行了非抽吸穿刺细胞学检查,其中资料完整的124例,现总结如下。     

Sequential fine needle aspiration biopsy in glomerulonephritis

Cellular immune mechanisms have been shown to play a prominent role in glomerulonephritis. Cellular mediators of inflammation cause both acute and progressive glomerular and tubular injury. Understanding the mediation pathways offers the opportunity for therapeutic manipulation. In addition to polymorphonuclear leucocytes, monocytes/macrophages, B-cells and T-cells subsets are being enumerated in normal and diseased renal tissues. The correlation between immunological findings in peripheral blood and infiltrate composition in renal tissue, by using weekly Fine Needle Aspiration Biopsy (FNAB), for assessing the clinical status and monitoring the immunosuppressive therapy was the aim of this study. When determining the intensity of inflammation the numerical values of the Total Corrected Increment (T.C.I.) were defined as follows: less than 1.5 no inflammation; from 1.5 to 2.0 inflammation possible; greater than 2.0 inflammation. The ratio between OKT4 and OKT8 was used as the index: greater than 2.0 immunologic activation; greater than 2.0 no immunologic activation. When the T.C.I. was greater than 1.5 and the OKT4/OKT8 less than 2.0, or the T.C.I. less than 1.5 and the OKT4/OKT8 greater than 2.0 we used only a standard treatment. When both activation indexes were in the normal range we have not treated the patients. When the T.C.I. was greater than 1.5 and the OKT4/OKT8 was greater than 2.0 we treated the patients with standard treatment plus methylprednisolone pulses every time the activation indexes monitored by FNAB, showed an increase. A spontaneous improvement was obtained in untreated patients. The patients treated by standard therapy alone showed a different outcome. All patients treated with standard therapy plus methyl-prednisolone pulses showed a progressive clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)     

甲状腺细针穿刺细胞学检查对桥本甲状腺炎的诊断价值

目的　探讨甲状腺非抽吸细针穿刺细胞学 (FNAB)检查对儿童慢性淋巴细胞性甲状腺炎 (HT)诊断价值。方法　对 16 9例弥散性甲状腺肿儿童进行FNAB检查、甲状腺自身抗体测定 ,分别行FNAB诊断和临床诊断 ,并进行随访。结果　 16 9例中 76例诊断为儿童HT ;FNAB初诊准确率 98.6 8% (75 /76 ) ,明显高于临床初诊准确率 80 .2 6 % (6 1/76 ) (P <0 .0 1) ;HT 76例FNAB细胞学表现可分为 3种类型 :以淋巴细胞为主型最多(37/76 ) ,以嗜酸性变型最典型 ,上皮破坏型少见。结论　FNAB检查对诊断儿童HT和细胞学分型有较好的实用价值     

Fine needle aspiration cytology in childhood TB lymphadenitis

Objective  

To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features.     

Fine needle aspiration cytology in advanced pediatric tumors

Eighty-one children with clinically suspected malignant tumors were subjected to percutaneous fine needle aspiration cytology (FNAC) at the Pathology Department of the National Institute of Child Health, Jinnah Postgraduate Medical Centre, Karachi, from August 1986 through July 1987. There were 47 malignant diagnoses including lymphoma, neuroblastoma, nephroblastoma, Ewing's sarcoma, and leukemia. Histological findings confirmed the FNAC diagnoses in 36 cases in which a subsequent incisional biopsy or surgically removed specimen was available. FNAC results were confirmed in all benign cases. In 10 advanced cases of NonHodgkin's lymphoma, surgery was not possible because of marked malnourishment. One false negative and no false positive result was encountered. Forty-eight were females and thirty-three males. FNAC can be a quick, effective, and inexpensive alternative to open biopsy, particularly in advanced cases of malignancy in undernourished children where anesthesia and immediate surgery are contraindicated.     

CT-guided percutaneous needle biopsy of small lung nodules in children

Malignant pulmonary nodules in a patient with neoplasia alters clinical staging and therapy. Although it may be difficult, it is imperative to obtain a tissue diagnosis of such nodules. We describe a coaxial technique using controlled respirations, which we have found useful for biopsy of small pulmonary nodules in children. Clinical records, imaging and pathology (histology and cytology) were reviewed for 17 children who had 18 nodules biopsied in the method described. A diagnosis of malignant or benign tissue was made in 15 nodules. One biopsy was inadequate and there was one false-negative. Adequate cores were obtained in 15 nodules, cytology in 2 and inadequate material in 1. There was no significant morbidity. Received: 17 December 1997 Accepted: 16 October 1998     

儿童超声引导下肾活检116例临床分析

肾活检术有助于明确肾脏病的组织类型、免疫病理及超微结构,对于明确诊断、指导治疗和判断预后有不可替代的作用,小儿肾穿刺活检术在国内的应用也越来越多.我院儿科从2004年10月至2008年3月采用超声引导下自动活检针对116例患儿进行肾组织活检.     

Hyperfunctioning thyroid nodules in children

We studied two cases of hyperfunctioning thyroid nodules in children. A 9-year-old girl and an 11-year-old girl had thyroid masses in otherwise nonpalpable thyroid glands. Scintiscan showed hyperfunctioning thyroid nodules. The former patient had elevated values for T4 and T3, and plasma thyrotropin (TSH) level failed to respond to stimulation with thyrotropin releasing hormone (TRH), whereas the latter patient had normal values for T4, and T3 and plasma TSH response to TRH was normal. After the surgical removal of nodules, scintiscan exhibited radioactivity in the contralateral lobe of the thyroid gland in the former and in the ectopic thyroid tissue in the latter. Results of microscopic examinations of thyroid nodules were consistent with adenomatous goiter.