radiographia.ru

Авторизация

ИНФОРМАЦИЯ

 

Реклама

НАЖИМАЕМ НА КНОПКУ!

КНИГИ

 
РАДИОЛОГИЧЕСКАЯ БИБЛИОТЕКА

10.02.2009 Тонкоигольная Аспирационная Биопсия Щитовидной Железы под УЗ-контролём.

Тема была открыта здесь: http://www.radiographia.ru/node/1037
Предлагаю продолжить обсуждение в этой ветке.

Вашему вниманию предоставляется глава из книги:


  Thyroid Ultrasound and Ultrasound-Guided FNA

Second Edition
H. Jack Baskin, M.D., MACE
Orlando, FL, USA
Daniel S. Duick, M.D., FACE
Phoenix, AZ, USA
Robert A. Levine, M.D., FACE
Nashua, NH, USA
Foreword by
Leonard Wartofsky, M.D., MACP
Washington, DC, USA

CHAPTER 7
Ultrasound-Guided Fine-needle
Aspiration of Thyroid Nodules
Daniel S. Duick and Susan J. Mandel

INTRODUCTION
There are many benefits to performing an ultrasound examination prior to performing a fine-needle aspiration (FNA) as discussed in Chap. 6. They include determining the size and position of a nodule, which allows better selection of needle length and needle size. In patients having multinodular goiter, ultrasound assures biopsy of the dominant nodule or the nodules most likely to be malignant—those having microcalcifications, increased vascularity, marked hypoechogenicity, blurred irregular borders or other characteristics associated
with malignancy. Finally, ultrasound may redirect the FNA to other areas of suspicion, such as an enlarged lymph node or  parathyroid adenoma.
Once the endocrinologist becomes accustomed to performing thyroid ultrasound at the time of doing an FNA, it is a simple progression to combine the two procedures into an ultrasoundguided FNA (UGFNA). Indeed, this technique is essential to biopsy non-palpable nodules and most nodules less than 1.5 cm in size. UGFNA is also necessary in many obese, muscular or large frame patients or in patients having osteoporosis where a nodule is felt in the upright position, but it is difficult to palpate when the patient is supine. UGFNA is indicated for the
biopsy of complex or cystic nodules in order to obtain material from the mural or solid component of the nodule and assure adequate cytology. In solid nodules, the best cytology material is usually obtained from the entire nodule. However, many nodules undergo changes centrally as they grow and this chapter will describe a number of ultrasound-guided FNA techniques utilized to diagnose problematic nodules. In heterogeneous nodules, the biopsy should be taken from the hypoechoic area of the nodule and any area with any additional suspicious findings (e.g., regions of intranodular Doppler blood flow, microcalcifications, etc). UGFNA allows for this more precise placement of the
needle tip within the nodule.
Multiple investigators have revealed that combining ultrasound and FNA into a single procedure, UGFNA, leads to a three-fold to five-fold increase in satisfactory cellular yields for cytology interpretation compared to conventional FNA (1, 2). Others have demonstrated an increase in both FNA specificity and sensitivity when UGFNA was performed (3, 4). UGFNA assures the needle tip is in the nodule (avoiding false negatives) and allows the operator to avoid the trachea and great vessels in the neck. The technique will usually allow the operator to
avoid passing the needle through the sternocleidomastoid muscle and thus significantly decreases the discomfort of the procedure. Because UGFNA maximizes the quality and quantity of the cytology, it has become the single best tool with which to evaluate and manage thyroid nodules.

MICRONODULES
The question of whether to biopsy nodules less than 1.5 cm (micronodules or “incidentalomas”) is controversial. Many argue that nodules this size seldom present a threat and are so common in the population that routine biopsy of all such nodules is not cost effective. However, several investigators have shown that the incidence of malignancy in small nonpalpable nodules is the same as in palpable nodules (5, 6).
In addition, others have shown that cancers that present less than 1.5 cm in size are often as aggressive as larger cancers (7). Clearly some judgment is required in deciding which nodules require FNA.

Показания к пункции:

   The American Association of Endocrinologists (AACE) recommends performing FNA on nodules over 1 cm in size (8). Smaller nodules in patients who received external radiation to the head or neck during childhood or in patients with a family history of medullary or papillary thyroid cancer also need UGFNA. Patients who have had a hemithyroidectomy for thyroid cancer are candidates for UGFNA if a micronodule should be found in the remaining lobe. Small nodules that appear taller than wide in the transverse view on ultrasound or have an increased intranodular vascular pattern with Doppler interrogation have a higher risk of malignancy and should have an UGFNA. Other characteristics such as microcalcifications, an irregular/blurred border, or marked hypoechogenicity which is comparable to strap muscles also indicate micronodules that may require UGFNA (9, 10). Most other nodules 1 cm or less in size can safely be observed over a period of time using ultrasound, and FNA can be avoided if there is no significant increase in size.

PREPARATION
 Prior to consideration of a thyroid nodule aspiration, a history of relative contraindications should be obtained. These are the same as with a conventional FNA and include patients who may not be able to lie recumbent due to physical problems, or who have difficulty in controlling the rate and depth of respiration, as well as patients who are uncooperative because of anxiety. The former may be able to be aspirated at 45–60
degrees elevation of the upper body or in a semi-sitting position. Patients with breath rate control issues or anxiety may require mild sedation or an anxiolytic medication in order to obtain a satisfactory biopsy.
An informed written and signed consent should be obtained after a verbal discussion during which all questions have been answered. The consent form should contain in lay language all details and additional information regarding the reason for the procedure, who will be performing the UGFNA, a description of the procedure and risks, as well as patient and witness signatures. An absolute contraindication is the
presence of a severe, uncorrected bleeding, platelet or coagulopathy disorder rendering the patient incapable of homeostasis.
Relative contraindications include the use of injectable heparin products, warfarin with an above-therapeutic-range INR, clopidrogrel and large-dose aspirin therapy. These latter situations can be associated with an increased frequency of local puncture site bleeding, ecchymoses and hematoma formation. These can usually be treated by manual tamponage followed by a pressure-taped dressing and an ice pack. If
a hematoma occurs, it should be observed by ultrasound to assure stabilization prior to the patient’s departure. The individual physician operator’s judgment and experience in performing UGFNA in these situations of potentially increased risk is most important. Full disclosure of risks to the patient is mandatory prior to proceeding with UGFNA. If withholding anticoagulation or anti-platelet therapy for greater than 24 hours is deemed appropriate, the procedure should be deferred and the referring or treating physician should be contacted regarding concerns, risks and plans for problem resolution and UGFNA disposition.

MATERIALS
The ultrasound laboratory should consist of an ultrasound machine with a probe and linear transducer that has a 3.5–5.0 cm footprint and multiple frequency settings ranging between 7.5–14MHz. The machine should also have Doppler imaging capabilities (e.g., color-flow Doppler and preferably power Doppler also). Larger footprint transducers are cumbersome and may impede aspiration capabilities. An additional or utility probe with a similar or lower frequency range is a 1–2 cm curvilinear or curved linear array transducer (a linear transducer with a convex-curved footprint that produces an image with an increased field of view in a sector format). The smaller curvilinear transducer is useful for imaging difficult locations, especially in the low neck at the level of the manubrium, clavicles and insertions of the sternocleidomastoid muscle.
Additional laboratory items should include a mobile ultrasound machine, set up tray and imaging table each of which can be moved for optimum positioning visualization and utilization during an UGFNA or other procedure. The setup tray should include all materials required for topical cleansing, as well as transducer covers, sterile coupling gel and an assortment of needles readily assembled and accessible to perform UGFNA. A detachable needle guide adapted for the transducer (Fig.1).

From L to R demonstrates different footprint size, linear array transducers with the transducer on the right demonstrating a smaller, curvilinear array transducer is usually not necessary for routine UGFNA but is often used and helpful in specialized and prolonged procedures such as
drainage of a large cyst followed by percutaneous ethanol injection. Almost any needle will be visible on modern highresolution ultrasound equipment; this makes use of echogenic needles unnecessary. An assortment of small needles (25–27 g) and medium needles (21–23 g) and specialty needles (25 g, 23 g or 21 g stylet-type needles or spinal needles) of variable lengths and types should be part of the routine setup (Fig.2).

FIG.2. Tray of needles used for UGFNA

The stylet-type needles are used for prolonged fluid aspirations or aspirating structures posterior to the thyroid, which may or may not lie within the thyroid (e.g., thyroid nodule versus parathyroid tumor or lymph node). The stylet can be left in while advancing the needle into the lesion of interest and prevents the uploading of thyroid cells into the needle. The stylet also stiffens the needle, making it easier to maneuver prior to
withdrawing the stylet when in the nodule and performing an aspirate. Use of commercially available heparinized needles is not necessary for properly obtained specimens, and heparin may interfere with cytology interpretation.
For aspiration technique, a 10 cc slip-on tip or Luer lock syringe is recommended—preferably with a peripheral or eccentric tip (enhances visibility of the syringe hub and bevel tip viewing of the needle. Pistol grip holders are not recommended since they are cumbersome and often apply excessive negative aspiration pressure, inducing bleeding and poor aspirates.
A useful variation of the pistol grip holder is a smaller, spring-loaded aspiration device (e.g., Tao aspirator), which combines both a syringe holder for stabilization and allows for the presetting of the aspiration pressure. This may be especially useful when UGFNA is performed without assistance and when both hands are required for imaging and aspirating.
The preset aspiration pressure setting is triggered after needle insertion into the nodule and the other hand continues to hold the transducer and monitor the procedure (Fig.3).

FIG.3. Demonstrates use of a small, spring-loaded aspiration device
(Tao) during UGFNA without the use of an assistant for stabilizing the transducer and monitor image during the procedure

The use of injectable or topical anesthesia is optional for a 27 g or 25 g needle procedure. For aspirations with larger needles (e.g., less than 25 g), the operator may choose to use one or more of the following: ethyl chloride spray, topical lidocaine gel or patch (applied prior to procedure) or injectable 1% or 2% lidocaine. These should all be readily available depending on the patient’s request or the perceived need of a procedure that is technically difficult or may involve multiple nodules or repetitive aspirations. Spray fixative or transport fixative solution
for thin smears of slides should also be readily available on the setup tray. A written laboratory protocol for the performance of UGFNA and all laboratory associated procedures should be available for reference.

TECHNIQUE
The patient should be positioned supine with the neck extended and soft pillow or pad inserted beneath the shoulders to optimize extension of the neck. An additional, small, soft pillow may be placed behind the head for patients who have known neck problems or discomfort with extension of the head and/or rotation of the extended neck. Based on prior knowledge of the planned procedure, the operator should position oneself optimally for the performance of the aspiration procedure. The monitor should be clearly visible to the operator/physician during the entire procedure. Prior to prepping the neck, an extended field of view should be performed before every needle biopsy. Both lobes of the thyroid, the isthmus, low central region and the lateral neck should all be observed for any abnormalities or lymphadenopathy not previously
detected. Coupling gel is applied to the transducer face, and the transducer is then enclosed in a sheath or cot to avoid direct contact with any blood products. A low cost alternative transducer cover is Parafilm. The covered transducer is dipped in alcohol, and the neck area is prepped with alcohol swabs. Sterile coupling gel can be applied to the covered transducer face or directly to the prepped neck area.

FIG.4. Use of monitor for imaging UGFNA

The key to utilizing ultrasound guidance for performance of the FNA is understanding the orientation of the azimuthal plane, which is the mid-sagittal plane of the transducer face. The transducer sends and receives high frequency ultrasound waves from and along the azimuthal or mid- sagittal plane of the transducer face. Utilization of the azimuthal plane during UGFNA imaging allows the operator to visualize the needle pathway or approach, angle of needle insertion and either track the entire needle by a parallel approach or locate only the bevel of the needle within a nodule by a perpendicular approach. Thus, there are basically two approaches for performing the UGFNA based on orientation to the azimuthal plane.

PARALLEL APPROACH
The ultrasound-guided parallel approach tracks the needle from the point of insertion down and along the azimuthal plane to the nodule. The needle is oriented and introduced at either end of the mid portion of the transducer, which is in parallel to the mid-plane of the long axis or sagittal plane (Fig.5.)

FIG.5. Longitudinal orientation and alignment of transducer, needle and syringe during performance of parallel approach for UGFNA

On the monitor screen, the nodule is positioned off-center and closer to the screen’s lateral border on the side of planned needle insertion. The needle is best inserted with the bevel up towards the transducer since this has angular edges with a flat surface producing greater reflectance and a “brighter” ultrasound image of the tip of the needle. The transducer and needle need to be maintained in the same plane. Upon needle penetration of the skin the needle tip appears at the upper right or upper left corner (depending on orientation of the transducer) of the monitor screen. As the needle is advanced forward and into the nodule, it is carefully guided along and within or adjacent to the azimuthal plane in parallel fashion. This approach allows the operator to observe needle penetration, location and pathway of the entire needle within the neck, thyroid and nodule, which remain visible on the monitor (Fig.6.)

FIG.6. The upper panel graphically depicts parallel approach with needle and tip visualization during UGFNA. The lower panel demonstrates
ultrasound image of needle and tip (arrows) during parallel approach for UGFNA

If the needle course veers laterally or away from or out of the azimuthal plane even a few degrees, it will be lost from the monitor screen. The parallel technique requires practice and experience to utilize successfully.

PERPENDICULAR APPROACH
In the perpendicular approach, the nodule is imaged and positioned in the mid portion of the screen rather than off center to either lateral side of the monitor. In this way, the point of needle introduction and the nodule beneath for aspiration are both centered in the mid point of the transducer’s side or long axis in order to transversely cross the azimuthal plane at 90 degrees (Fig.7).

FIG.7. Transverse orientation of transducer at 90 degrees to alignment of needle and syringe during perpendicular approach for UGFNA

This again requires experience and skill since the needle itself will not be visualized during the performance of the biopsy. The needle bevel is again introduced with the bevel facing upward toward the transducer to reflect the ultrasound waves and detect its bright image as it crosses the azimuthal plane during needle penetrance of the nodule (Fig.8.).

FIG.8. The upper panel graphically depicts perpendicular approach with needle tip only visualization as it crosses azimuthal plane in a
nodule during UGFNA. The lower panel demonstrates ultrasound image of the needle tip only as it crosses azimuthal plane (arrow) within a nodule during perpendicular approach for UGFNA

Understanding and visualizing the various angles of needle descent needed to match the depth of the nodule in the neck is most important when performing UGFNA in the perpendicular approach. The angle of descent dictates whether the needle bevel will be visualized within
the nodule (necessary to perform FNA) or above the nodule (descent angle too shallow) or below the nodule (descent angle too steep) as the bevel crosses the narrow beam of the azimuthal plane. Repetitive practice and utilization of both the parallel approach and the perpendicular approach will result in optimizing the orientation and skills of the operator to enhance the performance of UGFNA.

ASPIRATION AND NON-ASPIRATION TECHNIQUES
In general, the use of ultrasound at the time of planned FNA allows the operator to assess for solid, partially cystic and multi compartmental cystic nodules. Based on this assessment and the initial pass of an UGFNA, different approaches may be required to obtain adequate sampling and aspirated material or cytologic interpretation. UGFNA can localize tissue areas with vascularity by Doppler interrogation in partially or mostly cystic nodules and enhance acquisition of material for cytology interpretation.
There are two basic techniques for obtaining cellular material from a nodule during UGFNA: (1) the closed suction, “free hand” technique is performed with a 27 or 25 g needle attached to a 10 cc syringe. This needle is introduced into the nodule, under ultrasound guidance and the plunger is withdrawn for 1–3 cc of negative pressure to induce aspiration. The needle\ is moved back and forth within diameter of a solid nodule at 3 cycles per second over 5 to 6 seconds. After this, sure is released and the needle withdrawn. When liquid or low viscosity diluted material is encountered, this technique may be modified to perform the aspiration in the 2–5 mm subcapsular region (peripherally located tissue is less likely to undergo degenerative changes or dilute the aspirate specimen from complex nodules). The syringe is then detached from the needle, the plunger withdrawn (allowing 2 or 3 cc of air into the syringe), the needle reattached and the plunger moved slowly forward to extrude aspirated material onto a glass slide for smear and fixation preparation. Many times, however, the nodule is composed of loosely formed microcystic and degenerating tissue and fluid, or the nodule is highly vascularized internally. In these situations a more dilute material rapidly appears in the syringe above the level of the needle hub. If this continues after repeat aspiration attempts with less negative
pressure, switching to the “needle only” (Zajdela) technique usually improves acquisition of optimum cellular material for slide preparation (13). The “needle only” or Zajdela technique utilizes a 27 or 25 g needle and the principles of needle bevel nodule penetration and
capillary action uploading of cellular material into the needle without aspiration. The needle is grasped at the hub between the thumb and index finger and introduced into the nodule with one–three quick up and down motions over 1–3 seconds. The index fingertip is then placed over the hub to close the system and the needle is withdrawn, reattached to a syringe with the plunger retracted approximately 2–3 cc, and the material is extruded onto a slide for smear preparation and fixation. Usually two to four separate needle passes are made. A modification of this approach is to remove the plunger from a 10 cc syringe, attach the needle to the syringe (for enhanced control of the needle) and perform an open-system aspirate. The thumb pad is placed over the end of the syringe at the time of needle withdrawal. The needle is detached and reattached to a syringe with a partially withdrawn plunger, and material is extruded onto a slide for smear and fixation. Another modification
is to leave the plunger in the syringe and draw up 2–3 cc of air in the syringe prior to aspiration. Cellular material enters the needle via capillary action during the procedure, and the aspirate can then be extruded directly onto a slide. If the material obtained is frank blood or a watery mixture of interstitial, cystic and degenerative or bloody fluid, a modification of the “needle only” technique is often helpful. Again,
two–four individual needle passes are performed, but an exceedingly rapid forward penetration approximating a fraction of a second is utilized, and the hub is immediately capped by the fingertip. This allows for maximum needle bevel cutting and cellular acquisition with only minimal capillary action time to avoid fluid uploading into the needle. If the extruded material continues to be a watery texture or if it is optimal texture material but the physician is inexperienced in smear and slide preparation, the material can be extruded into a transport media (check with your reference laboratory for the required or preferred transport media) and forwarded to the laboratory to process, cytospin and prepare
slides for interpretation.
When slides are produced on sight, they are either fixed with a spray or placed in a 95% ethanol solution bottle and capped.
Additional air dried smears may be requested by the cytopathologist. Cellularity may also be checked by microscopy at the time of FNA by air drying 1 or 2 smears and performing a rapid staining technique with Diff Quick or a similar product.
The essence and desired outcome of UGFNA is the acquisition of cellular material and the production of smears on glass slides for fixation, future staining and interpretation. The capability to produce interpretable slides of aspirated material cannot be overemphasized. If the physician has poor technical skills in slide production, the entire procedure is a worthless exercise and a wasted opportunity. The repetitive need to depend on or utilize diluted material in transport media for subsequent cytospin or cell block preparations usually reduces diagnostic accuracy which is more optimally accomplished by having the capability of producing direct smears and fixation of aspirated materials on glass slides. Although slide production is not intrinsic to this chapter, the reader who is poorly trained or repeatedly has non-interpretable slides should either enroll in a slide-making cytology course or attend a training course to learn this and all skills associated with UGFNA.

SUMMARY
There are different methods of performing UGFNA, but there is no single best method. The techniques described are those widely utilized; they are not meant to be prescriptive but to provide a starting point for those who desire to start learning this procedure. You will discover many adaptations that can be customized to individual situations. It is important that the endocrinologist develop expertise in UGFNA in order to optimize patient care, safety and outcomes.

References
1. Takashima S, Fukuda H, Kobayashi T (1994) Thyroid nodules:
clinical effect of ultrasound-guided fine needle aspiration biopsy.
J Clin Ultrasound 22:536–542
2. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A
(1998) Diagnostic accuracy of conventional versus sonographyguided
fine needle aspiration biopsy of thyroid nodules. Thyroid
8:15–21
3. Carmeci C, Jeffery RB, McDougall IR, Noweis KW, Weigel RJ
(1998) Ultrasound-guided fine-needle aspiration biopsy of thyroid
masses. Thyroid 8:283–289
4. Yang GCH, Liebeskind D, Messina AV (2001) Ultrasound-guided
fine-needle aspiration of the thyroid assessed by ultrafast papanicolaou
stain: data from 1,135 biopsies with a two to six year
follow-up. Thyroid 11:581–589
5. Hagag P, Strauss S, Weiss M (1998) Role of ultrasound-guided
fine-needle aspiration biopsy in evaluation of nonpalpable nodules.
Thyroid 8:989–995
6. Leenhardt L, Hejblum G, Franc, Fediaevsky LD, Delbot T,
Le Guillozic D, Menegaux F, Guillausseau C, Hoang C, Turpin
A, Aurengo A (1999) Indications and limits of ultrasound-guided
cytology in the management of nonpalpable thyroid nodules.
J Clin Endo Metab 84:24–28
7. Rosen I, Azadian A, Walfish P, Salem S, Lansdown E, Bedard Y
(1995) Ultrasound-guided fine-needle aspiration biopsy in the
management of thyroid disease. Am J Surg 166:346–349
8. Gharib H, Papini E, Valcavi R et al (2006) American Association
of Clinical Endocrinologist/Associazone Medici Endocrinologi
Medici guidelines for clinical practice for diagnosis and management
of thyroid nodules. AACE/AME Task Force on Thyroid
Nodules. Endocrine Practice 12:63–192
9. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna O,
Nardi F, Panunzi C, Rinaldi R, Toscano V, Parcella CM (2002)
Risk of malignancy in nonpalpable thyroid nodules: predictive
value of ultrasound and color-Doppler features. J Clin Endo Metab
87:1941–1946
10. Kim E, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS (2002)
New sonographic criteria for recommending fine-needle aspiration
biopsy of nonpalpable solid nodules of the thyroid. AJR 178:687–691
11. Marqusee E, Benson CB, Frates MC et al (2000) Usefulness of
ultrasonography in the management of nodular thyroid disease.
Ann Int Med 133: 696–700
12. Baudin E, Travagli JP, Ropers J et al (1998) Microcarcinoma of the
thyroid gland: the Gustave Roussy Institute experience. Cancer 83:
553–559
13. Zajdela A, de Maublanc MA, Schlienger P, Haye C (1986) Cytologic
diagnosis of orbital and periorbital palpable tumors using fineneedle
sampling without aspiration. Diagn Cytopathol 2:17–20

 

 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

Английским не владею, к сожадению, сейчас прохожу занятия по языку, т.ч. хотелоь бы в кратце перевод, хотя бы основные показания. Технологию проведения пункции знаю, делаю это достаточно давно.

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

"Английским не владею, к сожалению, сейчас прохожу занятия по языку, т.ч. хотелоь бы в кратце перевод, хотя бы основные показания. Технологию проведения пункции знаю, делаю это достаточно давно"  
 
Насколько я вас понял, требуется перевод показаний к ТАБ? Ок, постараюсь сделать.  
 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

MICRONODULES
The question of whether to biopsy nodules less than 1.5 cm (micronodules or “incidentalomas”) is controversial. Many argue that nodules this size seldom present a threat and are so common in the population that routine biopsy of all such nodules is not cost effective. However, several investigators have shown that the incidence of malignancy in small nonpalpable nodules is the same as in palpable nodules (5, 6). In addition, others have shown that cancers that present less than 1.5 cm in size are often as aggressive as larger cancers (7). Clearly some judgment is required in deciding which nodules require FNA.

Микроузелки:

Узелки < 1.5 см в размере (incidentalomas случайномы-от случйная находка-incidental finding). Отношение к таким узлам разнится, многие авторы считают нецелесообразным проводить ТАБ таких узелков, т.к. они редко представляют собой угрозу. Рутинная биопсия таких узлов будет представлять собой неоправданные материальные затраты. С другой стороны, некоторые работы указывают на одинаковую частоту малигнизации в крупных и мелких узлах. Плюс, существуют публикации которые показали, что раки < 1.5 см в диаметре, имеют такую же степень агрессивности, как и более крупные.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

The American Association of Endocrinologists (AACE) recommends performing FNA on nodules over 1 cm in size (8). Smaller nodules in patients who received external radiation to the head or neck during childhood or in patients with a family history of medullary or papillary thyroid cancer also need UGFNA. Patients who have had a hemithyroidectomy for thyroid cancer are candidates for UGFNA if a micronodule should be found in the remaining lobe. Small nodules that appear taller than wide in the transverse view on ultrasound or have an increased intranodular vascular pattern with Doppler interrogation have a higher risk of malignancy and should have an UGFNA. Other characteristics such as microcalcifications, an irregular/blurred border, or marked hypoechogenicity which is comparable to strap muscles also indicate micronodules that may require UGFNA (9, 10). Most other nodules 1 cm or less in size can safely be observed over a period of time using ultrasound, and FNA can be avoided if there is no significant increase in size.

 

Показания: Американская Ассоциация Эндокринологов рекомендует проводит ТАБ всех узлов > 10 мм (8). Пункция более мелких узелков показана в случае наличия в анамнезе (в детстве) облучения области головы и шеи, медуллярный или паппилярны рак у ближайщих родственников. Пациенты с гемитиреоидэктомией с доказанным злокачественным процессом, так-же являются кандидатами на ТАБ микроузелков в сохраннённой доле. Микроузелки с поперечником > длинника при поперечном сканировании и увеличенным кровотоком при Допплеровском картировании являются подозрительными на злокачественность, и должны быть пунктированы. Узелки с прямыми признаками подозрительными на злокачественность (неровность/нечёткость контуров, микрокальцификаты, выраженная гипоэхогенность узелков) тоже подвергаются пункции, независимо от размера.

Основная масса узлов < 10 мм в диаметре наблюдаются консервативно, ТАБ проводится только в случае резкого увеличения в размерах в сравнении с предыдущим контролем.

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

 Огромнейшее спасибо  , Dr. Mario ! Всегда с удовольствием читаю предоставленные Вами материалы .

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

Марио! Протестую! Это дискриминация! ТАБ ЩЖ переводите, а BI-RADS http://www.radiomed.ru/forum/pierievod-stat-i-po-mammoghrafii?page=3 забросили, мне одному не вытянуть :(  это я так, брюжжу ;)

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

Ваша правда Владимир; подзабыл немного, везде не успеть! Сегодня продолжим?

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

Как на счет не ТПАБ, а забора тканевого материала(как еще называют трепанобиопсия)? Наши клиницисты относятся к ТПАБ с недоверием, и я их понимаю.

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

"Как на счет не ТПАБ, а забора тканевого материала(как еще называют трепанобиопсия)? Наши клиницисты относятся к ТПАБ с недоверием, и я их понимаю."

Core-biopsy: cмысл? Мелкий узел-опасно; крупный-наверно можно, но опять же, при правильно теxнически выполненной аспирации, материла для цитологии вполне достаточно для морфологического заключения.

 
 #

Re: 10.02.2009 Тонкоигольная Аспирационная Биопсия ...

С 2005 года проводим ТПАБ щитовидной железы. Пунктируем узлы более 1 см. Правда в тандеме с врачами-хирургами. Результаты хорошие. Осложнений (тьфу-тьфу-тьфу) не было.

 
 

Новый опрос

Кто подскажет как попасть в DropBox для загрузки видео в свой каталог? Не могу нигде найти.
Ссылка не работает
60%
Нет нигде закладки
40%
Total votes: 10

RADIOGRAPHIA и FACEBOOK

МЦ "Тигренок"