Sabato 27 ottobre 2012 - Pacini Editore

RElaziONi
Thyroid aspiration cytology
G. Fadda
Chief of the Cytopathology Section, Division of Anatomic Pathology
and Histology, Catholic University, Rome (Italy
Nodular lesions represent a very common problem for the clinicians
as well as a diagnostic challenge for the pathologists.
Up to 5% of the general population has a palpable thyroid
nodule though only approximately 5% of these clinically
apparent thyroid nodules actually harbour malignancy. The
real challenge facing general practitioners, endocrinologists,
surgeons, and pathologists is to reach an accurate preoperative
diagnosis of malignancy and to ensure that the patient receives
a timely and appropriate treatment. FNA is the only test that
can provide a definitive preoperative diagnosis of malignancy.
The sensitivity and specificity of FNA are reported to be 68-
98% and 56-100%, respectively. FNAB is also regarded as the
most accurate method for the selection of patients with thyroid
nodules for surgery or for the ‘wait and see’ management and
it can be considered a very cost-effective diagnostic test. The
use of liquid-based techniques (LBC) applied to FNA specimens
for the cytological evaluation of thyroid nodules is still
controversial. Although the transition to this methodology
requires adaptation by technologists and cytopathologists who
evaluate the samples, it appears to be a valuable investment.
An innovative diagnostic approach includes the addition and
the enforcement of molecular diagnostics on FNA material. As
good quality nucleic acid can be extracted from thyroid cells
processed by LBC the molecular diagnosis will be playing a
role in the management of patients with suspected endocrine
neoplasms. Considering that the most common malignancy of
the thyroid gland is papillary carcinoma (PC), the evaluation
of a thyroid nodule on FNA is, therefore, primarily a search
for PC. More than half of PCs harbor one of several mutations
involving both Ret/PTC and PAX8/PPAR_ rearrangements and
the mutations of RAS and BRAF genes. The identification of
one or many of these genetic alterations on FNA specimens
from thyroid lesions may improve the diagnostic yield of this
technique, especially in indeterminate cases.
Although PC is typically an indolent disease, recurrence is
common (15%-30% of patients), even in early-stage disease.
In vitro studies in benign thyroid cell models have demonstrated
a particularly important role for BRAF as a central
regulator of thyroid-specific protein expression (i.e., differentiation)
and proliferative capacity. At the molecular level,
mutations resulting in a V600E substitution in BRAF and
consequent constitutive activation occur in more than 50% of
PCs in adults. This figure makes BRAF mutations the most
common defined genetic abnormality in thyroid cancers. In
several studies, the presence of a BRAF mutation has been
associated with a more aggressive clinical course. Therefore
it might be crucial to identify patients at higher risk of recurrence
so that a more aggressive therapy and a closer monitoring
can be realized. In this way, molecular investigation
performed on FNA could also assume a prognostic role.
Sabato, 27 ottobre 2012
Sala Giotto – 11.30-12.30
Citologia agoaspirativa in twitter: tutto in sei minuti e tre slide
Moderatori: Luigi Di Bonito (Trieste), Cesare Gentili (Massa Carrara)
247
references
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Fine needle cytology / core needle biopsy in
pancreatic tumors
G. Zamboni
Departement o Pathology, University of Verona, Ospedale Don Calabria,
Negrar, Verona, Italy
The extensive utilisation of imaging has increased the discovery
of pancreatic masses. Unfortunately, most (80 to 90 percent)
of the clinically detected masses in the pancreas are adenocarcinomas.
With the exception of functioning endocrine
tumors, characterised by a specific clinical picture, the other
pancreatic tumors manifest with either non-specific symptoms,
or symptoms similar to pancreatitis. Although a correct
diagnosis is mandatory to plan the therapeutic approach and
establish a prognosis, accurate preoperative diagnosis sometimes
is very difficult to achieve.
The ideal diagnostic test, as in other disease, should be the tissue
diagnosis with a trucut biopsy, since the tissue can be also
used for ancillary studies. Unfortunately, diagnostic pancreatic
tissue biopsies are not always available. The less invasive
methods, like the FNAB with US guidance or the EUS-guided
biopsies have a better level of safety and are considered reliable
in detecting the presence of malignant cells, although of
lower sensitivity. Independently on the used sampling method
the accuracy of pathologic evaluation is higher when a pathologist
makes the procedures or cooperates to them.
Whether a lesion should be punctured or not it depends on
many different aspects, and most of them are basically clinical
and radiological ones. In many centres, if a mass is resectable
the surgeons perform a pancreatectomy. A morphological diagnosis
has to be served to all patients, either on the primary
or secondary lesions, before to plan chemotherapy.