Avaliação do seguimento citopatológico em pacientes com diagnóstico de atipias de significado indeterminado em punção aspirativa por agulha fina da tireoide

Abstract

Introduction: The cytopathologic evaluation of the thyroid by the Bethesda System has allowed a better correlation between the categories and anatomopathological results. The risk of malignancy in Bethesda III patients (atypia of undetermined significance) is approximately 5 to 15% and a new puncture is recommended after three months. However, this practice is not observed in all cases and many patients undergo thyroidectomy. This practice is corroborated by some studies which suggest a greater risk of malignance and discuss the possibility of immediate surgery in these cases. The present research aimed to evaluate the use of repeated fine-needle aspiration in category III patients. Materials and Methods: This is a descriptive, observational and retrospective study of 1339 patients submitted to fine-needle aspiration from May 2011 to May 2017. It was selected category III patients submitted to new puncture after the initial diagnosis. The identification of a new fine-needle aspiration cytology after the initial diagnosis characterized the repeated puncture. Results: It was identified 88 Bethesda III patients (6.57%), of which 30 (34.09%) were submitted to repeated fine-needle aspiration and were classified as: Category I: 21.9%; Category II: 50%; Category III: 15,6%, Category IV: 3.1%; Category V: 9.4%, respectively. Conclusion: The repeated fine-needle aspiration of category III thyroid nodules enabled the definitive diagnosis in most patients and 50% of them presented a benign cytology after new puncture. These data corroborate non-invasive medical management for Bethesda III nodules and do not suggest immediate surgery after this diagnosis.