PREDICT is a tool designed to estimate the benefits of adjuvant therapy and the overall survival of women with early breast cancer. The model uses clinical, histological, and immunohistochemical variables. This study aimed to evaluate the model's performance in a Brazilian population. We assessed the discrimination and calibration of the PREDICT model to estimate overall survival (OS) in five and ten years of follow-up in a cohort of 873 women with early breast cancer diagnosed from January 2001 to December 2016. A total of 743 patients had estrogen receptor (ER)-positive and 130 had ER-negative tumors. The area under the receiver operating characteristic (ROC) curve (AUC) for discrimination was 0.72 (95%CI: 0.66–0.78) at five years and 0.67 (95%CI: 0.61–0.72) at ten years for women with ER-positive tumors. The AUC was 0.72 (95%CI: 0.62–0.81) at five years and 0.67 (95%CI: 0.54–0.77) at ten years for women with ER-negative tumors. The predicted survival in ER-positive tumors was 91.0% (95%CI: 90.2–91.6%) at five years and 79.3% (95%CI: 77.7–81.0%) at ten years, and the observed survival 90.7% (95%CI: 88.6–92.9%) and 77.2% (95%CI: 73.4–81.4%), respectively. The predicted survival in ER-negative tumors was 84.5% (95%CI: 82.5–86.6%) at five years and 75.0% (95%CI: 71.6–78.5%) at ten years, and the observed survival 76.3% (95%CI: 69.1–84.3%) and 67.9% (95%CI: 58.6–78.6%), respectively. In conclusion, PREDICT was accurate to estimate OS in women with ER-positive tumors and overestimated the OS in women with ER-negative tumors.

Chondroitin sulfate (CS) is a type of glycosaminoglycan described as an antioxidant molecule that has been found in animal species such as fish. Tilapia (Oreochromis niloticus) represents an eco-friendly source of this compound, since its economical processing generates usable waste, reducing the negative environmental impact. This waste was used for CS extraction, purification, characterization by enzymatic degradation, and evaluation of its antioxidant effect. CS obtained from tilapia presented sulfation mainly at carbon 4 of galactosamine, and it was not cytotoxic at concentrations up to 200 µg/mL. Furthermore, 100 µg/mL of CS from tilapia reduced the levels of reactive oxygen species to 47% of the total intracellular reactive oxygen species level. The ability of CS to chelate metal ions in vitro also suggested an ability to react with other pathways that generate oxidative radicals, such as the Haber-Weiss reaction, acting intracellularly in more than one way. Although the role of CS from tilapia remains unclear, the pharmacological effects described herein indicate that CS is a potential molecule for further study of the relationship between the structures and functions of chondroitin sulfates as antioxidants.

Dyslipidemia has been described in sickle cell anemia (SCA) but its association with increased disease severity is unknown. Here, we examined 55 children and adolescents with SCA as well as 41 healthy controls to test the association between the lipid profiles in peripheral blood and markers of hemolysis, inflammation, endothelial function, and SCA-related clinical outcomes. SCA patients exhibited lower levels of total cholesterol (P<0.001), low-density lipoprotein cholesterol (LDL-c) (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P<0.001), while displaying higher triglyceride (TG) levels and TG/HDL-c ratio values (P<0.001). TG/HDL-c values were positively correlated with lactate dehydrogenase (P=0.047), leukocyte count (P=0.006), and blood flow velocity in the right (P=0.02) and left (P=0.05) cerebral artery, while being negatively correlated with hemoglobin levels (P<0.04). Acute chest syndrome (ACS) and vaso-occlusive events (VOE) were more frequent in SCA patients exhibiting higher TG/HDL-c values (odds ratio: 3.77, P=0.027). Multivariate logistic regression analysis confirmed independent associations between elevated TG/HDL-c values and SCA. Thus, children and adolescents with SCA exhibited a lipid profile associated with hemolysis and inflammatory parameters, with increased risk of ACS and VOE. TG/HDL-c is a potential biomarker of severity of disease.

Abstract: The aim of this study was investigate the effects of a low-protein, high-carbohydrate (LPHC) diet introduced to rats soon after weaning. The animals were distributed in the following groups: LPHC45: fed an LPHC diet (6%-protein, 74%-carbohydrate) for 45 days; C45: fed a control (C) diet (17%-protein, 63%-carbohydrate) for 45 days; R (Reverse): fed with LPHC for 15 days followed by C diet for 30 days. The LPHC45 group showed alterations in the energetic balance with an increase in brown adipose tissue, and in glucose tolerance, and lower final body weight, muscle mass and total protein in blood when compared with C45 group. The HOMA-IR index was similar between LPHC45 and C45 groups, but this parameter was lower in LPHC45 compared with R groups. Serum adiponectin was higher in LPHC45 group than C45 and R groups. The R group presented higher fed insulin than C45 and LPHC45 and higher T4 compared with C45 group. Total cholesterol in R group was higher when compared with LPHC45 group. Thus, the data show that the change of the diet LPHC for a balanced diet led to different metabolic evolution and suggest that the different response can be due to different levels of adiponectin.

Foram estudados parâmetros de incubação e de qualidade física de codornas japonesas neonatas oriundas de ovos submetidos a diferentes condições de armazenamento. Os tratamentos constituíram-se de combinações entre temperaturas e períodos de armazenamento dos ovos férteis. O delineamento foi em blocos casualizados em arranjo fatorial 2x5, temperaturas (ambiente (28±1,5ºC) e refrigerada (14ºC)) x períodos de armazenamento (um, três, seis, nove ou doze dias), totalizando 10 tratamentos com 105 repetições, sendo cada ovo uma unidade experimental. Os ovos foram incubados nas condições de 37,9ºC e 60% de umidade relativa (UR). Houve aumento de perda de peso do ovo com o período de armazenamento, com efeito linear positivo. Observou-se maior taxa de eclosão/ovos férteis para os ovos armazenados sob refrigeração. Houve efeito linear negativo para o período de armazenamento sobre a taxa de eclosão somente para os ovos armazenados em 28ºC. Para o peso da codorna neonata, houve efeito linear negativo, independentemente da temperatura de armazenamento. O comprimento do intestino delgado em temperatura ambiente sofreu influência do período de armazenamento, sendo que o período de 12 dias apresentou pior resultado. O pior escore de qualidade física foi encontrado em codornas neonatas oriundas de ovos armazenados em temperatura ambiente por 12 dias. Pode-se concluir que, para melhorar a eclosão e a qualidade física da progênie, ovos de codorna devem ser armazenados por até nove dias e em temperatura de 14ºC.

ABSTRACT Incubation parameters and physical quality of neonate Japanese quails hatched from eggs that were subject to different storage conditions were evaluated. The treatments consisted of a combination of temperatures and storage periods of hatching eggs from breeder quails. The experiments were conducted in a randomized block design in a factorial arrangement 2x5, with two storage temperatures (ambient temperature ± 28°C and refrigerated temperature 14°C) and five storage periods (one, three, six, nine and twelve days), totaling 10 treatments with 105 repetitions, each egg considered to be an experimental unit. The eggs were incubated at 37.9°C with 60% of relative humidity (RH). There was a positive linear effect between egg weight loss and storage period. Higher rates of hatching/fertile eggs were observed for eggs stored in refrigerated conditions. A negative linear effect was observed between storage period and hatching rate when the eggs where stored at a temperature of 28ºC. There was a negative effect for neonate quail weight, independent of storage temperatures. The intestine length was influenced by storage period and 12 days of storage showed the shortest intestine length. Lower scores of physical quality were observed in quails that hatched from eggs stored in ambient temperatures during 12 days. In this context, to improve hatching rates and physical quality of neonate quails the eggs should be stored up to nine days at a temperature of 14°C.

RESUMO A toxoplasmose cerebral pode ser altamente debilitante e ocasionalmente fatal em pessoas com deficiências do sistema imune. Nesse estudo, nós avaliamos a resposta de anticorpos das subclasses da IgG para o Toxoplasma gondii em 19 amostras de líquido cefalorraquidiano (LCR) de pacientes com toxoplasmose cerebral que apresentavam uma reação IgG anti-T. gondii positiva com ELISA padronizada com uma preparação antigênica de cistos. Não foram encontradas diferenças significativas entre as taxas de positividade e as concentrações de anticorpos (média aritmética das absorbâncias das reações ELISA, MEA) para IgG1 e IgG2, mas as taxas de positividade e valores MEA para estas duas subclasses de IgG foram significativamente superiores aos da IgG3 e IgG4. A resposta marcante de anticorpos IgG2 em LCR de pacientes com toxoplasmose cerebral merece investigação adicional.

SUMMARY Cerebral toxoplasmosis can be highly debilitating and occasionally fatal in persons with immune system deficiencies. In this study, we evaluated the Toxoplasma gondii-specific IgG subclass antibody response in 19 cerebrospinal fluid (CSF) samples from patients with cerebral toxoplasmosis who had a positive IgG anti-T. gondii ELISA standardized with a cyst antigen preparation. There were no significant differences between the rates of positivity and the antibody concentrations (arithmetic means of the ELISA absorbances, MEA) for IgG1 and IgG2, but the rates of positivity and MEA values for these two IgG subclasses were significantly higher than those for IgG3 and IgG4. The marked IgG2 response in CSF from patients with cerebral toxoplasmosis merits further investigation.

OBJETIVOS: Avaliar repercussões da doença renal crônica (DRC) sobre a qualidade de vida na percepção das crianças e dos pais, força muscular respiratória, função pulmonar e capacidade funcional em crianças e adolescentes. MÉTODO: Estudo transversal de crianças e adolescentes com DRC de oito a 17 anos. Excluídas as incapazes de realizar os testes. Após entrevista, aplicou-se questionário de qualidade de vida (PedsQLTM), testes de força muscular, função pulmonar e teste de caminhada de 6 minutos (TC6 min). Foi utilizado o teste t de Student e ANOVA (diferenças de médias) e o coeficiente de correlação de Pearson. Considerou-se nível de significância de 5%. RESULTADOS: Dentre os 40 pacientes, a média da distância percorrida no TC6 min foi de 396 ± 71 metros, e a média do escore final de qualidade de vida percebida pelas crianças e pelos pais de 50,9 e 51, respectivamente. Na percepção das crianças, os transplantados apresentaram maior escore de qualidade de vida, comparados aos em hemodiálise (p < 0,001), e aos com atividade física e melhor qualidade de vida, comparadas às sedentárias (p < 0,001). Na percepção das crianças e dos pais, o sexo masculino apresentou maior escore de qualidade de vida (p < 0,05). Houve correlação positiva entre a distância percorrida no TC6 min e as variáveis idade, altura, PedsQLTM final da criança, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) e negativa entre VEF1/CVF e a distância percorrida. CONCLUSÃO: Observou-se redução significativa na qualidade de vida e na capacidade funcional em crianças com DRC influenciadas pelo tipo de tratamento, sexo e sedentarismo.

OBJECTIVES: To evaluate the impact of the chronic kidney disease (CKD) on quality of life, from the children's and their parents' perspective, respiratory muscle strength, lung function, and functional capacity in children and adolescents. METHOD: Cross-sectional study of children with CKD aged 8 to 17 years. Those incapable of taking the tests were excluded. After an interview, quality of life by Pediatric Quality of Life Inventory) (PedsQLTM), muscular strength, pulmonary function tests, and the 6-minute walking test (6MWT) were applied. Student's t-test, ANOVA (difference in means), and Pearson's coefficient of correlation were used. The level of significance was set at 5%. RESULTS: Of the 40 patients, the mean distance walked at the 6MWT was 396 meters, and the mean final score at the quality of life test as perceived by the children and parents was 50.9 and 51, respectively. From the children's perspective, the transplanted patients had a higher quality of life score when compared to those undergoing hemodialysis (p < 0.001); those who practiced physical activity had better quality of life when compared to the sedentary children (p < 0.001). From the children's and the parents' perspectives, the male gender had a higher quality of life score (p < 0.05). There was a positive correlation between the distance walked at the 6MWT and age, height, final PedsQLTM, forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), as well as a negative correlation between FEV1/FVC and the distance walked. CONCLUSION: A significant reduction in the quality of life and the functional capacity was observed in children with CKD, influenced by the type of treatment, gender, and sedentary life style.

Cultivaram-se condrócitos obtidos da articulação do joelho de coelhos. Metade das células foi mantida em cultura para posterior implantação, e a outra metade foi congelada durante seis meses com a finalidade de avaliar a viabilidade. Criou-se um defeito circular osteocondral no joelho direito de outros vinte e sete coelhos. O grupo controle (GC) não recebeu tratamento. Os grupos descongelado (TH) e fresco (FH) receberam, respectivamente, implantes heterólogos de condrócitos cultivados descongelados e frescos, associados com PRP. O grupo GC apresentou maior dor e claudicação em comparação com os outros grupos aos sete dias após o implante. Microscopicamente, aos 45 e 90 dias, os grupos TH e FH mostraram preenchimento da falha com tecido cartilaginoso contendo condrócitos circundados por uma matriz densa de glicosaminoglicanos. Nesse período, no grupo CG, a cura ocorreu com tecido conjuntivo fibroso vascularizado e sem integração com o osso subcondral. Condrócitos heterólogos criopreservados foram viáveis para implantação e tratamento de lesões osteocondrais; a associação com o PRP permitiu a fixação de células na lesão e ofereceu fatores de crescimento que aceleraram a reparação com o tecido semelhante à cartilagem hialina articular.

Chondrocytes obtained from stifle joint of New Zealand White rabbits were cultivated. Half of cells were maintained in culture for later implantation and the others frozen during six months to evaluate viability. A circular osteochondral defect was created in the right stifle of other twenty seven rabbits. The control group (CG) received no treatment. The thawed (TH) and fresh (FH) heterologous groups received, respectively, an implant of cultivated thawed or fresh heterologous chondrocytes associated with platelet rich plasma (PRP). The CG group showed greatest pain and lameness compared to the other groups seven days after the implantation. Microscopically, at 45 and 90 days, the TH and FH groups showed filling with cartilaginous tissue containing chondrocytes surrounded by a dense matrix of glycosaminoglycans. In the CG group, healing occurred with vascularized fibrous connective tissue without integration to the subchondral bone. Cryopreserved heterologous chondrocytes were viable for implantation and healing of osteochondral lesions; the association with PRP allows the fixation of cells in the lesion and offers growth factors which accelerates repair with tissue similar to articular hyaline cartilage.

A ectopia dos ureteres é raramente observada em gatos. Assim, para aumentar as chances de sucesso do procedimento cirúrgico corretivo e promover a sobrevivência, o diagnóstico deve ser firmado precocemente. O relato em tela ilustra a ocorrência de ureter ectópico bilateral em uma gata Maine Coon, de sete meses, e descrevem-se as manobras médico-cirúrgicas adotadas na correção dessa anormalidade.

Ectopic ureters are rarely observed in cats. Therefore, for a better chance of success in the corrective surgical procedure and survival of the patient, diagnosis should be confirmed early. This report illustrates the occurrence of bilateral ectopic ureters in a seven month old Maine Coon cat and describes the medical and surgical management adopted for correction of the abnormality.

Avaliou-se a suplementação enzimática em rações contendo milheto ou sorgo sobre a microbiota intestinal e o desempenho de frangos. Foram alojados 420 pintos - ensaio de microbiota - e 1.200 pintos - ensaio de desempenho -, submetidos aos tratamentos com sorgo ou milheto suplementados ou não com complexo enzimático. O delineamento utilizado foi inteiramente ao acaso, com sete repetições de 15 aves cada, para o ensaio de microbiota, e em blocos ao acaso, com cinco repetições e 60 aves por parcela para desempenho. Foram realizadas pesquisas de bactérias Gram-negativas e contagem do número total de microrganismos aeróbios do intestino delgado. A suplementação enzimática não afetou a microbiota intestinal de frangos aos 14 e 28 dias de idade. Houve efeito da suplementação enzimática nas dietas com sorgo para conversão alimentar na fase pré-inicial. Nas dietas com milheto, a suplementação melhorou o ganho de peso no período de um a 35 dias de idade. No período total de criação, de um a 42 dias, não foi observado efeito da suplementação para milheto ou sorgo. Conclui-se que a utilização da suplementação de enzimas em rações com sorgo ou milheto pode melhorar os resultados de desempenho, dependendo da fase de crescimento de frangos de corte.

Two experiments were conducted to examine the supplementation enzyme in broilers fed with sorghum or pearl millet. The intestinal microflora and broiler performance was conducted with 420 and 1.200 broiler chickens, respectively. The treatments consisted of sorghum or pearl millet diet with enzymatic complex. The microflora assay consisted of 15 birds per experimental unit in completed randomized delineament, with seven replicates, and the performance study consisted of 60 birds per experimetal unit in a randomized block design, with five replicates. A study of bacteria negative-gram and total number bacteria aerobic in the small intestine was carried out. The averages were compared by contrasts (performance) and the Kruskal-Wallis (bacteria) tests applied for the research. The enzyme supplementation did not affect the broiler intestinal microflora at the age of 14 and 28 days. Feed conversion in the pearl millet diets supplemented with enzymes was better in the initial phase. The body weight was better to treat enzymatic complex in diets pearl millet (at age of 1- 35 days), however, at the age of 1 to 42 days there was no effect of supplementation for millet or sorghum. The results showed that the sorghum or pearl millet diets supplemented with enzymes are a viable strategy to improve the nutritional value of the diets and performance results depending on the age of the broilers.

Foi avaliado o efeito da suplementação da glutamina em dietas contendo ingredientes de origem animal sobre o desempenho e a integridade intestinal de pintos de corte, criados até 21 dias de idade. Os tratamentos constituíram-se de combinações entre tipos de dieta, com ingredientes de origem vegetal ou vegetal+animal e suplementação de glutamina (0,0; 0,5; 1,0 e 2,0%). O delineamento foi em blocos ao acaso em arranjo fatorial 2x4, tipos de ração x percentagem de glutamina, com cinco repetições e 12 pintos por unidade experimental. Não houve efeito da interação tipo de dieta versus suplementação de glutamina sobre o desempenho, e os tratamentos não influenciaram o desempenho de pintos de corte. Houve efeito quadrático da suplementação de glutamina sobre o coeficiente de digestibilidade da proteína bruta. A suplementação com glutamina aumentou altura de vilos e profundidade de cripta no duodeno. A utilização de produtos de origem animal em dietas para pintos na fase inicial não prejudica o desempenho, e a inclusão de glutamina melhora a integridade intestinal.

The effect of glutamine supplementation in diets formulated with animal by-products on the performance and integrity of the small intestine of broiler chicks up to 21 days of age was evaluated. The treatments were the combination of types of diets (only with ingredients from a vegetal source or vegetal plus animal source) and levels of glutamine (0.0; 0.5; 1.0 and 2.0%). The experimental design was randomized blocks in a 2x4 factorial scheme (kinds of diets x levels of glutamine), with five replicates and 12 birds per experimental unit. No interaction between diets and glutamine supplementation and treatment effects on the performance traits were observed during the chick starter phase. There was a quadratic effect of glutamine on the crude protein digestibility coefficient. Birds supplemented with glutamine diets showed higher villus height and crypt depth in the duodenum. Broiler diets formulated with animal ingredients have no effect on chick performance during the initial phase, and glutamine supplementation improved the small intestine integrity.

Com o objetivo de modificar a escala de coma de Glasgow pediátrica para utilização na medicina veterinária, foram utilizados 30 cães adultos com alterações neurológicas passíveis de avaliação da consciência. A escala modificada para cães foi aplicada em três momentos com intervalos de 48 horas entre eles, resultando em 90 eventos diversos. A escala foi aplicada para avaliação da abertura ocular (AO), da melhor resposta associada à vocalização (MRV) e da melhor resposta motora (MRM). Com a análise fatorial para os indicadores AO, MRV e MRM, obtiveram-se valores iniciais de 2,482, 0,302 e 0,215, respectivamente. A variância foi de 82,7%, 10,1% e 7,2%, respectivamente, e cumulativa de 82,7%, 92,8% e 100%, respectivamente. A extração esperada do principal fator, AO, foi de 2,482 com variância de 82,7% e cumulativa de 82,7%. O resultado da avaliação da consciência dos cães foi normal em 10% dos animais, alteração leve em 20%, moderada em 45% e grave em 25%, com escores de Glasgow iguais a 15, entre 13 e 14, entre 9 e 12 e entre 8 e 3, respectivamente. A escala de coma de Glasgow pediátrica modificada para cães é ferramenta segura para avaliação da consciência de cães adultos.

The pediatric Glasgow coma scale was modified for use in veterinary medicine. Thirty adult dogs with neurological alterations susceptible to evaluation of the conscience were studied. The modified scale for dogs was applied at three moments with intervals of 48 hours, resulting in 90 events. The scale was applied for evaluation of the ocular opening (OO), the best answer associated to vocalization (BAV), and the best motor answer (BMA). With the factorial analysis for the indicators OO, BAV, and BMA the initial values of 2.482, 0.302, and 0.215, respectively, were obtained. The variance was of 82.7%, 10.1%, and 7.2%, respectively, and cumulative of 82.7%, 92.8%, and 100%, respectively. The expected extraction of the main factor, OO, was 2.482 with variance of 82.7% and cumulative of 82.7%. The evaluation result of the conscience was normal in 10% of the animals, light alteration in 20%, moderate in 45%, and severe in 25%, with scores of Glasgow equal to 15, from 13 to 14, nine to 12, and eight to three, respectively. The pediatric Glasgow coma scale modified for dogs was a safe tool for evaluation of the conscience of adult dogs.

Avaliou-se a infecção experimental por Salmonella Enteritidis fagotipo 4 (SEpt4) em embriões de frango de corte para averiguar a habilidade de penetração através da casca e o efeito da inoculação no albúmen, considerando-se a mortalidade, a eclodibilidade e a colonização intestinal dos pintos eclodidos. Foram realizados dois experimentos, distribuídos em quatro tratamentos (T) cada, com 200 e 194 ovos incubáveis das linhagens Ross e ISA Label, respectivamente. Utilizaram-se ovos não sanitizados e inoculados na casca com Salmonella Enteritidis (T1) ou com placebo (T2); ou inoculados no albúmen com Salmonella Enteritidis (T3) ou com placebo (T4). Imediatamente após a inoculação, os ovos foram incubados, e a mortalidade embrionária avaliada após 96, 432 e 528 horas. Salmonella Enteritidis inoculada na casca manteve-se viável na casca e nas membranas durante todo o período de incubação e migrou para o interior dos ovos, entretanto não afetou os parâmetros de incubação. O patógeno inoculado no albúmen determinou mortalidade embrionária tardia nas linhagens Ross, 17,0%, e ISA Label, 13,0%, e originou pintos com maior freqüência de colonização intestinal por Salmonella Enteritidis, 76,7% e 26,7% para Ross e ISA Label, respectivamente.

The experimental infection of Salmonella Enteritidis phagotype 4 (SEpt4) was evaluated in broilers embryos to verify the ability of penetration through eggshell and the effect of albumen inoculation considering embryo mortality, hatchability, and intestinal colonization of hatched chicks. Two trials were conducted using in four treatments each, totaling 200 and 194 fertile eggs of Ross and ISA Label lineages, respectively. Non-sanitized eggs were inoculated on the shell with Salmonella Enteritidis (Treatment 1) or placebo (Treatment 2); and eggs were inoculated in albumen with Salmonella Enteritidis (Treatment 3) or placebo (Treatment 4). Immediately after inoculation, the eggs were incubated and embryo mortality was evaluated after 96, 432, and 528 hours. The results showed that Salmonella Enteritidis inoculated on egg shell remained active there and in shell membranes during all incubation period and migrated to the interior of the eggs; however, it did not affect the incubation parameters. It was observed that Salmonella Enteritidis inoculated in albumen caused late embryo mortality in Ross (17.0%) and ISA Label (13.0%) lineages, and originated chicks with high frequency of intestinal colonization by Salmonella Enteritidis, being 76.7% and 26.7% for Ross and ISA Label, respectively.

Com a introdução da ultra-sonografia cervical (USC) no seguimento dos pacientes com carcinoma papilífero de tiróide (CPT), tornou-se freqüente o encontro de pequenos linfonodos (LNs) cervicais. Porém, apesar de a USC apresentar alta sensibilidade, o estudo citológico obtido por punção aspirativa (PAAF) e, nos últimos anos, a dosagem da tiroglobulina (Tg) no lavado da agulha da PAAF (Tg-PAAF) vêm assumindo papel importante no diagnóstico de LNs cervicais. O objetivo deste estudo é verificar a acurácia da combinação da USC, citologia e Tg-PAAF em LNs suspeitos. Estudamos 32 pacientes que apresentavam 44 LNs à USC, classificados como "inflamatórios" (19) ou "suspeitos" (25). Dos 25 LNs suspeitos, 15 apresentavam Tg-PAAF elevada (13 com citologia compatível com metástases e 2 com citologia não-diagnóstica). Esses 15 LNs (11 pacientes) foram confirmados como metástase de CP pelo exame histopatológico. Os 19 LNs "inflamatórios" e os 10/25 LNs "suspeitos" apresentaram citologia negativa e Tg-PAAF indetectável. Concluímos que a USC apresenta alta sensibilidade na detecção de linfonodos cervicais, porém citologia e dosagem de Tg-PAAF são fundamentais para o diagnóstico. A associação USC, citologia e Tg-PAAF pode ser considerada a abordagem mais sensível e específica na detecção de LNs metastáticos em pacientes com CPT.

The widespread use of neck ultrasonography (US) during the follow-up of patients with papillary thyroid carcinoma (PTC) has led to the discovery of small cervical lymph nodes (LN). Although US has a high sensitivity for diagnosing LN, fine needle aspiration biopsy (FNA) and measurement of thyroglobulin in fine needle aspirates (FNA-Tg) have proven to be invaluable tools. The aim of this study is to determine the sensitivity of the combined use of neck US, FNA biopsy and FNA-Tg for diagnosis of cervical lymph nodes. We have studied 32 patients with 44 LN detected by US, 19 classified as inflammatory and 25 as suspicious. 15 of those 25 suspicious LN had high FNA-Tg (13 of the 15 had positive cytology and 2 indeterminate). All of these 15 LN (11 patients) were proven to be PTC metastasis by histopathology. All 19 inflammatory LN and those 10/25 suspicious LN, had cytology negative for malignancy and undetectable FNA-Tg. We conclude that fine needle aspiration biopsy and FNA-Tg combined with neck US are essential for detecting positive cervical lymph nodes due to its high sensitivity and specificity and it should be considered the standard for investigating locally recurrent disease in patients with PTC.

Nódulos de tiróide são comuns na prática médica. Para estabelecer o valor preditivo dos diversos testes diagnósticos, estudamos prospectivamente os dados de exame clínico, cintilografia, ultra-sonografia, citologia aspirativa e tiroglobulina sérica pré-operatória de 110 pacientes com nódulos operados e os comparamos com o diagnóstico anátomo-patológico da cirurgia. Nos 110 pacientes encontramos à histologia 124 lesões distintas, sendo 106 (85%) benignas e 18 (15%) malignas. Entre as benignas havia 90 bócios colóides (73%), 8 adenomas foliculares (6%), 4 cistos tiroglossos (3%) e outras 4 lesões; entre as malignas havia 16 (13%) carcinomas primários da tiróide (9 papilíferos, 3 foliculares, 3 indiferenciados e 1 medular) e 2 secundários. Entre os testes diagnósticos a citologia aspirativa apresentou os melhores resultados (sensibilidade: 94%, especificidade: 97%), em comparação com a cintilografia (sensibilidade: 89%, especificidade: 21%), ultra-sonografia (sensibilidades entre 60 e 100% e especificidades entre 25 e 69%) e tiroglobulina pré-operatória (sensibilidade: 7% para qualquer valor discriminatório e elevada especificidade). Alguns dados clínicos também apresentaram elevada especificidade, mas baixa sensibilidade, como rouquidão, disfagia, aparecimento de nova lesão, adenomegalia cervical e antecedentes de radiação. Neste estudo prospectivo concluímos que a citologia aspirativa é o melhor método disponível para o diagnóstico dos nódulos de tiróide.

Thyroid nodules are common in medical practice. To establish the predictive values of diagnostic tests we studied prospectively the results obtained from physical examination, aspiration cytology, scintigraphy, ultra-sonography and pre-operative serum thyroglobulin in 110 patients operated and compared them with the results obtained from surgical pathology specimens. We found 124 lesions in the 110 patients: 106 (85%) benign and 18 (15%) malignant. The benign were 90 simple goiters (73%), 8 follicular adenomas (6%), 4 thyroglossal cysts (3%) and 4 other rare lesions; the malignant were 16 (13%) primary thyroid carcinomas (9 papillary, 3 follicular, 3 undifferentiated and 1 medullary) and 2 secondary thyroid carcinomas. Aspiration cytology presented the best results (sensitivity: 94%, specificity: 97%), compared with scintigraphy (sensitivity: 89%, specificity: 21%), ultra-sonography (sensitivities from 60 to 100%, specificities from 25 to 69%) and pre-operative serum thyroglobulin (very low sensitivity and high specificity). Few clinical signs and symptoms also presented high specifity, but low sensitivity, as hoarseness, dysphagia, new lesion, cervical adenomegaly and previous local irradiation. We conclude that aspiration cytology is the best available method to diagnose thyroid nodules.