Fine-needle Puncture Research Articles

Informative value of diagnostic imaging methods in the detection of subepithelial formations of the stomach: a clinical case

INTRODUCTION: Subepithelial formations (SubEO) of the upper gastrointestinal tract (GI tract) are asymptomatic in most cases, and are a diagnostic finding in routine studies. Given the risk of malignancy of some SubEO, the question of treatment tactics remains relevant today: observation or surgical intervention.PURPOSE: To demonstrate diagnostic capabilities at the outpatient stage when choosing observational tactics in a patient with SubEO.MATERIALS AND METHODS: A dynamic observation of a 68-year-old woman with a randomly identified SubEO was demonstrated. The patient has been observed by a gastroenterologist since 2005 with a diagnosis of functional disorder of the gallbladder and sphincter of Oddi. In August 2022, when contacting the clinic with complaints of epigastric pain and heartburn, the following studies were performed: gastroscopy (FGDS), endoscopic ultrasound (EUS) with fine needle puncture, transabdominal ultrasound (TAUZI), computed tomography (CT) of the abdominal cavity, during which a submucosal formation of the stomach was diagnosed. The picture is more consistent with a gastrointestinal stromal tumor (GISO). Given the small size of the formation, the surveillance tactic was chosen. At the time of 12.2023, according to the results of control studies of the SubEO without dynamics.RESULTS: The follow-up period was 17 months, the results of the control studies justified the wait-and-see tactics and allowed avoiding unjustified surgical interventions and intraoperative complications.CONCLUSION: The combined use of TAUZI with endoscopy contributes to a better differential diagnosis and the choice of adequate treatment tactics.

Expert consensus on ultrasound guided thyroid and neck lymph node puncture (2023 edition)

Thyroid nodule and cervical lymph node biopsy is the main clinical method for evaluating the condition and determining the follow-up treatment plan. The literature on thyroid nodule puncture predominantly focuses on thyroid fine needle puncture, and there are limited systematic articles on coarse needle aspiration for thyroid-related diseases and needle biopsy of thyroid-related cervical lymph node diseases. However, this shortage of articles does not reflect the diagnostic value of coarse needle aspiration in thyroid biopsy and cervical lymph node-related diseases. Currently, different departments of many hospitals in China are conducting or planning to perform needle biopsy of thyroid and cervical lymph node-related diseases to improve the standardization and safety of related operations. Standardization is needed for the indications, contraindications, perioperative period, postoperative complications management, puncture specimen processing, and related genetic analysis of thyroid and cervical lymph node puncture. For this purpose, Interventional Ultrasound Committee of Chinese College of Interventionalists organized a panel of domestic experts in the field of thyroid diseases to discuss and formulate a consensus. Based on the latest research progress, combined with the clinical realities in China, this Expert Consensus on Ultrasound Guided Thyroid and Neck Lymph Node Puncture (2023 edition) is released.

Use of fine-needle puncture under endosonographic control in the diagnosis of left atrium sarcoma – case report

Background. Over the past 30 years, with the development of endoscopic technologies and the advent endoscopic ultrasound-guided fine-needle aspiration (EuS-FnA) it has become possible to diagnose with preliminary verification of cardiac tumors, which in turn is an undoubted advantage in detecting cardiac pathology. A rare clinical case is presented: the detection of a tumor of the left atrium using high-tech endoscopic techniques, in particular a EuS-FnA. when studying the surgical material using immunohistochemistry and FISH hybridization, the final diagnosis sounded like intimal sarcoma. Diagnosis of intimal sarcoma is a complex clinical task, and difficulties in making a diagnosis delay the duration of treatment. Our experience demonstrates the modern role of endoscopy as a minimally invasive method of diagnosing intracardiac tumors.

The capabilities of ultrasound diagnostics in head and neck tumours: rare clinical cases

The aim of this work is to assess the capabilities of ultrasound examination as part of the diagnostic algorithm in head and neck tumours. Five clinical cases of patients are presented with masses in the head and neck area, with different diagnostic approaches used. When examining the patients, the following diagnostic methods were employed: ultrasound examination, X-ray computed tomography, magnetic resonance tomography, positron emission tomography combined with computed tomography, endoscopic examination, as well as contrast-enhanced ultrasound examination, endosonographic examination and ultrasound-controlled fine-needle puncture biopsy. The clinical cases described demonstrate the high diagnostic value of the ultrasound method. Ultrasound examination is a highly informative multiparameter examination method that can be used in patients with head and neck tumours.

Experiencia de la utilización de la punción ecoguiada en pacientes portadores de nódulos mamarios

Objective: To describe the experience achieved by the Surgery Service of the National General Hospital “Dr. Ángel Larralde” in terms of the study of patients with breast nodules, through the use of ultrasound-guided punctures during the period January 2020 – November 2022. Methods: Observational-descriptive study, with a non-experimental, prospective, cross-sectional design. A deliberate nonprobabilistic sample of 138 patients was conducted. Breast ultrasound, fine needle puncture or core needle puncture were performed, depending on the type of lesion. The technique used was correlated with the diagnosis. Results: An average age of 46.72 ± 2.33 years was recorded; Females predominated (91.30%). The most frequent ultrasound finding was nodules in BI-RADS 4-A (30.43%). High percentages of effectiveness were obtained in both puncture techniques: sensitivity, specificity, positive predictive value and negative predictive value: 100%. There were no complications. Conclusions: The experience developed performing ultrasound-guided punctures in the management of the breast nodule is a useful and feasible method, avoiding unnecessary excisional biopsies, with high sensitivity and specificity, and minimizing the risks of complications inherent to the procedure.

#4970 SINGLE-CELL RNA SEQUENCING REVEALS THE MOLECULAR CHARACTERISTIC OF IGA-MCD

Abstract Background and Aims IgA nephropathy (IgAN) is the most common primary glomerular disease in children and adolescents worldwide, and is one of the major causes of end-stage renal disease in China. Minimal change disease(MCD) is the most common pathological type of nephrotic syndrome in children. In some rare cases, the renal pathology of these patient has IgA deposits in the mesangial regionns and diffuse fusion of podocyte foot process,which is called IgA-MCD. Previous studies have analyzed the characteristics of IgA-MCD from the aspects of clinical manifestations, pathological features, therapeutic response and prognosis, but the molecular mechanism of its occurrence and development has not been clarified. For the first time, single-cell transcriptome sequencing technology was used to compare IgA-MCD, IgAN and MCD, in order to describe the unique molecular characteristics of IgA-MCD and elucidate the molecular mechanism related to clinical manifestations. It lays the foundation for formulating more appropriate treatment plan and improving prognosis. Method Renal fine-needle puncture tissues were collected from 3 children with IgAN, 4 children with MCD, and 1 child with IgA-MCD in Children's Hospital of Chongqing Medical University, and adjacent normal tissues were collected from 1 child with renal tumor as control group. Children in the three disease groups had clinical manifestations of nephrotic syndrome, and nephrotic-level proteinuria at the time of sampling. High-throughput, unbiased single-cell transcriptome sequencing was performed on the above renal tissue samples, and the sequencing results were systematically compared and analyzed. Results By analyzing single-cell sequencing data, we systematically described single-cell transcriptome cell maps of renal tissues form children with nephrotic-level albuminuria with different pathologic types (IgAN, MCD, IgA-MCD). Twelve cell types, such as mesenchymal cells and podocytes, were defined by classical marker genes. By comparing the constituent ratio of renal cells and PC analysis of cell subsets in the control group and the three disease groups, it was found that IgA-MCD was closer to MCD. By comparing the differential genes of the three disease groups with those of the control group, we found that the number of differential genes in IgAN’s podocytes was significantly higher than that in the other two groups. Compared with the control group, HMGCS2 was significantly up-regulated in IgA-MCD, and cellular energy metabolism was enhanced. Through pairwise comparison among the three disease groups, it was found that there was no significant difference in genes in podocytes between IgA-MCD and MCD. Compared with IgAN, CXCL12 gene expression in IgA-MCD is significantly up-regulated, and CXCL12 can recruit immune cells and lead to cell damage. Conclusion The overall transcription profile of IgA-MCD is more similar to that of MCD. CXCL12 was specifically highly expressed in the podocytes of IgA-MCD, which may be used as a marker molecule for functional changes of IgA-MCD podocyte. IgA-MCD mesenchymal cells were significantly different from those in the other two disease groups. The significant up-regulation of CD81 may be a molecular signal that leads to the activation, proliferation, and secretion of more extracellular matrix of IgAN-MCD glomerular mesenchymal cells.We analyzed the associations and differences among IgAN, MCD and IgA-MCD at the single-cell transcriptome level, which provided a new perspective and insight for the follow-up study of the pathogenesis of the diseases.

Molecular profile of follicular tumors of the thyroid gland

More than 90 % of newly diagnosed cases of endocrine cancer occur in the thyroid gland. Introduction of fine needle puncture of the thyroid gland, with the classification of cytological material according to the Bethesda system, has become the cornerstone of the diagnosis of malignant neoplasms of the thyroid gland. However, traditionally in this classification there remains a weak link called a follicular tumor (category IV). The detection of a follicular tumor in the cytological material does not allow one to reliably classify the mass as benign or malignant and requires surgical intervention with morphological verification. In recent years, the possibilities of molecular genetic testing have improved markedly. Follicular tumors tend to accumulate mutations, which over time can lead to malignant transformation, but can also be used as a method of timely diagnosis. This review analyzes the literature on the possibilities of molecular genetic testing in assessing the malignant potential of follicular formations of the thyroid gland.

The place of US for the diagnosis of clinically suspected abdominal bleeding in trauma patients

Aims and Objectives: The detection of liquid collections remains a challenge for the trauma team, especially when there is multiple trauma. We present our experience in the diagnosis, follow-up and planning therapy of free and encapsulated abdominal liquid collections by performing ultrasound examination. Methods: 143 emergency trauma patients /116 male and 27 female/ were examined using ultrasound for a period of 2 years. The right and left oblique and propositioning view was used for US examination to identify free and bounded liquid collections in the abdominal cavity. The examination was performed immediately after the initial clinical survey with patients supine. Positive findings of liquid collections on US were compared with those provided by CT, punctures under US control or surgery. US machine supplied with 3.5 and 7 MHz linear and convex transducers, MDCT device, needles and catheters were used. Results: One hundred and fifteen /80.41%/ of all 143 US examined trauma patients had free and encapsulated liquid collections, confirmed by CT scan, surgery, or clinical course. In 59 /51.30%/ patients we performed fine needle puncture under US control. There were 95 true-positives, 14 true-negatives, 2 false-positives and fore false-negative results. Overall this demonstrated that ultrasonography had a sensitivity of 95.95%, specificity of 87.50% and accuracy of 94.78%. The PPV is 97.93% and the NPV – 77.77%. Conclusion: Our experience and literature reports support the opinion that US examination should be used as a primary method for diagnosis and follow-up of abdominal liquid collections in emergency patients.

Artisanal model replaces animal use for ultrasound-guided fine needle puncture practice in medical sciences teaching.

Fine needle puncture (FNP) is a widespread technique used to collect cellular samples. Its efficiency can be enhanced by the use of ultrasonography to guide the procedure. Ultrasound-guided FNP is therefore an operator-dependent exam. For this reason, it demands the acquisition of psychomotor skill, ability to recognize structures, and dexterity during the needle puncture. This study describes the development of an artisanal simulator made with gelatin to replace the use of live animals during practical classes in veterinary or medical sciences education. The experimental set consisted of three phases in which the student performed different tasks such as recognition of the target structure with ultrasound and injection of ink (phase 1) or aspiration (phase 2) of its content and evaluation of a parenchymatous organ (liver) and puncture of its surface (phase 3). A survey on the acceptance of the model was carried out, and students filled out a questionnaire elaborated with the visual analog scale system. Participants considered the artisanal model a strong method to teach ultrasound-guided FNP. Other attractive advantages of this simulator are the low manufacturing costs (compared with expensive high-technology devices) and the possibility to replace the use of live animals in practical classes.NEW & NOTEWORTHY This study describes an artisanal simulator made with gelatin to teach ultrasound-guided fine needle puncture during practical classes in veterinary or medical sciences education. A three-phase experimental set allowed the students to practice ultrasound-guided fine needle puncture, aspiration, and injection in three different target structures. This cost-effective simulator may be an alternative to the use of expensive devices or the use of live animals during practical classes.

Improving the pathological diagnosis efficacy of fine needle puncture specimens with the changing trend in clinical diagnosis and treatment mode

The pursuit of minimally invasive biopsy and targeted treatment as well as technical progress have boosted the extensive clinical usages of fine needle puncture cell/tissue acquisition technology in recent years. How to rationally use the limited fine needle puncture materials which are usually minimal and fragmented, while making pathological diagnosis, accomplish the auxiliary tests of immune phenotype, molecular features and other tests required by the clinician, and comprehensively improve the diagnostic benefits of fine needle puncture material is a big challenge facing the pathology community. Up to now, there has been no successful experience that can be learned from abroad. Some suggestions for the further improvement of diagnostic efficacy of fine needle puncture specimens from the aspects of sub-specialty cooperation and comprehensive utilization of the materials are put forward based on the progress trend in pathology and the current situation in China.

Comparison of the effects of ultrasound- guided needle puncture, radial shock wave therapy, and combined treatments on calcific tendinitis of the shoulder: A single-blind randomized controlled trial.

Calcific tendinitis of the shoulder is a common disorder resulting in restricted motion and pain. This study compared the effects of ultrasound-guided fine-needle puncture (USNP), radial shock wave therapy (RSWT), and the combination of both treatments (COMB) on calcific tendinitis of the shoulder. We enrolled 62 patients who had unilateral shoulder pain for more than 3 months. The patients were randomly divided into three groups: USNP, RSWT, and COMB. All USNP needle punctures were guided with ultrasound (US), and RSWT was delivered at 2 Hz (2000 shock waves; 0.26 mJ/mm2) once a week for 3 weeks. The COMB group received three weekly rounds of RSWT after a single US-guided needle puncture. The primary outcome was the pain visual analog scale (VAS), and secondary outcomes were the Constant scores, 36-Item Short-Form Health Survey, and range of motion. A within-group comparison at 3 months revealed significant improvements in the pain VAS (p< 0.05, during activity) and Constant (p< 0.05) scores, but between-group comparisons revealed no statistically significant differences in the pain VAS (p> 0.05) or Constant (p= 0.089) scores. Only improvement differences in role-emotional (SF-36; p= 0.01) and active external rotation (p= 0.035) were determined over time, which favored the USNP and COMB groups. Although no significant differences were observed among the groups in the treatment of calcific tendinitis of the shoulder, more satisfactory outcomes were noted in the USNP and COMB groups than in the RSWT group. Larger samples, longer follow-up times, and other treatment protocols are suggested for future studies.

A model for training ultrasound-guided fine-needle punctures.

SUMMARYOBJECTIVE:To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model.METHODS:We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure.RESULTS:The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure.CONCLUSIONS:An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.

Canine Transmissible Venereal Tumor in the Larynx with Pulmonary Metastasis

Background: Canine transmissible venereal tumor (TVT) is one of the most common canine neoplasms in Brazil. Lesions develop mainly in the genital tissue and less frequently in other areas, in the extragenital form. Metastasis is rare, and the disease progression depends on the patient's immune status. The treatment of choice is chemotherapy with vincristine sulfate, considered an effective and safe modality. The present work describes the first case of extragenital TVT in the larynx with pulmonary metastasis at the time of diagnosis. Case: An approximately 4-month-old mixed-breed bitch was attended manifesting acute clinical respiratory signs. The patient had been rescued from the street 2 months beforehand. Physical examination revealed pale mucous membranes and crackling pulmonary auscultation. Thoracic radiography was performed in 3 projections, showing multiple nodules in the lung parenchyma, followed by cytopathological examination using fine needle puncture guided by thoracic ultrasound, confirming the diagnosis of TVT. Considering the cytological finding and the absence of primary tumor lesions in the genital, oral, cutaneous or nasal regions, endoscopy was performed in order to locate a possible primary focus. The exam revealed a small erythematous tumor with smooth and regular surface, measuring approximately 2.5 cm, located in the larynx, between the arytenoid cartilages. Chemotherapy was performed with vincristine sulfate with radiographic follow-up throughout the treatment. Full remission of the pulmonary and laryngeal nodules was achieved at the end of the protocol. The animal remained in complete remission for a period of 2 years. Discussion: TVT is more frequently observed in animals of active reproductive age, and rarely in animals under 1 year of age, as in the case described here. When considering extragenital lesions, the manifestation can be single or multiple, occurring more frequently in the cutaneous, oral and nasal forms. This case describes a laryngeal lesion with pulmonary involvement, without lesion in the genitalia or any other site. Cases of TVT in young and prepubescent animals, associated with extragenital involvement and aggressive behavior, similar to this case, have been described in literature, but never in this location. Literature suggests there is a relationship with the immune status of such patients, which do not have a well-developed immune system, facilitating disease progression. In these animals, transmission can be maternal, since in some cases the patient develops the disease without having contact with other animals except the mother. This form of transmission would facilitate the extragenital form in the oral cavity, airways and ocular region, related to licking, lactation and direct contact. Vincristine sulfate chemotherapy, considered the treatment of choice, was effectively used in this case, despite the atypical form. The TVT prognosis tends to be favorable, with the exception of the aggressive presentations with the presence of distant metastases. However, in the case described here, even though metastatic pulmonary nodules were present, complete remission was achieved, with survival exceeding 2 years. The development of TVT in the larynx is a rare form of the disease, and this report is possibly the first description of this tumor location. Thus, we highlight the importance of a complete investigation of the patient and of TVT as a differential diagnosis in this location. Keywords: dog, bitch, coitus, neoplasm, round cells, extragenital. Título: Tumor venéreo transmissível canino em laringe com metástase pulmonar Descritores: cão, cadela, coito, neoplasia, células redondas, extragenital.

Granuloma por Acanthocheilonema spp. em um cão - relato de caso

ABSTRACT A canine patient, 13-year-old mixed breed male, 24kg, was seen at a private clinic in the city of Guayaquil, Ecuador. The main reason for consultation was the evaluation of a mass in the right knee and neck that had previously been cytologically diagnosed of neoplastic origin by another team of veterinarians through fine needle puncture and cytology. The contacts were asymptomatic. At the time of the consultation, a detailed exploration and complementary methods were performed that included hematological and urinary exams, mass cytology, serological test, chest radiography and biopsy for further histopathological study. The final diagnosis was a cutaneous granuloma due to microfilariae of Acanthocheilonema spp. and its subsequent surgical and medical treatment with excellent results. The canine heartworm is a cosmopolitan disease caused by nematodes of the genus Dirofilaria, with D. immitis being the best-known species. Less frequently, the species Acanthocheilonema spp., found in this patient, is also reported in Americas, with little knowledge about it. This is the first report of its kind hoping that it will serve as a basis for future studies.

Clinical case of indolent primary medullary cancer

Medullary thyroid cancer (MRSH) has a high malignant potential in the vast majority of cases, but in some patients with MRSH is characterized by a sluggish, non-aggressive course, when patients with the presence of proven medullary carcinoma or distant metastases and / or relapse, can live without progression for a sufficiently long time. Such a course of a malignant tumor is called indolent. The article presents a clinical case of diagnosis and treatment of indolent primary MRSH in a patient with a duration of the disease of 11 years. Shows some features of the dynamics of the level of basal calcitonin and cancer-embryonic antigen (CEA), ultrasound characteristics and data of fine-needle puncture biopsy of the tumor. The phenomenon of indolent course of MRSH characterized, as a rule, by a high malignant potential, is probably due to the biological characteristics of the tumor and requires further research.

Submandibular Gland Schwannoma - Case Report

Schwannomas are benign tumors that originate in the myelin sheath of neurons, more specifically in Schwann cells. Between 25-45% of these tumors occur in the topography of the head and neck, and may appear in various anatomical sites –oral cavity, larynx, pharynx, parapharyngeal space, and others. The main complaints are a painless, slow-growing mass and symptoms related to compression of nearby structures by the lesion. Its diagnosis is almost always given with the anatomopathological study after resection of the lesion, since fine-needle punctures usually show indeterminate results and imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) cannot confirm this diagnosis, although they bring important information about location, size and contact with adjacent structures. Treatment, if there is no contraindication, is through surgical excision of the tumor. In this report, we present the case of a 47 year-old female patient complaining of left submandibular nodulation, whose diagnosis of schwannoma was only given after a left submaxillaryectomy, through the pathological examination.

Proteomics and Organoid Culture Reveal the Underlying Pathogenesis of Hashimoto's Thyroiditis.

Hashimoto’s thyroiditis (HT) is an autoimmune disease, and its incidence continues to rise. Although scientists have studied this disease for many years and discovered the potential effects of various proteins in it, the specific pathogenesis is still not fully comprehended. To understand HT and translate this knowledge to clinical applications, we took the mass spectrometric analysis on thyroid tissue fine-needle puncture from HT patients and healthy people in an attempt to make a further understanding of the pathogenesis of HT. A total of 44 proteins with differential expression were identified in HT patients, and these proteins play vital roles in cell adhesion, cell metabolism, and thyroxine synthesis. Combining patient clinical trial sample information, we further compared the transient changes of gene expression regulation in HT and papillary thyroid carcinoma (PTC) samples. More importantly, we developed patient-derived HT and PTC organoids as a promising new preclinical model to verify these potential markers. Our data revealed a marked characteristic of HT organoid in upregulating chemokines that include C-C motif chemokine ligand (CCL) 2 and CCL3, which play a key role in the pathogenesis of HT. Overall, our research has enriched everyone’s understanding of the pathogenesis of HT and provides a certain reference for the treatment of the disease.

Nuclear Morphological Characteristics in Breast Cancer: Correlation with Hormone Receptor and Human Epidermal Growth Factor Receptor 2.

Background Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) are the common diagnostic/prognostic markers in breast cancer. Few articles have recently reported the correlation between cytology and molecular subtypes. We combined nuclear morphological characteristics with HR and HER2 status to observe the relationship and provide ideas for machine learning. Methods We reanalyzed fine-needle aspiration cytology samples and core-needle puncture histological specimens from 142 patients with invasive breast cancer between March 2019 and December 2019, and the findings were compared with the two groups (HR+/HER2- and HR-/HER2+) following nuclear cytomorphological features: nuclear/cytoplasmic ratio, difference of nuclear size, nuclear pleomorphism, chromatin feature, nuclear membrane and nucleoli, and Nottingham grading. Results Two groups were significantly associated with the difference of nuclear size, nuclear pleomorphism, and nucleoli (P < 0.001) and consistent with histological grading (P < 0.001). Moreover, nucleolar characteristics of size and number had obviously statistical significance (P < 0.001). Multiple micro-nucleoli were frequently seen in the HR+/HER2- group compared with the HR-/HER2+ group which mostly were observed centered medium-large nucleoli. We described four interesting nuclear morphologies in the experiment. Conclusions There were significant differences in nuclear characteristics between two groups. HR and HER2 status not only might be predicted in cytological samples, but some specific nuclear morphological features might have potential value to help us understand molecular function and predict more information.

Implementation of molecular genetic tests in the diagnostics of thyroid cancer: own research

Aim — to investigate the significance of BRAFV600E, NRAS, KRAS, HRAS, RET/PTC (RET/PTC1 and RER/PTC3), PAX8/PPARg mutations for the development and course of thyroid cancer with the determination of a significant predictor mutation. Materials and methods. The analysis included 63 selected case histories of patients who, at the preoperative stage, underwent molecular genetic testing (MHT) of the thyroid gland (TG) masses and subsequently underwent surgical treatment in the surgical department of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues. The average age of the patients was 41.0 ± 1.8 years; from them 7men and56women. All patients underwent fine-needle aspiration puncture biopsy(FNAB) of thyroid nodules according to the standard method followed by a cytological conclusion in accordance with the Bethesda system.The Bethesda III category was revealed in 3 patients (4.8 %), Bethesda IV — 13 patients (20.6 %), Bethesda V — 12 patients (19.0 %), Bethesda VI in 35 (55.6 %) patients. The pathogenic mutations were detected in 47 (74.6 %) patients (group 1), among them two mutations were simultaneously found in two subjects. In 16 cases (25.4 %), no pathogenic mutation was found at all (group 2). Results. The genes that occurred most often were BRAFV600E — in 35 patients (55.6 %), NRAS — in 11 patients (17.5 %), KRAS — in 3 patients (4.8 %). In case of thyroid cancerdiagnosis, pathogenic mutations were found in 38 (79.1 %) subjects. The BRAFV600E gene mutation was observed when establishing a cytological conclusion classified as Bethesda III—V in 28.9 %, and in Bethesda V and in 77.1 %. Accordingly, the sensitivity of the test was low — 0.646, specificity — 0.733. The high prognostic significance of a positive result(PPV) value (from 0.784 to 0.943) indicated the likelihood of detecting thyroid cancer. This assumption confirms the calculation of the c-square criterion with the Yates correction, which is 5.207 (p = 0.023). The use of this test for the presence of the NRAS gene to detect thyroid cancer was ineffective, the value of the c -square criterion with Yates correction = 0.009 (p = 0.927). The incidence of thyroid cancer in group 1 in the cytological class Bethesda III—V was higher than in group 2, but it did not differ significantly between the groups. The aggressiveness of thyroid cancer in patients of group 1 with a positive MHT result did not have significant differences compared with the results obtained in group 2 (39.5 % and 33.3 %, respectively). Conclusions. The use of the kit for the determination of MHTmade it possible to identify pathogenic mutations in the genes BRAFV600E, NRAS, KRAS in 79.1 % of cases. The presence of these genes in combination with the analysis of cytomorphological findings classified according to the Bethesda III—V system did not increase the detection of thyroid cancer in the studied patients. The BRAFV600E gene, which was observed in 64.6 % of cases (PPV from 0.784 to 0.943), was a significant predictor among the studied candidate genes for establishing the diagnosis of thyroid cancer. Detection of a pathogenic mutation in patients with thyroid cancer did not indicate in favour of its aggressive course.&#x0D;

Parotidomégalies : diagnostic

Parotid enlargement can be of inflammatory (sialitis), metabolic or tumoral. Many systemic diseases, mainly Sjögren's syndrome and sarcoidosis, can lead to parotid hypertrophy. The differential diagnosis, which is sometimes difficult, despite radiological investigations) (ultrasound, MRI, cytological fine needle puncture) will be infectious, lithiasis or tumor.