Blastemal Tumours: Cytological Features and the Usefulness of Fine Needle Aspiration.

In order to evaluate the relative merits of fine‐needle aspiration (FNA) and Tru‐cut® needle biopsy (TNB), we conducted a prospective controlled trial in 384 patients who had dominant thyroid nodules. FNA had a slightly higher diagnostic yield and fewer complications than TNB. Definitive confirmation of the biopsy diagnoses was obtained in 41.1% of the patients. Both techniques achieved a very high degree of overall accuracy, and false‐positive errors among non‐follicular lesions occurred only in cases labeled as possibly malignant. However, neither method could reliably distinguish between a benign and malignant follicular neoplasm. Including follicular neoplasms as suspicious for malignancy, the individual sensitivity rates for cancer were 86.5% and 91.9% for FNA and TNB, respectively. The combined use of FNA and TNB, however, detected 97.3% of the 37 malignancies.Rather than demonstrating any overwhelming relative advantage, this study would support the use of both FNA and TNB to investigate dominant nodules. When combined with clinical information and imaging studies, needle biopsy can reduce the number of unnecessary operations without seriously compromising the removal of thyroid cancers.

To retrospectively investigate and compare the usefulness of transthoracic fine needle aspiration (FNA), core biopsy and a combination of the two in the diagnosis of pulmonary lesions. Two hundred ninety-six patients who had undergone FNA, core biopsy or both for lung lesions were divided into malignant and benign groups according to the final diagnoses, which were based on the cytologic and histopathologic findings combined with clinical features. In each group, the diagnostic usefulness of FNA, core biopsy and a combination of the two were evaluated by comparing the results of each with the final diagnoses. In the malignant group, FNA was diagnostically helpful in 188 of 205 patients (91.7%) and core biopsy in 158 of 180 patients (87.8%). The combination of the two methods improved the result to 172 of 178 patients (96.6%). The sensitivities were 94.6%, 88.3% and 97.2%, respectively, for each result. In the benign group, 71.1% (64/90), 70.1% (47/67) and 74.2% (49/66) of cases received specific or nonspecific diagnoses by FNA, core biopsy and their combination, respectively. The rates of specific diagnoses were 20.1%, 21.0% and 31.8%, respectively. The combination of FNA and core biopsy markedly improved the diagnostic yields in the malignant group and, to a lesser degree, also in the benign group.

Objective:In recent years, several publications have described the use of ultrasound-guided fine-needle aspiration (FNA) by cytopathologists to achieve better diagnostic accuracy. Some cytopathologists enroll in courses to learn and apply ultrasound (US) guidance themselves. However, no standard procedure has been established that cytopathologists can follow to perform US for FNA. Alternatively, FNA can be a useful tool when cytopathologists collaborate with radiologists. Here, we aimed to evaluate the diagnostic accuracy of FNA for non-thyroidal head-and-neck masses retrieved by a cytopathologist with US guidance provided by a radiologist.Material and Methods:The FNA results for non-thyroidal head-and-neck masses at a private clinic using the Scandinavian FNA model with radiologist‒cytopathologist collaboration were compared with the histopathology results.Results:In all, 1890 patients who underwent FNA were identified, among whom 1435 (76%) also had histopathological results. Non-cystic lesions were obtained from lymph nodes (LNs), salivary glands, and soft tissue, while the other lesions were cystic in nature. For FNA, the accuracy was 99.4%, the sensitivity was 99.6%, the specificity was 99.3%, the positive predictive value was 99.3%, and the negative predictive value was 99.6%. No FNA results were non-diagnostic. Surgical follow-up revealed that only eight of the 1435 assessments (0.5%), all performed for LN lesions, yielded false-negative or false-positive results.Conclusion:The present study is based on single-center observations. The use of FNA, when performed by a specialized cytopathologist and with US assistance from a radiologist, produces accurate results and sufficient material for analysis, especially for LNs in extrathyroidal head-and-neck lesions. This study also reveals that the technique is a low-cost and effective process. The way in which FNA is presented here indicates that this procedure would be useful and ideal for any health service.

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

Neuroblastic tumor (NT) is the most common extracranial solid tumor of childhood with variable outcome which again depends on risk stratification related to distinct biology of the tumor. The use of fine-needle aspiration (FNA) material for evaluation of cytomorphological parameters and risk stratification in NTs using cytology prognostic score (PS) is limited in routine practice. We reviewed 38 FNA cytology cases diagnosed as pediatric small round cell tumor between time period June 2017 to December 2019 for clinical, cytomorphological and immunohistochemical features. Ten out of 38 small round cell tumors were NTs. All 10 cases were further subclassified according to International Neuroblastoma Pathology Classification into undifferentiated neuroblastoma (n = 1), poorly differentiated neuroblastoma (n = 5), differentiating neuroblastoma (n = 2), and ganglioneuroblastoma (n = 2). Cytologic PS was done using the morphological criteria as described previously in literature. The patients were divided into favorable and unfavorable cytomorphological prognostic categories with a cut off scoring of 12. A score of more than 12 is associated with high risk morphology and advanced stage. All cases with PS > 12 (n-4) (unfavorable cytomorphology) had a poor outcome compared to six patients with PS < 12 (n-6) (favorable cytomorphology). Aspiration cytology can be used as a first line investigation to evaluate the cytomorphological features for risk stratification and diagnosis in patients with NTs using cytological prognostic scoring system. A larger multi-centric validation study necessitates for cytological risk stratification.

Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.-Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982-1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.

Over the past decade, core biopsy rapidly replaced fine needle aspiration (FNA) in evaluation of diseases of the female breast in many centers in the USA. The inability to diagnose invasive cancer by FNA, and the general feeling of unease in interpretation of cytologic specimens among pathologists who are not trained in cytopathology are among factors leading to decline in the use of FNA. At our institution, we continue to rely heavily on FNA for evaluation of breast masses. In this article, we discuss our multidisciplinary team approach which is essential in sustaining a successful breast cancer screening program. We also review the general utility of breast FNA and core biopsy in a comparative fashion. In the second part of this article which will appear in an upcoming issue, we will review the use of FNA and core biopsy in challenging breast lesions focusing on the pitfalls and limitations of both modalities in selected specific lesions.

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study.

Evaluation of the HBV liver reservoir with fine needle aspirates

Introduction: Parotid gland tumors, although uncommon, present clinical and radiological features that don’t demonstrate their aggressiveness and behavior. Objective: In this study, we aimed to deepen the applicability of Fine Needle Aspiration and Frozen Sections as diagnostic methods. Materials and Methods: A search was conducted in the PubMed, Web of Science, Embase, and Scopus databases using the combination (Frozen Sections) AND (parotid gland) AND ((Surgical Procedures, Operative) OR (Elective Surgical Procedures)). A total of 170 articles were obtained, which underwent a selection based on title and abstract, resulting in 46 articles. From these articles, a second selection was made through complete reading, resulting in 24 articles. Results: 70.83% of the articles reported that Fine Needle Aspiration can provide reliable diagnoses. According to 54.17%, surgical planning can be obtained through Fine Needle Aspiration. No article addressed the chance of recurrences with the use of Fine Needle Aspiration. Frozen Sections can modify surgical planning, as reported in 91.67%. The use of Frozen Sections to modify neck dissection was indicated in 50%. In 8.33%, it was highlighted that Frozen Sections reduce the chance of recurrences. Among the articles that clearly expressed their ideas, 7 out of 11 advocated for the application of Frozen Sections with reservations, while 4 out of 11 supported their routine use. Conclusion: Fine Needle Aspiration is a widely used method for initial evaluations but has limitations in terms of accurate diagnosis and individualized treatment. Frozen Sections are a method that can assist the surgeon in intraoperative decision-making.

Fine-Needle Aspiration Diagnosis of Thyroid Blastomycosis

The goal of our study was to evaluate the efficacy of the combined use of fine-needle aspiration and tissue core biopsy under real-time CT fluoroscopy guidance. One hundred thirty-eight percutaneous needle lung biopsy samples were obtained by two methods. The samples obtained by tissue fine-needle aspiration underwent cytologic evaluation, and those obtained by core biopsy using an automated cutting needle underwent histologic evaluation. The final diagnosis was confirmed by independent surgical pathologic findings, independent culture results, or clinical follow-up. Rates of adequate specimens obtained and of precise diagnosis by combined use of fine-needle aspiration and core biopsy were 97.1% (134/138) and 94.2% (130/138) evaluated lung lesions, respectively, whereas those rates were 84.8% (117/138) and 79.7% (110/138) by fine-needle aspiration alone and 91.3% (126/138) and 89.1% (123/138) by core biopsy alone, respectively. Precise diagnosis was achieved by the combined use of the techniques in 30 (93.8%) of 32 lesions ranging from 3 to 10 mm in diameter, 42 (93.3%) of 45 lesions ranging from 11 to 20 mm, 43 (93.5%) of 46 lesions ranging from 21 to 30 mm, and 100% of 15 lesions ranging from 31 to 100 mm. In 89 of 90 lesions shown to be malignant by CT-guided lung biopsy and 30 of 44 shown to be benign, specific cell types could be proven from specimens obtained by the combined use of the two different types of needle biopsy. The combined use of fine-needle aspiration and core biopsy improves the diagnostic ability of CT fluoroscopy-guided lung biopsy, even in small lesions.

Activating mutations in the epidermal growth factor receptor (EGFR) in non-small cell lung carcinoma (NSCLC) are associated significantly with responsiveness to EGFR tyrosine kinase inhibitors. The objective of this study was to investigate the suitability of cytologic specimens for assessing EGFR mutations in lung adenocarcinomas. Sixty paired histologic and cytologic specimens of lung adenocarcinoma were collected. Exons 18 through 21 of the EGFR gene were amplified using polymerase chain reaction, and the mutation status of each sample was analyzed by pyrosequencing. A comparison of EGFR mutation status between histologic specimens and cytologic specimens was performed. The overall EGFR mutation concordance rate between histologic specimens and corresponding cytologic specimens was 91.7%. No significant difference was observed in the concordance rate between cytologic specimens from primary lesions and specimens from metastatic lesions (P = .63). The following parameters were correlated with the most reliable EGFR mutation results using the pyrosequencing method (100% concordance with the corresponding histologic specimens) in cytologic samples: a DNA concentration >25 ng/μL, content of >30 tumor cells, or a tumor percentage >30%. In this study, routinely prepared cytologic specimens were reliable sources for assessing EGFR mutation status. The authors concluded that cytologic specimens from metastatic lesions and primary tumors are suitable for the successful assessment of EGFR mutation status.

Childhood sarcomas: fine-needle aspiration cytopathology with an emphasis on the use of molecular studies.

Hyaline basement membrane-like stromal material and tigroid background are distinctive cytologic features observed in Diff-Quik (DQ)- or Giemsa-stained smears of clear-cell adenocarcinoma (CCA) of the female genital tract. However, it is uncertain how often these features are present in different types of cytologic specimens, and which type of preparation is optimal for this diagnosis. We therefore reviewed the cytologic features of CCA in three types of specimens, including 15 scrape cytology specimens, 7 fine-needle aspiration (FNA) specimens, and 15 peritoneal cytology specimens, with emphasis on the features observed in DQ-stained smears. The cell morphology in scrape cytology specimens and FNA specimens was comparable, whereas in peritoneal cytology specimens, the cytoplasm was better preserved. Most tumor cells had fragile cytoplasm containing variable amounts of fine vacuoles, and round nuclei with distinct or prominent nucleoli. Hyaline stroma was present in 93% of scrape cytology specimens, 71% of FNA specimens, and 80% of peritoneal cytology specimens. Tigroid background was observed in 47% of scrape cytology specimens, 43% of FNA specimens, but in none of the peritoneal cytology specimens. Formation of a tigroid background may be prevented by the abundant fluid content in peritoneal cytology specimens. Hyaline stroma and tigroid background were uncommonly seen in scrape smears from other types of primary ovarian tumors, mainly juvenile granulosa cell tumor and yolk sac tumor. However, the additional presence of papillary structures allows CCA to be readily distinguished from these other tumors. We propose that scrape cytology offers the best approach for the intraoperative cytologic diagnosis of CCA.