Accuracy Of Fine-needle Aspiration Biopsy Research Articles

Accuracy of fine-needle aspiration biopsy in Albanian experience

Accuracy of fine-needle aspiration biopsy in Albanian experience

Re: Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging.

Axillary management in breast cancer has evolved tremendously in the last decades. Sentinel lymph node biopsy (SLNB) has replaced axillary dissection in patients without any clinical and radiological involvement in the axilla. Although the complication rate of SLNB is lower than axillary dissection, the search for an accurate method to determine the axillary status in breast cancer with even lower complication rate is continuing. Fine needle aspiration biopsy (FNAB) is performed under ultrasonography guidance in case of suspicious lymph nodes in the axilla, especially in those with cortical thickening or decreased echogenecity in the hilum in addition to changes in size and shape of the lymph node. The accuracy of FNAB in predicting the status of the axilla is investigated in recent studies. Fine needle aspiration biopsy of the axilla helps the clinician in determining surgical approach and neoadjuvant chemotherapy. Nowadays, extent of axillary surgery has almost no definitive role in deciding the mode of adjuvant treatment. Obtaining information about the presence of metastatic disease in the axilla is enough to determine the prognosis of the patient. However, 30% of axillary metastases were detected with FNAB under ultrasonography guidance and additional 30% with SLNB whereas the axillary status of the remaining patients were determined by histopathologic examination (1). In addition to the information about the axilla, FNAB enables us to place clips into the metastatic lymph nodes to follow the results of neoadjuvant treatment. Akinci et al. investigated this topic in the article entitled “Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging” (2). This study aimed to determine the role of ultrasound-guided FNAB in axillary staging. Sensitivity, specificity, positive and negative predictive value, and accuracy of FNAB were studied. Sensitivity and negative predictive value showed moderate values (60%) whereas specificity and positive predictive values were 100%. Overall accuracy of axillary FNAB was reported as 76.1%. These results are in accordance with the results of the previous studies. Sensitivity of FNAB under ultrasound guidance changes between 45–95% and the specificity is almost 100% (3, 4). Microbiopsies using larger needles and addition of immunohistochemical examination increase the sensitivity and presence of micrometastases in the lymph node contributes to the false negative results (5). Small number of patients included in the study may be its limitation, however, prospective design of the study supports the results with higher reliability. Finally, this study encourages the clinicians to utilize ultrasound-guided FNAB more frequently to avoid unnecessary SLNB in breast cancer. As a conclusion, randomized controlled trials including large enough number of patients are required to establish the value of FNAB in axillary staging of breast cancer. Sentinel node vs. observation after axillary ultrasound (SOUND) trial is an ongoing prospective randomized trial comparing SLNB and no axillary surgery in patients with normal axillary ultrasound (6). If a high predictive power of FNAB for axillary lymph node metastases could be proven, SLNB might be replaced by this method in the future. Detection of axillary metastases with FNAB might avoid performing SLNB and frozen section study decreasing time spent during surgery and total expenses in treatment.

Fine Needle Aspiration and Medullary Thyroid Carcinoma: The Risk of Inadequate Preoperative Evaluation and Initial Surgery when Relying upon Fnab Cytology Alone

ObjectivesTo evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) to preoperatively diagnose medullary thyroid cancer (MTC) among multiple international centers and evaluate how the cytological diagnosis alone could impact patient management. MethodsWe performed a retrospective chart review of sporadic MTC (sMTC) patients from 12 institutions over the last 29 years. FNAB cytology results were compared to final pathologic diagnoses to calculate FNAB sensitivity. To evaluate the impact of cytology sensitivity for MTC according to current practice and to avoid confounding results by local treatment protocols, changes in treatment patterns over time, and the influence of ancillary findings (e.g., serum calcitonin), therapeutic interventions based on FNAB cytology alone were projected into 1 of 4 treatment categories: total thyroidectomy (TT) and central neck dissection (CND), TT without CND, diagnostic hemithyroidectomy, or observation. ResultsA total of 313 patients from 4 continents and 7 countries were included, 245 of whom underwent FNAB. FNAB cytology revealed MTC in 43.7% and possible MTC in an additional 2.4%. A total of 113 (46.1%) patients with surgical pathology revealing sMTC had FNAB findings that supported TT with CND, while 37 (15.1%) supported TT alone. In the remaining cases, diagnostic hemithyroidectomy and observation were projected in 32.7% and 6.1%, respectively. ConclusionFNAB is an important diagnostic tool in the evaluation of thyroid nodules, but the low sensitivity of cytological evaluation alone in sMTC limits its ability to command an optimal preoperative evaluation and initial surgery in over half of affected patients. (Endocr Pract. 2013;19:920-927)

MRI-guided biopsy and fine needle aspiration biopsy (FNAB) in the diagnosis of musculoskeletal lesions

ObjectivesThe purpose of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) guided musculoskeletal biopsy and the value of fine needle aspiration biopsy (FNAB) when combined with histologic biopsy. Materials and methodsA total of 172 biopsies were performed under MRI guidance, 170 were histologic biopsies. In 112 cases, a fine needle aspiration biopsy was also performed. In two cases, a stand-alone FNAB was performed. The diagnostic performance was evaluated retrospectively by comparing the histopathologic and cytologic diagnosis with the current or final diagnosis after at least one year of clinical and imaging follow-up. A 0.23T open MRI scanner with an interventional stereotactic guidance system was used. ResultsThe overall diagnostic accuracy of MRI guided biopsy was 0.95, sensitivity 0.91, specificity 0.98, positive predictive value (ppv) 0.97 and negative predictive value (npv) 0.93. The diagnostic accuracy of trephine biopsy alone was 0.93, sensitivity 0.89, specificity 0.98, ppv 0.97 and npv 0.91 and accuracy for FNAB alone was 0.85, sensitivity 0.80, specificity 0.90, ppv 0.89 and npv 0.82. ConclusionsMRI guidance is a feasible and accurate tool in percutaneous musculoskeletal biopsies. Fine needle biopsy is a useful low-cost supplement to histologic biopsy.

Clinical, ultrasonographical and histopathological aspects in Hashimoto’s thyroiditis associated with malignant and benign thyroid nodules

The reported prevalence of chronic autoimmune thyroiditis associated with differentiated thyroid cancer (DTC) is heterogeneous.The aim of this study was to evaluate some epidemiological, clinical, sonographical and histological features of operated thyroidnodules with background diffuse autoimmune thyroiditis. The study included 411 cases with Hashimoto's thyroiditis (HT), of which 118 presented thyroid nodular disease(TND). Thyroidectomy was performed in 76 cases. Of these patients, 24 presented histologically confirmed DTC and 52 benign lesions.DTC types were as follows: papillary thyroid cancer (PTC) (n = 6), follicular variant of PTC (FVPTC) (n = 6), papillary microcarcinomas(n = 8), follicular thyroid carcinoma (n = 1) and the mixed form (classic PTC and FVPTC) (n = 3). The benign nodules were dominatedby: follicular adenoma (48%), and colloid goitre (40.3%). The sonographic features with predictive risk for malignancy in cases with HT associated with TND were represented by: solidcomposition, hypoechogenicity and microcalcifications. The characters of margins, the nodular shape and the type of vascularity do notseem to be as useful for identification of malignant nodules in HT. Fine needle-aspiration biopsy (FNAB) showed in DTC cases differentcytological smears: malignant (ten), indeterminate (eight), benign (two), and non-diagnostic (four). In the group of benign nodules, theindeterminate smears represented also a significant percentage (n = 12). The incidence of TND associated with HT was 28.7%. Among 76 operated cases, 31.5% presented DTC. The accuracyof FNAB in the preoperative diagnosis showed higher sensitivity (90.0%) and specificity (61.5%) compared to sonographic criteria.

Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

To compare the diagnostic accuracy of ultrasonographically (US)-guided fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) of the axillary lymph nodes (LNs) of patients with newly diagnosed invasive breast cancer. This prospective single-center study had institutional review board approval, and written informed consent was obtained. Between April 2011 and March 2012, 178 consecutive patients (182 axillae) were evaluated by using axillary US. Sixty-six axillae fulfilled the inclusion criteria (cortical thickness greater than 2 mm or abnormal morphologic characteristics), and patients with these axillae underwent US-guided axillary LN biopsy. Both FNAB and CNB were obtained from the same suspicious LN. Patients with biopsy-proved metastasis underwent axillary clearance, and those with a negative biopsy underwent sentinel LN biopsy with completion axillary clearance if needed. Diagnostic performance was calculated separately for US, FNAB, and CNB. Statistical differences in sensitivities were evaluated by using the McNemar test. From the total study population, 45.6% (83 of 182 axillae) had metastases. A total of 66 axillae underwent both FNAB and CNB. The sensitivity for US was 61.4% (51 of 83 axillae), and specificity was 84.8% (84 of 88 axillae). The sensitivities for FNAB and CNB were 72.5% (37 of 51 axillae) and 88.2% (45 of 51 axillae), respectively (P = .008). Specificity for both was 100% (15 of 15 axillae). The negative predictive value for FNAB was 81.7%, and that for CNB was 91.2%. The positive predictive value was 100% for both methods. When accurate preoperative staging of the axilla is needed in patients with newly diagnosed invasive breast cancer, CNB is more sensitive than FNAB.

Diagnostic accuracy of fine-needle aspiration cytology of the breast in Japan: Report from the Working Group on the Accuracy of Breast Fine-Needle Aspiration Cytology of the Japanese Society of Clinical Cytology

The Working Group of the Japanese Society of Clinical Cytology was assembled to assess the current status of breast cytology in Japan by conducting a large-scale survey regarding the accuracy of fine-needle aspiration biopsy (FNAB) in Japan. We collected data and investigated the status of breast cytological diagnosis at 12 different cooperating facilities in Japan, and re-evaluated their false-negative and false-positive cases. Among 30,535 individuals who underwent a breast cytological examination, analyses were conducted on 10,890 individuals (35.7%) in whom cytological diagnoses were confirmed by histology. Among these patients, the cytological diagnosis had an inadequate rate of 17.7%, an indeterminate rate of 7.8%, a positive predictive value of 'malignancy suspected' cells of 92.4%, an absolute sensitivity of 76.7%, a complete sensitivity of 96.7%, a specificity of 84.3%, a positive predictive value of 'malignant' cells of 99.5%, a false-negative value of 3.31%, a false-positive value of 0.25% and an accuracy rate of 88.0%. Subsequently, 297 false-negative and 23 false-positive cases were re-evaluated and several factors were characterized (i.e. histological type, tumor size and misread points). This survey collected data from a large number of cases for breast FNAB. Based on our survey, the accuracy of FNAB in Japan was relatively high compared with the goal of assessment of diagnostic accuracy. However, there were some false-negative and false-positive cases. Improvements in accuracy resulting from the learning points in the present study will lead to more useful and reliable diagnostic tools in clinical practice.

Thyroid nodules in children and adolescents: a single institution’s experience

The aims of this study were to analyze the role of fine-needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules and to analyze the malignancy risk of thyroid nodules by studying the association between autoimmune thyroiditis and thyroid cancer. We conducted a retrospective study on 111 patients with thyroid nodules diagnosed in childhood or adolescence. FNAB was performed in 46 participants with thyroid nodules after ultrasonography (US). Cytology diagnoses were categorized as insufficient, benign, suspicious, and malignant. Clinical and surgical follow-up data were obtained from medical records. The clinical correlation and accuracy of FNABs were evaluated. The family history was positive in four patients. Forty-six patients had positive antithyroid antibodies and an inhomogeneous hypoechogenic US pattern. One patient had previous neck irradiation history. Eighty-six patients (%77.5) were euthyroid. All patients underwent US examination. The FNAB results of the 46 patients were 29 (63%) benign cases, 7 (15%) insufficient, and 10 (22%) suspicious patients. Malignancy was not reported at all. A repetition of FNAB in two benign cases, which were diagnosed with papillary carcinoma during followup, reported these cases as suspicious. Ten patients with suspicious FNAB results underwent surgery because of increases in the size of the nodules; two patients were diagnosed with papillary carcinoma. In this study, the prevalence of malignancy was 4.5% in patients with thyroid nodules. In this study, the importance of FNAB in the diagnosis and follow-up of thyroid nodules in childhood has been observed, and risk factors, such as history of familial thyroid carcinoma, radiotherapy to the neck at younger ages, suspicious cytological findings, and increased nodular sizes during follow-up in cases with Hashimoto thyroiditis have been correlated with increased thyroid carcinoma malignancy risk.

Reply to diagnostic criteria and risk‐adapted approach to indeterminate thyroid cytodiagnosis

We thank Dr. Yang for his interest in our article1 and appreciate his comments. We fully agree that close communication between the clinician and cytopathologist is essential. Information on the clinical characteristics of the patient as well as the ultrasonographic characteristics of the nodule have the potential to profoundly influence both interpretation of the cytology and clinical management decisions. We further agree that improved selection of which nodules to biopsy will decrease the rate of indeterminate cytodiagnosis. However, all of the published guidelines, including the American Thyroid Association Guidelines2 revised in 2009, recommend biopsy in most nodules larger than 1-1.5 cm. Dr. Yang correctly points out that having a high rate of histological correlation of biopsy samples would be ideal. Indeed, his excellent article published in this journal in 20073 provided important information on the diagnostic accuracy of fine-needle aspiration biopsy of thyroid lesions. In his study of 4703 biopsies, histological correlation was obtained in 1052 patients. The rate of indeterminate thyroid cytodiagnosis varies with the reference cited. We cited 15% as a commonly accepted national average. Dr. Yang points out that 1 of our references indicated the rate to be as high as 22%. It is of interest that in Dr. Yang's series, the rate was only 11.6%. Further, in his patients with initial diagnosis of follicular neoplasm who underwent repeat biopsy, 40% were reclassified as benign. Our contention that the rate of diagnosis of follicular neoplasm is excessive is, in large part, based on our role to provide second opinions on biopsies previously categorized as follicular neoplasm. We consistently find that in a large number of these cases, the nodules are reclassified as benign, either on the basis of a review of the original biopsy sample or on the basis of a high-quality repeat biopsy when the initial sample was thought to be insufficient or of poor quality. Finally, Dr. Yang suggests that our preference for the term microfollicular neoplasm does not add significant clarification. We agree that the follicular neoplasm category in the Bethesda System includes “follicular cells...arranged predominately in microfollicular or trabecular arrangements.”4 However, we have frequently found that among cases we have reviewed for a second opinion, samples with orderly monolayer sheets were often misinterpreted as follicular neoplasm simply on the basis of hypercellularity. In his article,3 Dr. Yang correctly states that these should be classified as benign, and we agree completely. We believe that the description microfollicular neoplasm adds clarity to this category by emphasizing the need for architectural abnormality for this diagnosis. Those patients whose nodules demonstrate simple hypercellularity should not be misclassified as having a follicular neoplasm and placed at risk of unnecessary surgery. No specific funding was disclosed. CONFLICT OF INTEREST DISCLOSURES The authors made no disclosures.

Acurácia da punção aspirativa por agulha fina e da punção por agulha grossa no diagnóstico de lesões mamárias

to determine the accuracy of fine-needle aspiration biopsy (FNAB) and of core-needle biopsy (CNB) in diagnosing breast lumps and breast cancer. this was a cross-sectional, retrospective and descriptive study based on the review of medical records. FNAB and CNB were carried out sequentially according to the routine of the Mastology Service. Both percutaneous procedures were applied to 233 patients during the period from March 2005 to February 2007. Women aged 18 years or more with changes in the clinical and/or image examination of the breast or a family history of breast and/or ovarian cancer were included. FNAB and CNB were carried out according to the technical recommendations of the National Institute of Cancer. The percentage of agreement, Cohen's Kappa coefficient, sensitivity, specificity, positive and negative predictive values and the accuracy of FNAB and CNB were calculated, considering the surgical biopsy as the gold standard. the average age of the patients was 49.0 years (±12.7) and the tumors measured 26.9 mm on average (±23.1), being larger than 20 mm in 47.2% of cases. Sensitivity, specificity, positive and negative predictive values and accuracy were higher for CNB than for FNAB, regardless of the size of the breast lesion. The diagnostic accuracy was 97.5% for CNB and 77.5% for FNAB. although the CNB showed higher rates of sensitivity, specificity, positive predictive value, negative predictive value and accuracy than FNAB for palpable and non-palpable breast lumps, the method remains useful for the minimally invasive diagnosis of mammary lesions, especially when its results are analyzed together with the clinical and imaging examination.

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Objective: To assess the role of fine−needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules.Methods: Results of 30 FNABs performed in our clinic were retrospectively reviewed. Clinical and surgical follow−up data were obtained from the patient files, and clinical correlation and accuracy of FNAB were evaluated.Results: The results of 30 FNABs were reported as benign in 24 (80%), insufficient in 4 (13.3%) patients, malignant in 1 (3.3%), and suspicious in 1 (3.3%) patient. One patient with a FNAB result of malignancy underwent surgery and the histological diagnosis was papillary carcinoma. FNAB was repeated in two of the insufficient biopsies, and reported as benign; in one of these patients, the thyroid nodule disappeared and in one, remained stable at clinical follow−up. Four of the patients with benign FNAB results underwent surgery at clinical follow−up because of an increase in the size of the nodules and one patient was found to have papillary carcinoma. The remaining patients were clinically followed. In this study, the malignancy prevalence was 6.6% in patients with thyroid nodules. There was only one falsenegativecase.Conclusion: FNAB is a reliable diagnostic tool in the management of pediatric thyroid nodules.Conflict of interest:None declared.

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4cm or Larger

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4cm or Larger

Diagnostic Markers and Prognostic Factors in Thyroid Cancer

There has been considerable progress identifying biomarkers in thyroid tumors that improve the accuracy of fine-needle aspiration biopsy and also help predict tumor aggressiveness or behavior. In this review we address both the clinical potential of molecular biomarkers and their usefulness, based on the most recent literature. We describe the current best clinical staging systems and the common somatic mutations in thyroid cancer. The BRAF mutation is the most common mutation in papillary thyroid cancer and has recently been reported to be associated with disease aggressiveness; it is also an independent predictor of tumor behavior. Combined testing of RET/PTC, NTRK, RAS and PAX8-PPARgamma, which are mutually exclusive mutations, helps improve the accuracy of fine-needle aspiration biopsy. Gene-expression profiling studies have identified a variety of potential molecular markers to help distinguish benign from malignant thyroid neoplasms. Expression analysis of differentially expressed microRNAs also appears to be a promising diagnostic approach for distinguishing benign from malignant thyroid neoplasm. It is especially useful for indeterminate nodules by fine-needle aspiration biopsy.

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger

All thyroid nodules 4 cm or larger should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results because of an unacceptably high rate of false-negative preoperative biopsy results in these large nodules. Retrospective cohort study. Single-institution, tertiary academic referral center. A retrospective analysis was performed on all patients who underwent surgery for a thyroid nodule 4 cm or larger from May 1, 1994, through January 31, 2007. Preoperative FNAB results were correlated with final surgical pathologic results. The FNAB results were reported as nondiagnostic, benign, inconclusive (follicular neoplasm), or malignant, whereas the final surgical pathologic data were reported as benign or malignant. Of 155 patients who underwent a thyroidectomy for a nodule 4 cm or larger, 21 patients (13.5%) had a clinically significant thyroid carcinoma within the nodule on final pathologic analysis. Preoperative cytologic testing of the mass was performed on 97 patients, and the results read as benign for 52, inconclusive for 23, nondiagnostic for 11, and malignant for 11. In lesions 4 cm or larger, 26 of 52 FNAB results reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%. In patients with thyroid nodules 4 cm or larger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Furthermore, those patients with a nondiagnostic FNAB result display a high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy be strongly considered in patients with thyroid nodules 4 cm or larger regardless of FNAB cytologic test results.

BRAF V600E mutation analysis increases diagnostic accuracy for papillary thyroid carcinoma in fine-needle aspiration biopsies

Papillary thyroid carcinoma (PTC) represents the majority of differentiated thyroid cancers, presenting the V600E activating BRAF mutation in 29-83% of cases. The aim of our study is to analyze the influence of BRAF mutation analysis on the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) in patients with suspected PTC. Thyroid cytoaspirates from 469 nodules (size: 1.1+/-0.8 cm) with ultrasonographic features suspicious of malignant lesion, performed in 374 patients, were submitted to cytological evaluation and to biomolecular analysis, carried out after somatic DNA isolation, specific PCR amplification, and subsequent automated direct sequencing. All PCR fragments were also processed by specific enzyme restriction analysis. BRAF V600E mutation was found in 48 samples, 41 of which were also cytologically diagnosed as PTC, with histologic confirmation after thyroidectomy. Total thyroidectomy was perfomed also in seven patients with negative cytology but positive BRAF mutation, with histological confirmation of PTC in all. Among the 429 BRAF-negative samples, 407 had negative cytology for PTC, while 22 were diagnosed as suspected PTC and underwent total thyroidectomy with histological diagnosis of PTC in 17 and benign lesion in five. The prevalence of BRAF V600E mutation among histologically diagnosed PTC patients was 64%. Biomolecular analysis significantly increased cytology sensitivity for PTC from 77.3 to 86.7% (P<0.01). These data indicate that BRAF V600E mutation analysis can significantly improve FNAB diagnostic accuracy. However, biomolecular analysis is complementary to cytology, which should always be performed.

Fine needle aspiration biopsy of intraoral and oropharyngeal mass lesions

BackgroundFine needle aspiration (FNA) biopsy has been rarely used in oral and oropharyngeal lesions. The goal of this study was to assess the value and accuracy of FNA biopsy in the diagnosis of oral and oropharyngeal lesions particularly in regards to discriminating benign from malignant tumors.MethodsSixteen cases of FNA biopsies obtained of various intraoral and oropharyngeal masses or lesions performed at our institution during the eight-year period from 1998 to 2006 were retrospectively reviewed. The aspiration cytologic diagnoses were correlated with the histologic examination of the corresponding resected lesions.ResultsSixteen cases of intraoral lesions evaluated by FNA biopsies during the period of 1998–2006 were reviewed. The sites of involvement were: lip [1], maxillary sinus [3], pharynx/oropharynx [5], floor of mouth [4], buccal mucosa [2] and peritonsillar area [1]. Patients' age ranged from 30 to 87 with an average of 54 years. Male to female ratio was 1:3. Cytologically, 7 cases were diagnosed as suspicious/malignant, and 9 cases as benign (including 6 benign neoplasm, 1 atypical, and 2 reactive or "descriptive"). Fifteen cases had corresponding surgical resection for histologic examination, of these, 9 cases were interpreted as malignant, and 6 as benign. There were no false positive diagnoses of malignancy on FNA. Two cases were interpreted as benign or atypical cytologically, but were found to be malignant on histologic examination.ConclusionFNA biopsy of intraoral and oropharyngeal masses is a valuable procedure for the initial evaluation of various lesions. It provides helpful information about these lesions and avoids hasty or unnecessary surgical biopsy. It is a rapid and relatively noninvasive procedure. Furthermore, aspiration biopsy is an important tool in the diagnosis and management of these lesions, both neoplastic and non-neoplastic, and can be sometimes complemented by ancillary studies for more accurate interpretation. However, its sensitivity in the diagnosis of malignancy is lower than that of histologic samples. This is probably due to the superficial nature and small size of these lesions, the limited space for maneuvering the needle and difficulty in immobilizing the lesion to obtain adequate samples, rather than to interpretation or inherent limitations of the technique itself.

Combined analysis of galectin-3 and BRAFV600E improves the accuracy of fine-needle aspiration biopsy with cytological findings suspicious for papillary thyroid carcinoma

Ten to fifteen percent of fine-needle aspiration biopsy (FNAB) of thyroid nodules are indeterminate. Galectin-3 (Gal-3) and the oncogene BRAFV600E are markers of malignancy useful to improve FNAB accuracy. The objective of this study was to determine whether the combined analysis of Gal-3 and BRAFV600E expression in thyroid aspirates could improve the diagnosis in FNAB with suspicious cytological findings. Two hundred and sixty-one surgical thyroid tissues and one hundred and forty-four thyroid aspirates were analyzed for the presence of the two markers. In surgical specimens, Gal-3 expression was present in 27.4% benign nodules, 91.9% papillary (PTC) and 75% follicular (FTC) thyroid carcinomas. BRAFV600E was not detected in 127 benign nodules, as well as in 32 FTCs, while was found in 42.9% PTC. No correlation was found between BRAF mutation and Gal-3 expression. Forty-seven consecutive FNAB suspicious for PTC were analyzed for the presence of the two markers. Of these nodules, 23 were benign at histology, 6 were positive for Gal-3, none displayed BRAFV600E, and 17 were negative for both the markers. Twenty suspicious nodules were diagnosed as PTC and four FTCs at histology. Of these 24 carcinomas, 9 resulted positive for BRAFV600E, 17 for Gal-3, and 22 for one or both the markers. The sensitivity, specificity, and accuracy for the presence of Gal-3 and/or BRAFV600E were significantly higher than those obtained for the two markers alone. Notably, the negative predictive value increased from 70.8 to 89.5%. In conclusion, the combined detection of Gal-3 and BRAFV600E improves the diagnosis in FNAB with cytological findings suspicious for PTC and finds clinical application in selected cases.

Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is an osseous mass lesion that accounts for 1% of primary bone tumors. We describe 23 cases of ABC initially evaluated by fine-needle aspiration biopsy (FNAB). In 4 cases, the ABC was secondary to another primary tumor. Aspirates from 6 cases (26%) were insufficient. Twelve aspirates diagnosed as ABC by FNAB were confirmed as ABC by histologic examination. The accuracy of FNAB was 82% when cases insufficient for evaluation were excluded. One case diagnosed as ABC cytologically was subsequently found to be metastatic carcinoma. In another, the specimen was interpreted as ABC vs giant cell tumor. In the remainder, a diagnosis of ABC was favored cytologically. Owing to the nonspecific findings, ABC cannot be definitively diagnosed by FNAB. However, the presence of typical clinical and radiographic features in conjunction with a blood-rich, mesenchymal cell containing aspirate devoid of overtly malignant cells strongly suggests the diagnosis of ABC.

A clinical analysis of patients with submandibular gland tumors

A retrospective investigation was performed on 33 patients with submandibular gland tumors treated between 1998 and 2005. The tumors consisted of 17 benign and 16 malignant types. Fifteen of 16 malignant tumors were cancerous, and the most common histological type was adenoid cystic carcinoma (33.3). The accuracy of FNAB (fine-needle aspiration biopsies) was 84%, eight of 12 aspirates from malignant tumors were correctly diagnosed by FNAB, for a sensitivity of 66.7%, while all of 13 aspirates from benign tumors were correctly diagnosed by FNAB, for a specificity of 100%. The five-year survival rate calculated by the Kaplan-Meier method was 81.3% in 15 patients with submandibular gland cancer. Pathological neck lymph node metastasis in all NO cases was detected in level 2, so we concluded that supraomohyoid neck dissection might be suitable for NO cases of submandibular gland cancer. To improve the prognosis of submandibular gland cancer, postoperative chemotherapy may be necessary for T3 and T4 cases.

Fine-needle aspiration biopsy and the diagnosis of thyroid cancer.

Conventional criteria for the evaluation of thyroid nodules are inaccurate in identifying the small proportion of malignant neoplasms. The diagnostic accuracy of fine-needle aspiration biopsy (FNAB) for cytology was therefore assessed in 562 patients with nodular thyroid disease, 373 of whom (66.4 per cent) had histological confirmation of the cytological diagnosis. Sixty-one aspiration biopsies were positive for malignancy, and the diagnosis was confirmed histologically in 59 of these (96.7 per cent). Thus, there were two false positive cytology results among 310 patients with proven benign disease (0.6 per cent). Four of sixty-three patients with proven carcinoma had a benign cytological diagnosis, a false negative rate of 6.3 per cent. In 57 of the 59 malignancies (96.6 per cent) correctly diagnosed by FNAB the histological type of tumour was successfully identified. Overall 367 of 373 patients received correct cytological discrimination between benign and malignant nodules, an overall accuracy of 98.4 per cent for FNAB. The sensitivity of the test was 93.7 per cent and the specificity 99.4 per cent. Besides being safe, cost-effective and reliable, FNAB directs the appropriate selection of patients for surgery and enables the correct operation to be performed for each type of tumour.