Results Of Aspiration Cytology Research Articles

Adiposity is associated with a higher number of thyroid nodules and worse fine-needle aspiration outcomes.

Adiposity may be associated with thyroid nodularity. However, its impact on the number of nodules and the risk of malignancy is unclear. To evaluate the impact of adiposity on thyroid nodules using body mass index (BMI), ultrasonographic (US) data and cytological data. A retrospective cohort study of 310 patients with thyroid nodules was performed. Patients were categorized based on their BMI, and grayscale US data and fine-needle aspiration cytology results were evaluated. Patients with BMI ≥ 25 kg/m2 were found to have a higher number of thyroid nodules compared to those with BMI < 25 kg/m2 (4.25 ± 2.42 vs 3.66 ± 1.93) (P value = 0.05). Patients with BMI ≥ 25 kg/m2 had more suspicious and malignant cytology than those with BMI < 25 kg/m2 (P value = 0.029). Patients with BMI ≥ 25 kg/m2 had more nodules with intermediate and high suspicion sonographic patterns. However, this did not reach statistical significance. Overweight and obese patients have a trend for more thyroid nodules and have a higher risk of being diagnosed with thyroid malignancy.

Retrospective Study of Fine Needle Aspiration Cytology of Patients with Thyroid Nodule in Benghazi in the Period of (2021-2023)

Background: Thyroid nodules constitute a common endocrine disorder, these nodules could be solitary, multiple, cystic, or solid. Increasing age, female gender, iodine deficiency, and history of thyroid radiation all are high risk for thyroid nodules. FNAC representing the most cost-effective diagnostic tool used in the assessment of nodules of the thyroid. Objective of the study: The aim of this study is to evaluate the result of fine needle aspiration cytology (FNAC) and assess thyroid status using of thyroid hormone obtained from patients with thyroid nodules. Materials and methods: this is a retrospective study, includes collection of data from available cases of thyroid nodules underwent fine needle aspiration between 2021 to 2023, data regarding age, sex, TFT, USS, FNAC was collected from the archive of endocrine out patients clinic of Benghazi Medical Center and from endocrine clinic of Benghazi diabetic center. The analysis was done using the SPSS program. Result: A total of 60 cases were studied, Data was collected from 60 patient’s files for years between 2021 and 2023. The mean age of the patients with FNAC selected for this study was 49.65, and ranged from 21-80 years. The gender distribution shows female predominance in which female cases were 53 (98.33%) while only one case (1.67%) was reported among men. The size of nodules in our cases range from 1cm to 4.5 cm. The mean size of nodules is 1.89cm. In this study the largest group of nodules located in right lobe (21) cases then left lobe (20) cases then both (17) cases and in isthmus only 2 cases. Most of the cases thyroid function test result shows an euthyroid status (38) cases. FNAC of thyroid nodule showed that most of patient’s result diagnosed as benign nodules (47) cases. Conclusion: FNAC is a key tool in diagnosis of thyroid nodule as it has safe, minimally invasive and cost effective diagnostic role.

Diagnostic Accuracy of Bethesda Classification of Thyroid Nodules at a Kenyan Hospital: A Retrospective Study

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was developed to standardize the reporting of thyroid nodule fine-needle aspiration cytology (FNAC) results. The adoption of TBSRTC is based on the implied risk of malignancy per category, but this has shown wide variation in different regions worldwide. Aim: The aim of this study is to determine the diagnostic accuracy of the Bethesda classification of thyroid nodules in a Kenyan hospital. Methods: A retrospective longitudinal study examined FNAC and histopathology data of thyroid gland nodules at a Kenyan hospital from 2010 to 2019; specimens from 347 patients were found. An analysis was performed to determine the diagnostic accuracy of the Bethesda classification in detecting malignancy among these patients. Results: The malignancy rate was 16.1%. The risk of malignancy as per the Bethesda category was as follows: non-diagnostic— 19.6%, benign—6%, atypia of undetermined significance—20%, follicular neoplasm—16.7%, suspicious for malignancy—80%, and malignant—85.7%. The diagnostic properties of FNAC defining “malignant” and “suspicious for malignancy” categories as malignant were as follows: sensitivity—64.7%, specificity—97.6%, and accuracy—92.7%. Conclusion: The Bethesda classification had high diagnostic accuracy, with the risk of malignancy consistent with the Bethesda findings. Classifying malignancy as “malignant” and “suspicious for malignancy” yielded the most favorable diagnostic properties for FNAC.

Evaluation of ACR TI-RADS for Predicting Malignancy in Thyroid Nodules: Insights from Fine-Needle Aspiration Cytology and Histopathology Results

Evaluation of ACR TI-RADS for Predicting Malignancy in Thyroid Nodules: Insights from Fine-Needle Aspiration Cytology and Histopathology Results

Diagnostic yield of combined ACR TI-RADS and Sonoelastography in solid thyroid nodules in tertiary care center: A prospective cross-sectional Study

Background: Thyroid nodules are prevalent, and accurate differentiation between benign and malignant nodules is crucial for management. We aim to evaluate the effectiveness of combining Thyroid Imaging Reporting and Data System (TIRADS) scoring with strain elastography, specifically the Elasticity Contrast Index (ECI), to differentiate between benign and malignant thyroid nodules. Methods: This analytical cross-sectional study involved 77 patients with solid thyroid nodules identified through B-mode ultrasonography. ACR TI-RADS scores, ECI values, and combined scores were compared with Fine needle aspiration Cytology (FNAC) results. Statistical analysis was performed using SPSS, and Pearson correlation tests were conducted to assess the correlation with FNAC findings. Result: The TI-RADS scoring system has a sensitivity of 83.3%, a specificity of 66.1%, and a positive predictive value of 42.9% for distinguishing benign and malignant nodules. Strain elastography with ECI values has a sensitivity of 94.4%, specificity of 98.3%, PPV of 94.4%, and NPV of 98.3%. Combining ACR TI-RADS and strain elastography achieves a sensitivity of 100%, specificity of 66.1%, NPV of 100%, and PPV of 47.4%. Conclusion: The study emphasizes the benefits of integrating noninvasive methods like ultrasound elastography and ACR TI-RADS for improved diagnostic precision, minimizing invasion and patient discomfort. This strategy is particularly advantageous for TI-RADS 3 nodules and reduces unnecessary procedures. However, FNAC should be reasonable and validated for higher classifications.

Positive Predictive Value of Thyroid Imaging, Reporting and Data System (TI-RADS) (3-5) When Compared to Fine Needle Aspiration Cytology Results

Abstract Background Thyroid nodules are a very common finding in the population. Evaluation of a patient with a thyroid nodule for possibility of malignancy could be challenging. Ultrasound is one tool that could be of help, several scoring systems are utilized to help differentiate benign from malignant nodules. One of the most used is TIRADS as proposed by ACR. Another invasive tool that could help is fine needle aspiration cytology. Objective Evaluating and comparing the accuracy of TI-RADS in the assessment of suspicious thyroid nodules by matching their results with the results of FNAC. Patients and Methods Our study was conducted on 72 adult patients with thyroid nodules and were referred to undergo FNA procedures in ‘Interventional radiology unit’ at the Radiology Department “Ain Shams University hospitals”, Cairo, Egypt. Results The present study concludes that TIRADS classification as proposed by ACR showed less statistical significance in predicting malignancy when compared to results of fine needle aspiration cytology. However, several components of the TIRADS scoring system were better predictors of malignancy than other components, namely the irregular margin, the taller than wider shape and the presence of calcifications within the nodule. Conclusion Our study concludes that better applying and implementing the TIRADS scoring system by the sonographer or using other scoring system available in evaluating thyroid nodules like ATA scoring system might result in more reliable ultrasound results decreasing the need to do fine needle aspiration.

Evaluation of Sensitivity and Specificity of Ultrasound-Guided FNA of Suspicious Axillary Lymph Nodes in Patients with Breast Cancer

Background: The axillary lymph node status in breast cancer is a major prognostic factor in survival and establishing a personalized treatment scheme. The ultrasound-guided fine needle aspiration (US-FNA) is a method for taking a lymph node sample. It allows physicians to decide how to manage the axilla. Objectives: This study was conducted to investigate the sensitivity of the US-FNA technique on suspicious axillary lymph nodes with a thickness of 3 to 6 mm in breast cancer patients. Methods: In a cross-sectional study, all the patients were subjected to preoperative ultrasound evaluation of the axilla to determine the presence of lymph nodes suspicious of malignancy. In cases where the suspicious lymph node cortex size was between 3 and 6 mm, US-FNA was performed. After surgery, the frozen section of the biopsy sample was examined histologically and compared with fine needle aspiration (FNA) cytology results. Results: A total of 102 patients were examined in the study. FNA test results indicated that 46 subjects had axillary malignant tissue, and benign cases summed 56. Also, the final results of frozen section surgical histopathology identified 46.1% of patients with involved lymph nodes. The sensitivity and specificity of FNA were 93.62% and 96.36%, respectively. Also, the overall diagnostic accuracy was 95.1%. Conclusions: This study showed that the sensitivity, specificity, and accuracy were more than 90% for the ultrasound-guided FNA test in identifying involved lymph nodes in patients with breast cancer. Therefore, the results of this test can be considered clinically reliable. However, there is still a need to examine the sensitivity and specificity of this method in identifying lymph node involvement.

Diagnostic Accuracy of Fine Needle Aspiration Cytology as Compared to Histopathology in Parotid Gland Swelling.

The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling. It was a descriptive cross sectional study carried out in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis. There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study. The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions.

SAT571 When Two Is Too Few: Bethesda IV Pathology On Repeat Thyroid Fine Needle Aspiration

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. M.K. Shakir: None. T.D. Hoang: None. Background: The 2015 American Thyroid Association Guidelines for Adult Patients with Thyroid Nodules provide a strong recommendation against routine ultrasound surveillance of thyroid nodules for which two benign fine needle aspiration (FNA) cytology results have been previously obtained. Strict adherence to these guidelines may hinder detection of malignancy, especially in large nodules where there is potential to miss heterogeneous pathology based on sampling technique. Clinical Case: A 36-year-old female was evaluated for surveillance of a large non-toxic multinodular goiter. Thyroid ultrasound demonstrated a dominant right thyroid nodule greater than 7 centimeters in size. The patient had undergone FNA of this nodule in 2014 and 2019 with Bethesda II (benign) cytopathology results. A chest x-ray showed tracheal deviation without evidence of narrowing. She noted a sensation of neck pressure without dysphagia or shortness of breath. She denied fatigue, heat or cold intolerance, hand tremor, or pretibial myxedema. She denied a family history of thyroid cancer or any history of neck irradiation. Due to new compressive symptoms a repeat FNA was performed. Three passes were performed with adequate samples, and the final FNA cytopathology demonstrated a Hurthle cell oncocytic-type follicular neoplasm with Bethesda IV classification. The sample was submitted for ThyGeNEXTTM and ThyraMIRv2TM molecular testing, which returned with NRAS q61R mutation of moderate-to-high risk of malignancy (65-75%). The patient was subsequently referred for total thyroidectomy with pending surgery date. Discussion: The current ATA guidelines offer a cost-effective surveillance strategy for the vast majority of patients with thyroid nodules. False negative FNA results are rare and are reported to occur in about 1% of cases1. As in this vignette, it is reasonable to perform an additional FNA after two consecutive Bethesda II results in nodules with clinically significant growth, new compressive symptoms, or if there is concern for incomplete sampling in nodules of large size. During an FNA, care should be taken to gently move the needle at various angles to capture follicular cells from different areas within a nodule. Large nodules should be sampled via multiple, separate skin entry points when feasible. Judicious use of repeat FNA along with these sampling techniques may help to prevent under-diagnosis in nodules containing multifocal areas of heterogeneous pathology. Reference: 1) Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Filetti S. 2015. The natural history of benign thyroid nodules. JAMA 313:926-935 Presentation: Saturday, June 17, 2023

Extrapulmonary Tuberculosis: A Retrospective Study in Eastern India Based on Diagnostic Modalities

Background: The most common site of tubercular infection is lungs, but various extrapulmonary sites also can be affected by tuberculosis (TB). Very few fine-needle aspiration-based studies supplemented by cartridge-based nucleic acid amplification test (CBNAAT) and radiology have been conducted in any center of tribal-based area situated in Eastern India. Materials and Methods: Sixty extrapulmonary TB cases (28 males and 32 females) received during 3 years (May 2018–April 2021) were included in this study. Results: Diagnoses of different extrapulmonary tubercular lesions were: lymphadenitis (n = 27), cold abscess (n = 18), breast abscess (n = 2), epididymitis (n = 4), oral cavity (n = 3), spine, long bone (n = 2 cases each) and fingertip and TB of the penis (n = 1 case each). Forty-six cases were diagnosed by fine-needle aspiration cytology. CBNAAT diagnosed ten cases where the result of aspiration cytology was inconclusive. Radiology directly diagnosed four cases, whereas it helped another seven cases indirectly to clinch the proper diagnosis of extrapulmonary tubercular lesions. Conclusion: Tuberculous lymphadenitis was the most common extrapulmonary lesion. Females outnumber male cases. Aspiration cytology aided by CBNAAT and radiology proved indispensable to diagnose extrapulmonary tubercular lesions, especially for economically constrained persons.

Toxoplasmic Lymphadenitis of the Head and Neck Region.

We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery. A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled. All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period. It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Association of the Thyroid Nodules' Sonographic Features With Fine Needle Aspiration (FNA) Cytology Results

Thyroid nodules are a common finding in clinical practice. Although ultrasonography is an accepted method for evaluating these nodules, Fine Needle Aspiration (FNA) is the procedure of choice for assessing the risk of malignancy. This study aims to determine the association between sonographic features of thyroid nodules based on Thyroid Imaging Reporting and Data System classification and the cytology results. In this prospective cohort study, 147 patients from Tehran Medical Imaging Center who had thyroid nodules underwent ultrasonography-guided FNA, and their sonographic features were recorded. The pathologic findings were also obtained according to the Bethesda system. Finally, the association between sonographic features and cytological results was analyzed. Eighteen (12.3%) nodules were malignant, and 129 nodules (87.7%) were benign. The association of TIRADS categories with the risk of malignancy is as follows: TIRADS 1 (n=0, 0%), TIRADS 2 (n=10, 16.9%), TIRADS 3 (n=6, 10.5%), TIRADS 4 (n=2, 16.7%), and TIRADS 5 (n=0, 0%). The bloody lamellae of thyroid nodules were significantly correlated with the risk of malignancy (P&lt;0.05). However, there was no statistically significant association between the risk of malignancy and gender (P=0.47), calcification (P=0.9), firmness (P=0.19), halo sign (P=0.95), location of nodules (P=0.35), and nodules' echogenicity (P=0.058). Although there are trusted classifications such as TIRADS for categorizing thyroid nodules, there is still uncertainty in utilizing them, especially in the management of nodules classified as TIRADS 2, in which various sonographic features are shared between benign and malignant nodules.

Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

BackgroundFine needle aspiration cytology has been established as a minimally invasive, non-tumour seeding investigation of choice in the initial diagnostic pathway of parotid lesions. The purpose of this study was to compare the accuracy of fine needle aspiration cytology performed with and without ultrasound to determine whether one method should be preferred to the other. A retrospective review of all patients undergoing fine needle aspiration cytology with and without ultrasound for parotid masses in a large district general hospital between 2012 and 2016 was performed. Specificity, sensitivity, accuracy, positive and negative predictive value, percentage of inconclusive fine needle aspiration cytology and percentage of second fine needle aspiration cytology were determined for each group.ResultsA total of 397 fine needle aspiration cytology results were available for analysis. The numbers performed with ultrasound guidance and free-hand were roughly equal (208 (52.3%) versus 189 (47.7%)). The number of inconclusive fine needle aspiration cytology reports was significantly higher in the free-hand group (65/189 (34.4%)) than the ultrasound group (25/208 (12%)) (p < 0.0001). A significantly higher number of repeated fine needle aspiration cytology were undertaken in the free-hand group vs ultrasound group (43 vs 15, p < 0.0001); overall 7.2% of ultrasound-guided fine needle aspiration cytology required a second fine needle aspiration cytology, compared to 22.8% in the free-hand group. The sensitivity, specificity, positive and negative predictive values were all higher in the ultrasound group versus the free-hand group.ConclusionsUltrasound-guided fine needle aspiration cytology is superior to free-hand fine needle aspiration cytology in the investigation of parotid tumours. There is a significant benefit in reducing the number of inconclusive results and repeat fine needle aspiration cytology, and a potential benefit in improving the sensitivity and positive predictive value, when immediate cytology assessment of the sample quality is not performed.

An Exceptional Cause of Increased 18F-Fluorodeoxyglucose Uptake on PET/CT in a Thyroid Nodule.

A 41-year-old female underwent a cervical spine CT for the workup of posterior neck pain irradiating to the shoulders for several months. An incidental thyroid nodule was found and classified as Bethesda III on the Fine-needle aspiration cytology (FNAC) results. Three months later, the patient developed mild shortness of breath, dry cough, and fever. Chest X-ray revealed a mild enlargement in the bilateral hilar regions. CT showed mediastinal and bilateral hilar enlarged lymph nodes and pulmonary micronodules. The workup was further completed with a 18F-FDG PET/CT, showing intense FDG uptake in the mediastinal and bilateral hilar lymph nodes and increased uptake in the thyroid nodule. Endobronchial Ultrasound-guided Transbronchial needle aspiration (EBUS-TBNA) of a left hilar lymph node showed epithelioid non-necrotizing granulomas. Because of the FNAC results, size of the nodule and tracheal shift, thyroid lobectomy was performed one month later. Histopathological results also revealed multiple non-necrotizing epithelioid granulomas, suggesting systemic sarcoidosis with involvement of the thyroid. To our knowledge, this is the first report of thyroid sarcoidosis detected on 18F-FDG PET/CT. Although an increased FDG uptake in a thyroid nodule is usually suggestive of thyroid malignancy, toxic nodule, or follicular hyperplasia, our case report shows that it could also suggest thyroid sarcoidosis.

Correlating Fine Needle Aspiration Cytology Results of Mammary Malignancy with Corresponding Ultrasound BIRADS Score

Objective: Breast mass is a major complaint making women attending any breast clinic. About 10% of the lumps are usually malignant. Triple assessment techniques using clinical examination, ultrasound, and cytology are usually sufficient in reaching the final diagnosis, especially in specialized breast centers. The aim of this study was to assess how accurate ultrasound was in the diagnosis of definite breast cancer according to BIRADS (Breast Imaging Reporting and Data System), and correlate these radiological findings with the results of fineneedle aspiration cytology (FNAC). Methods: A retrospective study included 42 patients who presented with a self-detected breast lump and attending the Early Detection of Breast Tumors clinic in the Oncology Teaching Hospital, Medical City Complex, Baghdad during the period from May 2019 to August 2020. Their age ranged from 29 to 92 years. Patients underwent ultrasound examination after clinical examination and the reported BIRADS score was correlated with the corresponding cytology data. Results: the main ultrasound findings are masses that are either irregular in the majority of cases and this represents 55%, poorly demarcated lesions seen in (26%) while 14% of them were well defined. axillary lymphadenopathy with typical malignant features was noted in (50%). FNAC revealed mammary carcinoma in (93%); while severe atypia was seen in 7%, BIRADS V score was assigned in 76%, of breast exam BIRADS IV in 21% while the remaining 3% were in BIRADS III category. By correlating these ultrasound findings of BIRADS with FNAC results, the ultrasound accuracy in the diagnosis of breast cancer was reaching to 90%. Conclusion: Ultrasonography represents an accurate diagnostic radiological modality for any breast lesion and is thus considered a recommended method for assessment of underlying cause responsible for palpable breast mass or any presenting symptoms related to the breasts. Its value was demonstrated in characterizing the mass lesion, assessing its location, its echo texture, margin, and size, it has a major role in analyzing the axilla for normal or pathological lymph nodes.

Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology?

Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p < 0.0001). On univariate regression, patient sex, age, and Bethesda category were associated with cancer/NIFTP probability (p < 0.05 for each). Although ATA (p = 0.1211) and TI-RADS (p = 0.1359) US categories demonstrated positive trends, neither was significantly associated with cancer/NIFTP probability. A multivariate regression model incorporating the four most informative non-MT covariates (sex, age, Bethesda category, and ATA US pattern; Model No. 1) yielded a C index of 0.653; R2 = 0.108. When TSv3 was added to Model number 1, the C index increased to 0.888; R2 = 0.572. However, age (p = 0.341), Bethesda category (p = 0.272), and ATA US pattern (p = 0.264) were nonsignificant, and other than TSv3 (p < 0.0001), male sex was the only non-MT parameter that potentially contributed to cancer/NIFTP risk (p = 0.095). The simplest and most efficient clinical model (No. 3) incorporated TSv3 and sex (C index = 0.889; R2 = 0.588). Conclusions: In this multicenter study of thyroid nodules with indeterminate cytology and MT, neither the ATA nor TI-RADS US scoring systems further informed the risk of cancer/NIFTP beyond that predicted by TSv3. Although age and Bethesda category were associated with cancer/NIFTP probability on univariate analysis, in sequential nomograms they provided limited incremental value above the high predictive ability of TSv3. Patient sex may contribute to cancer/NIFTP risk in thyroid nodules with indeterminate cytology.

Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules?

In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.

A Fascinating Experience with A Rare Case of Granulomatous Mastitis

We Report a case of Idiopathic granulomatous mastitis in a 30 year old pregnant woman who came to our hospital with complaints of painful lump in her right breast because the results of initial aspiration cytology was mammary abscess with focal mastitis, incision and drainage was performed when MRI breast showed intermediate concern for malignancy – Excision biopsy was done. However the final histopathological diagnosis was granulomatous mastitis with no evidence of malignancy. A review of literature revealed that idiopathic granulomatous mastitis has a tendency to affect young woman with a history of child birth on oral contraceptive usage. Clinical diagnosis and imaging has often been difficult. Complete resection or corticosteroid therapy can be recommended as appropriate treatment. Since recurrence rate is as high as 50%, long term follow up is indicated in such patients.

A Comparative Study of Scrotal Pathologies by Ultrasound and Their Correlation with CT and MRI

Background: The scrotum is a readily examinable structure clinically in normal conditions. However, in cases of swelling and tenderness, its clinical examination alone may not reveal any significant information. Therefore, imaging techniques such as ultrasound including CT and MRI may be required in cases. We in the current study tried to evaluate the role of ultrasound, CT, and MRI in the evaluation of scrotal pathologies. Methods: All the cases of scrotal pathologies referred from the Departments of Urology and General Surgery, were included in the study. All the patients were studied using Highfrequency real-time grayscale ultrasonography and Doppler. Before subjecting the patients for ultrasound examination, patient details, detailed clinical history was obtained along with thorough physical examination. The color Doppler sonography was routinely performed in all these patients. Subsequently, these cases were followed up and correlated with histopathology report, fine needle aspiration cytology results, surgical findings, response to treatment. Results: Out of n=50 cases studied most of the casesClinically presented with a combination of multiple symptoms wasscrotal swelling, as in n=18 cases (36%).Out of which n=30(60%) were unilateral and n=20(40%) werebilateral.Combination of pain, swelling, and fever in four cases (8%). The n=30 unilateral swelling showed n=14 cases of right-side involvement and n=16 cases of left-side involvement. Of n=5 cases of congenital anomaly associated with the descent of testes, n=2 cases were referred with clinical suspicion of incompletely descended testes, which were clinically palpable. 4% cases of scrotal and testicular trauma were detected. Among non-neoplastic scrotal swellings, hydrocele is the commonest pathology noted in n=9 cases. Epididymal cyst in n=2 cases, varicocele in n=6 cases. Conclusion: ultrasonography is best for the demonstration of morphological changes due to acute scrotal inflammation. The color doppler sonography can accurately differentiate between testicular ischemia and torsion from acute inflammatory diseases. High-frequency ultrasonography with Doppler is highly sensitive in demonstrating the varicoceles. MRI provides better delineation of borders, cystic components, and tissue signal intensities of the testicular masses. CT is the imaging modality of choice for detecting metastatic deposits

Evaluation of diagnostic utility of Acridine orange staining using fluorescence microscopy in lung cancers: A diagnostic test evaluation

Lung cancer causes more deaths than most other cancers. Conventional sputum cytology (CSC) has low diagnostic yield for lung cancer. Thus, there is a need for rapid, accurate and cost-effective test for detecting lung cancers. 1). To study sensitivity, specificity and accuracy of Acridine Orange staining with fluorescence microscopy (AOFM) in detection of lung cancer against histo-pathology and fine needle aspiration cytology (FNAC) results. 2). To compare results of AOFM and CSC in diagnosis of lung cancer.It was a diagnostic test evaluation conducted at a tertiary care institute over a period of 24 months.Sputum samples of 60 patients suspicious of lung cancer were examined using AOFM. After staining with Acridine Orange, exfoliated cells in the sputum samples were categorized as benign or malignant based on the type of fluorescence they emitted when examined under a fluorescence microscope, and results were compared with histo-pathology and/or FNAC reports.Chi-square test, Cohen’s kappa statistic etc.AOFM had sensitivity, specificity and accuracy of 92.31%, 87.67% and 90.24% respectively when compared with histopathology and/or FNAC. P=0.0000026 implies significant difference between sensitivities of AOFM and CSC (30.77%). There was significant difference between AOFM and CSC in context of specificity [P=0.04] and accuracy [P=0.05].AOFM in the patients with suspected lung cancer is a useful ‘first diagnostic test’. It is a rapid pre-screening tool which will reduce cost of cyto-diagnosis in under-served and remote areas.