Benign Categories Research Articles

A modified Papanicolaou Society of Cytopathology system for reporting respiratory cytology specimens: Implications for estimates of malignancy risk and diagnostic accuracy.

In 2016, the Papanicolaou Society of Cytopathology (PSC) proposed a classification scheme for reporting cytologic specimens obtained from the respiratory system. Diagnostic sensitivity, specificity, and risk of malignancy were reported for endobronchial ultrasound guided fine needle aspiration but data for other sampling techniques has been poorly documented. In 2016, a modified version of the PSC guidelines was adopted at the University of Missouri for classification of sputum, bronchial washing, bronchial brushing, and fine-needle aspiration specimens. Specimens assigned to the negative category included all specimens containing evaluatable inflammatory or epithelial cells including benign appearing respiratory epithelium. Only specimens with marked artifactual distortion or obscuring blood or mucus were placed in the non-diagnostic category. 672 bronchial washing specimens (479 with histology) and 511 bronchial brushings specimens (324 with histology) were reviewed. Washing specimens were classified as non-diagnostic (3%), benign (73%), atypical (10%), suspicious (4%), and malignant (10%). Bronchial brushing specimens were classified non-diagnostic (0.4%) benign (73%), atypical (6%), suspicious (3%), and malignant (17%). Malignancy risks for bronchial washings were insufficient (50%), benign (38%), atypical (62%), suspicious (83%), and malignant (98%). Risks of malignancy for bronchial brushings were insufficient (0%), benign (32%), atypical (79%), suspicious (75%), and malignant (94%). Malignancy risks associated with bronchial washings and bronchial brushings are different than those reported for EBUS FNA. When the benign category includes specimens with "normal" appearing cellular elements, the risk of malignancy is substantial (between 32% and 38%).

Fast discrete curvelet transform and modified PSO based improved evolutionary extreme learning machine for breast cancer detection

A significant research area in medical imaging analysis is digital mammography breast cancer detection in the early stage. For breast mass classification into the benign or malignant category, an enhanced automated computer-aided diagnosis (CAD) model is suggested in this work, enabling radiologists to identify breast diseases correctly in less time. First, a fast discrete curvelet transform with wrapping (FDCT-WRP) is deployed to extract the curve-like features and create a feature set. Then, a combined feature reduction strategy called principal component analysis (PCA) and linear discriminant analysis (LDA) is used to produce more relevant and reduced feature sets. Finally, a new enhanced learning algorithm called MODPSO-ELM incorporates modified particle swarm optimization (MODPSO) and an extreme learning machine (ELM) proposed for the classification task. In the MODPSO-ELM algorithm, MODPSO is utilized to optimize the hidden node parameters (input weights and hidden biases) of single-hidden-layer feedforward neural networks (SLFN) and analytically determined the output weight. The proposed CAD model has been evaluated on three standard datasets with a 10 × k-fold stratified cross-validation (SCV) test. It is found from the experiment that the suggested CAD model yields the best outcome for the MIAS dataset and obtains an accuracy of 98.94% and 98.76% for DDSM and INbreast datasets, respectively. The experimental results indicate that the proposed model is superior to other state-of-the-art models with a substantially reduced number of features with better classification accuracy.

Breast FNA cytology reporting using new proposed IAC Yokohama reporting system: A single institution retrospective study

Introduction: Breast lumps are a common presenting complaint in general practice. Breast cancers are the most common cancers diagnosed over the world along with unfortunate rise in number of mortality due to them. Proper diagnostic evaluation is necessary. The fine needle aspiration cytology (FNAC) examination of breast lumps is important as it can be used either to differentiate between benign and malignant breast lesion or as an adjunct to core needle biopsy. In 2016 the IAC Yokohama five category reporting system was proposed to allow uniform reporting of breast FNA aspirates. Aim: The current study aims to reclassify breast lump aspirates using the proposed Yokohama reporting system and also to assess the risk of malignancy of each category. Materials and Methods: This single institution retrospective study included female breast lump FNAC cases over 4 year period. Clinical details of included cases were recorded from archives. Cytology slides were reevaluated as per new reporting system and the histopathology correlation was done where available. Statistical analysis was performed. Risk of malignancy of each category was calculated. Results: 649 breast FNAC cases were studied of average age 36.97 years. Maximum cases were in benign category followed by malignant category. Fibroadenoma was most common benign diagnosis. The risk of malignancy was 3.17% in benign category and 95.45% in suspicious for malignancy category. The diagnostic accuracy in current study was 97.83%. Conclusion: Use of a standard categorical cytology reporting system will give improved reports for better patient care.

Osseous Tumor Reporting and Data System-Multireader Validation Study.

To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management. In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity. Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively. Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.

The role of fine-needle aspiration biopsy and post-operative histology in the evaluation of thyroid nodules

Thyroid nodules present a serious problem, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. The risk of malignancy varies from 5 to 15 %. Steps to diagnose malignancy should include a careful clinical evaluation, laboratory tests, a thyroid ultrasound exam and a fine-needle aspiration biopsy. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules. Today it is considered the gold standard for malignancy diagnosis in thyroid cancer. In this review we evaluate the role of FNAB and post-operative cytology in the evaluation of thyroid nodules. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). Unsatisfactory smears (5–10 %) result from hypocellular specimens usually caused by cystic fluid, bloody smears, or suboptimal preparation. Diagnostic smears are conventionally subclassified into benign, indeterminate, or malignant categories. Benign cytology (60–70 %) is negative for malignancy, and includes cysts, colloid nodule, or Hashimoto thyroiditis. Malignant cytology (5 %) is almost always positive for malignancy, and includes primary thyroid tumors or nonthyroid metastatic cancers. Indeterminate or suspicious specimens (10–20 %) include atypical changes, Hurthle cells or follicular neoplasms. The new Bethesda Cytologic Classification has a 6-category classification, subdividing indeterminate further by risk factors. Considering the increasing worldwide incidence of thyroid microadenomas, recently it is recommended to undergo FNAB under ultrasound guidance even in small (< 1cm) nodules if they are correlated with suspicious ultrasonographic features or suspicious neck lymph nodes. FNAB is a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and pre-operative diagnosis of thyroid carcinomas. It was concluded that FNAB is the gold standard in the evaluation of thyroid nodules and can prevent many unnecessary surgeries. False-negative FNA cytology remains a concern for clinicians treating patients with thyroid nodules. Post-operative histology give the definitive diagnosis and studies confirm that it has a significant discordance between pre-operative cytology and post-operative histology in patients with thyroid nodule. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis, cystic lesions or suspicious thyroid nodules to avoid misdiagnoses.

RECLASSIFICATION OF THYROID LESIONS BASED ON THE BETHESDA SYSTEM BY FINE NEEDLE ASPIRATION CYTOLOGY: A 2 YEAR STUDY FROM A TERTIARY CARE CENTRE IN NORTH-EAST INDIA

Background: Thyroid gland is affected by a vast array of disorders like developmental, inflammatory, hyperplastic and neoplastic disorders. Both non-neoplastic and neoplastic diseases affect it and led to diffuse or nodular enlargement. FNAC is widely considered as the diagnostic technique of choice in the assessment of thyroid lesions. In the Bethesda system for reporting thyroid cytopathology (TBSRTC), the six diagnostic categories have been designated one to six roman numbers. A thyroid FNA specimen is considered to be satisfactory for evaluation (and benign), at least 6 groups of benign follicular cells are required, and each group composed of at least 10 cells. Methods: A two year retrospective cross sectional study was conducted. Patients attending cytology out-patient department, were the study population. Consent was obtained from all the patients before the start of the procedure. Twenty ml syringe with 24 gauge needle fitted in Cameco handle was used for aspiration. Prepared smears were stained with Giemsa stain. Any cystic fluid thus withdrawn from the swelling was centrifuged and the deposit was studied microscopically after spreading. Results: A total of 539 thyroid swelling were aspirated during the study period. Of 539 cases 88% of cases were reported in females and 12% of cases were reported in males. Ninety percentage of cases were reported under benign category. Twenty five(4.6%) cases were reported as malignant during the study period, out of which 23(4.2%) cases were reported as papillary carcinoma. Papillary carcinoma constitutes the most common malignant lesion reported during the study period. Conclusion: The Bethesda system provides a standardized nomenclature for thyroid cytopathology reporting with improved interobserver reproducibility. Facilitates better understanding between cytopathologist and clinicians for uniform and proper management. Key words: Thyroid, Fine needle aspiration cytology (FNAC), The Bethesda system.

Diagnostic concordance of phyllodes tumour of the breast.

Phyllodes tumours (PT) are rare and distinct breast tumours, which span a morphological continuum. Classification into benign, borderline and malignant categories reflects their biology and clinical behaviour and is essential to guide management. This study aims to assess the diagnostic agreement of PT using the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology external quality assurance (EQA) scheme data. Twenty-six PTs were identified in the EQA scheme, which were diagnosed by an average of 607 participants/circulation. Data on diagnostic categories were collected and representative slides were reviewed. The level of concordance between reporting pathologists was assessed. There were 14 benign, six borderline and six malignant PT. The overall rate of diagnosis agreement was 86% when analysed as benign lesions, borderline PT and malignant lesions, which decreased to 79% when diagnosed as PT (irrespective of grade) and to 63% when the diagnosis was further refined to PT categories (benign, borderline and malignant PTs). The highest agreement rate was observed in malignant PT (86%) and the lowest in borderline PT (42%). Malignant heterologous elements, stromal overgrowth and leaf-like architecture are features associated with higher concordance rates. Lower-priority features were stromal expansion, clefting and multinodularity. The concordance of PT diagnosis, as an entity, is high, but its classification into benign, borderline and malignant has variable agreement levels, with borderline tumours having the lowest concordance rate. More research to refine the diagnostic criteria for categorisation of PT is warranted to improve concordance between pathologists.

Serum WNT-induced secreted protein 1 level as a potential biomarker for thyroid nodules

Background. Thyroid nodule (TN) is a common thyroid disease worldwide, and it has increased significantly last decades. Most TNs are usually incidental findings of asymptomatic, benign lesions discovered by imaging modalities performed for reasons unrelated to thyroid diseases. The purpose of this study was to investigate the value of serum WNT-induced secreted protein 1 (WISP1) level as a supporting biomarker to perform differential diagnosis of benign and non-benign thyroid nodules. Materials and methods. The study was completed with the 89 patients undergone fine needle aspiration biopsy and 43 controls. The patients were composed of 96 (72.7%) females and 36 (27.3%) males. And they were divided into 2 group according to the Bethesda cytological evaluation as Benign (Bethesda 2) and Non-Benign (Bethesda 3–6) groups. Their serum WISP1 levels were measured by an ELISA method. Results. There were 58 (43.9%) patients in Benign (Bethesda 2) and 31 (23.5%) in non-Benign (Bethesda 3–6) groups. In the contrary nodule size was bigger in the Non-benign group than that benign group (p=0.006). The serum WISP1 level in the Benign (Bethesda 2) group was significantly higher than that in the and Non-Benign (Bethesda 3–6) group, and controls (p<0). The difference between benign and non-benign group accordingly to their echogenicitiy was significant (p<0.05). In benign group there was 76.9% mixed echoic nodules, 76.7% isoechoic nodules 68.4% isohypoechoic nodules and 35.7% hypoechoic nodules. In the non-benign group, the highest hypoechoic echo (64.3%), the least mixed echo (23.1%), while in the benign group, the most mixed echo (76.9%), the least hypoechoic echo (35.7%) was present. There was no relation between WISP1 levels and echogenicity with Kruskal-Wallis H test. Conclusions. According to the preliminary results of current study, addition of serum WISP1 measurement to the differential diagnostic work-up of thyroid nodules patients may provide supportive information. Inthyroid nodules patients with Benign (Bethesda 2) category of cytological evaluation, a higher level of serum WISP1 may support cytological diagnosis.

The Bethesda System for Reporting Thyroid Cytopathology: A Retrospective Review of its Diagnostic Utility at Johns Hopkins Aramco Healthcare, Saudi Arabia

PurposeFine needle aspiration (FNA) is the gold standard for assessment of thyroid nodules, with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) used to predict the malignancy risk of these nodules. Our aim was to evaluate the diagnostic utility of the TBSRTC for a Saudi population, by comparing the malignancy risk based on histopathology to FNA-based diagnosis of each of the TBSRTC categories and to previously published malignancy risk in other population. Materials and methodsThis was a retrospective study of the data of 241 patients who underwent FNA assessment of thyroid nodules and surgical resection with histopathology at John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, between January 2016 and December 2019. ResultsThe malignancy risk for each of the TBSRTC categories was as follows: non-diagnostic, 25%, benign; 5.74%; atypia of undetermined significance, 37%; suspicious for follicular neoplasm, 38%; suspicious for malignancy, 100%; and malignant, 95%. Our finding were comparable to previously published malignancy risks, except for a higher rate of malignancy in the benign category at 18% compared to 0–3%. ConclusionOur findings validate the diagnostic reproducibility of the TBSRTC for a Saudi population, with the risk of malignancy confirmed by histopathological assessment being consistent with those previously reported for other populations.

Indeterminate Thyroid Nodules With RAS Mutations Have Higher Rates of Malignancy When Multiple Non-Cystic Nodules or Irregular Borders Are Present

Background: There is heterogeneity in positive predictive value for cancer in RAS-mutated cytologically indeterminate nodules and paucity of data with regards to specific ultrasound features that are associated with malignancy in these nodules. The goal of this study is to assess the ultrasonographic characteristics, in relation to clinical and histopathologic outcomes of thyroid nodules known to have a RAS mutation. Design and Methods: Cases were identified using our institutional Afirma® Genetic Sequence Classifier (GSC) database, and a retrospective review of electronic medical records for thyroid nodules biopsied between January 2018 and August 2020. Nodules categorized as Bethesda III or IV and harboring a RAS mutation by Xpression Atlas® were included. Thyroid ultrasound images were reviewed by the authors and were risk stratified according to the 2015 American Thyroid Association Thyroid Nodule and Differentiated Thyroid Cancer Guidelines (ATA Guidelines) and the 2017 ACR TIRADS system (ACR Guidelines). The nodules were divided into benign or malignant categories based on surgical pathology. Noninvasive follicular thyroid neoplasms with papillary like nuclear features (NIFTP) were categorized as benign. Results: A total of 22 nodules were identified to have a RAS mutation. NRAS mutated nodules, all with the same point mutation (pQ61R c.182A>G), were most common 14/22 (63.6%). There was no significant difference in clinical features, ultrasonographic appearance or histopathologic outcomes between NRAS- and HRAS-mutated nodules. 12/22 (54.4%) were low risk by ATA Guidelines and 11/22 (50%) were TIRADS 4 (moderately suspicious) by ACR Guidelines. There was no significant difference in predictive value of ATA Guidelines vs ACR Guidelines. The prevalence of malignancy was 45.4% (only slightly lower than the general risk for a suspicious GSC). Invasive follicular variant papillary thyroid cancer (FVPTC), was the most common malignancy, 4/10 (40%). 6/10 (60%) were classified as low risk of recurrence post-operatively. All malignant RAS-mutated nodules (10/10) had at least one other non-cystic nodule present on ultrasonography whereas only 4/9 (44%) of RAS-mutated benign nodules did [P=.006]. RAS-mutated malignant nodules had significantly more nodules with irregular borders compared to RAS-mutated benign nodules (4/10 and 0/10, 40% and 0% respectively) [P=.03]. Conclusions: This is the first study to observe higher rates of malignancy in RAS-mutated indeterminate nodules when other non-cystic nodules are present. A lobectomy is the preferred surgical approach for RAS-mutated nodules, however a total thyroidectomy may be considered in patients with other non-cystic nodules or irregular nodules borders. Overall, RAS-mutated nodules have a low risk of recurrence post-operatively.

Accuracy of Breast Fine-Needle Aspiration Biopsy Using the International Academy of Cytology Yokohama System in Clinico-Radiologically Indeterminate Lesions: Initial Findings Demonstrating Value in Lesions of Low Suspicion of Malignancy

Background: Fine-needle aspiration biopsy (FNAB) in breast lesions offers accurate results in differentiating benign and malignant lesions. However, its role is unclear when core-needle biopsy (CNB) is available, the latter providing additional information regarding tumor grade, invasion, and hormone receptor status in malignant lesions. In benign breast lesions, especially in BIRADS category 4a and 4b, FNAB, and CNB provide similar pathological information, whereby FNAB may serve as a more rapid and cost-effective investigation. The study was planned to reevaluate the diagnostic accuracy of FNAB in BIRADS category 4a, 4b, and 4c lesions. Materials and Methods: FNAB and biopsy reports of all patients with breast lesions sent between September 1, 2018, and November 30, 2020, were collected and the International Academy of Cytology (IAC) Yokohama category and BIRADS score were recorded for each case. The rate of malignancy and the accuracy of FNAB in diagnosing malignancy were calculated for each BIRADS 4a, 4b, and 4c subgroup. Results: A total of 249 cases of BIRADS 4 lesions had corresponding cytology and histopathology diagnoses. FNAB showed high diagnostic accuracy in all BIRADS groups. A benign categorization was associated with a very low number of false-negative diagnoses, especially in BIRADS 4a lesions. Conclusion: The study reconfirms the excellent accuracy of breast FNAB using the IAC Yokohama system in diagnosing breast malignancies. Furthermore, BIRADS 4a lesions found to be belonging to the cytological benign category may be excluded from CRB and kept on clinical follow-up.

Multimodal Feature Fusion and Knowledge-Driven Learning via Experts Consult for Thyroid Nodule Classification

Computer-aided diagnosis (CAD) is becoming a prominent approach to assist clinicians spanning across multiple fields. These automated systems take advantage of various computer vision (CV) procedures, as well as artificial intelligence (AI) techniques, to formulate a diagnosis of a given image, e.g., computed tomography and ultrasound. Advances in both areas (CV and AI) are enabling ever increasing performances of CAD systems, which can ultimately avoid performing invasive procedures such as fine-needle aspiration. In this study, a novel end-to-end knowledge-driven classification framework is presented. The system focuses on multimodal data generated by thyroid ultrasonography, and acts as a CAD system by providing a thyroid nodule classification into the benign and malignant categories. Specifically, the proposed system leverages cues provided by an ensemble of experts to guide the learning phase of a densely connected convolutional network (DenseNet). The ensemble is composed by various networks pretrained on ImageNet, including AlexNet, ResNet, VGG, and others. The previously computed multimodal feature parameters are used to create ultrasonography domain experts via transfer learning, decreasing, moreover, the number of samples required for training. To validate the proposed method, extensive experiments were performed, providing detailed performances for both the experts ensemble and the knowledge-driven DenseNet. As demonstrated by the results, the proposed system achieves relevant performances in terms of qualitative metrics for the thyroid nodule classification task, thus resulting in a great asset when formulating a diagnosis.

Prospective evaluation of accuracy of fine-needle aspiration biopsy for breast lesions using the International Academy of Cytology Yokohama System for reporting breast cytopathology.

Classification of breast lesions into different cytological groups can accurately be done using the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology. Fine needle aspiration biopsy (FNAB) of breast lesions has been considered to be the primary investigation in detecting breast cancers, especially in low-cost settings. The main objective of this study was to prospectively re-confirm the diagnostic accuracy of breast FNAB using the IAC Yokohama system. Additionally, separate secondary subgroup analysis was done to confirm the accuracy of breast FNAB excluding lymph-node positive and lymphadenopathy positive tumors. A prospective study was done on patients undergoing biopsy of breast lesions between September 01, 2019 and November 30, 2020 (519 biopsies on 487 unique patients). Of these 519 histopathology biopsies, 505 had corresponding FNAB report of the same site. The FNAB was reported using the IAC Yokohama system and the most suitable category was allotted in every case. The rates of malignancy for each category and the accuracy of breast FNAB in diagnosing malignancy were calculated. Of the total 487 patients, 120 cases were benign on histology, while 367 were malignant. The rates of malignancy in benign, atypical, suspicious and malignant categories were 5%, 25%, 71%, and 99.7%, respectively. The diagnostic accuracy of atypical, suspicious and malignant categories was calculated as 90.1%, 95.2%, and 93.3%, respectively. The high diagnostic accuracy for each BIRADS category suggest excellent accuracy for Breast FNAB using the IAC Yokohama system.

Update on Endometrial Stromal Tumours of the Uterus.

Endometrial stromal tumours (ESTs) are rare, intriguing uterine mesenchymal neoplasms with variegated histopathological, immunohistochemical and molecular characteristics. Morphologically, ESTs resemble endometrial stromal cells in the proliferative phase of the menstrual cycle. In 1966 Norris and Taylor classified ESTs into benign and malignant categories according to the mitotic count. In the most recent classification by the WHO (2020), ESTs have been divided into four categories: Endometrial Stromal Nodules (ESNs), Low-Grade Endometrial Stromal Sarcomas (LG-ESSs), High-Grade Endometrial Stromal Sarcomas (HG-ESSs) and Undifferentiated Uterine Sarcomas (UUSs). ESNs are clinically benign. LG-ESSs are tumours of low malignant potential, often with indolent clinical behaviour, with some cases presented with a late recurrence after hysterectomy. HG-ESSs are tumours of high malignant potential with more aggressive clinical outcome. UUSs show high-grade morphological features with very aggressive clinical behavior. With the advent of molecular techniques, the morphological classification of ESTs can be integrated with molecular findings in enhanced classification of these tumours. In the future, the morphological and immunohistochemical features correlated with molecular categorisation of ESTs, will become a robust means to plan therapeutic decisions, especially in recurrences and metastatic disease. In this review, we summarise the morphological, immunohistochemical and molecular features of ESTs with particular reference to the most recent molecular findings.

Comparison between biparametric and multiparametric MR imaging of Prostate Imaging Reporting and Data System Version 2.1 in detection of prostate cancer

BackgroundProstate cancer (PCa) is considered to be the commonest cancer among males. Early and precise diagnosis of PCa is essential for adequate treatment. Multiparametric MR imaging (mpMRI) is actually the most precise imaging technique used for early diagnosis of PCa. The aim of this work was to assess the diagnostic capability of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) of PI-RADS V2.1 in detection of prostate cancer (PCa). This prospective study was carried on 60 male patients with high PSA. bpMRI and mpMRI were performed for all patients using a 3-T MRI scanner. The diagnostic performance of bpMRI of PI-RADS V2.1 was compared to that of mpMRI of PI-RADS V 2.1. The diagnosis of Pca was confirmed by transrectal ultrasound-guided biopsy and the results of open prostatectomy specimens.ResultsWhen considering PI-RADS categories 1, 2, and 3 as benign and categories 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI (sensitivity was 88.6% for mpMRI versus 60% for bpMRI and diagnostic accuracy was 91.7% for mpMRI versus 75% for bpMRI). When considering PI-RADS categories 1 and 2 as benign and PI-RADS categories 3.4 and 5 as malignant, the sensitivity and diagnostic accuracy of bpMRI and mpMRI were comparable (sensitivity was 94.3% for both bpMRI and mpMRI and diagnostic accuracy was 86.7% for both bpMRI and mpMRI).ConclusionConsidering PI-RADS scores 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI; however, when considering PI-RADS scores 3, 4, and 5 as malignant, both bpMRI and mpMRI had similar diagnostic accuracy.

Accuracy of fine-needle aspiration cytology for detecting cancer in resected thyroid nodules at a referral hospital

Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.

A CORRELATIONAL STUDY BETWEEN FINE NEEDLE ASPIRATION CYTOLOGY AND HISTOPATHOLOGY OF PALPABLE BREAST LUMPS

Incidence of breast malignancies has been rising. Any breast lump needs to differentiated as surgery may not be required in all cases. The National Health Services Breast Screening Program recommends Fine Needle aspiration cytology (FNAC) as a non-operative diagnostic tool. FNAC is a cheap, readily available, relatively painless, repeatable and patient-friendly investigation with good sensitivity and specificity. FNAC does not yield a tissue diagnosis as opposed to core biopsy, however, a well-performed FNAC and reporting by an expert pathologist help to avoid unnecessary surgeries in benign lesions where only conservative management or elective surgery is needed. Aims: To study the correlation between FNAC and histopathological reports of palpable breast lumps. Materials and method: We conducted an observational study at a tertiary care hospital. The study included 237 patients of palpable breast lumps who had undergone FNAC, excisional biopsy and histopathology in the same institution. The results of FNAC and histopathology reports were correlated into benign and malignant categories. Results: There were 225 women and 12 men in this study. FNAC had reported 20 malignant (C4+C5) cases and 217 benign cases. Histopathology revealed 21 malignant cases and 216 benign cases. We observed a sensitivity of 90.48%, specificity of 99.54%, a positive predictive value of 95%, a negative predictive value of 99.08%, a concordance of 92.41%, a diagnostic accuracy of 98.73% and a negative likelihood ratio of 0.1 for FNAC. Conclusions: Besides other advantages, FNAC of a breast lesion is reliable enough to rule out malignancy.

A computer-aided diagnostic system for mammograms based on YOLOv3

Due to a large amount of noise in medical images, the task of detecting and classifying the lesions of mammograms remains a huge challenge. Based on the existing deep learning methods, focusing on the diversity of breast cancer lesion types, this paper proposes a computer-aided diagnosis system based on YOLOv3 (You Only Look Once version 3) convolutional neural network for mammograms. In this system, we integrate detection and multi-classification problems of breast lesions into a regression problem, thereby simultaneously accomplish the two tasks in one framework. The proposed computer-aided diagnosis system is mainly divided into three components: preprocessing part of the original mammograms, deep convolutional neural network based on YOLOv3, processing and evaluation of the network output. We use the dataset from CBIS-DDSM to train three models: general model, mass model and microcalcification model. These trained models can detect the position of the input mammograms in different situations, and then classify them into mass, microcalcification, benign, malignant, and other categories. After evaluating the performance by using test set images, the accuracy rates of the general model, mass model, and microcalcification model trained by our system reach 93.667 %, 97.767 %, 96.870 % in the detection task, and 93.927 %, 98.121 %, 97.045 % in the classification task. The computer-aided diagnosis system performs well in lesion detection and classification tasks with high-noise mammograms, reflecting well robustness.

Cytological Sub-Classification of Atypia of Undetermined Significance May Predict Malignancy Risk in Thyroid Nodules

Background: Atypia/follicular lesion of undetermined significance (AUS/FLUS) carries a malignancy risk reaching up to 50%. Based on the reported malignancy rate in a given population, the clinical practice towards such a category varies. We hereby identify clinical parameters for risk stratification to aid in decision-making for either surgical referral or a clinical follow-up. Our aim is to identify clinical parameters that guided both clinicians and patients at our institutions to reach a clinical decision including atypia types. Methods: A retrospective review of patients with Bethesda III category thyroid nodules from tertiary centres in the Emirate of Abu Dhabi during January 2011 through December 2015 was carried out. Malignancy risk in Bethesda category III nodules and repeat FNA utility were calculated. Parameters that guided both clinicians and patients for appropriate referral to surgery were studied. Results: Two hundred and two cases were included in the study. Of these, 101 cases underwent surgery initially following the first FNA and 10 cases following FNA repeat. Histology confirmed malignancy in (41%) of cases that went initially to surgery and in (40%) of cases that underwent a repeat FNA. Repeat FNA resulted in 17 (44.74%) cases being re-classified into benign category, 10 (26.3%) being AUS/FLUS category, 6 (15.7%) being both suspicious and malignant, and 5 (13.16%) being unsatisfactory. Repeating FNA resulted in a definitive diagnostic utility in 50% of the cases. Eighty percent of malignant cases demonstrated nuclear atypia. Conclusion: The relatively high malignancy rate in our institutions, the suspicious radiographic features, the atypia groups, and the repeat FNA predictive value stratified Bethesda III category nodules for proper malignancy prediction and appropriate management.

Comparison of P-53, Ki-67 and Cd-10 Expression Between Fibroadenoma, Benign Phyllodes Tumor and Malignant Phyllodes Tumor

Background: Fibroepithelial tumors of the breast are a heterogeneous group of biphasic lesions comprising of an epithelial component and a quantitatively predominant mesenchymal component. These are classified into two major categories: Fibroadenoma and phyllodes tumor (PT). Phyllodes tumors are classified into benign, borderline and malignant grade categories based on histological parameters.
 Methods: An analytical-cross sectional study was conducted in the Department of Pathology, Hindu Rao Hospital, Delhi-110007 from November 2016 to December 2018. Total 50 cases were included in the study comprising of 30 cases of fibroadenoma, 15 cases of benign phyllodes tumor and 5 cases of malignant phyllodes tumor. All specimens were fixed in 10% buffered formalin. Tissue were processed and embedded in paraffin. The sections were stained with hematoxylin and eosin (H&E) to study the histopathological section. Immunostaining using CD-10, Ki-67 and p53 antibodies was done in all cases.
 Result: Among fibroadenoma cases only 3.33% showed positive CD-10 expression and 96.66% were negative. CD-10 expression was positive in 26.67% cases of benign phyllodes while 73.33 showed negative expression. 40% malignant phyllodes cases showed positive CD-10 expression and 60% showed negative CD-10 expression. CD-10 expression was significantly higher in benign phyllodes (p value = 0.019) and malignant phyllodes (p value 0.007) group as compared to fibroadenoma. P-53 expression in epithelium was seen in 56% of fibroadenoma and 26% of benign phyllodes cases, while all cases of malignant phyllodes tumor show negative P-53 expression. The stromal expression of P-53 was significantly higher in malignant phyllodes as compared to fibroadenoma and benign phyllodes tumor. Stromal expression of Ki-67 was significantly higher in malignant phyllodes as compared to benign phyllodes and fibroadenoma. Epithelial expression of Ki-67 was negative in all malignant phyllodes cases while positive epithelial Ki-67 expression was seen in 56% of fibroadenoma and 33% of benign phyllodes tumor.
 Conclusion: Both Ki-67 and P-53 showed a significantly increasing expression from fibroadenoma to benign phyllodes to malignant phyllodes tumor. The difference in expression of CD-10 was insignificant among fibroadenoma, benign phyllodes and malignant phyllodes tumor.