Benign Cytologic Findings Research Articles

Validation of the 2015 American Thyroid Association Management Guidelines for Thyroid Nodules With Benign Cytologic Findings in the Era of the Bethesda System.

The purpose of this study is to investigate follow-up strategies for cytologically benign thyroid nodules according to size and ultrasound (US) pattern according to the 2015 American Thyroid Association (ATA) guidelines in the era of the Bethesda system. This retrospective study included 1208 patients with 1230 nodules that were cytologically benign at initial fine-needle aspiration performed from June 2012 to December 2014. False-negative rates (FNRs) were calculated by considering nodule size and US pattern according to the 2015 ATA guidelines and were compared between nodules with the high-suspicion US pattern and nodules with the high- or intermediate-suspicion US patterns according to size. Twenty-five of the 1230 nodules (2.0%) were malignant. The FNRs were 5.1% (8/158) for nodules with the high-suspicion US pattern and 1.6% (17/1072) for nodules with other US patterns. With regard to nodule size, the FNRs were 3.2% (9/277) for nodules 3 cm or larger and 5.2% (6/115) for nodules 4 cm or larger. The FNRs of nodules with the high-suspicion pattern were not significantly higher than those of nodules with the high- or intermediate-suspicion patterns among nodules 2 cm or larger (2.5% vs 1.9%; p = 0.208), 3 cm or larger (3.4% vs 2.9%; p = 0.498), and 4 cm or larger (5.4% vs 3.8%; p = 0.353). Thyroid nodules with initial benign cytologic findings had a low malignancy rate in the era of the Bethesda system, regardless of US pattern and size. Therefore, any immediate diagnostic intervention may be discouraged in cytologically benign nodules.

Role of nipple discharge cytology in predicting NAC involvement in carcinoma breast

Introduction Cancer of the breast in women is a major health burden worldwide. It is the most common cause of cancer among women in both high-resource and low-resource settings, and is responsible for over one million of the estimated 10 million neoplasms diagnosed worldwide each year in both sexes. Limited number of studies have addressed the optimal surgical management of patients with breast carcinoma associated with benign or pathologic nipple discharge Material and methods- Thirteen breast carcinoma cases with nipple discharge were studied. Nipple discharge cytology was studied using giemsa method. Later all the mastectomy specimens were inked and sectioned from medial to lateral into no greater than 1 cm thick tissue sections and grossly examined. Extensive sampling of nipple areola was followed taking 12 sections from each nipple areolar complex. Thirteen breast carcinoma cases without nipple discharge were chosen as control and also grossed and examined for nipple areolar involvement . Results- In our study, there were 13 cases with nipple discharge. Out of which, 10 cases were having benign cytologic findings and 3 cases showed malignant cytologic findings Spss statistical software was used which showed no association between presence of nipple discharge and nipple areolar involvement also it showed no association between malignant nipple discharge cytologic findings and nipple areolar involvement. Conclusions- Nipple discharge itself has no association with nipple areolar involvement and should not deter a clinician from nipple sparing mastectomy if other factors are conducive. Careful patient selection can be done in cases with malignant nipple discharge cytologic findings, if negative margins could be achieved and appropriate adjuvant therapy given. Further studies are needed to study the role of nipple discharge cytology in conservative mastectomy procedures. DOI: 10.21276/AWCH.1543

Natural history of infections with high-risk HPV in Chinese women with abnormal cervical cytology findings at baseline

To clarify the natural history of disease in Chinese women with benign cytologic observation and positive for high-risk human papillomavirus (HR-HPV). From September 1, 2004, to June 30, 2008, this prospective study followed up 893 women positive for HR-HPV who also had benign cytologic findings at baseline. After 3 to 57 months, the viral clearance rate was higher for patients younger than 30 years and for patients who had a low viral load at baseline than for those in their comparison groups. Conversely, the occurrence rate of cervical intraepithelial neoplasia (CIN) 2 or 3 was higher for patients with persistent HR-HPV infection, those who had CIN 1 at baseline, and those whose the second viral load was increased. Age, viral load, and presence of CIN 1 at the first evaluation were the main factors affecting the natural history of HR-HPV infection in women with benign baseline cytologic findings. The result(s) of the second HR-HPV testing were independent indicators of histologic progression.

Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) of Pancreatobiliary Masses in Patients with a Previously Negative Cytologic Evaluation

Purpose: Establishing a diagnosis for pancreaticobiliary malignancy is of paramount importance for prognostic and therapeutic purposes. Radiologic guided fine needle aspiration (RG-FNA), cytological brushings during endoscopic retrograde cholangiopancreatography (CB-ERCP), and EUS-FNA are all common techniques used for tissue acquisition. There is limited experience on the role of repeat FNA in patients with previous non-diagnostic FNA. We evaluate the yield of EUS-FNA in patients with prior non-diagnostic RG-FNA, CB-ERCP, and EUS-FNA. Methods: A retrospective review of medical records of all patients undergoing EUS-FNA between 01/2002 through 04/2005 for suspected pancreaticobiliary neoplasm was performed. Patients with previous non-diagnostic cytological or pathological evaluation and 6 months of clinical followup were included. Results: Ninety-two patients underwent EUS-FNA for a suspected pancreatic or biliary mass during the study period. Of these, 20 patients had 23 procedures with benign cytologic findings by previous FNA: RG-FNA in 7, CB-ERCP in 13, EUS-FNA in 2, and exploratory laparoscopy with pancreatic biopsy in 1. Overall, the cytologic diagnostic accuracy was 90% for EUS-FNA in patients with a previous non-diagnostic FNA. EUS-FNA established a diagnosis of malignancy in 14 of 20 (70%) patients. Other findings included: chronic pancreatitis (1), benign papillary neoplasm (1), neuroendocrine tumor (1), and benign tissue (1). Two patients with benign cytology on EUS-FNA were found to have pancreatic adenocarcinoma on long-term follow up. EUS-FNA established a cytologic diagnosis in patients with a previous benign CB-ERCP or RG-FNA in 85% and 100%, respectively. The two patients with previously non-diagnostic EUS-FNA had a repeat EUS-FNA yielding adenocarcinoma. In the patient with a previous non-diagnostic surgical biopsy, adenocarcinoma was confirmed with EUS-FNA. For establishing the diagnosis of adenocarcinoma in patients with a previous non-diagnostic FNA, EUS-FNA demonstrated a PPV of 100% and NPV of 67%. The sensitivity of EUS-FNA for adenocarcinoma was 88% with a specificity of 100%. Conclusions: The role of EUS-FNA continues to evolve in pancreaticobiliary diseases. In patients with previous unsuccessful cytological or pathological studies, EUS-FNA provides an excellent means of tissue acquisition with a high overall diagnostic accuracy.

Pitfalls and infrequent findings in fine‐needle aspiration of the prostate gland

Based on the experience accumulated over two decades and in more than 7,000 transrectal fine-needle aspirations (FNAs) of the prostate gland, several benign and malignant unusual cytologic findings are described. Infrequent benign cytologic findings and possible pitfalls are atrophic prostatic epithelium, squamous metaplasia, transitional cells, granulomatous prostatitis, seminal vesicle epithelium, ganglion cells, lubricant artifacts, and treatment effects. Infrequent variants of carcinoma are foamy-cell carcinoma, prostatic duct adenocarcinoma, mucinous adenocarcinoma, transitional-cell carcinoma, small-cell carcinoma, squamous-cell carcinoma of the prostate, metastatic solid tumor within the prostate, and mesenchymal tumors. Cytopathologists must be able to diagnose these variants of prostate adenocarcinoma because on most occasions the variants imply a worse clinical prognosis. Appropriate training is essential to achieve success in this field of cytopathology. FNA of the prostate provides in a matter of minutes useful information concerning clinical management, prognosis, and treatment of patients.

Ultrasound-Guided Laser Thermal Ablation for Treatment of Benign Thyroid Nodules

To evaluate the efficacy of ultrasound (US)-guided laser thermal ablation (LTA) in reducing the volume of hypofunctioning benign thyroid lesions. The criteria for entry into the study were as follows: (1) presence of a hypofunctioning thyroid nodule with a volume exceeding 8 mL, (2) benign cytologic findings, (3) local compression symptoms or patient concern, and (4) refusal of or ineligibility for surgical treatment. Twenty patients (15 women and 5 men; mean age, 63.3 +/- 14.1 years) fulfilling the entry criteria were enrolled in the study. Under US monitoring, a 75-mm, 21-gauge spinal needle was inserted into the thyroid gland, and a flat-tipped 300-microm quartz fiberoptic guide was placed through the needle into the tissues. LTA was performed with use of a 1.064-microm continuous-wave neodymium yttrium-aluminum-garnet laser that had an output power of 3 W for 10 minutes. US scans were used to assess the decrease in nodule volume at 1 month and 6 months after LTA. After LTA, mean nodule volume decreased from a baseline value of 24.1 +/- 15.0 mL to 13.3 +/- 7.7 mL at 1 month and to 9.6 +/- 6.6 mL at 6 months. Mean nodule volume reduction in comparison with baseline was 43.8 +/- 8.1% at 1 month and 63.8 +/- 8.9% at 6 months. LTA induced burning cervical pain, which rapidly decreased after the laser energy was turned off. Three patients (15%) required treatment with betamethasone for 48 hours. No patient had local bruising, cutaneous burning, or dysphonia. LTA may be an effective procedure for the treatment of benign cold thyroid nodules that cause pressure symptoms in patients who are not candidates for surgical treatment or who refuse to undergo a surgical procedure.

The incidence of carcinoma in cytologically benign thyroid cysts

The management of cytologically benign thyroid cysts is controversial. Treatment options include observation, chemical sclerosis, and surgery. This study was undertaken to determine the incidence of carcinoma in cytologically benign thyroid cysts that recur after complete aspiration and to determine the indications for surgery in these patients. The medical records of 1189 consecutive patients undergoing thyroid surgery between July 1995 and November 2000 were reviewed. In 34 patients the indication for surgery was a thyroid cyst with benign cytologic findings that refilled at least once after complete aspiration. These patients were selected for further study. The 26 women and 8 men had a median age of 42 years. Fine-needle aspiration cytology was consistent with a benign cyst in all these cases. Final pathologic findings revealed the nodule to be a papillary carcinoma in 4 patients (12%). In another 4 patients (12%) an incidental microscopic papillary carcinoma, separate from the cyst, was identified on final pathologic findings. In all 4 patients with papillary carcinoma the cyst size was greater than 3 cm (range, 3.4 to 5.0 cm). The incidence of malignancy in cytologically benign thyroid cysts that recur after aspiration is high enough to warrant surgical excision, especially if the cyst is greater than 3 cm in size.

Sensitive and specific detection of the 4B5 antigen in bronchial lavage specimens from patients with primary bronchogenic carcinoma.

The monoclonal antibody 4B5 binds to a mucin-like antigen elaborated by respiratory epithelium of patients with non-small cell bronchogenic carcinoma. Several immunoassay formats were used to determine the presence of the antigen in lavage specimens. A qualitative immunodrop binding assay showed immunoreactivity in 37 (64%) of 58 specimens from patients with non-small cell lung cancer. In contrast, only 11 (12%) of 93 specimens from patients with either metastatic carcinoma or benign pulmonary diseases exhibited 4B5 immunoreactivity. A quantitative radioimmunoassay using standardized amounts of mucin exhibited similar sensitivity and specificity. Positive immunoreactivity was associated significantly with tobacco use and the cytopathologic diagnoses of squamous metaplasia, atypia, or dysplasia. Conversely, no significant association was found between 4B5 immunoreactivity and age, gender, race, benign cytologic findings, frankly malignant cytologic findings, or stage of disease. The expression of 4B5 antigen in bronchial secretions from patients with bronchogenic carcinoma deserves additional evaluation as a potential marker of pulmonary carcinogenesis.

Recombinant human transforming growth factor-alpha stimulates in vitro colony formation of fresh human tumor specimens.

Transforming growth factor-alpha (TGF alpha) is a low molecular weight peptide that has been implicated in an autocrine growth-stimulation of tumor cell lines in vitro. Although its mRNA has been detected in biopsies from human malignancies, the importance of an autocrine mechanism for the growth of human malignancies in vivo is unknown. The purpose of our study was to determine the effects of recombinant human TGF alpha (rhTGF alpha) on the in vitro growth of fresh human tumors using a capillary cloning system. Growth was detected in control capillaries in 17 of 47 specimens (36%) without rhTGF alpha. Further stimulation of 12 of these tumors with rhTGF alpha obtained a maximal effect at 0.1 to 1 microgram/ml. Stimulation by rhTGF alpha was concentration-dependent with some tumors showing a biphasic response. Eight of 22 specimens not showing colony formation in control capillaries were recruited to form colonies by rhTGF alpha (p less than 0.005). Responsiveness to rhTGF alpha varied among individual tumors. In control experiments, rhTGF alpha failed to stimulate colony formation in three low-passage fibroblast cell lines. Furthermore, three additional human tumor specimens with benign cytologic findings displayed no colony formation. We concluded that a subgroup of primary human tumors was sensitive to rhTGF alpha in vitro.

Diagnostic Accuracy and Use of Aspiration Biopsy in the Management of Thyroid Nodules

The diagnostic accuracy of fine-needle aspiration biopsy of thyroid nodules was assessed in 111 patients who underwent thyroidectomy and in three persons whose thyroid glands were examined at autopsy. The basis for not performing surgery in 107 patients studied during the same period is also discussed. Carcinoma (excluding incidental occult carcinoma) was found in 76% of the nodules with malignant cytologic findings (class 5, 10/10; and class 4, 3/7), 20% (3/15) of the nodules with suspicious cytologic findings (class 3), and 9% (8/87) of the nodules with benign cytologic findings (classes 1 and 2). The major reasons for avoiding surgery included resolution of the nodule after aspirating a cyst (eight cases) or after hemorrhage (two cases), multinodular goiter (13 cases), functioning nodule (ten cases), lymphocytic thyroiditis (nine cases), high operative risk without suspicious cytologic findings (15 cases), and response to suppression therapy (27 cases). Among 186 patients given thyroxine suppression therapy, 10% of the nodules disappeared and 12% decreased to less than 1 cm in diameter or more than 50% in volume. Aspiration biopsy is useful to select patients for early surgery or for long-term medical management. Its lack of precision, however, requires that it be employed as an adjunct to other clinical considerations.