Benign Fine-needle Aspiration Cytology Research Articles

DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES

This study aimed to compare the effectiveness of ultrasonography and fine-needle aspiration cytology (FNAC) in distinguishing between benign and malignant thyroid nodules. To conduct this cross-sectional study, we obtained ethical approval from the institutional review board and collected data from KRL Hospital between December 1, 2021, and April 30, 2022. We included patients of either gender, aged 18 years or above, referred to the radiology department for diagnosis of benign or malignant thyroid nodules or FNAC of nodules, using non-probability consecutive sampling. After giving informed consent, all patients underwent high-resolution Gray ultrasonography performed by a consultant radiologist. The results showed that ultrasonography had a sensitivity of 90.62%, specificity of 88.37%, positive predictive value of 85.29%, negative predictive value of 92.68%, and an overall accuracy of 89.33% in detecting benign and malignant thyroid nodules, as compared to the gold standard, FNAC. Based on these findings, we conclude that ultrasonography is an excellent non-invasive diagnostic tool, with high accuracy and no invasiveness, making it the preferred method for identifying malignant thyroid nodules.

Correlation between thyroid fine needle aspiration cytology and postoperative final histopathology: a 5-year single-centre retrospective study

Background: Thyroid nodules are common problems encountered in our routine practice. Fine needle aspiration cytology (FNAC) is the most accurate and cost-effective method for evaluating thyroid nodules. It is the procedure of choice for identifying patients who require surgical excision. Methods: This is a retrospective single-center observational study in Salmaniya Medical Complex, a tertiary care center, in Kingdom of Bahrain that aims to to correlate preoperative FNAC results with the post-surgical histopathology report, and to compare our diagnostic performance results to previously published literature. Results: The post-operative histology was reported as benign in 62% of patients and malignant in 38% of patients. Bethesda II was the most common category in our sample, with 14.3% having a final histopathological diagnosis of malignancy (false negative results). Malignancy was found in 84% and 96.8% of Bethesda V and VI, respectively. Our FNAC data achieved an 80.95% sensitivity, specificity of 93.51% specificity, and a total accuracy of 87.86%. The positive predictive value was 91.07%, and an 85.71% negative predictive value, which were comparable to data from published series. Conclusions: FNAC remains the most accurate and cost-effective method for evaluating thyroid nodules. However, its diagnostic value varies among different institutions. Our results demonstrated higher rates of malignancy compared to other published series in both category I and II. Due to the chance of false negative rates in these categories and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow up.

Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman.

BACKGROUND: Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling need to explore FNAC accuracy among Omanis.OBJECTIVE: Describe cytological features of FNAC and assess FNAC accuracy compared to the postsurgical histopathology report.DESIGN: Retrospective diagnostic accuracy studySETTING: Tertiary care center.PATIENTS AND METHODS: Our study included adult Omani adult patients with thyroid nodules who underwent FNAC from 2014 to 2017 and had final pathology results for patients who underwent thyroid surgery. The results were classified according to the UK Royal college of Pathologists ‘Thy’ categories. Accuracy of FNAC was calculated by determining false and true positive and negative results based on histopathology findings.MAIN OUTCOME MEASURES: FNAC accuracy (sensitivity and specificity) compared to the postsurgical histopathology.SAMPLE SIZE: 867 patients with 1359 ultrasound guided FNACs of thyroid nodule; 137 underwent surgery.RESULTS: The mean age of the 867 patients was 43.7 (13.3) years, with a median of 42 years, and 87.8% were females. Out of 1359 FNACs, 1001 (73.7%) were benign (Thy2), 119 (8.8%) were atypia of undetermined significance or follicular lesion of undetermined significance (Thy3a), 31 (2.3%) were follicular neoplasm or suspicious for a follicular neoplasm (Thy3f), 52 (3.8%) were suspicious for malignancy (Thy4), 55 (4%) were malignant (Thy5), 101 (7.4%) as Unsatisfactory (Thy1). Only 137 patients underwent thyroid surgery, and the FNAC reports were compared with their final histopathology reports. The sensitivity, specificity and total accuracy of FNAC were 80.2%, 98.9% and 89.9%, respectively. The positive and negative predictive values of FNAC were 98.6% and 84.3%, respectively.CONCLUSION: Our study findings confirmed that FNAC of the thyroid is a sensitive, specific, and accurate initial tool for the diagnosis of thyroid lesions. Most of the FNACs were benign with a very low malignancy rate. Due to the minimal chance of false negative results and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow-up.LIMITATIONS: Retrospective design and single-center study, and thyroid nodule size unavailable.CONFLICT OF INTEREST: None.

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors: which is the best technique?

To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology. The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard. Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively. CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.

A tru-cut biopsy proven rare thyroid neoplasia in a giant nodule with a benign fine needle aspiration cytology

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A tru-cut biopsy proven rare thyroid neoplasia in a giant nodule with a benign fine needle aspiration cytology

A tru-cut biopsy proven rare thyroid neoplasia in a giant nodule with a benign fine needle aspiration cytology

A tru-cut biopsy proven rare thyroid neoplasia in a giant nodule with a benign fine needle aspiration cytology

A tru-cut biopsy proven rare thyroid neoplasia in a giant nodule with a benign fine needle aspiration cytology

Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma.

Simple SummaryFine-needle aspiration cytology (FNAC) with measurement of thyroglobulin concentrations obtained through aspiration (FNA-Tg) is routinely used for the diagnosis of metastatic lymph nodes (LNs) from differentiated thyroid carcinomas. However, some areas of uncertainty remain, including the optimal FNA-Tg cutoff and its interpretation based on ultrasound (US) features. In this study, we evaluated the appropriate strategies for interpreting FNAC and FNA-Tg results based on the sonographic features of LNs. We confirmed that the malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg was sufficiently high to be diagnosed as metastasis, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and US features of LNs, for diagnosing metastatic LNs of differentiated thyroid carcinomas.We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid carcinomas (DTCs) from January 2014 to December 2018 were reviewed retrospectively. LNs were categorized sonographically as suspicious, indeterminate, or benign. The optimal FNA-Tg cutoff for metastatic LNs was evaluated preoperatively, after lobectomy, and after total thyroidectomy. The diagnostic performances of FNA-Tg, FNAC, and their combination were analyzed based on the sonographic features of LNs. The malignancy rates of LNs were analyzed based on the sonographic features, FNAC, and FNA-Tg results. Of the 1543 LNs analyzed, 528 were benign, whereas 1015 were malignant. FNA-Tg increased the sensitivity and accuracy of FNAC for LNs. The malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg ranged from 82% to 100%, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and ultrasound features of LNs, for diagnosing metastatic LNs of DTCs.

A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It’s the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery. Subjects and Methods: This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery. Results: 20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were 4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules 4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05). Conclusion: Thyroid nodules 4 cm are not risk factor of malignancy. Thyroid nodules 4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

The role of fine-needle aspiration cytology in papillary thyroid carcinoma cases

Aim: Thyroid diseases are among the most common diseases in our country and all over the world. Fine-needle aspiration cytology (FNAC) is a useful and simple method for diagnosing papillary thyroid carcinoma (PTC) and can be used as a first step. The aim of this study was to determine the diagnostic value of FNAC in PTC cases by comparing FNAC and histopathological findings and to present our experiences.Material and Methods: This retrospective study evaluates 800 cases who underwent thyroidectomies in our center and had a histopathological examination in the pathology clinic. The age, gender, operation procedure, FNAC findings, and histopathological results of PTC cases were recorded.Results: Of 800 thyroidectomy cases, 119 (14.9%) were diagnosed with PTC; 50 (42%) were classic PTC cases and 69 (58%) were papillary microcarcinoma (PMC) cases. Of the 50 classic PTC cases, 45 had FNAC, which were included in the study. Of these, the positivity rate was 84.5% when atypia of undetermined significance (AUS) cases and suspected malignancies were included with those diagnosed with malignancy. Of 45 PTC cases, 3(6.6 %) were inadequate, 4 (8.9 %) were benign, 7 (15.5 %) were AUS, 4 (8.9 %) were suspected of follicular neoplasm, 18 (40 %) were suspected of malignancy, and 9 (20 %) were diagnosed as malignant. Conclusion: In our study, the false positivity rate was 0.5% and the false negative rate was 8.9%. Carcinomas in the follicular pattern can only be diagnosed by histopathological approach. FNAC is currently the gold standard for diagnosing PTC. However, a benign FNAC diagnosis should be viewed with caution as false-negative results do occur. When a benign FNAC diagnosis is given, surgery is necessary if there is any clinical suspicion of malignancy.

False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

Axillary nodal status remains an important determinant of prognosis and of the therapeutic strategy in patients with a newly diagnosed breast cancer. The aim of this study was to assess the false-negative rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in axillary node staging at breast cancer diagnosis. All patients with a newly diagnosed breast cancer who had an indeterminate or suspicious axillary node sampled with an FNAC between 2007 and 2014 were included in the study. FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes. Patient demographics, tumor, and nodal characteristics were analyzed. Diagnostic accuracy tests were performed using IBM SPSS, version 22. A total of 3515 patients with breast cancer were identified, 675 of whom had ultrasound-guided FNAC of ipsilateral axillary lymph nodes (mean age: 55years; Range: 26-84). A benign (C2) result was observed in 52% (n=351) and a malignant (C5) result in 35% (n=238). C1 was obtained in 11% (n=76), C3 in 0.6% (n=4), and C4 in 0.9% (n=6). Of the 238 patients with a malignant (C5) FNAC, 99.6% had confirmed axillary lymph node metastatic disease on histopathology. Of the 351 patients with benign FNAC (C2), 31% (n=108) of patients had a positive lymph node on histology. The false-negative rate of preoperative FNAC remains too high (31%) to omit definitive surgical staging of the axilla. The high diagnostic accuracy when a positive FNAC is obtained allows appropriate tailored decisions regarding definitive therapy.

Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates.

Whether thyroid nodules 4 cm or larger with benign cytology carry a higher risk of malignancy, and should be managed differently than smaller nodules remains controversial. We aimed to evaluate the malignancy rate and benign cytology false-negative rate in thyroid nodules ≥4 cm compared with those <4 cm. All thyroidectomies between January 2010 and December 2014 were reviewed. Patient demographics, preoperative sonographic nodule size, fine needle aspiration cytology (FNAC), and final surgical pathology results were compared for index nodules ≥4 vs. <4 cm. A total of 490 index nodules with preoperative FNAC were identified. A total of 137 nodules were ≥4 cm and 353 nodules were <4 cm. The prevalence of carcinoma was lower (23 vs. 53%) in nodules ≥4 vs. <4 cm (p < 0.0001). The false-negative rate of benign FNAC for ≥4 and <4 cm index nodule was 5.2% and 5.9%, respectively (p = 1.000). This study shows that thyroid nodules ≥4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Thyroid nodules over 4 cm do not require resection, to rule out malignancy, based on size alone.

SAT-592 Amiodarone-Induced Cure Of Graves' Disease

INTRODUCTION While amiodarone-induced thyrotoxicosis is known to potentially exacerbate latent subclinical hyperthyroidism, we describe a rare case of amiodarone-induced hypothyroidism in a patient with longstanding subclinical hyperthyroidism secondary to Graves disease. CASE The patient is a 66-year-old woman with longstanding subclinical hyperthyroidism due to Graves’ disease and non-toxic multi-nodular goiter. Her mild Graves’ disease was diagnosed nine years back when she presented with hyperthyroidism, negative thyrotropin receptor antibodies (TRAb), and homogenously increased radioactive iodine uptake. The thyroid sonogram and RAI scan had shown bilateral nontoxic nodules, with benign fine needle aspiration cytology. She was intermittently and successfully treated with methimazole 2.5 mg daily, and had no interest in receiving Radioactive Iodine therapy. Her course over the subsequent years was significant for diagnosis of breast cancer treated with lumpectomy and paclitaxel-adriamycin, complicated by the onset of severe congestive heart failure and permanent atrial fibrillation, for which she was started on oral Amiodarone 200mg twice a day. Her serum TSH subsequently increased from baseline 4.53 mcIU/mL (normal 0.73-4.60 mcIU/mL) to 6.04 mIU/L at 6 weeks. Amiodarone dose was tapered to a daily dose and later discontinued because of a prolonged QT on electrocardiogram. Repeat thyroid testing at six months showed a markedly elevated TSH at 66.32 mcIU/mL (normal 0.73-4.60 mcIU/mL) with a serum T4 of less than 0.25 ng/dl (normal 0.58-1.64 ng/dl). TRAb and thyroid peroxidase antibodies remained negative. So with a provisional diagnosis of amiodarone-induced hypothyroidism, methimazole was discontinued and levothyroxine 25 mcg daily started. A follow-up testing one month later showed a TSH of 11.5 mcIU/mL and serum T4 of 0.72 ng/dl. DISCUSSION Amiodarone, through its high iodine content, has been associated with hypothyroidism as well as hyperthyroidism in both normal and dysfunctional thyroid glands. It typically induces thyrotoxicosis in autonomously functioning thyroid glands by stimulating excessive thyroid hormone biosynthesis in response to iodine load, whereas it typically induces hypothyroidism in patients with underlying autoimmune thyroiditis likely because of failure to escape Wolf-Chaikoff effect. Our patient illustrates a very rare and interesting permanent cure of Graves’ disease followed by hypothyroidism after amiodarone exposure.

The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology.

This study focused on parotid gland tumours diagnosed as benign by fine-needle aspiration cytology and investigated the necessity of frozen section biopsy. There were 104 cases of parotid gland tumour where fine-needle aspiration cytology was benign and frozen section biopsy was subsequently performed, between April 2006 and June 2016. In this retrospective study, the results of frozen section biopsy were analysed and compared with the final histological diagnosis. Among the 104 cases diagnosed as benign by fine-needle aspiration cytology, 102 cases and 2 cases were diagnosed as benign and malignant, respectively, by frozen section biopsy. The final histological diagnoses showed that 98 cases were benign and 6 cases were malignant. The sensitivity and specificity values of frozen section biopsy in detecting malignant tumours were 33 per cent and 100 per cent, respectively. The necessity of frozen section biopsy in cases with benign fine-needle aspiration cytology may be low in parotid gland surgery.

Accessory thyroid gland of the lateral neck

To the Editor, A 34-year-old Turkish woman presented with a left-sided cervical accessory thyroid gland. Her B-Mode thyroid ultrasonography exhibited an accessory thyroid parenchyma adjacent to the inferolateral border of left lobe of the thyroid gland (Figure 1a). fine-needle aspiration (FNA) cytology (FNAC) is a frequently used primary diagnostic procedure worldwide due to its preciseness, easiness, non-invasiveness, possessing very little complications and low cost [1, 2]. The thyroid gland ectopia and accessory thyroid tissue are two patterns of the abnormal thyroid gland migration. Ectopic thyroid gland is rare phenomenon and described as a functioning thyroid tissue in an aberrant area along the embryological descending line of the thyroid gland. Its most common form is known as lingual thyroid, accounting for 90 %. Aproximately 70 % of patients will exposed to the hormonal status of sub-clinical hypothyroidism [3]. These phenomenon may later undergo a malignant transformation [4]. An accessory thyroid gland is determined as a permanence of the thyroidal parenchyma anywhere from the base of the tongue to the thyroid isthmus, with the majority of the functional thyroid in its normal pre-tracheal area. The incidence of accessory thyroid gland is unknown [3]. Of 58 cadavers just one (1/58) was detected as the accessory thyroid gland on the thyroid cartilage by Braun et al [3]. Radkowski et al [5] performed thyroid US on 230 cases of the throglossal duct cyst and detected four cases (4/230) with the accessory thyroid tissue and three (3/230) with the ectopic thyroid gland. Therefore, they propunded the possibility of their equality in the incidence. The accessory thyroid glands are classified into five groups, based on their anatomical location: (1) cranial, (2) caudal, (3) lateral, (4) ventral, and (5) dorsal glands. They usually are founded along the former course of the thyroglossal duct and emigrate laterally [6]. Pyramidal lobes, superior accessory thyroids, retrotracheal, inferior/lateral extensions or extrusions are involved in the reasons of the recurrent thyroid diseases as the anomalies of the gland. Richards et al [3] asserted both thyroid gland ectopia and accessory thyroid tissue being vulnerable to the same potential diseases as a normally-situated thyroid gland. An accessory thyroid gland do not lead to clinical complication except in cases of the pathologic conditions such as goitre, malignancy, and the others. A thyroid FNA were planned, performed and its cytopathological evaluation with Haematoxylin and Eosin revealed a huge cellular cluster including the benign thyrocytes (Figure 1b). Therefore, a clinical follow-up was suggested for the present case, after a benign FNAC. Conclusively, education, training, and cognition of the thyroid anatomy and its associated variations and anomalies are very much essential for these kinds of the cases and it will lead to increasing the level of awareness.

Comparison Of Fnac And Histopathological Results For 4 Cm Or Larger Benign Thyroid Nodules

To assess the fine-needle aspiration cytology (FNAC) and histopathological results of thyroid nodules sized 4 cm or larger with benign cytology. Analytical study. Health Science University Umraniye Training and Research Hospital, Istanbul, Turkey. Patients with thyroid nodule size 4 cm. or larger and benign FNAC results were included in the study. All patients' age, gender, size of nodule, results of FNAC, types of surgery and histopathological results of thyroid specimen were extracted from patients' files. Out of 720 patients, who underwent thyroidectomy between January 2009 and January 2018, 310 patients with a benign FNAC results, between the ages of 18 and 78 years, with nodule diameters ranging from 4 to 8.4 cm were included in the study. Of these 310 patients, 243 (78.4%) were females and 67 (21.6%) were males. In the final histopathological examination, thyroid carcinoma was detected in five of the cases (1.6%). The risk of malignancy in 4 cm and larger thyroid nodules with benign FNAC was as much as expected in other benign nodules.

Thyroid nodule size as an indicator for surgery

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.Methods: Authors conducted a retrospective review of 201 patients who underwent thyroidectomy between 2011 and 2017 at Bahrain defense force hospital. Authors compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (&lt; 4cm or &gt;4cm) and indication of surgery.Results: 201 patients with thyroid nodule underwent thyroid surgery. 136 patients had nodule &lt;4cm and 65 patients were ≥4 cm. For patients with nodules &lt;4 cm, 37 patients (18.4%) had a malignancy, and for those with nodules ≥4 cm, 13 patients (6.4%) had a malignancy. comparison between size of the nodule, FNAC result and final histopathology: FNAC diagnosed 55 cases (27.3%) are malignant, final histopathology reported only 50 cases are malignant. But for benign cases FNAC and histopathology reports are showing same results, (p&lt;0.05).Conclusions: Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

Fine needle aspiration cytology accuracy in diagnosis of thyroid lesions: a comparative study with histopathological examination of thyroid swellings

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Thyroid enlargement, whether diffuse or in the form of a nodule, leads to a battery of investigations to be done. Fine needle aspiration cytology (FNAC) is usually the first line of investigation but the limitations of cytology are well recognized in the diagnosis of some thyroid malignancies, in particular it is not able to differentiate between follicular adenoma and carcinoma. We conducted a prospective study to assess the role of FNAC in diagnosing the nature of thyroid swelling and comparing its result with histopathology finding.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study conducted on 100 consecutive patients presented with thyroid swelling in department of otorhinolaryngology. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The present data show high specificity (96.29%) of FNAC as compared to sensitivity, which came out to be (78.9%). Positive and negative predictive value is 93.75% and 95.23%. This is quite similar to previous studies.&lt;/p&gt;&lt;p class="p1"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; FNAC has high specificity (96.29%), sensitivity (78.9%), positive predictive value (93.75%), negative predictive value (95.23%) and accuracy (95%) therefore it can be reliably used as initial investigation. A benign FNAC diagnosis should be viewed with caution as false negative results do occur and these patients should be followed up clinico-radiologically for any progression that will require repeated FNAC and/or surgery. &lt;/p&gt;

Risk of Malignancy in Thyroid Nodules 4 cm or Larger.

BackgroundSeveral authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.MethodsThis is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.ResultsThe overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.ConclusionNodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

Histological Surprises in Benign Cytologies after Lymph Node Biopsy-Surgeon's Knife Improving Patient Care.

Lymphadenopathy can be due to multitude of causes. Owing to the high prevalence of infectious diseases in India, and malignancy being a life threatening cause for lymphadenopathy; accurate diagnosis is important in preventing delay or misdiagnosis and in improving patient care, thereby increasing longevity with quality. Fine needle aspiration cytology (FNAC) is the first line investigation commonly done. Should the doctor be contented with the benign FNAC or is a lymph node biopsy needed in this age? The aims of this study are the following: (1) to study the spectral pattern of lymph node biopsies done in a surgical oncology unit of tertiary care centre, (2) to assess the yield of malignant cases from lymph node biopsy and (3) to compare the reliability of benign FNAC with lymph node biopsy. Cross-sectional study of 114 cases that underwent lymph node biopsy during the year 2014, at the Surgical Oncology Department of St. John's Medical College Hospital, Bangalore. Lymph node biopsies were done in the outpatient department (OPD) under local anaesthesia or in the operation theatre under local anaesthesia/monitored anaesthesia care based on the clinical condition of the patient. Regional lymph node dissections, central node biopsy, patients with known case of malignancy were excluded. Specimen sent for histopathological study and immunohistochemistry (IHC) done when needed. 58.8% were males among study population, age ranging from 15 to 80years, 57% cervical and 29.8% axillary lymph node biopsies done. Sixty-seven percent (67%) of biopsies done in OPD. Thirty-three percent (33%) of biopsies in the operation theatre among which 60.5% under local anaesthesia only. 35.1% cases were reactive hyperplasia, 24.6% lymphomas with non-Hodgkin's lymphoma being the commonest, 13.2% metastatic disease with adenocarcinoma being the commonest. 72.7% of the supraclavicular nodes were malignant. 47.4% of subjects had prior FNAC of the lymph node. Twenty-five percent (25%) of the reactive hyperplasia's on FNAC (p<0.0001), 33.3% of inadequate FNAC (p=0.003) and 75% of atypical cells in FNAC turned to be malignant on lymph node biopsy with a discordance rate of 20.3%. Lymph node size didn't correlate with neoplasm. In our study, benign cytologies were malignant on biopsy and statistically significant. Lymph node biopsies are reliable in detecting malignancy and subtyping of the disease. In the presence of strong clinical suspicion, lymph node biopsy is essential even when the FNAC is promisingly benign in a country with limited resources. Lymph node biopsy can be safely done in OPD under local anaesthesia at a lower cost, resulting in a reliable diagnosis thereby improving patient care.