Biopsy Cytology Research Articles

87. Isolated tumour cells and breast cancer recurrence after core needle biopsy or fine needle aspiration cytology

87. Isolated tumour cells and breast cancer recurrence after core needle biopsy or fine needle aspiration cytology

Adequacy of Pleural Fluid Cytology and Pleural Biopsies for Multiple Tumor Genotyping Techniques in Non-small Cell Lung Cancer

Adequacy of Pleural Fluid Cytology and Pleural Biopsies for Multiple Tumor Genotyping Techniques in Non-small Cell Lung Cancer

Abstract 4365: miR-106b modulates C1orf24 expression in thyroid tumors

Abstract BACKGROUND: Thyroid nodules are commonly found in clinical practice. Fine-needle aspiration biopsy (FNA) cytology is currently the most used method for the initial evaluation of a thyroid nodule. Although FNA remains the gold standard method, its accuracy is related to the histological subtype, being much lower for both benign follicular adenoma (FTA) and malignant follicular carcinoma (FTC). Hence, to improve preoperative diagnosis, we previously performed gene expression profiling of FTC and FTA. We have identified 4 genes (ARG2, DDIT3, ITM1 and C1orf24) over-expressed in carcinomas that, in combination, can distinguish FTA from FTC with high sensitivity and specificity. Despite their relevance as molecular marker, little is known about the mechanism that controls their expression and their role on thyroid cancer development. Since microRNA (miR) is an emerging class of small RNAs that regulates gene expression, we hypothesized if over-expression of C1orf24 in thyroid cancer was due to miR deregulation. We here sought to identify miRs that potentially modulate C1orf24 expression, analyze their levels in tumor samples and verify their effect on C1orf24 regulation. METHODS: C1orf24 expression was evaluated in 64 benign and malignant thyroid samples by quantitative PCR (qPCR). In parallel, candidate miRs were identified in Silico and their endogenous levels were evaluated by qPCR in all thyroid samples. Additionally miRs and C1orf24 expression were measured in 5 thyroid cell lines by qPCR and Western Blot. miR precursor and negative control were transfected by siPORTNeoFX. C1orf24 3′-UTR was cloned in pmiR-Glo Dual Luciferase Vector and luciferase activity was measured by Dual-Luciferase Reporter Assay System. One-way ANOVA or t-test was used for statistical analysis (p< 0.05). RESULTS: Analysis of miRBase Sequence database suggested two miRs - miR-17-5p and miR-106b - that potentially regulate C1orf24 expression. miR-106b expression was significant lower in thyroid carcinomas (TC) than FTA (p-value 0.0060). On the other hand, C1orf24 expression was higher in TC (p-value 0.0018), suggesting that miR-106b potentially regulates C1orf24 expression. Next, we investigated if miR-106b could directly modulate C1orf24 expression. As thyroid carcinoma cell line (WRO) presented high levels of C1orf24 expression and low levels of miR-106b, we transiently transfected miR-106b precursor into WRO cells and measured C1orf24 expression. Both mRNA (p-value 0.0433) and protein levels (p-value 0.0877) were diminished when compared to control. Luciferase activity was lower in WRO cells transfected with both C1orf24 3′-UTR and miR-106b precursor than negative control (p-value 0.0026), suggesting a direct interaction between them. CONCLUSION: Our findings suggest that miR-106b, but not miR-17-5p, directly modulates C1orf24 gene expression acting as a tumor suppressor miR, suggesting a novel mechanism of C1orf24 expression in thyroid cancer. Citation Format: Bruno H. Nozima, Gianna M. Carvalheira, Janete M. Cerutti. miR-106b modulates C1orf24 expression in thyroid tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4365. doi:10.1158/1538-7445.AM2014-4365

Fine needle aspiration cytology versus core needle biopsy in the diagnosis of primary bone tumors: a retrospective study

Background Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are two outpatient procedures used in the differential diagnosis of a suspected bone tumor. Although open biopsy is a recommended procedure, its invasive nature mandates the search of a minimally invasive procedure for the diagnosis of a bone tumor prior to surgical resection or radio/chemotherapy. Therefore, the aim of this study was to compare the FNAC and CNB regarding their diagnostic accuracy in the diagnosis of primary bone tumor.

A Review of the Utility of Cytology and Core Needle Biopsies for Lesions of Possible Müllerian Origin

A Review of the Utility of Cytology and Core Needle Biopsies for Lesions of Possible Müllerian Origin

Role of Fine Needle Aspiration Cytology (FNA) and Core Biopsy (CBx) in the Presurgical Diagnosis of Medullary Thyroid Carcinoma (MTC): Fifteen Years of Experience in a Cancer Center (CC)

Role of Fine Needle Aspiration Cytology (FNA) and Core Biopsy (CBx) in the Presurgical Diagnosis of Medullary Thyroid Carcinoma (MTC): Fifteen Years of Experience in a Cancer Center (CC)

The 4C Anatomic Pathology Report - An 18-year Experience with Consolidation of Cytology, Cell Block and Core Biopsy Report

The 4C Anatomic Pathology Report - An 18-year Experience with Consolidation of Cytology, Cell Block and Core Biopsy Report

Lymphadenopathy in a Series of Egyptian Pediatric Patients and the Role of Pathology in the Diagnostic Workup.

Assessment of lymphadenopathy in children represents a diagnostic challenge because of the extensive differential diagnoses including reactive and malignant conditions. Knowledge of the etiologic pattern of lymphadenopathy in a given geographical region is essential for making a confident diagnosis or suspecting a disease. Hence, the present study was carried out to identify different etiologies of lymphadenopathy in children in our region, and assess parameters commonly associated with malignancy, with an emphasis on the role of pathology in the diagnostic workup. One hundred and twenty patients aged one month to 18 years were included in the study. They were sorted into neoplastic and non-neoplastic (Infectious and non-infectious). In only 56 patients, biopsy, whether fine needle aspiration cytology (FNAC), core needle or excision biopsy, was essential to reach the final diagnosis. Sensitivity of FNAC in the differentiation between neoplastic and non-neoplastic lymphadenopathy was 92.3%, specificity 90.0%, with a diagnostic accuracy of 91.3%. We concluded that malignancy should be suspected in the following conditions: presence of abdominal or multiple symptoms, symptoms duration of 1-6 months, generalized lymphadenopathy, multiple groups of lymph node (LN) involved, LN size > 2 cm, amalgamated, hard, fixed and non-tender LNs, certain abnormal CBC findings, blast cells in blood film and elevated LDH level. In such cases, LN biopsy is highly recommended. A final diagnosis was achieved after integrating information from history and clinical findings with those of the laboratory, radiological, pathological and microbiological findings. Accordingly, an algorithm for primary diagnostic evaluation of children with lymphadenopathy is suggested.

Evaluación del rendimiento diagnóstico de FISH y citología guiada por ultrasonido endoscópico en las lesiones pancreatobiliares malignas

BackgroundEndoscopic ultrasound (EUS) is the best diagnostic method for pancreatobiliary lesions. EUS-FNA guided cytology biopsy has a sensitivity 90%. However, there are some cases in which diagnosis cannot be achieved. Fluorescence in situ hybridization (FISH) technique has proven to be superior to cytology (Sn 97% vs 87%). This might suggest that performing FISH could improve the diagnostic yield and have an impact on the management of patients with previous negative samples. AimTo evaluate the effectiveness of FISH in improving EUS-FNA guided cytology diagnostic yield in malignant pancreatobiliary lesions. Material and methodsA diagnostic test was performed in patients with malignant pancreatibiliary lesions scheduled for EUS-FNA. EUS was performed using a linear array ecoendoscope and FNA using a EchoTip needle. Samples were sent to cytology, cellular block and FISH analysis. Sn,SP NPV and PPv were calculated using a construct or surgery as standar. Results56 patients (34 females, 22 males) were included. Average age was 58.9 years. The most commonly found histology was pancreatic cancer in 71.4% of cases. Nine patients were operated, and the remaining were clinically and imaging followed up. FISH Sn,Sp,VPP and VPN were 47,100, 89 and 90% respectively. For EUS-FAN cytology were 85,100,100 and 80%. ConclusionsPerforming FISH does not improve diagnostic yield of EUS-FNA cytology.

Pseudoaneurysm of the Breast Treated with Percutaneous Ethanol Injection

The incidence of complications following core needle biopsy (CNB) or fine needle aspiration cytology (FNAC) of the breast is low, and the subsequent need for surgical management of any complication is rare. We herein report such a case in whom a pseudoaneurysm of the breast developed 2 days after a manually guided FNAC of a benign breast lesion. Percutaneous ethanol injection for treatment of the pseudoaneurysm was successfully done with remaining thrombosed hematoma in a single session.

Su1144 Conventional Y Stent Versus Niti-S Large Cell D-Type (LCD) Stent in Bilateral Stent Placement for Advanced Hilar Malignancy

G A A b st ra ct s evidence-based consensus statements for the diagnosis of biliary strictures. Methods: Initial statements on the use of CLE for the characterization of indeterminate biliary strictures were developed by a single CLE expert based on the available clinical evidence. Those preliminary statements were edited and submitted by an external group of 16 GI physicians using a modified Delphi approach. After two rounds of votes based on relevant data, quality of the evidence and strength of recommendation, statements were validated if the threshold of agreement was higher than 75%. Results: Out of 9 proposed statements, 7 were validated and 3 rejected.CLE can be used to evaluate biliary strictures, and the probe can be delivered via a catheter or a cholangioscope. CLE is more accurate than ERCP with brush cytology and/or forceps biopsy in determining malignant or benign strictures, using established criteria. The accuracy of CLE in indeterminate biliary strictures may be decreased by prior presence of plastic stent. The Negative Predictive Value (NPV) of CLE is very high. The use of CLE can assist clinical decision-making such as excluding malignancy. CLE should be cited as a valuable tool for an increased diagnostic yield in official guidelines. The «black bands» that can be seen in pCLE images have been shown to be collagen fibrils that predictably increase in pathologic tissue. Conclusion: According to the panel of 16 physicians, given its very high accuracy, Confocal Laser Endomicroscopy has the potential to improve the current diagnostic algorithm of biliary strictures. At centers where expertise is available, Confocal Laser Endomicroscopy used during ERCP in the evaluation of biliary strictures should be considered as a standard practice complementary to conventional tissue sampling.

Su1146 Comparative Analysis Between Early and Delayed Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage

G A A b st ra ct s evidence-based consensus statements for the diagnosis of biliary strictures. Methods: Initial statements on the use of CLE for the characterization of indeterminate biliary strictures were developed by a single CLE expert based on the available clinical evidence. Those preliminary statements were edited and submitted by an external group of 16 GI physicians using a modified Delphi approach. After two rounds of votes based on relevant data, quality of the evidence and strength of recommendation, statements were validated if the threshold of agreement was higher than 75%. Results: Out of 9 proposed statements, 7 were validated and 3 rejected.CLE can be used to evaluate biliary strictures, and the probe can be delivered via a catheter or a cholangioscope. CLE is more accurate than ERCP with brush cytology and/or forceps biopsy in determining malignant or benign strictures, using established criteria. The accuracy of CLE in indeterminate biliary strictures may be decreased by prior presence of plastic stent. The Negative Predictive Value (NPV) of CLE is very high. The use of CLE can assist clinical decision-making such as excluding malignancy. CLE should be cited as a valuable tool for an increased diagnostic yield in official guidelines. The «black bands» that can be seen in pCLE images have been shown to be collagen fibrils that predictably increase in pathologic tissue. Conclusion: According to the panel of 16 physicians, given its very high accuracy, Confocal Laser Endomicroscopy has the potential to improve the current diagnostic algorithm of biliary strictures. At centers where expertise is available, Confocal Laser Endomicroscopy used during ERCP in the evaluation of biliary strictures should be considered as a standard practice complementary to conventional tissue sampling.

Thyroid Nodules ≥4 cm: Can Ultrasound and Cytology Reliably Exclude Cancer? Reply

Background Whether a threshold nodule size should prompt diagnostic thyroidectomy remains controversial. We examined a consecutive series of patients who all had thyroidectomy for a ≥4 cm nodule to determine (1) the incidence of thyroid cancer (TC) and (2) if malignant nodules could accurately be diagnosed preoperatively by ultrasound (US), fine needle aspiration biopsy (FNAB) cytology and molecular testing.

Servikal Smear Sitolojisi ile Servikal Biyopsilerin Sitohistolojik Korelasyonu

Amaç: Servikovajinal smearler ile servikal biyopsiler arasındaki sitohistolojik korelasyonu saptamayı amaçladık. Gereç ve Yöntemler: Servikovajinal smear alınan ve servikal biyopsi, loop elektrocerrahi eksizyon prosedürü veya histerektomi materyallerine ulaşılan 61 olgu çalışmaya alındı. Sitoloji sonuçları ile histopatoloji sonuçları retrospektif olarak karşılaştırıldı. Bulgular: Sitolojik incelemede; önemi bilinmeyen atipik skuamöz hücreler (ASC-US) olarak değerlendirilen 13 olgunun %23 (n=3)'ünün biyopsi sonuçlarında benign bulgular, %54 (n=7)'ünde servikal intraepitelyal neoplazi I (CIN I), %23 (n=3)'ünde CIN II saptandı. Düşük dereceli skuamöz intraepitelyal lezyon (LG-SIL) olarak değerlendirilen 13 olgunun %61,6 (n=8)'sında CIN I, %23 (n=3)'ünde CIN II, %7,7 (n=1)'sinde CIN III ve %7,7 (n=1)'sinde karsinoma in-situ (CIS) saptandı. Yüksek dereceli skuamöz intraepitelyal lezyon (HG-SIL) olarak değerlendirilen 9 olgudan %11,1 (n=1)'inde CIN I, %22,2 (n=2)'sinde CIN III ve %66,7 (n=6)'sinde CIS görüldü. Yüksek dereceli skuamöz lezyonun dışlanamadığı atipik skuamöz hücreler (ASC-H) olarak değerlendirilen 3 olgunun %33,3 (n=1)'ünde CIN II ve %33,3 (n=1)'ünde CIS saptanırken, %33, (n=1) olguda benign bulgular saptandı. Sitolojik incelemede enfeksiyon saptanan 21 olgunun %66,6 (n=14)'sının biyopsi sonuçlarında benign bulgular, %28,6 (n=6)'sında CIN I, %4,8 (n=1)'inde CIN III saptandı. Normal Pap smear olarak değerlendirilen 2 olgunun biyopsi sonuçlarında benign bulgular saptandı. Verilerimize göre biyopsi ve smear sonuçları benign bulgular ve CIN'ler olarak iki grupta sınıflandırıldığında, ASC-US ile ASC-H tanılı olgular dışlandığında, özgüllük %100, duyarlılık %75,9, yanlış negatiflik %30,4, pozitif tahmini değer %100 ve negatif tahmini değer %69,6 olarak hesaplandı. McNemar testine göre sitoloji ile biyopsi sonuçları arasında anlamlı farklılık saptandı (p=0,004). Sonuç: Servikal smear sitolojisi, hata payı olmasına rağmen, servikal neoplazilerin değerlendirilmesinde etkin bir tarama yöntemidir.

Liquid-based trans-epithelial flexible brush cytology of high-grade laryngeal mucosal lesions

Laryngeal cytology, which was popular in the 1950s and 60s, has lost its appeal due to difficulties in obtaining adequate specimens and frequent false negative results which are often associated with smears of suboptimal quality. Flexible laryngoscope and brushes, and liquid-based cytology (LBC) allow for improved collection and quality of laryngeal mucosal samples. In LBC the cells are optimally fixed and significantly retrieved. The samples are virtually devoid of air drying artefact and obscuring elements such as blood, mucus, necrotic debris and inflammation. The diagnostic accuracies of liquid-based transepithelial flexible brush cytological (LBTEFBC) samples and flexible biopsies (FB) were compared with those of biopsy under general anaesthesia (BUA) in 49 and 46 patients respectively. Cytology specimens were graded and scored using a recently proposed oral cytological grading and scoring system. When compared with BUA, the cytology showed 97% sensitivity and 100% specificity, and FB yielded 77.1% sensitivity and 100% specificity. Reactive/mildly dysplastic lesions can be discriminated from high-grade dysplasias/invasive squamous cell carcinomas with 100% sensitivity and specificity. LBTFBC is a simple, cost-effective, relatively atraumatic office-based procedure, and with the recently proposed classification, it can be accurate in the detection of high-grade laryngeal lesions.

Oral Pigmented Lesions as a Consequence of the Human Papillomavirus

Our research is based on oral cavity pigmentation caused by melanocytes. From my medical experience, pigmented lesions may originate from endogenous or exogenous causes. It is a known fact that human papilloma virus is a type of virus that has more than 100 species that is likely to develop cervical cancer. They manifest in various forms such as papillary hyperplasia and squamous epithelium of the oral mucosa. In a pilot study we conducted, a control group composed of 30 patients who have pigmentation of melanocytes in the form of lesion in the oral cavity underwent cytological smear biopsy test using Polymerase Chain Reaction (PCR) technique from the area of pigmentation. The results revealed that 68% of the subjects have the presence of HPV 16 with the presence of koilocytes. However, 14% of the subjects who have pigmented lesions do not have a single type of HPV but rather with pigmented melanocytes changes with normal epithelium layer. In addition, 14% of the subjects with pigmented changes did not have a single type of HPV but rather pigmented melanocytes changes with normal epithelium layer. This pilot study also revealed that 18% of the subjects with pigmented melanocytes lesions have pathological changes in the oral cavity. Therefore in conclusion, based on the pilot study the presence of the human papilloma virus is not the only cause for the presence of hyperplastic, papillomatosis lesions but also the emergence of other pathological changes in the oral cavity.

Solitary pulmonary nodule: A rare presentation of pulmonary mucormycosis in an immunocompetent adult

Pulmonary mucormycosis is a rare opportunistic infection of immunocompromised individuals. Here, we report a case of 70-year-old male, smoker presenting with high-grade fever for 2 weeks and episodes of hemoptysis. Contrast-enhanced computed tomography (CT) thorax revealed a solitary pulmonary nodule measuring 2.3 × 1.6 cm in the right upper lobe. CT guided fine needle aspiration cytology and true cut biopsy showed plenty of typical fungal hyphae consistent with the diagnosis of mucormycosis. Fungal culture confirmed the organism as mucor. Positron emission tomography-CT scan showed a non- 18 fluorodeoxy glucose avid nodule ruling out possibility of malignancy. Investigation did not reveal any evidence of immunosuppression. Patient was treated with intravenous liposomal amphotericin B for 4 weeks. Follow-up chest X-ray and CT scan after 6 weeks were normal.

Nodular fasciitis of the breast mimicking breast cancer.

Nodular fasciitis is a benign proliferative lesion that is usually found in the soft tissue of the upper extremity and trunk in young to middle-aged persons. It has rarely been described in the breast. A 35-year-old woman had noticed a mass in her left breast. It was elastic-hard, 13 mm in size, and located mainly in the upper inner quadrant of the left breast. Mammography did not detect the mass. Ultrasonography revealed a hypoechoic lesion with an irregular margin. Neither fine-needle aspiration cytology nor core needle biopsy established a definitive diagnosis. Excisional biopsy was therefore performed. Histologically, the excised tumor tissue results were consistent with a diagnosis of nodular fasciitis of the breast. We report a case of nodular fasciitis of the breast, a rare histological type of breast tumor.

Surgeon-Performed Touch Preparation of Breast Core Needle Biopsies May Provide Accurate Same-Day Diagnosis and Expedite Treatment Planning

We aimed to determine the accuracy of surgeon-performed touch-preparation cytology (TPC) of breast core-needle biopsies (CNB) and the ability to use TPC results to initiate treatment planning at the same patient visit. A single-institution retrospective review of TPC results of ultrasound-guided breast CNB was performed. All TPC slides were prepared by surgeons performing the biopsy and interpreted by the pathologist. TPC results were reported as positive/suspicious, atypical, negative/benign, or deferred; these were compared with final pathology of cores to calculate accuracy. Treatment planning was noted as having taken place if the patient had requisition of advanced imaging, referrals, or surgical planning undertaken during the same visit. Four hundred forty-seven CNB specimens with corresponding TPC were evaluated from 434 patient visits, and 203 samples (45.4 %) were malignant on final pathology. When the deferred, atypical, and benign results were considered negative and positive/suspicious results were considered positive, sensitivity and specificity were 83.7 % (77.9-88.5 %) and 98.4 % (95.9-99.6 %), respectively; positive and negative predictive values were 97.7 % (94.2-99.4 %) and 87.9 % (83.4-91.5 %), respectively. In practice, patients with atypical or deferred results were asked to await final pathology. An accurate same-day diagnosis (TPC positive/suspicious) was hence feasible in 83.7 % (170 of 203) of malignant and 79.5 % (194 of 244) of benign cases (TPC negative). Of patients who had a same-day diagnosis of a new malignancy, 77.3 % had treatment planning initiated at the same visit. Surgeon-performed TPC of breast CNB is an accurate method of same-day diagnosis that allows treatment planning to be initiated at the same visit and may serve to expedite patient care.

Abstract P1-01-25: Predictive factors of micrometastases in the sentinel node of patients affected by invasive early breast cancer

Abstract Aim: nodal metastatic involvement is the most important prognostic indicator in breast cancer. Sentinel node biopsy led to an increase in the detection of micrometastases. The aim of our analysis was to identify predictive factors of micrometastases and macrometastases of sentinel node. Materials and Methods: between January 2000 and December 2006, 675 patients were treated with breast surgery and sentinel node evaluation at University of Florence (Florence, Italy). Estrogen receptor status, progesterone receptor status, and Ki-67 labeling index determined with the MIB1 monoclonal antibody were assessed. HER2 immunohistochemistry (IHC) expression was scored as follows: 0, no staining or faint membrane staining; 1+, faint membrane staining in >10% of tumor cells, incomplete membrane staining; 2+, weak to moderate membrane staining in >10% of tumor cells; and 3+, intense circumferential membrane staining in >10% of tumor cells. HER2 scores of 0 and 1+ were considered negative. HER2 IHC 3+ and fluorescent in situ hybridization (FISH) – amplified tumors were considered positive. All IHC 2+ tumors and indeterminate tumors were tested for gene amplification by FISH. The sentinel node was examined by hematoxylin and eosin. The patients were divided into three groups based on AJCC TNM staging: sentinel node negative (n = 601); micrometastases if tumor deposit more than 0.2 mm but <2 mm (n = 20), and macrometastases if tumor deposit more than 2 mm (n = 53). Results: at the logistic regression with polytomous analyses (outcome micrometastases or macrometastases), age (p = 0.048), menopausal state (p = 0.013), breast quadrant (p = 0.005), lymph vascular invasion (p = 0.0001), post-surgical T stage (p = 0.0001), histotypes (p = 0.023), HER2 status (p = 0.02), Ki-67 proliferative index (p = 0.001) and nuclear grade (p = 0.024) were significantly correlated with sentinel node macrometastases. Sentinel node biopsy technique (cytological aspiration versus histological biopsy) was not associated with micrometastases (p = 0.89) or macrometastases (p = 0.48) occurrence. The only feature significantly associated with micrometastases in sentinel node was the lymph vascular invasion (p = 0.0001). Conclusion: the presence of micrometastases remained fairly constant over time if compared to macrometastases. In our experience the only feature significantly associated with micrometastases in sentinel node is the lymph vascular invasion. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-25.