Fine Needle Aspiration Cytology Research Articles

Effects on lymph node size, staging and primary tumor histology on diagnostic accuracy of axillary lymph node aspirate of breast cancers.

Fine-needle aspiration cytology is preferred for axillary lymph node metastasis with low costs and minimal risks. To improve diagnostic performance by incorporating clinical-radiological-pathological parameters, a large cohort pre-operative aspirates in were reviewed for parameters affecting adequacy rate and accuracy. Axillary nodal aspirates from three institutions with histologic correlation were retrieved. Case notes were reviewed for parameters pertaining to the primary tumor, nodal status, histologic and cytologic diagnoses. Totally 1361 specimens were included. The risk of malignancy for C1-C5 categories were 53.39%, 27.45%, 70.97%, 83.33% and 88.00%, increasing to 75.86%, 94.59% and 99.28% for C3/C4/C5 categories excluding cases with neoadjuvant therapy. Node size (p < 0.001) and histologic grade (p = 0.003) of primary tumor positively correlated with specimen adequacy. Presence of in situ component trended towards inadequacy (p = 0.069). Lymph node size remained a strong predictor of concordant cytologic diagnosis (p < 0.001). A higher percentage of involved node (p = 0.006) and HER2 overexpressed breast cancers (p = 0.027) increased concordance. Cases with ≥ 4 (up to ≥ 10) positive nodes were more likely to be concordant (p = 0.009- < 0.001), with improvements of 8.27%-12.37%. For size, cut-offs of ≥ 5 and ≥ 10mm were significant (p = 0.006- < 0.001). It is critical that clinical-radiological-pathological findings be interpreted together with cytology. Aspirates from smaller nodes are more likely to be non-informative, irrespective of the total number of suspicious nodes, or a high-grade primary. In axillae with less than 4 suspicious nodes and/or a target node of less than 5-10mm, the diagnostic accuracy of aspiration cytology decreases and should be interpreted cautiously.

Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia

Background: This study was designed to compare diagnostic categories of thyroid fine needle aspiration cytology (FNAC) and incidence of thyroid tumors in the multi-institutional Asian series with a special focus on diagnostic category IV (suspicious for a follicular neoplasm) and follicular thyroid carcinomas (FTCs). Methods: Distribution of FNAC categories, incidence of thyroid tumors in resection specimens and cytologic diagnoses of surgically confirmed follicular adenomas (FAs) and FTCs were collected from 10 institutes from five Asian countries and were compared among countries and between FAs and FTCs. Results: The frequency of category IV diagnoses (3.0%) in preoperative FNAC were significantly lower compared to those in Western countries (10.1%). When comparing diagnostic categories among Asian countries, category IV was more frequent in Japan (4.6%) and India (7.9%) than in Taiwan (1.4%), Korea (1.4%), and China (3.6%). Similarly, incidence of FAs and FTCs in surgical resection specimens was significantly higher in Japan (10.9%) and India (10.1%) than in Taiwan (5.5%), Korea (3.0%), and China (2.5%). FTCs were more commonly diagnosed as category IV in Japan (77.5%) than in Korea (33.3%) and China (35.0%). Nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were more common in FTCs compared with FAs. Conclusions: Our study highlighted the difference in FNAC diagnostic categories of FTCs among Asian countries, which is likely related to different reporting systems and thyroid cancer incidence. Cytologic features such as nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were found to be useful in diagnosing FTCs more effectively.

A systematic review of ultrasonography-guided transcutaneous fine needle aspiration cytology in the diagnosis of laryngeal malignancy.

Direct laryngoscopy and biopsy is the gold standard for obtaining a tissue diagnosis in patients with suspected laryngeal cancer. In patients with advanced disease or other medical comorbidities, this may come with significant anaesthetic risks, including tracheostomy. Ultrasonography-guided biopsy has been widely used in the diagnosis of malignancy involving cervical lymph nodes but it is not commonly employed in the diagnosis of laryngeal tumours. A systematic review was undertaken to assess the literature looking at whether ultrasonography-guided transcutaneous fine needle aspiration cytology (FNAC) is an adequate method in diagnosing laryngeal malignancy. Two independent researchers conducted a systematic review of the literature using the MEDLINE® and Cochrane Library databases in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 568 studies were identified from the search, of which 3 met the inclusion criteria, resulting in 162 patient episodes. The pooled accuracy of transcutaneous FNAC in acquiring a sample adequate for histological diagnosis was 74.9%. Data on complications were limited, with a few cases of mild haemoptysis being recorded. Transcutaneous FNAC can be considered a safe and quick method for establishing a histological diagnosis of laryngeal lesions, particularly in patients who may be severely comorbid, and it could therefore could reduce the risks of general anaesthesia and tracheostomy prior to commencing definitive treatment.

VS 03 - BN Laparoscopic Excision of Aortic Schwannoma

Abstract Background This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy. Method The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative Results MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma. Conclusion This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up

Warthin-like Papillary Thyroid Carcinoma: A Case Report and Review of the Literature.

Warthin-like subtype of papillary thyroid carcinoma (WLPTC) is a rare subtype of papillary thyroid carcinoma. This PTC subtype shows some pattern resemblance to Warthin tumors of the salivary gland, which confers its name but is a not genetically similar to salivary Warthin tumor, with the most frequent genetic change in WLPTC being BRAF p.V600E, the most frequent genetic driver of PTC. Warthin-like subtype of papillary thyroid carcinoma is found to have a favorable prognosis. We report a 44-year-old woman who presented with anterior neck swelling and elevated levels of antithyroid peroxidase antibodies. Fine-needle aspiration cytology showed features of papillary thyroid carcinoma and lymphocytic thyroiditis. On histopathological examination, thyroid follicular cells have oncocytic cytoplasm with infiltration of the tumor and fibrovascular cores by a dense lymphoplasmacytic infiltrate. Numerous multinucleated giant cells in the tumor are a notable feature. The final diagnosis is Warthin-like papillary thyroid carcinoma arising in association with chronic lymphocytic (Hashimoto) thyroiditis. Along with this case report, we perform a literature review of WLPTC between 2010 and 2024.

Comparison of Histopathology (Incisional Biopsy) Vs Fine Needle Aspiration Cytology in Diagnosing Tuberculous Cervical Lymphadenopathy

Objectives: To evaluate and compare the sensitivity and specificity between Fine Needle Aspiration Cytology (FNAC) and histopathology of incisional biopsy in diagnosing blood culture positive tuberculous lymphadenopathy (LAD). Methods: : This descriptive study was conducted in the Department of Pathology at Jinnah Teaching Hospital (JTH) Peshawar from January 2021 to August 2022. The study samples included were collected from thepatients at tertiary care Hospitals who were acid fast bacillus(AFB) positive and blood culture positive. The culture and sensitivity and Zn staining was carried out at JTH Peshawar. Seventy subjects with AFB and culture positive with high clinical suspicion of tuberculous LAD were included in the study. After the recruitment of subjects according to the inclusion criteria, subjects underwent FNAC followed by incisional biopsy for histopathology carried out at JTH Peshawar. Subjects’ blood was checked and screened for Hepatitis B and C, TLC, DLC and ESR at Microbiology and Haematology laboratories of JTH Peshawar respectively. The data was then organised and analysed in SPSS software version. 26. Results: Out of the seventy subjects included in the study, 30 were males while 40 were females. Subjects had a mean age of 33.5 years. The sensitivity of FNAC was 89%, however the Specificity came out to be 59%. Conclusion: Our study obviates the use of FNAC as a good screening test however due to the low specificity or in cases where there is a high clinical suspicion of TB, the results need to be confirmed by Incisional biopsy for histopathology. However, further studies are required for not only understanding the medical condition.

Combined modalities for the rapid diagnosis of patients with suspected tuberculous lymphadenitis: A cross-sectional study.

In settings with high burden of extrapulmonary tuberculosis, the use of various diagnostic modalities can result in superior and quick diagnosis leading to prompt initiation of treatment. This study assessed the diagnostic performance of the fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, fluorescence microscopy (FM) and cartridge-based nucleic acid amplification test (CBNAAT) in patients with suspected tuberculous lymphadenitis (TBLN). This cross-sectional studyodes, who underwent FNAC. The FNAC samples were subjected to cytomorphological examinati involved 255 patients clinically suspected of TBLN with palpable lymph non, ZN stain, FM and CBNAAT. The diagnostic performance of each modality was compared with CBNAAT, and combined performance was determined. The diagnostic performance of CBNAAT was determined by comparing it with composite reference standard. Of 255 patients, 148 (58.04%) showed features of TBLN on FNAC. The presence of epithelioid cell granulomas with caseous necrosis (67.57%) was the predominant cytomorphological pattern. On ZN stain, FM and CBNAAT, 31 (20.95%), 63 (42.57%) and 100 (67.57%) patients were found to be positive for TBLN, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT was 58.59%, 91.83%, 92% and 58.06%, respectively. Finally, the combination of ZN stain, FM and CBNAAT led to the detection of 88.51% patients with TBLN. Combined use of ZN stain, FM and CBNAAT leads to superior and swift diagnosis of patients with clinically suspected TBLN.

Comparison of British Thyroid Association and TIRADS classifications and their impact on the radiological and surgical management of indeterminate thyroid nodules

BackgroundThe British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer advocate for fine-needle aspiration cytology for all thyroid nodules graded indeterminate (U3) at ultrasound assessment. This approach raises concerns regarding potential over-diagnosis of low-risk lesions. Conversely, equivalent Thyroid Imaging Reporting and Data Systems (TIRADS) guidelines permit surveillance or discharge of indeterminate thyroid nodules of certain sizes. This service analysis analyses how guideline choice impacts the fine-needle aspiration cytology rate and subsequent surgical management of indeterminate thyroid nodules. MethodsAll patients with an indeterminate (U3) thyroid nodule identified on ultrasound over a 12-month period were included. Indeterminate thyroid nodules were retrospectively rescored using three equivalent TIRADS classifications by three independent reviewers, blinded to the histopathology. Hypothetical differences in fine-needle aspiration cytology rates and surgical activity were then compared. ResultsNinety-six nodules were identified. Retrospective application of TIRADS guidelines resulted in a hypothetical 44.8-55.2% reduction in fine-needle aspiration cytology performed for indeterminate thyroid nodules compared to BTA. A statistically significant increase in rates of surgical activity for indeterminate thyroid nodules was observed between BTA guidance and all retrospectively applied TIRADS guidelines (p<0.001). Of four confirmed thyroid cancers, three would have been unanimously removed. ConclusionUnder BTA guidance, increased fine-needle aspiration cytology rates for indeterminate thyroid nodules resulted in significantly increased surgical activity in our cohort compared to retrospectively applied TIRADS guidelines.

Conventional and Emerging Diagnostic Approaches for Differentiated Thyroid Carcinoma

Differentiated thyroid carcinoma (DTC) is among the most prevalent endocrine cancers. The diagnosis of DTC has witnessed tremendous progress in terms of technological advancement and clinical operational guidelines. DTC diagnostics have evolved significantly over centuries, from early clinical examinations to modern molecular testing and imaging modalities. The diagnosis and management of DTC are currently dependent on the international histological classification and identification of specific genetic abnormalities in tumor tissue, as well as the prognostic implications that can inform treatment decisions. This study goes down the memory lanes of various diagnostic methods for DTCs, highlighting recent advancements in molecular testing and point-of-care (POC) technology. Beginning with conventional methods like fine needle aspiration biopsy (FNAB), fine needle aspiration cytology (FNAC), and ultrasound (US) and moving to contemporary innovative approaches such as POC-thyroglobulin (POC-Tg) and liquid biopsy, this review showcases the current trends in DTC diagnostics. Although considerable progress has been achieved in early malignancy detection, patient stratification, prognosis, and personalized treatment, there is a need to refine the mainstay diagnostic procedures. Finally, future perspectives were provided, and emerging roles of artificial intelligence in DTC diagnostics were explored.

Incidental diagnosis of subcutaneous filariasis with an unusual presentation in a non-endemic area—Need to worry?

ABSTRACT We report an interesting case of Bancroftian filariasis diagnosed on fine needle aspiration cytology in a young female hailing from a non-endemic hilly area of India, who presented with a subcutaneous swelling on the left forearm. This is an unusual extra-lymphatic site to harbor filarial infestation and the cytology smears showed adult worms, eggs, and microfilariae of Wuchereria bancrofti.

P005 Ultrasound (US) with Fine Needle Aspiration Cytology (FNAC) as an adjunct in staging cN0 penile cancer patients: Outcomes of a regional centre in the UK

P005 Ultrasound (US) with Fine Needle Aspiration Cytology (FNAC) as an adjunct in staging cN0 penile cancer patients: Outcomes of a regional centre in the UK

O08 Ultrasonography - Guided fine needle aspiration cytology with rapid on-site evaluation technique for inguinal nodes in penile cancer – A pivotal point in surgical management

O08 Ultrasonography - Guided fine needle aspiration cytology with rapid on-site evaluation technique for inguinal nodes in penile cancer – A pivotal point in surgical management

Chondromyxoid Fibroma of Phalanges

Chondromyxoid fibroma (CMF) is a rare, benign metaphyseal bone tumour characterised by a combination of chondroid, myxoid, and fibrous elements, which can affect any bone at any age, without a gender predilection. We report the case of CMF in a 47-year-old lady who presented with swelling of the left little finger to a tertiary care hospital at Kolkata, India, in May 2024. Imaging showed presence of a lobulated lesion arising from the middle phalanx of the left little finger, extending to involve the base of the distal phalanx. Fine needle aspiration cytology of the lesion was indicative of a moderately cellular myxoid lesion. Histopathology remains crucial for diagnosis, which revealed a lobulated tumour with zones of spindle to stellate cells, associated with abundant myxoid and chondroid matrix in the intercellular areas. Treatment involves complete local excision with tumor free margins, as recurrence can occur with local curettage.

The Spectrum of Thyroid Lesions on Cytology in a Secondary Care Centre, Karkala, Karnataka

Fine Needle Aspiration Cytology (FNAC) is a cost effective, minimally invasive procedure with less complications. It can be used in the diagnosis of thyroid lesions, aiding the clinician in the patient management and reducing the incidence of unnecessary surgeries. Thyroid profile test, ultrasonography and radionuclide scan are used as adjuvant diagnostic modalities.

Management of pediatric thyroglossal duct cyst: A case report

Introduction: Thyroglossal duct cysts are common congenital neck anomalies in children, diagnosed through clinical assessment and ultrasound, and treated with the Sistrunk procedure to prevent complications like infection and malignancy. Case Description: We present a case of a 4-year-old male patient with a progressively enlarging neck mass for three months. The mass was asymptomatic, did not cause any eating difficulties, and moved upwards during swallowing and tongue protrusion. Upon physical examination, a soft, mobile, cystic mass approximately 3 cm in diameter was identified beneath the hyoid bone. Supporting examinations, including ultrasound and fine-needle aspiration cytology, led to the diagnosis of a thyroglossal duct cyst. The patient underwent a successful Sistrunk procedure, which involved the excision of the cyst along with a portion of the hyoid bone. Postoperative management included administration of intravenous antibiotics and paracetamol, culminating in a full recovery without any signs of infection. The patient exhibited complete wound healing within two weeks. There was no evidence of cyst recurrence during a follow-up examination six months later. Conclusion: Despite being common, thyroglossal duct cysts require thorough evaluation to avoid misdiagnosis, and are typically identified by a slowly growing midline neck mass that moves with swallowing and tongue protrusion, often near the hyoid bone.

RELATO DE CASO: HIPERPLASIA MAMÁRIA EM FELINO MACHO

Feline mammary fibroepithelial hyperplasia (FMFH) is a benign, non-neoplastic condition that primarily affects young female cats, usually less than two years old. It is characterized by the proliferation of mammary duct epithelium and periductal connective tissue, associated with the hormonal effects of endogenous and exogenous progestogens. Although more common in females during pregnancy, pseudopregnancy, or early estrus, it can also occur in males after prolonged treatment with progestogens. This report describes the case of an uncastrated male cat in which two small nodules were found in the abdominal region, and subsequently, five more nodules were detected in the mammary region via ultrasound. These nodules underwent fine-needle aspiration cytology, revealing well-differentiated epithelial and mesenchymal cells, suggestive of fibroadenomatous mammary hyperplasia. The animal then underwent castration and, the next day after the procedure, the nodules completely disappeared.

Primary Adrenal Neuroblastoma in an Adult: A Rare Case Report

ABSTRACT Neuroblastoma (NB), an embryonal malignancy originating from neural crest cells, is predominantly a pediatric disease, making adult cases exceedingly rare. This case report documents the presentation and diagnostic process of a 23-year-old female diagnosed with adrenal NB, a condition scarcely encountered in adults. The patient presented with abdominal pain and a palpable mass. Imaging through computed tomography scan revealed a large necrotic mass in the left adrenal region. Ultrasound-guided fine-needle aspiration cytology (FNAC) showed round cells with scant cytoplasm and characteristic nuclear features, suggesting a round cell tumor, potentially NB. Surgical excision confirmed the diagnosis of poorly differentiated NB with low mitotic-karyorrhectic index. Adult NB, with an incidence of 1 in 10 million per year, has a notably worse prognosis compared to pediatric cases. The literature lacks consensus on optimal treatment protocols for adult patients, though a multimodal approach including surgery, chemotherapy, and possibly radioactive iodine therapy is often employed. This case underscores the utility of FNAC in preliminary diagnosis and highlights the clinical challenges posed by adult NB, emphasizing the need for more comprehensive studies to develop standardized treatment guidelines.

Bias in Evaluating Trends of Thyroid Cancer Incidence between Rural and Urban Populations

Abstract Background Diagnosis of thyroid cancer is based on fine needle aspiration cytology of thyroid nodules, based on nodules’ sonographic appearance and size. The American Thyroid Association published new guidelines for management of thyroid nodules in 2009 and 2015, where in some cases, only follow-up of thyroid nodules without any other procedure is recommended. This may lead to a decrease in diagnosed thyroid cancer cases. We studied thyroid cancer trends in Israel between the Arab population who are more likely to be living in rural areas, and the Jewish population who predominantly living in urban areas, and assesses whether these guidelines were reflected in the trends. Methods Data on new thyroid cancer cases were retrieved for Jews and Arabs separately from the Israel National Cancer Registry. Trends in age standardized incidence rates between 1996-2019 were evaluated for the two population groups using joinpoint regression model. Population group was included in the regression models to compare the trends between the two groups. We also studied trends in treatment of thyroid cancer at Rambam Health Care Campus. Results In both populations, age standardized thyroid cancer incidence rate increased between 1996 and 2013. However, between 2013-2019, Annual Percentage Change continuously increased in Arabs, but decreased in Jews. In the hospital study, we found that the Arab patients were 30% more likely to have surgery for small tumors. Conclusions The decrease in thyroid cancer incidence in the Jewish population compared with the Arab population may be related to differences in implementing the 2009 guidelines, which do not recommend fine needle aspiration cytology for very small tumors. We have found evidence that these guidelines were not followed to the same extent among Arab community clinics. This may explain the persisting increasing trend among Arabs, and could be one of the possible explanations for the differences in trends between the two groups. Key messages • Updated Guidelines regarding thyroid cancer diagnosis may be differently implemented by rural and urban populations. • Trends assessment may be biased due to differences in guidelines implementation.

Asymptomatic presentation of diffuse large B-cell lymphoma as isolated submental lymphadenopathy

Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, Diffuse larger B-cell lymphoma (DLBCL) being most common type of NHL. Patients usually present at later stage with b-symptoms, lymphadenopathy and organomegaly. Isolated asymptomatic lymphadenopathy is a rare presentation. A 50-year-old female presented with complaints of swelling in the sub mental region. It increased in size over 1month without any associated local or systemic symptoms. On examination a firm, non-tender, mobile swelling of around 2×1.5 cm was present at sub mental region. Abdominal examination revealed no organomegaly. Blood picture- HB- 9.7 gm/dl, TLC- 5200/mm3, neutrophils/ lymphocytes/ eosinophil/ basophils-43.4/44.4/5.1/0.4 and Platelets-2.41 lakhs/mm3. Ultrasonography study was suggestive of necrotic lymph node. Fine needle aspiration cytology demonstrated nonspecific reactive lymphadenitis. After routine pre-operative workup patient was taken up for lymph node excision in elective OR under general anesthesia and the excised lymph node was sent for biopsy. A histopathological diagnosis of diffuse large B-cell lymphoma was made and confirmed with Immunohistochemistry (IHC), (CD20-diffuse positive; CD3-focal positive; Cyclin D-negative; BCL6-positive; CD10- focally positive). Post-operative hospital stay was uneventful. Our case was atypical with asymptomatic presentation with isolated lymphadenopathy with suspicious lymphocytosis. Diagnosis was only possible by histopathology.

The accuracy of fine needle aspiration cytology and ultrasonography in assessing thyroid nodules in correlation with histopathology: a retrospective study

Background: Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. Method: A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Result: Histopathological findings revealed that 187(61%) cases were benign, while 120 (39%) were malignant. The US features of “taller-than-wider” forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83% and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33%, 63.10%, 60.6%, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P&lt;0.001) than individual parameters. FNAC’s sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50%, 95%, 86%, 75%, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P&lt;0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P&lt;0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (&gt;4 cm), “taller-than-wider,” infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P values &lt;0.05). Conclusion: Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.