Cytology Reports Research Articles

The physician factor and anatomical site in 8846 consecutive mediastinal lymph node aspirations in a cross-sectional study

Mediastinal lymph node fine needle aspiration (MLN-FNA) is a common procedure; however, the physician factor in pathological category, and anatomical site are not routinely assessed. Cytology reports for endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS) MLN-FNA specimens (8846) were retrieved for July 2012–Dec 2019, classified by hierarchical free text string match algorithm into 51 diagnostic categories, four mutually exclusive diagnostic groups (benign |suspicious |malignant |insufficient), and 24 anatomical sites. Pathologist and submitting physician/surgeon bias were assessed using logistic regression and funnel plots|control charts centered on the group median (diagnostic/capture) rate. Eleven pathologists and seven submitting physician/surgeon were involved in more than 250 specimens each. Overall, the MLN-FNAs were benign|suspicious|malignant|insufficient in 46%|4%|25%|24% of specimens. Percent malignant (number of samples) varied by station; 7| 4R| 4L| 2R| 10R| 11R| 11L were respectively 21%(3,101), 27%(2,453), 19%(1,289), 41%(435), 27%(497), 24%(357), 26%(229). The number of outlier (P < 0.05/P < 0.001) pathologists of 11 from the group median rate for benign|suspicious|malignant|insufficient was 0/0| 3/1| 0/0| 3/0 respectively. The outlier (P < 0.05/P < 0.001) submitting physicians/surgeons of 7 for benign|suspicious|malignant|insufficient was 3/2| 2/2| 3/2| 3/2 respectively. The physician and anatomical site are significant predictors of MLN-FNA pathology.

Detecting evidence of invasive fungal infections in cytology and histopathology reports enriched with concept-level annotations

Invasive fungal infections (IFIs) are particularly dangerous to high-risk patients with haematological malignancies and are responsible for excessive mortality and delays in cancer therapy. Surveillance of IFI in clinical settings offers an opportunity to identify potential risk factors and evaluate new therapeutic strategies. However, manual surveillance is both time- and resource-intensive. As part of a broader project aimed to develop a system for automated IFI surveillance by leveraging electronic medical records, we present our approach to detecting evidence of IFI in the key diagnostic domain of histopathology. Using natural language processing (NLP), we analysed cytology and histopathology reports to identify IFI-positive reports. We compared a conventional bag-of-words classification model to a method that relies on concept-level annotations. Although the investment to prepare data supporting concept annotations is substantial, extracting targeted information specific to IFI as a pre-processing step increased the performance of the classifier from the PR AUC of 0.84 to 0.92 and enabled model interpretability. We have made publicly available the annotated dataset of 283 reports, the Cytology and Histopathology IFI Reports corpus (CHIFIR), to allow the clinical NLP research community to further build on our results.

COLPOSCOPIC EVALUATION OF POST-MENOPAUSAL WOMEN WITH NORMAL CERVICAL CYTOLOGY

1. Introduction The most common genital cancer seen in Indian women is Carcinomacervix Its incidence is approximately 1 in 53 Indian women during their lifetime compared to 1 in 100 in developed countries. In women ≥ 50 years where the lifetime risk of cervix cancer is estimated as 3.5%, which can be reduced to 0.8% with screening. Pap smear evaluation alone is inadequate for predicting the precancerous lesions in postmenopausal women due to hypoestrogenic changes of menopause which makes it difcult to differentiate atrophic cellular changes from other pathologic conditions, giving more false negative results which can be reduced if combines with colposcopy examination and guided biopsy wherever needed 2. Aim &amp; Objective To diagnose intraepithelial lesions in postmenopausal patients with normal cytological ndings and to assess the usefulness of cytological screening, colposcopy, and colposcopy-directed biopsy in these patients. 3. Material And Method- A retrospective study was carried out from 1st January 2018 to 31 October 2022 at a colposcopy clinic, in district Shivpuri M.P. on 104 post-menopausal females of age group 45-68 years. After detailed history and examination, a pap smear in all 104 patients was taken. All patients with negative cytology reports for Intra epithelial lesions with persistent symptoms and suspicious signs were subjected to colposcopy. 23 Patients with positive Colposcopic ndings were subjected to Colposcopic guided biopsy. histopathological evaluation was done. 4. Result This study analyzed 104 postmenopausal patients who had Pap smear reports with NILM (Negative for intraepithelial Lesion or Malignancy). 58% of the patients were referred by other Doctors. The most common post-menopausal age group nd in this study was between 45-55 (52.88%), Most of the patients were of a low socioeconomic group (54.81%), Multipara (3-5 parity 66.35%). with a history of menopause of 5-10 years (49.04%) duration. Only 5.77% of patients had 3 Pap smear reports with them, and a history of smoking was present in 6.73% of cases. The most common presenting symptom was discharge PV (47.11%) followed by Foul smelling bloody discharge (14.42%). Post-coital bleeding (12.5%), Post-menopausal bleeding (8.65%), and dyspareunia (4.80%). On colposcopy, (77.89%) of cases had normal Colposcopic ndings while (22.11%) had abnormal Colposcopy ndings. In 17.30% of cases, LSIL was suspected, in 4.80% of cases HSIL was suspected on colposcopy Colposcopy-guided biopsy was done in 23 (22.11%) patients with suspected CIN. On histopathology 9.61% of cases were positive for intraepithelial lesions, CIN1 was found in 7.69%, and CIN2 in 1.92%. Carcinoma in situ and Invasive carcinoma were not found in any case. 10(9.61%) out of 104 patients had cervical intraepithelial neoplasia diagnosed on colposcopy-guided biopsy and histopathology report. 5. Conclusion- In our study, despite the Pap smear report as NILM (Negative for intraepithelial lesion or malignancy). ,10(9.61%) out of 104patients had cervical intraepithelial neoplasia diagnosed on colposcopy guided biopsy, thus we recommend, the combined use of cervix cytology, colposcopy, and histopathology in postmenopausal cervix cancer screening evaluation to improve the diagnosis of the cervical intraepithelial lesion.

Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

BackgroundFine needle aspiration cytology has been established as a minimally invasive, non-tumour seeding investigation of choice in the initial diagnostic pathway of parotid lesions. The purpose of this study was to compare the accuracy of fine needle aspiration cytology performed with and without ultrasound to determine whether one method should be preferred to the other. A retrospective review of all patients undergoing fine needle aspiration cytology with and without ultrasound for parotid masses in a large district general hospital between 2012 and 2016 was performed. Specificity, sensitivity, accuracy, positive and negative predictive value, percentage of inconclusive fine needle aspiration cytology and percentage of second fine needle aspiration cytology were determined for each group.ResultsA total of 397 fine needle aspiration cytology results were available for analysis. The numbers performed with ultrasound guidance and free-hand were roughly equal (208 (52.3%) versus 189 (47.7%)). The number of inconclusive fine needle aspiration cytology reports was significantly higher in the free-hand group (65/189 (34.4%)) than the ultrasound group (25/208 (12%)) (p < 0.0001). A significantly higher number of repeated fine needle aspiration cytology were undertaken in the free-hand group vs ultrasound group (43 vs 15, p < 0.0001); overall 7.2% of ultrasound-guided fine needle aspiration cytology required a second fine needle aspiration cytology, compared to 22.8% in the free-hand group. The sensitivity, specificity, positive and negative predictive values were all higher in the ultrasound group versus the free-hand group.ConclusionsUltrasound-guided fine needle aspiration cytology is superior to free-hand fine needle aspiration cytology in the investigation of parotid tumours. There is a significant benefit in reducing the number of inconclusive results and repeat fine needle aspiration cytology, and a potential benefit in improving the sensitivity and positive predictive value, when immediate cytology assessment of the sample quality is not performed.

Prevalence of Precancerous Cervical Lesions among Nonvaccinated Kazakhstani Women: The National Tertiary Care Hospital Screening Data (2018).

At the present time, cervical cancer remains the fourth most prevalent cancer among women worldwide. Most cervical cancer cases are attributed to high-risk human papillomavirus (HPV) infection. Because the natural history of cervical cancer takes decades, the disease could be prevented if premalignant conditions are identified and appropriately managed. The aim of this study is to identify the prevalence of precancerous lesions among non-vaccinated women attending the national tertiary care hospital in Kazakhstan. This was a retrospective study of the cervical cancer screening database (2018) from the national tertiary care hospital in Kazakhstan. Records of 6682 patients, who had cervical cytology tests by Papanicolaou (Pap test), were analyzed. Out of the revised cases, 249 patients had abnormal cervical cytology reports. The Pap test was performed using liquid-based cytology (LBC). The data were analyzed using the statistical software STATA 16. A p-value of less than 0.05 was considered statistically significant. In this retrospective analysis of 6682 patients' records, we found 3.73% (249 patients) out of all Pap tests performed in 2018 were abnormal. The prevalence of high-grade squamous intraepithelial lesion (HSIL) was high at 19.28%, and the proportion of atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells (ASCs-H) was 18.47%, while low-grade squamous intraepithelial lesion (LSIL) were identified in 62.25% of the cases. Almost 25% of the women included in the study had concurrent lower and upper genital tract infections. Although the overall rate of abnormal Pap test results was not high, the study shows the elevated prevalence of HSIL. It calls the attention of local policymakers and gynecology specialists and requires immediate actions to improve the prophylactic measures to decrease morbidity and mortality from cervical cancer in Kazakhstan.

Accuracy of fine‐needle aspiration cytopathology to differentiate malignant and benign thyroid nodules with ≥4 cm diameter: A retrospective study

Thyroid nodules (TN) are commonly present in the general population and are usually pathologically benign. An initial diagnosis with fine-needle aspiration (FNA) cytopathology could help clinical decision-making with fewer complications. As the previous studies suggest surgical procedures for >4cm TNs, we aimed to investigate the accuracy of preoperative FNA cytology to predict malignancy risk in these nodules in a sample of the Iranian population. Patients with ≥4cm TNs who had preoperative FNA cytology, underwent nodulectomy and had a histopathological report were included. Each patient's preoperative demographic, ultrasonographic, and cytology data were gathered. After surgery, resected samples were assessed pathologically and diagnosed as benign or malignant. Finally, data were analyzed to evaluate the presurgical accuracy of the FNA cytology. We identified 41 (51.25%) patients with malignant legions among our study population (N= 80). The pathology reports were indeterminate in 3 patients with follicular neoplasm. Bethesda scores were substantially higher in patients with malignancy. The sensitivity, specificity, and false-negative rate of FNA cytology reports using the Bethesda system were 73.7%, 74.2%, and 26.3%, respectively. There was no association between malignancy and TNs' size, neither their volume nor their highest diameter. FNA cytology is not as sensitive and specific in nodules>4cm as in smaller ones. However, it can still be used alongside other diagnostic procedures in malignancy screening. Clinicians should make more complex decisions considering various influential factors to avoid missing malignant lesions and reduce diverse probable complications of highly invasive diagnostic surgery. Further prospective research on >4cm TNs and their multiple features' association with malignancy is required for more precise judgment.

Parotid Metastasis in a Case of Papillary Thyroid Carcinoma: Case Report and Review of Literature.

Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid neoplasm. Common sites of regional and distant metastasis includes lymph nodes, lungs and bone. 51year old female patient who was a known case of PTC with a history of multiple surgeries, radioactive iodine therapy (RAI) and oral chemotherapy presented with a painful right parotid mass. PET scan demonstrated FDG avid lesions in the right parotid gland, cervical lymph nodes and other distant sites. Cytology report showed features of metastatic PTC. Patient underwent extended total parotidectomy with facial nerve resection, skin and masseter muscle resection and extended radical neck dissection. Final histopathology (HPE) report showed metastatic papillary carcinoma thyroid. Patient is currently on oral chemotherapy and on regular follow up. PTC rarely metastasizes to parotid gland and such cases have to be treated with surgery alone or with a combination of surgery and RAI based on tumour burden.

Evaluation of the Implementation and Diagnostic Accuracy of the Paris Classification for Reporting Urinary Cytology in Voided Urine Specimens: A Cyto-Histological Correlation Study in a Cancer Center

Introduction: The Paris classification highlights the need to focus on accurately identifying high-grade urothelial carcinoma (HGUC). Herein, we aimed to assess the overall implementation and diagnostic performance of the Paris classification for reporting urinary cytology in a cancer center. Methods: All urinary cytology reports from July 2018 to December 2019 were collected (n = 1,240). Only voided urine samples were included (n = 1,180). Risk of high-grade malignancy (ROHM) was calculated for each Paris category. The diagnostic performance of urinary cytology was assessed, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results: The distribution of categories was: 0.3% unsatisfactory, 90.5% negative for HGUC, 5.6% atypical urothelial cells (AUC), 1.6% suspicious for HGUC, 1.9% HGUC, and 0.1% other malignancies. No diagnosis of low-grade urothelial neoplasia was given. The ROHM was 21.4% for negative for HGUC, 66.7% for AUC, 91.7% for suspicious for HGUC, and 100% for HGUC. When using suspicious for HGUC as a cutoff, the diagnostic performance of urinary cytology in identifying HGUC histology was 46% sensitivity, 98% specificity, 96% PPV, 68% NPV, and 74% accuracy. Conclusion: Specificity of urinary cytology was very high (with only 1 false-positive result), which is important since this will trigger a clinical intervention. The ROHM for each category was in accordance with literature, except for AUC where ROHM was slightly higher (66.7%). This may be explained by the study population characteristics (cancer center; many patients treated with intravesical therapies; lack of clinical annotation for patients referred from outside institutions).

Thyroid carcinoma in nodules with Thy3 cytology: Retrospective study in a district general hospital.

Background and Aim Thyroid cancer is the most common malignant endocrine tumour. Fine needle aspiration cytology plays an important role in diagnosis of these tumours. The aim of the current study was to determine thyroid cancer risk for Thy3 cytology over a seven-year period from 2015 to 2021 at Royal Lancaster Infirmary, UK. Methods 206 medical records with Thy3 cytology were retrospectively reviewed from January 2015 to December 2021. Patients were classified into two groups: Thy3a and Thy3f. Histopathology reports were compared with cytology reports in order to determine malignancy rates. Results 18.9% of male patients and 23% of female patients had a malignant histology The average overall malignancy rate was 22.2%. More specifically, 22% of Thy3a and 22.4% of Thy3f were malignant. 22 patients eventually underwent completion thyroidectomy of which 6 patients had malignancy in the contralateral lobe. Conclusion Malignancy rates at our center was lower as compared to the national data rates.

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017-18.

Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied. In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017-18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional). Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1-3, 24% 4-6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028). Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.

An innovative synthetic support for immunocytochemical assessment of cytologically indeterminate (Bethesda III) thyroid nodules.

Fine needle aspiration (FNA) is the procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Bethesda III and IV, pose challenges in clinical practice and are frequently submitted to diagnostic surgery. CytoFoam Core (CFCS) uses an absorbent foam device inserted into the needle hub to collect the cytological sample aspirated during FNA. Specimen is formalin-fixed and paraffin-embedded. Assessing diagnostic efficacy of CFCS, compared to traditional cytology, in re-evaluating thyroid nodules classified as Bethesda III, using post-surgical histology as reference standard. Retrospective study on 89 patients with a first indeterminate cytological report who were referred to the Department of Endocrinology of Regina Apostolorum Hospital (Albano L. Rome, Italy) for a second FNA. FNA was performed after at least one month under ultrasound guidance with a 23G needle according to the established procedure. During the second procedure, both traditional cytological (TC) smears and a single-pass CFCS specimen were obtained for each patient. On CFCS samples immunocytochemical staining for Galectin-3, HBME-1, and CK-19 was also performed. 51 patients eventually underwent surgery, and their histological diagnoses were compared to the TC and CFCS reports. Four parameters were evaluated: inadequacy rate, rate of persistent indeterminate (Bethesda III and IV) reports, rate of malignancy in persistently indeterminate nodules, and rate of cancer in lesions cytologically classified as malignant. Non-diagnostic samples were 6 (11.8%) in TC vs 3 (5.9%) in CFCS (p=0.4). Persistent indeterminate samples were 31 (60.8%) in TC vs 19 (37.2%) in CFCS (p=0.01). Rate of malignancy in persistently indeterminate nodules was 8/19 (42.1%) in CFCS vs 9/31 (29%) in TC group (p=0.3). Nine/51 (17.6%) samples were classified as benign by TC vs 21/51 (41.2%) samples by CFCS (p<0.01). All nodules resulted benign at post-surgical evaluation. Five/51 (9.8%) samples were classified as suspicious for malignancy/malignant in TC group against 8/51 (15.7%) samples in CFCS (p=0.5). Post-surgical evaluation confirmed malignancy in all these cases. CFCS demonstrated greater diagnostic accuracy than TC in repeat FNA assessment of cytologically indeterminate nodules. CFCS increased the conclusive diagnosis rate and decreased the number of cytologically indeterminate cases.

Cytology Reporting System for Lung Cancer from the Japan Lung Cancer Society and the Japanese Society of Clinical Cytology: A Study on the Cytomorphological Characteristics of "atypical cells" Category

Cytology Reporting System for Lung Cancer from the Japan Lung Cancer Society and the Japanese Society of Clinical Cytology: A Study on the Cytomorphological Characteristics of "atypical cells" Category

Cytologic features of epithelioid gastrointestinal stromal tumor in a pleural effusion. A diagnostic challenge.

Abstract Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Despite the possibility of peritoneal spread, few cytologic reports of GIST in effusions are available. In this report, we describe cytologic features of a case of abdominal epithelioid GIST metastatic to the pleura. To our knowledge, it is the first cytologic description of this tumor in such a location. The rarity of pleural involvement coupled with the cytologic features of epithelioid GIST can lead to a difficult diagnosis. The patient, an 86-year-old woman underwent surgery 8 years earlier due to a malignant GIST with predominant epithelioid morphology. She now presented with a pleural effusion. Smears showed medium-size cohesive clusters of large tumoral cells with moderate amounts of cytoplasm. Occasional short cords of tumoral cells showing cell windows between them were present. Cells were polygonal, sometimes with eccentric nuclei and no spindle shape. Due to the previous history of GIST, we decided to evaluate immunohistochemical expression of c-kit and DOG1. In both cases, a positive result was obtained. In conclusion, GISTs are rarely responsible for malignant effusions, mainly if extra-abdominal. The few reported cases, including ours, correspond to epithelioid variants that can closely resemble carcinoma. Therefore, the use of immunocytochemistry is extremely important for reaching a precise diagnosis.

Association of ultrasonographically determined anatomical location of Bethesda 3 thyroid nodules with differentiated thyroid cancer.

The size of a thyroid nodule and certain sonographic features, such as marked hypoechogenicity, microcalcifications, taller-than-wide shape, microlobulated, or irregular margins, indicate the greater malignancy risk. The frequency of the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category among cytology reports from thyroid fine-needle aspirations ranges from 0.8% to 28%, whereas the risk of malignancy of these nodules varies from 6% to 97%. This retrospective analysis investigated whether the preoperative ultrasonographic location of Bethesda 3 thyroid nodules is a predictive risk factor for differentiated thyroid cancer (DTC). A total of 387 patients who underwent total thyroidectomy for a nodule with AUS/FLUS cytology and diagnosed with a DTC at five tertiary referral centers between 2010 and 2020 were retrospectively analyzed. The location of the thyroid nodule with AUS/FLUS cytology was categorized into two groups: one group was composed of the isthmus, upper lobe, middle lobe, and lower lobe, whereas the latter consisted of right lobe, left lobe, and isthmus. DTC was diagnosed in 40.6% (n=157) of the operated nodules. Multiple logistic regression analysis has revealed that hypoechogenicity of the nodule (odds ratio [OR]=2.929, p<0.001) was the only independent predictive factor for the malignancy of the nodules with AUS/FLUS, whereas the location of the nodule, age, and sex were not significantly independent risk factors. Multifocality and contralateral benign nodules were independent predictive factors for multicentricity (OR=3.5, p=0.002; OR=5.5, p=0.001, respectively). As the first study investigating the association between a Bethesda 3 nodule location and the risk of malignancy by evaluating postoperative cytology reports, the results showed that nodule location with AUS/FLUS on fine-needle aspiration biopsy was not a predictive risk factor for the diagnosis of DTC.

The utility of WhatsApp-based off-site evaluation for rapid cytology of EBUS-TBNA samples.

Whether off-site evaluation of slides by a cytologist viewing the images shared by WhatsApp improves the on-site evaluation by a pulmonologist (P-ROSE) remains unknown. This study's objective was to compare the sensitivity of P-ROSE and WHOSE for adequacy and diagnosis of cytology specimens obtained by endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). We retrospectively reviewed our bronchoscopy database to identify subjects who underwent EBUS-TBNA for lymph node sampling and had reports of P-ROSE and WHOSE. We collected data on the adequacy of samples as reported by the pulmonologist (P-ROSE), remotely by the cytologist (WHOSE), and finally after detailed cytologic evaluation. The study's primary outcome was to assess the increment in sensitivity for adequacy and diagnostic category (using the final cytology report as reference) by incorporating WHOSE. We included 264 (P-ROSE, n=184; WHOSE, n=80) subjects. The sensitivity (95% CI) for sample adequacy by P-ROSE and WHOSE was 65.3% (57.9%-72%) and 92% (83.6%-96.2%), respectively. There was a 26.6% (95% CI, 16%-35.2%) increment in the sensitivity for adequacy. The sensitivity (95% CI) for diagnosis by P-ROSE and WHOSE was 53.9% (46%-61.1%) and 89.8% (79.5%-95.3%), respectively. There was a 35.9% (95% CI, 23.4%-45%) increment in the sensitivity for diagnosis with WHOSE. The agreement between P-ROSE and final cytology in adequacy was poor (κ=-0.023, p=0.616). The agreement between WHOSE and final cytology was moderate for adequacy (κ=0.491, p=<0.001). We found WHOSE significantly improves the performance of P-ROSE for rapid assessment of cytology specimens obtained by EBUS-TBNA.

Cytopathology Practice in the Covid-19 Pandemic, During the Lockdown and Post-lockdown Period: A Tertiary-Care Center Experience

Background: Covid-19 pandemic has changed the healthcare delivery and cytopathology practice worldwide. We evaluated our cytopathology laboratory workload during the lockdown and post-lockdown period and compared it with the same period in 2019, to see the impact of the Covid-19 pandemic. Methods: The cytological reports issued during the lockdown (10 March - 31 May 2020) and the post-lockdown period (1 June -31 August 2020); and the corresponding periods in 2019 were retrospectively reviewed from the database. Sample type, sampling site, and diagnostic categories were recorded. Results: During the Covid-19 lockdown period, the total number of cytological specimens, was reduced from n=3197 to n=745, with a rate of 76,7%. The most reduction was in thyroid fine-needle aspiration (FNA) and cervicovaginal smears. Relative increases were observed for soft tissue, lung, and liver FNA samples (p&lt;0.05) and cerebrospinal fluid, peritoneal and pleural fluid samples (p&lt;0.05). In the post-lockdown period, the total number reduced from n=2461 to n=2032 with a rate of 17.4%. Significant reduction continued for thyroid FNAs, but other samples have nearly reached the pre-covid levels. During the total six months period, the rate of the malignant category increased while the negative for malignancy category decreased compared to 2019. Conclusion: During the Covid-19 lockdown period, the reduction was primarily observed in the samples taken for screening purposes, and high-risk oncological patients continued to receive healthcare services. In the initial phase of the post-lockdown period, health services and cytopathology practice have rapidly reached almost the levels of the pre-pandemic period.

Concordance between TIRADS and Cytology in Thyroid Nodule.

Palpable thyroid nodules are stated in 4 to 7% of individuals. This study was designed to evaluate the relation of Thyroid Imaging Reporting and Data System (TIRADS) and fine-needle aspiration (FNA) based cytology reports in patients with thyroid nodules. In this retrospective cross-sectional study, individuals with thyroid nodules who were selected for ultrasonographic-guided FNA enrolled in this study. Demographic data, radiologic assessment, and cytology report were gathered based on hospital medical records. TIRADS grading of the nodules was assessed for each nodule. Cytology was performed on all samples. Sensitivity and specificity were calculated by comparing cytology with ACR-TIRADS and also cytology with TIRADS 4-5 cut-off point as a radiologic malignant lesion. 172 patients were studied, 151 of whom were female and 21 were male. The mean age of the patients was 49.46 years. Most of the patients had TIRADS 4 (53.5%) followed by 3 (31.4%), and 5 (11.6%). 151 patients (87.8%) had a benign lesion in cytology. Of them, 118 had colloid nodules. There was a statistically significant relation between TIRADS and cytology (p-value<0.001). Sensitivity, specificity, AUC, and positive and negative predictive value for ACR-TIRADS classification were 76.19%, 47.54%, 0.619, 20.00%, and 92.06%, respectively. These values for cut-off "4-5" classification was 86.36%, 38.00%, 0.622, 16.96%, and 95.00%. According to the significant concordance between TIRADS and cytology, as shown in the results of our study, it seems that TIRADS could be used to decrease the amount of unnecessary FNA in individuals with thyroid nodules.

ODP451 A Case of Papillary Thyroid Cancer Presenting with Marantic Endocarditis and Recurrent Stroke

Abstract Marantic endocarditis or non-bacterial thrombotic endocarditis (NBTE) is characterized by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and are devoid of inflammation or bacteria. The hypercoagulable state associated with malignancy is well known to be associated with NBTE. Here we report a rare case of Papillary Thyroid Cancer presenting with Marantic Endocarditis and Recurrent Stroke. A 52-year-old lady, with medical background of hypertension, presented to the Emergency Department with history of sudden onset of difficulty in speaking for 3 days. On examination she had slurred speech and tongue deviation to the right side. Neurological examination was otherwise normal. Imaging revealed left frontal, right frontal and left cerebellar infarcts. Transthoracic Echocardiogram showed a large, highly mobile vegetation 18 mm in size, attached to the posterior mitral valve leaflet as well as severe Mitral Regurgitation. She was diagnosed as a case of Cardioembolic ischemic stroke due to endocarditis. She completed a course of empiric antibiotic therapy. However, her blood cultures and fungal culture revealed no growth. After 5 years, she again presented to the hospital with acute stroke. Trans esophageal Echocardiography now revealed multiple filamentous vegetations on the atrial surface of mitral valve, largest measuring 20 mm×4 mm. Her inflammatory markers were negative and 3 sets of blood cultures were again negative. A question was raised, as to whether the filamentous masses represent prolapsing ruptured chordae tendinae rather than vegetations. FDG PET-CT scan was thus performed and revealed: Left thyroid lobe focal uptake seen with an FDG-avid left parajugular lymph node. Ultrasound neck was then performed, which showed bilateral thyroid nodules with high suspicion ultrasound pattern per American Thyroid Association: ill-defined nodule seen in the lower pole measuring 8×8×7 mm with multiple foci of macrocalcification. Thyroid function tests were normal. Ultrasound guided thyroid fine needle aspiration (FNA) biopsy of the left thyroid nodule was performed. The cytology report was consistent with papillary thyroid carcinoma. She is planned for total thyroidectomy, after undergoing mitral valve replacement surgery. This case illustrates one of the paraneoplastic syndromes associated with thyroid cancer. A hypercoagulable state has been observed in several types of thyroid cancer, although the pathogenesis has not been well studied. The etiology of cancer-associated coagulopathy is complex, related to an imbalance in the hemostatic system and abnormal levels of coagulation factors. Further studies on the occurrence of thrombosis in different types of thyroid cancer would help to inform clinical practice in the management of thyroid cancer, including the need for anticoagulation in certain situations. Presentation: No date and time listed

Cytologic-Histologic Correlation of Musculoskeletal Lesions, an Examination of the Proposed Cytology Reporting System

Cytologic-Histologic Correlation of Musculoskeletal Lesions, an Examination of the Proposed Cytology Reporting System

Fine Needle Aspiration Biopsy Cytology Reporting of Breast Lesions with Special Reference to International Academy of Cytology Standardized Reporting Yokohama Grading System: A Retrospective Study at Tertiary Care Centre in India

Fine Needle Aspiration Biopsy Cytology Reporting of Breast Lesions with Special Reference to International Academy of Cytology Standardized Reporting Yokohama Grading System: A Retrospective Study at Tertiary Care Centre in India