Diagnostic Accuracy Of Fine-needle Aspiration Cytology Research Articles

Utility of the United Kingdom National Health Services Breast Screening Program Diagnostic Protocol in Fine-needle Aspiration Cytology with Cell Block Preparation in Cases of Palpable Breast Lumps: A Reliable, Fast, and Accurate Diagnostic Method for the Assessment of Breast Lumps with Histopathologic Correlation

ABSTRACT Introduction: A palpable breast lump is a common diagnostic problem for clinicians and surgeons. Fine-needle aspiration cytology (FNAC) has many advantages such as less cost, less sample processing time, less pain, less chance of hematoma, and less discomfort. FNAC with cell block preparation further increased both sensitivity and specificity by nearly 100%. With the cell block preparation, we can also use newer tests like estrogen receptor–progesterone receptor–human epidermal growth factor receptor 2. Aims: The aim of this study was to derive conclusions about the correlation, including sensitivity, specificity, positive and negative predictive values (NPVs), and the diagnostic accuracy of FNAC, with or without cell blocks, compared to the final histopathology in cases of palpable breast masses. Materials and Methods: A cross-sectional prospective study was conducted after getting approval from the Human Ethics Research Committee from January 2018 to December 2019, which included 65 patients. Patients diagnosed clinically for breast lumps who underwent diagnostic FNAC with cell block, followed by a histopathological examination at our hospital, were included in the study. Results: FNAC without cell block sensitivity, specificity, positive predictive value (PPV), NPV, efficiency rate, and diagnostic accuracy are 91.3%, 100%, 100%, 90.1%, 86.2%, and 96.5%, respectively. FNAC with cell block sensitivity, specificity, PPV, NPV, efficiency rate, and diagnostic accuracy are all 100%. All of our results beat the standard estimate. Conclusions: Fine-needle aspiration cytology is a patient-friendly, easy, reliable, repeatable, and simple diagnostic test. Whenever it is combined with cell block preparation, improves the accuracy of FNAC diagnosis which is more accurate and comparable to golden-standard biopsy with histopathology examination.

Diagnostic Accuracy of FNAC in Tuberculous Cervical Lymphadenitis- Experience from a Tertiary Care Centre

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tubercu- lous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospi- tal Karachi’s ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gen- der of the patients, the duration of disease noted down. The dominating nodes’ FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients’ average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was ob- served in 10 (20%) of patients. With a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis.

Cytomorphology of mesenchymal lesions in a tertiary care centre and its correlation with histopathology.

Fine needle aspiration cytology (FNAC) is a minimally invasive method for sampling a heterogenous lesion. It is one of the first-line investigations in the evaluation of soft tissue tumours. However, the heterogeneity of mesenchymal lesions pose a challenge to the cytological diagnosis. The present study aims at evaluation of the cytomorphological findings of mesenchymal lesions on FNAC along with their histopathological correlation. This was a retrospective study conducted over a period of 1 year from January 2021 to January 2022. All the patients of cytologically diagnosed mesenchymal lesions on their FNA aspirates were included in the study. Cytomorphology of the May Grunwald Giemsa and Papanicolaou stained slides were examined and correlated with clinical and histopathological details wherever available. Out of the 90 patients, 69 (76.7%) were males and 21 (23.3%) were females. Maximum number of cases were in 4-5th decade of life. The lower limb was found to be the most common site (57.8%) for the mesenchymal lesions. Majority of the cases on FNA in our study were found to be benign - 79 (87.8%), while only 11 cases were malignant (12.2%). On cytological examination, spindle cell lesions were most common followed by adipocytic lesions. Based on the cyto-histological correlation, sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of FNAC in diagnosis of mesenchymal lesion was 78.6%, 100%, 92.5%, 100% and 94.1% respectively. FNAC is a simple and minimally invasive tool that plays an important role in triaging patients with good specificity and sensitivity.

Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Lesions with Histopathological Examination (HPE) Correlation in a Tertiary Care Centre in Southern India.

This study aimed to determine the diagnostic yield of fine-needle aspiration cytology (FNAC) in salivary gland lesions compared to histopathological diagnosis. The present study was done on patients above 18years of age, with a palpable swelling, who are clinically diagnosed as salivary gland lesions were evaluated. A total of 31 patients were evaluated in this study. The mean age of the patients was 41years ± 16.08. The male to female ratio of patients evaluated in our study was 1: 1.066, with a marginal preponderance in the female population. There was a higher incidence of carcinoma in females than males. Parotid gland lesions comprised 83.9% of all the salivary gland lesions analyzed, while submandibular gland lesions comprised 16.1%. In our study, the distribution between non-neoplastic, neoplastic benign, and neoplastic malignant lesions was 9.6%, 83.8%, and 6.4%. The overall diagnostic accuracy for non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity of 89% and a specificity of 100%. The segregation of the results into the positive and negative class of diagnostic outcomes shows 80.6% for true positive, 9.7% for true negative, 0% for false-positive, and 9.7% for false-negative reports. Diagnostic accuracy in differentiating non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity and specificity of 89.0% and 100%, respectively. The diagnostic accuracy of FNAC in differentiating benign from malignant lesions in our study is 93.5% (29 out of 31), the sensitivity of FNAC in our study for diagnosing malignancy is poor, and the specificity is 100%. It can be concluded that FNAC is more accurate in diagnosing benign lesions and more specific than sensitive in diagnosing malignant lesions.

A CYTOLOGICAL AND HISTOPATHOLOGICAL CORRELATIVE STUDY ON NEOPLASTIC LESIONS WITH MILAN SYSTEM FOR REPORTING SALIVARY GLAND CYTOPATHOLOGY.

Salivary gland tumors are rare. Nevertheless, theaccurate preoperative diagnosis of themalignant potential of thelesion is essential for appropriate patient management. Therecently published Milan system for reporting salivary gland cytology (MSRSGC) is an effort to provide better communication regarding thenature of lesions to clinicians.Aim: To evaluate thediagnostic utility of fine-needle aspiration cytology (FNAC) of neoplastic salivary gland lesions and theMSRSGC applicability in risk stratification. This was a retrospective study of thecytological and histopathological correlation between neoplastic lesions of salivary gland lesions conducted over four years (August 2010- September 2014) in two tertiary care hospitals. There were 66cases of FNAC of salivary gland neoplasms. Thesensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of FNAC were analyzed. Therisk of malignancy for MSRSGC was calculated. Theoverall diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were 93.94; 95.5; 99.8; 96.8, and 98.7%, respectively. By correlating thecytological diagnosis of benign neoplasm with histopathological diagnosis, therisk of malignancy was 0% and risk of neoplasm was 100%. For cases in thecategory suspicious of malignancy, risk of neoplasm was 100% and risk of malignancy was 85%. Thepresent study demonstrated that this salivary gland cytology reporting system was useful in classifying thelesions in well-delineated categories with ease. MSRSGC system of standardized reporting is helpful for guiding clinicians in appropriate management of thepatient. However, many multicenter studies with large sample sizes and long-term follow-up are needed along with wide propagation of its standardized reporting format to be adopted universally.

A Comparative Study Between Fine-Needle Aspiration Cytology and Core Needle Biopsy in Diagnosing Clinically Palpable Breast Lumps.

Background and objectiveMost breast diseases present as palpable lumps. The accuracy of their diagnosis can be enhanced by a combination of clinical examination, mammography, fine-needle aspiration cytology (FNAC), and core needle biopsy (CNB) preoperatively. The ultimate aim of FNAC or CNB of the breast mass is to confirm the diagnosis of cancer preoperatively, which may help avoid unnecessary surgeries for benign conditions. Histopathology is the gold standard to establish the diagnosis of a breast mass. In this study, we aimed to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC with those of trucut biopsy, and provide a combined assessment of FNAC and CNB against the final histopathological diagnosis of excised breast mass in suspected breast malignancies.Materials and methodsThis was a prospective, observational, cross-sectional study conducted for a duration of one year involving 42 patients with suspected breast cancer cases who underwent FNAC, CNB, and surgical excision followed by a histopathological examination. Data were collected and analyzed in terms of sensitivity, specificity, PPV, NPV, and diagnostic accuracy of FNAC and CNB in comparison with histopathology.ResultsThe majority of the patients in the study (78.6%) were in the age group of 31-50 years. In our study, FNAC showed a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 74.1%, 76.9%, 87.0%, 64.7%, and 75% respectively. CNB had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 85.2%, 92.8%, 95.8%, 76.5%, and 87.8% respectively. The level of agreement between the two modalities (FNAC and CNB) was moderate and statistically significant (k=0.543; p<0.001). In the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 89.3%, 85.7%, 92.6%, 80%, and 88.1% respectively.ConclusionThe diagnostic accuracy of the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis was better than that of FNAC or CNB alone. This finding shows that both the techniques complement each other. FNAC and CNB are used as the first- and second-line methods of pathological diagnosis respectively.

FINE NEEDLE ASPIRATION CYTOLOGY OF SALIVARY GLAND LESIONS WITH CATEGORIZATION BASED ON MILAN SYSTEM – A 5-YEAR RETROSPECTIVE STUDY

Objectives: Fine needle aspiration cytology (FNAC) is a well-established technique for initial assessment of salivary gland lesions. The Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to provide a guide for diagnosis and management of salivary gland lesions according to risk of malignancy (ROM) in different categories. Methods: A 5-year retrospective study was conducted to reclassify the salivary gland lesions from previous diagnosis. Clinical data, FNAC, and histopathology report was retrieved and cases were reclassified according to the Milan system of classification. Risk of malignancy was calculated for each category. The positive predictive value, negative predictive value, and diagnostic accuracy of FNAC was calculated. Results: A total of 314 cases were evaluated cytologically. Histopathology was available in 81 cases. The distribution of cases in different categories according to the Milan system was 1.27% (Cat I), 48.4% (Cat II), 1.91% (Cat III), 38.21%, (Cat IV A), 2.22% (Cat IV B), 3.18% (Cat V), and 4.77% (Cat VI). Overall risk of malignancy reported was 0%, 0%, 50%, 14.7% (Cat IV A), 66.66% (Cat IV B), 83.3%, and 100%, respectively. Overall sensitivity, specificity, positive predictive value, and negative predictive value was 70.58%, 93.75%, 75%, and 92.30%, respectively. Diagnostic accuracy was 88.89%. Conclusion: MSRSGC is a useful system for conveying risk of malignancy (ROM) and deciding further treatment protocol and, hence, improves overall patient care and management.

Fine needle and core needle ultrasound guided biopsies for assessing suspected melanoma metastasis in lymph nodes and subcutaneous tissue.

The aim of this study was to investigate the diagnostic accuracy of ultrasound guided fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in different clinical scenarios for melanoma patients with lesions suspected of metastasis. We included all patients at our department attending follow-up after surgery for cutaneous melanoma, who had undergone either FNAC or CNB between December 2016 and June 2019. Biopsy results were classified into one of four categories and verified with follow-up including imaging, re-biopsy or histology upon excision. The diagnostic accuracy of FNAC and CNB were calculated overall, and based on location of suspected metastasis, reason for suspicionand stage. We identified 232 biopsies in 164 patients; 109 FNACs and 123 CNBs. For FNAC, overall sensitivity was 83.3% and negative predictive value was 88.4%. For CNB, overall sensitivity was 92.4% and negative predictive value was 88.0%. There were significantly fewer nondiagnostic results using CNB compared to FNAC (χ1 2 = 6.7, p = 0.0095). There were no significant differences between the diagnostic accuracy of FNAC and CNB in the different clinical scenarios. We found significantly fewer nondiagnostic biopsies when using CNB, although this may reflect the type of lesions selected for each approach.

Comparison of Cytological and Histomorphological Findings in Breast Tumours- A Study from a Tertiary Care Hospital in Southern India

Introduction: Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in females. There is increasing awareness and the associated anxiety and stress among women, who perceive every symptom in breast as carcinoma, compels the patients to seek medical advice. Fine Needle Aspiration Cytology (FNAC) is a relatively simple, reliable, atraumatic, economical and complication free technique for the evaluation of mass lesions. Aim: To study the varied spectrum of breast tumours and to evaluate the diagnostic utility of cytological findings by comparing it with histopathological findings in breast tumours. Materials and Methods: The present study was a hospital- based cross-sectional study conducted in the Department of Pathology, Indira Gandhi Medical College and Research Institute, Pondicherry, India, from November 2017-October 2019. All cases of breast tumours, sent by surgeon, as out-patient or in- patient, who underwent FNAC followed by surgical biopsy, were included in this study. A total of 150 cases were studied. FNAC smears were stained using Haematoxylin and Eosin (H&amp;E) and Papanicolaou (Pap) stains and air-dried smears were stained using May Grunwald Giemsa (MGG) stain. The excised specimen after surgery was subjected to detailed histopathological examination. Representative bits were taken from appropriate sites and stained using H&amp;E stains, special stains and Immunohistochemistry (IHC) were carried out wherever necessary. Results: Majority of cases were in the age group of 21-30 years. There were 149 cases of female patients and only one case of male patient with breast carcinoma during the study period. Cytology showed 117 cases of benign tumours and 33 cases were malignant. Histopathology revealed 116 cases of benign tumours and 34 cases of malignant. One case was given as Atypical Ductal Hyperplasia (ADH) in cytology, found to be malignant Infiltrating Ductal Carcinoma (IDC) on histopathological examination. Five cases on cytology which were given as suspicious of carcinoma (C4 category) were found to be IDC on excision biopsy. Benign lesions were common in right breast, whereas malignant lesions were common in left breast. The diagnostic value of FNAC was assessed and showed sensitivity: 97.06%, specificity: 100%, Positive Predictive Value (PPV): 100%, Negative Predictive Value (NPV): 99.15% Accuracy of 99.33%. Conclusion: The present study was an attempt to compare cytological and histomorphological findings in breast tumours to know the diagnostic accuracy of FNAC and also studying the spectrum of breast lesions. The high specificity and negative predictive value showed high accuracy of FNAC in diagnosing the malignancy. It is an established method to determine the nature of breast lesions. In the present study, fibroadenoma was the commonest benign tumour and IDC- Not Otherwise Specified (NOS) type was the commonest malignant tumour.

Diagnostic Accuracy of FNAC and Ultrasonography in Salivary Gland Lesions in Comparison with Histopathology

Introduction: Modern era demands for early and accurate diagnosis. Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) are two such diagnostic modalities which have gained importance in recent years due to their rapid, repeatable and precision properties. Aim: To study the accuracy of FNAC and USG in diagnosing salivary gland lesions in comparison with histopathology and to study the expression of p63 and Cytokeratin 7 (CK7) Immunohistochemical (IHC) markers in malignant salivary gland tumours. Materials and Methods: A cross-sectional study was conducted on 106 cases who presented with salivary gland lesions possessing USG reports and underwent FNAC and surgical specimens received in Cytopathology and Histopathology Department, Government Medical College Thiruvananthapuram, Kerala, India during one year period (February 2017-January 2018). In each case FNAC was performed and slides were stained with Papanicolaou and Giemsa, surgical specimens were grossed, histopathological features studied under microscope and tumours classified according to World Health Organisation (WHO) Classification of Salivary gland Tumours 2017. Diagnosis on USG and FNAC were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance was calculated by Statistical Package for the Social Sciences (SPSS) software 24.0 version. p63 and CK7 IHC markers were done only in malignant salivary gland tumours. Results: In the present study majority of lesions i.e. 82 cases (77.4%) were seen predominantly in parotid gland and pleomorphic adenoma was the most commonest lesion and neoplasm overall with 50 cases (47.2%). Most common malignant neoplasm was mucoepidermoid carcinoma (four cases, 3.8%). USG and FNAC had high diagnostic accuracy of 89.6% and 97.2% in comparison to histopathology in diagnosing salivary gland lesions. Conclusion: High sensitivity and specificity of USG and FNAC makes them most acclaimed preoperative diagnostic modality for salivary gland lesions, but histopathology remains gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology

“ROLE OF FNAC IN THE DIAGNOSIS OF SALIVARY GLAND LESION”

Background: Fine needle aspiration cytology (FNAC) has been used for diagnosis of salivary gland lesions for many years. Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. FNAC is a safe, simple, cost effective, 1-4 accurate and minimal invasive procedure for the evaluation of salivary gland lesions. FNAC is not only useful in planning denitive preoperative 2,5-6 diagnosis but also can prevent unnecessary surgical intervention. Salivary gland swelling occur more commonly in 3rd decade of life with equal sex incidence. Parotid is one of the most commonly involved glands in the head &amp; neck region swellings. FNAC appears to be highly sensitive for benign tumours and highly specic for malignant tumors and it should be the rst line of investigation in evaluating the salivary gland pathologies. 7 Early diagnosis and appropriate management carries good prognosis. Methods: Patients with suspected salivary gland enlargements, referred for FNAC, were included in this study. FNAC was performed by using the standard procedure. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: In the present study conducted in the department of pathology, Shyam Shah Medical College Rewa MP, over a period of 5 years, 152 Patients with suspected salivary gland enlargements were retrospectively appraised. The benign lesions of salivary gland were 133 (87.5%), out of which Pleomorphic adenoma was diagnosed in 75 (56.39%) cases, clinical correlation was found in 58 (77.33%) cases. 29 cases were subsequently correlated with histopathological examination 26 correctly correlated and the diagnostic accuracy of FNAC was found to be 89.65%. Inammatory lesions were proved correct in 08 out of 10 cases after histopathology. Therefore, accuracy of FNAC was 80.0%. Malignant lesions of salivary gland were found in 19 cases, out of which 15 (78.94%) cases correlated with clinical diagnosis. 13 cases were subjected to histopathology 10 correctly correlated and the diagnostic accuracy of FNAC was found to be 76.92%. Overall diagnostic accuracy of FNAC was 84.61%. Conclusion:In conclusions it can be established that FNAC is an efcient and accurate procedure with high sensitivity index, and its usefulness is enhanced due to it being a relatively easy procedure which can be carried out even on outdoor patients.

Fine-needle Aspiration Cytology Thyroid : Cytohistological Correlation of 76 patients

Background: Surgical excision of all thyroid nodules would result in a large number of unnecessary procedures. Fine needle aspiration cytology is safe and minimally invasive OPD procedure for the pre-operative assessment of patients with a thyroid nodules . The purpose of our study was to assessment of diagnostic significance of FNAC and its applicability to detect which patients need follow-up and who need surgical intervention. Patients and methods: A prospective cross sectional study was conducted on 76 patients with thyroid lesions at Surgical oncology unit in department of General surgery, Zagazig university hospital who had FNAC, underwent surgery and histopathological results was obtained from the period of December 2019-May 2020 were recruited in the study. Results: In this study, benign thyroid lesions were the commonest found in 58 patients (76.3%). Out of all benign lesions, simple colloid goiter (36.8%) was the most common. Thyroid lesions showed female preponderance, with 88.2 % females and 11.8 % males and a male: female ratio of 1:7.5. , The sensitivity, specificity, and diagnostic accuracy of FNAC were 83.33%, 100 %, and 76.5 %, respectively. Conclusion: Fine needle aspiration cytology (FNAC) is a simple and safe procedure and devoid of any serious complications. it is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings.

The Utility of Fine Needle Aspiration Cytology in the Assessment of Hepatic Lesions

Introduction: Fine Needle Aspiration Cytology (FNAC) is a less invasive, rapid and less expensive diagnostic technique which was initially used for only readily palpable masses and superficial organs. In recent years however, modern imaging techniques like Ultrasonography (USG) and Computed Tomography (CT) have made it possible to use this procedure for inaccessible lesions and deeper organs like the liver. Aim: To evaluate the utility of FNAC in the assessment of neoplastic and non-neoplastic hepatic lesions and to determine its diagnostic accuracy particularly in malignant hepatic neoplasms. Materials and Methods: The combined analysis of retrospective and prospective data was conducted over a period of 22 years (from January 1998 to December 2019) in the Department of Pathology, Goa Medical College, Goa, India, on 535 patients who presented clinically and radiologically with hepatic lesions. The Fine Needle Aspirations (FNAs) were performed under ultrasound and CT guidance. The cytology smears were then stained with Haematoxylin and Eosin (H&amp;E) and May Grunwald Giemsa (MGG) stains. A cytohistopathological correlation was performed manually wherever possible with the available data. The overall diagnostic accuracy of FNAC as well as the diagnostic sensitivity of the procedure in detecting malignant hepatic lesions and its positive predictive value was calculated. The chi-square distribution of the categories of cytological reporting and of the various cytopathological diagnosis among the diagnostic aspirates was also studied to find the statistical significance. Results: Among the 535 patients studied, 386 (72.1%) cases were diagnostic of which 76 were non-neoplastic and 310 (57.9%) were neoplastic lesions. The remaining 149 cases contributed to the non diagnostic category. The distribution of the diagnostic aspirates was statistically significant (p&lt;0.0001). This series showed a male preponderance with most of the patients in the 51-60 years age group. Pyogenic abscess of the liver was the commonest non- neoplastic and non malignant lesion (non-neoplastic lesion+Benign neoplasms) and Hepatic metastasis was the commonest neoplastic and malignant lesion. The Chi-square statistics for the same was also significantly high (p&lt;0.0001). While adenocarcinoma was the most frequent metastasis morphologically, the commonest site of known primary cancer with hepatic metastasis was the gastrointestinal tract. Cytohistopathological correlation was available in 72 cases. The overall diagnostic accuracy of FNAC in this study was 90% and the diagnostic sensitivity for malignant hepatic lesions was 98% with a positive predictive value of 94%. Conclusion: Guided FNAC of liver was thus confirmed as a safe procedure that was useful in the successful diagnosis of hepatic lesions especially malignancies.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Breast Masses among Children and Adolescents Aged Below 21 Years of Age- A Cross-sectional Study

Introduction: Breast diseases in paediatric and adolescence are unusual. Fine Needle Aspiration Cytology (FNAC) has an important role in triaging breast masses, more so in younger population, wherein preoperative accurate diagnosis has significant impact on selecting and planning treatment. Role of FNAC in breast lesions amongst children and adolescents has not been explored much. Aim: To study the role of FNAC in diagnosis of breast lesions in children and adolescents. Materials and Methods: A cross-sectional study was conducted between June 2017 to May 2019 at Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. All the patients presenting with breast lesion aged below 21 years, referred to FNAC clinic during this period were included in the study. The diagnoses were categorised as inflammatory, benign, atypia, suspicious and malignant. Cytohistopathology concordance was attempted wherever possible. Analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: Out of total 45 cases, 37 (82.22%) were females and 8 (17.78%) were males. Breast lesions in paediatric and adolescents accounted for 15.20% (45/296) of total breast FNAC performed during the study period. The morphologic spectrum seen most commonly was fibroadenoma (FA) 62.22% (2-8/45), benign breast disease 8.88% (4/45), mastitis 4.44% (2/45). Morphologic variations observed in FA were epithelial hyperplasia 32.14% (9/28), cystic change 28.57% (8/28), hyper cellular stoma 21.42% (6/28), multinucleate giant cells 32.14% (9/28), apocrine change 14.28% (4/28), adenosis 10.71% (3/28), columnar cell change 10.71% (3/28), squamous metaplasia 3.57% (1/28) and atypia 3.57%(1/28). Histopathologic correlation was obtained in 31 cases (68.88%). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC was found to be 50, 100%, 100%, 96.6%, 96.77%, respectively. Conclusion: Majority of the breast lesions in paediatric and adolescents are benign in nature with FA being the most common. FNAC had high specificity and diagnostic accuracy, thereby establishing its role in selecting appropriate treatment for this age group of patients.

Spectrum of breast lesions and cyto- histopathological correlation - A retrospective study in a teaching institution in North Malabar

Introduction: Breast carcinoma is the most common malignancy in women. Fine needle aspiration Cytology (FNAC) is an important component of triple approach for diagnosing breast lesions and is highly sensitive, specific, rapid and easy to perform. FNAC has an important role in the preoperative evaluation of breast lesions and deciding treatment. Materials and Methods: The present study was carried out among 350 patients who presented to a tertiary care hospital in North Malabar during a 4 year period from June 2013- June 2017. All cases that presented with breast lump were evaluated with FNAC and the lesions were categorised as C1- C5 as per National Health Service Breast screening programme (NHSBSP) reporting criteria. In 240 cases cytohistopathological correlation was obtained and diagnostic accuracy of FNAC was determined. Aims: To study the spectrum of benign and malignant breast lesions and the efficacy of FNAC as a diagnostic tool by correlating with histopathological findings. Results: Statistical analysis showed that sensitivity of FNAC was 99.46% in benign lesions and 96.2 % in malignant lesions. The specificity and positive predictive value of malignant lesions were 99.46% and 98.07% respectively and that of benign lesions were 96.2% and 98.93% respectively. Conclusions: FNAC serves as a rapid and reliable tool for evaluation of breast lumps with high sensitivity and specificity. However, grey zone lesions of breast which shows atypical / suspicious morphology needs confirmation by biopsy. Keywords: Fine needle aspiration cytology, Breast lumps, Histopathology, Correlation.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15&lt;sup&gt;th &lt;/sup&gt;November 2015 to 15&lt;sup&gt;th&lt;/sup&gt; May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.&lt;/p&gt;

Diagnostic accuracy of fine needle aspiration cytology (FNAC) in detecting breast malignancy with the clinical location of lumps.

The objectives were to study the diagnostic accuracy of FNAC in detecting malignancy in palpable breast lumps and know the relationship of the tumor with the quadrants of the breast (clinical location of breast lumps). FNAC slides of 420 female patients with a palpable breast lump were evaluated. Relationship of tumor with the quadrants of the breast was as follows: upper outer 57.14%, upper inner 13.33%, lower outer 11.9%, lower inner 6.67%, and central quadrant 10.95%. The sensitivity, specificity, disease prevalence, positive predictive value, negative predictive value, and diagnostic accuracy of FNAC in this study were calculated as 93.42%, 100%, 57.86%, 100%, 91.71%, and 96.19%, respectively.

A Prospective Study of Ultrasonographic and FNAC Correlation of Thyroid Swellings with Histopathology.

The present study was undertaken to identify the complimentary role of high resolution ultrasonography and fine needle aspiration cytology (FNAC) in diagnosis of thyroid gland swelling pathology, also determine sensitivity, specificity and accuracy of both USG and FNAC and correlate it with histopathology report. Total 75 cases of thyroid swellings were evaluated in detail by taking history, doing clinical examination, USG, FNAC and histopathology. USG findings were correlated with the FNAC report. After thyroidectomy surgery, USG and FNAC results were followed up and correlated with histopathology report. Thyroid swellings were more common in the age group of 31-40years (34.66%) with female preponderance 70(93.33%). According to USG diagnosis, most common benign thyroid swelling was multinodular goitre (37.33). Amongst all the thyroid swellings, on FNAC, 17(18.67%) cases were diagnosed as a malignancy. 12(16%) cases were of follicular carcinoma which was the most common in this study. The sensitivity, specificity and diagnostic accuracy of USG was 86.66%, 91.66% and 90.66% respectively whereas sensitivity, specificity and diagnostic accuracy of FNAC was 93.3%, 95% and 94.66% respectively. USG and FNAC are simple methods of diagnosing thyroid gland swellings. The sensitivity, specificity and diagnostic accuracy of USG and FNAC for thyroid gland swellings was reasonably good. USG followed by FNAC increases the accuracy to diagnose various thyroid swellings so by which unnecessary thyroid gland surgery and hence complications can be avoided. However the most accurate and confirmatory diagnosis is given by histopathology.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases.

Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

DIAGNOSTIC ACCURACY OF FNAC VERSUS OPEN BIOPSY IN DIAGNOSING CARCINOMA BREAST IN PALPABLE ADULT FEMALE BREAST LESIONS IN POPULATION OF KHYBER PAKHTUNKHWA, PAKISTAN

Background: FNAC is usually considered as a reliable, easily performed and inexpensive test for diagnosing palpable lesions of breasts with a high degree of accuracy. The objective of this study was to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC) versus open biopsy in carcinoma breast in adult palpable female breast lesions in population of Khyber Pakhtunkhwa, Pakistan. Material and Methods: This cross-sectional study was conducted at Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 31st December 2019. Sixty (60) FNAC reports of palpable breast lesions in definitive categories {(C2 (benign) and C5 (malignant)} with respective open biopsy reports were included in the study. Nine (9) FNAC reports of inconclusive categories (C1, C3 &amp; C4) were excluded. Age in years was a single demographic variable. The data for “presence of carcinoma breast” for both the open biopsy and FNAC were placed in two-by-two table. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC were determined as percentages with confidence intervals at 95% confidence level. Results: The mean age of the sample was 37 ± 17 (17-70, range 53) years. Out of 60 cases on open biopsy, 14 (23.33%) were confirmed as having and 46 (76.67%) as not having carcinoma breast and on FNAC, 12 (20%) were positive and 48 (80%) were negative for carcinoma breast. Two-by-two table showed 12 true positive (TP), 46 true negative (TN), two false negative (FN) and zero false positive (FP) cases. The sensitivity of FNAC was 85.71%, specificity 100%, PPV 100%, NPV 95.83% and accuracy was 96.67%. Conclusion: FNAC is a reliable method in diagnosing carcinoma breast in adult palpable female breast lesions in population of Khyber Pakhtunkhwa, Pakistan.