Diagnostic Performance Of Fine-needle Aspiration Cytology Research Articles

Is thyroglobulin detection in fine-needle aspirates useful for the diagnosis of central neck metastatic papillary thyroid cancer?

The central neck lymph node (LN) status is important for the treatment strategy of papillary thyroid cancer (PTC), while the diagnosis is difficult. This study aims to evaluate the diagnostic value of fine-needle aspiration (FNA) and its washout thyroglobulin (FNA-Tg) detection in central neck LN metastasis. Central neck LNs with FNA cytology (FNA-C) and FNA-Tg measurements from a tertiary hospital were included. Tg levels were correlated with histopathological or follow-up results. The diagnostic performance of FNA-C, FNA-Tg, and combining FNA-C and FNA-Tg for detecting LN metastasis was assessed. A total of 132 LNs in the central neck from 129 patients were studied. The median FNA-Tg concentration of 74 metastatic LNs was 552.5 ng/mL, whereas, in 58 benign LNs, the median Tg concentration was 0.1 ng/mL (P < 0.001). Receiver operating characteristic analysis (area under the curve, 0.861) was used, and a cutoff value of 14.6 ng/mL was obtained. There was no significant increase in the diagnostic accuracy when FNA-Tg was used or combined with FNA-C, compared with FNA-C alone. The size, location of LNs, the presence of the ipsilateral thyroid gland, and Hashimoto's thyroiditis did not affect the incidence of misdiagnosis. FNA-C is the gold standard for evaluating central neck metastasis in PTC patients. Measurement of Tg levels in FNA washout does not improve the diagnostic accuracy any further.

Value of FNAC in abnormal axillary lymph nodes with non specific mammograms

ObjectiveThis study aimed to evaluate the role of fine-needle aspiration cytology (FNAC) in the diagnosis of abnormal axillary lymph nodes identified in patients with nonspecific mammographic findings. Patients and methodsThis study included 60 patients (a mean age 52.1 years ± 15.2) with suspected abnormal axillary lymph nodes.Mammography was done using medio-lateral oblique (MLO) view. Ultrasound (US) was done as a complementary examination for all patients with an otherwise normal or benign findings on mammogram, US was done as a first diagnostic modality in patients under age of thirty. Fifty-one patients were recalled for further US guided FNAC. The other 9 patients had a known underlying diagnosis. ResultsFrom December 2014 to August 2016, A total of 60 patients (56 women and 4 men) had abnormal axillary lymph nodes with nonspecific mammogram were included; 9 patients who had a known underlying cause were not recalled for US guided biopsy. The other 51 cases required an US guided FNAC. An excisional biopsy was done in 32 cases (63%) (14 were malignant& 18 were benign). The other 19 cases (37%) had follow-up (range, 3–18 months; mean, 7.9 months).The overall diagnostic performance of FNAC in diagnosing axillary lymph adenopathy was: Sensitivity 65%; specificity, 97%; positive predictive value 93%; and negative predictive value, 81% with accuracy of 88%. The diagnostic performance of FNAC in differentiating benign from malignant axillary lymph adenopathy was: Sensitivity 85%; specificity, 97%; positive predictive value 92%; and negative predictive value, 94% with accuracy of 94%. ConclusionsFNAC was a good cytological predictor in the majority of patients with abnormal lymph nodes and nonspecific mammography. FNAC is cost effective in assessing axillary lymph node status especially in limited resource setting like in our developing country. FNAC is preferred diagnostic tool in all cases of abnormal axillary lymph adenopathy.

Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis.

The early detection of medullary thyroid carcinoma (MTC) can improve patient prognosis, because histological stage and patient age at diagnosis are highly relevant prognostic factors. As a consequence, delay in the diagnosis and/or incomplete surgical treatment should correlate with a poorer prognosis for patients. Few papers have evaluated the specific capability of fine-needle aspiration cytology (FNAC) to detect MTC, and small series have been reported. This study conducts a meta-analysis of published data on the diagnostic performance of FNAC in MTC to provide more robust estimates. A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Scopus databases was conducted by searching for the terms 'medullary thyroid' AND 'cytology', 'FNA', 'FNAB', 'FNAC', 'fine needle' or 'fine-needle'. The search was updated until 21 March 2014, and no language restrictions were used. Fifteen relevant studies and 641 MTC lesions that had undergone FNAC were included. The detection rate (DR) of FNAC in patients with MTC (diagnosed as 'MTC' or 'suspicious for MTC') on a per lesion-based analysis ranged from 12·5% to 88·2%, with a pooled estimate of 56·4% (95% CI: 52·6-60·1%). The included studies were statistically heterogeneous in their estimates of DR (I-square >50%). Egger's regression intercept for DR pooling was 0·03 (95% CI: -3·1 to 3·2, P = 0·9). The study that reported the largest MTC series had a DR of 45%. Data on immunohistochemistry for calcitonin in diagnosing MTC were inconsistent for the meta-analysis. The presented meta-analysis demonstrates that FNAC is able to detect approximately one-half of MTC lesions. These findings suggest that other techniques may be needed in combination with FNAC to diagnose MTC and avoid false negative results.

Effect of previous radiotherapy on cervical lymph node fine‐needle aspiration cytology diagnostic accuracy in head and neck cancers

It is not uncommon for head and neck surgeons to encounter patients with previous neck irradiation that require fine-needle aspiration cytology (FNAC) for assessment of neck mass. It had been observed that the diagnostic performance of FNAC appears to be poorer among patients with previous irradiation. However, to the best of our knowledge, the effect of previous irradiation on diagnostic performance of FNAC has never been studied. Retrospective study. A computer search was performed to identify all patients who had been treated under the Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, from January 2008 to December 2010. We retrospectively retrieved all FNAC of cervical lymphadenopathy procedures, and only cases with subsequent histologic confirmation were included. All patients with squamous cell carcinoma of the head and neck (HNSCC) were included. When compared to patients without previous irradiation, FNAC among patients with history of previous irradiation had comparable specificity (100% vs. 88%) and positive predictive value (100% vs. 89%) but significantly worse sensitivity (82% vs. 40%), negative predictive value (74% vs. 37%), and accuracy (88% vs. 54%). History of previous irradiation was found to be strongly associated with false-negative cytologic results among those with positive final histology (60% vs. 18%; P = .001). FNAC remains an important diagnostic tool in assessment of cervical nodal status in HNSCC. However, our study showed that false-negative rate is significantly higher among patients with previous neck irradiation. Negative FNAC results in this group of patients should be interpreted with caution.

Accuracy of Fine Needle Aspiration Cytology of Salivary Gland Lesions: Routine Diagnostic Experience in Bangkok, Thailand

Fine needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimal invasive and cost-effective method for diagnosis of salivary gland lesions. This study evaluated the accuracy and diagnostic performance of FNA cytology in Thailand. A consecutive series of 290 samples from 246 patients during January 2001-December 2009 were evaluated from the archive of the Anatomical Pathology Department of our institution and 133 specimens were verified by histopathologic diagnoses, obtained with material from surgical excision or biopsy. Cytologic diagnoses classified as unsatisfactory, benign, suspicious for malignancy and malignant were compared with the histopathological findings. Among the 133 satisfactory specimens, the anatomic sites were 70 (52.6%) parotid glands and 63 (47.4 %) submandibular glands. FNA cytological diagnoses showed benign lesions in 119 cases (89.5 %), suspicious for malignancy in 3 cases (2.2 %) and malignant in 11 cases (8.3%). From the subsequent histopathologic diagnoses, 3/133 cases of benign cytology turned out to be malignant lesions, the false negative rate being 2.2 % and 1/133 case of malignant cytology turned out to be a benign lesion, giving a false positive rate was 0.8%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.0% (95% CI, 70.6%-99.4%), 81.3% (95% CI, 54.4%-96.0%), 99.1% (95% CI, 95.4%-100%), 92.9% (95% CI, 66.1%-99.8), 97.5% (95% CI, 92.8%-99.5%), respectively. This study indicated that FNA cytology of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.

Lymph Node Thyroglobulin Measurement in Diagnosis of Neck Metastases of Differentiated Thyroid Carcinoma

Aim. Enlarged cervical lymph nodes (LNs) in patients with thyroid cancer are usually assessed by fine-needle aspiration cytology (FNAC). Thyroglobulin (Tg) is frequently elevated in malignant FNAC needle wash specimens (FNAC-Tg). The objectives of the study were to (1) determine an appropriate diagnostic cut-off for FNAC-Tg levels (2) compare FNAC and FNAC-Tg results in a group of 108 patients affected by differentiated thyroid carcinoma (DTC). Methods. A total of 126 consecutive FNACs were performed on enlarged LNs and the final diagnosis was confirmed by surgical pathology examination or clinical follow-up. The best FNAC-Tg cut-off level was selected by receiver operating curve analysis, and diagnostic performances of FNAC and FNAC-Tg were compared. Results. The rate of FNAC samples adequate for cytological examination was 77% in contrast FNAC-Tg available in 100% of aspirates (P < .01). The sensitivity, specificity, and accuracy of FNAC were 71%, 80%, 74%, 100%, 80%, and 94%, respectively. The most appropriate cut-off value for the diagnosis of thyroid cancer metastatic LN was 1.1 ng/mL (sensitivity 100%, specificity 100%). Conclusions. The diagnostic performance of needle washout FNAC-Tg measurement with a cut-off of 1.1 ng/mL compared favorably with cytology in detecting DTC node metastases.

Should we use stylet needles for aspiration cytology of thyroid nodules?

Fine-needle aspiration cytology (FNAC) is a widely useed method for identifying malignant thyroid nodules. The main limitation of FNAC is the relatively high number of non-diagnostic specimens. The author of this Viewpoint suggests that the use of a stylet needle remarkably improves the diagnostic performance of FNAC and reduces health care costs.