Fine Needle Aspiration Biopsy Examination Research Articles

Diagnostic Test of FNAB Towards Histopathology in Lipoma Soft Tissue Tumor Patients

Lipomas are the most common soft tissue tumor neoplasms. Their range from benign lipomas to high grade liposarcomas. Liposarcoma happens when the neoplasm of a lipoma is malignant. There are various diagnostic methods that can be used to evaluate lipomas, one of which is Fine Needle Aspiration Biopsy (FNAB). FNAB is the initial diagnosis to determine the diagnosis of lipoma soft tissue tumors. Histopathology is the definitive diagnosis or the gold standard for diagnosing lipoma soft tissue tumors. This research aims to determine the value of the Fine Needle Aspiration Biopsy diagnostic test against histopathological tests as the gold standard in lipoma soft tissue tumor patients. This research is a retrospective with a descriptive observational design. This research involved taking medical records of patients with lipoma soft tissue tumors who were examined by FNAB at RSPAL dr. Ramelan, Surabaya for the period August 2019 - December 2021. The results of the FNAB examination were then matched against the histopathological examination data as the gold standard. Data processing using 2x2 cross tabulation to calculate the diagnostic test which includes sensitivity, specificity, positive predictive value, negative predictive value, and accuracy against the gold standard. The results of the Fine Needle Aspiration Biopsy diagnostic test for histopathology in soft tissue lipoma tumors obtained sensitivity of 100.00%, specificity 95.83%, positive predictive value (NRP) 87.5%, negative predictive value (NRN) 100.00%, and 96.77% accuracy. Fine Needle Aspiration Biopsy (FNAB) has good diagnostic value for diagnosing lipoma soft tissue tumors.

Diagnostic Test Fine Needle Aspiration Biopsy (FNAB) Examination on Gold Standard Histopathological Tests for Identification of Colli Lymphadenopathy Patients at RSPAL. Dr. Ramelan Surabaya

Lymphadenopathy is a common clinical manifestation which requires rapid and accurate diagnosis. Fine Needle Aspiration Biopsy (FNAB) is used as an initial and direct diagnosis in cases of lymphadenopathy, confirmatory diagnosis of colli lymphadenopathy is carried out by histopathological examination. The purpose of this study was to determine the value of the FNAB diagnostic test for lymphadenopathy colli FNAB against the gold standard histopathology of Paraffin Blok for benign and malignant lymphadenopathy, examination data for Colli Lymphadenopathy obtained at RSPAL has never been studied before. This type of research is observational descriptive by taking medical record data (SIM-RS) of patients with lymphadenopathy in the colli region who were examined for FNAB and histopathology at the Anatomical Pathology Laboratory Installation, RSPAL dr. Ramelan Surabaya for the period January 2019 – March 2022. The sample used was selected using the total sampling method, obtained as many as 66 samples that met the inclusion criteria. The results of the FNAB examination were then matched against the histopathological gold standard examination data. Furthermore, the data was processed by 2x2 crosstabulation and diagnostic tests were carried out to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The results showed that the accuracy of the FNAB diagnostic test was 86.56%, sensitivity 80.48%, specificity 96.15%, positive predictive value 97.05%, negative predictive value 75.75%. In general, it can be stated that the FNAB examination can be a screening diagnostic tool that is easy, fast, relatively affordable and applicable in helping to establish the diagnosis of colli lymphadenopathy.

Cytomorphological Characteristics Of Ameloblastoma By Fine Needle Aspiration Biopsy Procedure Confirmed With Histopathological Examination

Background: Ameloblastoma is the most common benign epithelial odontogenic tumor with malignant potential and is usually located in the jaw. It constitutes about 1-3% of all tumors and cysts of jaws. This entity has a very high recurrence rate of over 50% even after wide excision. Preoperative diagnosis of ameloblastoma can be made by fine-needle aspiration biopsy (FNAB) which is used as a guide for surgical planning. Case report: We report a case of a tumor in the mandible of a 41-year-old man with a preoperative diagnosis of ameloblastoma from a fine needle aspiration biopsy. Cytological examination of FNAB was confirmed by histopathological preparation of tumor tissue. Conclusion: The fine needle aspiration biopsy cytology is a reliable procedure for the pre-operative diagnosis of ameloblastoma. Pre-operative diagnosis of ameloblastoma can be used for planning therapy and early diagnosis of recurrence cases that can improve patient survival

The Accuracy of the Cytological Examination of Fine Needle Aspiration in Papillary Thyroid Carcinoma at General Hospital H. Adam Malik (HAM), Medan

Background: Thyroid nodules are disorders of the thyroid gland, consisting of colloid nodules, cysts, and thyroiditis found in 80% of cases, while benign follicular neoplasms and thyroid carcinomas occur in 10%-15% and 5% of cases. The most common thyroid carcinoma is Papillary Thyroid Carcinoma (PTC), with an incidence rate of about 80% of all thyroid carcinomas. Distinguishing preoperative benign lesions is very important to prevent unnecessary surgery, therefore Fine Needle Aspiration Biopsy (FNAB) is needed, and easy to perform, this examination is the first line in evaluating preoperative thyroid lesions. Objective: Assess the accuracy of FNAB examination compared to histopathological examination in diagnosing PTC. Methods: This study is a diagnostic test. The population of this consisted of secondary data, patients with thyroid nodules diagnosed with PTC and non-PTC who underwent FNAB examination compared with Histopathological at the Anatomical Pathology Unit of General Hospital HAM, Medan. Results: Based on age group, from 62 samples, there were 56.5% PTC aged 41-60 years, (21.0%) 21-40 years, (19.4) and (3.2%) <21 years. There are 80.6% of the samples are female. PTC has a sensitivity value of 28.57%, specificity of 100%, false positive of 100%, false negative of 73.21%, and accuracy of 85.48%. Conclusion: This study can be used as a diagnostic tool for early diagnosis and a fairly accurate monitoring tool, however, a cytological diagnosis is not a substitute for a histopathological diagnosis which is still a definite diagnosis. Malignancy of PTC on cytological examination must be followed by Histopathological as the gold standard. Background: Thyroid nodules are disorders of the thyroid gland, consisting of colloid nodules, cysts, and thyroiditis found in 80% of cases, while benign follicular neoplasms and thyroid carcinomas occur in 10%-15% and 5% of cases. The most common thyroid carcinoma is Papillary Thyroid Carcinoma (PTC), with an incidence rate of about 80% of all thyroid carcinomas. Distinguishing preoperative benign lesions is very important to prevent unnecessary surgery, therefore Fine Needle Aspiration Biopsy (FNAB) is needed, and easy to perform, this examination is the first line in evaluating preoperative thyroid lesions. Objective: Assess the accuracy of FNAB examination compared to histopathological examination in diagnosing PTC. Methods: This study is a diagnostic test. The population of this consisted of secondary data, patients with thyroid nodules diagnosed with PTC and non-PTC who underwent FNAB examination compared with Histopathological at the Anatomical Pathology Unit of General Hospital HAM, Medan. Results: Based on age group, from 62 samples, there were 56.5% PTC aged 41-60 years, (21.0%) 21-40 years, (19.4) and (3.2%) <21 years. There are 80.6% of the samples are female. PTC has a sensitivity value of 28.57%, specificity of 100%, false positive of 100%, false negative of 73.21%, and accuracy of 85.48%. Conclusion: This study can be used as a diagnostic tool for early diagnosis and a fairly accurate monitoring tool, however, a cytological diagnosis is not a substitute for a histopathological diagnosis which is still a definite diagnosis. Malignancy of PTC on cytological examination must be followed by Histopathological as the gold standard.

Inflammatory Myofibroblastic Tumor in the Thyroid Gland: A Retrospective Case Series Study and Literature Review

Background: The objective of this study was to investigate the clinical characteristics, diagnosis, and treatment of inflammatory myofibroblastoma tumor (IMT) in the thyroid gland. Methods: A total of 17 patients with IMT by pathology from 2010 to 2020 were included in this study. Clinical features, imaging features, treatment, and prognosis were analyzed in this retrospective study. Results: The case series comprised 5 males and 12 females, with an average age of 49.6 ± 15.36 years. The patients were divided into two cohorts: with IMT without further pathological changes and with further pathological changes of the thyroid gland (e.g., nodular goiter or autoimmune thyroid disease). No significant differences were detected in tumor size and extrathyroid extension between the two groups. Fine needle aspiration biopsy examination before the operation was performed in 2 cases, and rapid freezing pathology examination during the operation was performed in 7 cases. Ultrasound images of 5 cases with only one type of pathology, IMT, presented a high and intermediate risk of malignancy. In the other 11 cases with further pathological changes of the thyroid gland, the image could be very low risk of malignancy or benign feature. Only 2 cases showed a high risk of malignancy ultrasound features. 5/17 patients underwent preventive cervical lymph node dissection additional to thyroid surgery. None of the lymph nodes were confirmed positive by postoperative pathology. Thyroid ultrasound, computed tomography scan of the lungs, abdomen ultrasound, and thyroid function tests were routine follow-up tests. During the follow-up period of 26–141 months, 2 cases were lost, and remaining 15 cases had no recurrence or metastasis and were considered cured. Conclusion: IMT in the thyroid gland is a rare disease with a good prognosis and surgical resection is the preferred treatment.

Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer?

The aim of this study was to assess the efficacy of preoperative axillary ultrasonography (AUS) and preoperative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement. Clinically node-negative early-stage breast cancer patients were included in the study. These patients underwent preoperative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or axillary dissection. Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious, and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100%, and negative predictive value (NPV) 83.5%. The false negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumour size were found statistically significant factors for false negativity. It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early-stage breast cancer patients.

Macrofollicular Variant of Follicular Thyroid Carcinoma (MV-FTC) with a Somatic DICER1 Gene Mutation: Case Report and Review of the Literature

Benign thyroid lesions such as multinodular goiter and adenomatoid nodules are well-circumscribed lesions displaying a macrofollicular growth pattern and lack of nuclear atypia. The highly unusual macrofollicular variant of follicular thyroid carcinoma (MV-FTC) mirrors these attributes and is thereby misclassified by cytological examination of fine-needle aspiration biopsies. The MV-FTC diagnosis is instead suggested following histological investigation, in which malignant attributes, most commonly capsular invasion, are noted. The bulk of MV-FTCs described in the literature arise in younger female patients and carry an excellent prognosis. A recent coupling to mutations in the DICER1 tumor suppressor gene has been proposed, possibly indicating aberrancies in micro-RNA (miRNA) patterns as responsible of the tumorigenic process. We describe the cytological, histological and molecular phenotype of a 35 mm large MV-FTC arising in the right thyroid lobe of a 33-year-old female with a family history of multinodular goiter. The tumor was encapsulated and strikingly inconspicuous in terms of cellularity and atypia, but nevertheless displayed multiple foci with capsular invasion. A next-generation molecular screening of tumor DNA revealed missense variants in DICER1 (p. D1709N) and MET (p. T1010I), but no established fusion gene events. After sequencing of germline DNA, the DICER1 mutation was confirmed as somatic, while the MET variant was constitutional. The patient is alive and well, currently awaiting radioiodine treatment. This MV-FTC mirrors previous publications, suggesting that these tumors carry a favorable prognosis and predominantly arise in younger females. Moreover, DICER1 mutations should be considered a common driver event in the development of MV-FTCs.

Rare type of grade ii lipid-rich canine mammary carcinoma

A Daschund intact bitch had a single spherical, multinodular and greyish white mass, measured about 6.5cm, on the left caudal abdominal mammary gland. Fine needle aspiration biopsy examination revealed the presence of numerous epithelial clusters with malignant characteristic of nucleus and cytoplasm. Histopathological examination revealed that cysts were separated by fibrovascular connective tissue. Round to oval neoplastic cells with distinct cell borders. There were multiple small to large solitary vacuoles in the cytoplasm that pushed the nuclei to the periphery of the cell (Signet ring cell). Based on the cytological and histopathological examination the case was diagnosed as special type of Grade II lipid- rich carcinoma.

A panel of four genes accurately differentiates benign from malignant thyroid nodules.

BackgroundClinicians are confronted with an increasing number of patients with thyroid nodules. Reliable preoperative diagnosis of thyroid nodules remains a challenge because of inconclusive cytological examination of fine-needle aspiration biopsies. Although molecular analysis of thyroid tissue has shown promise as a diagnostic tool in recent years, it has not been successfully applied in routine clinical use, particularly in Chinese patients.MethodsWhole-transcriptome sequencing of 19 primary papillary thyroid cancer (PTC) samples and matched adjacent normal thyroid tissue (NT) samples were performed. Bioinformatics analysis was carried out to identify candidate diagnostic genes. Then, RT-qPCR was performed to evaluate these candidate genes, and four genes were finally selected. Based on these four genes, diagnostic algorithm was developed (training set: 100 thyroid cancer (TC) and 65 benign thyroid lesions (BTL)) and validated (independent set: 123 TC and 81 BTL) using the support vector machine (SVM) approach.ResultsWe discovered four genes, namely fibronectin 1 (FN1), gamma-aminobutyric acid type A receptor beta 2 subunit (GABRB2), neuronal guanine nucleotide exchange factor (NGEF) and high-mobility group AT-hook 2 (HMGA2). A SVM model with these four genes performed with 97.0 % sensitivity, 93.8 % specificity, 96.0 % positive predictive value (PPV), and 95.3 % negative predictive value (NPV) in training set. For additional independent validation, it also showed good performance (92.7 % sensitivity, 90.1 % specificity, 93.4 % PPV, and 89.0 % NPV).ConclusionsOur diagnostic panel can accurately distinguish benign from malignant thyroid nodules using a simple and affordable method, which may have daily clinical application in the near future.Electronic supplementary materialThe online version of this article (doi:10.1186/s13046-016-0447-3) contains supplementary material, which is available to authorized users.

Cytopathology Lymphadenopathy Feature in HIV Positve Patient: Diagnosis Tools Comorbidities

Lymphadenopathy is enlarged lymph nodes caused by infection, inflammation or malignancy. On HIV positive patients, lymphadenopathy is one of the most common clinical manifestations and it is usually persistent. Fine-needle aspiration biopsy (FNAB) is an effective cytology technique in determining the diagnosis of lymphadenopathy. This study aimed to describe the cytopathology of lymphadenopathy in HIV positive patients. This is a descriptive study of 21 cases of lymphadenopathy in patients with HIV positive who underwent FNAB examination in Anatomical Pathology Department of Dr.Hasan Sadikin Hospital between 2013-2014. Medical data was taken from the patient medical records including age, sex, location, size and cytopathological diagnosis. Cytopathology overview of FNAB specimens were reassessed by 2 pathologists. In this study, lymphadenopathy in HIV positive patients were mainly found in men (n = 15.71%) with an average age between 20-30 years. The most frequent location was the neck (n = 20.95.2%). The lymph nodes size were found between 0.5-3 cm. Most diagnosis was tuberculous lymphadenitis (n = 15.71%) with the most common cytology feature was granulomatous lymphadenitis (n = 5.33.3%) and suppurative lymphadenitis (n = 5.33.3%). FNAB examination in lymphadenopathy is very helpful to identify the cause of infection in HIV positive patients. Keywords: FNAB, HIV, lymphadenopathy, cytopathology

Renal Cell Carcinoma: Delayed Metachronous Metastases to Parotid and Cerebellum

The purpose of this report is to describe a rare case of delayed metachronous isolated metastases of renal cell carcinoma (RCC) to the parotid gland and the cerebellum. The metastases occurred more than a decade after treatment of the primary tumor without any other systemic involvement. In addition, the potential differential diagnosis of the parotid mass based on presentation and imaging is discussed. An 83-year-old man presented for evaluation and treatment of a rapidly growing mass at the right parotid region. He had a history of RCC resection 10 years before this presentation and had no evidence of persistent disease at the primary site. The diagnosis of metastatic RCC was made after fine-needle aspiration biopsy examination of the mass. The patient underwent superficial parotidectomy for resection of the tumor. Approximately 1.5 years later, he complained of loss of balance. Further investigation disclosed a cerebellar mass that at biopsy examination was found to represent RCC. He underwent stereotactic ablation of the mass. He currently remains free of disease at the primary site and the parotid and without further known brain metastases. This report presents the 29th case of a solitary parotid mass consistent with metastatic RCC 10 years after successful treatment of the primary RCC. Approximately 1.5 years later, the patient presented with new-onset loss of balance. Further investigation disclosed a mass to the cerebellum consistent with metastatic RCC. This case is unique because the brain involvement occurred extremely late, 11.5 years after successful treatment of primary RCC and 1.5 years after resection of a metastatic RCC to the parotid, and without any evidence of other metastases. Late distant metastases of RCC are not uncommon and patients require life surveillance follow-up, but such late presentation of metachronous metastases without systemic disease progression is unique. The patterns of metastases of RCC are not clearly defined and this diagnosis should be considered, especially in patients with relevant history.

Ultrasound and cytological diagnostics of thyroid - its proper application in case of coexisting disturbing clinical signs and symptoms, suggestive of active proliferative lesion

Ultrasound and cytological diagnostics of thyroid - its proper application in case of coexisting disturbing clinical signs and symptoms, suggestive of active proliferative lesion

Relevance of BRAF(V600E) mutation testing versus RAS point mutations and RET/PTC rearrangements evaluation in the diagnosis of thyroid cancer.

A molecular profile including BRAF and RAS mutations as well as RET/PTC rearrangement evaluation has been proposed to provide an accurate presurgical assessment of thyroid nodules and to reduce the number of unnecessary diagnostic surgeries, sparing patients' health and saving healthcare resources. However, the application of such molecular analyses may provide different results among different centers and populations in real-life settings. Our aims were to evaluate the diagnostic utility of assessing the presence of BRAF and RAS mutations and RET/PTC1 and RET/PTC3 rearrangements in all cytological categories in an Italian group of thyroid nodule patients assessed prospectively, and to understand whether and which mutation testing might be helpful in cytologically indeterminate nodules. A total of 911 patients were submitted to ultrasound and fine-needle aspiration biopsy examination. Cytological evaluation was performed in parallel with molecular testing and compared to pathological results in 940 thyroid nodules, including 140 indeterminate lesions. BRAF mutation testing provided the best contribution to cancer diagnosis, allowing the disease to be detected at an early stage, and identifying indeterminate nodules in which diagnostic lobectomy could be spared. On the contrary, RAS and RET/PTC analysis did not further increase diagnostic sensitivity for thyroid cancer. In addition, we found RET/PTC rearrangements in benign lesions, indicating that this molecular marker might not be useful for the detection of thyroid cancer. BRAF(V600E) mutation analysis is superior to RAS point mutations and evaluation of RET/PTC rearrangements in the diagnosis of thyroid cancer, even in indeterminate lesions.

A three-gene panel that distinguishes benign from malignant thyroid nodules.

Reliable preoperative diagnosis of malignant thyroid tumors remains challenging because of the inconclusive cytological examination of fine-needle aspiration biopsies. Although numerous studies have successfully demonstrated the use of high-throughput molecular diagnostics in cancer prediction, the application of microarrays in routine clinical use remains limited. Our aim was, therefore, to identify a small subset of genes to develop a practical and inexpensive diagnostic tool for clinical use. We developed a two-step feature selection method composed of a linear models for microarray data (LIMMA) linear model and an iterative Bayesian model averaging model to identify a suitable gene set signature. Using one public dataset for training, we discovered a three-gene signature dipeptidyl-peptidase 4 (DPP4), secretogranin V (SCG5) and carbonic anhydrase XII (CA12). We then evaluated the robustness of our gene set using three other independent public datasets. The gene signature accuracy was 85.7, 78.8 and 85.7%, respectively. For experimental validation, we collected 70 thyroid samples from surgery and our three-gene signature method achieved an accuracy of 94.3% by quantitative polymerase chain reaction (QPCR) experiment. Furthermore, immunohistochemistry in 29 samples showed proteins expressed by these three genes are also differentially expressed in thyroid samples. Our protocol discovered a robust three-gene signature that can distinguish benign from malignant thyroid tumors, which will have daily clinical application.

Papillary Thyroid Carcinoma with Predominant Spindle Cell Component: Report of Two Rare Cases and Discussion on the Differential Diagnosis with Other Spindled Thyroid Neoplasm

Spindle cell transformation or metaplasia has been so far demonstrated in the context of both benign and malignant conditions. Spindle cell lesions of the thyroid gland of either primary or secondary origin to metastatic disease represent rare entities. We describe two patients with papillary thyroid carcinoma (PTC) showing spindle cell metaplasia, submitted to thyroidectomy due to euthyroid bilateral nodular thyroid disease. Cytological examination of fine-needle aspiration biopsy performed in the dominant nodules was consistent with follicular neoplasm in one case and with a hyperplastic/adenomatous nodule in the other patient. Histological examination disclosed unencapsulated follicular variant of PTC with spindle cell metaplasia in either cases. Both patients are doing well without clinical or laboratory evidence of PTC recurrence at 3- and 1-year follow-up, respectively. We present the clinical, pathological, and immunohistochemical aspects of these unusual cases and thoroughly discuss the differential diagnosis with other spindle cell lesions of the thyroid gland.

Nodular lesions due to infestation by Dirofilaria repens in dogs from Italy

Canine subcutaneous dirofilariosis caused by Dirofilaria repens is an important cause of human dirofilariosis in the Old World. To describe the clinical and pathological features of infestation by D.repens in dogs with cutaneous nodules and to discuss key diagnostic procedures. Sixteen privately owned dogs of different breeds, ages and genders with subcutaneous nodules were positive for D.repens on at least one diagnostic test. Diagnostic tests included cytological examination of fine-needle aspiration biopsies, detection of circulating larvae by Knott's test, morphological and molecular identification of adult parasites and microfilariae, and histopathological examination of excised nodules. Twelve animals were positive for D.repens microfilariae, using cytology and at least one other diagnostic test. Four of twelve dogs screened by Knott's test had circulating D.repens microfilariae, and three of them were co-infected with Dirofilaria immitis. In eight dogs, adult nematodes were morphologically identified as D. repens. Nodular panniculitis was observed in all cases, with nodules containing either one or several cross-sections of nematodes and microfilariae. The nematodes extracted were identified as D.repens by an RT-PCR on the second internal transcribed spacer (ITS-2). Adults and larvae of D.repens can induce skin nodules in dogs, and these lesions should be carefully evaluated in endemic areas. Clinicians should be aware that correct tissue sampling (including the storage of part of a sample in ethanol instead of formalin) is pivotal to achievement of a specific diagnosis. Cytology of fine-needle tissue aspirates was shown to be useful.

Preoperative serum thyroglobulin concentration is an independent predictive factor of malignancy in follicular neoplasms of the thyroid gland

A distinction between a benign follicular neoplasm (FN) and a malignant FN based entirely on cytologic examination of fine-needle aspiration biopsy is not possible. The aim of this retrospective study was to find predictive factors of carcinoma in patients with FN. A chart review of 388 patients (314 females, 74 males; mean age 50 years, range 9-81 years) with FN, who were surgically treated between 1988 and 2009, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression. The histopathological diagnoses were carcinoma, adenoma, and benign goiter in 127 (33%), 126 (32%), and 135 (35%) patients, respectively. The independent predictors of malignancy as shown by multivariate logistic regression were age of patients (OR 1.88, P = 0.008), solitary tumor (OR 1.72, P = 0.037), and Tg concentration (OR 2.36, P = 0.001). Carcinoma was more common in patients younger than 45 years, with solitary tumor and with preoperative serum Tg concentration more than 400 ng/ml. The independent predictors of malignancy in FN were age of patients, solitary tumor, and preoperative Tg concentration. The determination of Tg concentration may be useful in the patients with FN in order to decrease the number of completion thyroidectomies.

COX-2 expression in papillary thyroid carcinoma (PTC) in cytological material obtained by fine needle aspiration biopsy (FNAB)

BackgroundCOX-2 is an enzyme isoform that catalyses the formation of prostanoids from arachidonic acid. An increased COX-2 gene expression is believed to participate in carcinogenesis. Recent studies have shown that COX-2 up-regulation is associated with the development of numerous neoplasms, including skin, colorectal, breast, lung, stomach, pancreas and liver cancers. COX-2 products stimulate endothelial cell proliferation and their overexpression has been demonstrated to be involved in the mechanism of decreased resistance to apoptosis. Suppressed angiogenesis was found in experimental animal studies as a consequence of null mutation of COX-2 gene in mice. Despite the role of COX-2 expression remains a subject of numerous studies, its participation in carcinogenesis or the thyroid cancer progression remains unclear.MethodsTwenty three (23) patients with cytological diagnosis of PTC were evaluated. After FNAB examination, the needle was washed out with a lysis buffer and the obtained material was used for COX-2 expression estimation. Total RNA was isolated (RNeasy Micro Kit), and RT reactions were performed. β-actin was used as endogenous control. Relative COX-2 expression was assessed in real-time PCR reactions by an ABI PRISM 7500 Sequence Detection System, using the ΔΔCT method.ResultsCOX-2 gene expression was higher in patients with PTC, when compared to specimens from patients with non-toxic nodular goitre (NTG).ConclusionsThe preliminary results may indicate COX-2 role in thyroid cancer pathogenesis, however the observed variability in results among particular subjects requires additional clinical data and tumor progression analysis.

Role of ultrasound-guided axillary fine-needle aspiration in the management of invasive breast cancer

Background Previous studies from Women & Infants’ Hospital have reported the accuracy of ultrasound-guided fine-needle aspiration biopsy examination of axillary lymph nodes (USFNAB) for locally advanced breast cancer. The aim of this article is to report our further experience with USFNAB in staging the axilla and determining its affect on management decisions. Methods We performed a retrospective review of prospectively collected data between January 1998 and June 2005. Results A total of 220 patients underwent USFNAB for breast cancer. Of these, 52 were excluded. Of the 168 remaining patients, 79 had positive and 89 had negative USFNAB results. A total of 107 (63%) patients underwent primary surgery and 61 (37%) patients underwent neoadjuvant chemotherapy. In these patients, the sensitivity and specificity of USFNAB was 35% and 96% for T1, and 67% and 100% for T2, respectively. Conclusions The high specificity of USFNAB could safely eliminate sentinel lymph node biopsy examination before axillary lymph node dissection, particularly in T2 lesions.

Prevalence of malignancy within cytologically indeterminate thyroid nodules

Background The optimal management of cytologically indeterminate thyroid nodules is controversial given the variable malignancy rates reported in this patient population. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on cytologic features. Methods Cytopathology reports obtained after fine-needle aspiration biopsy (FNAB) examination of indeterminate follicular thyroid lesions were examined over a 4-year period. The prevalence of malignancy on final histology was determined in 4 indeterminate cytologic categories. Results A total of 107 records were available (91 women, 16 men). The mean patient age was 45.4 ± 16 years. Forty-eight patients (45%) underwent surgery and had histopathologic diagnosis, while 57 patients did not have surgery. The prevalence of malignancy in patients who underwent thyroidectomy was 42% (20 of 48). Conclusions The high prevalence of malignancy within indeterminate follicular lesions may necessitate thyroidectomy for patients with indeterminate follicular lesions on FNAB examination.