Final Histopathological Results Research Articles

Impact of narrow band imaging in prediction of histology of advanced colorectal neoplasia

We assessed the diagnostic performance of the Narrow-Band Imaging (NBI) International Colorectal Endoscopic Classification (NICE) and the Japan NBI Expert Team classification (JNET) in predicting histological outcomes of advanced colorectal lesions. Additionally, we evaluated the sensitivity and positive predictive value (PPV) of the JNET and NICE classifications individually for high-grade lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas). This was a retrospective analysis of prospectively collected data, involving 211 patients (130 men, mean age 60 years) who underwent colonoscopy with endoscopic resection of advanced colorectal neoplasia (lesions ≥ 10 mm). Lesions were classified using both NICE and JNET criteria, and final histopathological results were used for comparison. Of the 257 lesions analyzed, the NICE classification accurately classifies a large proportion of lesions (93.8%). In JNET classification we observed 77.4% correctly classified lesions. Specifically, the sensitivity and positive predictive value (PPV) of the NICE classification for high-grade lesions were 100% and 24.4%, respectively. For the JNET classification, the sensitivity and PPV for high-grade lesions were 56.6% and 57.7%, respectively. The JNET classification, with a positive predictive value of 57.7% for high-grade colorectal lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas), should be used for decision-making regarding appropriate subsequent endoscopic therapy.

Evaluation of Ex Vivo Shear Wave Elastography of Axillary Sentinel Lymph Nodes in Patients with Early Breast Cancer.

Background: The pretherapeutic assessment of axillary lymph node status is crucial in staging early breast cancer patients, significantly influencing their further treatment and prognosis. According to current guidelines, patients with clinically unsuspicious axillary status regularly undergo a biopsy of sentinel lymph nodes (SLNs), whereby metastasis is detected in up to 20% of cases. In recent years, the use of shear wave elastography (SWE) has been studied as an additional ultrasound tool for the non-invasive assessment of tumors in the breast parenchyma and axillary lymph nodes. Previous studies (examining the axilla in patients) have shown that metastases have significantly higher SWE values than benign nodes. Methods: This study aims to evaluate whether SWE can differentiate between tumor-free and metastatic-affected SLN ex vivo, i.e., by examining the pathological specimen. SWE was performed ex vivo on SLN specimens and compared with final histopathological results. Results: A total of 168 SLNs from 105 patients were measured using ex vivo SWE and subjected to standard histopathological processing. In this group, 17 metastases in 17 patients (16.19%) were detected. Tumor-free SLNs had a mean velocity of 1.33 ± 0.23 m/s, while metastatic nodes showed a mean velocity of 1.35 ± 0.29 m/s (p = 0.724). There was no significant difference in ex vivo SWE between benign and malignant SLNs in this population. Conclusions: Contrary to previous studies, this study did not find SWE effective in differentiating lymph node metastases. Further research is needed to clarify SWE's potential role in axillary staging.

Multiphoton Microscopy: A Feasability Study to Explore the Potential Intraoperative Tool for TURBT Diagnosis

Background: Multiphoton microscopy (MPM) is a nonlinear optical imaging technology, allowing process-free imaging of fresh tissue up to a depth of 0.5 mm, with a combined signal of autofluorescence and second harmonic generation. The absence of bladder muscle in a transurethral resection of bladder tumor (TURBT) increases risk of residual disease, recurrence, and understaging, and an intraoperative assessment of resection depth and margins may avoid unnecessary second TURBTs. Objective: The objective of this study was to test the feasibility of MPM in the real-time detection of bladder muscle in cold cup biopsies of patients undergoing TURBT. Methods: This was a prospective feasibility study. Cold cup biopsies were taken intraoperatively from the resection bed during TURBT. Tissue was stored in phosphate buffered saline solution combined with fluorescent dyes (orange acridine and rhodamine). MPM imaging of the tissue was performed first, with z stack images of 100 µm maximum depth for 3D imaging. After MPM imaging, tissue was fixed in formalin and sent to the biorepository for standard histopathology. A descriptive analysis was performed between MPM tissue detection and final histopathology results. Results: Ten patients were included in this pilot study. Tissue was properly imaged for all patients, although 3 of them had artifacts, and we detected 5 times muscularis propria on MPM imaging. MPM average procedure time from biopsy to formalin fixation (MPM imaging) was 16.2 minutes (12-20 minutes). On final pathology, resection depth was correctly performed for only 4 patients of 10 (resection including bladder muscle). We found an 80% sensitivity on resection depth between first layer identified on MPM and final pathology (8/10 patients) and 100% correlation with final histopathology in specimens for the assessment of detrusor muscle. Conclusions: This study supports the use of MPM as a novel intraoperative tool which can evaluate cold cup biopsies during TURBT for resection depth and potentially avoid unnecessary second look procedure.

Intraoperative label-free tissue diagnostics using a stimulated Raman histology imaging system with artificial intelligence: An initial experience.

Accurate intraoperative tissue diagnostics could impact on decision making regarding the extent of resection (EOR) during brain tumor surgery. Stimulated Raman histology (SRH) is a label-free optical imaging method that uses different biochemical properties of tissue to generate a hematoxylin-eosin-like image and, in combination with an artificial intelligence-based image classifier, offers the opportunity to obtain rapid intraoperative tissue diagnoses. The goal of this study was to report on our initial experience with SRH to evaluate its accuracy in comparison to final tissue diagnosis. We evaluated 70 consecutive adult cases with brain tumors. We compared results of the three different SRH classifier (diagnostic, molecular and tumor/non-tumor) to the respective final histopathological result. Similarly, we evaluated the isocitrate dehydrogenase (IDH) mutations in 18 patients using SRH. Lastly, we compared SRH results of samples taken from the tumor margins with early postoperative MRI. Prediction accuracy was evaluated by logistic regression and Receiver Operator Curve (ROC) analysis. We included 19 gliomas, 9 metastases, 22 meningiomas and 14 other tumor entities. Regarding accuracy of intraoperative SRH predictions, regression analysis showed an Area Under the Curve (AUC) of 0.77 (95 % C.I. 0.64-0.89, p = 0.0008), suggesting agreement of predictions with final diagnosis. For specific tumor entities, variable accuracies were observed: The highest accuracy was obtained for meningiomas followed by high-grade glioma. IDH mutations were predicted with an AUC of 0.93 (95 % C.I. 0.88-0.98; p < 0.0001). The SRH examination of tissue samples from tumor margins corresponded with postoperative MRI in 4 out of 5 cases. Our initial experience with SRH shows that this novel imaging technique is a promising approach to obtain rapid intraoperative tissue diagnosis to guide surgical decision making based on histology and cell-density. With further refinement of AI-based automated image classification and a better integration into the surgical workflow, prediction accuracy and reliability could be improved.

Adenoid Cystic Carcinoma of the External Ear Canal: A Case Report

Objective: To present a rare case of Adenoid Cystic Carcinoma of the external ear canal in a 73-year-old man, including its diagnosis and surgical management. Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One Results: A 73-year-old man who consulted due to decreased hearing on the right ear had a 4-year history of gradually enlarging mass occupying the right external auditory canal. Wide en bloc resection of the external auditory canal mass and superficial parotidectomy with facial nerve preservation was performed with final histopathology results of adenoid cystic carcinoma. Follow-up at 2 years has shown no signs or symptoms or recurrence. Conclusion: Adenoid cystic carcinoma of the external ear canal is a very rare disease that can present similarly to other otologic infections. Early identification of symptoms, performance of necessary imaging, and timely biopsy are key to reducing misdiagnosis and improving the survival rate. Complete resection of the tumor with adequate margins is the recommended treatment due to its high rates for recurrence.

Sensitivity and Predictive Value of the Frozen Section of Sentinel Lymph Node Biopsy in the Post-neoadjuvant Setting: Experience From a Tertiary Care Hospital in a Resource-Limited Country.

Background Axillary lymph node status is one of the most important prognostic factors in breast cancer treatment, which can be confirmed by sentinel lymph node biopsy (SLNB).Intraoperative frozen sectionis an alternative method for SLNB, which can reduce the risks associated with secondary surgery.The feasibility and accuracy of SLNB after post-neoadjuvant chemotherapy (NACT) are affected by many factors as lymphatic drainage from the breast could be impaired due to fibrosis, fat necrosis, and granulation tissue formation, thus hampering the detection of the sentinel lymph node and afterward interpretation by pathologists due to therapy-related changes.Despite the increasing use of SLNB in post-NACT settings, there is still limited information on the accuracy of SLNB in resource-limited countries. Objective Our study aims to detect the sensitivity and predictive value of frozen section SLNB in the post-NACT setting while comparing it with final permanent histopathological results and considering final permanent histopathological results as standard. Materials and methods A total of 286 patients meeting the inclusion criteria from 2021 to 2022 were included in the study. Hematoxylin and eosin (H&E)-stained microscopic glass slides of frozen SLNB after NACT, permanent paraffin-embedded sections, and immunohistochemical stains were retrieved and reviewed.For all the categorical variables, including histologic type and grade, frequencies and percentages were obtained. Measures of central tendency and variability for continuous data such as age, number of sentinel lymph nodes received, and size of the largest nodal deposit were calculated.The chi-square test was used for the comparison of qualitative variables. A p-value of less than or equal to 0.05 was considered statistically significant. Results The median age of presentation was 47 years (range = 39 to 55 years). The median number of sentinel lymph nodes received was three (range = 2-4). At the time of frozen section reporting, out of a total of 286 cases, 229 (80.1%) cases were labeled as negative, 55 (19.2%) cases as positive, and two (0.7%) cases were deferred for permanent section results. Out of 229 cases labeled as negative at the time of the frozen section, 220 (76.9%) cases were true negative confirmed on permanent sections. A total of 66 (33.1%) cases were true positive, including two deferred cases and nine false negative cases, in addition to 55 cases labeled as positive on the initial frozen section. The study showed sensitivity, specificity, and accuracy of frozen section analysis of SLNB at 83.00%, 100%, and 96.15%, respectively, with a false negative rate (FNR) rate of 16.7%. Conclusion Further follow-up studies to definitively determine the role of SLNB following post-NACT inpatients who did not undergo axillary lymph node dissection (ALND) are needed. Continuous monitoring of the rate of false positives and false negatives of frozen sections on SLNB is essential as feedback for pathologists.

The value of a multimodal approach combining radical surgery and intraoperative radiotherapy in the recurrence treatment of gynecological malignancies - analysis of a large patient cohort in a tertiary care center

BackgroundRecurrent and locally advanced gynecological malignancies have a poor prognosis. In particularly, pelvic local recurrence after previous radiotherapy and/or positive resection margins during surgical treatment for recurrent disease result in low survival rates. Consequently, locoregional control is of utmost importance in this cohort of patients. The aim of this study was to analyze treatment outcomes and determine prognostic factors for patients treated with surgery and intraoperative radiotherapy (IORT) for recurrent and locally advanced gynecological malignancies.Methods40 patients who underwent surgical treatment and IORT between 2010 and 2022 were eligible for inclusion. The median follow-up time was 22 months. The outcomes measured were locoregional control (LRC), overall survival (OS), and survival without distant metastases (DMFS). The Cox proportional hazards model was used for univariate and multivariate analysis to assess the impact of patient variables and treatment factors on the endpoints mentioned. The following variables were analyzed: age at surgical treatment and IORT and initial diagnosis (< 65 vs. ≥65 years, each), disease-free interval (DFI) between initial diagnosis and first recurrence, DFI to surgical treatment and IORT, grading, histology, IORT dose (≤ 13 vs. >13 Gy) and technique (high dose radiotherapy (HDR) vs. IORT using electrons, (IOERT)). Survival curves were generated using the Kaplan-Meier method.ResultsThe mean IORT dose was 13.8 Gy (range 10–18 Gy). Cervical carcinoma was most frequently found in 27.5% of patients followed by endometrial carcinoma and vulvar carcinoma in 25% respectively. The final histopathologic results after surgery with IORT showed no residual tumour in 24 patients (60%), microscopic residual disease in 5 patients (12.5%), resection status could not be evaluated in three patients (7.5%) and the resection status was unknown in eight patients (20%). Subsequently, 27.5% of patients also received adjuvant radiotherapy of the local recurrence bed. However, after IORT, 65% of the women suffered a recurrence. Of these, the recurrences were localized: in-field 32.5%, out-of-field 22.5% and margin-of-field 12.5%. The 3- and 5-year OS was 69% and 55% respectively. The 3- and 5-year LRC was 56% respectively. The 3- and 5-year DMFS was 66% and 49%. Whereas the comparison between groups by IORT dose level (≤ 13 vs. >13 Gy) showed a non-significant trend in favor of the higher dose only for OS (p = 0.094), but not in LRC and DMFS (p > 0.05). OS and DMFS, but not LRC, differed significantly between the HDR-IORT and IOERT groups (p = 0.06 and p = 0.03,) in favor of the HDR-IORT technique. For HDR-IORT technique a trend towards superior OS and LRC was observed in the univariate analysis: HR 3.76, CI 95%: 0.95–14.881, p = 0.059 and HR 2.165 CI 95%: 0.916–5.114, p = 0.078ConclusionsThe survival rate for pelvic recurrence in gynecological malignancies remains poor and comparable with historical data from the last two decades. Particularly HDR-IORT, appears to provide a long-term oncological benefit in carefully selected patients.

The Role of Fine-Needle Aspiration Cytology in the Evaluation of Breast Lumps.

Background Breast cancer is the most frequently diagnosed cancer in women worldwide, accounting for more than one in ten new cancer cases each year. It ranks as the second leading cause of cancer-related mortality among women. The majority of patients present with palpable breast lumps. Effective surgical management of breast cancer largely depends on accurate preoperative pathological diagnosis. This study evaluates the diagnostic accuracy and prognostic implications of fine-needle aspiration cytology (FNAC) compared with core needle biopsy (CNB) in breast carcinoma. Objectives The objectives of this study are to assess the sensitivity and specificity of FNACand CNB, to compare the diagnostic accuracy of FNAC and CNB against histopathological findings from gross specimens in the evaluation of breast lumps, and to identify and examine the limitations associated with both FNAC and CNB procedures. Materials and methods This study included female patients presenting with clinically suspicious palpable breast lumps at the General Surgery OPD of Bankura Sammilani Medical College and Hospital, Bankura. All patients underwent FNAC followed by CNB. The cytological and CNB diagnoses were compared with the final pathological diagnosis obtained from excisional biopsy. Results The study included 44 female patients aged 20 to 70 years. The most common age group for breast carcinoma was 50-59 years (36.36%). Malignancy was diagnosed in 75% of cases (33/44), with right breast involvement (65%) being more common than the left. The upper outer quadrant (59%) was the most frequently affected area. Among the 33 confirmed malignant cases, 69.70% had lesions larger than 5 cm. FNAC demonstrated a sensitivity of 93.93%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 84.61%, and diagnostic accuracy of 95.45%. CNB showed a sensitivity of 96.97%, specificity of 100%, PPV of 100%, NPV of 91.67%, and diagnostic accuracy of 97.73%. Both methods correlated significantly with the final histopathology results (p < 0.05). FNAC identified ductal carcinoma in 93.55% of cases, while CNB identified it in 96.77%. Conclusion CNBprovides additional information on receptor status but is more resource-intensive. FNACremains a cost-effective and time-efficient first-line diagnostic tool, especially in resource-constrained settings like rural India. FNAC should be employed for initial diagnosis, with CNB reserved for cases requiring further clarification.

Rare case of Lingual Nerve Schwannoma Presenting as Submandibular Area Swelling with Parapharyngeal Extension.

Schwannoma is a rare benign encapsulated nerve sheath tumor which originates from Schwann cells. Generally, schwannoma arising from lingual nerve involves the oral tongue and tongue base in the oral cavity. We report a rare case of lingual nerve schwannoma in a 16-year-old girl with complaint of right-side submandibular swelling for last 4-5 years. A diagnosis was established based on computed tomography (CT scan) and fine needle aspiration cytology (FNAC). CT scan showed tumor involving right submandibular region and superiorly reaching up to parapharyngeal space without any intraoral swelling. She underwent excision under general anesthesia (transcervical approach) without any complication. Per operatively, the tumor was found eccentrically placed with relation to the lingual nerve and lingual nerve fibers were splayed over the tumor. The final histopathological results confirmed the diagnosis of schwannoma.

Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting.

Small rectosigmoid colorectal polyps (<10 mm) are prevalent, with a low prevalence of advanced neoplastic lesions. The "diagnose-and-leave" strategy, employing narrow band imaging (NBI), is gaining popularity for its safety and cost-effectiveness by reducing polypectomy complications and minimizing histopathology expenses. This study assessed the diagnostic efficacy of NBI with dual focus (DF) magnification for real-time neoplastic prediction of rectosigmoid polyps and explored the feasibility of implementing this strategy in Vietnam. In a prospective single-center study, 307 rectosigmoid polyps from 245 patients were analyzed using three consecutive endoscopic modes: white light endoscopy (WLE), NBI, and NBI-DF. Endoscopists assessed polyps for size, location, macroscopic shape,optical diagnosis, and confidence levels before histopathological evaluation. High confidence was assigned when the polyp exhibited all features of a single histology type. Predictions were compared with final histopathology results. Of the total, 237 (77.2%) were diminutive (≤5 mm) polyps, and 18 (5.8%) were advanced neoplastic lesions. WLE + NBI and WLE + NBI + NBI-DF exhibited significantly higher accuracy compared to WLE (88.6% and 90.2% vs 74.2%, P < 0.01). For diminutive polyps, the DF mode significantly increased the rate of high-confidence optical diagnoses (89.1% vs 94.9%, P < 0.001). WLE + NBI + NBI-DF demonstrated high sensitivity (90.1%), specificity (95.5%), and negative predictive value (93.4%) in high-confidence predictions, enabling the implementation of the "diagnose-and-leave" strategy. This approach would have reduced 58.2% of unnecessary polypectomies without missing any advanced neoplastic lesions. NBI and DF modes provide accurate neoplastic predictions for rectosigmoid polyps. For diminutive polyps, DF magnification improves the confidence level of the optical diagnosis, allowing the safe implementation of the "diagnose-and-leave" strategy.

A cross-sectional study approach towards management of ovarian tumour by frozen section at laparotomy and assessing its validity by gold standards of histopathology

Background Ovarian tumours represent a complex clinical challenge, requiring accurate diagnosis to guide appropriate surgical management. This study protocol outlines a cross-sectional investigation to evaluate the diagnostic accuracy of frozen section analysis during laparotomy for ovarian tumours, comparing it with the gold standard of histopathology. Methods The study will be conducted over two years (2022-2024) at the Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, India. Fifty eligible patients with ovarian masses will be included, with data collected through comprehensive demographic and clinical assessments, ultrasonography, and computed tomography scans. Frozen section analysis will be performed during staging laparotomy, and diagnoses will be compared with final paraffin-embedded histopathological results. Statistical analyses will be conducted to assess diagnostic accuracy, including sensitivity, specificity, positive predictive value, and negative predictive value. Expected outcomes The study aims to provide insights into the effectiveness of frozen section analysis as a real-time diagnostic tool for ovarian tumours, with implications for surgical decision-making. The results will be presented in peer-reviewed journals and conferences, enhancing clinical practice in gynecologic oncology.

Colposcopic and Histopathologic Comparative Interpretations Among Patients Undergoing Evaluation for Cervical Dysplasia in Western Kenya

Objective: To determine the correlation between colposcopic and final histopathologic results amongst patients undergoing a colposcopic evaluation in cervical dysplasia clinics in Western Kenya. Methods: This was a cross-sectional study, conducted among 164 females undergoing colposcopic evaluation across several cervical dysplasia clinics in Western Kenya. Colposcopy and histopathology were performed. Colposcopy findings were graded using modified Reid’s Colposcopic Index (RCI). Bayes’ theorem model was used to determine the sensitivity, specificity, positive predictive value, and negative predictive value. An overall ĸ value was calculated as an estimate of the strength of correlation between colposcopy and histopathology. Results: Mean age of the study participants was 40.6 years. Modified RCI classified 20.7%, 40.2%, and 39.1% between a score of 0–2, 3–5, and 6–8, respectively. Colposcopy classified 0.6%, 38.4%, and 60.1% as normal, cervical intraepithelial neoplasia (CIN) 1 (low risk), and CIN 2–3 (medium–high risk), respectively. Histopathology classified 16.5%, 26.2%, 53.3%, and 3.0% as having normal, CIN 1, CIN 2–3, or carcinoma in situ, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 85.3%, 69.7%, 80.3%, and 69.7%, respectively. The estimated strength of correlation between colposcopy and biopsy was relatively strong (ĸ=0.55). Conclusion: There is an association between the discriminatory powers of colposcopy and histology, but colposcopy had a lower specificity when compared to histopathology.

Protocol: revolutionizing central nervous system tumour diagnosis in low- and middle-income countries: an innovative observational study on intraoperative smear and deep learning.

The aim of this study is to assess the feasibility and implementation of a novel approach for intraoperative brain smears within the operating room, which is augmented with deep learning technology. This study is designed as an observational to evaluate the feasibility and implementation of using an innovative approach to intraoperative brain smears within the operating room, augmented with deep learning technology. The study will be conducted at Aga Khan University Hospital in Karachi, Pakistan, from May 2024 to July 2026, with an estimated sample size of 258. A neurosurgical trainee, trained by the study neuropathologist, will prepare and examine the smears under a microscope in the operating room. The findings of the trainee will be documented and compared to routine intraoperative consultations (smear and/or frozen section) and final histopathology results obtained from the pathology department. Additionally, the study will incorporate artificial intelligence tools to assist with the interpretation of smear and a telepathology interface to enable consultation from an off-site neuropathologist. The results of this study will hold significant potential to revolutionise neurosurgery practices in lowand middle-income countries by introducing a cost-effective, efficient, and high-quality intraoperative consultation method to settings that currently lack the necessary infrastructure and expertise. The implementation of this innovative approach has the potential to improve patient outcomes and increase access to intraoperative diagnosis, thereby addressing a significant unmet need in LMICs.

Comparative Cross Sectional Study Between Accuracy of Ultrasonography and Cytology in Diagnosis of Thyroid Cancer with Final Histopathology Results

Comparative Cross Sectional Study Between Accuracy of Ultrasonography and Cytology in Diagnosis of Thyroid Cancer with Final Histopathology Results

Clinical, Radiological, and Pathological Analysis of Breast Lump

Background The occurrence of breast lumps is more prevalent in the present-day population. Eighty percent of breast lumps are benign. There is no definitive examination or clinical analysis for the diagnosis of breast lumps.Aim The present study aimed to investigate the individual and combined accuracy of clinical breast examination ultrasonography and fine-needle aspiration cytology in the early diagnosis of breast lumps related to histopathology.Methods All female patients aged gt18 years who presented with a palpable breast lump underwent clinical breast examination. Ultrasonography USG and fine-needle aspiration cytology FNAC of the breast lump and subsequent excision biopsy were included in the study. The final histopathological results were analyzed using the results of clinical breast examination ultrasonography and fine-needle aspiration cytology. A detailed history of the presenting complaints was obtained from all eligible patients.Results On analysis a larger breast lump was observed in the age group of 21-30 yrs. In 100 of cases individuals reported a breast lump as their primary concern accompanied by pain. Majority of these cases 60 involved lumps ranging from 3 to 5 cm in size. Fibroadenomas 58 were found to be common observations. Most cases presented with a lump on the right side 54. FNAC was performed in all cases and was diagnostic 92.25. USG suggested that if the lesion was cystic or solid further typing of the lesion had limitations even though fibroadenoma would be diagnosed accurately 72.4. There was a statistically significant correlation between the clinical diagnosis and USG diagnosis Plt0.05. Among 50 patients 40 80.0 showed a correlation between the clinical diagnosis and USG diagnosis. There was a statistically significant correlation between USG and histopathological diagnosis Plt0.05 however among 50 patients the diagnosis of lesions was correlated in 34 68.0. There was a statistically significant correlation between the clinical findings USG and histopathological diagnosis Plt0.05. Conclusion The accuracy of breast lump diagnosis increases when all three modalities that is clinical examination USG and FNAC are combined. Triple-modality diagnosis of breast lumps may avoid many unnecessary surgeries.

Parotid FNAC Diagnostic Utility and Its Role in Surgical Residency Training.

This study aimed to investigate the relationship between preoperative fine needle aspiration cytology (FNAC) for parotid tumors and the level of surgical training among residents, as well as to further elucidate its effectiveness as a diagnostic tool in the hands of the treating physician. Surgical records from patients who underwent parotid surgery between 2014 and 2022 were retrieved. Residents reported their perceived level of training duringthese procedures. Contingency tables were used to correlate the cytological with final histopathological results. A total of 286 patients who had undergone preoperative FNAC were included in the study. A preoperative diagnosis of pleomorphic adenoma or Wharthin's tumor was significantly associated with higher training scores among surgical residents. In contrast, a diagnosis of malignancy, other benign tumors, or indeterminate cytology was correlated with poor training scores (χ2 = 176.35; df = 2; p-value <0.001, Cramer's V 0.79). FNAC demonstrated a sensitivity of 88% and a specificity of 99.2% for detecting malignancy, with a positive likelihood ratio of 103.8 (95% CI: 26.02-414.34) and a negative likelihood ratio of 0.12 (95% CI: 0.06-0.26). Our findingssuggest that preoperative cytological diagnoses of parotid tumors with a favorable prognosis, such as Wharthin's tumors, can enhance training and mentorship opportunities provided by senior surgeons. This is particularly significant for academic institutions with residency programs.

Primary mucinous skin cancer: A case report and review of the literature

Primary mucinous carcinoma of the skin (PMCS) is an extremely uncommon skin cancer originating from sweat glands. We present a case of a male patient diagnosed with PMCS who was initially misdiagnosed with benign sebaceous cysts. A 62-year-old male patient presented to a private clinic with a chief complaint of a slowly progressing nodule located under his lower lip for the past two years; The nodule was locally excised . The histopathology analysis yielded a diagnosis of mucinous carcinoma with a positive circumferential margin. Reexcison was performed, and the final histopathology result was a small nest of mucinous carcinoma with a negative surgical margin. He underwent thorough investigation, including gastroduodenoscopy, colonoscopy, and computerized tomography (CT) scans of the chest, abdomen, and pelvis, and found no signs of primary tumor. He was discharged from our hospital and educated to follow up closely for local recurrence. This paper illustrates the rarity of this disease, its vague presentation, and a brief review of diagnosis and treatment.

The importance of preoperative and perioperative Narrow Band Imaging endoscopy in the diagnosis of pre-tumor and tumor lesions of the larynx.

Narrow band imaging (NBI) is an endoscopic imaging method intended for the diagnosis of mucosal lesions of the larynx that are not visible in white-light endoscopy, but are typical of pre-tumor and tumor lesions of the larynx. To compare preoperative/perioperative white light endoscopy and NBI endoscopy with the results of histopathological examinations in pre-tumor and tumor lesions of the larynx. A prospective study, over a period of five years (5/2018-5/2023), included 87 patients with laryngeal lesions aged 24-80 years. We evaluated preoperative/ perioperative white light and NBI endoscopy, established a working prehistological diagnosis, and compared this with the definitive histopathological results of laryngeal biopsies. In relation to the definitive histology score, a statistically significant correlation was found between the evaluation of the finding and the definitive histology for preoperative and perioperative white light endoscopy and NBI endoscopy (p < 0.001). Both methods showed higher precision when used perioperatively. NBI endoscopy is an optical method that allows us to improve the diagnosis of laryngeal lesions, perform a controlled perioperative biopsy, and refine the surgical scope. The NBI endoscopy is a suitable method for the diagnosis of early cancerous lesions of the larynx. The use of preoperative/perioperative NBI endoscopy allowed us to achieve a high level of agreement correlation (p < 0.001) between the prehistological working diagnosis and the final histopathological result. The NBI method proves its application in the diagnosis of pre-tumor and tumor lesions of the larynx.

Clinico-pathological Factors in Malignant Transformation of RRP.

Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.