Fine-needle Aspiration Biopsy Findings Research Articles

Abstract LB276: qPCR in the diagnosis of papillary thyroid cancer: Assessment of BRAF V600E mutation in FNA biopsies of thyroid nodules

Abstract Papillary thyroid carcinoma (PTC) accounts for up to 90% of thyroid cancer cases, and its differentiation from benign conditions presents a challenge in clinical practice. Fine needle aspiration biopsy (FNAB) has become a recommended practice for evaluating thyroid nodules (TN) with imaging features suspicious of malignancy. Although FNAB demonstrates high accuracy in discriminating TN, a significant number are classified as malignant indeterminate (MTI), which can only be fully diagnosed by post-surgical histologic evaluation. Up to 30% of FNAB findings are expected to be MTI, leading to a high rate of unnecessary hemithyroidectomies in about 75% of patients. In PTC, the most common mutation is c.T1799A in the BRAF gene (rs113488022), resulting in V600E in the B-raf protein, leading to an increase expression by altering the MAPK pathway. The aim of this study was to evaluate the efficacy of discriminating patients with malignant and benign TNs by detecting BRAF V600E in tissue from FNAB for molecular diagnosis of PTC. The qPCR technique with allele-specific probes was used to detect the BRAF c.1799T>A mutation in somatic DNA samples extracted by FNAB from TN (n=99) with suspected malignancy by ultrasonography. Cytologic diagnosis of biopsies was performed using the Bethesda System (TBSRTC). Diagnostic accuracy measures for evaluation of BRAF c.1799T>A as a diagnostic tool were performed with MedCalc software. Of the 99 patients, it was determined by cytology that 50 patients (50.51%) had PTC and 49 benign neoplasms (49.49%). The mutation was detected in 28 of the PTC samples (56%) (AA homozygotes [n=12, 24%] and AT heterozygotes [n=16, 32%). No mutation carriers were found among patients with benign neoplasms. Regarding accuracy measures were 56% for sensitivity of 56% and 100% specificity. The positive predictive value was 100% and the negative predictive value was 69.01%, with an accuracy of 77.78%. Finally, the negative likelihood ratio (LR-) value was 0.44 (95% CI: 0.32 to 0.60), while the positive likelihood ratio (LR+) value could not be calculated as there were no patients with the mutation in the group of patients with benign TN. In conclusion, our results suggest that the presence of BRAF c.1799T>A mutation could be indicative of PTC, confirming its usefulness in the differentiation between malignant and benign tumors. BRAF V600E detection may be valuable as an adjunct to conventional cytology, improving diagnostic accuracy and reducing the need for unnecessary surgical procedures. While highlighting the potential utility of this technique as a diagnostic tool, further analysis and consideration of other metrics is recommended for a full evaluation of its clinical relevance. Citation Format: Anette R. Gastelum-Quiroz, Andrea Ross-Orozco, Marco A. Álvarez-Arrazola, Eliakym Arambula-Meraz, Karla L. Morales-Hernández, Hanna M. Tolosa-Lerma, Fred Luque-Ortega, Paola Y. Sánchez-Aboytes, Noemí García-Magallanes. qPCR in the diagnosis of papillary thyroid cancer: Assessment of BRAF V600E mutation in FNA biopsies of thyroid nodules [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB276.

Fine-needle aspiration biopsy of axillary lymph nodes: Areliable diagnostic tool for breast cancer staging.

Pathologic evaluation of sentinel lymph node biopsy (SLNB) samples is crucial for axillary staging in patients newly diagnosed with breast cancer. Patients with pathologic evidence of nodal metastasis scheduled for upfront surgery typically also undergo axillary lymph node dissection (ALND). Although SLNB is the gold standard method for detecting nodal metastasis, axillary lymph node fine-needle aspiration biopsy (FNAB) utility has not been thoroughly explored. Ultrasound-guided axillary lymph node FNAB samples along with concurrent ipsilateral breast tissue samples were searched and reviewed. The control group included histologic findings of axillary dissection or intraoperative SLNB results. A total of 354 axillary lymph node FNAB samples with matched histology were included. Of these, 187 (52.8%) were positive for metastatic carcinoma of breast origin; 143 (40.4%) were negative for metastasis; 12 (3.4%) showed atypical cells; six (1.7%) were suspicious for metastasis; and six (1.7%) were nondiagnostic because of a lack of lymphoid tissue and malignant cells. Of the 143 negative FNAB samples, 22 (15.4%) were positive on either intraoperative SLNB or ALND. When only the positive and negative FNAB samples were accounted for (n=330; 93.2%), overall diagnostic sensitivity and specificity were 89.4% and 99.2%, respectively. Although axillary SLNB is the standard procedure for detecting nodal metastasis of breast origin, axillary lymph node FNAB appears to be a suitable alternative in a significant proportion of patients. A standard SLNB should be performed in cases of negative axillary lymph node FNAB findings, particularly nodes with abnormal imaging findings.

Fine-Needle Aspiration Biopsy Findings of the Thyroid Gland in Renal Transplant Patients.

For patients with end-stage renal disease, thyroid diseases are common due to altered hormone excretion and transport, and for renal transplant recipients this is due to immunosuppressive drugs. We investigated the prevalence of thyroid disorders, including thyroid cancer, by fine-needle aspiration biopsy in kidney transplant candidates and recipients and estimated the outcomes. For 305 thyroid fine-needle aspiration biopsies performed from January 2000 to December 2020 in patients with end-stage renal disease, we recorded patient demographics, thyroid ultrasonography, and biopsy findings. Of biopsy results from 305 patients, 272 (89.2%) were benign, 24 (7.9%) showed atypia of undetermined significance/follicular lesion of undetermined significance, 2 (0.7%) had suspicion for malignancy, and 7 (2.3%)were malignant.Thyroid surgery was performed for 13 patients with benign results, 6 with atypia of undetermined significance/follicular lesion of undetermined significance, 2 with suspicion for malignancy, and 7 with malignancy. In 13 patients with benign cytology, the histopathology finding was also benign in lobectomy specimens. In 6 patients with atypia of undetermined significance/follicular lesion of undetermined significance, the final diagnosis was papillary thyroid carcinoma in 3 patients, adenomatous hyperplasia in 2 patients, and Hurthle cell adenoma in 1 patient. For all 9 patients for whom fineneedle aspiration biopsy was suspicious for malignancy or malignant, histopathologic examination showed papillary thyroid carcinoma in total thyroidectomy materials. Among 12 papillary thyroid carcinoma patients, 4 underwent renal transplant after thyroidectomy, and survival for these 4 patients was 116.25 ± 29.30 months after transplant without tumor recurrence or distant metastases. Thyroid diseases are more frequent in patients with end-stage renal disease or renal transplant versus the normal population and also affect morbidity and mortality at higher rates in these patients. Fine-needle aspiration biopsy is a useful diagnostic modality in evaluation and treatment of thyroid nodules in both kidney transplant candidates and recipients.

Cytopathology of benign sebaceous salivary gland neoplasia: Comparison of two analogous yet dissimilar entities.

Benign sebaceous salivary gland (SG) neoplasms represent approximately 0.2% of all salivary gland neoplasms. Not only are fine needle aspiration (FNA) biopsy findings of sebaceous adenoma (SA) and sebaceous lymphadenoma (SLA) limited, but their findings are also rarely compared with one another. Our cytopathology files were searched for examples of benign sebaceous SG neoplasms with concomitant histopathological verification. FNA biopsy and cell collection were performed using standard technique. One case each of parotid SA and parotid SLA showed markedly dissimilar cytomorphology. The SA case was composed of a repetitive population of profusely multivacuolated polygonal cells with single and multiple nuclei, and was specifically recognised cytologically as a sebaceous neoplasm due to its characteristic cytoplasmic vacuolisation. The SLA case, however, was characterised by smears filled primarily with lymphocytes and only scant widely scattered basaloid cell clusters. A non-specific diagnosis of basaloid neoplasm was rendered. In retrospect, recognition of sebaceous differentiation was limited to rare cell groups. Though nominally, epidemiologically, and to a degree histopathologically analogous, the cytopathology of SA and SLA are markedly dissimilar, reflecting the dominant cell component in each. With FNA biopsy, a specific interpretation is more likely for SA than SLA due to the overwhelming obscuring lymphoid population in the latter.

Oncocytic Carcinoma of Parotid Gland: A Case Report

Oncocytic carcinoma is a rare malignant carcinoma, representing only 5% of all oncocytic tumors. Furthermore, oncocytic carcinoma of the parotid gland is uncommon, accounting only for under 1% of all salivary gland tumors. We reported an 82-year-old female presented with a right parotid mass. She had experienced a similar complaint six months ago and had undergone treatment. Physical examination showed a mobile and painless cystic mass of the right parotid without facial nerve involvement. Fine needle aspiration biopsy (FNAB) finding suggested benign cystic lesions with inflammatory cells and amorphous debris. Subsequently, she underwent surgical tumor excision and right-sided partial parotidectomy. Histopathological examination showed proliferative tumor cells with an atypical nucleus, abundant eosinophilic cytoplasm, and solid, trabecular, and tubular growth pattern, suggesting an oncocytic carcinoma of the parotid gland. In conclusion, oncocytic carcinoma must be considered in all parotid gland tumors with oncocytic cells despite the rarity. Considering its recurrence and metastasis nature, patients with oncocytic carcinoma should remain in a long-term follow-up. The role of radiotherapy and chemotherapy remains controversial but may be used for treating advanced-stage cases or distant metastasis Keywords: oncocytic carcinoma; parotid gland; partial parotidectomy

The usefulness of [99mTc]MIBI scintigraphy in the diagnostic algorithm of ultrasonographical suspected thyroid nodules by using EU-TIRADS criteria.

Although not yet involved in the algorithm of thyroid nodules, 99mTc-methoxy-isobutyl-isonitrile ([99mTc]MIBI) scintigraphy may help in the individual diagnostic workup of a thyroid patient, especially where indeterminate fine needle aspiration biopsy (FNAB) is present. The aim of this study was to evaluate the usefulness of [99mTc]MIBI thyroid scintigraphy in the diagnostic algorithm of thyroid nodules, particularly in ultrasound EU-TIRADS 4 or 5 lesions, that cytologically were either indeterminate or benign. ETHODS: A retrospective randomized study, including 42 thyroid patients, with mean age 47 ± 17 years, was conducted. [99mTc]MIBI scan was compared with ultrasound (US) EU-TIRADS criteria, pertechnetate scan, FNAB and histopathological findings for the differentiation of malignant thyroid nodules from benign lesions. The US mainly detected hypoechoic inhomogeneous presentation of the thyroid nodules (35/42, 83.33%), 4 cases with isoechoic nodules and 2 cases presented with hyperechoic thyroid nodules. Histopathology revealed malignancy in 15/42 (35.71%), while all other patients 27/42 (64.29%) were benign. Visual analysis score showed that patients scored with 1+ and 2+ were statistically significant to be benign, while 13 vs. 10 pts that were visual score 3+ were malignant vs. benign (p > 0.05). Sensitivity was 100%, while specificity was very low 22.22%, PPV was 41.67%. Even [99mTc]MIBI scan is not routinely used as a daily practice diagnostic tool of thyroid nodules, we will further apply it on a larger group of patients and try to quantify the uptake of the radiotracer to see whether it will help in the diagnostic algorithm of thyroid nodules.

The Role of Ultrasound in Thyroid Assessment

The recent prevalence of ultrasonography (US) has facilitated the early detection and qualitative evaluation of thyroid nodules. Furthermore, novel technical developments are extending the application range of US for other thyroid diseases. The use of US to differentiate between thyroid carcinoma and benign nodule, between a metastatic lymph node and a reactive node, between thyroid lymphoma and chronic thyroiditis, and between destruction-induced thyrotoxicosis and Graves’ disease is introduced. Classification systems for thyroid nodule have shown high diagnostic accuracy for thyroid carcinomas except follicular carcinoma. US diagnosis of lymph node metastasis showed high specificity but low sensitivity. Patients who were suspected of thyroid lymphoma based on US findings should undergo incisional biopsy or thyroidectomy for diagnosis of the histologic type if fine needle aspiration biopsy findings suggest lymphoma. Patients should be carefully followed even if they were diagnosed as negative based on cytologic findings. Measurement of thyroid blood flow is helpful for diagnosing destruction-induced thyrotoxicosis, such as painless thyroiditis, by distinguishing the lesion from Graves’ disease. Ultrasonography is useful for diagnosing various thyroid diseases, including thyroid carcinoma. The remaining issue to be resolved is the diagnosis of follicular carcinoma. Trials using novel techniques to differentiate these lesions are expected. Key words: ultrasound, thyroid assessment

Prevalence of thyroid cancer in hyperthyroidism: Identifying risk factors for malignancy

Objective: Contrary to the previously held belief that hyperthyroidism may be protective against the development of cancer, a growing number of studies suggest a link between hyperthyroidism and thyroid cancer. The purpose of this study is to investigate the incidence of malignancy in patients undergoing total thyroidectomy for hyperthyroidism with toxic adenoma (TA), toxic multinodular goiter (TMNG), and/or Graves' disease (GD), and to identify factors predictive of malignancy. Materials and Methods: This is a retrospective study of patients aged 18 years and older who underwent total thyroidectomy for toxic adenoma and toxic multinodular goiter associated with hyperthyroidism and Graves' disease. Thyroidectomies were performed by a single surgeon at a tertiary teaching hospital between January 2014 and December 2020. Our cohort was divided into two separate groups based on whether the pathology results were malignant or benign. Results: Between January 2014 and December 2020, 199 patients were included, 66.3% were female and the average age was 44.6 years. Hyperthyroidism cases included 52.7% toxic multinodular goiter (TMNG), 9.1% toxic adenoma (TA), and 38.2% Graves’ disease (GD). The cohort revealed a 32.6% thyroid cancer incidence in hyperthyroid patients. The leading malignancy was papillary carcinoma. Hyperthyroidism causes significantly predicted malignancy; TMNG had a 42.8% malignancy rate, compared to 22.4% for GD and 16.3% for TA (p=0.005). Fine needle aspiration biopsy (FNAB) findings were significant for malignancy prediction (p=0.001), with 62.9% malignancy after non-diagnostic FNAB results. Conclusion: The study emphasizes the need for careful consideration of malignancy risk in hyperthyroidism cases. Factors such as FNAB results and the type of hyperthyroidism condition significantly influenced malignancy prediction. The results underscore the necessity for a thorough evaluation of hyperthyroid patients at risk of malignancy.

Clinico-Pathologic Evaluation of Surgeon-Performed Point of Care Neck and Thyroid Ultrasound in A Tertiary Government Institution: A Cross Sectional Study

Introduction: This is a cross sectional study conducted in a training hospital which seeks to evaluate the competency of surgical trainees in performing preoperative thyroid ultrasound. It aims to compare the surgeons’ ultrasound impression with the preoperative clinical diagnosis, fine needle aspiration biopsy (FNAC) findings, as well as the histopathology to determine the predictive accuracy of point of care ultrasound which can improve preoperative diagnosis and aid in surgical decision making. Methods: After a workshop on thyroid ultrasound, surgical oncology fellows and senior residents performed neck ultrasound using the ACR TIRADS criteria for describing thyroid nodules. Patients with thyroid nodules consulting from January to December 2021 were included. TIRADS score of 4 and above was used as a basis for FNAC. The histopathology was used as reference standard to determine accuracy of the US and FNAC. Results: There were 83 patients - 73 were females (87.95&) and 68 were less than 55 years old (81.93%). The agreement between clinical diagnosis and TIRADS was observed to be low (49.4%, kappa: 0.1) while the agreement between TIRADS and FNAC was moderately high (68.6%, kappa: 0.34). Clinical diagnosis alone tends to underreport malignant cases while the TIRADS score was able to correctly select the nodules which need to be biopsied. Using the TIRADS score of 4 as the cut off value, the sensitivity was 88.37% and the specificity was 43.6%. Conclusion: The study showed that surgeon performed ultrasound can improve preoperative diagnosis and can guide surgical decision making.

The Role of Fine Needle Aspiration Biopsy in The Diagnosis of Parotis Masses

Objective: The aim of this study is to determine the accuracy and usefulness of fine needle aspiration biopsy(FNAB) in the diagnosis of parotid masses. Materials and Methods: FNAB findings of 123 patients who were operated over a last ten years period were retrospectively analyzed and compared with histopathological findings. We examined the sensitivity, the specificity, the positive predictive value (PPV), the negative predictive value (NPV) of FNAB. Results: FNAB results of the patients who participated in the study are as follow; non-diagnostic for 7 patient (%5.7), atypia of undetermined significance for 7 patients(%5.7), bening neoplasm for 98 patients (79.7%) and malign cytology for 11 patients (%8.9). Histopathological results were maligned found in 1 out of 98 patients with benign neoplasm in cytology results in FNAB. The histopathological result was benign in 2 of 11 patients with malignant neoplasm in the cytology findings with FNAB. The specificity of FNAB in the diagnosis of parotid masses was found as 98% and the sensitivity was 90%. The positive predictive value (PPD) was detected as 86% and the negative predictive value was detected 98%. Conclusion: Since malignant masses of the parotid are rare and diverse, diagnosis with FNAB can be difficult. Another complicating factor is the similarity of low-grade malignant tumor and benign tumor. As a result, FNAB has high accuracy for benign parotid tumors, but low for malignant parotid tumors.

Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings

ObjectivesTo determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. Material and methodsThis retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. ResultsCore-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. ConclusionsCore-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.

The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience.

Assessing the validity and clinical utility of axillary ultrasonography (AUS)-guided fine needle aspiration biopsy (FNAB) in detection of nodal metastasis during preoperative axillary investigation in comparison to the histopathologic diagnosis in early-stage breast cancer. A total of 279 operated primary breast cancer patients (age: 55.3 ± 12.8, ranged 17-90 years) were included. Data on AUS findings at the time of initial diagnosis (first look AUS), second-look AUS findings performed by the breast radiologist during breast biopsy procedure and the AUS-guided FNAB findings were evaluated with respect to the final histopathology report obtained through axillary surgery via sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The diagnostic performance of each method in detecting metastatic ALNs were compared in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). The sensitivity, specificity, and accuracy of the first look AUS in detecting nodal metastasis were 64.56%, 86.78%, and 74.19% while the PPV and NPV were 86.44% and 65.22%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS were 70.25%, 87.60%, and 77.78%, while PPV and NPV were 88.10% and 69.28%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS guided FNAB were 89.19%, 73.33%, and 87.30%, while the PPV and NPV were 96.12% and 47.83%, respectively. The consideration of second-look AUS and finding of nodal metastasis in FNAB was associated with significantly higher likelihood of ALND (55.4% vs. 44.6%, p < 0.001) and lower likelihood of SLNB (34.7% vs. 65.3%, p < 0.001) compared to consideration of nonmetastatic ALN status. In 23 (22.3%) patients with positive findings on AUS-guided FNAB, SLNB was applied; 21 had positive results after surgical dissection, indicating that nearly 20% of patients had unnecessary SLNB. US-guided FNAB of suspicious ALNs is a simple, minimally invasive, and highly effective method for preoperative axillary staging in patients with invasive breast cancer avoiding the more invasive method SLNB and it enables the surgeon to proceed directly to ALND in positive cases.

Metastatic prostate adenocarcinoma to cervical lymph nodes: an unusual diagnosis on fine-needle aspiration biopsy

Metastatic prostatic adenocarcinoma (PAC) has mostly involved the pelvic lymph nodes; metastases to the cervical lymph nodes are exceedingly rare. A retrospective review of cytopathology files (January 1990 to March 2019) identified 13 cases of metastatic PAC to cervical lymph nodes diagnosed using fine-needle aspiration biopsy (FNAB). The clinical and demographic information were collected from the electronic medical records, and the slides were reviewed. A total of 13 male patients with a mean age at FNAB 69 years (range, 61-86 years); 12 patients had a known history of PAC. In the patient without a history of PAC, the FNAB finding had been misinterpreted as papillary thyroid carcinoma. The interval between the original diagnosis and cervical lymph node metastasis was 98.5 months (range, 1-288 months). Most involved the left side (85%). Most smears had a clean background with few lymphocytes (46%) and numerous cellular clusters in flat sheets and acini (62%) and were composed of polygonal cells (46%) with round-oval shaped nuclei and indistinct cell borders (92%). The cytoplasm was granular (61%) or scanty (46%). The nuclei were uniform, size ≥2 times that of a neutrophil (69%). Prominent nucleoli and anisonucleosis were seen in 54% of cases; cellular pleomorphism was infrequent (30%). Immunostains confirmed the prostate origin in 7 tissue cores. Metastatic PAC to the cervical lymph nodes occurs infrequently. If the history is unknown, cases can be misdiagnosed as metastases from cervical neoplasms. The findings indicating metastatic PAC to the cervical lymph nodes on FNAB include involvement of left-sided cervical lymph nodes in elderly male patients and cellular smears composed of uniform polygonal cells, arranged in flat sheets and acini, with granular cytoplasm, indistinct cell borders, and round-oval nuclei with prominent nucleoli.

Tükürük Bezi Kitlelerinde İnce İğne Aspirasyon Biyopsisi ve Histopatoloji Sonuçlarının Karşılaştırılması

Tükürük Bezi Kitlelerinde İnce İğne Aspirasyon Biyopsisi ve Histopatoloji Sonuçlarının Karşılaştırılması

Evaluation of axillary lymph node metastasis burden by preoperative ultrasound in early-stage breast cancer with needle biopsy-proven metastasis.

The findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial have questioned the use of axillary lymph node (ALN) dissection (ALND) in breast cancer patients with low ALN burden. In this study, our aim was to evaluate axillary nodal metastasis burden in patients with early-stage breast cancer who presented with metastatic lymph nodes diagnosed by fine needle aspiration biopsy (FNAB). The data from 346 patients with cT1-T2 breast cancer who showed positive FNAB results and were seen at Tianjin Medical University Cancer Hospital from January 2014 to December 2017 were retrospectively analyzed. The patients were divided into high axillary nodal burden (≥ 3 positive lymph nodes) or low axillary nodal burden (one to two positive lymph nodes) groups. The clinical, radiological, and pathological features were compared between the two groups. From the 346 patients, 136 (39.3%) had low axillary nodal burden and 210 patients had high axillary nodal burden. Compared to patients with high metastatic burden, the patients with low metastatic burden were more likely to have two or fewer abnormal lymph nodes detected by AUS (95.6% vs. 65.3%, p < 0.05), and more likely to have HR-/HER2- lesions (15.4% vs. 5.2%, p < 0.05). Multivariate analysis revealed that patients with more than two abnormal lymph nodes had an odds ratio of 18.385 (95% CI 7.315-46.205, p < 0.05) to have axillary metastasis. The presence of three or more abnormal lymph nodes on AUS was a significant indicator of high axillary nodal burden in early-stage breast cancer patients with positive FNAB findings. The combination of radiological and clinicopathological findings allows physicians to identify patients with high axillary nodal burden who will likely benefit from ALND in the post-ACOSOG Z0011 trial era.

MicroRNAs – promising molecular markers for detecting cancer in thyroid nodules

Thyroid nodules are one of the most common thyroid diseases. The prevalence of thyroid nodules is estimated to be 2–65% depending on the detection methods. Yet despite the high frequency of thyroid nodules only about 5–10% of such nodules are malignant. Fine needle aspiration cytology of the thyroid nodule is currently the primary diagnostic tool for determining the nature of a thyroid nodule. Now, the fine needle aspiration biopsy is the gold standard for diagnosing thyroid cancer but in 30% of cases the cytological conclusion is uncertain. Cytological research is not enough to diagnose benign and malignant tumors. The need to improve the effectiveness of fine needle aspiration biopsy findings led to the search for new diagnostic biomarkers and the creation of diagnostic panels on their basis for their application in the diagnosis of uncertain nodules. Determination of molecular markers in the thyroid aspirate will allow to differentiate benign and malignant tumors more accurately at the preoperative stage and reduce the number of inappropriate surgery. The review article presents the characteristics of MicroRNAs, allowing them to be used in preoperative diagnosis of thyroid nodules. Diagnostic panels based on gene mutations and MicroRNA expression demonstrating high sensitivity and specificity of these methods are also indicated. Analysis of literature indicates that molecular analysis of fine needle aspiration genetic material from thyroid nodal formations demonstrates great prospects of prognosis, diagnosis and treatment of thyroid cancer. However, there is no sufficient evidence to recommend or to prohibit of utilization this molecular testing during the cytological conclusion of indeterminate thyroid nodules. Molecular analysis (MicroRNA) is a perspective method for evaluation of thyroid nodal formations with indeterminate cytology, however, this method requires further study and improvement.

Prevalence of papillary thyroid cancer in subacute thyroiditis patients may be higher than it is presumed: retrospective analysis of 137 patients.

BackgroundThe association of subacute thyroiditis (SAT) and papillary thyroid carcinoma is a rare finding. In this study, we aimed to investigate the prevalence of differentiated thyroid cancer in a cohort of patients followed with the diagnosis of SAT.Patients and methodsWe retrospectively screened medical records of Endocrinology and Metabolism outpatient clinic in the past 20 years for patients with SAT. Patients with nodules and suspicious ultrasonography findings who underwent fine needle aspiration biopsy (FNAB) and operated due to malignancy risk were identified.ResultsWe identified 137 (100 females, 37 males) patients with reliable records to confirm the diagnosis of SAT. The mean age of female patients was 41.1 ± 9.1 (range, 20–64) and of male patients was 43.0 ± 9.3 (range, 20–65). One or more FNAB was performed in 23 of the patients (16.8%) at the beginning and/or during the follow-up period when needed. Seven patients with suspicious FNAB findings were operated, and histopathological examination of the nodules confirmed the diagnosis of papillary thyroid carcinoma in 6 patients (4.4%).ConclusionsOur observations suggesting a relatively higher prevalence of thyroid cancer in a small series of SAT patients warrant further studies to identify the real frequency of differentiated thyroid cancer and its association with inflammatory pathogenesis of SAT. This finding is compatible with the trend of increased thyroid cancer incidence all over the world. A repeat ultrasonography after resolution of clinical and inflammatory findings, and FNAB should be recommended to all patients with suspicious nodules.

Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study.

AIMTo evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery.METHODSWe retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinical parameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric Mann-Whitney U test was used to compare quantitative data that were not normally distributed, and Pearson’s chi-squared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method.RESULTSThis study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy (P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively.CONCLUSIONThis study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.

Cytological and Ultrasound Findings in Indeterminate Lesions of the Thyroid Gland

Thyroid nodules are common, and the majority are discovered incidentally on physical examination or imaging studies. Certain features on ultrasound (US) have been traditionally associated with malignant lesions and others with benign lesions. The aim of this study was to investigate the efficacy of US in determining malignancy in thyroid lesions diagnosed as indeterminate or malignant according to the cytological findings on fine needle aspiration biopsy (FNAB). The records of 270 patients, referred to a single clinic with multinodular goiter were evaluated retrospectively, and 400 thyroid nodules sized larger than 5 mm in diameter were selected for the study. After exclusion of nodules classified as benign according to the FNAB findings, 203 thyroid nodules were included in this study. The nodules were divided into two groups on the basis of the FNAB findings: group 1 consisted of 82 nodules with indeterminate cytology and group 2 consisted of 121 nodules with cytological findings of malignancy or suspicious for malignancy. The diagnostic accuracy of ill-defined borders was 69.5% in group 1 (indeterminate) and 56% in group 2 (p=0.04). The diagnostic accuracy of solid composition was 50% in group 1 and 73% in group 2 (p=0.01). Positive correlation was demonstrated between ill-defined margins and malignant histology in group 1 (r=0.411, p=0.001), and between microcalcifications and malignant histology in group 2 (r=0.247, p=0.002). In this study, the only US finding shown to be correlated with malignant histology in thyroid nodules of indeterminate cytology on FNAB was ill-defined margins. More precise US criteria are needed to decide on surgery in patients with thyroid nodules of indeterminate cytology.

Comparison of ultrasound and fine needle aspiration biopsy in terms of determining of preoperative malignancy in thyroid nodules

To reveal the diagnostic efficacy and accuracy, compared with postoperative histopathological diagnosis, preoperative ultrasonography (US) and fine needle aspiration biopsy (FNAB) in determining benign and malignant disease in patients undergoing thyroidectomy in our clinic. Materials and methods: The research was designed with records of 95 patients who were examined thyroidectomy at our hospital Ear, Nose and Throat Clinic for five years. Preoperative ultrasound findings, FNAB results, postoperative histopathological findings, blood groups, age and sex were recorded. These data were each compared with the histopathological results in order to determine which technique was superior in distinguishing malignant from benign thyroid nodules. Ninety-five patients, aged between 21 and 76, 27 male and 68 female, were included. Mean age of male patients was 51.11±13.54 and mean age of female patients 49.18±11.92. Total thyroidectomy was performed in 82 (86.3%) cases, left lobectomy in 3 (3.2%), right lobectomy in 4 (4.2%) and total thyroidectomy plus neck dissection in 6 (6.3%). Of the cases thought to be benign at US, 76.4% were actually benign, and 83.33% of the cases thought to be malignant were actually malignant. The level of cases incorrectly identified as benign or malignant was 23.16%. Validity (test power) of US on the basis of postoperative diagnosis was 76.84%. In terms of FNAB findings, 27.78% of cases suspected of being malignant were malignant, and 72.73% of the group assessed as having benign cytology was actually benign. The level of cases incorrectly identified as being malignant or benign was 35.79%. FNAB test reliability (test power) on the basis of postoperative diagnosis was 56.1%. In addition, only US findings were significant when compared with histopathological findings in preoperative determination of malignant or benign disease (p=0.001), all other data being not significant (p˃0.05). The use of US findings in differentiating malignant from benign thyroid nodules and in accordingly planning treatment is more effective than use of FNAB.