Fine-needle Aspiration Biopsy Research Articles

Fine-Needle Aspiration Biopsy of Adrenal Gland Lesions: The Roles of Image Guidance, Rapid On-Site Evaluation and Additional Tissue Sampling.

An accurate fine-needle aspiration (FNA) diagnosis of adrenal lesions may be challenging. This study was to investigate roles of imaging guidance, rapid on-site evaluation (ROSE) and additional tissue sampling in FNA diagnosis of adrenal lesions. Adrenal FNA cases were retrieved from pathology archive. Patients' demographics, lesion size and location, imaging guidance methods, cytologic diagnoses and histopathologic diagnoses were reviewed and analysed. The study cohort included 72 cases of left (86%) and right (14%) adrenal lesions. Endoscopic ultrasound (EUS) and computed tomography (CT) were used in 47 (65%) and 25 (35%) cases, respectively. Left adrenal lesions were sampled mostly by EUS-FNA (73%), whereas right adrenal lesions by CT-guided FNA (80%). There were no differences between the EUS-FNA and CT-FNA groups in terms of non-diagnostic rate and cytologic diagnostic categories. The non-diagnostic rate and cytologic diagnostic categories were the same between ROSE and non-ROSE groups. In a subset of 18 cases with concurrent core tissue biopsy, a definite diagnosis was rendered in all biopsy cases including three cases with a non-diagnostic or indeterminate cytology diagnosis. Our study demonstrates that FNA has great efficacy for evaluation of adrenal lesions, either via EUS or CT guidance. Incorporation of ROSE evaluation into FNA procedure does not directly affect the performance of FNA biopsy but may help direct additional tissue sampling to salvage the cases with a non-diagnostic or indeterminate cytology diagnosis, increasing diagnostic yield.

Thyroid Nodules with Indeterminate Cytology and Negative Molecular Profile: Prevalence of Malignancy and Practice Paradigms for Surveillance.

Background: In the era of molecular testing, thyroid nodules with indeterminate cytology are increasingly being managed nonoperatively. The false-negative rates of these molecular tests, and therefore missed malignancies, are not well defined in real-world clinical practice. Methods: This retrospective study of patients undergoing fine needle aspiration (FNA) biopsy at our health system between November 2017 and March 2022 included nodules with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) III and IV cytology and negative, currently negative, or negative but limited ThyroSeq version 3 (TSv3) results. Surgical pathology of resected nodules, as well as details of ultrasound (US) surveillance practices, was recorded. A range of prevalence of malignancy (PoM) estimates were calculated based on all nodules (PoM low) and surgically resected nodules (PoM high). Results: The study cohort consisted of 556 nodules. TSv3 results were distributed as 443 (80%) negative, 85 (15%) currently negative, and 28 (5%) negative but limited. Overall, 75 nodules were resected: 54 nodules (9.7%) had immediate surgery, and 21 nodules (3.8%) had delayed surgery after surveillance imaging. Currently negative and negative but limited nodules were more likely to undergo immediate surgical resection compared with negative nodules (20%, 18%, and 7%, respectively, p < 0.001). The PoM in molecularly benign TBSRTC III and IV thyroid nodules ranged between 3% and 23% depending on the inclusion of all versus resected nodules. TBSRTC IV molecularly benign nodules had a higher PoM than TBSRTC III (PoM low 7.3% vs. 1.6%, p < 0.001; PoM high 48% vs. 13%, p = 0.0013). In the 90% of nodules that were managed nonoperatively, 63% had at least one surveillance US. Timing of initial surveillance US ranged from 3 to 60 months (median 13 months, interquartile [IQR] 11-19 months). Median follow-up duration was 25 months (IQR 17-34 months). Nodule growth occurred in 24% of nodules; only a minority (7%) underwent repeat FNA. Conclusions: Negative subtype of TSv3 should be considered in clinical management recommendations. For negative but limited samples, repeat FNA should be performed. Optimal surveillance strategy for nonresected negative and currently negative nodules remains unknown. Until further real-world data are available, surveillance ultrasonography is recommended for TSN and TSCN nodules, similar to the ATA guidelines for TBSRTC II nodules.

P-13 EXTRANODAL LYMPHOMA WITH ENDOCRINE ORGAN INVOLVEMENT: CASE REPORTS

Abstract Introduction The incidence of extranodal lymphomas has increased in the last decade, most commonly occurring in the gastrointestinal tract, head and neck, skin/soft tissue and central nervous system. We report two cases of extranodal lymphoma in the thyroid and adrenal gland. Clinical Cases A 61-year-old male patient diagnosed with Small Lymphocytic Lymphoma (CLL) was referred to us after his follow-up at the Hematology Clinic. Thyroid ultrasonography (USG) revealed a nodular ovoid lesion, that has a semisolid structure of 36x12 mm in size, with a cystic component in the center, located at the right lobe - isthmus junction, and with increased vascularity. Laboratory tests were as in Table 1. It was learned that the patient had received chemotherapy for CLL in 2009 and was in remission, and there was no family history of thyroid cancer. Since the fine needle aspiration biopsy (FNAB) was suspicious for lymphoid neoplasia, a tru-cut biopsy was performed. The flow cytometry result was found to be compatible with B-cell clonality, and the pathology result revealed mature B-cell neoplasia infiltration. Immunohistochemically, dense plasma cells were observed with CD138. Thyroidectomy was recommended to the patient, but he refused and was followed up. A 73-year-old female patient was referred to our clinic with the suspicion of adrenal insufficiency due to ongoing nausea, vomiting, and hypotension symptoms. Laboratory tests at presentation were as shown in Table 2. The patient was started on 80 mg/day methylprednisolone, which was thought to be acute adrenal insufficiency biochemically and clinically, and since hyperkalemia persisted, 0.05 mg/day fludrocortisone was added to the treatment. It was learned that the patient had been examined for abdominal pain for 6 months, and 15 mm nodular lesions were observed in both adrenal glands in the abdominal CT, but no further examination was performed. In adrenal CT, lesions measuring 41x30 mm on the right and 30x22 mm on the left at the body-medial crus level were observed in both adrenal glands, with a density higher than expected for adenoma (Figure 1). The findings were evaluated as significant in favor of nonadenomatous lesions, and due to progression in lesion sizes and high suspicion of malignancy, pheochromocytoma was excluded by checking urine catecholamines from the lesion in the right adrenal gland, and a tru-cut biopsy was performed. As a result of the pathology, the patient was diagnosed with high-grade B-cell neoplasia and hematological treatment was started. Conclusion Extranodal lymphoma involvement has been described with multiple different presentations in every tissue of the body, even within an organ system. Therefore, it should be included in the differential diagnosis of mass lesions. Tissue biopsy and immunohistochemistry are the most important methods for determining the specific subtype and cell origin.Figure 1:CT images of patientLesions in bilateral adrenal glands Table 1:Laboratory workup*Thyroid Stimulating Hormone. Table 2:Laboratory workup*Blood Urea Nitrogen,C-reactive Protein, Adrenocorticotropic hormone, Thyroid Stimulating Hormone

P-19 A PATIENT WITH ATYPICAL PARATHYROID ADENOMA

Abstract Introduction Primary hyperparathyroidism is most frequently caused by a parathyroid adenoma, occasionally by parathyroid hyperplasia, rarely by atypical parathyroid adenoma and parathyroid carcinoma. Here, we present a case diagnosed as PHPT pathology revealed atypical parathyroid adenoma. Clinical Case A 49-year-old male patient was referred to our endocrinology clinic because of hypercalcemia identified for the investigation of nephrolithiasis. The patient reported no hypercalcemia-related symptoms. His physical checkup was unremarkable. The results of the laboratory investigations were as follows: calcium 10.9 mg/dL (8.8–10.6), albumin 4.2 g/dL (3.5–5.2), phosphorus 2.15 mg/dL (2.5–4.5), 25-OH vitamin D 13 μg/L, PTH 142 ng/L (15–65), creatinine 0.59 mg/dL (0–1.2), and 24-hour urine calcium 647.4 mg/day (0–300). Neck ultrasonography revealed two hypoechoic nodules, the biggest measuring 13.5 x 9 mm in the right thyroid lobe. Parathyroid scintigraphy revealed no typical signs consistent with a parathyroid adenoma in the neck or mediastinum. Four-dimensional computed tomography of the neck revealed an 8 mm, well-circumscribed, bilobed lesion in the posterior-inferior region of the right thyroid lobe, that did not augment with intravenous contrast and was regarded as an exophytic thyroid nodule. A fine-needle aspiration biopsy was done and the results were reported as follicular lesions of uncertain significance. A PTH washout test was performed on the same nodule, resulting in a value of almost 5000 ng/L. A choline PET/CT scan revealed a 13 mm soft tissue lesion with enhanced radiotracer uptake (SUV max: 5.39) posterior to the lower pole of the right thyroid lobe, indicating a parathyroid adenoma. The patient underwent a right thyroid lobectomy and the right inferior pole parathyroid adenoma was excised. The surgical specimen's histopathological investigation revealed neoplastic parathyroid tissue with lack of reticulin architecture and fibrotic bands, abnormal lack of parafibromin staining indicating an atypical parathyroid adenoma. The postoperative calcium level was 9.7 mg/dL, the phosphorus level was 2.8 mg/dL, and the PTH level was 65.2 ng/L. Conclusion Atypical parathyroid adenoma is very rare and hard to diagnose. Its prognosis is unclear, so regular surveillance is crucial. The patient is closely monitored for recurrence.

P-59 A CASE REPORT: A RARE CASE OF PAPILLARY THYROID CARCINOMA WITH BRAIN METASTASIS WITHOUT LOCAL RECURRENCE

Abstract Introduction Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and generally has an excellent prognosis. However, distant metastases, particularly to the brain, are rare and associated with poor outcomes. This case report presents a 67-year-old female patient with a history of PTC, who developed brain metastasis in the follow-up. Clinical Case A 67-year-old female patient presented four years ago with a rapidly growing 4 cm mass, extending from the right thyroid gland to the right jugular vein. Fine-needle aspiration biopsy (FNAB) of the lesion was reported as suspicious for follicular neoplasm. Ultrasound imaging revealed pathological lymphadenopathy in the bilateral cervical chains. The patient underwent total thyroidectomy and bilateral neck dissection. Pathology confirmed the diagnosis of the follicular variant of papillary thyroid carcinoma (PTC), with extrathyroidal extension into muscle and adipose tissue, as well as lymph node metastases. After surgery, while the patient's TSH level was 68.6 µIU/ml, her thyroglobulin (Tg) level was 1.02 ng/ml, with negative anti-Tg antibodies. The patient received 150 mCi of radioactive iodine (RAI) approximately 3 months after surgery. One year after RAI therapy, a whole-body iodine scan showed no evidence of residual disease or metastasis. Follow-up Tg levels of the patient remained around 0.04 ng/ml. 3.5 years after surgery, there was a slight increase in thyroglobulin levels (0.26 ng/ml), although no recurrent disease was detected on ultrasound of the thyroid bed. The patient was planned to be under close surveillance but she did not come to visits regularly. The patient subsequently presented with complaints of imbalance and brain MRI revealed a mass lesion measuring 46x43x55 mm in the frontal region. The mass was surgically resected, and the pathology confirmed metastatic papillary thyroid carcinoma (PTC). A postoperative whole-body iodine scan was negative for metastatic disease. At that time, the TSH level was 0.5 µIU/ml, and thyroglobulin (Tg) was 0.04 ng/ml. Cranial radiotherapy was planned for the patient. Conclusion Approximately 10% of patients with PTC develop distant metastases, most commonly to the lungs and bones. Brain metastasis from PTC is extremely rare, occurring in less than 1% of cases. Due to its rarity, brain metastasis from PTC is not typically considered in the differential diagnosis for patients presenting with new neurological symptoms, potentially delaying diagnosis. Despite aggressive treatment, the prognosis for patients with PTC and brain metastasis remains poor, with a median survival of approximately 17 months. This case highlights the importance of considering the possibility of brain metastasis in high-risk PTC patients who present with neurological symptoms despite the lack of significant elevation in thyroglobulin (Tg) levels or evidence of recurrence on neck ultrasound.

P-66 A INSTANCE OF PAPILLARY THYROID CANCER MANIFESTED WITH SCAPULAR METASTASIS

Abstract Introduction Bone metastasis of well differentiated thyroid tumors observed in 2% and 13% of the patients. Bone metastasis usually occurs mostly in spine, but also in extremities, rib cage and pelvic bones. Here we present a case differentiated thyroid cancer diagnosed with scapular bone metastasis. Clinical Case A 58-year-old male patient had pain on his left scapula that began a year ago. The intensity of the pain worsened over the months. It did not wake him up, but it worsened when he slept on his back. There was no history of trauma, shortness of breath, or pain while swallowing. Physical examination revealed soreness and abnormality at the lateral edge of the scapula. The thyroid gland was not palpable. He was diagnosed with benign prostatic hyperplasia. His family did not have a history of malignancy. He was a lifelong nonsmoker who consumed alcohol infrequently. A magnetic resonance imaging (MRI) of the left shoulder was scheduled due to a suspicious tumor seen on shoulder x-ray imaging. An MRI revealed a 44x40 millimeter mass lesion, T1A hypointense and T2A hyperintense, superimposed on the body of the scapula, causing bone structural enlargement (Figure 1). A tru-cut biopsy was performed, and the pathology results were consistent with thyroid cancer metastases. Positron emission tomography/computed tomography was planned for further metastatic investigation; no new metastases were identified. Hemoglobin: 14.3 g/dL, platelets: 192x109/L creatinine: 0.85 mg/dL calcium: 9.13 mg/dL, AST/ALT: 14/13 U/L, TSH: 1.67 mIU/L, free T4: 0.94 ng/dL. Ultrasonography showed 16x8x8 mm hypoechoic solid nodule with microcalcifications was seen in the posterior of the left lobe and 7x6 mm hypoechoic solid nodule was seen in the posterior right lobe, and reactive lymph nodes smaller than 1 cm were discovered in the bilateral cervical chain. A fine needle aspiration biopsy of a thyroid left lobe inferior nodule revealed follicular neoplasm bethesda V. Total thyroidectomy was performed. Pathology report revealed papillary carcinoma with a classic+follicular pattern, localized in the right lobe, invasion of the tumor capsule, and multifocal intrathyroidal and lymphatic invasion were present. The mitotic index was 0–1/2 mm². The patient’s cancer stage was T1bNxM1, STAGE 4B according to thyroid cancer staging calculator. Risk score was evaluated as high according to American Thyroid Association. Bone metastases received 30 GY of radiation over a 10-day period. 150 mci radioactive iodine therapy (RAI) was scheduled for two months after radiation treatment. Anti-thyroglobulin antibody 12.8 U/mL (0-115), thyroglobulin 0.0693 µg/L, TSH 0.013 mIU/L, and freeT4 1.28 ng/dL at fourth month following surgery under levothyroxin suppression medication. Conclusion Papillary thyroid cancer with bone metastasis shortens life expectancy. Total thyroidectomy, anti-resorptive bone agents, corticosteroids, RAI, metastasectomy, radiotherapy, tyrosine-kinase inhibitors are the treatment options.Figure1:44*40 milimeter mass lesion on scapula

Limited Utility of Routine Surveillance Ultrasound in Differentiated Thyroid Cancer Patients With Undetectable Postoperative Thyroglobulin Levels.

Neck ultrasound (US) and serum thyroglobulin (Tg) measurements are mainstays of long-term differentiated thyroid cancer (DTC) surveillance. Given the high sensitivity of serum Tg, we aimed to assess the utility of neck US in DTC patients who underwent total thyroidectomy and have undetectable serum Tg. We performed a retrospective cohort analysis of DTC patients who underwent a total thyroidectomy at our institution (2010-2023) and received US-guided fine needle aspiration (FNA) during their surveillance. Patients were categorised into three lab categories based on serum Tg and Tg antibody (Tg Ab) status before the biopsy: (1) 'Negative Tg' if undetectable Tg ( < 0.2 ng/dL) and Tg Ab, (2) 'Positive Tg' if detectable Tg and undetectable Tg Ab, and (3) 'Positive Tg Ab' if detectable Tg Ab. To calculate the positive predictive value (PPV) of neck US, we defined the 'true positive' of US as findings that prompted an FNA biopsy resulting with DTC, and 'false positive' findings prompting an FNA biopsy that did not result as DTC. A total of 118 patients were included, encompassing 146 FNA biopsies: 33 (23%) had Negative Tg, 84 (57%) had Positive Tg, and 29 (20%) had Positive Tg Ab lab results before their biopsies. The PPV of neck US in the setting of Negative Tg was 3% (one true positive, 32 false positives), while the PPV was 50% (42 true positives, 42 false positives) for Positive Tg, and 52% (15 true positives, 14 false positives) for Positive Tg Ab cohorts. Sub-analysis of the Positive Tg cohort using different serum Tg level cutoffs revealed a PPV of 29% at just detectable serum Tg of 0.2 ng/dL, and PPV of 38% for Tg < 1.0 ng/dL. The PPV stabilised at 58% for Tg levels ≥ 1 ng/dL. With the low PPV of neck US, high cost of surveillance, and the advent of ultra-sensitive serum Tg measurements, future guidelines should consider reducing routine neck US surveillance in patients with undetectable serum Tg and only performing it when there is a rise in serum Tg levels.

Improving the efficiency of thyroid cancer diagnostics in difficult diagnostic conditions using molecular diagnostic methods

Purpose of the study. To develop a diagnostic calculator for assessing the expression of profile microRNAs (miRNAs) that are significant for the oncogenesis of thyroid cancer, to introduce it into clinical practice and to evaluate the effectiveness of the proposed method for early diagnosis of malignant neoplasms of the thyroid gland in uncertain diagnostic situations after fine-needle aspiration biopsy (FNAB).Material and methods. The previously developed «Method for Diagnosing Malignant Neoplasms of the Thyroid Gland» (patent RU2820815 C1) was tested on 284 patients of the dispensary group with nodular formations of the thyroid gland according to the results of ultrasound and an uncertain conclusion after FNAB. The number of patients with papillary thyroid carcinoma was 83 (29,2%), follicular carcinoma 43 (15,1%) and with benign thyroid pathology (follicular adenoma) – 158 (55,6%) people. The expression of miRNA-146b and –574–3p in cytological samples of thyroid nodules after FNAB was assessed using the real-time PCR method.Results. In thyroid cancer patients, the expression of miRNA-146b was higher (p=0,007) compared to patients with benign pathology, while the expression activity of miRNA-574–3p was lower (p=0,013). To assess the index of reciprocal paired dysregulation of miRNA-146b and miRNA-574–3p expression in thyroid cells, it is recommended to determine the ratio of the expression values of the corresponding molecules. If the ratio index of miRNA-146b and miRNA-574–3p expression is higher than 4.5, then a conclusion is made about a malignant neoplasm of the thyroid gland. The diagnostic coefficient calculated by the developed formula using the logistic regression method also allows diagnosing malignant neoplasm of the thyroid gland when compared with the cutoff level. The proposed methods are highly informative.Conclusion. Evaluation of the expression of miRNA-146b and miRNA-574–3p in the cells of thyroid nodules obtained by FNAB allows improving the diagnosis of malignant pathology in mutation-negative thyroid nodules with uncertain FNAB results.

Claudin 18.2: An attractive marker in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDA) is a highly aggressive tumor with limited treatment options. Zolbetuximab, a monoclonal antibody against the tight junction protein Claudin 18.2 has recently been developed. At present, few and conflicting data have been reported regarding the clinical-pathological features of Claudin 18.2 expression in PDA. The present study investigated the expression of Claudin 18.2 in histological samples from PDA patients with the aim of verifying its utility as a therapeutic biomarker. Claudin 18.2 immunoreactivity was assessed by immunohistochemical staining on 70 formalin-fixed, paraffin-embedded PDA specimens (28 surgical specimens and 42 fine needle aspiration biopsies). The results obtained were associated with the clinicopathological characteristics and the survival rate of patients. Claudin 18.2 was detected only in neoplastic cells, not in normal pancreatic tissue. Claudin 18.2 was positive in 50% of samples and a higher expression was associated with well- and moderately-differentiated tumors and lymph node-negative status. The high expression of Claudin 18.2 in neoplastic tissue and absence in normal cells suggested that this protein had an attractive role in PDA as both a diagnostic and a prognostic-therapeutic marker. High expression of Claudin 18.2 in neoplastic tissue was associated with more favorable prognostic parameters and the high percentage of positive samples obtained suggests that Zolbetuximab may be suitable for a large number of patients.

Analysis of the service needs of outpatients undergoing thyroid fine needle aspiration biopsy based on the Kano model

BackgroundThyroid nodules are common, and fine needle aspiration biopsy (FNAB) is essential for diagnosis and treatment. Patients’ service needs are rarely addressed and discussed. This study was to analyze the nursing service needs of patients undergoing outpatient thyroid FNAB.MethodsUsing the Delphi method, indicators of nursing service needs were established. A survey based on the Kano model was conducted from February to May 2024 to analyze service needs among patients undergoing thyroid FNAB. A quadrant analysis chart was used to visualize the impact of service characteristics on patient satisfaction.ResultsAmong the 32 service needs, 12 items were in the improved category, 10 items were in the advantage category, 9 items were in the reserved category, and 1 item was in the observation category.ConclusionsThe Kano model effectively categorizes the service needs of outpatients undergoing thyroid FNAB, guiding healthcare providers to enhance patient satisfaction through optimized services.Trial registrationThe registration number is ChiCTR2400080522, and the registration date is January 30, 2024.

Direct Prediction of 48 Month Survival Status in Patients with Uveal Melanoma Using Deep Learning and Digital Cytopathology Images.

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The median overall survival time for patients who develop metastasis is approximately one year. In this study, we aim to leverage deep learning (DL) techniques to analyze digital cytopathology images and directly predict the 48 month survival status on a patient level. Fine-needle aspiration biopsy (FNAB) of the tumor was performed in each patient diagnosed with UM. The cell aspirate was smeared on a glass slide and stained with H&E. Each slide then underwent whole-slide scanning. Within each whole-slide image, regions of interest (ROIs) with UM cells were automatically extracted. Each ROI was converted into super pixels, and the super pixels were automatically detected, segmented and annotated as "tumor cell" or "background" using DL. Cell-level features were extracted from the segmented tumor cells. The cell-level features were aggregated into slide-level features which were learned by a fully connected layer in an artificial neural network, and the patient survival status was predicted directly from the slide-level features. The data were partitioned at the patient level (78% training and 22% testing). Our DL model was trained to perform the binary prediction of yes-versus-no survival by Month 48. The ground truth for patient survival was established via a retrospective chart review. A total of 74 patients were included in this study (43% female; mean age at the time of diagnosis: 61.8 ± 11.6 years), and 207,260 unique ROIs were generated for model training and testing. By Month 48 after diagnosis, 18 patients (24%) died from UM metastasis. Our hold-out test set contained 16 patients, where 6 patients had passed away and 10 patients were alive at Month 48. When using a sensitivity threshold of 80% in predicting UM-specific death by Month 48, our model achieved an overall accuracy of 75%. Within the subgroup of patients who died by Month 48, our model achieved a prediction accuracy of 83%. Of note, one patient in our test set was a clinical surprise, namely death by Month 48 despite having a GEP class 1A tumor, which typically portends a good prognosis. Our model correctly predicted this clinical surprise as well. Our DL model was able to predict the Month 48 survival status directly from digital cytopathology images obtained from FNABs of UM tumors with reasonably robust performance. This approach, if validated prospectively, could serve as an alternative survival prediction tool for patients with UM to whom GEP is not available.

Incidental Mucinous Neoplasms of the Pancreas: Performance of the AGA, European, and IAP Guidelines in Advising Further Management after Endoscopic ultrasound-guided fine-needle Aspiration Biopsy.

We compared the performance of AGA-2015, ESG-2018, and IAP-2024 guidelines in referring patients for surgery versus surveillance when applied to incidental after diagnosis by EUS-FNA. Single-center, retrospective study with prospective data collection. PLs identified incidentally on CT or MRI/MRCP performed for other diseases with inconclusive imaging results were eligible for analysis. After EUS-FNA and microhistological diagnosis, each of the guidelines was applied; sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were compared. 140 asymptomatic patients (mean age 64.7y, 61% female) had a confirmed diagnosis of MN. Of these, 42 (30%) had "high rik stigmata" and 16 (11.4%) were malignant. AGA-2015, ESG-2018, and IAP-2024, criteria would have advised surgery unnecessarily in 66%, 15%, and 46%, respectively (P<0.001). AGA-2015, ESG-2018, and IAP-2024, and criteria failed to identify 59%, 46.1%, and 33.3% of HGD/IC, respectively (P=1.00). The AGA-2015 criteria were highly specific, while IAP-2024 had superior sensitivity. All had moderate sensitivity to indicate surgery, and all missed similar numbers of malignant lesions. Performing EUS-FNA before application of guidelines seems appropriate to guide further management of asymptomatic PLs, preventing unnecessary surgery and referring patients appropriately for surveillance. The ESG-2018 guideline proved most accurate for this purpose.

Fine-Needle Aspiration Biopsy as an Adjunct Diagnostic Tool for Polymorphous Adenocarcinoma of the Soft Palate: A Case Report.

Fine-Needle Aspiration Biopsy as an Adjunct Diagnostic Tool for Polymorphous Adenocarcinoma of the Soft Palate: A Case Report.

Correlation between TI-RADS classification, fine needle aspiration biopsy and paraffin biopsy in the diagnosis of thyroid nodular disease

Introduction: nodular thyroid disease requires invasive and non-invasive means of diagnosis, the former being the gold standard. Objective: to determine the existence of correlation between the results of the TI-RADS and Bethesda classifications and paraffin biopsy in patients with nodular thyroid disease treated at the Hospital General Docente ‘Abel Santamaría Cuadrado’ between 2019 and 2022. Methodological design: an observational, analytical and cross-sectional study was conducted. The universe consisted of 202 patients according to inclusion criteria. To test the effectiveness of the procedures, sensitivity and specificity were evaluated. To determine the agreement between variables, Cohen's kappa was studied. Results: 63 patients were studied, with a mean age of 50.11 ± 15.71 years and predominantly female (82.5 %). Benign nodular disease was identified by biopsy in 73 % of patients. Inter-instrument agreement was Kappa=0.733 (good agreement) between TI-RADS and biopsy, Kappa=0.374 (poor agreement) between Bethesda and biopsy and Kappa=0.445 (moderate agreement) between TI-RADS and Bethesda. The sensitivity of TI-RADS was 88.2 % and specificity 89.1 % and of Bethesda sensitivity 94.1 % and specificity 55.6 %. Conclusions: There was good agreement between TI-RADS and paraffin biopsy, poor agreement between fine needle aspiration biopsy and paraffin biopsy and moderate agreement between TI-RADS classification and fine needle aspiration biopsy

Safety and Feasibility of US-guided Microwave Ablation for the Treatment of Bethesda III Thyroid Nodules with Negative Eight-Gene Panel Mutational Profile.

Purpose To evaluate the safety and efficacy of US-guided thermal ablation in the treatment of Bethesda III thyroid nodules with negative eight-gene panel testing results. Materials and Methods This retrospective single-center study included patients with thyroid nodules diagnosed as Bethesda category III (atypia of undetermined significance) at fine-needle aspiration biopsy and with negative eight-gene testing results who were treated with US-guided microwave ablation (MWA) between July 2020 and September 2023. Incidence of complications, technical success rate (TSR), volume reduction rate (VRR), nodule recurrence, and thyroid function were evaluated over a follow-up period of 2 years. Data before and after MWA were compared using variance analysis and the Cochran-Mantel-Haenszel χ2 test. Results A total of 101 Bethesda III nodules were detected in 95 patients (mean ± SD age, 47.08 years ±14.63; 79 female patients, 16 male patients), all of which were completely ablated (100% TSR). Two patients experienced mild neck swelling and pressure sensation after the minimally invasive operation, and the incidence of postoperative complications was 2% (two of 95). None of the patients experienced tumor recurrence or progression. At 2-year follow-up, the mean VRR of the ablated area was 90.88% ± 13.59 in 15 patients; 87% (13 of 15) of these patients had a 100% VRR. There was no evidence of a difference in thyroid function before and after MWA from 1 to 24 months (P = .15-.99). Conclusion US-guided MWA was safe and effective for the treatment of Bethesda III thyroid nodules with negative eight-gene panel testing results. Keywords: Ablation Techniques, Radiation Therapy/Oncology, Head/Neck, Thyroid, Safety, Observer Performance Published under a CC BY 4.0 license.

Proteomics unveil candidate biomarkers and pathogenesis of subacute thyroiditis.

Subacute thyroiditis (SAT) is an inflammatory thyroid disease characterized by neck pain, tenderness, general symptoms, and thyroid dysfunction. Despite gaining new insights into the epidemiology, pathogenesis, and treatment of SAT in recent years, the exact pathogenesis and determinants of its clinical progression remain unclear. Here, we profiled thyroid in situ protein alterations in fine needle aspiration biopsy samples from SAT patients using proteomic analysis and uncovered 57 differentially abundant proteins. Gene Ontology and KEGG enrichment analyses identified that these proteins were enriched in processes involving infection, inflammatory response, and cell adhesion and junction, which likely contribute to the pathogenesis. Moreover, the top three high-abundance proteins (NNMT, FTL, and TYMP) were further validated in the plasma from a larger SAT cohort using an enzyme-linked immunosorbent assay. After adjusting for sex, Spearman correlation analysis showed that NNMT, FTL, and TYMP levels were positively correlated with FT3, FT4, T3, T4, Tg, and ESR and negatively correlated with TSH. Furthermore, binary logistic regression analyses revealed that NNMT, FTL, and TYMP were independent factors of SAT. We also conducted a receiver operating characteristic (ROC) curve analysis to assess the diagnostic accuracy of NNMT, FTL, and TYMP for SAT. The results revealed that each factor demonstrated an area under the curve (AUC) score above 0.8. Thus, these high-abundance proteins can potentially serve as biomarkers for SAT diagnosis and outcome prediction. Our findings provide valuable insights into SAT biomarkers, and shed light on the potential pathogenesis and therapeutic targets of SAT.

Potential of radiomics in the diagnosis of gastrointestinal stromal tumors: a literature review.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, originating from Cajal's interstitial cells and accounting for approximately 80% of all primary gastric tumors. Traditional diagnostic methods for GISTs, such as computed tomography (CT), endoscopy, endoscopic ultrasound (EUS), and fine needle aspiration biopsy (FNAB), despite their widespread use, face several limitations including diagnostic uncertainty and limited biopsy capabilities. In this context, radiomics, which involves the analysis of image texture features, emerges as an innovative method potentially capable of enhancing the accuracy of GIST diagnosis. This approach allows to interpret of tissue changes through mathematical processing of images, which are imperceptible to the human eye, potentially facilitating more accurate detection of tumors at an early stage. The aim of this literature review is to evaluate the advantages and disadvantages of current diagnostic methods for GISTs, as well as to assess the potential of radiomics in improving diagnostic outcomes for these tumors. The review aims to identify the best methods of application and promising directions for future research in this important field.

The necessity of fine-needle aspiration biopsy in surgical decision-making for thyroid nodules larger than 3 cm.

Ultrasound-guided fine-needle aspiration biopsy (FNAB) is an essential diagnostic tool for detecting malignancy in thyroid nodules. The objective of this study was to evaluate the necessity of FNAB in the treatment decision-making process for thyroid nodules exceeding 3 cm in size. The records of patients who underwent thyroidectomy in our center between 2018 and 2023 were retrospectively reviewed. The study included patients with an index nodule size exceeding 3 cm. Exclusion criteria were missing data, treatment for a different oncological condition, recurrent disease, and purely cystic nodule. Patients were categorized into 2 groups based on the size of the index nodule: Group 1 included nodules measuring between 3 to 4 cm, and Group 2 included nodules 4 cm and larger. Demographic data, FNAB results, and histopathological findings were recorded. The specificity, sensitivity, false negative, and false positive rates of FNAB were calculated. There were 1935 patients who underwent thyroidectomy within the specified date range. In 359 of these patients, the index nodule size was 3 cm or more. There were 188 patients with nodule size between 3 and 4 cm. The mean age was 50.42 ± 13.34 years, and 257 patients were female (F/M ratio = 2.5/1). Fine needle aspiration biopsy was performed on 237 patients, resulting in 65 false negatives. Both the incidence of malignancy and the rate of FNAB false negatives were higher in nodules measuring 4 cm or larger. This study identified a high malignancy rate and a significant rate of false negatives in FNAB of thyroid nodules larger than 3 cm. These findings highlight the importance of carefully considering these factors in the surgical planning of such nodules.

Description of a New miRNA Signature for the Surgical Management of Thyroid Nodules.

The diagnosis of malignant thyroid nodules is mainly based on the fine-needle aspiration biopsy (FNAB). To improve the detection of malignant nodules, different molecular tests have been developed. We present a new molecular signature based on altered miRNA expressions and specific mutations. This is a prospective non-interventional study, including all Bethesda categories, carried out on an FNAB sampled in suspicious nodule(s) during thyroidectomy. miRNA quantification and mutations detection were performed. The reference diagnosis was the pathological assessment of the surgical specimen. Different classification algorithms were trained with molecular data to correctly classify the samples. A total of 294 samples were recorded and randomly divided in two equal groups. The random forest algorithm showed the highest accuracy and used mostly miRNAs to classify the nodules. The sensitivity and the specificity of our signature were, respectively, 76% and 96%, and the positive and negative predictive values were both 90% (disease prevalence of 30%). We have identified a molecular classifier that combines miRNA expressions with mutations detection. This signature could potentially help clinicians, as complementary to the Bethesda classification, to discriminate indeterminate FNABs.

Modern Thyroid Cancer Diagnosis: A Review of AI-Powered Algorithms for Detection and Classification

Thyroid nodules are one of the most common abnormalities in the thyroid gland, which are often harmless in nature (benign), but in a few unfortunate instances, they may be fatal (malignant). This review explores recent advancements in artificial intelligence (AI) applied to thyroid cancer detection and classification, with a focus on machine learning, deep learning, and image processing techniques. We provide a comprehensive evaluation of AI applications across key imaging modalities—Ultrasonography (USG), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Single-Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET/CT)—as well as cytopathological analysis using Fine Needle Aspiration Biopsy (FNAB). By critically examining studies on AI-driven preoperative assessments, we highlight improvements in diagnostic accuracy, sensitivity, specificity and efficiency. This review also identifies current limitations in AI applications, including technical challenges and unresolved issues that hinder widespread clinical adoption. Although significant progress has been achieved, the integration of AI in clinical settings remains limited, as AI-based outputs currently serve as supportive tools rather than definitive diagnostic evidence. We discuss the potential of AI to transform thyroid cancer diagnostics by enhancing reliability and accessibility, while addressing the need for further research to develop a unified, robust and clinically trustworthy AI framework for thyroid cancer diagnosis.