Fine Needle Aspiration Cytology Findings Research Articles

International Academy of Cytology standardized reporting of breast fine-needle aspiration cytology with cyto-histopathological correlation of breast carcinoma

Background: The International Academy of Cytology (IAC) has developed a standardized approach for reporting the findings of breast fine-needle aspiration cytology (FNAC). Accordingly, there are five chief categories of breast lesions, C1 (insufficient material), C2 (benign), C3 (atypical), C4 (suspicious), and C5 (malignant). The prognostication and management of breast carcinoma can be performed readily on the basis of this classification system. The aim of this study was to classify various breast lesions into one of the above-named categories and to further grade the C5 lesions specifically using the Robinson system. The latter grades were then correlated with modified Scarff-Bloom-Richardson (SBR) grades. Methods: This retrospective study was undertaken in the pathology department of a hospital located in the urban part of the city of Bangalore. All FNAC procedures performed on breast lumps spanning the year 2020 were included in the study. Results: A total of 205 breast lesions was classified according to the IAC guidelines into C1 (6 cases, 2.9%), C2 (151 cases, 73.7%), C3 (13 cases, 6.3%), C4 (5 cases, 2.5%), and C5 (30 cases, 14.6%) groups. The C5 cases were further graded using Robinson’s system. The latter showed a significant correlation with the SBR system (concordance=83.3%, Spearman correlation=0.746, Kendall’s tau-b=0.736, kappa=0.661, standard error=0.095, p≤.001). Conclusions: A standardized approach for FNAC reporting of breast lesions, as advocated for by the IAC, improves the quality and clarity of the reports and assures diagnostic reproducibility on a global scale. Further, the cytological grading of C5 lesions provides reliable cyto-prognostic scores that can help assess a tumor’s aggressiveness and predict its histological grade.

Diagnostic yield of combined ACR TI-RADS and Sonoelastography in solid thyroid nodules in tertiary care center: A prospective cross-sectional Study

Background: Thyroid nodules are prevalent, and accurate differentiation between benign and malignant nodules is crucial for management. We aim to evaluate the effectiveness of combining Thyroid Imaging Reporting and Data System (TIRADS) scoring with strain elastography, specifically the Elasticity Contrast Index (ECI), to differentiate between benign and malignant thyroid nodules. Methods: This analytical cross-sectional study involved 77 patients with solid thyroid nodules identified through B-mode ultrasonography. ACR TI-RADS scores, ECI values, and combined scores were compared with Fine needle aspiration Cytology (FNAC) results. Statistical analysis was performed using SPSS, and Pearson correlation tests were conducted to assess the correlation with FNAC findings. Result: The TI-RADS scoring system has a sensitivity of 83.3%, a specificity of 66.1%, and a positive predictive value of 42.9% for distinguishing benign and malignant nodules. Strain elastography with ECI values has a sensitivity of 94.4%, specificity of 98.3%, PPV of 94.4%, and NPV of 98.3%. Combining ACR TI-RADS and strain elastography achieves a sensitivity of 100%, specificity of 66.1%, NPV of 100%, and PPV of 47.4%. Conclusion: The study emphasizes the benefits of integrating noninvasive methods like ultrasound elastography and ACR TI-RADS for improved diagnostic precision, minimizing invasion and patient discomfort. This strategy is particularly advantageous for TI-RADS 3 nodules and reduces unnecessary procedures. However, FNAC should be reasonable and validated for higher classifications.

Correlation between ultrasonographic and cytologic features of thyroid nodules: a single-center cross-sectional study.

A thyroid nodule is managed according to the clinical context, ultrasound (US) findings, and fine needle aspiration (FNA) results. Most thyroid nodules are benign; however, nodule classification is crucial to avoid unnecessary thyroid surgery. We conducted this study to compare the findings of fine-needle aspiration cytology (FNAC) expressed using the Bethesda system with the features of thyroid US classified using the EU-TIRADS classification to assess the risk of malignancy. A descriptive and analytical study involving 99 patients with thyroid nodules followed up in the Department of Endocrinology-Diabetology and Nutrition. Data were collected from medical records and analyzed using SPSS software V21. FNA was performed on 121 nodules using the BETHESDA system. These nodules were classified as malignant, suspicious for follicular neoplasm, and suspicious for malignancy in 5.8%, 5%, and 1.7% of cases, respectively. As for the EU-TIRADS 2017 classification, 59.5% of benign nodules were classified as EU-TIRADS III, whereas 66.7% of malignant nodules were classified as EU-TIRADS V and significantly related to malignant prediction (P = 0.000). The size of nodules was significantly correlated to the risk of malignancy (P = 0.013). Seventy-five percent of nodules with central vascularity were malignant (P = 0.012). Irregularity of nodule contours was significantly associated with the risk of malignancy, as 30% of nodules with irregular contours were Bethesda VI (P = 0.003). Hypoechogenicity was found in 77.8% of malignant nodules (P = 0.004). Additionally, only 9.2% of the nodules were taller than wide, of which 37.5% were malignant (P = 0.012). For a safe management strategy, US-guided FNAC should be performed on each suspicious thyroid nodule, given the correlation between EU-TIRADS classification features and the risk of malignancy.

Correlation of Ultrasound Guided (USG) Fine Needle Aspiration Cytology (FNAC) With Postoperative Histopathology in the Diagnosis of Thyroid Swelling

Background: Thyroid swelling is a common problem in Bangladesh. Early and systematic evaluation of a nodular thyroid swelling is necessary as it is a frequent presentation of thyroid neoplasia. USG Guided Fine needle aspiration cytology (FNAC) is one of the diagnostic tools for early evaluation of thyroid nodules. USG Guided FNAC is considered as a cost-effective, simple, minimally invasive and easily repeatable procedure for preoperative screening in the diagnosis for most of the thyroid lesions. The objective of this study is to determine the sensitivity and specificity of USG Guided fine needle aspiration cytology (FNAC) and compare the efficacy with histopathology in diagnosis of thyroid swellings. Objective: To evaluate the sensitivity and specificity of USG Guided fine needle aspiration cytology (FNAC) and histopathology for the diagnosis of thyroid swelling. Method: This Observational Prospective Study was performed in the department of Otolaryngology & Head Neck Surgery, Dhaka Medical College Hospital. Dhaka over 6 month’s duration from January 2019-June 2019. Total 50 patients with thyroid swelling was selected after taking informed written consent and fulfilling the inclusion criteria. Smears was taken by standard procedure and then was stained with papanicolaou stain and haematoxylin and eosine stain. The smears was classified into categories like benign, indeterminate, malignant and unsatisfactory. Sensitivity, specificity, positive and negative predictive value and accuracy of USG Guided FNAC was calculated and compared to already available data. Appropriate statistical analysis was done to make comparison between final histopathological findings with initial USG Guided FNAC findings. Result: During the study period a total 73 were found eligible for USG Guided FNAC. Most of the patients (52%) were from 20-39 years age group. Among them 67.12% were female and rest (32.87%) were male. In this government hospital 75.34% were from low income group. ......

A prospective cross-sectional observational comparative study: evaluating palpable breast lumps through comparative analysis of sonomammography breast imaging reporting and data system scores and fine needle aspiration cytology

This study protocol outlines a prospective cross-sectional observational investigation aimed at assessing the correlation between Sonomammography Breast Imaging Reporting and Data System (BI-RADS) scores and Fine-Needle Aspiration Cytology (FNAC) findings in diagnosing benign and malignant palpable breast lumps among patients admitted to AVBRH. The primary objective is to understand the diagnostic accuracy of FNAC and Sonomammography BI-RADS scoring in identifying breast lumps’ nature. Four specific objectives guide this study: 1) To determine the diagnostic accuracy of FNAC; 2) To evaluate the diagnostic precision of Sonomammography BI-RADS scores; 3) To compare the diagnostic outcomes of sonomammography and FNAC with HPE, and 4) To examine the age-wise distribution of benign and malignant palpable breast diseases. The study will be conducted at AVBRH, Sawangi (Meghe), Wardha, over three years, commencing in June 2022. The anticipated findings from this study will significantly contribute to refining the diagnostic strategies for palpable breast lumps, enhancing patient care and decision-making.

Reporting Pancreatic FNAC using the Papanicolaou System: Still a Diagnostic Challenge.

The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology for Breast Lump by Yokohama System for Reporting and Its Correlation with Histomorphology

Abstract Background: The International Academy of Cytology (IAC). Yokohama System has created a standardized method of describing breast cytology by grouping them into five categories: inadequate, benign, atypical, suspicious, and malignant. To validate the likelihood of cancer in the various categories, several investigations have been undertaken at various institutions as a mandate. Aim: The main objective of the research is to identify the accuracy of fine-needle aspiration cytology (FNAC) for breast lumps by the Yokohama system for reporting and its correlation with histopathology. Methodology: The present study was a retrospective research performed over 8 months. Fine-needle aspiration cytology (FANCs) for breast lumps are performed by the Yokohama system. Whenever accessible, histopathological diagnoses were also retrieved. Statistical Analysis Used: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were estimated using a histological diagnosis as the gold standard concerning each of the five categories. Results: Out of 200 cases, 106 had histopathological concordance. Five categories: insufficient, benign, atypical, suspicious, and malignant of the IAC Yokohama system were 1.00%, 62.50%, 4.50%, 1.50%, and 30.50%, Category 1 (1%), Category 2 (62.5%), Category 3 (4.5%), Category 4 (1.5%), and Category 5 (30.5%). When malignant, suspicious, and unusual cases were taken into account as positive test findings, the highest level of sensitivity (90.60%) was attained. The maximum specificity (100%) was seen when only malignant patients were taken into account as positive test findings, but the highest diagnostic accuracy (96.22%) was shown when the malignant and suspect categories were taken into account as positive test results. Conclusion: FNAC using the Yokohama system for reporting is an accurate diagnostic tool for breast lumps. The system provides a standardized framework for reporting FNAC findings, and studies have reported high sensitivity and specificity rates for diagnosing breast lumps using FNAC. Therefore, FNAC can be used in conjunction with histomorphology to ensure accurate diagnosis and appropriate management of breast lumps.

Diagnostic Utility of Fine-Needle Aspiration Cytology (FNAC) and Frozen Section Against Histopathology in Evaluating Benign and Malignant Breast Lesions.

Breastlesions, particularlylumps, pose concerns for females, varying between benign and malignant conditions. Accurate differentiation solely through clinical assessment is challenging, necessitating a definitive diagnostic strategy. Fine-needle aspiration cytology (FNAC) is integral in the "triple approach" to breast evaluation, offering simplicity, reliability, and cost-effectiveness. However, FNAC has limitations, occasionally failing to yield definitive diagnoses due to inherent constraints. Contrarily, frozen-section analysis, a long-standing intraoperative diagnostic method, plays a crucial role in swift diagnosis during surgeries. Despite technological advancements, frozen sections serve specific diagnostic purposes, confirming carcinoma when FNAC is inconclusive and evaluating resected margins. However, freezing artifacts may affect tissue assessment, emphasizing the continued reliance on histopathology for guiding treatment decisions. This study was conducted at KVG Medical College and Hospital, Sullia, Karnataka, India. It aimed to analyze the morphological characteristics of benign and malignant breast lesions using FNAC, frozen section, and histopathology and evaluate the sensitivity, specificity, and predictive values of FNAC and frozen section against histopathology as the reference standard. Across-sectional investigationwas carried out at a tertiary care hospital's Department of Pathology, on 60 female patients who presented with palpable breast masses over a span of two and a half years. FNACwas conducted, and the observations were classified into five categories as per the International Academy of Cytology guidelines. In addition, intraoperative frozen-section analysis was undertaken. A comparative analysis was conducted between the FNAC and intraoperative frozen-section findings, juxtaposed with the subsequent histopathological diagnoses. FNAC revealed 51.7% malignant, 45% benign, and 3.3% inadequate cases; the frozen-section analysis indicated 51.6% malignant, 45% benign, and 3.3% deferred cases; histopathology showed 53.3% malignant, 45% benign, and 1.6% borderline cases. FNAC demonstrated 93.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), 93.1% negative predictive value (NPV), and 96.7% accuracy. The frozen-section analysis exhibited 96.9% sensitivity, 100% specificity, 100% PPV, 96.4% NPV, and 98.3% accuracy. Intraoperative frozen-section analysis displays superior diagnostic utility compared to preoperative FNAC. However, histopathology remains the definitive gold standard. Integrating all three diagnostic modalities is crucial for precise diagnosis and effective patientmanagement.

The Milan system for reporting salivary gland cytopathology - Assessment of utility and the risk of malignancy.

Cytological diagnosis of salivary gland lesions furnishes several challenges to pathologists and clinicians owing to their diverse morphology and varying reporting terminology. The Milan system for reporting salivary gland cytopathology was proposed to overcome these defects. The aim of this study was to grade histopathologically diagnosed cases of salivary gland pathology using Milan system and to correlate Milan system with histopathological diagnosis. The study aims to assess the utility of the Milan system and the risk of malignancy in each category. This is a retrospective study of 4 years duration. All the cases of salivary gland pathology with fine-needle aspiration cytology findings from January 2015 to December 2018 were retrieved and classified according to the Milan system. Histopathology follow-up of these cases were reviewed from the archives, and risk of malignancy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using histopathological diagnosis as the gold standard. Cytology slides of 151 cases were reviewed, and the Milan system was applied. Histopathology follow-up was obtained in 94 cases (attrition rate = 37.74%). The percentage of cases in each category were as follows: nondiagnostic = 9.27%, nonneoplastic = 4.64%, atypia of undetermined significance = 3.97%, benign neoplasm = 23.84%, neoplasm of uncertain malignant potential = 8.61%, suspicious for malignancy = 11.92%, and malignant = 37.75%. Sensitivity, specificity, positive predictive value, and negative predictive value of the Milan system were 94.20%, 96.00%, 98.48%, and 85.71%, respectively. The Milan system has high sensitivity and specificity in comparison with histopathology. This system proves helpful to the pathologist as well as the clinician in achieving uniformity of reporting terminology by classifying salivary gland lesions into subcategories with prognostic relevance.

Correlation of FNAC with Histopathology in the Diagnosis of Differentiated Thyroid Carcinoma

Background: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool for differentiating between neoplastic and non-neoplastic lesions of the thyroid. The current study was carried out to observe the comparison between preoperative fine needle aspiration cytology (FNAC) and postoperative Histopathology in the diagnosis of Differentiated Thyroid Carcinoma. Methods: This cross-sectional observational study was conducted in the department of Pathology, Rajshahi Medical College (RMC), Bangladesh from January 2019 to December 2020. Clinically suspected and diagnosed by FNAC, a total of forty patients of differentiated thyroid carcinoma attending outpatient and inpatient department of Otolaryngology, RMCH were enrolled in this study. Biopsy material was examined for histopathological diagnosis. Results: In this study, out of forty cases, 35 were papillary and 5 were follicular carcinoma. Mean age was 25.48+9.70 years and Male: Female was 1:6. Among 40 cases of FNAC findings, 33 cases (82.5%) were classic papillary carcinoma, 01(2.5%) case was follicular variant of papillary carcinoma, 5 cases were (12.5%) were follicular lesion and 01(2.5%) case was nodular goitre. Among 40 cases of histopathological findings, 32(80%) cases were classic papillary carcinoma, 03(7.5%) were follicular variant of papillary carcinoma and 5 cases were follicular carcinoma. In histopathological findings, none of them was nodular goitre. So, all FNAC findings were consistent with histopathological findings except nodular goitre which was diagnosed as classic papillary carcinoma in histopathology. Conclusion: FNAC is a safe and relatively accurate method for preoperative evaluation of thyroid malignancy before surgery. Therefore it is a reliable diagnostic test for evaluation of thyroid carcinoma. J Shaheed Suhrawardy Med Coll 2022; 14(1): 28-31

Evaluation of Recurrent Lymphadenitis after Six Months Anti-Tuberculous Therapy

Background: Recurrence or persistence of tuberculous lymphadenitis even after treatment occurs due to paradoxical immune response, non-tubercular mycobacterial (NTM) infection, drug resistance tuberculosis or because of misdiagnosis. In these situations sometimes the patients are asked to continue category-1 more than six months on the basis repeat fine needle aspiration cytology (FNAC) findings. This study evaluated the cause of persistence or appearance of new lymph node after anti-TB category-1. Methods: This observational study was done from January, 2013 to March, 2014 after getting ethical clearance from Bangabandhu Sheikh Mujib Medical University (BSMMU). Patients who had persistent or new lymphadenitis after completing anti-TB category-1 for six months were selected. After analysis of treatment records, patients were selected for either FNAC or biopsy with local surgical clearance. Cyto/histopathological analysis, AFB stain (LED fluorescent), AFB culture (MGIT and L-J media) and GeneXpert test was done. Follow-up of the patients were done after two weeks and six months of FNA/surgery. Results: Thirty-two patients (M/F=11/21) with mean age 25(±12) years were investigated. Altogether 26 cases (81.25%) Journal of Bangladesh College of Physicians and Surgeons Vol. 41, No. 4, October 2023 were confirmed as tuberculous lymphadenitis and six (18.75%) were non-tuberculous (03 lymphomas, 01 sarcoidosis, 01 reactive lymphadenitis and 01 pyogenic abscess). Among the TB patients, granuloma was present in 23 cases (88.46%) (FNA-07, biopsy-16). Twenty-three (88.46%) cases were GeneXpert positive, comprising 21 rifampicin sensitive and 02 rifampicin resistant. One rifampicin resistant case was confirmed by culture and the remaining 25 were culture negative. One case was AFB stain positive and no NTM was found in AFB culture. After surgery, rapid healing was observed within two weeks among tuberculous lymphadenitis patients. Conclusions: Persistent granuloma after anti-TB category-1 does not indicate active tuberculosis if it is culture negative. It may occur due to immunological reaction against dead bacilli in deep seated sinus. Local surgical clearance results rapid recovery and other diagnosis should be excluded without further continuation of anti-TB category-1. J Bangladesh Coll Phys Surg 2023; 41(4): 262-268

A Clinicopathological Study of Cervical Lymphadenopathy

Lymphadenopathy is a very common clinical manifestation of many diseases. It is a disease of the lymph nodes, inwhich they are abnormal in size or consistency. The study intends to find out systematically the various pathologicalconditions presenting with enlarged lymph nodes in the neck, also the various nodes of clinical presentations andbehavior of these conditions. This study consisted of 200 consecutive cases and diagnosis was made on the basis ofclinical, fine needle aspiration cytology and histopathological findings. Out of 200 cases in the study 30.0% werenon-specific lymphadenopathy, 47% were tuberculosis, 15% were secondary metastatic lymphadenopathy due toprimary malignant lesion in head-neck region, 5% were primary malignant lesion that is lymphoma (Hodgkins andnon-Hodgkins lymphoma), rest 3% were due to other lesions like Kikuchi's disease, histiocytosis. After swelling inthe neck, pain and fever were the most common presentations. Some patients presented with suppurativelymphadenopathy. In this study, fine needle aspiration cytology was found to be so reliable. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):29-32

Fine needle aspiration cytology findings in orbital rhabdomyosarcoma: An urgency

Fine needle aspiration cytology findings in orbital rhabdomyosarcoma: An urgency

A clinico – pathological study of patients undergoing thyroidectomy in a rural tertiary care center of northern Kerala

The aim of the study is to assess the clinical profile of patients undergoing thyroidectomy and to determine its association with FNAC (fine needle aspiration cytology) and histopathological report; and to compile a statistical data on the percentage of various malignancies and benign conditions of thyroid in patients undergoing thyroidectomy. This was a prospective study conducted in a rural tertiary care centre among the patients undergoing thyroidectomy. Minimum sample size was estimated to be 110. Convenience sampling technique was adopted and data was collected using pretested semi-structured questionnaire with the help of interviews, clinical examinations and investigation reports. Data was analyzed using SPSS trial v25. Mean age of those who underwent thyroidectomy was 44.81 years. 96% were females. Most common clinical diagnosis was multinodular goiter (80%). Malignancies constituted 4%. Most common diagnosis as per FNAC was Colloid goiter (73%). There was statistically significant association of clinical diagnosis with, FNAC findings and with postoperative histopathological examination. As per the present study, efficacy of FNAC to differentiate malignant lesions was 100%. Most common malignancies were: Papillary Ca and Follicular Ca. Among benign lesions, colloid goiter was most common. Clinically, 4% thyroid cases were identified as malignancies, which were consistent with findings of FNAC and post-operative HPE reports. With efficacy of 100% in the present study, FNAC stands as an important premanagement investigation; hence the study recommends FNAC mandatorily with or without other investigation such as radiological features.

Diagnostic strategy for malignant and benign thyroid nodules smaller than 10 mm based on surface-enhanced Raman spectroscopy and machine learning

The diagnostic rate of thyroid nodules has increased considerably in recent years. Malignant nodules can reduce the quality of and even endanger the lives of patients. Fine needle aspiration (FNA) with cytological diagnosis is the most common modality for diagnosing malignant and benign nodules. However, a certain percentage of nodules still cannot be diagnosed definitively, especially when they are less than 10 mm in diameter. Surface-enhanced Raman spectroscopy (SERS) is a molecule-specific analysis method suitable for tumor diagnosis. In this study, the SERS technique was used to analyze FNA samples of thyroid nodules smaller than 10 mm and combined with multiple machine learning algorithms (principal component analysis-linear discriminant analysis, partial least squares discriminant analysis (PLS-DA), and support vector machines) to develop a novel and precise diagnosis model for malignant and benign thyroid nodules. The results showed that the hyphenated method of SERS and the PLS-DA algorithm efficiently diagnosed malignant and benign thyroid nodules, with an area under the curve (AUC) of 97.479% and accuracies of 95.59% and 85.58% in the training and cross-validation sets, respectively. Moreover, the classification model outperformed cytology in diagnosing FNA samples from microscopic thyroid cancers. This study demonstrates that a novel diagnostic strategy based on SERS and machine learning can constitute a complementary diagnosis method for nodules with unknown FNA cytological findings. Furthermore, this strategy can improve the diagnostic accuracy of thyroid nodules smaller than 10 mm, achieve an early and exact diagnosis of microscopic thyroid cancer, and prevent misdiagnoses, underdiagnoses, and overtreatment of thyroid nodules.

A Prospective Study Comparing Diagnosis of Neck Swellings by Fine Needle Aspiration Cytology with Histopathology

Aim: To to correlate the fine needle aspiration cytology findings with histopathology findings of specimens from neck swellings. Study Design; Cross-Sectional Observational Setting: Pathology Department, Chandka Medical College, Larkana Period: June 2021 to June 2023 Methods: This study consisted of neck swelling samples received in the Department of Pathology by FNAC or excision. Both Cytology and Histopathology were evaluated by an experienced pathologist. Diagnoses of cytology were compared with the histopathological examination and the data was recorded into groups that comprised of lymph nodes, thyroid gland, and salivary glands. Lesions that did not fit into these groups were classified into as “others”. Data was entered and analyzed using SPSS Version-22. Results: There were a total of 261 cases of neck swelling samples received in our department. Most of the cases were due to lymph node (n=104) pathologies notably due to reactive hyperplasia and tuberculosis. The thyroid gland (n=95) was the second most common region for FNAC and most samples showed the diagnosis of colloid goiter followed by follicular adenomas. There were n=30 samples of salivary glands whereas n=32 were classified into others. Overall sensitivity and specificity were variable among the regions of FNAC with the highest being (100%) in the salivary glands and lesions classified into others category. Practical Implication: Comparing neck swelling diagnosis via Fine Needle Aspiration Cytology (FNAC) with Histopathology is vital to validate FNAC's accuracy before definitive treatment. It ensures informed decision-making, avoiding unnecessary surgeries and minimizing risks. Conclusion: FNAC of the neck swellings is a highly accurate technique and provides the first line of diagnosis. However, FNAC does have its own limitations and this technique should always be complemented by a confirmatory histopathology. Keywords: Fine needle Aspiration Cytology, Neck Swellings, Lymph node, Salivary Glands, Thyroid Glands

A Comparative Study between Silver Impregnated Hydrofiber Dressing Verses Silver Sulfadiazine Dressing in the Non-Operative Management of Omphalocele

Background: Breast lump is one of the most common surgical problems in female. Many diagnostic modalities available for the evaluation of breast lump. For several years, fine needle aspiration cytology (FNAC) was the most practiced method for the pathological diagnosis of breast lump specially differentiation of benign from malignant. The advent of Trucut biopsy in the new millennium has resulted in many surgeons switching to Trucut biopsy since it provides a sufficient amount of tissue for pathologists to make an accurate histological diagnosis. Aim of the Study: The aim of the study was to find out the diagnostic accuracy of FNAC findings in comparison to Trucut biopsy for evaluation of breast lump. Materials and Methods: The cross sectional observational study was carried out in the Department of Surgery of Mymensingh Medical College Hospital, Mymensingh. Patients with a breast lump were enrolled by purposive sampling during July, 2018 to June, 2019. All the patients were assessed by FNAC and Trucut biopsy. Final diagnosis was made on the basis of histopathology. A pre-formed semi-structured, case record form was prepared which was used to collect data. Data analysis was done by SPSS Version 23. Results: The mean age was found 41.4±10.6 years with range from 24 to 68 years. Clinical examination revealed suspicious for malignancy 52(61.9%) patients and 32(38.1%) in benign. In FNAC diagnosis, benign breast lump was found 39(46.4%), suspicious malignant cell was 10(11.9%) and malignant was 35(41.7%). In trucut biopsy, 48(57.1%) patients were found in malignant and 36(42.9%) in benign tumor. In histopathological diagnosis, 49(58.3%) patients were found in malignant and 35(41.7%) in benign tumor. 49 cases were malignant breast lump evaluated by histopathological diagnosis, out of which 41(83.7%) cases were suspicious for malignancy evaluated by clinical findings, 43(87.8%) cases were malignant breast lump evaluated by FNAC diagnosis and 47(95.9%) cases were ..........

Significance of Nuclear Morphometry in Breast Lesions: A Cross-Sectional Study.

Background Fine-needle aspiration cytology (FNAC) is one of the reliable methods in diagnosing breast cancers. Morphometric studies are done in benign and malignant neoplasms of various organs by using software, which measures cellular, cytoplasmic, and nuclear parameters. Nuclear parameters define the behavior of the neoplasm. This study aims to evaluate nuclear morphometry parameters in aspirated smears of breast lesions and determine the association between cytological findings with nuclear morphometry parameters. Methodology It's a retrospective cytology study from July 2020 to June 2022 conducted at a tertiary health care center in Kolar, Karnataka, India. The FNAC smears of breast mass were analyzed cytologically and were subjected to nuclear morphometry study. Nuclear parameters such asnuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor were captured inZen software (Zeiss, Oberkochen, Germany) and ImageJ software (National Institutes of Health,Bethesda, MD, USA;Laboratory for Optical and Computational Instrumentation [LOCI], University of Wisconsin-Madison, Madison, WI, USA). The association between nuclear morphometric findings and cytological findings was noted. A descriptive statistical analysis was done. Results Sixty cases of mass in the breast were considered for the study of which37 cases were benign and 23 were malignant. Nuclear morphometry parameters such asnuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor for benign breast lesions were 25.16 ± 3.2 µm2, 21.58 ± 1.89 µm, 6.5± 0.94 µm, 4.87 ± 0.50 µm, and 0.92± 0.02, respectively, and for malignant breast cases were 46.57 ± 12.24 µm2, 27.53 ± 3.26 µm, 10.08 ± 1.18 µm, 6.49± 0.88 µm, and 0.93 ± 0.01, respectively. The association of all nuclear parameters between benign and malignant lesions was statistically significant (P= 0.001). Conclusions Nuclear morphometric study in breast lesions is a concept that supplements FNAC findings in differentiating benign from malignant lesions.

Repeated Surgery in a Case of Epithelial-Myoepithelial Carcinoma of the Parotid Gland that was Difficult to Distinguish from Pleomorphic Adenoma.

Epithelial-myoepithelial carcinoma (EMC) of the parotid gland is a comparatively rare tumor that accounts for less than 1% of all salivary gland tumors. A patient with EMC of the parotid gland that was initially diagnosed as pleomorphic adenoma and that recurred locally during the watchful waiting period but was controlled by surgery under local anesthesia is reported. An 80-year-old man had noticed a swelling in the left infra aural region. A left parotid gland tumor was suspected, and he was referred to our department. Magnetic resonance imaging (MRI) and fine-needle aspiration cytology findings were suggestive of pleomorphic adenoma of the superficial lobe of the parotid gland, and this was therefore resected under general anesthesia. Postoperative histopathological examination, immunostaining, and genetic tests resulted in a diagnosis of EMC. Postoperative pathological review showed that part of the resection margin was positive. The possibility of recurrence was explained to the patient, and additional treatment was recommended, but since the patient did not desire this, a policy of watchful waiting was adopted. Signs of cutaneous metastasis in the left infra aural region were detected at 13 months postoperatively, and this metastasis was excised under local anesthesia. The resection margin was negative, and the patient's course remains uneventful. EMC is classified as a low-grade malignant tumor, but it requires stringent monitoring because of its frequent local recurrence. Since local control can usually be achieved by surgical treatment alone, and postoperative adjuvant therapy may not necessarily warranted.

Study of Fine Needle Aspiration Cytology (FNAC) of Thyroid Gland According to the Bethesda System.

Fine needle aspiration cytology (FNAC) of thyroid gland is a powerful diagnostic tool for thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classifies thyroid FNAC findings into six categories. It is a standardized, simple, and convenient method of reporting which also provides guidelines for management. To study the cytomorphology of thyroid lesions and classify them as per TBSRTC.Determine the epidemiology and distribution of various thyroid lesions in our tertiary care hospital.Correlation of cytopathology with histopathological diagnosis in cases which were operated in our hospital. This is a prospective analytical study of 105 patients with clinically enlarged thyroid gland presenting at G.K. General Hospital, Bhuj during July 2018 to August 2020. FNAC smears of these patients were studied and correlated with histopathology wherever available. Out of a total 105 cases, 94 were non-neoplastic, eight were neoplastic, and three were unsatisfactory for evaluation. There were 94 cases in the benign category (category II), with colloid goiter being the most common cytological diagnosis (38 cases). There were no cases in categories III and V, respectively. On cytology, two cases in category IV were diagnosed as follicular neoplasm. Category VI had six cases comprising papillary carcinoma of thyroid (five cases) and medullary carcinoma of thyroid (one case). Out of a total 105 cases, 55 patients were operated in our center and hence their cytopathological findings were correlated with histopathological findings. Out of 55 operated cases, 45 cases (81.8%) had benign lesion and 10 cases (18.2%) were malignant. The sensitivity of FNAC was 70% and specificity was 100%. Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. The Bethesda system is very useful for a standardized and reproducible system of reporting thyroid FNAC. It satisfactorily correlates with the histopathological diagnosis and helps in comparing results amongst various institutes.