Fine Needle Aspiration Cytology Research Articles

Risk of TIRADS-based inappropriate FNAC in autonomous thyroid nodules is clinically negligible.

Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size. Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS. Forty-eight AFTNs were included of which 37.5% had FNAC indication according to TIRADS. The FNAC indication rate in the case of TSH lower than 0.4 mIU/L was significantly higher than in other cases (P = 0.0078). The most accurate TSH cut-off and AFTN size associated with UN-FNAC were ≤ 0.41 mIU/L and > 22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR of 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped to 4.16%. Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.

Positive Predictive Value of Thyroid Imaging, Reporting and Data System (TI-RADS) (3-5) When Compared to Fine Needle Aspiration Cytology Results

Abstract Background Thyroid nodules are a very common finding in the population. Evaluation of a patient with a thyroid nodule for possibility of malignancy could be challenging. Ultrasound is one tool that could be of help, several scoring systems are utilized to help differentiate benign from malignant nodules. One of the most used is TIRADS as proposed by ACR. Another invasive tool that could help is fine needle aspiration cytology. Objective Evaluating and comparing the accuracy of TI-RADS in the assessment of suspicious thyroid nodules by matching their results with the results of FNAC. Patients and Methods Our study was conducted on 72 adult patients with thyroid nodules and were referred to undergo FNA procedures in ‘Interventional radiology unit’ at the Radiology Department “Ain Shams University hospitals”, Cairo, Egypt. Results The present study concludes that TIRADS classification as proposed by ACR showed less statistical significance in predicting malignancy when compared to results of fine needle aspiration cytology. However, several components of the TIRADS scoring system were better predictors of malignancy than other components, namely the irregular margin, the taller than wider shape and the presence of calcifications within the nodule. Conclusion Our study concludes that better applying and implementing the TIRADS scoring system by the sonographer or using other scoring system available in evaluating thyroid nodules like ATA scoring system might result in more reliable ultrasound results decreasing the need to do fine needle aspiration.

566 Serum Thyroid Stimulating Hormone (S-TSH) Levels as a Predictor of Malignancy in Thyroid Nodules

Abstract Introduction The evaluation of thyroid nodules include: a clinical history and examination followed by ultrasonography and fine needle aspiration cytology of ultrasonically suspicious nodules. Even after a full evaluation, some thyroid nodules are found to be indeterminate in respect of malignancy. It has been suggested that high levels of sTSH can be used as a predictor of malignancy in thyroid nodules. Method A retrospective analysis of patients who underwent surgery for thyroid nodules between 01st January 2019 and 31st December 2022. Patients who had been on Thyroxine or Carbimazole/ Propylthiouracil were excluded. Data was collected using previous medical records and patient interviews. Statistical analysis was performed using SPSS version 24. Results Data collection was completed on 102 patients. 86 patients (84.3%, mean age 43.6 years) were female, and 16 patients (15.6%, mean age 45.2 years) were male. Histologically confirmed thyroid malignancy was present in 18 patients (17.6%), out of which 15 (83.3%) were female and 3 (16.6%) were male. There was no statistically significant (P<0.05) difference in the sTSH noted in patients with thyroid carcinoma (mean sTSH 1.378 μIU/ml) compared to histologically benign nodules (mean sTSH 1.350 μIU/ml). Conclusions Multiple studies done in different settings have shown an association between a high sTSH and a higher possibility of thyroid carcinoma. However, in our cohort of patients no such association was observed.

Mucoepidermoid Carcinoma of the Thyroglossal Duct: Two Rare Entities in a Unique Case Report.

Mucoepidermoid Carcinoma (MEC) of the thyroid represents less than 0.5% of all thyroid neoplasms. Thyroglossal duct cyst carcinoma is a rare condition with only approximately 300 cases reported. A 34-year-old pregnant woman at 37 weeks gestation presented to an endocrinological center for primary autoimmune hypothyroidism. The thyroid ultrasound revealed a pseudonodular pattern. The patient was followed up after two years. She reported a full-term delivery without complications. A new thyroid ultrasound was performed, showing a cystic lesion in the median suprathyroid area, measuring 6 x 9 x 10 mm, not previously reported. After 4 months, the suprathyroid cystic lesion was confirmed by thyroid ultrasound, measuring 6 x 11 x 12 mm. The patient was referred for fine-needle aspiration cytology. Cytological examination showed lymphocytes, red blood cells, and some epithelial aggregates with large cytoplasm and nuclear polymetrism with oxyphilic aspects. The patient underwent the Sistrunk procedure for the suprathyroid lesion. The histological examination revealed lymphocytic thyroiditis in heterotopic thyroid tissue with solid cell nest, epidermoid epithelium, and mucus-secreting cells suggestive of low-grade mucoepidermoid carcinoma. The immunohistochemistry study was positive, exhibiting thyroid transcription factor 1 and cytokeratin-19. No positivity was observed for thyroglobulin, calcitonin, galectin-3, and Hector Battifora mesothelial antigen 1. The recent follow-up examination, 13 months after the surgery, has been found negative for disease recurrence. This is the first case of an MEC occurring within a thyroglossal duct. Considering the age of the patient, the histological diagnosis, and the absence of thyroid nodules and metastasis, we decided on the Sistrunk procedure without total thyroidectomy.

Regional Lymphadenitis Related to Bacille Calmette–Guerin Vaccination: A Case Series from a Tertiary Care Childrens’ Hospital

Background: Immunization with Bacille Calmette–Guerin (BCG) vaccine, used worldwide for years, for the prevention of tuberculosis, rarely leads to complications like regional lymphadenitis. There is controversy regarding the management of BCG lymphadenitis. We share our experience regarding the management and course of this rare complication in nine infants. Clinical Description: Over a period of 24 months, 9 infants, who had received BCG vaccination after birth, presented to us between 1 and 3 months of age, with left-sided supraclavicular swellings. The infants were otherwise thriving well, with no constitutional symptoms. On examination, the infants were stable with normal systemic examination. Local examination revealed all the swellings to be supraclavicular lymphadenopathies, two of them being suppurative. Thus, the infants fulfilled the clinical criteria for BCG regional lymphadenitis. Management and Outcome: Fine-needle aspiration cytology from the swellings of all infants was consistent with BCG lymphadenitis. Two of the smears were positive for acid-fast bacilli. Besides percutaneous pus aspiration in two infants, no other intervention was done in any of the infants, and no antibiotics nor antitubercular treatment was administered. With observation and regular follow-up, the lymphadenopathies resolved over time in all the infants. Conclusion: This case series creates awareness regarding the benign, self-resolving nature of BCG regional lymphadenitis, which may be followed conservatively without any medical or surgical intervention.

Study of Diagnostic Yield of Nucleic Acid Amplification Test among Tuberculous Cervical Lymphadenitis in Immunocompetent Patients.

The most common form of extrapulmonary tuberculosis (TB) is tuberculous lymphadenitis, which constitutes about 30-40% of all extrapulmonary TB cases. A new diagnostic method like the nucleic acid amplification test (NAAT) is a very sensitive and rapid test for diagnosing tuberculous cervical lymphadenopathy. It also detects rifampicin sensitivity among positive patients. (1) To evaluate the diagnostic yield of TrueNAT for detecting Mycobacterium tuberculosis bacteria in the fine-needle aspirated samples of cervical lymph nodes compared with Ziehl-Neelsen (ZN) staining; (2) to evaluate the diagnostic yield of TrueNAT for diagnosis of tuberculosis through comparison with the cytology report of fine-needle aspiration (FNA) sample of cervical lymph node and with necrotic cervical lymph node on ultrasonography (USG) neck. A total of 50 patients enrolled in this prospective study from January to December 2022. Demographic profile and clinical history were noted. Fine-needle aspirate samples were sent for TrueNAT assay, cytological examination, and ZN staining. USG neck was done for necrotic findings in the cervical lymph nodes. The TrueNAT positivity rate was 70%. TrueNAT sensitivity and specificity were assessed according to the cytology report, acid-fast bacilli (AFB) positivity on ZN stain, and the finding of necrosis in the cervical lymph node on the USG neck. The sensitivity and specificity of the TrueNAT assay were 80.49 and 77.78%, respectively, in accordance with necrosis on FNA cytology; 17.14 and 93.33%, respectively, in accordance with AFB positivity on ZN stain; and 74.29 and 33.33%, respectively, in accordance with lymph node necrosis on USG neck. The TrueNAT assay should be used as an adjunctive test in addition to the conventional cytological examination of the FNA sample of lymph nodes for the rapid diagnosis of tuberculosis. It also detects rifampicin resistance simultaneously.

Modified TI-RADS Coupled with BRAFV600E Enhances Diagnostic Efficiency in Papillary Thyroid Carcinoma: Prospective Study.

Thyroid disorders, relatively common diseases of the endocrine system, have risen gradually in recent years. Early detection and accurate diagnosis of thyroid cancer hold exceptional importance. This study aimed to determine the efficacy of a modified TI-RADS and BRAFV600E mutation testing for thyroid cancer (PTC) diagnosis. Ninety five thyroid nodules (48 benign and 47 malignant) from 81 patients were examined using Kwak Thyroid Imaging Reporting and Data System (TI-RADS) were subjected to shear wave elasticity (SWE), BRAFV600E genotyping and fine needle aspiration (FNA) cytology. The modified TI-RADS exhibited superior diagnostic accuracy compared to TI-RADS in differentiating benign nodules from malignant thyroid nodules. Moreover, the AUC of modified TI-RADS in conjunction with BRAFV600E was the highest at 95% CI (0.898-0.992, p=0.003), surpassing other diagnostic methods in enhanced sensitivity and maintaining high specificity. The diagnostic efficiency of this combination surpassed that of individual diagnostic methods.

BRAF Detection in FNAC Combined with Semi-Quantitative 99mTc-MIBI Technique and AI Model, an Economic and Efficient Predicting Tool for Malignancy in Thyroid Nodules.

Technology allows us to predict a histopathological diagnosis, but the high costs prevent the large-scale use of these possibilities. The current liberal indication for surgery in benign thyroid conditions led to a rising frequency of incidental thyroid carcinoma, especially low-risk papillary micro-carcinomas. We selected a cohort of 148 patients with thyroid nodules by ultrasound characteristics and investigated them by fine needle aspiration cytology (FNAC)and prospective BRAF collection for 70 patients. Also, we selected 44 patients with thyroid nodules using semi-quantitative functional imaging with an oncological, 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) radiotracer. Following a correlation with final histopathological reports in patients who underwent thyroidectomy, we introduced the results in a machine learning program (AI) in order to obtain a pattern. For semi-quantitative functional visual pattern imaging, we found a sensitivity of 33%, a specificity of 66.67%, an accuracy of 60% and a negative predicting value (NPV) of 88.6%. For the wash-out index (WOind), we found a sensitivity of 57.14%, a specificity of 50%, an accuracy of 70% and an NPV of 90.06%.The results of BRAF in FNAC included 87.50% sensitivity, 75.00% specificity, 83.33% accuracy, 75.00% NPV and 87.50% PPV. The prevalence of malignancy in our small cohort was 11.4%. We intend to continue combining preoperative investigations such as molecular detection in FNAC, 99mTc-MIBI scanning and AI training with the obtained results on a larger cohort. The combination of these investigations may generate an efficient and cost-effective diagnostic tool, but confirmation of the results on a larger scale is necessary.

Accuracy of diffusion-weighted magnetic resonance imaging in diagnosing malignant musculoskeletal tumours

Background: Conventional magnetic resonance imaging (MRI) lacks specificity for differentiating several tumours. Combining advanced techniques like diffusion-weighted imaging (DW-MRI) with conventional MRI may enhance diagnostic accuracy. However, we do not have such data for Bangladeshi patients. This study aimed to examine the diagnostic accuracy of apparent diffusion coefficient values obtained by DW-MRI. Methods: A cross-sectional study was conducted from July 2022 to June 2023 in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU). After collecting their baseline data, thirty-five patients with musculoskeletal tumours underwent DW-MRI and histopathology tests or fine needle aspiration cytology (FNAC). The apparent diffusion coefficient (ADC) values obtained by DW-MRI were examined for diagnostic accuracy against a standard of histopathology/FNAC. Results: According to the gold standard (histopathology/FNAC), there were 28 patients with malignancy, and 7 had benign tumours. Their mean age was 33 (standard deviation, 17) years (range, 4 to 74 years). The mean ADC value was 0.86 ± 0.30×10-3 mm2/s. The malignant musculoskeletal tumour group had significantly lower ADC (0.79 ± 0.24 ×10-3 mm2/s) compared to the benign tumour group (1.15 ± 0.37×10-3 mm2/s.) (P = 0.04). The DW-MRI ADC categories correctly diagnosed 27 malignant and five benign tumours using a cut-off value of ≤ 1.1×10−3 mm2/s. DW-MRI had a sensitivity of 96.4% and a specificity of 71.4%. Diagnostic accuracy was 91.4% for detecting malignant musculoskeletal tumours. Conclusions: Malignant musculoskeletal tumours have lower DW-MRI-derived ADC levels, demonstrating good diagnostic accuracy. However, a larger and more representative sample is needed before it is recommended for clinical practice.

Research progress of ectopic thyroid cancer in thyroglossal duct cyst: A case report and literature review.

Thyroglossal duct carcinoma, a rare clinical condition characterized by ectopic thyroid adenocarcinoma within thyroglossal duct cysts (TGDCs), typically confirmed through intraoperative rapid pathology, this condition generally has a favorable prognosis. Nevertheless, comprehensive treatment guidelines across all disease stages are lacking, the purpose of this study is to report 1 case of the disease and propose the treatment plan for each stage of the disease. A patient presented with thyroid swelling, classified as C-TIRADS 4A following a physical examination. Preoperative thyroid puncture identified papillary thyroid carcinoma, and genetic testing revealed a BRAF gene exon 15-point mutation. Ancillary tests showed a slightly decreased thyroid stimulating hormone (TSH) level (0.172) with no other significant abnormalities. Preoperative fine-needle aspiration cytology (FNAC) confirmed right-side thyroid cancer. Intraoperative exploration uncovered a TGDC and intraoperative rapid pathology confirmed thyroglossal duct carcinoma. A Sistrunk operation and ipsilateral thyroidectomy were performed. Postoperative recovery was satisfactory. Thyroglossal duct carcinoma is a rare disease affecting the neck. Due to limited clinical cases and the favorable prognosis associated with this condition, there is currently no established set of diagnostic and treatment guidelines. According to tumor size, lymph node metastasis, thyroid status and other factors, the corresponding treatment methods were established for each stage of thyroglossal duct cancer, which laid the foundation for the subsequent treatment development of this disease.

Clinical Value of Fine Needle Aspiration Cytology and Core Needle Biopsy in Head and Neck Pathology - A Nationwide Survey in Germany.

Fine-needle aspiration cytology (FNA) and core needle biopsy (CNB) of the thyroid gland, salivary glands, and lymph nodes are considered simple and rapid methods for minimally invasive tissue collection. We performed a postal survey to analyse the diagnostic value and complication rate of FNA and CNB in Germany. A questionnaire comprising 11 questions was sent to all 161 German ENT departments in September 2015. The response rate was 45%. In 33 of the 73 responding clinics neither FNA nor CNB were carried out. Of the 26 clinics that provided detailed reasons, the majority (n=18) cited a lack of expertise among the collaborating pathologists. Overall, FNA was used more often, regardless of the anatomical region investigated. The study was based on a total of 36,684 FNAs and 9,624 CNBs. The rate of estimated meaningful and correct findings was 63% (10%-90%) for FNA, and 83% (50%-100%) for CNB. In eight cases (<0.001%) a potential tumor cell spread was reported. This is the first nationwide survey in Germany to investigate the utility of FNA and CNB across different localizations in the head and neck region. This study revealed comparable results to the literature regarding the diagnostic value of FNA and CNB. Cell spreading was only observed in individual cases. The appraisal of needle biopsies in the head and neck area seems to be rather inhomogeneous in Germany.

Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis

IntroductionProper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis.MethodsFine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25.ResultsThe sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785).ConclusionThe fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.

Correlation Between the Thyroid Imaging Reporting and Data System and Bethesda System of Cytology in Thyroid Nodule Evaluation

Background: Accurate diagnosis of thyroid nodules is important for avoiding unnecessary surgeries and allowing timely treatment. Ultrasound and fine needle aspiration cytology (FNAC) are the most commonly used diagnostic procedures. Objective: To correlate ultrasonography with the FNAC report findings using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in differentiating malignant from benign thyroid nodules. Patients and Methods: A prospective study conducted from January 2021 to January 2024 assessed 103 cases of thyroid nodules who underwent ultrasound examination and fine needle aspiration. Ultrasonography findings were analyzed and correlated with FNA cytology reports based on ACR-TIRADS and BSRTC. Results: Patients were predominantly female, n = 87 (84.4%). Most of the patients were in the 31–40 year group (n = 55, 53.39%). Most of the patient nodules had TIRADS 3 (n = 59, 57.28%), followed by TIRADS 2 (n = 20, 18.44%). When comparing the ACR TI-RADS scoring system with the TBSRTC, the percentage of malignancy for TR1, 2, 3, 4, and 5 was 0, 0, 1.6, 80, and 89%, respectively. In our study, the overall sensitivity and specificity of the TIRADS score were 94.11% and 96.51%, respectively. PPV: 84.21%; NPV: 98.80%; and accuracy: 96.11%. In addition, there was a significant association between TIRADS and the Bethesda system of classification (P &lt; 0.001). Conclusion: ACR-TIRADS scoring is highly sensitive and accurate for diagnosing thyroid malignant nodules. It is a sensitive tool and could be used alone to determine the nature of thyroid nodules. Keywords: Thyroid malignancies, Ultrasonography, Yemen

Correlation Between the Thyroid Imaging Reporting and Data System and Bethesda System of Cytology in Thyroid Nodule Evaluation

Background: Accurate diagnosis of thyroid nodules is important for avoiding unnecessary surgeries and allowing timely treatment. Ultrasound and fine needle aspiration cytology (FNAC) are the most commonly used diagnostic procedures. Objective: To correlate ultrasonography with the FNAC report findings using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in differentiating malignant from benign thyroid nodules. Patients and Methods: A prospective study conducted from January 2021 to January 2024 assessed 103 cases of thyroid nodules who underwent ultrasound examination and fine needle aspiration. Ultrasonography findings were analyzed and correlated with FNA cytology reports based on ACR-TIRADS and BSRTC. Results: Patients were predominantly female, n = 87 (84.4%). Most of the patients were in the 31–40 year group (n = 55, 53.39%). Most of the patient nodules had TIRADS 3 (n = 59, 57.28%), followed by TIRADS 2 (n = 20, 18.44%). When comparing the ACR TI-RADS scoring system with the TBSRTC, the percentage of malignancy for TR1, 2, 3, 4, and 5 was 0, 0, 1.6, 80, and 89%, respectively. In our study, the overall sensitivity and specificity of the TIRADS score were 94.11% and 96.51%, respectively. PPV: 84.21%; NPV: 98.80%; and accuracy: 96.11%. In addition, there was a significant association between TIRADS and the Bethesda system of classification (P &lt; 0.001). Conclusion: ACR-TIRADS scoring is highly sensitive and accurate for diagnosing thyroid malignant nodules. It is a sensitive tool and could be used alone to determine the nature of thyroid nodules.

Diagnostic value of ultrasound-guided fine-needle aspiration cytology in the pathological natures of thyroid nodules: A retrospective study.

Thyroid nodules, a clinical disease with high incidence, include benign and malignant types. This study aims to evaluate the diagnostic value of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in determining the pathological nature of thyroid nodules and to conduct an in-depth analysis of its diagnostic efficacy across nodules of varying sizes. This retrospective study identified 116 patients undergoing thyroidectomy in Zibo Central hospital from January 2022 to March 2023, with 98 meeting the study's inclusion criteria. All patients received ultrasound and US-FNAC examinations before surgery to analyze the ultrasonic features of thyroid nodules. The diagnosis results of pathological natures obtained by US-FNAC were analyzed with the result of post-operative pathological examination as the gold standard. The patients were divided into four groups according to the median and quartile of nodular diameters to explore the diagnostic efficacy of US-FNAC for the pathological natures of thyroid nodules with various diameters and comprehensively evaluate its application value. The evaluation tool of diagnostic efficacy was the receiver operator characteristic (ROC) curve. A total of 98 puncture nodules were evaluated, with a diameter of 0.8-5.2 cm. Post-operative pathological examination showed 10 (10.20%) benign and 88 (89.80%) malignant lesions. The ultrasound examination showed 14 (14.29%) benign and 84 (85.71%) suspected malignant lesions. The US-FNAC results showed 2 cases (2.04%) of type I, 9 cases (9.18%) of type II, 3 cases (3.06%) of type III, 29 cases (29.59%) of type IV, 39 cases (39.80%) of type V, and 16 cases (16.33%) of type VI, including 9 (9.18%) benign and 84 (85.72%) malignant lesions and 5 (5.10%) uncertain pathological natures. According to the median and quartile of nodular diameters, specifically, 1.90 (1.60, 2.30) cm, 93 nodules with decided pathological natures were divided into groups Q1 (n = 24, ≤1.6 cm), Q2 (n = 26, 1.7-1.9 cm), Q3 (n = 24, 2.0-2.3 cm), and Q4 (n = 19, >2.3 cm). The results of ROC analysis showed that the area under the curve (AUC), sensitivity, and specificity of US-FNAC diagnosis were 0.894, 98.80%, and 80.00%, respectively. The AUCs of US-FNAC in groups Q1, Q2, Q3, and Q4 were 0.978, 1.000, 0.977, and 0.971. The AUCs of Q1 group, Q2 group, Q3 group and Q4 group were all > 0.9, and US-FNAC had high diagnostic efficiency for the pathological properties of thyroid nodules with different diameters. US-FNAC has a high diagnostic efficiency for the pathological properties of thyroid nodules. Whether the nodule diameter has an effect on the accuracy of this method requires more clinical evidence.

Fine-needle aspiration cytology of diffuse type tenosynovial giant cell tumor with malignant trasformation and review of literature.

Tenosynovial giant cell tumors (TGCTs) arise from the synovium of joint, bursa, and tendon sheath. Diffuse type often affects large joints, has higher recurrence rates, metastases, and malignant transformation potential compared to the localized type. The cytopathology of TGCT, a fibrohistiocytic neoplasm distinct from other giant cell-rich soft tissue tumors, is rarely reported. Here we describe cytomorphology of a case of TGCT that was initially diagnosed on fine-needle aspiration cytology (FNAC) consisting of a mixture of singly scattered polygonal or spindle mononuclear cells with hemosiderin laden macrophages, inflammatory cells, and a population of multinucleated osteoclast-like giant cells. Persistent symptoms and repeat excision were consistent with high-grade malignant transformation of the TGCT. Atypical cytologic features in a recurrent, infiltrative, or a metastatic lesion should raise suspicion for malignancy.

Detection of Breast Lumps with Fine Needle Aspiration Cytology: Experience of 50 Cases in Bangladesh

Background: Detection of breast lump is very crucial. Objective: This study was carried out to evaluate the effectiveness of FNAC as a diagnostic method for breast lump. Methodology: This cross sectional study was conducted among 50 women with breast lump at Popular Medical College Hospital, Dhaka, Dhaka Medical College Hospital and Ad-Din Barrister Rafique Ul Huq Hospital, Dhaka during the period of November 2021 to April 2022. This study was conducted using convenient type of non-probability sampling technique. Data were collected by face to face interview, clinical examination and findings of both cytological and histopathological examination. Results: The study revealed the most benign breast lesion (89.45%) were below the age of 40 years and most of the breast cancer (91.2%) were above the age of 40 years. The study showed that 29 cases (58.0%) were diagnosed as benign clinically but cytologically 30(60.0%) cases were benign. Clinically 14(27.0%) cases were malignant but cytologically 13(26.0%) cases malignant. Clinical diagnosis of 8(7.5%) cases were uncertain, whereas cytologically 2(4.0%) cases were suspicious of malignancy and 1(2.0%) case was atypical. The comparison study between cyological and final histopathological diagnosis showed that out of 28 benign lesions diagnosed cytologically among which only 2 cases were found malignant histologically like false negative 2 (7.20%). 13 malignant cases were diagnosed cytologically which were confirmed histologically like no false positive was found. The study found that sensitivity of FNAC 85.3% of the presence of breast cancer and specificity 100.0% for absence of breast cancer. They also showed that the negative predictive value of FNAC for benign breast lump was 93.5% and positive predictive value for malignant breast lump was 100.0% and the overall diagnostic accuracy was 95.40%. Conclusion: In conclusion, FNAC can be used as a diagnostic method in the management of breast lump which has reasonable sensitivity and specificity. Journal of Current and Advance Medical Research, July 2023;10(2):65-69

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

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

Agreement between Sonographic Features and Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules in a Tertiary Hospital

Agreement between Sonographic Features and Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules in a Tertiary Hospital

Unveiling the link between ACR TI-RADS grading and Bethesda score of thyroid nodules in diabetic patients: A comprehensive analysis.

This study aimed to explores the factors influencing thyroid nodules (TNs) in individuals with type 2 diabetes mellitus (T2DM) and evaluates the consistency between different American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) grades and Bethesda scores. Total of 642 T2DM patients were divided into TN group (245) and control group (397) based on the presence or absence of TNs. TN patients were further categorized into ACR TI-RADS classification (TR) 1 to 4 and TR5 subgroups. Diabetes-related clinical and biochemical parameters were collected, and differences were analyzed using univariate analysis. Logistic regression analysis was utilized to pinpoint independent influencing factors for TN occurrence and different TN classifications. Consequently, age, body mass index (BMI), fasting plasma glucose level (FBGL), low density lipoprotein cholesterol (LDL-C), diabetic progression, and family history of TNs emerged as independent risk factors for TN development in T2DM patients. Additionally, glycosylated hemoglobin (HbA1c), nodule diameter, and family history of TNs were identified as independent risk factors for TR5 TN development in T2DM patients. All TR1 to 2 nodules had a Bethesda score of 2 and all showed benign pathological findings. In 97.10% of cases (67/69), nodules classified as TR3 exhibited a Bethesda score of 2, with all pathological results indicating benign findings, aligning with the Bethesda score. In addition, the concordance between TR4 nodules and Bethesda score was only 78.57% (88/112). In conclusion, TNs and their malignancy in T2DM patients are significantly linked to blood glucose and lipid metabolism indexes. TR3 classification in T2DM patients poses a low malignancy risk, suggesting caution when conducting fine needle aspiration cytology (FNAC) testing.