Fine Needle Aspiration Cytology Biopsy Research Articles

Thyroid nodule malignancy is associated with increased non-invasive hepatic fibrosis scores in metabolic subjects.

Thyroid cancer incidence is increasing, and adiposity-related conditions are gaining space in its pathogenesis. In this study, we aimed to detect any anthropometric, biohumoral, and clinical features that might be associated with thyroid nodule malignancy, potentially representing novel non-invasive markers of thyroid cancer. The study was conducted in a group of 142 consecutive outpatients (47 men and 95 women) who underwent fine-needle aspiration biopsy/cytology (FNAB/C) due to suspicion of malignancy from January 2018 to September 2022. We compared lipid and glycemic blood profiles as well as non-invasive liver fibrosis indexes such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet ratio index (APRI), and fibrosis index based on four factors (FIB-4) between patients with benign and malignant newly diagnosed nodules. Then, we performed receiver operating characteristic (ROC) analysis to assess their best cutoff values for discrimination of malignant nodules and chi-squared test to evaluate the association of specific dysmetabolic conditions with malignancy. To understand whether and to what degree dysmetabolic conditions increased the risk of thyroid nodule malignancy, we also calculated the odds ratio (OR) of the main biomarkers. After FNAB/C, 121 (85%) patients were diagnosed with benign thyroid nodules, while 21 (15%) individuals were diagnosed with thyroid cancer. Comparing patients with benign and malignant nodules, we found that individuals with thyroid cancer exhibited increased body mass index (BMI) (p = 0.048) and fasting plasma glucose (p = 0.046). Intriguingly, considering non-invasive scores for liver fibrosis, subjects with thyroid cancer presented increased AAR (p < 0.001) and APRI (p = 0.007), and these scores were associated with malignancy (p < 0.005) with OR = 7.1 and OR = 5, respectively. Moreover, we showed that only in the cancer group, low levels of vitamin D correlated with stigmata of impaired metabolism. In our study, AAR and APRI scores were associated with thyroid nodule malignancy and could be used to predict it and to speed up the diagnostic process. From a pathogenic point of view, we speculated that metabolic-associated fatty liver disease (MAFLD) along with hyperglycemia and vitamin D deficiency may represent putative drivers of thyroid carcinogenesis.

Photoacoustic Tomography Combined with Ultrasound Mapping for Guiding Fine-Needle Aspiration of Thyroid Nodules: A Pilot Study

This study aims to explore the feasibility of fine-needle aspiration biopsy (FNAB) under dual modal photoacoustic tomography(PAT)/ultrasound (US) imaging. A total of 25 patients who have thyroid nodules with thyroid imaging reporting and data system (TIRADS) 3 and 4 (malignant risk &lt;85%) were recruited. The specimens obtained from the PAT/US-guided FNAB were collected for cytology analysis. Cytological diagnoses for the 25 patients were classified in perspective of the Bethesda system for reporting thyroid cytopathology diagnostic category (DC) I: 4%(1/25); DC II: 12% (3/25); DC III: 20% (5/25); DC IV: 8% (2/25); DC V: 32% (8/25); and DC VI: 24% (6/25). The DC I nodule exhibited inadequate cytology and had structural characteristic of predominant calcifications in PAT/US mapping. The DC V-VI nodules showed lower photoacoustic (PA) signals compared to the DC I-IV nodules. Regions with a high PA signal demonstrated a significant number of erythrocytes in FNAB cytology. Moreover, nodules with microcalcifications did not show a significant difference compared to their surroundings in the PA signal, while nodules with macrocalcifications gave higher PA signals compared to their surroundings. The conclusions are as follows: combining US with PAT can evaluate the structure and function of thyroid nodules in vivo. This study demonstrates that dual modal PAT/US imaging has the potential to be an effective clinical tool to guide FNAB of thyroid nodules.

B-200 Preoperative Classification of Thyroid Nodules by Desorption Electrospray Ionization Mass Spectrometry Imaging of Fine Needle Aspiration Biopsies

Abstract Background Preoperative diagnosis of thyroid lesions by fine-needle aspiration (FNA) biopsy cytology can be challenging, and in up to 20% of cases is unachievable. Patients with an indeterminate preoperative diagnosis are often recommended for diagnostic surgery, with the majority receiving a benign diagnosis, rendering the surgery unnecessary. Consequently, new technologies that can provide accurate preoperative diagnosis of thyroid lesions are needed. Here, we have employed DESI-MS imaging along with statistical modeling to determine molecular signatures of benign and malignant thyroid lesions using banked thyroid tissue samples with known histopathology diagnosis. We then applied this methodology for analysis and classification of preoperatively collected FNA smears. Methods A total of 199 fresh-frozen thyroid tissues including 50 normal, 55 follicular adenoma (FTA), 58 follicular carcinoma (FTC), and 36 papillary carcinoma (PTC) were sectioned at a thickness of 10 µm and stored at −80 °C until analysis. FNA biopsies were prospectively collected at Baylor College of Medicine. DESI-MS imaging was performed in the negative ion mode using a Waters Xevo G2-XS mass spectrometer fitted with a DESI-XS source. Samples were H&amp;E stained and pathologically evaluated after analysis. Molecular profiles from tissue regions of clear histology were used to build classification models. For the FNA smears, mass spectra corresponding to clusters of thyroid cells were extracted for statistical prediction, and the predictive performance of the models on FNA smears was assessed in correlation with pathology. Results DESI-MS analysis of thyroid tissue sections generated 151 317 individual mass spectra, comprised of hundreds of lipid and metabolite features, that were used to build and validate two classification models: PTC vs benign thyroid, comprised of normal thyroid and FTA, and FTC vs benign thyroid. For each of these models, the data was randomly split with two-thirds used as a training set to generate the model and one-third used as an independent validation set to assess the performance of the model. For the PTC vs benign thyroid model, a prediction accuracy of 97.7% was achieved for the training set with an accuracy of 96.6% for the withheld validation dataset. For the FTC vs benign model, an accuracy of 78.4% was achieved for both the training and validation datasets. We are currently refining statistical workflows to improve the performance of the FTC model and to generate a model discriminating benign thyroid from thyroid cancer (FTC and PTC combined). When testing the prediction of the classifiers built from tissue imaging data on an initial sample set of 19 FNAs, overall per-sample prediction accuracies of 79% and 89% were obtained using the PTC vs benign thyroid model and the FTC vs benign thyroid model, respectively. We are currently working to collect, analyze, and validate the performance of the classification models on additional FNA biopsies, with a focus on samples with indeterminate cytology. Conclusions Overall prediction accuracies of 79% and 89% were achieved for the benign vs PTC model and benign vs FTC model, respectively, for thyroid FNA classification. With the addition of DESI-MS, unnecessary diagnostic surgeries could be prevented by providing improved preoperative specificity.

Cut-off Value for Thyroglobulin Washout Concentration in the Detection of Cervical Lymph Node Metastases in Patients after Thyroidectomy Due to Differentiated Thyroid Cancer.

The aim of this study was to establish the cut-off value for the thyroglobulin (Tg) concentration in washout fluid from fine needle aspiration biopsy (FNA-Tg) in the detection of cervical lymph node metastases of differentiated thyroid cancer (DTC). We evaluated the validity and clinical utility of fine needle aspiration biopsy cytology (FNAB-C), FNA-Tg, and the combined method in detecting DTC recurrences. The study included 82 patients after the total thyroidectomy and elective and, in some cases, also selective cervical lymphadenectomy. The majority of patients also underwent subsequent 131I ablative therapy. The patients presented with 1-6 enlarged and/or ultrasonographically suspicious cervical lymph nodes. One to four aspirates of each lymph node were taken, with a total of 297 samples. An FNA-Tg of 4.34 ng/mL was established as the cut-off value for detecting cervical lymph node DTC metastases for the IRMA Brahms DYNO test, Tg-S. FNAB-C is highly specific (91-99%) but not sensitive enough (53-69%) to be used as a standalone method in the detection of cervical lymph node metastases. FNA-Tg is more sensitive (91%), but caution should be taken when selecting patients for surgery with an FNA-Tg higher than the established cut-off value but lower than the serum Tg concentration. To select patients for lymphadenectomy, we recommend using the combined method (FNAB-C and FNA-Tg) with a sensitivity of 96% and specificity of up to 97%. More than one sample should be taken with each fine needle aspiration biopsy (FNAB) to obtain a representative set of samples.

Fine needle aspiration cytopathology of pleomorphic dermal sarcoma.

Pleomorphic dermal sarcoma (PDS) is an uncommon cutaneous mesenchymal neoplasm. It is cytomorphologically identical to atypical fibroxanthoma (AFX), but differs due to its invasion beyond the dermis. We undertook an examination of our experience with fine needle aspiration (FNA) biopsy cytology of PDS. Our cytopathology files were searched for examples of PDS with concomitant histopathological verification. FNA biopsy smears and cell collection were performed using standard techniques. Seven cases of PDS were retrieved from four different patients (M:F, 1:1; age range: 63-88 years; mean age = 78 years). All patients (57%) presented with a primary tumour with one having an FNA biopsy of two local recurrences and a single distant metastasis. Five aspirates were from the extremities and two from the head/neck. Tumours ranged from 1.0 to 3.5 cm (mean, 2.2 cm). Specific cytological diagnoses were pleomorphic spindle/epithelioid sarcoma (3 cases), PDS (2), AFX (1), and atypical myofibroblastic lesion, query nodular fasciitis (1). Immunohistochemical (IHC) staining from FNA-generated cell blocks in two cases showed non-specific staining with vimentin in both cases; positive CD10, CD68, and INI-1 staining in one case; and smooth muscle actin expression in the other. Multiple negative stains were performed in both of these cases to exclude malignant melanoma, carcinoma, and specific forms of sarcoma. Cytopathology consisted of a mixture of spindle, epithelioid, and bizarre pleomorphic cells. Coupled with ancillary IHC stains, FNA biopsy can help recognise PDS as a sarcomatous cutaneous neoplasm, but is unable to distinguish PDS from AFX.

Validation of the IAC Yokohama system for reporting breast fine-needle aspiration cytology categorization of breast lesions in Vindhya region population

Background: In 2016, International academy of cytology (IAC) has established a standardized approach for reporting breast fine-needle aspiration cytology (FNAC) by categorizing the lesions in five tier system from C1 to C5 to standardize reporting, which will enhance Breast fine-needle aspiration biopsy cytology performance, interpretation, and reporting. Aims and Objectives: The aim of the study was to categorize FNAC cases according to The IAC Yokohama System and evaluate the diagnostic ability of FNAC. Materials and Methods: The current prospective analytical study was carried out in the Department of Pathology, Shyam Shah Medical College, Rewa, Madhya Pradesh, for a period of 15 months from January 2021 to March 2022 (15 months). A total of 100 cases were included in the study based on inclusion criteria. The results were analyzed based on cytological reporting and P value calculated. Results: Among the 100 cases studied highest number of cases were from the age group of 21–30 years with 29% (n=29). The most common breast laterality affected was left with 69% of affected cases. The maximum number of cases, 69% (n=69) of the total, were found to be categorized under the category C2 (benign) which was followed by Category C5 (Malignant) seen in 13% (n=13). About 9% (n=9) of the total cases were categorized as suspicious of malignancy (C4). Atypical Lesion (C3) and Unsatisfactory Lesions (C1) were categorized in 5% (n=5) and 4% (n=4) of the total cases, respectively. Conclusion: FNAC is a minimally invasive, quick, and efficient pre-operative diagnostic tool that can also be used for postoperative breast lump follow-up to prevent recurrences. FNAC using IAC Yokohama system is a rapid and effective method for the primary categorization of palpable breast lumps and provides better clarity to the clinicians in the management of the patient and can reduce unnecessary surgeries.

Assessing the accuracy of the International Academy of Cytology Yokohama System for reporting breast fine needle aspiration biopsy cytology at a Vietnamese oncology centre.

Fine needle aspiration biopsy (FNAB), accompanied by classification systems for cytology, can offer a cheap and convenient option for the diagnosis of breast cancer in women with suspicious breast lumps. In this study, we aimed to assess the accuracy of the International Academy of Cytology (IAC) Yokohama system in a Vietnamese oncology centre. A retrospective cross-sectional study was conducted from November 2021 to April 2022 at Vietnam National Cancer Hospital. We included patients with full hospital records regarding breast lesions for which FNAB was indicated. A total of 803 patients' FNAB specimens were assessed according to the IAC Yokohama system. The basic characteristics were summarised using the appropriate summary measurements. The risk of malignancy (ROM) was calculated for each classification category. The median age was 42.7 years (range: 14-85). The mean size of the lesions was 17.9 mm (range: 4-123 mm). We had 215 histopathological reports. The most common benign and malignant diagnoses were fibroadenoma and invasive carcinoma, respectively. The ROM for categories II, III, IV, and V was calculated as 3.4%, 37.5%, 95%, and 99.2% respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.4%, 97.2%, 98.5%, and 93.2%, respectively. The IAC Yokohama system offers a good option with which to predict underlying breast pathology using a simple and cheap procedure. However, pathologists require continuous training to ensure accurate interpretation of the slides.

Challenges in Risk Stratification of Solid Atypical Mixed Echogenicity Thyroid Nodules

Background: To determine the prevalence and risk of malignancy (ROM) in solid atypical mixed echogenicity thyroid nodules (SAMENs) with sonographic patterns not classifiable by the 2015 American Thyroid Association Ultrasound Risk Stratification System (NC ATA). Methods: We searched our prospectively collected endocrine surgery thyroid nodule (TN) database, with particular attention to those solid nodules that were NC ATA. An algorithm assigned each into one of the five ATA risk groups per the 2015 American Thyroid Association Ultrasound Risk Stratification System (ATA USRSS). TNs that the algorithm could not assign to a risk group were deemed NC ATA and were subsequently analyzed. Additionally, we categorized this group using an algorithm based on the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). We were specifically interested in the characteristics that resulted in non-classification by the 2015 ATA USRSS and the fine needle aspiration biopsy (FNAB) cytology and surgical pathology results from the group. Results: We evaluated data from 5,040 nodules, of which 1,772 had surgical pathology. There were 150 solid nodules not classified by 2015 ATA USRSS, all of which demonstrated atypical features along with iso-, hetero-, hyper- and mixed echogenicity (solid atypical mixed echogenicity nodules- SAMENs). Sixty of these nodules were excised and sent for surgical pathology, while 90 were followed without surgical excision. Out of the 90 that did not undergo surgery, 82 underwent FNAB with cytologic evaluation. Of our 150 SAMENs, 40 were malignant by surgical histology and six were likely malignant by cytology (total SAMEN ROM without noninvasive follicular thyroid neoplasm with papillary-like nuclear features 31%). The most common sonographic pattern present in our SAMEN group consisted of an isoechoic solid component with microcalcifications (28/40–70% of all excised malignant nodules). In our excised malignant SAMENs, 50% demonstrated follicular-patterned neoplastic architecture while 48% displayed papillary architecture. Conclusion: Our study demonstrates that SAMENs with at least one suspicious sonographic feature: including (1) microcalcifications; (2) irregular or other suspicious margins,;opulation, and a higher ROM (31%) than the intermediate-risk group of the 2015 ATA USRSS (10–20%).

Cytomorphological Characteristics Of Ameloblastoma By Fine Needle Aspiration Biopsy Procedure Confirmed With Histopathological Examination

Background: Ameloblastoma is the most common benign epithelial odontogenic tumor with malignant potential and is usually located in the jaw. It constitutes about 1-3% of all tumors and cysts of jaws. This entity has a very high recurrence rate of over 50% even after wide excision. Preoperative diagnosis of ameloblastoma can be made by fine-needle aspiration biopsy (FNAB) which is used as a guide for surgical planning. Case report: We report a case of a tumor in the mandible of a 41-year-old man with a preoperative diagnosis of ameloblastoma from a fine needle aspiration biopsy. Cytological examination of FNAB was confirmed by histopathological preparation of tumor tissue. Conclusion: The fine needle aspiration biopsy cytology is a reliable procedure for the pre-operative diagnosis of ameloblastoma. Pre-operative diagnosis of ameloblastoma can be used for planning therapy and early diagnosis of recurrence cases that can improve patient survival

Fine Needle Aspiration Biopsy Cytology Reporting of Breast Lesions with Special Reference to International Academy of Cytology Standardized Reporting Yokohama Grading System: A Retrospective Study at Tertiary Care Centre in India

Fine Needle Aspiration Biopsy Cytology Reporting of Breast Lesions with Special Reference to International Academy of Cytology Standardized Reporting Yokohama Grading System: A Retrospective Study at Tertiary Care Centre in India

Diagnostic accuracy of palpation versus ultrasound-guided fine needle aspiration biopsy for diagnosis of malignancy in thyroid nodules: a systematic review and meta-analysis

Thyroid nodule is a common health problem in endocrinology. Thyroid fine-needle aspiration biopsy (FNAB) cytology performed by palpation guided FNAB (PGFNAB) and ultrasound-guided FNAB (USGFNAB) are the preferred examinations for the diagnosis of thyroid cancer and part of the integration of the current thyroid nodule assessment. Although studies have shown USGFNAB to be more accurate than PGFNAB, inconsistencies from several studies and clinical guidelines still exist.The purpose of this study is to compare the diagnostic accuracy of Palpation versus Ultrasound-Guided Fine Needle Aspiration Biopsy in diagnosing malignancy of thyroid nodules.The systematic review and meta-analysis were prepared based on the PRISMA standards. Literature searches were carried out on three online databases (Pubmed/MEDLINE, Embase, and Proquest) and grey literatures. Data extraction was carried out manually from various studies that met the eligibility, followed by analysis to obtain pooled data on sensitivity, specificity, Diagnostic Odds Ratio (DOR) and Area Under Curve (AUC), and the comparison of the two methods.Total of 2517 articles were obtained, with 11 studies were included in this systematic review. The total sample was 2382, including 1128 subjects using PGFNAB and 1254 subjects using USGFNAB. The risk of bias was assessed using QUADAS-2 with mild-moderate results. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using PGFNAB were 76% (95% CI, 49–89%), 77% (95% CI, 56–95%), 0.827 and 11.6 (95% CI, 6–21) respectively. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using USGFNAB were 90% (95% CI, 81–95%), 80% (95% CI, 66–89%), 0.92 and 40 (95% CI, 23–69), respectively the results of the comparison test between PGFNAB and USGFNAB; Tsens USGFNAB of 0.99 (p = 0.023), AUC difference test of 0.093 (p = 0.000023).The diagnostic accuracy of USGFNAB is higher than PGFNAB in diagnosing malignancy of thyroid nodules. If it is accessible, the author recommends using USGFNAB as a diagnostic tool for thyroid nodules.

Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System.

BackgroundA new category system comprising five classes (C1-insufficient material, C2-benign, C3-atypical, C4-suspicious, and C5-malignant) has been proposed by the International Academy of Cytology (IAC) for fine needle aspiration biopsy cytology (FNAB) for proper diagnosis of breast cancer.Aims and ObjectivesThis study is designed to categorize institutional FNAB data according to the new system and calculation of the absolute risk of malignancy (ROM), sensitivity, specificity, positive predictive values, false negative and false-positive rate.Study DesignWe conducted a retrospective cross-sectional study involving 2133 cases collected between June, 2008 and August, 2019, at Foundation University Medical College’s Department of Histopathology and the Surgery and Oncology Department at the Fauji Foundation Hospital. All cases fulfilling the inclusion and exclusion criteria were retrieved from the archives and reviewed by two expert pathologists. Matching histopathology was compared with the cytology reports for concordance or discordance of results.FindingsWe found 6.9% (n = 147) insufficient, 65.8% (n = 1403) benign, 7.2% (n = 153) atypical, 7.5% (n = 160) suspicious and 12.6% (n = 270) malignant cases. Cyto-histological correlation was found in 421 cases from the year 2014 to 2019 with 370 concordant and 51 discordant cases. The maximum number of concordant cases was 151 in the C5 category and discordant cases had a diagnosis of C3 and C4 on cytology with 16 cases in each category. The calculated values of ROM were 45.45%, 10.3%, 30.6%, 82.79% and 99.34% from C1 to C5, respectively. We calculated 83.42% absolute sensitivity and 85.24% specificity. The positive predictive value for category 3, 4 and 5 was 67.34%, 82.7% and 99.34%, respectively, while false-negative rate was 7.9% and false-positive rate was 0.66%.ConclusionThe ROM for C1 category calculated from this study is quite high (45.45%) compared to previous studies; therefore, it is recommended to perform core needle biopsy in all these cases. The higher sensitivity and specificity of this method of diagnosing malignant lesions supports its use.

Tumor-infiltrating lymphocytes in breast FNA biopsy cytology: A predictor of tumor-infiltrating lymphocytes in histologic evaluation.

Tumor-infiltrating lymphocytes (TILs) are associated with various clinicopathological features. Using cytologic specimens for assessing TILs remains to be established. This retrospective study aimed to establish a practical method to assess TILs in cytologic samples. The authors found 1101 breast fine-needle aspiration biopsy (FNAB) cytology samples in their hospital, and 214 of them met the inclusion criteria. The TILs score was evaluated using histologic slides, and breast cancers were divided into 2 groups: low- (<60%) and high-TILs (≥60%). Training and validation tests composed of 50 breast cancer samples each were constructed. A cytologic TILs (cTILs) score was introduced to evaluate lymphocytes in FNAB cytology and it was compared with histologically evaluated TILs. The cTILs score was calculated by subtracting the number of neutrophils from the number of lymphocytes surrounding the tumor cells. In the training test, a 2-tier system with low- and high-TILs groups showed a large area under the curve (AUC) (0.943; 95% confidence interval [CI], 0.84-0.99). A cTILs score cutoff value of >8 had 87.5% sensitivity and 90.5% specificity. In the validation test, the AUC was 0.79 (95% CI, 0.6-0.93) whereas sensitivity and specificity were 57% and 89.5%, respectively. When small tumors <0.5cm were excluded, the AUC improved to 0.93 (95% CI, 0.83-1.0), and sensitivity and specificity were 80% and 88.5%, respectively. The cTILs scoring system had acceptable reproducibility and concordance with TILs on histologic samples for tumors ≥0.5cm. Cytologic evaluation can potentially substitute for histologic evaluation of TILs.

Fine-needle aspiration biopsy versus frozen section examination in assessing cervical lymph node metastasis in primary clinically positive neck papillary thyroid carcinoma.

Both fine-needle aspiration biopsy (FNAB) and frozen section (FS) examination are reliable methods for assessing cervical lymph node (level II-V) metastasis (LNM) in papillary thyroid carcinoma (PTC). Our goal was to compare the diagnostic accuracy of FNAB and FS in clinically positive neck (cN+) PTC patients. Altogether, 264 lymph node samples from 220 patients were prospectively enrolled. Samples were assessed by FNAB cytology (FNAB-C), thyroglobulin (Tg) FNAB needle wash testing (FNAB-Tg), and FS simultaneously. Diagnostic performance of the different methods were analyzed by the Chi-square test. The sensitivity and specificity of FNAB-C alone in predicting LNM was 87.4% and 85.7%, respectively. Combined with FNAB-Tg, the sensitivity and specificity of FNAB-C increased to 98.9% and 81.6%, respectively. The sensitivity and specificity of FS in predicting LNM was 92.4% and 81.1%, respectively. FNAB-C and FNAB-Tg had better sensitivity than FS when applied to solid lymph nodes, and comparable sensitivity when applied to cystic and cystic-solid lymph nodes. The utilization of FNAB-Tg significantly improved the diagnostic ability of FNAB-C. FS can be replaced by preoperative FNAB combined with FNAB-Tg without compromising diagnostic accuracy.

Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases

ObjectiveTo investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. MethodsData of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. ResultsA thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). ConclusionAlthough the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.

Sistema Internacional Yokohama para el informe de la citología mamaria. Academia Internacional de Citología

Fine needle aspiration biopsy cytology is part of the diagnostic triad in the evaluation of breast pathology, along with clinical and mammography or ultrasound findings. The Yokohama international system of the International Agency for Cytology has been proposed to report fine needle puncture-aspiration biopsy breast cytology, through 5 diagnostic categories: Inadequate/insufficient, benign, atypical, suspicious for malignancy and malignant, including in each of these definitions, key cytological diagnostic criteria and suggestions for clinical management. The objective of this article was to know the guidelines of this new breast cytological classification system for its implementation in this region. Fine needle puncture-aspiration biopsy is a precise and effective method to diagnose different breast lesions, which requires an adequate cell sample and a precise cytomorphological interpretation. The application of standardized Yokohama system will allow to improve the evaluation, diagnosis and clinical management of the breast pathology. Keywords: Breast cytology. Fine-needle aspiration biopsy (FNAB). Reporting system Yokohama.

Application of Hans Algorithm for Subcategorization of Diffuse Large B-Cell Lymphoma in Fine-Needle Aspiration Biopsy Cytology

Introduction: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with remarkably variable clinical presentation and outcome. Hans algorithm subclassified DLBCL into prognostically distinct molecular subtypes by using immunohistochemistry (IHC). Fine-needle aspiration biopsy cytology (FNABC) is a first-line diagnostic modality in lymphadenopathy. The study aims to perform IHC on FNABC cell blocks (CBs) for subclassifying according to the Hans algorithm and correlate with case-matched histopathology. Methods: This was a retrospective study carried out between January 2017 and December 2019. All DLBCL FNABC cases with CBs and smears and which had follow-up histopathology were included in the study. Detailed cytomorphological evaluation and CD10, B-cell lymphoma 6 (BCL6), and multiple myeloma oncogene 1 IHCs were performed on CBs. The cases are divided into 3 distinct molecular subtypes based on the Hans algorithm as germinal centre B-cell (GCB), activated B-cell (ABC), and unclassified subtypes. The results were compared with the final histopathology. Results: A total of 44 cases were diagnosed as DLBCL, and 33 cases with sufficient material for further IHC were included in the study. Twelve cases were of the GCB type, 19 were of the ABC type, and 2 remained unclassified. Follow-up histopathology was available in 20 cases. Overall, histopathological concordance was found in 95% of cases (19/20). The single discordant case was classified as GCB on FNABC and was ABC on histopathology. Conclusion: FNABC with CBs is an acceptable alternative to biopsy for providing a complete diagnosis of DLBCL as per the current WHO classification.

The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy.

Objectives:Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category.Material and Methods:A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology.Results:The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively.Conclusion:FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

A five-gene panel refines differential diagnosis of thyroid nodules.

BackgroundMolecular testing for oncogenic mutations in fine‐needle aspiration has showed high predictive value in identifying malignant lesions from thyroid nodules with indeterminate cytology.MethodsTo figure out an efficient and economical gene panel for most medical institutions in China, we designed a five‐gene panel including BRAF/NRAS/KRAS/HRAS/TERT genes and conducted a retrospective study to evaluate the role of this five‐gene diagnostic panel in differential diagnosis of thyroid nodules.ResultsA total of 665 patients with 695 thyroid nodules were investigated in the current study. The fine‐needle aspiration biopsy and surgically separated thyroid tissue specimens were harvested to test BRAF, TERT, NRAS, KRAS, and HRAS mutations. We identified 261 mutations in 665 patients, including 177 V600E mutations in BRAF. Three hundred and sixty‐nine patients who underwent thyroid surgery after completion of the initial clinical and cytological evaluation were enrolled in the final analysis. The diagnostic sensitivity, specificity, and accuracy of the combination of FNAB cytology and five‐gene detection were 74.7%, 93.8%, and 84.8%, respectively. BRAF V600E and five‐gene panel could recognize 46.4% and 53.6% of papillary thyroid carcinoma in the patients with cytologically indeterminate nodules.ConclusionThe five‐gene panel can effectively improve the sensitivity, negative predictive value, and accuracy of fine‐needle aspiration biopsy cytology, especially in the patients with cytologically indeterminate nodules.

The role of fine-needle aspiration biopsy and post-operative histology in the evaluation of thyroid nodules

Thyroid nodules present a serious problem, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. The risk of malignancy varies from 5 to 15 %. Steps to diagnose malignancy should include a careful clinical evaluation, laboratory tests, a thyroid ultrasound exam and a fine-needle aspiration biopsy. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules. Today it is considered the gold standard for malignancy diagnosis in thyroid cancer. In this review we evaluate the role of FNAB and post-operative cytology in the evaluation of thyroid nodules. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). Unsatisfactory smears (5–10 %) result from hypocellular specimens usually caused by cystic fluid, bloody smears, or suboptimal preparation. Diagnostic smears are conventionally subclassified into benign, indeterminate, or malignant categories. Benign cytology (60–70 %) is negative for malignancy, and includes cysts, colloid nodule, or Hashimoto thyroiditis. Malignant cytology (5 %) is almost always positive for malignancy, and includes primary thyroid tumors or nonthyroid metastatic cancers. Indeterminate or suspicious specimens (10–20 %) include atypical changes, Hurthle cells or follicular neoplasms. The new Bethesda Cytologic Classification has a 6-category classification, subdividing indeterminate further by risk factors. Considering the increasing worldwide incidence of thyroid microadenomas, recently it is recommended to undergo FNAB under ultrasound guidance even in small (&lt; 1cm) nodules if they are correlated with suspicious ultrasonographic features or suspicious neck lymph nodes. FNAB is a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and pre-operative diagnosis of thyroid carcinomas. It was concluded that FNAB is the gold standard in the evaluation of thyroid nodules and can prevent many unnecessary surgeries. False-negative FNA cytology remains a concern for clinicians treating patients with thyroid nodules. Post-operative histology give the definitive diagnosis and studies confirm that it has a significant discordance between pre-operative cytology and post-operative histology in patients with thyroid nodule. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis, cystic lesions or suspicious thyroid nodules to avoid misdiagnoses.