Fine Needle Aspiration Cytology In Diagnosis Research Articles

Cyto-serological correlation in toxoplasma lymphadenitis: Is bypassing biopsy plausible?

To study ten cases of toxoplasmic lymphadenitis (TL) in which the diagnosis was made by fine needle aspiration cytology and confirmed by subsequent serology. Retrospective study done over a period of five years. We retrieved ten cases of Toxoplasma lymphadenitis in which fine-needle aspiration cytology (FNAC) of lymph node was done after clinical examination. Serology with electrochemiluminescense was done in all the cases. The cytological features were characterised by microgranulomas, abundance of tingible body macrophages and absence of necrosis. Serologic testing for toxoplasma in all the cases revealed elevated titres. Lymphadenitis due to Toxoplasma infection should be considered in the diagnosis of unexplained lymphadenopathy at all sites, especially the cervical region. Serologic confirmation should be recommended for all suspected cases. FNAC diagnosis can eliminate the need for hospitalization and surgery. To the best of authors’ knowledge, this is 5 case series of cytodiagnosis of TL in the English literature and 2 in the Indian literature. This is the largest case series of cytodiagnosis of TL in the Indian literature and 2 largest in the world literature next to the one done by Haque et al.

Is it possible to eliminate the number of inappropriate thyroid surgeries combining scintigraphy and cytology?

Objective: Although fine needle aspiration cytology (FNAC) is the most reliable, safe and accurate method for the clinical management of abnormal thyroid nodules, 5%-15% of cases lead to indeterminate diagnoses and surgery is the recommended practice for them as they may be malignant. Nevertheless, the majority of cases with indeterminate cytology are benign, so the risk of unnecessary surgery is significant. In our study we combined FNAC and scintigraphy in order to reduce the number of inappropriate surgeries. Subjects and Methods: From 219 patients with thyroid fine needle aspiration cytology 33(9 males and 24 females) aged 18-73 years, had indeterminate FNAC diagnoses and were referred for scintigraphy. Surgery was performed in all cases. The results of FNAC, scintigraphy and histology were collected and compared. Results: From 33 cases with indeterminate cytology 32 had a benign histological diagnosis and only one was malignant (follicular Ca). That case had a positive scan. All cases with negative thyroid scans (29/33) were benign. False positive scans were 3, whereas one scan was true positive with final diagnosis follicular carcinoma. Conclusion: This study showed that combining the FNAC with the thyroid scintigraphy in cases of thyroid nodules with indeterminate cytology it is possible to reduce the number of inappropriate surgeries from 32 to 3.

Colossal Parotid Tumors: A Diagnostic and Surgical Challenge

Tumors of the salivary glands constitute 3% of all head and neck tumors. The parotid gland (PG) is the most common site involved in 85% of cases. PG tumors' size varies from a few millimeters to several centimeters and is about 2-6 cm on average. However, because of insidious growth and asymptomatic nature, untreated tumors of the PG can attain large size. Pleomorphic adenoma (PA), as large as 33 cm in size or 26.5 kg in weight, has been reported in the literature. Similarly, untreated Warthin’s tumor (WT) rarely becomes giant, size up to 20 cm is reported. Giant PG tumors are commonly symptomatic and have a rare tendency to become malignant.We are reporting two giant PG tumors with different histopathological diagnoses, PA and WT of size 15x15 cm and 10x8 cm, respectively. Therefore, with a size of 10 cm, our case is the second-largest WT reported in the literature. Both the giant PG tumors were present for 15-20 years, and mild pain and discomfort were the only symptoms. We had the differential preoperative tissue diagnosis in fine-needle aspiration cytology (FNAC) because of varying consistency. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) of the neck were done for these cases for preoperative planning. Compared to the former, the latter was more informative about nerve involvement preoperatively. Both the patients underwent superficial parotidectomy, and meticulous dissection was done to identify and safeguard the facial nerve and its branches. We had a challenge in closing the flaps, which was achieved with an acceptable cosmetic outcome. Both the patients were discharged in stable condition with minimal facial nerve weakness.

Medullary thyroid carcinoma a relatively uncommon entity: A case report

Introduction: Medullary thyroid carcinoma is an uncommon primary thyroid tumour (5-10% of all thyroid malignancies) arising from parafollicular cells or C-cells. Most tumours are sporadic (75-80%) and familial syndrome multiple endocrine neoplasia; MEN-2A, MEN-2B and familial MTC in 20 to 25% cases. Case Report: We report a case of primary medullary thyroid carcinoma in a 30 years old male patient presented with complaint of midline neck swelling. On fine needle aspiration cytology diagnosis of medullary carcinoma was suggested with a differential of SETTLE (spindle epithelial tumor with thymus like differentiation). The swelling was excised and send for histopathological examination which revealed polygonal to plump spindle shaped tumor cells, arranged in lobules separated by fibrous septa, having abundant eosinophilic granular cytoplasm with round to oval nuclei, finely stippled nuclear chromatin and indistinct nucleoli and diagnosed as primary medullary thyroid carcinoma, confirmed on immunohistochemistry. Conclusion: MTC is the first human malignancy known to be associated with tumour marker and hormone calcitonin. Immunohistochemistry has definite role in confirmation of diagnosis. Keywords: Amyloid, Medullary carcinoma, Procalcitonin, Synaptophysin.

Diagnostic Accuracy of Magnetic Resonance Imaging in Infective Vertebral Lesions

Background: Infective vertebral lesions usually involve the vertebral column, including the bone, intervertebral disk and paravertebral soft tissues. Variable imaging characteristics in conjunction with clinical findings can facilitate early diagnosis and treatment. MRI is a powerful imaging tool that can be help to evaluate spinal pathology specially infection. Typical MRI findings of infective vertebral disease are vertebral endplate destruction, bone marrow and intervertebral disc signal intensity changes and para vertebral soft tissue involvement. Objective: This study was aimed to assess whether the MRI can different the in differentiate the invective vertebral lesions from benign or malignant Tumors. Methods: This cross-sectional study was conducted on a total of 52 clinically suspected patients of infective vertebral lesions to establish diagnostic accuracy of MRI. The validity of MRI diagnosis for infective vertebral lesion was compared against CT-guided fine needle aspiration cytological (FNAC) diagnosis. Results: The sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) and finally diagnostic accuracy of MRI were calculated by comparing the MRI diagnoses with those of fine needle aspiration cytological diagnosis of vertebral lesions. Finally the sensitivity, specificity, PPV and NPV of MRI diagnosis for infective vertebral lesion were 95.6%, 85.7%, 97.7% and 75.0% respectively. The overall diagnostic accuracy was 94.2%. Conclusion: Finding of this study suggested that MRI should be considered as the imaging modality of choice for patients with suspected infective vertebral lesions. Bangladesh Med Res Counc Bull 2020; 46(3): 233-239

Utility of ultrasound-guided fine needle aspiration cytology in assessing malignancy in head and neck pathology.

Fine needle aspiration cytology (FNAC) is a well-established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2-year period, to assess the reliability of FNAC for the evaluation of malignancy. We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin-prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology. The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non-diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological-histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity. FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Breast Masses among Children and Adolescents Aged Below 21 Years of Age- A Cross-sectional Study

Introduction: Breast diseases in paediatric and adolescence are unusual. Fine Needle Aspiration Cytology (FNAC) has an important role in triaging breast masses, more so in younger population, wherein preoperative accurate diagnosis has significant impact on selecting and planning treatment. Role of FNAC in breast lesions amongst children and adolescents has not been explored much. Aim: To study the role of FNAC in diagnosis of breast lesions in children and adolescents. Materials and Methods: A cross-sectional study was conducted between June 2017 to May 2019 at Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. All the patients presenting with breast lesion aged below 21 years, referred to FNAC clinic during this period were included in the study. The diagnoses were categorised as inflammatory, benign, atypia, suspicious and malignant. Cytohistopathology concordance was attempted wherever possible. Analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: Out of total 45 cases, 37 (82.22%) were females and 8 (17.78%) were males. Breast lesions in paediatric and adolescents accounted for 15.20% (45/296) of total breast FNAC performed during the study period. The morphologic spectrum seen most commonly was fibroadenoma (FA) 62.22% (2-8/45), benign breast disease 8.88% (4/45), mastitis 4.44% (2/45). Morphologic variations observed in FA were epithelial hyperplasia 32.14% (9/28), cystic change 28.57% (8/28), hyper cellular stoma 21.42% (6/28), multinucleate giant cells 32.14% (9/28), apocrine change 14.28% (4/28), adenosis 10.71% (3/28), columnar cell change 10.71% (3/28), squamous metaplasia 3.57% (1/28) and atypia 3.57%(1/28). Histopathologic correlation was obtained in 31 cases (68.88%). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC was found to be 50, 100%, 100%, 96.6%, 96.77%, respectively. Conclusion: Majority of the breast lesions in paediatric and adolescents are benign in nature with FA being the most common. FNAC had high specificity and diagnostic accuracy, thereby establishing its role in selecting appropriate treatment for this age group of patients.

Role of Fine Needle Aspiration Cytology in Evaluation of Bony Lesions

Introduction: Fine Needle Aspiration Cytology (FNAC) is increasingly being recognised for its diagnostic utility in evaluation of bone tumours. Though open surgical biopsy is the procedure of choice for diagnosis of bony tumours. Aim: To evaluate the efficacy and reliability of FNAC in diagnosis of bony tumours. Materials and Methods: This cross-sectional study included 40 patients with bony lesions from July 2018 to December 2019 in tertiary level centre of Rajasthan. The FNAC was performed after clinical and radiological assessment. The smears were stained using standard techniques. Also, open biopsy was performed in the patients who presented with bony lesions of patients and slides prepared for histopathological examination using standard techniques. The data was entered in Excel sheets and the results were evaluated using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Adequate material was obtained in FNAC in 29 (72.5%) cases. Out of 29 cases, FNAC results were accurate in 96.5% cases. False Negative report was obtained in one case with no false positives. Sensitivity of FNAC in diagnosing bony lesions comes to be 90% and Specificity was 100%. The Positive Predictive Value (PPV) was 100% and the Negative Predictive Value (NPV) 95.4%. Conclusion: The FNAC is invaluable tool in primary diagnosis of bony lesions. The technique of obtaining sufficient material though needs to be mastered and will definitely improve with more experience and radiologic correlation.

Utility of Fine-Needle Aspiration Cytology in Diagnosis of Cutaneous and Subcutaneous Metastasis

Introduction: Cutaneous metastasis (CM) is an uncommon clinical presentation and poses trouble in diagnosis. However, it is remarkable and can occur due to a known or an unknown primary tumor. Despite the fact that clinical assessment helps in the diagnosis, Fine-needle aspiration cytology (FNAC) is a modest, basic, and quick principle line of investigation for the finding of CM. Materials and Methods: It was a retrospective study conducted in the department of pathology at a tertiary care teaching hospital. The study was conducted from January 2010 to May 2020. All cases of CM that has been diagnosed by FNAC were included. Results: During the study period, a total of 37 cases of CM were observed, constituting 0.15% of all FNACs. The age of the patients ranged from 35 to 74 years, and the male: female ratio was 1.05:1. Primary tumor was known in all 37 cases. Among males, lung carcinoma was the more common whereas breast was the most common organ of primary among females. The most common lesion was a single nodule (27 cases), with predominant site being chest wall (32.5%), and the most common tumor at microscopy was metastatic adenocarcinoma. Conclusion: FNAC is a fast and safe procedure that can be utilized as a first line of investigation in diagnosing metastatic skin lesions. Basic assessment of cytomorphology alongside significant clinical subtleties could help in recognizing the site of an unknown primary.

Utility of Fine-Needle Aspiration Cytology in Diagnosis of Lymphadenopathy

Introduction: Abnormal shape, size, and consistency of the lymph node constitute lymphadenopathy. The etiology of lymphadenopathy varies from reactive to malignancy. It is the significant manifestation of local and systemic ailments specially an occult malignancy. Fine-needle aspiration cytology (FNAC) is a simple, reliable initial diagnostic modality. Materials and Methods: This is a retrospective study from January 2005 to December 2017. The lesions were classified into reactive lymphadenopathy, granulomatous lymphadenitis, necrotizing lymphadenitis, suppurative lymphadenitis, lymphoma, and metastatic lesions. Primary organ was identified in available cases of metastatic lesions. Cytological and histopathological correlation was done in available cases. Results: A total of 3676 cases were retrieved constituting 16% of total FNAC performed during the study, females outnumbered the male. Most of the cases were observed in the age of 21–30 years. Cervical lymph nodes were the common site of involvement (88.8%). Among the benign lesions, granulomatous (40%) was most common followed by reactive (39%). Metastatic lymphadenopathy (13%) was the most common malignant lesion. Squamous cell carcinoma was the most common metastatic tumor followed by adenocarcinoma. The lung was the most common primary organ. FNAC is having high sensitivity and specificity for malignant lesions than the benign. Conclusion: FNAC is a rapid, initial diagnostic tool for lymphadenopathy. It is an effective tool to differentiate inflammatory, benign, and malignant lesions.

Expression of B-type RAF V600E in Thyroid Carcinoma and its Association with Histological Type

Introduction: Thyroid cancer is one of the most common cancers amongst all endocrine cancers. Incidence of thyroid malignancy is about 3-4% of all malignancy in India and 80% of thyroid malignancy belongs to Papillary Thyroid Carcinoma (PTC). Factors affecting the prognosis of PTC include patient’s gender, age, histological findings, tumour size, lymph node metastasis, extrathyroidal extension, and remote metastasis. Presence of B-type RAF V600E (BRAF V600E) mutation in thyroid carcinoma patients tends to present with more aggressive clinicopathological behaviours of PTC, prompting more aggressive radioiodine treatment. Aim: To find out the frequency of occurrence and expression of BRAF V600E mutation by Immunohistochemistry (IHC) in thyroid cancer and its association with histological type and Tumour Nodes Metastases (TNM) Staging. Materials and Methods: The present observational retrospective study included patients treated for thyroid carcinoma between January 2014 to February 2019 at RL Jalappa hospital and Research centre, Kolar, Karnataka, India. The IHC was done with rabbit monoclonal anti-BRAF V600E antibody IgG Clone RM8 (VE1). Clinical records, Fine Needle Aspiration Cytology (FNAC) diagnosis were analysed for 45 thyroid carcinoma cases. Immunopositivity was scored positive when unambiguous clear cytoplasmic staining for the antibody was observed in tumour cells. Categorical data was presented in the form of frequencies and proportions and continuous data was presented as mean and standard deviation. The t-test were applied to find out the difference in means among the groups. The p-value <0.05 was considered statistically significant. Results: Out of total 45 cases, 18 were classical PTC, 18 were Follicular Variant of Papillary Thyroid Cancer (FV-PTC), 4 were micropapillary carcinomas, 3 were Follicular carcinomas, 1 was Oncocytic variant of PTC and 1 undifferentiated thyroid carcinoma. Out of total 45 cases, 33 cases (73%) were found to be BRAF V600E positive and 12 (26%) were negative for BRAF V600E. Out of the total 33 BRAF V600E positive cases, 19 cases showed strong staining, 14 cases showed moderately positive staining. Conclusion: The PTC is the most frequent type of thyroid carcinoma amongst all the sub-types. BRAF V600E expression is commonly seen in higher tumour size (T3, T4) and classical PTC. Tumours with extrathyroidal extension and capsular invasion showed strong positivity.

Evaluation of Thyroid Swellings for Incidence of Thyroid Cancer and their Association with Serum Thyroid Stimulating Hormone and Triglyceride Levels: A Cross-sectional Study

Introduction: Earlier, several studies have been evaluated the role of Thyroid Stimulating Hormone (TSH) as a predictor of thyroid cancer in patients presenting with thyroid swelling but it remains unclear. Aim: To evaluate the role of TSH in non neoplastic tumours and neoplastic tumours and its association with various types of thyroid neoplastic tumours. Materials and Methods: In this retrospective cross-sectional study, the records of 138 patients from March 2017 to February 2019 with thyroid swelling were evaluated and analysis was done in October 2020. Examination of following parameters like age, sex, Free Triiodothyronine (FT3), Free Tetraiodothyronine (FT4), Thyroid Stimulating Hormone (TSH), Total Cholesterol (TC), Triglycerides (TGL), Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL) cholesterol were done. All the patients were divided into two groups viz., neoplastic and non neoplastic on the basis of Fine Needle Aspiration Cytology (FNAC) diagnosis. One-way ANOVA and Student's t-test were used for the analysis of thyroid tumour patients. The p-value of <0.05 was considered to be significant. Results: Out of 138 cases identified, 38 cases (27.5%) were between 10-30 years of age, 90 cases (65.2%) between 31- 50 years and 10 cases (7.3%) between 51-70 years of age. The incidence of thyroid pathology was significantly high in patients with age >30 years of age as compared to ≤30 years of age patients (27.5% vs 72.5%, Υ2=55.7, p-value <0.05). The incidence of thyroid tumours was high in females than in males and is statistically significant (20.3% vs 79.7%, Υ2=97.44, p-value <0.05). Out of 138 patients, euthyroid was observed in 71 patients, overt hypothyroidism in 37, Subclinical Hypothyroidism (SCH) in 14, overt hyperthyroidism in 11 and subclinical hyperthyroidism in four patients. Hypothyroidism was found in 50% of neoplastic tumour patients which is significantly high as compared to non neoplastic tumour patients. Significantly higher levels of TSH were noted in neoplastic group as compared to non neoplastic group (p-value <0.05). Conclusion: The high serum concentrations of TSH in patients with thyroid swellings should be evaluated properly for the early diagnosis of thyroid cancers. The data from our study provided the evidence for a possible association of TSH, TGL with thyroid cancer.

Atypical cytological presentation of granular cell tumour: Tumour-associated fibrosis may affect fine-needle aspiration cytology accuracy.

The cytological features of granular cell tumour (GCT) are generally quite typical but, in some cases, the fine needle aspiration cytology (FNAC) diagnosis of GCT may be difficult or impossible because of unusual sites of onset or equivocal cytological features. In this report, two GCTs with atypical FNAC features are described in order to investigate the causes and provide possible diagnostic tips. From a series of nine histologically proven GCTs, two inconclusive FNAC cases were retrieved. Smears were poorly cellular showing isolated naked nuclei, anisonucleosis, granular chromatin and occasional small nucleoli. The background was finely granular in one case. Histological controls of these cases revealed marked fibrosis. Tumour-associated fibrosis in GCT is variable and does not seem to influence clinical behaviour but it influences the harvest and the integrity of granular cells collected by FNAC. When GCT smears are poorly cellular, attention should be paid to the granular background and to the few granular cells, if any, as they might be the only features to suggest a GCT.

Comparative study between fine needle aspiration cytology and histopathology in the diagnosis of breast lump

Aims and Objectives: 1.To compare the results of fine needle aspiration cytology (FNAC) and histopathological study of biopsy in detecting breast cancer in suspicious breast lumps in outpatient setting.; 2. To study the accuracy of FNAC in diagnosing various breast lumps.; 3. To know whether the cancer patients can be managed based on FNAC diagnosis alone without histological study. Methodology: It was a hospital based retrospective study carried out from the data retrieved from the Dept. of Pathology of Mysore Medical College, Mysore in a period from August 2016 – September 2016. Period of Study: 2 months, Sample Size: 50 patients. Results: In the present study, FNAC had sensitivity of 50%, specificity of 100%, positive predictive value of 100%, negative predictive value of 88.37%. In this case FNAC is highly specific with maximum positive predictive value. Conclusion: Benign neoplasms of the breast are more common than malignant one.The present study shows FNAC correlation with histopathology with high specificity and maximum positive predictive value. The sensitivity of FNAC is less compared to biopsy. However, FNAC can be used as an indicative diagnosis (one stop) for breast cancer examination in outpatient setting. Accuracy of FNAC enables to proceed with surgery or not. It bridges the gap between clinical evaluation and final surgical pathological diagnosis in majority of cases. It enables the clinician to obtain a diagnosis in high percentage of cases with minimal expenditure of time, amd money and often to avoid unnecessary surgery. Keywords: Fine needle aspiration cytology, Sensitivity, Specificity, Diagnostic accuracy.

Study of FNAC in diagnosis of thyroid lesions: A prospective study

Introduction: Fine needle aspiration cytology ((FNAC) is the most sensitive, accurate and cost effective initial method for the clinical management of patient with thyroid nodules. Majority of the thyroid nodules are benign, with cancer accounting for only 1% of all the lesions. Hence it is imperative for the treating surgeon to know the biologic nature, as to benign versus malignant lesions and thus plan appropriate treatment. This would in turn avoid unnecessary surgeries. Follicular patterned lesions is a grey zone area in cytology. Aims and Objectives: To study the various morphological features of thyroid lesions by fine needle aspiration cytology and classify them according to Bethesda system for thyroid cytopathology-2007 and to evaluate the utility of FNAC in planning the management of thyroid lesions. Materials and Methods: The study was conducted in Department of Pathology, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, on patients meeting the mentioned inclusion and exclusion criteria. Results : Out of 90 cases, 3 cases (3.34%) were unsatisfactory for reporting, 69 cases (76.67%) were benign, 7 cases (7.77%) were categorized under AUS/FLUS. 9 cases (10%) were reported as Follicular Neoplasm (FN) or Suspicious for FN, 1 case (1.11%) was reported as suspicious of malignancy and 1 case (1.11%) were reported as malignant. Conclusion: FNAC of the thyroid is simpler and accurate preoperative diagnostic test compared with other diagnostic modalities. The results of thyroid cytology must be assessed in conjunction with the clinical findings and other investigations like TFT and USG findings, in view of the possibility of false negative or false positive cytological diagnosis. Keywords: FNAC, Bethesda, Thyroid, Follicular Neoplasm.

Cytomorphological study of head and neck lymph node lesions

The head and neck area is a complex anatomical structure which includes various non-neoplastic and neoplastic lesions of lymph node, salivary gland, thyroid gland and soft tissue. Fine needle aspiration cytology of head and neck lymph nodes proved useful in separating inflammatory lesions, which do not require surgical excision from cystic and neoplastic lesions with good certainty. Fine needle aspiration cytology (FNAC) is a simple, feasible, cost effective and minimally invasive procedure. But histopathological examination is more valuable for confirmatory diagnosis in suspected lesions. To assess the utility of FNAC in diagnosis of head and neck lymph node lesions and to establish the diagnostic accuracy of cytology by comparing with the histopathological diagnosis, wherever possible. Materials and Methods: A 6 months retrospective study was done from March 2020 to August 2020 at Khaja Bandanawaz institute of medical sciences on 50 patients presenting with head and neck lymph node enlargement. 50 cases were evaluated by FNAC. In this study out of 34 benign cases, 14 cases were of Reactive lymphadenitis, 17 cases of Granulomatous/Tuberculous lymphadenitis and 3 cases were of Acute suppurative lymphadenitis. Out of 16 malignant cases, 5 cases were of Non Hodgkins lymphoma, 2 cases were of hodgkins lymphoma and 9 cases were of metastatic carcinoma. FNAC has been found to be a satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy in our study. The lucidity and rapidity of the procedure makes it most appropriate for use on outpatient basis even in peripheral hospitals and dispensaries.

Comparative study of fine-needle aspiration cytology and biopsy in diagnosis of lymphadenopathy in pediatric age group

Background: Excision biopsy and its histopathological examination have for many years been the final diagnostic procedure in diagnosis of lymphadenopathy. However, it is troublesome, expensive, and delays in treatment. Objective: The objective of the study was to find the association between fine-needle aspiration cytology (FNAC) and histopathology in diagnosing children with lymphadenopathy. Materials and Methods: This observational analytical cross-sectional study was conducted in the department of pediatrics of a teaching institution of Odisha, India. Fifty children attending our outpatient department and/or inpatient department for any cause, clinically diagnosed as local or general lymphadenopathy under 14 years of age were included in the study. Proportion of lymphadenopathies detected by FNAC, histopathology, and biopsy was calculated. We also calculate the proportion of lymphadenopathy detected by FNAC in three different types of scenarios, that is, definite diagnosis, diagnosis suspected and undiagnosed cases. Results: The median age was 7 years (2–14 years) and male-to-female ratio was 1.4:1. The most common symptom was fever (98%) and the most common physical finding was painless enlargement of lymph nodes (90%). There was statistically significant association between FNAC and definite diagnosis, diagnosis suspected and undiagnosed cases of tuberculosis by FNAC (Chi-square value=11.37, p<0.05), for Hodgkin’s lymphoma (Chi-square value=17.64, p<0.01). FNAC has significant association in detecting tuberculosis, Hodgkin’s, and non-Hodgkin’s diseases of childhood (p<0.05). Conclusion: FNAC can be used as a first-line diagnostic test for tuberculosis, Hodgkin’s disease, and non-Hodgkin’s lymphoma in the pediatrics age group in view of its availability.

Utility of cell block preparation in diagnosis of paediatric abdominal neoplasms.

Paediatric abdominal neoplasms are fairly common. Fine needle aspiration cytology (FNAC) is used for the initial evaluation of paediatric abdominal neoplasms. However, sometimes FNA interpretation can be difficult on limited material, owing to tumour heterogeneity and overlapping features. Therefore, we attempted to obtain additional information using cell block (CB) preparation from residual aspiration material along with immunohistochemistry (IHC) to enhance the diagnostic accuracy. To evaluate the correlation between CB preparation and FNAC in diagnosis of paediatric abdominal tumours with the help of an extended panel of IHC markers and to highlight some of the diagnostic difficulties. A total of 113 cases of paediatric abdominal masses were studied. In addition to routine FNA smears, CBs were prepared from the residual material for IHC analysis as considered appropriate. This study included a total of 113 children with abdominal masses. Histopathology following surgical resection was available in 53 cases. Histology was taken as gold standard to measure the diagnostic accuracy with reference to sensitivity (Sn), specificity (Sp), positive predictive value and negative predictive value. The Sn of FNA alone was 87.5% and Sp was 97.78%. The Sn and Sp increased with use of CB alone and were 100% and 97.78% respectively. The highest Sn and Sp were observed when CB was combined with IHC where both the values were 100%. CB with IHC is a useful adjunct to the routine FNA smears that further contributes to enhance the accuracy of the cytopathological diagnosis and is useful for choosing pre-operative chemotherapeutic regimen.

Pediatric fine-needle aspiration cytology: An audit of 266 cases of pediatric tumors with cytologic-histologic correlation.

Objectives:Fine-needle aspiration cytology (FNAC), a well-accepted minimally invasive diagnostic technique utilized in adults, is gradually gaining ground for pediatric patients as well. However, there are very few comprehensive reports in the literature on utility of FNA in pre-operative diagnosis of pediatric tumors.Material and Methods:An observational study was conducted at a cancer research center and a pediatric tertiary care hospital over a 5-year period. A cytologic-histologic correlation was performed for FNACs performed in pediatric patients for a clinical diagnosis of neoplastic lesions at both the centers. Relevant clinical details and histopathology, wherever available, were retrieved. Sensitivity, specificity, and accuracy of FNAC in diagnosis of malignant lesion were calculated from the cases with available histologic correlation.Results:Of the 266 cases included, there was a slight male predominance with lymphadenopathy being the most common presentation and non-Hodgkin’s lymphoma as the most frequent diagnosis in cases clinically suspected to have a neoplasm. Histologic correlation was available in 112 cases with 100% concordance in liver and kidney tumors. Few rare cytologic diagnoses such as papillary renal cell carcinoma, mesenchymal hamartoma of the liver, and thymolipoma could be accurately rendered on FNAC smears in conjunction with the clinic-radiologic features. The sensitivity, specificity, and accuracy of FNA in diagnosing malignant pediatric tumors were found to be 100%, 92.6%, and 97.7%, respectively.Conclusion:The present study underscores the high sensitivity and accuracy of FNAC in diagnosis of pediatric tumors, both in superficial and deep-seated locations. Awareness of the cytomorphologic features and clinic-radiologic correlation may assist the cytopathologists in rendering a precise diagnosis of rare pediatric tumors as well.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

<p><strong>Background: </strong>Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.</p><p><strong>Method</strong>: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15<sup>th </sup>November 2015 to 15<sup>th</sup> May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.</p><p><strong>Results</strong><strong>: </strong>The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.</p><p><strong>Conclusions: </strong>FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.</p>