Fine-needle Aspiration Cytology In Patients Research Articles

Diagnostic accuracy of fine-needle aspiration cytology in patients presented with thyroid nodules in Al-Ain city, UAE

Background: Thyroid diseases are a common health problem affecting 5% of the general world population. Thyroid nodules represent one of the main clinical presentations of many of the thyroid diseases, including benign and malignant lesions. Fine-needle aspiration cytology (FNAC) is considered one of the main techniques used for the evaluation of thyroid nodules. Objectives: The aim of this study is to investigate the accuracy of fineneedle aspiration (FNA) biopsy in the diagnosis and evaluation of thyroid nodules. Patients and Methods: The study is a retrospective study that involves 131 patients presented with a thyroid nodule and attended the surgical departments in Tawam Hospital. Results: Our results showed that the majority of patients (68.6%) were younger than 45 years. Females were pre-dominant, with 88.4% compared to males (11.6%). According to the Bethesda system, 4.87% of the cases were classified as Category I, 32.92% as Category II, 21.95% as Category III, 10.97% as Category IV, 14.63% as Category V and 14.63% as Category VI. Final pathological reports revealed that all the 4 cases of Category II (benign) (100%) were confirmed to be non-cancerous. In addition, 8/18 of cases (44.4%) classified as Category III (atypia of undetermined significance) were confirmed to be malignant and one (5.6%) diagnosed with the atypical follicular lesion, whereas the other cases were diagnosed with non-cancerous lesions. In contrast, all cases 9/9 suspicious for follicular neoplasm (Category IV) were confirmed to be malignant. Similarly, all cases 12/12 with Category V (suspicious for malignancy), and all cases categorised as malignant (VI) in FNA were also confirmed to be malignant. Conclusion: The results highlighted the importance of using a combined approach that consists of clinical, radiological as well as pathological approaches for a more accurate evaluation of the thyroid lesions. In addition, the results also showed that FNAC is a sensitive tool that can detect malignant thyroid nodules.

Analysis of efficacy and safety of core-needle biopsy versus fine-needle aspiration cytology in patients with cervical lymphadenopathy and salivary gland tumour

In this study, we compared the diagnostic accuracy and safety of fine-needle aspiration cytology and core-needle biopsy in patients with cervical lymphadenopathy or salivary gland tumour, and provided a basis for selecting the appropriate diagnostic method in clinical situations. A total of 278 patients were included in this study. The sensitivities of fine-needle aspiration cytology and core-needle biopsy were 66.7% and 100%, respectively, and negative predictive values were 92.6% and 100%, respectively, for diagnosing malignancy. In diagnosing lymphoma, fine-needle aspiration cytology gave false-negative results in all patients. In diagnosing tuberculous lymphadenopathy, the sensitivities of fine-needle aspiration cytology and core-needle biopsy were 33.3% and 91.15%, respectively, and the negative predictive values were 90.0% and 95.1%, respectively. The sensitivities of fine-needle aspiration cytology and core-needle biopsy were 42.9% and 100% in diagnosing malignant salivary gland tumours, and the negative predictive values were 91% and 100%, respectively. The results of this study showed that core-needle biopsy was superior in diagnosing and distinguishing critical diseases such as malignant lymphadenopathy and tuberculosis in patients with cervical lymphadenopathy and salivary gland tumour.

False negative cytology in large thyroid nodules.

Controversy exists regarding the accuracy of fine-needle aspiration (FNA) in large thyroid nodules. Recent surgical series have documented false-negative rates ranging from 0.7 to 13 %. We examined the accuracy of benign FNA cytology in patients with thyroid nodules ≥3 cm who underwent surgical resection and identified features characteristic of false-negative results. We retrospectively studied all thyroidectomy specimens between January 2009 and October 2011 and identified nodules ≥3 cm with corresponding benign preoperative FNA cytology. We collected clinical information regarding patient demographics, nodule size, symptoms, sonographic features, FNA results, and final surgical pathology. For comparison, we analyzed nodules <3 cm from this cohort also with benign FNA cytology. A total of 323 nodules with benign preoperative cytology were identified. Eighty-three nodules were <3 cm, 94 nodules were 3-3.9 cm, and 146 nodules were ≥4 cm in size. The false-negative rate was 11.7 % for all nodules ≥3 cm and 4.8 % for nodules <3 cm (p = 0.03). Subgroup analysis of nodules ≥3 cm revealed a false-negative rate of 12.8 % for nodules 3-3.9 cm and 11 % for nodules ≥4 cm. Age ≥55 years and asymptomatic clinical status were the only patient characteristics that reached statistical significance as risk factors. Final pathology of the false-negative specimens consisted mainly of follicular variant of papillary thyroid cancer and follicular thyroid cancer. When referred for thyroidectomy, patients with large thyroid nodules demonstrate a modest, yet significant, false-negative rate despite initial benign aspiration cytology. Therefore, thyroid nodules ≥3 cm may be considered for removal even when referred with benign preoperative cytology.

Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer

This study evaluated the role of axillary ultrasonography (AUS) and fine-needle aspiration cytology (FNAC) in preoperative staging of the axilla in patients with invasive breast cancer. Between October 2006 and March 2009, 502 patients scheduled to undergo surgery for invasive breast cancer had preoperative AUS. All patients with suspicious nodes on ultrasonography underwent FNAC, and those with positive cytology proceeded directly to axillary node clearance. Patients with normal findings on AUS or negative cytology underwent sentinel node biopsy (SNB). A total of 137 (27.3 per cent) of 502 patients had axillary node metastases on final histology. Thirty-nine (28.5 per cent) node-positive patients were identified by AUS-FNAC and spared unnecessary SNB. AUS-FNAC had a sensitivity of 28.5 per cent and a specificity of 100 per cent for detecting axillary nodal metastases. AUS-FNAC findings were normal in all 15 patients with nodal micrometastases and in 11 patients with isolated tumour cells on histopathology. The sensitivity of AUS-FNAC had a positive correlation with invasive tumour size (odds ratio 1.03) and grade (odds ratio 2.80). Preoperative AUS-FNAC avoided unnecessary SNB in 28.5 per cent of node-positive patients and in 7.8 per cent of patients overall.

High Risk of Malignancy in Patients with Incidentally Discovered Adrenal Masses: Accuracy of Adrenal Imaging and Image-Guided Fine-Needle Aspiration Cytology

The incidental finding of nonfunctioning adrenal masses (incidentalomas) is common, but no reliable criteria in differentiating between benign and malignant adrenal masses have been defined. The aim of this preliminary study was to assess the usefulness of adrenal imaging and image-guided fine-needle aspiration cytology in patients with nonfunctioning adrenal incidentalomas with the aim of excluding or confirming malignancy before surgery. Forty-two consecutive patients (18 men and 24 women; median age, 54 years; range, 25-75 years) with incidentally discovered adrenal masses of 3 cm or more in the greatest diameter were prospectively enrolled in the study. All patients underwent helical computerized tomography scan and image-guided fine-needle aspiration cytology, 33 (78.6%) underwent magnetic resonance imaging, and 26 (61.9%) underwent norcholesterol scintigraphy before adrenalectomy. The revised final pathology showed 30 (71.4%) benign (26 adrenocortical adenomas, of which 3 were atypical, 2 ganglioneuromas, and 2 nonfunctioning benign pheochromocytomas) and 12 (28.6%, 95% CI = 15-42) adrenal malignancies (8 adrenocortical carcinomas and 4 unsuspected adrenal metastases). The definitive diagnosis of adrenocortical carcinoma was made according to Weiss criteria and confirmed on the basis of local invasion at surgery or metastases. The sensitivity, specificity and accuracy were 75%, 67% and 83% for computerized tomography scan, 92%, 95% and 94% for magnetic resonance imaging, 89%, 94% and 92% for norcholesterol scintigraphy, and 92%, 100% and 98% for fine-needle aspiration cytology. The sensitivity and accuracy of image-guided fine-needle aspiration cytology and magnetic resonance imaging together reached 100%. Immediate periprocedural complications of fine-needle aspiration cytology occurred in 2 (4.7%) patients: self-limited pneumothorax (n = 1), and severe pain (n = 1) requiring analgesic therapy. No postprocedural or late complications were observed. With the aim of selecting for surgery patients with a non-functioning adrenal incidentaloma of 3 cm or more in diameter, the combination of magnetic resonance imaging and fine-needle aspiration cytology should be considered the strategy of choice.

Accuracy of fine-needle aspiration cytology in patients with radiation-induced thyroid neoplasms.

Fine-needle aspiration cytology (FNAC) is useful for selecting patients with thyroid nodules for thyroidectomy. Its value in patients who have been exposed to low-dose therapeutic radiation is questionable because these patients have an increased risk of multifocal benign and malignant tumours, and thyroid cancer is common in such patients. Between 1960 and 1999, 171 patients with one or more thyroid nodules who had a history of exposure to radiation underwent operation; 49 of these patients had preoperative FNAC. The cytology results in these 49 patients were compared with those of an age- and sex-matched control group of patients with thyroid nodules who did not have a history of radiation exposure. Of those who had been exposed to radiation, six of 20 patients with 'benign' cytology by FNAC and six of 16 patients with 'suspicious' cytology had thyroid cancer. All 13 specimens considered to be malignant on FNAC were indeed malignant. There was a higher rate of false-negative cytological examinations among patients with a history of irradiation that in those without. FNAC of thyroid nodules in patients with a history of irradiation is not as accurate as that in non-irradiated patients, primarily because of coexisting occult thyroid cancers.

Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management.

We evaluated the indications, accuracy and impact of image guided biopsy of focal renal masses. We retrospectively reviewed 79 image guided renal biopsies in 73 patients. Indications, imaging, and histological and clinical features were analyzed. We assumed that nephrectomy, partial nephrectomy or surgical biopsy of suspicious masses would be done when no percutaneous biopsy had been performed. A change in management was defined as surgical to nonsurgical. Clinical management was altered due to results in 32 of the 79 biopsies (41%) in cases managed nonoperatively, including positive and negative biopsies in those followed clinically and with imaging. Of 79 biopsies 49 (62%) were diagnosed positive for malignancy, including 15 (31%) that were not and 34 (69%) that were renal cell carcinoma. The histological diagnosis was negative on 25 biopsies (32%) and positive or negative on 74 (94%). All 5 of the 79 false-negative biopsies (6%) were due to insufficient tissue and involved highly suspicious imaging findings that required further evaluation, such as repeat biopsy or surgery. Renal cell carcinoma was identified in 4 of the 5 cases. In 12 of the 24 patients (50%) with a pre-biopsy history of nonrenal cancer biopsies were diagnostic of nonrenal cancer. No patient had major complications and in 4 small hematomas were treated with observation only. Image guided renal mass biopsy is safe, reliable and accurate, and it changes clinical management in many cases by avoiding nephrectomy or other surgical options. Radiologists should promote imaging guided biopsy as a potentially useful option for managing suspicious or indeterminate renal masses.

Diagnosis of renal cell carcinoma: value of fine-needle aspiration cytology in patients with metastases or contraindications to nephrectomy.

A retrospective study of imaging-directed percutaneous fine-needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspiration biopsy in establishing the diagnosis of renal cell carcinoma and avoiding nephrectomy in patients with a renal mass and disseminated metastases or with a renal mass and relative contraindications to nephrectomy. Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biopsies at our institution. We examined the medical records, pathology reports, imaging studies, and follow-up information of the 23 patients who had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminary diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients). Cytopathologic findings were true-positive in 12 patients, true-negative in eight, false-negative in three, and false-positive in none. The sensitivity was 80%, the specificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, and all died within 1 year. Of the 13 patients with relative contraindications to surgery, seven were treated without surgery. The cytologic diagnosis was renal cell carcinoma in two of the seven, and these two patients have since died. Cytopathology was negative for renal cell carcinoma in five of the seven, and subsequent imaging studies in these patients have shown no renal mass enlargement or metastases 2-3 years after biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining six patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications. Percutaneous renal aspiration biopsy cytology is accurate, safe, and useful in establishing the diagnosis of renal cell carcinoma in patients with disseminated metastases or relative contraindications to surgery.

Fine-needle aspiration cytology in patients with gynecologic malignancies

Four hundred five fine-needle aspiration (FNA) cytologies were obtained from 352 sites in 287 patients with gynecologic malignancies. The majority of specimens were aspirated for recurrent or metastatic disease. The most common clinical diagnosis was cervical carcinoma (128 cases) followed by ovarian carcinoma (80 cases) and others (79 cases). The sites of FNA were lymph node (134 cases), retroperitoneal lymphocyst (57 cases), pelvic mass (52 cases), subcutaneous mass (34 cases), and others (75 cases). Of 335 sites excluding inadequate specimens, 162 (48.4%) revealed malignant cells. There was no difference in the accuracy of FNA between diseases in the superficial sites and those in the deep sites. However, the sensitivity for local recurrent diseases was lower than that for primary or metastatic diseases (86.4% vs 100.0%). The overall accuracy of FNA cytology was 95.2%, and it was satisfactory for the diagnosis of gynecologic malignant diseases. FNA should be repeated if the initial FNA specimen is inadequate for diagnosis. When distinct malignant cells are observed in FNA cytology, a biopsy may be omitted.