Fine Needle Aspiration Cytology Material Research Articles

Combined fine needle aspiration cytology and core needle biopsy in the same setting: A two-years' experience.

Fine needle aspiration cytology (FNAC) combined with rapid on-site evaluation (ROSE) and ancillary techniques is an accurate diagnostic tool for many pathologies. However, in some cases, it may not be sufficient for actionable diagnoses or molecular testing, especially for cases that require large immunohistochemical panels or cases in which histological features are mandatory for the diagnosis. Core needle biopsy (CNB), on the contrary, provides samples that are suitable for histological features and sufficient for all ancillary studies. However, CNB is often performed by radiologists or clinicians without the direct participation of cytopathologists, which can lead to missed or delayed diagnoses. This study reports on the experience of combining FNAC and CNB performed in one setting by cytopathologists. The aim was to evaluate the impact of CNB on FNAC and the diagnostic efficiency of the combined procedures. One hundred forty-two FNAC and CNB procedures performed in the same setting over a period of 2 years were analysed. The FNAC diagnoses were compared and integrated with the subsequent CNB diagnoses. The impact of CNB was categorized as follows: non-contributory, in cases of inadequate samples; confirmed, when the CNB and FNAC diagnoses were the same; improved, when the CNB diagnosis was consistent with the FNAC diagnosis and further specified the corresponding entity; allowed, when CNB produced a diagnosis that could not be reached by FNAC; changed, when the CNB changed the previous FNAC diagnosis. CNB confirmed the FNAC diagnosis in 40.1% of cases (n = 57/142). CNB improved the FNAC diagnosis in 47.2% of cases (n = 67/142). CNB allowed a diagnosis that could not be performed on FNAC in 2.1% of cases (n = 3/142). CNB changed a previous FNAC diagnosis in 2.1% of cases (n = 3/142). CNB was non-contributory in 8.4% of cases (n = 12/142). CNB produced a positive impact on the whole diagnostic procedure in 51.4% of total cases (n = 73/142). The combined FNAC and CNB resulted in actionable diagnoses in 91.5% of all cases (n = 130/142). A complete molecular assessment was successfully performed in 14.7% of cases (n = 21/142) utilizing either FNAC or CNB material. The combined use of FNAC and CNB in one setting improves the diagnostic accuracy of both procedures. This approach exploits the advantages of each procedure, enhancing the accuracy of the final diagnosis.

Digital droplet PCR TERT promoter mutational screening in fine needle aspiration cytology of thyroid lesions: A highly specific technique for pre-operative identification of high-risk cases.

Despite the advent of comprehensive molecular testing in surgical pathology, most centers still rely on the morphological assessment of fine-needle aspiration cytology (FNAC) to triage patients with thyroid nodules for surgery. Subsets of patients could benefit from the inclusion of molecular testing to increase the diagnostic and/or prognostic properties of the cytology analysis, including the assessment of TERT promoter mutations, an event coupled with thyroid malignancy, and poor prognosis. In this prospective study, preoperative FNAC material from 65 cases was assessed for TERT promoter hotspot mutations C228T and C250T using the digital droplet PCR (ddPCR) technique on frozen pellets and re-evaluated postoperatively. Our cohort consisted of 15 B-III (23%), 26 B-IV (40%), 1 B-V (2%), and 23 (35%) B-VI lesions according to the Bethesda System for Reporting Thyroid Cytopathology. TERT promoter mutations were detected in 7 cases; 4 papillary thyroid carcinomas (all with preoperative B-VI status), two follicular thyroid carcinomas (one B-IV and one B-V status), and one poorly differentiated thyroid carcinoma (with B-VI status). All mutated cases were verified by mutational analysis of tumor tissue derived from postoperative formalin-fixed paraffin-embedded tissue, while all cases identified as wild-type on FNAC remained wild-type postoperatively. Moreover, the occurrence of a TERT promoter mutation was significantly associated with malignant disease and higher Ki-67 proliferation indices. In the present cohort, we found that ddPCR is a highly specific method for detecting high-risk TERT promoter mutations on thyroid FNAC material that could guide different surgical approaches in subsets of indeterminate lesions if reproduced in larger materials.

Comparative evaluation of Ziehl- Neelsen staining and kinyoun’s staining in the diagnosis of clinically suspected cases of tuberculosis

: Tuberculosis commonly affects lungs but can also be ex­tra-pulmonary. The increasing prevalence of extra-pulmonary manifestation of tuberculosis is a cause for concern. Microbiological diagnosis is essence for the effective treatment of mycobacterium tuberculosis. The smear detection tests differentiate infectious from non-infectious cases. Both Ziehl-Neelsen (Z-N) and kinyoun stain (KC) methods are over 100 years old; these are most economical in terms of processing time, needed equipment and personnel. The objective of research was to evaluate the two smear microscopy methods for the detection of tubercle bacilli in the sputum and Fine needle aspiration cytology (FNAC) material by comparing the sensitivity, specificity and validities of kinyoun’s method against Z-N staining.A prospective and comparative study was carried using 500 sputum samples and 100 FNAC material received in the department. All the 600 samples were subjected to two methods:Z-N stain and Kinyoun’s cold stain. They were compared for sensitivity and specificity in terms of qualitative results and grades of smear as recommended by RNTCP. : The smear positivity rate was 18% and 20.16% in Ziehl-Neelsen stain and Kinyoun’s cold stain respectively. The direct smear microscopy for Z-N staining showed sensitivity, 89.25%, specificity and positive predictive value (PPV) 100% and negative predictive value (NPV) 97.35% whereas KC method showed sensitivity 98.37%, specificity and PPV 100% and NPV 99.58% respectively. Kinyon’s method described is slightly longer to perform than the Ziehl-Neelsen technique but its ease of use and equal efficacy with Z-N method make it universally applicable, especially in those laboratories where facilities are poor.

Fungal Granulomatous Thyroiditis in A Renal Transplant Recipient

Fungal granulomatous thyroiditis is a relatively rare entity. Aspergillus is the fungus that most commonly affects the thyroid gland and is generally missed until autopsy. Aspergillus granulomatous thyroiditis diagnosed antemortem and treated in renal transplant recipient patients are extremely rare. We report a 35-year-old female renal transplant recipient who presented with fever, generalized weakness, and loss of appetite; her clinical examination revealed a left thyroid lobe nodule. Fine needle aspiration cytology (FNAC) microscopic examination of the nodule revealed fungal granulomatous thyroiditis. Subsequent examination of FNAC material with special stain Gomori`s Methenamine Silver (GMS), 10% KOH (potassium hydroxide) mounting, and culture confirmed the presence of fungus Aspergillus flavus. This case emphasizes the need for thorough clinical examination and the utility of FNAC in examining thyroid nodules. J Microbiol Infect Dis 2021; 11(4):234-238.

Advanced non-small cell lung cancer: Rapid evaluation of EGFR status on fine-needle cytology samples using Idylla

Advanced non-small cell lung cancer (NSCLC) needs to be managed rapidly; therefore, a rapid assessment of the epidermal growth factor receptor (EGFR) status is mandatory. Computed Tomography (CT)-guided or Ultrasound (US)-guided Fine-Needle Aspiration Cytology (FNAC) allows a rapid diagnosis of both primary and metastatic tumor through rapid on-site evaluation (ROSE) and the proper management of diagnostic material. Idylla (Biocartis, Mechelen, Belgium) is an automated RT-PCR system which evaluates the mutational status of specific genes in less than two hours. In this study, the EGFR mutational status in advanced NSCLC was analyzed on 28 FNAC samples with Idylla. After ROSE, residual FNAC material and/or additional passes were pipetted into the Idylla EGFR cartridge. Patients endorsed a consent form before carrying out the analysis. Results were controlled by pyrosequencing. Adequate EGFR status was obtained in 26/28 cases (22 wild type and 4 mutated). Mutated cases harbored EGFR Exon 19 deletion and L858R point mutation. In 2/28 cases the analysis failed. The combination of FNAC, ROSE and Idylla is a rapid, accurate and effective method that can be conveniently used to assess EGFR status in advanced NSCLC.

English

BACKGROUND Breast cancer is now the most common cancer in cities in India and 2 nd most common cancer in the rural areas. Fine needle aspiration cytology (FNAC) is a less invasive pre-operative diagnostic method and is preferred over core / excision biopsy to decide the benign or malignant nature of the breast lump. Prognostic factor assessment by FNAC would allow the identification of patients who would benefit from neo adjuvant treatment (patients with grade 3 tumours) and in whom conservation surgery is inadvisable.1 The purpose of this study is to compare the grades of breast cancer in FNAC with histopathology as gold standard and compare the oestrogen (ER) and progesterone (PR) hormonal expression pattern on immunocytochemistry (ICC) with immunohistochemistry (IHC). From this study we intend to assess the usefulness of cytological grading and ER, PR hormone receptor status pre-operatively so that hormonal therapy can be included with neoadjuvant chemotherapy. METHODS This is a cross sectional study with a sample size of 50, conducted in the Department of Pathology. RESULTS Out of 50 cases, maximum number of patients were in the age group of 51 - 60 years. 68 % had attained menopause; 69 % of patients had tumour size between 2 - 5 cm and 90 % of tumours were in the upper outer quadrant of breast. Considering hormonal expression, in case of ER there was a moderate agreement between ICC and IHC (κ = .428, P = 0.005) and no agreement was seen in case of PR (κ = .073, P = 0.625). Regarding the cytological grading, this study showed highest degree of concordance with grade II tumours with a sensitivity of 75.9 %. For Grade I it was 2.5 % and for grade III, it was 33.3 %. CONCLUSIONS Evaluation of hormonal status and nuclear grading is fairly reliable on cytology when performed on qualitatively superior FNAC material from the primary breast lesions. KEYWORDS Carcinoma Breast, FNAC, ER / PR, Immunocytochemistry, Immunohistochemistry, Cytological Nuclear Grading

The Value and Limitations of Cell Blocks in Endobronchial Ultrasound-Guided Fine-Needle Aspiration Cytology: Experience of a Tertiary Care Center in North India.

Background:Endobronchial ultrasound (EBUS)-guided fine-needle aspiration cytology (FNAC) is recommended for diagnosing bronchial neoplasms and evaluating mediastinal lymph nodes. However, it may not be possible to subtype or definitely categorize many bronchial neoplasms on FNAC smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from FNAC material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to EBUS guided FNAC smears.Material and Methods:One hundred and eighty-five cases of EBUS guided FNAC having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to FNAC smears alone for the above parameters were calculated.Results:Cell blocks provided additional information in 31 out of 185 cases. Cell blocks were necessary for subtyping 24/59 malignant tumors, definite categorization into benign and malignant in 10/140 adequate samples, and increasing adequacy in 6/185 total samples. A total of 45 samples were inadequate in spite of adding information from cell blocks to smears.Conclusion:Cell blocks added clinically significant information to EBUS guided FNAC and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated.

What do we know about the cytological features of pure intraductal carcinomas of the salivary glands?

Intraductal carcinomas (IDCs) are rare, poorly characterised salivary gland tumours. The cytological features of IDCs are even less known. In this paper, a systematic literature review of pure IDCs (without stromal invasion, not associated with other histotypes) of low-grade (LG-IDCs) and high-grade (HG-IDCs) was performed. The bibliographic research included multiple databases (PubMed, Scopus, Web of Science). Mild-moderate nuclear atypia favoured LG-IDCs, severe atypia favoured HG-IDCs. Preoperative fine-needle aspiration cytology (FNAC) was performed in 13/94 published cases (14%): 10 parotid; two oral; one submandibular. All the cases were histologically LG-IDCs, except two parotid IDCs. FNAC results included: negative for malignancy (three of 13 cases, 23%); tumour of uncertain malignant potential (seven of 13, 54%); malignancy (three of 13, 23%). The ductal component was identified in two cases; mucoepidermoid carcinoma was suggested in two additional cases. The grade was underestimated on FNAC evaluation in one HG-IDC as focal high-grade features were present on subsequent histological examination. The cases diagnosed as malignant tumours or describing intermediate atypia resulted in LG-IDCs on subsequent histology. Occasional mitoses were described only in one HG-IDC; this feature may have not been considered in the remaining published cases. FNAC and clinico-pathological correlation are important aids for clinicians and pathologists. FNAC could assist surgery even if an accurate diagnosis is sometimes impossible. Discrepancy in grading the nuclear atypia between the FNAC material and the resected specimen can occur, sometimes being unavoidable. Further studies are needed to better characterise this rare tumour.

Artificial neural network model to distinguish pleomorphic adenoma from adenoid cystic carcinoma on fine needle aspiration cytology.

To differentiate pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) on fine needle aspiration cytology (FNAC) is often challenging to cytologists. In the present study, we tried to make an artificial neural network (ANN) model from the FNAC smears to differentiate PA from ACC. The detailed cytomorphological features were analysed on the FNAC of histopathology proven cases of PA (n = 35) and ACC (n = 33) and enumerated semi-quantitatively by two independent observers. These data were used to make an ANN model to distinguish PA from ACC on FNAC material. We used neuro-intelligence software to build the ANN model. The network architecture was 10-2-1. The heuristic search engine was applied to have this model. We used backpropagation neural network to teach ANN. At least 500 iterations were done to train the model. The efficacy of this ANN model was assessed with the help of the confusion matrix and receiver operating characteristic curve. The data were separated automatically by the software as a training set (n = 48), validation set (n = 10) and test set (n = 10). The ANN model was able to differentiate every case (10/10) of PA and ACC in the final test set. The area under the receiver operating characteristic curve was 1. The currently built ANN model is competent to identify PA and ACC cases on FNAC. Additional parameters and new cases can be incorporated into this open-ended ANN model to make it more robust.

Development of a Low-cost NGS Test for the Evaluation of Thyroid Nodules.

Ultrasound-guided fine needle aspiration cytology (FNAC) is the preferred method of identifying malignancy in palpable thyroid nodules using the Bethesda reporting system. However, in around 30-40% of FNACs (Bethesda categories III, IV, and V), the results are indeterminate and surgery is required to confirm malignancy. Out of those who undergo surgery, only 10-40% of patients in these categories are found to have malignancies, thus proving surgery to be unnecessary for some patients or to be incomplete in others. While molecular testing on thyroid FNAC material is part of the American Thyroid Association (ATA) guidelines in evaluating thyroid nodules, it is currently unavailable in India due to cost constraints. In this study, we prospectively collected FNAC samples from sixty-nine patients who presented with palpable thyroid nodules. We designed a cost-effective next-generation sequencing (NGS) test to query multiple variants in the DNA and RNA isolated from the fine needle aspirate. The identification of oncogenic variants was considered to be indicative of malignancy, and confirmed by surgical histopathology. The panel showed an overall sensitivity of 81.25% and a specificity of 100%, while in the case of Bethesda categories III, IV, and V, the sensitivity was higher (87.5%) and the specificity was established at 100%. The panel could thereby serve as a rule-in test for the diagnosis of thyroid cancer and therefore help identify patients who require surgery, especially in the indeterminate Bethesda categories III, IV, and V.

Role of fine needle aspiration cytology as a diagnostic tool in lymphadenopathy with utility of CBNAAT in tuberculous lymphadenopathy

Introduction: Lymphadenopathy is a common, nonspecific clinical sign. Fine Needle Aspiration Cytology (FNAC) is the first line of investigation in the evaluation of lymphadenopathy. FNAC material can be used for cytological evaluation and other ancillary tests in Tuberculous Lymphadenopathy. Aims and Objectives To evaluate the role of FNAC as a diagnostic tool in lymphadenopathy. To assess the role of Cartridge based nucleic acid amplification test (CBNAAT) in suspected cases of tuberculous lymphadenopathy. Materials and methods: The study conducted at department of Pathology in MVJMC &RH, Hoskote, Bangalore from January 2017 to June 2018 A total of 104 cases of lymphadenopathy were subjected to FNAC. In each case at least 3 smears for H & E, Giemsa stain and Special stain like AFB done for tuberculous lymphadenopathy. FNAC material sent for CBNAAT in suspected cases of Tuberculosis . Results: The age ranged from 1-90years, Male:Female of ratio1.26 :1. Most common site was cervical and cytological pattern was granulomatous -41(39.4%) followed by reactive -38(36.5%).Majority of them presented with solitary node (77%) and followed by bilateral/multiple (23%). One case of reactive (11%), two cases of suppurative (50%) and ten cases of granulomatous (37%) were found to be positive for Tuberculosis by CBNAAT. Conclusion: FNAC is simple, cost effective diagnostic tool with high degree of accuracy.FNAC coupled with AFB staining is the first line of investigation for Tuberculous lymphadenopathy. According to New Revised National TB Control Programme (RNTCP) guidelines CBNAAT sputum is a must for paediatric cases. The present study highlights the utility of CBNAAT from FNAC material as one of the rapid and adjuvant diagnostic tool in tuberculous lymphadenopathy. Keywords: FNAC, Tuberculous lymphadenopathy, CBNAAT.

Cytology smears for DNA extraction: Practical approach for selecting the best slide.

Next generation sequencing (NGS) to detect actionable genetic abnormalities is standard of care in advanced stage lung adenocarcinoma. Many studies have shown that the molecular results obtained from fine needle aspiration cytology material are comparable to those obtained from formalin-fixed tissue samples. We undertook this study to validate DNA extraction from cytology material for molecular studies and to find any correlation between DNA yield, pattern of tumour cells and tumour fraction. DNA was extracted from 34 cytology slides of pulmonary adenocarcinoma cases with predetermined EGFR mutation status. Cytology slides were reviewed for pattern of tumour distribution and tumour fraction. NGS was performed on five slides with variable DNA and compared with original results. There were 14 alcohol-fixed and 20 air-dried smears. The mean DNA yield was 1.74μg and median of 0.4μg (range, 0.02-21μg). Tumour fractions varied from 10% to 90%. No correlation was found between tumour fraction and DNA yield (P=0.14). The mean DNA yield was high in slides with tumour throughout the slide (sheets or scattered clusters) as compared to rare scattered clusters and/or single cells. EGFR mutation was found in four of the five cases sent for NGS lung panel while one case revealed BRAF mutation. DNA with good quantity and quality can be extracted from the cytology slides for NGS irrespective of type of fixation. DNA yield has better correlation with distribution pattern of tumour cells on the slides rather than tumour fraction.

Artificial neural network model to distinguish follicular adenoma from follicular carcinoma on fine needle aspiration of thyroid.

To distinguish follicular adenoma (FA) and follicular carcinoma (FC) of thyroid in fine needle aspiration cytology (FNAC) is a challenging problem. In this article, we attempted to build an artificial neural network (ANN) model from the cytological and morphometric features of the FNAC smears of thyroid to distinguish FA from FC. The cytological features and morphometric analysis were done on the FNAC smears of histology proven cases of FA (26) and FC (31). The cytological features were analysed semi-quantitatively by two independent observers (RS and PD). These data were used to make an ANN model to differentiate FA versus FC on FNAC material. The performance of this ANN model was assessed by analysing the confusion matrix and receiving operator curve. There were 39 cases in training set, 9 cases each in validation and test sets. In the test group, ANN model successfully distinguished all cases (9/9) of FA and FC. The area under receiver operating curve was 1. The present ANN model is efficient to diagnose follicular adenoma and carcinoma cases on cytology smears without any error. In future, this ANN model will be able to diagnose follicular adenoma and carcinoma cases on thyroid aspirate. This study has immense potential in future. This is an open ended ANN model and more parameters and more cases can be included to make the model much stronger.

AKR1B10 expression by immunohistochemistry in surgical resections and fine needle aspiration cytology material in patients with cystic pancreatic lesions; potential for improved nonoperative diagnosis

Cystic pancreatic tumors account for 10% of cystic lesions in the pancreas. Evaluation focuses on identifying lesions that require surgical resection due to actual or potential malignancy. Cystic tumors with malignant potential include mucinous cystic neoplasms (MCNs), intraductal papillary mucinous neoplasms (IPMNs), and cystic neuroendocrine tumors (NETs). The sensitivity of endoscopic fine needle aspiration (FNA) to diagnose such lesions is low, and a more accurate marker of malignant potential is needed. Aldo-keto reductase 1B10 (AKR1B10) was originally found in human hepatocellular carcinoma. Since then, it has been identified in pancreatic adenocarcinoma and pancreatic intraepithelial neoplasia. Because there is difficulty in determining the malignant potential of cystic pancreatic tumors, we set out to examine the expression of AKR1B10 in these lesions as a potential biomarker of malignancy. AKR1B10 expression was analyzed in cell blocks from FNAs and surgical resection specimens using immunohistochemistry. We examined MCN (n=28), IPMN (n=18), and cystic NET (n=20) as well as nonmucinous cysts including pseudocysts (n=13) and serous cystadenomas (n=16). AKR1B10 expression was seen in 45 of 46 (98%) mucinous lesions evaluated. Strong staining (2+-3+/60%-100% staining) was seen in 16 of 18 (89%) IPMNs and 25 of 28 (90%) MCNs. No staining was seen in the nonmucinous lesions (n=49). In conclusion, AKR1B10 is upregulated in mucinous cystic pancreatic tumors, and this staining can be accomplished in cytology FNA material, making AKR1B10 a promising biomarker of malignant potential. Most importantly, this application could impact the clinical management of these patients by determining the best candidates for surgical resection.

Molecular Signature of Indeterminate Thyroid Lesions: Current Methods to Improve Fine Needle Aspiration Cytology (FNAC) Diagnosis.

Fine needle aspiration cytology (FNAC) represents the gold standard for determining the nature of thyroid nodules. It is a reliable method with good sensitivity and specificity. However, indeterminate lesions remain a diagnostic challenge and researchers have contributed molecular markers to search for in cytological material to refine FNAC diagnosis and avoid unnecessary surgeries. Nowadays, several “home-made” methods as well as commercial tests are available to investigate the molecular signature of an aspirate. Moreover, other markers (i.e., microRNA, and circulating tumor cells) have been proposed to discriminate benign from malignant thyroid lesions. Here, we review the literature and provide data from our laboratory on mutational analysis of FNAC material and circulating microRNA expression obtained in the last 6 years.

Application of a Novel Vibrating Device for Fine-Needle Aspiration Cytology

Objective: Fine-needle aspiration cytology (FNAC) is a valuable diagnostic technique. However, the procedure involves backand-forth motions of a needle within a mass, which can lead to unexpected complications. We have developed a novel device and sampling techniques that use vibration and rotation instead of backand-forth motions. Methods: The new device consists of a vibrating motor fixed to the stopper of a 5 ml syringe with its piston. A 22-gauge needle attached to the 5 ml syringe is used for FNAC. Samples were obtained from resected specimens using the following four procedures: suction only; suction and vibration for 5 seconds; suction and 180° rotation of the syringe; and suction, vibration for 5 seconds, and 180° rotation of the syringe. Samples were also obtained using the conventional technique. The numbers of well-visualized follicular groups on glass slides were counted to compare the amounts of cellular material obtained using the five different procedures. Next, 415 patients with thyroid nodules underwent ultrasound-guided FNAC to evaluate the rate of inadequacy. Results: Sufficient amounts of material were obtained from resected specimens using suction, vibration and rotation, and using the conventional technique. Inadequate thyroid FNAC material was obtained in 12.3% of cases. Conclusions: The new device and sampling techniques for thyroid FNAC collected sufficient amounts of adequate material and allowed safe and precise control of the device. Our device and sampling techniques are expected to be widely used not only for thyroid FNAC sampling but also for sampling from other anatomical sites.

Human papillomavirus detection in fine needle aspiration cytology of lymph node metastasis of head and neck squamous cell cancer

BackgroundCurrently, testing on HPV in oropharyngeal squamous cell carcinoma (OPSCC) is performed on histological material. However, in a certain percentage of the cases who present with lymph node metastases no primary tumor can be identified and only fine needle aspiration cytology (FNAC) is available for analysis. ObjectivesPurpose of this study was to assess HPV status on FNAC and to validate it using histological material of the same patients. Study designPatients with cervical metastasis from OPSCC or cancer of an unknown primary tumor (CUP), diagnosed between 2007 and 2012 were included. In 6 of the 47 patients, no primary tumor could be identified. HPV detection and genotyping was performed in both FNAC slides scrapings and formalin fixed paraffin embedded (FFPE) histological material from the same patients, using the HPV SPF10-LiPA25 assay. HPV PCR analysis on FFPE material was considered the reference standard for HPV status of each case. ResultsCompared with HPV negative cases (n=22), significantly more HPV positive cases (n=25) presented initially with cervical metastasis (27% vs 56% respectively; p=0·047). The HPV PCR assay on FNAC material showed a high sensitivity (96%; 95% CI 86.6–97.4) and specificity (100%; 95% CI 85.1–96.7) using the reference standard of HPV PCR analysis on FFPE material of the same patients. ConclusionIn this study, testing on HPV in FNAC of cervical lymph node metastases of SCC is validated. It provides a valuable alternative for testing of HPV on histological material from patients with oropharyngeal squamous cell carcinoma or cancer of an unknown primary tumor.

Study of clinical and epidemiological profile of thyroid swelling

Introduction: Thyroid swelling remains a problem of enormous magnitude all over the world. The problem in clinical practice is to distinguish reliably the few malignant tumors from the many harmless nodules so that a definitive preoperative tissue diagnosis of the malignancy allows planning of appropriate surgery and relevant patient counseling. FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid swelling before the surgery. Material And Methods : The present study was conducted in Department of Medical College. It included Cross sectional study of cytomorphology of fine needle aspiration cytology material of 156 patients presenting with thyroid nodule in the Department. Information about the clinical presentation, treatment modality and presence or absence of malignancy was collected in a proforma and was analyzed. Statistical tests employed are tests of proportion, tests of percentage, Student’s t-test and Fisher’s exact test. Results : The commonest age group affected was 51-60 yrs. The female patients (69.8%) outnumbered the male patients (30.1%). The cytomorphological analysis of 156 patients revealed 10 cases of neoplastic lesions. Maximum number (122) of patients was suffering with goiter followed by lymphocytic thyroiditis (12) and nodular disease (8). Amongst the malignant cases six cases were of papillary carcinoma and six cases of follicular carcinoma. Conclusion : FNAC is a simple, safe and cost-effective diagnostic modality in the investigation of thyroid disease with high specificity and accuracy. We concluded that FNAC diagnosis of malignancy is highly significant. A benign FNAC diagnosis should be viewed with caution as false negative results do occur and these patients should be followed up and any clinical suspicion of malignancy even in the presence of benign FNAC requires surgery. So, final diagnosis and treatment pattern should be based upon histopathology.

Evaluation profile of thyroid nodule by fnac in the rural population of khanpur kalan, sonepat, haryana.

Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%).The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Fungal foot abscess caused by Aureobasidium pullulans culture diagnosis of fine needle aspiration cytology material in a clinically unsuspected patient

Subcutaneous mycosis includes a large spectrum of infections caused by a heterogeneous group of fungi. Fungal infections of the skin can be identified in scrape preparations of lesions and Fine Needle aspirates of abscesses, with recognition of the specific morphological features such as hyphae and branching. We report a fungal abscess caused by Aureobasidium pollulans by smears and culturing the material obtained from Fine Needle Aspiration Cytology.