Fine-needle Aspiration Procedures Research Articles

Diagnostic utility of fine needle aspiration cytology in pediatric thyroid nodules based on Bethesda Classification.

The Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of thecategories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category. We retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined. A total of 171 patients were included with 203cytological samples. Average age at initial FNA was 14.7 years (range 6.9-18.6 years). The numbers of nodules reported for Bethesda categories I-VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8,4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014. The risk of malignancy for thyroid nodules inthis pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.

English

BACKGROUND The breast is composed of both specialised epithelial cells and stroma. Both benign and malignant lesions can occur in the breast as a palpable lump. Fine needle aspiration cytology (FNAC) is a rapid, easy to perform, minimally invasive and low cost first line high-diagnostic accuracy test for cytopathological evaluation of palpable breast lump with minimum complications. METHODS The study was carried out to evaluate the cytopathological patterns of 2706 palpable breast lumps by fine needle aspiration (FNA) procedure and cytohistopathological correlation of the available biopsied palpable breast lumps of the study in the Pathology department of Tezpur Medical College and Hospital, Assam, for a period of three years from July 01, 2016 to June 30, 2019. RESULTS Out of 2706 palpable breast lumps in the study, FNA smears of 19 (0.70 %) were inadequate for cytopathological reporting. Out of the remaining 2687 palpable breast lumps where FNA was adequate for cytopathological reporting, female patients (n = 2594) comprised 96.54 % and male patients (n = 93) comprised 3.46 % with a male and female ratio of 1:27.9. Out of the 2687 palpable breast lumps, 2318 were benign breast diseases (86.27 %) and 369 were malignant neoplasms (13.73 %), with a benign and malignant ratio of 6.28:1. Out of the benign breast lumps, fibroadenoma breast was seen in 1228 (52.98 %) and of the malignant neoplasms, infiltrating duct carcinoma was seen in 341 (92.41 %). Cytohistopathological correlation showed 98.70 % sensitivity, 99.38 % specificity, 99.35 % positive predictive value, 98.76 % negative predictive value, and 99.04 % diagnostic accuracy. CONCLUSIONS FNAC has high sensitivity and specificity in cytopathological diagnosis of palpable breast lumps. Based on the accurate cytopathological diagnosis of the palpable breast lumps, patients with palpable breast lumps can be given adequate treatment. KEYWORDS Fibroadenoma, Gynaecomastia, Duct Papilloma, Infiltrative Duct Carcinoma, Medullary Carcinoma, Mucinous Carcinoma, Malignant Phyllodes

Standardization of thyroid fine needle aspiration procedure and outcomes within an endocrine surgery department.

Fine needle aspiration (FNA) biopsy is an essential procedure for thyroid nodules. Although, the efficacy of surgeon-performed thyroid FNA biopsies has been demonstrated in the literature, there are insufficient data regarding how to establish an efficient program with a low insufficiency rate within a group practice. An endocrine surgery thyroid FNA biopsy program was established in 2000 by one surgeon, with training of additional partners during fellowship and upon recruitment. The results within 18 years were analyzed. The FNA biopsies were performed by endocrine surgeons under ultrasound guidance without on-site pathologist review. A total of 5,469 FNA biopsies were performed by 7 surgeons. The total number of FNA biopsies performed by each surgeon varied between 291-1,378. FNA biopsies were performed in 2 passes using 22-gauge needles under constant suction. The overall insufficiency rate was 4.3%, with individual surgeon rates ranging between 2.7% and 7.2%. The insufficiency rate for the whole team ranged between 3.3% and 5% when examined in 5-year blocks. This study shows that an establishment of a highly efficient thyroid FNA biopsy program within a group practice is possible with a structured endocrine surgical training and adoption of a standard technique.

Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis

PurposeWe aimed to assess the diagnostic performance of shear wave elastography (SWE) to assess perinodular stiffness before fine needle aspiration (FNA) of thyroid nodules with a maximum diameter of 1.0 cm. MethodThis retrospective study included 69 thyroid nodules in 68 patients who underwent conventional ultrasound and SWE before ultrasound-guided FNA or surgical excision. The stiffness of perinodular regions was evaluated using wave patterns. Quantitative SWE features were also assessed. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated using conventional ultrasound and conventional ultrasound with SWE. ResultsOf the 69 nodules, 57(82.6 %)were malignant and 12(17.4 %)were benign. The maximum elastic modulus (Emax) was higher for malignant nodules(P＜ 0.05). There was no significant difference in mean elastic modulus or minimum elastic modulus between malignant and benign nodules. The Emax≥ 28.2 kPa was the best cut-off value for malignant base on receiver operating curve. Perinodular stiffness was significantly greater for malignant nodules compared with benign nodules according to shear wave patterns. Compared with ultrasound alone, the rate of benign lesions recommended for FNA decreased from 75.0 % (9/12) to 25.0 % (3/12) with conventional ultrasound plus SWE. ConclusionSWE provides quantitative and qualitative information when used with conventional ultrasound. SWE has the potential to reduce the number of unnecessary FNA procedures.

Ex-Vivo Identification of Tumor From Parenchyma in Human Liver Using Electrochemical Impedance Spectroscopy on a Needle

Percutaneous ethanol injection for hepatocellular carcinoma and biopsy for pathological examination of lesions in the liver are widely performed using a fine needle under ultrasonography guidance. However, it is often difficult to distinguish a malignant tumor from a parenchyma via ultrasonography. This study proposes a method for identifying a malignant tumor in the liver using coplanar bipolar electrodes fabricated on a fine needle, called electrochemical impedance spectroscopy on a needle (EoN). The electrical impedances of the malignant tumor and parenchyma were measured in two pathological statuses, more specifically in human ex-vivo normal liver and in human ex-vivo cirrhotic liver. Statistically significant differences in the electrical impedance between the malignant tumor and parenchyma in each pathological status were observed in a frequency range of 0.46MHz to 1MHz (p < 0.05). Given a real-time measurement in clinical trials, the optimal frequency suggested was indicated by the largest value in the discrimination index between the malignant tumor and the parenchyma. The electrical properties (conductivity and permittivity) of the tissues were estimated to generalize the sensor output without regard to the dimension and shape of the electrodes. The values of the electrical properties of cancer in the cirrhotic liver and normal liver were significantly higher than those of each parenchyma. These experimental results imply that EoN can be used as a potential tool for identification of malignant tumors in the liver during percutaneous ethanol injection and fine needle aspiration procedures.

Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic

There is much reported variation in the impact of local anesthesia on thyroid fine-needle aspiration (FNA) related discomfort. We compare patients undergoing thyroid FNA with subcutaneous injection or topical anesthetic to no anesthetic. We conducted a retrospective review of 585 sequential ultrasound guided thyroid FNA procedures in Mayo Clinic. Group 1 (n = 200), no anesthetic; Group 2 (n = 185), subcutaneous injection anesthetic; and Group 3 (n = 200), topical anesthetic. Patient demographics, number of FNA passes, needle gauge, and cytopathology were recorded plus a discomfort score (0 to 10) before and immediately post procedure in all 3 groups and peak discomfort during the FNA in Groups 1 and 2. There were no differences among the 3 groups in age, sex, FNA sufficiency rate, cytopathology, and FNA passes number. There was no significant difference between Groups 1 and 2 in peak discomfort score during the FNA: 0 (45%, 42.2%), 1 to 2 (19%, 24.9%), 3 to 5 (23.5%, 20.5%), 6 to 8 (9.5%, 10.8%), 9 to 10 (3%, 1.6%), respectively. Discomfort score post procedure: 0 (78.5%, 77.8%, 53.5%), 1 to 2 (13%, 13%, 36.5%), 3 to 5 (7%, 7%, 9%), 6 to 8 (1.5%, 2.2%, 1%), 9 to 10 (0%, 0%, 0%) for groups 1, 2, and 3, respectively. There were no significant differences among the 3 groups for a discomfort score ≥3. FNA associated patient discomfort was comparable during and after the procedure regardless of the use of anesthetic or the type utilized. Approximately 90% of patients experienced mild to moderate discomfort during the procedure. And 90% reported no more than a level 2 discomfort post procedure. End = endocrinology; FNA = fine-needle aspiration; MCF = Mayo Clinic Florida; MCR = Mayo Clinic Rochester.

BRAF V600E as an accurate marker to complement fine needle aspiration (FNA) cytology in the guidance of thyroid surgery in the Chinese population: evidence from over 1000 consecutive FNAs with follow-up.

Currently, several commercial molecular tests have been developed for reclassifying thyroid nodules with indeterminate fine needle aspiration cytology. These tests are quite expensive and not available in China. Previous studies demonstrated a very high prevalence of the BRAF V600E mutation in Asian people. A high incidence may result in a robust sensitivity. We conducted this study to determine the prevalence of BRAF V600E mutation and its ability to reclassify cytologically indeterminate thyroid nodules in the Chinese population. Between January 2016 and October 2018, consecutive patients who underwent a fine needle aspiration procedure and agreed to provide materials for molecular analysis in our hospital were recruited in this study. All were followed up until they had a thyroidectomy and a final pathological diagnosis or until January 2019 (those did not have surgery). A total of 1960 patients were included in this study. Until January 2019, 1240 patients underwent surgery. Using histopathological diagnosis as a gold standard, the overall sensitivity and specificity of the BRAF V600E mutational analysis for the discrimination of benign nodules from cancer in thyroid fine needle aspiration samples were 83.3% (81.0-85.3%) and 96.0% (77.7-99.8%), respectively, with an area under the ROC curve of 0.90 (95% CI 0.85-0.95, P<0.001). Among cases with indeterminate cytology, BRAF-positive cases were showing malignancy in the final pathology, and BRAF-negative cases were showing safer to be followed up. The BRAF V600E mutation is highly prevalent in the Chinese population and can accurately complement cytopathology in the guidance of thyroid surgery.Mini-abstract: The BRAF V600E mutation has both high specificity and sensitivity to predict thyroid malignancy in the Chinese population. It can accurately complement cytopathology in the guidance of thyroid surgery.

Raman-based cytopathology: an approach to improve diagnostic accuracy in medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a rare form of thyroid malignancy that can be diagnostically challenging on fine needle aspiration (FNA) cytology. Ancillary tests such as elevated serum or immunohistochemical positive calcitonin have been helpful, yet they can occasionally provide false positive results. In search for an alternative method to improve diagnostic accuracy (DA), we applied hyperspectral Raman spectroscopy to characterize the biochemical composition of single cells from MTC and compared their spectral information to cells from other types of thyroid nodules. Hyperspectral Raman images of 117 MTC single cells from digested tissue were obtained with a line-scan hyperspectral Raman microscope and compared to 127 benign and 121 classic variant of papillary thyroid carcinoma (CVPTC) cells. When principal component analysis and linear discriminant analysis were used to classify the spectral data, MTC cells were differentiated from benign and CVPTC cells with 97% and 99% DA, respectively. In addition, MTC cells exhibited a prominent Raman peak at 1003 cm-1, whose intensity is 84% and 226% greater on average than that observed in benign and CVPTC cells, respectively. When specifically utilizing only this peak as a spectral marker, MTC cells were separated from benign and CVPTC cells with 87% and 95% DA, respectively. As this peak is linked to phenylalanine, which is known to be associated with calcitonin release in thyroid parafollicular cells, the increased intensity further suggests that this Raman peak could potentially be a new diagnostic marker for MTC. Furthermore, preliminary data from MTC cells (n=21) isolated from a simulated FNA procedure provided similar Raman signatures when compared to single cells from digestion. These results suggest that "Raman-based cytopathology" can be used as an adjunct technique to improve the diagnostic accuracy of FNA cytopathology at a single cell level.

Molecular testing and thyroid nodule management in North America.

The incidence of thyroid cancer is rising for a variety of reasons. At the same time, the nomenclature revision of non-invasive encapsulated follicular-variant PTC to noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) has modified the incidence of thyroid cancer. Given that thyroid neoplasia is a molecular event, it is important for the thyroid physician to evaluate each patient systematically. Most thyroid cancers are sporadic; however, some are familial and may be associated with syndromes with genetic implications. Advances in radiologic imaging have made ultrasonography a near equivalent of gross examination. The American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) classifies nodules from TR1 to TR5 and is valuable in determining which patients should be guided toward fine-needle aspiration (FNA) sampling. While FNA procedures and processing may be varied, the key elements are cytologic diagnosis and collection of samples for potential molecular testing. The Bethesda System for Reporting Thyroid Cytology (BSRTC) is commonly used and categorizes each FNA specimen into one of six diagnoses. The indeterminate diagnoses with risk of malignancy (ROM) ranging from 10-75% comprise approximately 30% of thyroid FNA cases and for these, molecular testing is beneficial. In North America, the two most common molecular platforms are Veracyte Afirma GSC and ThyroSeq v3. Both panels cover an extensive array of genomic alterations associated with thyroid neoplasia and a negative result from either test effectively refines the ROM of an Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) or Follicular Neoplasm/Suspicious for a Follicular Neoplasm (FN/SFN) diagnosis to 3-4%. Given that the refined ROMs are comparable to that of a Benign BSRTC diagnosis, these patients are recommended for observation of their nodules. However, differences exist in the implication of Afirma GSC-Suspicious and ThyroSeq v3-Positive molecular results with regard to the probability of cancer. For either test, the molecular test result should be integrated with other clinical parameters to determine if surgery is indicated and, if so, the extent of surgery.

Comparison of Efficiencies Between Shear Wave Elastography, Fine-Needle Aspiration Biopsy and American College of Radiology Thyroid Imaging Reporting and Data System Scoring System in Determining the Malignity Potential of Solid Thyroid Nodules.

We aimed to evaluate the efficiencies of quantitative shear-wave elastography, fine-needle aspiration (FNA) biopsy and American College of Radiology (ACR)-thyroid imaging reporting and data system (TIRADS) scoring system in determining the malignity potential of solid thyroid nodules. In period between September 2014 and January 2016, 191 solid thyroid nodules of 189 patients were enrolled in this study. The mean shear wave velocities of the nodules were recorded by acoustic radiation force impulse method. All nodules were classified according to ACR-TIRADS scoring system and underwent FNA procedure. The cytopathologic results (after FNA) were benign in nature, atypical-cytology/suspiciously malign and highly suspicious of malignity in 117, 28, and 21 nodules, respectively. The specimen from FNA was insufficient in 25 nodules. Thirty-four nodules of 33 enrolled patients were operated, and the efficiencies of shear wave elastography, FNA, and ACR-TIRADS procedures were statistically analyzed; relying on the histopathologic results, the shear-wave elastography had 83.3% sensitivity, 93.7% specificity (with a cutoff value of 2,74 m/s), the FNA had 94.4% sensitivity, 87.5% specificity, and ACR-TIRADS had 88.2% sensitivity, 94.1 specificity in determining malignant tyroid nodules (P < 0.005). Quantitative shear wave elastography is concluded to be an effective, noninvasive, and practical imaging modality with a lesser sensitivity and specificity values than TIRADS unless a lower sensitivity but a higher specificity values than FNA (93.7% vs 87.5%) in considering the malignity potential of solid thyroid nodules.

Spontaneous infarction of pleomorphic adenoma of the parotid gland: A case report.

Infarction after the fine-needle aspiration (FNA) procedure is a well-recognized phenomenon of salivary gland lesions. Though extremely rare, spontaneous infarction without previous FNA can occur in pleomorphic adenoma (PA). The present report describes a fourth cytological case of spontaneous infarction of PA of the parotid gland using immunocytochemical analysis, to the best of our knowledge, for the first time. A 57-year-old Japanese female presented with persistent swelling of the right neck region. Physical examination revealed a tumour in the right parotid gland, and FNA examination of the tumour was performed following surgical resection. The Papanicolaou smear demonstrated the presence of fully necrotic cell clusters of varying sizes in a necrotic background. Only a few viable cell clusters were observed. These cells were polygonal to spindle-shaped, and exhibited large round to oval nuclei with a conspicuous nucleoli. Although nuclear pleomorphism was noted, the nuclear chromatin was fine. No neoplastic myoepithelial cells were observed. Therefore, it was suspected that these cells were malignant. Immunocytochemical analysis indicated that these atypical cells were positive for p40. Histopathological examination of the resected parotid gland tumour revealed infarcted PA. Our study revealed that the presence of atypical squamous metaplastic cells in a necrotic background was a characteristic cytological feature of infarcted PA, and that these atypical squamous cells can have large nuclei with conspicuous nucleoli and exhibit pleomorphism. Although cytological diagnosis of infarcted PA is difficult, pathologists and cytopathologists must consider the presence of atypical metaplastic squamous cells in benign salivary gland tumours, including infarcted PA.

Bevel angle study of flexible hollow needle insertion into biological mimetic soft-gel: Simulation and experimental validation

BackgroundA thorough understanding of cutting-edge geometry and cutting forces of hollow biopsy needles are required to optimise needle tip design to improve fine needle aspiration procedures. ObjectivesTo incorporate the dynamics of needle motion in a model for flexible hollow bevel tipped needle insertion into a biological mimetic soft-gel using parameters obtained from experimental work. Additionally, the models will be verified against corresponding needle insertion experiments. MethodsTo verify simulation results, needle deflection and insertion forces were compared with corresponding experimental results acquired with an in-house developed needle insertion mechanical system. Additionally, contact stress distribution on needles from agar gel for various time scales were also studied. ResultsFor the 15°, 30°, 45°, 60° bevel angle needles, and 90° blunt needle, the percentage error in needle deflection of each needle compared to experiments, were 7.3%, 9.9%, 8.6%, 7.8%, and 9.7% respectively. Varying the bevel angle at the needle tip demonstrates that the needle with a lower bevel angle produces the largest deflection, although the insertion force does not vary too much among the tested bevel angles. ConclusionThis experimentally verified computer-based simulation model could be used as an alternative tool for better understanding the needle-tissue interaction to optimise needle tip design towards improved biopsy efficiency.

Comparison of core needle biopsy and fine-needle aspiration in diagnosis of ma lignant salivary gland neoplasm: Systematic review and meta-analysis.

In this meta-analysis, we compared the risk of obtaining nondiagnostic results and the diagnostic accuracy for detection of salivary gland malignancy between core needle biopsy (CNB) and fine-needle aspiration (FNA). All published English-language studies comparing CNB and FNA diagnostic accuracy for salivary gland masses through December 2019 were searched. Pooled risk ratios (RRs) of nondiagnostic results, sensitivities, and specificities of CNB and FNA for salivary gland malignancy diagnosis were determined. Complication rates were compared. Six studies (1924 procedures) were quantitatively analyzed. CNB yielded significantly fewer nondiagnostic results (P < .001) and had significantly higher pooled sensitivity (P < .001) and specificity (P = .002) than FNA for differentiating malignant and benign salivary gland neoplasms. Hematoma occurred in 0.3% of CNB, while no complication occurred in FNA procedures. CNB yielded fewer nondiagnostic results and had superior diagnostic performance compared with FNA for detecting salivary gland malignancies.

Surface Texturing Design to Enhance Echogenicity of Biopsy Needles During Endoscopic Ultrasound Imaging

The ultrasonic visibility of a biopsy needle tip is of critical importance for the success and safety of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) procedures. The aim of this study was to design a surface topology, in silico, which enhances the ultrasound visibility of a needle by controlling and optimising the direction of the reflections. Topographic enhancements to needle surface redirect scattered waves back to the transducer to enhance needle visibility, or “echogenicity.” Echogenicity enhancement is demonstrated across insonification angles of 30°–90° on full-length scale of biopsy needles used in practice. By applying a textured surface across the full length of the needle surface, the signal being returned to the transducer can be tripled from that of a constant periodic dimple echogenic surface and seven times that of an untextured flat surface. Our first principles model provides a quantitative insight to echogenicity and its enhancement. The model allows in silico design of needles for USG-FNA and biopsy with enhanced echogenicity and consequent improvement in visibility, including but not limited to needle tip area.

Determining whether surgeons perform thyroid fine-needle aspiration as well as radiologists: an analysis of the adequacy and efficiency of ultrasound-guided fine-needle aspiration performed by newly trained head and neck surgeons and radiologists.

Ultrasound-guided fine-needle aspiration (FNA) cytology is a crucial diagnostic technique used to assess thyroid nodules. In the past, ultrasound-guided FNA was performed mainly by radiologists. However, many surgeons are increasingly being trained for this procedure now. In this study, we aimed to compare the adequacy and efficiency of ultrasound-guided FNA performed by newly trained head and neck surgeons with experienced radiologists in a single institution. We also assessed the malignancy rates in nondiagnostic nodules and the differences between benign and malignant nodules. This is a retrospective study. The data from patients who underwent ultrasound-guided FNA performed by surgeons or radiologists in two consecutive years were collected. Medical records, cytology results, and surgical pathology results were analyzed. During the study period, a total of 2,405 ultrasound-guided FNAs were performed on 2,163 patients. The head and neck surgeons and radiologists performed 1,132 and 1,273 ultrasound-guided FNA procedures, respectively. The nondiagnostic rate was 14.49% for surgeons and 15.40% for radiologists (P=0.533). There were no differences in patient age, gender, nodule size, and other sonographic characteristics between the groups of patients who were treated by radiologists versus surgeons. The median waiting time from biopsy appointment to performing ultrasound-guided FNA was 0 days for head and neck surgeons, and 6 days for radiologists (P<0.001). Of the 40 patients who had a repeat FNA or surgery, 19 (47.50%) had a malignancy. Preoperative information about age, gender, operator, and characteristics of nodules did not predict the outcome of nodules with Bethesda category I. The adequacy of ultrasound-guided FNAs performed by head and neck surgeons is similar to that of skilled radiologists, while surgeons are more efficient than radiologists. Nondiagnostic FNA reports should not be considered benign, and repeat FNA or selective surgical treatment is recommended.

Handling of Thyroid FNA Samples During the COVID-19 Pandemic

Handling of Thyroid FNA Samples During the COVID-19 Pandemic

Mediastinal ve hiler lenfadenopatilerde endobronşiyal ultrason eşliğinde kullanılan power Doppler modunun benign ve malign lenf nodu ayırımına katkısı

Aim: The aim of this study was to investigate the contribution of power Doppler mode used in the differentiation of malignant and benign lymph nodes in patients with mediastinal and hilar lymphadenopathies undergoing diagnostic fine needle aspiration under the guidance of convex probe endoscopic ultrasound (EBUS).Material and Methods: Medical files of patients who underwent EBUS between March 2018 and February 2019 were retrospectively analyzed. A total of 143 lymph nodes of 85 patients were included in the study. The demographic characteristics of the patients with a definite diagnosis and EBUS radiological and sonographic characteristics of the sampled lymph nodes were recorded. As a result of the evaluation of mediastinal lymph nodes with EBUS, the sensitivity, specificity, negative and positive predictive values were calculated for power Doppler mode in the detection of malignant lymph nodes.Results: Of a total of 85 patients, 62 (73%) were males and 23 (27%) were females with a mean age of 62±10.4 (range, 37 to 80) years. In the vascular pattern evaluation, 87 (60.8%) lymph nodes were negative and 56 (39.2%) were positive for malignancy. Comparing final diagnoses and vascular pattern analysis results revealed a statistically significant difference between benign and malignant lymph nodes in favor of power Doppler mode under the guidance of EBUS (p &amp;lt;0.01).Conclusion: Convex probe EBUS can identify the first lymph node to be sampled based on sonographic characteristics of lymph nodes and allow simultaneous imaging and transbronchial fine needle aspiration procedures. Therefore, it may shorten the procedural time and reduce the amount of anesthesia to be used.

Normal Components and Contaminants.

The pancreas is a retroperitoneal organ located in the duodenal loop with the posterior wall of the stomach overlying it and the left lobe of the liver lying anteriorly to it. Tissues from these organs, in addition to the lesion of interest within the pancreas, may be sampled during fine-needle aspiration (FNA) procedures. Therefore, it is important to recognize the cytology of normal benign components of the pancreas and potential contaminants in order to render a correct diagnosis and avoid pitfalls. Normal components of the pancreas include ductal epithelial cells, acinar cells, and islet cells. In addition to the normal pancreatic cells, it is not uncommon to encounter epithelial cells from the duodenal and gastric mucosa with endoscopic ultrasound-guided fine-needle aspiration. It is important to recognize these cells as benign and to distinguish them from a well-differentiated pancreatic adenocarcinoma. Besides these, mesothelial cells and hepatocytes and bile duct cells from the liver may be sampled as well. Here, the cytological features of normal components and contaminants are described in detail.

Risk Stratification Study of Indeterminate Thyroid Nodules with a next-generation Sequencing Assay with Residual ThinPrep® Material.

Objective: The management of indeterminate thyroid nodules is challenging. Molecular testing has emerged as a promising method for stratifying this gray area of fine-needle aspiration (FNA) cytology. Next-generation sequencing (NGS) can be used to test a large variety of genetic changes with very small amounts of nucleic acids obtained from FNA samples.Methods: Thyroid FNA assays were classified according to the Bethesda System for Reporting Thyroid Cytopathology after routine ThinPrep® slide preparation. Indeterminate nodules with surgical outcomes were assayed with an 18-gene NGS panel with the residual ThinPrep® material, including nodules categorized as atypia of undetermined significance (AUS)/follicular lesions of undetermined significance (FLUS) or follicular neoplasm (FN)/suspicious for a follicular neoplasm (SFN). We evaluated the diagnostic efficacy of the 18-gene panel for thyroid malignancies and potential malignancies and compared it with a well-accepted examination, ThyroSeq v2 testing.Results: A total of 36 indeterminate nodules were assayed, seven were categorized as AUS/FLUS and 29 as FN/SFN. All of them had adequate DNA for the NGS procedure. When noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was considered malignant, the risk of malignancy was 71.4% for AUS/FLUS nodules, and 69.0%for FN/SFN nodules. The 18-gene panel showed 72.0% sensitivity, 72.7% specificity, 85.7% positive predictive value (PPV), and 53.3% negative predictive value (NPV) in identifying malignancies and potential malignancies in the indeterminate nodules. Compared with a multicenter report from ThyroSeq v2 testing, 18-gene panel showed a lower NPV (p=0.005), but a higher PPV (p=0.02).Conclusions: NGS assays are feasible on residual ThinPrep® material, with the advantage of not requiring additional FNA procedure. The 18-gene panel testing can be used as a 'rule in' test for surgical management based on indeterminate nodules and showed a lower NPV but a higher PPV compared to ThyroSeq v2 testing.

Endoscopic ultrasound-guided fine-needle aspiration of renal lesions: experience in a tertiary center.

endoscopic ultrasound (EUS) allows the histological diagnosis of radiologically undetermined renal lesions, although few series have been described. to describe the procedure, yield and complications of EUS-guided renal fine-needle aspiration (FNA). a retrospective case series in a prospective database was used that consecutively included EUS procedures from March 2014 to August 2018. Data on complications, outcome and follow-up were collected. A successful FNA was defined as any FNA that allowed a histological diagnosis. Lesions were considered as malignant when surgically confirmed as such (the histological diagnosis was used for non-surgical patients) and benign when radiographically stable for ≥ 12 months. eight patients were identified with a median age of 61.6 years (57.3-71.9), and five (62.5 %) were female. Five FNA procedures involved the right kidney and three involved the left kidney. 22G cytology needles were used. Renal FNA was diagnostic in all cases, with no complications. EUS-guided FNA may represent an effective, safe procedure for the diagnosis of renal lesions of an uncertain origin.