Fine-needle Aspiration Report Research Articles

Comparing ultrasound to fine needle aspiration in differentiating between benign and malignant thyroid masses

Introduction: Due to the possibility of malignancy of thyroid nodules, it is necessary to identify the type of thyroid nodule to choose the most accurate treatment possible. Objectives: Considering that there is no standard diagnostic method for masses with intermediate suspicion of malignancy, the present study was conducted to investigate the diagnostic value of ultrasound in differentiating between benign and malignant thyroid masses compared with fine needle aspiration (FNA). Patients and Methods: In this cross-sectional study, 150 patients who had been referred to an endocrinologist’s office in Bandar Abbas with a complaint of thyroid mass in 2019-2020 and had undergone ultrasound and FNA were included in the study by census. After obtaining their informed consent, the patient’s information was collected by reviewing their ultrasound and FNA reports and analyzed with descriptive and analytical tests in SPSS software version 26. Results: The sensitivity and specificity of ultrasound in detecting malignant and benign masses were 56.25% and 85.07%, respectively. The positive and negative predictive values of ultrasound were 60% and 98.27%, respectively. The number of malignant FNA reports was significantly higher in the intermediate suspicion category of patients than in patients with ultrasound results showing high suspicion of malignancy. Conclusion: Performing further diagnostic measures such as FNA and core needle biopsy after noticing an intermediate suspicion in a patient’s ultrasound seems necessary.

Relationship Between Sonographic Findings, Fine Needle Aspiration, and Histopathological Findings of Post-thyroid Surgery.

Thyroid diseases can affect various bodily functions and often go unnoticed. Tools such as sonography and fine needle aspiration (FNA) puncture are necessary to diagnose diseases that require surgical intervention. These tools help identify signs of malignancy or benignity and obtain further data to guide therapeutic decisions. This study aims to validate the relationship between sonographic results, FNA, and final thyroid pathology. This research describes the level of correlation between sonographic findings and FNA, the sonographic and final pathology reports, and the FNA and final pathology reports. Additionally, this research aims to identify the most common diagnoses in the final pathology. A retrospective descriptive observational study was carried out with a sample of 95 patients who underwent thyroid surgery at the National Institute of Diabetes, Endocrinology, and Nutrition (INDEN), Dominican Republic, in 2019 to determine whether a relationship exists between the sonography findings, FNA, and the final pathology in surgical thyroid pathologies. A total of 95 patients were studied. The success rate of the sonography results compared with the benign final biopsy result was 100% and 45.9% with the malignant final biopsy result. The success rate of the fine needle biopsy results was 95.9% for the benign final biopsy and 28% for the malignant final biopsy. Of the malignant final biopsy reports, 84.6% were papillary carcinomas, 7.7% were follicular carcinomas, and 7.7% were medullary carcinomas. The relationship between the sonographic results, FNA, and histopathological findings of surgical thyroid diseases is validated. The sonographic findings are specific for diagnosing benignity and malignancy. A fine needle biopsy is useful for diagnosing benignity, and the final biopsy is the standard for confirming both benign and malignant pathologies.

The yield of thyroid fine-needle aspiration in a primary care setting in Riyadh, Saudi Arabia.

Thyroid cancer is the second most common cancer among women. This study was conducted to assess the yield of fine-needle aspiration (FNA) cytology of thyroid nodules in a primary care setting in Riyadh, Saudi Arabia. In this retrospective cohort study, primary care patients of both genders with thyroid nodules who underwent FNA above the age of 18 years were enrolled. Patients with a prior history of cancer were excluded. The data was collected from the histopathology reports of FNAs done for thyroid nodules from January 01, 2002 to July 31, 2018. We enrolled 263 patients in this study. The mean age of the study population was 41.3 years old (Standard deviation (SD) ± 10.1), 81.7% were females and 18.3% were males. The rate of abnormal ultrasound (US) was 16%. The mean thyroid-stimulating hormone (TSH) level was 2.3 mU/L (SD ± 5.9). Post-thyroidectomy, 17.5% had carcinoma on pathology reports. Among those who were diagnosed with thyroid cancer, 76.2% had papillary thyroid cancer, 21.4% had follicular thyroid cancer, and 2.4% had medullary thyroid cancer. The mean age for cancer diagnosis was 40 years old (SD ± 8). There was no significant association between FNA findings (benign/malignant) and age, gender, history of smoking, size of the nodule, or TSH level. Thorough investigations including FNA should be considered for patients presenting with suspicious thyroid nodules, regardless of their size or the patients' gender. Access to such investigations and referrals to specialists should be available for primary care physicians.

False positive cases in thyroid cytopathology - the experience of a single laboratory and a systematic review.

Fine needle aspiration (FNA) is fundamental in the pre-operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with "suspicious for malignancy" or "malignant" cytology, whose surgical follow-up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms ("thyroid", "cytology", "false positive"). Out of 2031 FNA reports, 93 cases with "suspicious for malignancy" or "malignant" cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P=0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non-neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such.

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.

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Fine-needle aspiration to diagnose primary thyroid lymphomas: a systematic review and meta-analysis.

Primary thyroid lymphoma (PTL) is a rare malignancy, and its prognosis depends significantly on its early diagnosis. While fine-needle aspiration (FNA) represents the gold standard to identify differentiated thyroid carcinoma, its reliability for the detection of PTL is still unclear. Here, we conducted a systematic review and meta-analysis to evaluate the diagnostic performance of FNA in PTL. A comprehensive literature search of PubMed/MEDLINE and Scopus databases was conducted to retrieve papers reporting histologically proven PTL undergone FNA. The last search was performed in February 2018 without language and time restrictions. Thirty-two studies describing 593 PTL were included and the pooled FNA sensitivity was 0.48 (95% CI = 0.38-0.58). FNA sensitivity was 0.51 in 20 studies published before 2010 and 0.39 in those published later, 0.50 in six articles with at least 20 cases and 0.44 in nine series enrolled after 2000. This performance was similar in 12 articles including diffuse large B-cell lymphoma (0.54) and those six on marginal zone lymphoma (0.56). Remarkably, FNA sensitivity increased to 0.72 when considering also FNA reports suspicious for PTL reported in 14 articles. Heterogeneity among the series was found. Publication bias was not always detected. The present meta-analysis demonstrated that FNA has low sensitivity in diagnosing PTL. However, this rate increased when considering also FNA reports suspicious for PTL, which is relevant from a clinical standpoint. This result could support indirectly the use of additional imaging and/or core biopsy when PTL is suspected.

A cancer of undetermined significance: Incidental thyroid carcinoma.

The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non-incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non-complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

Does Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) Have a Unique Molecular Profile?

Recognizing preoperative characteristics of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is important for clinical management. Therefore, we assessed presurgical NIFTP molecular profiles using fine-needle aspiration (FNA) material. Presurgical FNA reports of 39 surgically confirmed NIFTP cases from January 2013 through May 2017 were assessed for Afirma and ThyroSeq results. Twenty-one of 39 NIFTP nodules were preoperatively tested with Afirma with two benign and 19 suspicious results. Twenty-seven of 39 nodules were tested with ThyroSeq (nine of 39 had both Afirma and Thyroseq): 18 (67%) had RAS mutations (13 NRAS, four HRAS, one KRAS), and three of 18 had multiple alterations (NRAS + TP53, n = 1; NRAS + PTEN, n = 2). BRAF T599_R603 + EIF1AX mutation (n = 1), PTEN mutation (n = 1), MET overexpression (n = 1), PAX8/PPARG fusion (n = 3), and THADA/IGF2BP3 fusion (n = 3) comprised the remainder. NIFTP cases most commonly displayed suspicious Afirma results and RAS mutations on ThyroSeq, lacking aggressive/BRAF-V600E-like mutations. While NIFTP remains a surgical entity, the lack of aggressive/BRAF-V600E-like mutations can aid in determining the extent of surgery.

Diagnostic Accuracy of Fine Needle Aspiration for Solitary and Multiple Thyroid Nodules in a Tertiary Care Center

Background: Thyroid nodules are common in clinical practice. They are usually benign, but malignancy must be ruled out. Fine needle aspiration (FNA) biopsy of the thyroid is a rapid and cost-effective procedure in the initial evaluation of a thyroid nodule, but its results may be inaccurate in 10% to 30% of cases. This prospective observational study was conducted to determine the prevalence of thyroid cancer, its related findings, and the diagnostic accuracy of preoperative FNA in a tertiary care center. Methods: We prospectively studied the medical records of 345 subjects, who underwent thyroid resection in the university hospital setting over a 4-year period. Age, gender, FNA and pathologic reports, and whether the lesion was multinodular or a solitary nodule were determined. Results: The sensitivity and specificity of FNA were 64.96% and 62.76%, respectively. The positive predictive value of the test for the diagnosis of malignant nodules was 59.30% and its negative predictive value was 68.20%. In 63.5% of the patients, the preoperative FNA matched the surgical histopathology results. The presence of multinodular goiter was an important risk factor for thyroid malignancy. Fifty-two subjects had papillary microcarcinoma and the rate of aggressive behavior was considerable in this group. Conclusions: Although fine needle aspiration biopsy is the most important step in the workup of the thyroid nodules, it may miss a significant number of malignant lesions. Therefore, there is a mandatory need to evolve other clinical and laboratory adjuncts, which assists the clinicians with the interpretation of FNA more accurately.

The 2017 Bethesda System for Reporting Thyroid Cytopathology

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid fine-needle aspiration (FNA) specimens. The 2017 revision reaffirms that every thyroid FNA report should begin with 1 of 6 diagnostic categories, the names of which remain unchanged since they were first introduced: (1) Nondiagnostic or Unsatisfactory; (2) Benign; (3) Atypia of Undetermined Significance (AUS) or Follicular Lesion of Undetermined Significance (FLUS); (4) Follicular Neoplasm or Suspicious for a Follicular Neoplasm; (5) Suspicious for Malignancy; and (6) Malignant. There is a choice of two different names for some of the categories: a laboratory should choose the one it prefers and use it exclusively for that category; synonymous terms (eg, AUS and FLUS) should not be used to denote 2 distinct interpretations. Each category has an implied cancer risk that ranges from 0% to 3% for the "Benign" category to virtually 100% for the "Malignant" category, and, in the 2017 revision, the malignancy risks have been updated based on new (post 2010) data. As a function of their risk associations, each category is linked to updated, evidence-based clinical management recommendations. The recent reclassification of some thyroid neoplasms as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has implications for the risk of malignancy, and this is accounted for with regard to diagnostic criteria and optional notes. Such notes can be useful in helping guide surgical management.

Endoscopic ultrasound-guided fine-needle aspiration of an aortocaval lymph node by the transcaval approach

AbstractA 59-year-old male was diagnosed as carcinoma gallbladder around 1 year back and underwent radical cholecystectomy. He also received four cycles of chemotherapy. Now, he complained upper abdominal heaviness; positron emission tomography-computed tomography (PET-CT) was done which showed PET-avid 8.5 mm sized lymph node at aortocaval region. There was no safe route, so endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) was advised. However, FNA was not possible without crossing inferior vena cava and further management depended on FNA report. The EUS-FNA was done, and cytopathological smears were consistent with metastatic adenocarcinoma. There was no complication.

Predictors of Malignancy in Patients with Solitary and Multiple Thyroid Nodules

Introduction: Ultrasound (US) and Fine-needle aspiration (FNA) are the main methods used for investigating thyroid nodules, with questionable predictive values in multinodular goiter (MNG) compared to solitary thyroid nodule (STN). Objective: To detect the independent predictors of malignancy in patients with solitary and multiple nodules. Patients and Methods: Medical records of patients who were admitted for thyroidectomy at Alexandria Main University Hospital and Medical Research Institute Hospital between January 2014 and January 2016 were reviewed. Demographic and clinical data, US reports, FNA reports (Bethesda “B” system), and final histopathological results were recorded and analyzed. Patients with hyper- or hypo-thyroidism, previous history of thyroid cancer or those with incomplete data were excluded. Results: Collectively, 20% (111/554) of the study population proved to have malignancyon final histopathology, 19.3% (82/422) with MNG and 22% (29/132) with a STN. Combining gender and age showed that significantly more male patients with MNG under the age of 45 years had thyroid cancer (X2=11.75, p=0.003).Statistically significant US features in the MNG Group included micro-calcifications, solid composition, echogenicity, incomplete halo, ill-defined margins, and suspicious cervical lymph nodes (LNs). In STN, significant US features included complex composition of nodules, peri-nodular vascularity, and also suspicious cervical LNs. The FNA results of BII-V reports showed that 16.9% (69/408) and 17.6% (22/125) of patients with MNG and STN, respectively, had false negative results. The risk of malignancy showed a significant rise from BIV to BVI lesions in both Groups. Multivariate analysis revealed that, in MNG, the highest malignancy predictor was micro calcification, followed by FNA (BVI) and then suspicious cervical LNs. In STN, the features that retained significance in multivariate analysis were suspicious LNs& BVI-FNA. Conclusion: Based on the data presented, it may be concluded that the independent predictors of malignancy were US findings of micro-calcification in patients with MNG, suspicious cervical LNs and Bethesda VI on FNA in patients with both MNG and STN.

The sydpath post-bethesda experience: an audit of thyroid fine-needle aspiration biopsy reports from 2008–2013

Aim This study is an evaluation of thyroid fine-needle aspiration (FNA) diagnostic reports from 2008 to 2013, during which there was continual implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Methods Thyroid FNA reports from 2008 to 2013 (inclusive) were reviewed by the author and categorised 1 to 6 according to TBSRTC. Reports interpreted as ‘unclear’ or ‘equivocal’ as to the category were retrospectively coded by the original reporting cytopathologist. FNA reports were counted, tabulated and analysed. Results A total of 2956 FNA reports were reviewed. From 2008 to 2013, there was an overall increase in FNAs reported; concurrently there was a decrease in Categories 1 (e.g. ‘nondiagnostic’ and ‘insufficient’ FNAs) and 3 [e.g. follicular lesion of uncertain significance (FLUS) and atypia of indeterminate significance (AUS)]. Discussion The aggregate mean data correlates well with TBSRTC recommendations for distribution of categories. The continual adoption of TBSRTC correlates with an improvement in clarity of reporting language. The decreases in Categories 1 and 3 could be the result of more strict use of diagnostic reporting criteria. Retrospective review of ‘unclear’ and ‘equivocal’ reports can be useful to monitor and improve reporting approach. This study is an evaluation of thyroid fine-needle aspiration (FNA) diagnostic reports from 2008 to 2013, during which there was continual implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thyroid FNA reports from 2008 to 2013 (inclusive) were reviewed by the author and categorised 1 to 6 according to TBSRTC. Reports interpreted as ‘unclear’ or ‘equivocal’ as to the category were retrospectively coded by the original reporting cytopathologist. FNA reports were counted, tabulated and analysed. A total of 2956 FNA reports were reviewed. From 2008 to 2013, there was an overall increase in FNAs reported; concurrently there was a decrease in Categories 1 (e.g. ‘nondiagnostic’ and ‘insufficient’ FNAs) and 3 [e.g. follicular lesion of uncertain significance (FLUS) and atypia of indeterminate significance (AUS)]. The aggregate mean data correlates well with TBSRTC recommendations for distribution of categories. The continual adoption of TBSRTC correlates with an improvement in clarity of reporting language. The decreases in Categories 1 and 3 could be the result of more strict use of diagnostic reporting criteria. Retrospective review of ‘unclear’ and ‘equivocal’ reports can be useful to monitor and improve reporting approach.

Electromagnetic navigation bronchoscopy‐guided fine needle aspiration for the diagnosis of lung lesions

Many peripheral lung lesions are beyond the reach of conventional bronchoscopes, and require percutaneous CT-guided or open surgical biopsy, which carry increased risks to the patient. Electromagnetic navigation bronchoscopy (ENB) is a relatively new technique, which uses an image guided localization system to direct steerable bronchoscopic tools to predetermined points within the bronchial tree. This technology allows improved access to peripheral lesions in particular. We investigated the sensitivity and specificity of ENB-guided fine needle aspiration (FNA) in the diagnosis of lung lesions. All ENB-guided FNAs performed at one institution were included in the study. The superDimension i-Logic System™ was used in all cases. Pathologic reports of the ENB-guided FNAs, as well as all other pulmonary sampling performed simultaneously with the FNA and within 1 year of the ENB-guided FNA were reviewed. Patients with a positive ENB-guided FNA or malignancy within the same lobe within the follow-up period were considered positive for malignancy. Patients with an atypical diagnosis but no definitive malignancy were considered negative for malignancy for statistical purposes. Ninety-one patients underwent 95 ENB-guided FNAs over a 3-year period. Thirty-five patients (38%) were positive for malignancy. ENB-guided FNA had a sensitivity of 63% for the detection of malignancy. The sensitivity for the detection of malignancy using all ENB-guided sampling methods, including FNA, bronchoscopic biopsy, and bronchial brushing was 83%. Pathologists and cytotechnologists should be aware of ENB-guided FNA as an emerging technology with a relatively high sensitivity for the diagnosis of peripheral lung lesions.

The Bethesda System for Reporting Thyroid Cytopathology: Interpretation and Guidelines in Surgical Treatment

(1) The aim of this study is to assess the efficacy of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in accurate prediction of thyroid lesions on fine needle aspiration (FNA). (2) To appraise the surgeon with guidelines for adequacy of samples, and interpretation of FNA reports with TBSRTC and hence aiding them in surgical decision making. Five hundred and sixty four FNAs were done on patients with thyroid swellings in the department of Pathology and reported using TBSRTC guidelines. In cases where surgery was done, histopathological report was correlated. Using TBSRTC the commonest cytological diagnosis was benign-Hashimotos thyroiditis followed by benign follicular nodule. TBSTRC reduces inter-observer variability in reporting thyroid FNAs and provides good communication between the surgeon and pathologist. It also implicates guidelines for cancer risk and clinical management to the surgeons, thus avoiding unnecessary surgery.

Thyroid follicular lesion of undetermined significance: Evaluation of the risk of malignancy using the two‐tier sub‐classification

The Bethesda 2007 Thyroid Cytology Classification defines follicular lesion of undetermined significance as a heterogeneous category of cases that are not convincingly benign nor sufficiently atypical for a diagnosis of follicular neoplasm or suspicious for malignancy. In our institution, we refer to these cases as indeterminate, and they are further sub-classified into two: (1) low cellularity with predominant microfollicular architecture and absence of colloid (IN(a)) and (2) nuclear features not characteristic of benign lesions (nuclear atypia) (IN(b)). We reviewed these indeterminate cases to document the follow-up trend using this two-tier classification. A search of the cytology records was performed for the period between January 2008 and June 2009. All thyroid fine-needle aspiration (FNA) cases were reviewed and the ones diagnosed as indeterminate were identified. Correlating follow-up FNA and/or surgical pathology reports were reviewed. The percentage of cases showing a malignancy was calculated. One hundred and seventy-one indeterminate cases were identified, representing 2.8% of the 6,205 thyroid FNA cases examined during the time under review (107 IN(a), 64 IN(b)). Records of follow-up procedures were available in 106 (61%) cases. Malignancy was identified in 27% of all indeterminate cases. This was disproportionately more in the IN(b) (56%) compared to the IN(a) (7%) cases. A diagnosis of "IN(a)" does not carry the same implication as that of "IN(b)". The IN(b) category needs a more aggressive follow-up than the IN(a) category and may justify an immediate referral for lobectomy. Despite the vague morphologic criteria for this diagnostic category, the indeterminate rate remains relatively low and falls within the NCI recommendation (<7%).

Predictive Value of Cytologic Atypia in Indeterminate Thyroid Fine-Needle Aspirate Biopsies

Fine-needle aspiration (FNA) biopsies are the most accurate method for diagnosis of thyroid nodules. Unfortunately, biopsies are indeterminate 15-30% of the time and surgery is thus required for a definitive diagnosis. We aimed to determine whether specific descriptors of cytologic atypia mentioned in indeterminate FNA reports were associated with malignancy on final histopathology. Retrospective review of 1000 surgery patients identified 466 indeterminate FNA lesions that underwent either a hemi- or total thyroidectomy between 1998 and 2009. We screened FNA reports for specific descriptors of nuclear atypia. Univariate and multivariate analyses were performed to evaluate the independent effect of cytologic atypia descriptors on the risk of malignancy. Nuclear atypia on FNA conferred a risk of malignancy of 42% (P < 0.0001). Risk of malignancy increased from 17% for zero descriptors to 81.2% when four or more descriptors of atypia were described. Nuclear grooves and inclusions together conferred a risk of malignancy, specificity, and false positive rate of 79.3%, 98.2% and 1.8% respectively. The presence of four or more descriptors of cytologic atypia or the presence of both nuclear inclusions and grooves together confers a high risk of malignancy on final histopathology and a low false positive rate. These findings should be taken into consideration when interpreting FNA reports and total thyroidectomy should be considered for those patients at higher risk.

Accuracy of Fine Needle Aspiration (FNA) in Diagnosis of Major Salivary Gland Tumors

Salivary glands tumors consist a major part of human tumors which their differentiation and treatment are very different. In addition to clinical experiments, biopsy is helpful method to obtain an accurate diagnosis. The biopsy of oral lesions is provided in different ways and one of them is Fine Needle Aspiration (FNA) which is a non-invasive, easy, quick and low cost experiment. The aim of this study was to define the accuracy of FNA in identifying major salivary glands tumors. The study was descriptive, retrospective. The medical records of Department of Pathology, Amir Alam Hospital were reviewed from 1994-2004. Data including age, gender, lesion site and FNA reports of all cases were registered. Histopathologic results of FNA samples and surgical gross reports were matched. Descriptive data was used for registered data analyzing. The SPSS 11.5 software was used for statistical analysis. From 656 specimen of FNA, there were 235 cases with both results of FNA and excisional biopsy. About 55 cases in gross experiment had not been shown tumor like lesion and 11 cases in FNA had not a definite diagnosis because of non sufficient of specimen; all these cases were rejected from study. Next study was for other 169 specimen. Considering negative for benign and positive for malignant, 37, 104, 10 and 18 cases were true positive, true negative, false positive and false negative, respectively. Sensitivity, specificity and accuracy were obtained about 67, 91 and 83%, respectively. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) also were computed 78 and 85%, respectively. FNA is a safe, useful and quick method for identifying tumors of major salivary glands.

Tuberculosis is the leading cause of lymphadenopathy in HIV-infected persons in India: Results of a fine-needle aspiration analysis

HIV infection is associated with a number of opportunistic infections and malignancies frequently involving the lymph nodes. Lymphadenopathy may occur at any stage of HIV infection. We aimed to determine the utility of fine-needle aspiration cytology in evaluating the causes of lymphadenopathy in HIV-infected individuals. Three hundred HIV-infected individuals with lymphadenopathy were included in the study. Fine-needle aspiration (FNA) was performed on peripheral or deep-seated lymph nodes. The material was used for cytological examination using May-Grunwald-Giemsa and haematoxylin and eosin staining. Special stains such as modified Ziehl-Neelsen staining for acid-fast bacilli and periodic acid-Schiff staining for fungi were also performed. The mean age of the study group was 35.0 ± 8.0 y (range 13-74 y). The median CD4 count was 152 cells/μl. Out of the 300 FNA reports, acid-fast bacteria were reported in 130 and cytological findings indicating mycobacterial infection in a further 43 patients. Cryptococcosis was reported in 4 individuals, histoplasmosis in 2 and aspergillosis in 1. Reactive hyperplasia was seen in 89 individuals. Lymphoma was noted in 7 individuals and suppurative inflammation in 5. In conclusion, tuberculosis is the predominant cause of lymphadenitis in HIV-infected individuals in India, especially in those with low CD4 cell counts.