Fine-needle Aspiration Results Research Articles

Solitary fibrous tumor of deep parotid gland preoperatively classified as salivary gland neoplasm of uncertain malignant potential by the Milan system for reporting salivary gland cytopathology: A common diagnosis for a rare entity.

Solitary fibrous tumor (SFT) is a rare fibroblastic tumor with spindle cell morphology, which is characterized by a prominent branching vasculature and a NAB2-STAT6 gene rearrangement. SFT may occur in any anatomical site and may involve salivary glands, including the parotid gland. We present a young female with a primary parotid SFT diagnosed as "neoplasm-Salivary gland neoplasm of uncertain malignant potential (SUMP)" per the Milan system for reporting salivary gland cytopathology by fine-needle aspiration (FNA) with surgical pathology follow-up. Cytomorphology of SFT is diverse and overlaps with more common entities causing a diagnostic challenge. Non-diagnostic FNA results are not uncommon. Thankfully, the majority of SFTs involving the salivary gland can be identified as "neoplasm" on FNA. The Neoplasm-SUMP subcategory is considered for the majority of cases, which would warrant a diagnostic excision with clear surgical margins, which is also curative in most cases. The Neoplasm-SUMP also perfectly encompasses the neoplastic behavior of SFT, which runs on a scale from indolent to malignant.

Interpreting thyroid fine-needle aspiration biopsy

One of the most commonly seen abnormalities of the thyroid gland is the thyroid nodule. A thorough clinical evaluation of the nodule includes careful history taking and physical examination, laboratory tests, neck ultrasound (US), and fine-needle aspiration (FNA). Although thyroid FNA serves as an important test with an accurate result, when paired along with US, the results obtained are superior to that obtained only with an FNA. Thyroid FNA or biopsy is an accurate test for determining malignancy in a nodule and is an integral part of current thyroid nodule evaluation. Results are superior when FNA is performed with ultrasound guidance. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). The hypocellular specimens produce unsatisfactory or nondiagnostic smears whereas satisfactory or diagnostic smears are categorized as benign, indeterminate, or malignant. In this article, we describe the indications and interpretation of thyroid fine-needle aspiration cytology. The Bethesda Cytologic Classification has a 6-category classification and has been described in the text.

Age and BRAFV600E Mutation Stratified Patients with Cytologically Benign Thyroid Nodules.

Our objective was to evaluate the diagnostic performance of BRAFV600E mutation for malignant, and to identify clinical characteristics associated with positive BRAFV600E mutation in low-risk cytological and ultrasound diagnostic thyroid nodules. This aims to identify patients who may benefit from BRAFV600E mutation testing and subsequent surgical intervention. We analysis the clinical characteristics correlated with BRAFV600E mutation in our detection cohort, including 204 patients with 217 thyroid nodules, and separate analyses were performed in 103 thyroid nodules with benign cytological result. Signaling pathway and immune response associated with age and BRAFV600E mutation status were also evaluated in Asian patients with thyroid cancer from the Cancer Genome Atlas (TCGA) dataset. The positive BRAFV600E mutation was significantly associated with higher Ultrasound (US) classification (p<0.001) and fine-needle aspiration (FNA) categories (p<0.001). BRAFV600E mutation as a risk factor for malignancy, showing the optimal diagnostic efficacy for malignancy combined with FNA categories, with the AUC was 0.923. Otherwise, BRAFV600E mutation is a risk factor in screening malignancy in low-risk FNA and US classification, which is significant correlation with patients age. Patients over 50 years old exhibiting a higher percentage of positive BRAFV600E mutation when both ultrasound and FNA results indicate benign conditions, with higher risk of malignancy. BRAFV600E mutation is an accurate adjunctive diagnostic marker on FNA to screen malignancy. In low risk of both ultrasound and FNA results, the positive BRAFV600E was significant increased in patients over 50 years old, which have higher risk of malignancy. Thus, the BRAFV600E mutation detection and further surgery should be strengthened in older patients with benign cytological and US results thyroid nodules.

Utility of the Milan System for Reporting Salivary Gland Cytopathology in Parotid Gland Masses: The Experience of Two Tertiary Centers.

Background The application of fine needle aspiration (FNA) in parotid masses via the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) enhances the diagnosis of these lesions alongside radiological investigations. Objectives Our objective was to assess the risk of malignancy, sensitivity, specificity, and false positive and negative results for each category of the MSRSGC. Additionally, we assessed the level of agreement between the FNA results using MSRSGC and post-resection histopathological diagnosis. Methods We conducted a retrospective chart review of parotid gland masses that received FNA and postoperative pathological diagnosis at King Saud University Medical City and King Fahad Medical City between 2018 and 2022. We summarized the categorical variables using frequencies and percentages. Results A total of 172 cases met the inclusion criteria. Males encompassed 102 patients (59.3%) of the study sample, and 89 (51.7%) of parotid masses were on the left side. The risk of malignancy for the MSRSGC categories was 37.5% (Category I), 9.0% (II), 50.0% (III), 4.7% (IVa), 50.0% (IVb), 100.0% (V), and 71.0% (VI). FNA had an overall success rate of 81%. The sensitivity was 64% and specificity was 94% for non-neoplastic masses. For benign masses, the sensitivity was 91% and specificity was 66%; however, the sensitivity was 40% and specificity was 97% for malignant lesions. We found that the percentage of agreement between the FNA and final pathology was 80%. Conclusion FNA using MSRSGC is a valuable preoperative clinical tool. However, the low sensitivity rates based on the diagnosis of malignant lesions should alert clinicians not to be overly reliant on biopsy results and instead defer to definitive surgical management.

Autonomously functioning thyroid nodules present intermediate malignancy risk according to European Thyroid Imaging Reporting and Data System (EU-TIRADS) and yield indeterminate cytology results.

The aim was to evaluate the clinical, ultrasound (US) and, when indicated, the cytological and histological characteristics of autonomously functioning thyroid nodules (AFTN) in consecutive patients. A prospective, single-centre study was conducted between March 2018 and September 2021. In total, 901 consecutive patients were referred for thyroid workup and of 67 AFTN were evaluated. All enrolled patients underwent 99mTcO4 - scintigraphy, additional 123I scintigraphy only in case of normal serum TSH, evaluation of thyroid function, US examination using European Thyroid Imaging and Reporting Data System (EU-TIRADS), and US-guided fine needle aspiration (FNA) cytology when indicated. All indeterminate FNA samples were subjected to DNA sequencing analysis. More than half of the evaluated patients with AFTN were euthyroid; median serum TSH was 0.41 (IQR: 0.03-0.97) mU/L. The median AFTN size measured by US was 27.0 (IQR: 21.1-35.0) mm. 28.4% of AFTN were classified as EU-TIRADS score 3 and 71.6% as EU-TIRADS score 4, indicating that the majority of AFTN had intermediate risk for malignancy according to US. Out of the 47 AFTN subjected to cytological evaluation, 24 (51%) yielded indeterminate FNA results. DNA sequencing revealed pathogenic TSHR and GNAS mutations in 60% of cases. No malignancy was detected at final histology in surgically excised AFTN (n = 12). Of the 67 AFTN evaluated in this study, 50% presented with normal serum TSH, 70% displayed ultrasound features suggesting an intermediate malignancy risk and 50% of the AFTN submitted to cytology yielded indeterminate results. No malignant AFTN was detected.

Diagnostic Accuracy of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): An Institution Experience.

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a standardized system which is used to classify results of thyroid fine-needle aspiration (FNA). This system is used to evaluate and determine which patients should get thyroid surgery. It was created in order to reduce the number of patients requiring surgery. The question remains as to whether this reporting system is accurate in determining those nodules that have malignant potential and those that do not. This study is a retrospective analysis of patients in one institution who have undergone FNA and then thyroid surgery based on TBSRTC. The outcome of the pathology reports after surgery was analyzed to determine the accuracy of TBSRTC in our institution (Lourdes Hospital, Binghamton, NY). The results from our institution were compared with similar studies in other institutions to determine accuracy and reproducibility. Our results indicated that the risk of malignancy in each Bethesda category was similar to the risk percentages described for most categories in the 2017 TBSRTC update.

Performance of CT-based deep learning in diagnostic assessment of suspicious lateral lymph nodes in papillary thyroid cancer: a prospective diagnostic study.

Preoperative evaluation of the metastasis status of lateral lymph nodes (LNs) in papillary thyroid cancer is challenging. Strategies for using deep learning to diagnosis of lateral LN metastasis require additional development and testing. This study aimed to build a deep learning-based model to distinguish benign lateral LNs from metastatic lateral LNs in papillary thyroid cancer and test the model's diagnostic performance in a real-world clinical setting. This was a prospective diagnostic study. An ensemble model integrating a three-dimensional residual network algorithm with clinical risk factors available before surgery was developed based on computed tomography images of lateral LNs in an internal dataset and validated in two external datasets. The diagnostic performance of the ensemble model was tested and compared with the results of fine-needle aspiration (FNA) (used as the standard reference method) and the diagnoses made by two senior radiologists in 113 suspicious lateral LNs in patients enrolled prospectively. The area under the receiver operating characteristic curve of the ensemble model for diagnosing suspicious lateral LNs was 0.829 (95% CI: 0.732-0.927). The sensitivity and specificity of the ensemble model were 0.839 (95% CI: 0.762-0.916) and 0.769 (95% CI: 0.607-0.931), respectively. The diagnostic accuracy of the ensemble model was 82.3%. With FNA results as the criterion standard, the ensemble model had excellent diagnostic performance ( P =0.115), similar to that of the two senior radiologists ( P =1.000 and P =0.392, respectively). A three-dimensional residual network-based ensemble model was successfully developed for the diagnostic assessment of suspicious lateral LNs and achieved diagnostic performance similar to that of FNA and senior radiologists. The model appears promising for clinical application.

Automatic ultrasound diagnosis of thyroid nodules: a combination of deep learning and KWAK TI-RADS

Objective. There has been a considerable amount of computer-aided diagnosis (CAD) methods highlighted in the field of ultrasonic examination (USE) of thyroid nodules. However, few researches focused on the automatic risk classification, which was the basis for determining whether fine needle aspiration (FNA) was needed. The aim of this work was to implement automatic risk level assessment of thyroid nodules. Approach. Firstly, 1862 cases of thyroid nodules with the results of USE and FNA were collected as the dataset. Then, an improved U-Net++ model was utilized for segmenting thyroid nodules in ultrasound images automatically. Finally, the segmentation result was imported into a multi-task convolutional neural network (MT-CNN), the design of which was based on the clinical guideline called KWAK TI-RADS. Apart from the category of benign and malignant, the MT-CNN also exported the classification result of four malignant features, solid component (SC), hypoechogenicity or marked hypoechogenicity (HMH), microlobulated or irregular margin (MIM), microcalcification (MC), which were used for counting the risk level in KWAK TI-RADS. Main results. The performance of the improved U-Net++ was evaluated on our test set, including 302 cases. The Dice coefficient and intersection over union reached 0.899, 0.816, respectively. The classification accuracy rates of SC, HMH, MIM, MC, were 94.5%, 92.8%, 86.1%, 88.9%, while the false positive (FP) rate was 6.0%, 5.6%, 10.6%, 12.9% respectively. As for the category of benign and malignant, the precision and recall rates were 93.7% and 94.4%. Significance. The proposed CAD method showed favourable performance in the diagnosis of thyroid nodules. Compared with other methods, it could provide reports closer to clinical practice for doctors.

SAT528 Evaluation of Fine Needle Aspiration Biopsy Results in Patients with History of Thyroid Surgery for Benign Thyroid Disease

Abstract Disclosure: A.S. Can: None. J. Naran: None. Objective: We aimed to compare our thyroid fine needle aspiration (FNA) biopsy results in patients with history of thyroid surgery for benign thyroid disease and in patients without history of thyroid surgery. Material and Method: FNAs were performed between January 2016 and December 2020. The demographic data and outcomes were reviewed retrospectively. The results were presented per nodule, not per patient. FNA was performed on two groups: Group 1: nodules with history of thyroid surgery for benign thyroid disease, and Group 2: nodules without history of thyroid surgery. FNA results were categorized as malignant, benign, indeterminate, and unsatisfactory. FNAs were performed under ultrasound guidance. Results: 711 thyroid nodules underwent ultrasound guided FNA. 18 FNAs were performed on nodules diagnosed in patients who had history of thyroid surgery for benign thyroid disease (Group 1). Average age and standard deviation (SD) of Group 1 were 63±10 years. Average maximum size of nodules in Group 1 was 20±12 mm and average volume was 5.4±13.0 mL. Group 1 nodules had surgery on average 18±10 years ago. Thirteen nodules had hemithyroidectomy, three subtotal thyroidectomy and two nodule removal only. 693 FNAs were performed on nodules diagnosed in patients without history of thyroid surgery (Group 2). Average age and SD of Group 2 patients were 58±14 years. Average maximum size of nodules in Group 2 was 21±11 mm and average volume was 4.7±9.7 mL. FNA results in Group 1 versus Group 2 nodules were as follows: malignant 0% versus 3% (n=0 versus n=22), benign 72% versus 68% (n=13 versus n=470), indeterminate 6% versus 10% (n=1 versus n=70), unsatisfactory 22% versus 19 % (n=4 versus n=131), Chi-Square= 1.08, degrees of freedom= 3, p= 0.78. There was no statistical difference between groups in biopsy results. The chi-square statistic may not be reliable because two of the expected frequencies were less than 5. Conclusions: We did not observe any malignancy in patients with thyroid nodules who had history of thyroid surgery for benign thyroid disease. FNA performed similarly well whether there was history of thyroid surgery for benign thyroid disease or not. Further studies on larger group of patients with history of thyroid surgery for benign disease can be considered to confirm our findings. Presentation Date: Saturday, June 17, 2023

SAT522 Validating Molecular Testing As An Adjunct To Fine Needle Aspiration In Pediatric Thyroid Malignancy

Abstract Disclosure: A. Aekka: None. N. Arva: None. M. Raval: None. J. Rastatter: None. S.D. Finkelstein: Employee; Self; Interpace Biosciences. J. Levine: Employee; Self; Interpace Biosciences. J. Josefson: None. The standard diagnostic approach for thyroid malignancy includes evaluation of cytopathology derived from thyroid fine needle aspiration (FNA). Nearly 40% of pediatric cases have indeterminate FNA results, and there is no clear consensus regarding the management of these cases. Molecular analysis is beneficial in increasing diagnostic yield and informing treatment stratification in adults, although its use remains limited in pediatrics. This study sought to assess the validity of next-generation sequencing mutational analysis and microRNA (miRNA)-based risk classification of FNA cytopathology derived from a single-center cohort of pediatric patients. The study hypothesized that molecular analyses improve diagnostic performance of FNA for children with thyroid cancer. Interpace Diagnostics’ validated multiplatform tool comprised of ThyGeNEXT (mutational panel capturing 10 oncogene sequence variants and 38 fusions) and ThyraMIR (miRNA risk classifier including 11 miRNA markers) was utilized for this study. Multiplatform testing was performed on 27 archived FNA thyroid samples collected from patients ages 7-20 years (mean age 14.1 years, 78% female). Molecular results were compared with final surgical pathology or repeat FNA results to determine validity. Surgical pathology confirmed papillary thyroid carcinoma in 14 patients and benign pathology in 6 patients. Repeat FNA confirmed benign pathology in 2 patients. Surgical pathology or repeat FNA was unavailable for 5 cases, all of which had benign initial cytopathology. The most common mutational finding was BRAF_V600E (6/14) followed by RET-PTC fusions (3/14). MiRNA findings were as follows: 16 high-risk expression profiles, 3 low-risk expression profiles, and 8 negative profiles. The validation analysis included 22 samples that had corresponding surgical or repeat FNA results. All cases of malignancy demonstrated high-risk miRNA profiles and all benign cases demonstrated negative or low-risk miRNA profiles. Multiplatform molecular testing demonstrated 100% sensitivity, 87.5% specificity, 93.3% positive predictive value, and 100% negative predictive value in detecting malignant versus benign pathology in our population. Molecular analyses appear to be a valid adjunct to FNA in pediatric thyroid cancer evaluation. Incorporation of molecular diagnostics advances precision medicine in pediatric thyroid care and may better inform presurgical treatment stratification, mitigate risks associated with unnecessary procedures, and ultimately improve outcomes for children and adolescents with thyroid nodules. Presentation Date: Saturday, June 17, 2023

SAT571 When Two Is Too Few: Bethesda IV Pathology On Repeat Thyroid Fine Needle Aspiration

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. M.K. Shakir: None. T.D. Hoang: None. Background: The 2015 American Thyroid Association Guidelines for Adult Patients with Thyroid Nodules provide a strong recommendation against routine ultrasound surveillance of thyroid nodules for which two benign fine needle aspiration (FNA) cytology results have been previously obtained. Strict adherence to these guidelines may hinder detection of malignancy, especially in large nodules where there is potential to miss heterogeneous pathology based on sampling technique. Clinical Case: A 36-year-old female was evaluated for surveillance of a large non-toxic multinodular goiter. Thyroid ultrasound demonstrated a dominant right thyroid nodule greater than 7 centimeters in size. The patient had undergone FNA of this nodule in 2014 and 2019 with Bethesda II (benign) cytopathology results. A chest x-ray showed tracheal deviation without evidence of narrowing. She noted a sensation of neck pressure without dysphagia or shortness of breath. She denied fatigue, heat or cold intolerance, hand tremor, or pretibial myxedema. She denied a family history of thyroid cancer or any history of neck irradiation. Due to new compressive symptoms a repeat FNA was performed. Three passes were performed with adequate samples, and the final FNA cytopathology demonstrated a Hurthle cell oncocytic-type follicular neoplasm with Bethesda IV classification. The sample was submitted for ThyGeNEXTTM and ThyraMIRv2TM molecular testing, which returned with NRAS q61R mutation of moderate-to-high risk of malignancy (65-75%). The patient was subsequently referred for total thyroidectomy with pending surgery date. Discussion: The current ATA guidelines offer a cost-effective surveillance strategy for the vast majority of patients with thyroid nodules. False negative FNA results are rare and are reported to occur in about 1% of cases1. As in this vignette, it is reasonable to perform an additional FNA after two consecutive Bethesda II results in nodules with clinically significant growth, new compressive symptoms, or if there is concern for incomplete sampling in nodules of large size. During an FNA, care should be taken to gently move the needle at various angles to capture follicular cells from different areas within a nodule. Large nodules should be sampled via multiple, separate skin entry points when feasible. Judicious use of repeat FNA along with these sampling techniques may help to prevent under-diagnosis in nodules containing multifocal areas of heterogeneous pathology. Reference: 1) Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Filetti S. 2015. The natural history of benign thyroid nodules. JAMA 313:926-935 Presentation: Saturday, June 17, 2023

Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Duodenal Subepithelial Lesions Showing a Hypoechoic Mass on Endoscopic Ultrasound Imaging.

For duodenal subepithelial lesions showing a hypoechoic mass on endoscopic ultrasound imaging, the utility of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types have not been the focus of previous literature. This study aimed to clarify this. This prospective observational study enrolled 22 consecutive patients who underwent endoscopic ultrasoundguided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass on endoscopic ultrasound. Immunohistochemical analysis was performed for all endoscopic ultrasound-guided fine-needle aspiration and surgically resected specimens. The main outcome measures were the technical results of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types of duodenal subepithelial lesions with hypoechoic mass. Thirteen fine-needle aspiration specimens were obtained from the duodenal bulb and eight from the descending duodenal region. The puncture was not performed because of intervening vessels in one patient. The diagnostic rate was 81% (95% confidence interval: 58.1-94.6, 17/21 patients). In 12 patients receiving surgical resection (excluding one cancellation of endoscopic ultrasoundguided fine-needle aspiration), the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration was 75% (95% confidence interval: 42.8-94.5, 9/12 patients). No complications were observed. The histopathological diagnoses included 11 cases of gastrointestinal stromal tumor (50%), 2 cases of leiomyoma (9%), 2 cases of metastatic cancer (9%), 2 cases of benign inconclusive, and 1 case each of carcinoid, malignant lymphoma, leiomyosarcoma, gauzeoma, and aberrant pancreas (4.5% each). The frequency of malignant tumors in the duodenal subepithelial lesions with hypoechoic mass group was 73% (16/22 patients). Endoscopic ultrasound-guided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass was safe and accurate. As duodenal subepithelial lesion with hypoechoic mass has a reasonably high possibility of containing malignant tumors, it is desirable to perform endoscopic ultrasound-guided fine-needle aspiration.

Comparison of the diagnostic value of fine needle aspiration and ultrasound in thyroid pathology

Fine needle aspiration (FNA) biopsy has been a powerful tool in the preoperative diagnosis of thyroid nodules for more than 60 years. The Bethesda scale standardizes the results of cytology and is a tool for interaction between the laboratory and the clinician. At the same time, there is a stratification of ultrasound signs of thyroid lesions according to the TI-RADS scale. In this regard, it became necessary to determine the diagnostic value of ultrasound signs of thyroid lesions, stratified by TI-RADS, in comparison with the results of a biopsy, classified by the Bethesda scale.AIM: a comparative assessment of the results of FNA and ultrasound in determining indications for the surgical treatment of thyroid nodules.MATERIALS AND METHODS: for 2018–2021 in the surgical department of the SCC №2 of the Petrovsky National Research Centre of Surgery, 859 FNA were performed. For comparative analysis, 141 patients who underwent surgery for thyroid nodules were selected. All patients at the preoperative stage underwent FNA with stratification of the results according to the Bethesda scale and ultrasound of the thyroid gland with stratification according to the EU-TI-RADS scale.RESULTS: FNA showed high diagnostic accuracy and sensitivity, preoperative thyroid ultrasound had high specificity, but low sensitivity. The high diagnostic value of FNA was confirmed by statistical analysis of the obtained data (OR 31.29 95% CI 2.20–4.69, RR 13.28 95% CI 1.46–3.71). When analyzing preoperative ultrasound, it was not possible to obtain reliable statistical results (OR 2.99 95% CI 0.34-1.85, RR 1.97 95% CI 0.23-1.12).CONCLUSION: Ultrasound of the thyroid gland cannot replace FNA in thyroid nodules. Biopsy remains the main diagnostic method for nodular goiter. The main objective of TI-RADS-stratified ultrasound is to select patients for subsequent FNA.

Tiroid İnce İğne Aspirasyon Biyopsi Sonuçlarının Değerlendirilmesi: Tek Merkez Deneyimi

Aim: It was aimed to examine the results of thyroid fine needle aspiration (FNA) biopsy performed in our clinic and to investigate its effectiveness. Methods: In this study, the results of 101 patients who underwent thyroid FNAB in Tarsus State Hospital endocrinology clinic between December 2021 and July 2022 were retrospectively analyzed. Results: Ultrasonographic features of thyroid nodules were classified according to EU-TIRADS, 51(50.5%) were in EU-TIRADS-3, 31 (30.7%) were in EU-TIRADS-4, 19(18.8%) were in EU-TIRADS-5. When we categorize cytology results according to Bethesda classification, 23 (22.8%) Bethesda I, 48 (47.5%) Bethesda II, 16 (15.8%) Bethesda III, 4(4%) Bethesda IV,10(9.9%) detected as Bethesda VI. Bethesda II was found in the EU-TIRADS-3 category with the highest frequency, while Bethesda VI was found in the EU-TIRADS-5 category with the highest frequency. The mean nodule diameter was found to be 20.48± 9.73mm. Conclusion: Ultrasonographic findings of the nodules correlated with cytology results. The EU-TIRADS categorization has a good concordance with the Bethesda system. The coordinated use of the two classifications helps the clinician to avoid the risk of unnecessary invasive procedures.

Liquid-based cytology (LBC) with immunocytochemical staining improves fine-needle aspiration cytology (FNA) performance for salivary gland tumors

BackgroundLiquid-based cytology (LBC), now used globally for the head and neck region, has been used at our hospital since 2011. This study was designed to analyze the efficacy of LBC with immunocytochemical staining on preoperative diagnosis of salivary gland tumors. MethodsThis retrospective analysis of fine-needle aspiration (FNA) performance for salivary gland tumors was conducted at Fukui University Hospital. Salivary gland tumor operations conducted during April 2006 – December 2010 (84 cases) were classified as the Conventional Smear (CS) group, which were diagnosed morphologically by Papanicolaou and Giemsa staining. Those done during January 2012 – April 2017 (112 cases) were classified as the LBC group, which were diagnosed using LBC samples with immunocytochemical staining. The FNA results and pathological diagnosis of both groups were analyzed to calculate the FNA performance. ResultsCompared to the CS group, cases of inadequate and indeterminate FNA sample were not reduced significantly by LBC with immunocytochemical staining. As for FNA performance, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CS group were, respectively, 88.7%, 53.3%, 100%, 100%, and 87.0%. Those of LBC group were all 100%, representing significant improvement over the CS group. ConclusionsAnalysis results indicated the usefulness of LBC with immunocytochemical staining for preoperative diagnosis of salivary gland tumors.

Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines.

The study purpose is to correlate clinical findings with rates of differentiated thyroid cancer (DTC) ina cohort of children presenting with thyroid nodules atasingle institution since the adoption of the 2015 American Thyroid Association (ATA) Guidelines Task Force on Pediatric Thyroid Cancer. Clinical, radiographic, and cytopathologic findings were retrospectively analyzed in a pediatric cohort (≤19 years) identified with ICD-10 codes for thyroid nodules and thyroid cancer from January 2017 until May 2021. We analyzed 183 patients with thyroid nodules. The mean patient age was 14 years (interquartile range 11-16) with a female (79.2 %) and white Caucasian (78.1 %) predominance. The overall DTC in our pediatric patient cohort was 12.6 % (23 out of 183). Most of the malignant nodules measured from 1-4 cm (65.2 %) with TI-RADS score of≥4 (69.6 %). Among the fine-needle aspiration results (n=49), the highest frequency of DTC was within the malignant category (16.33 %), followed by suspicious for malignancy (6.12 %), then atypia or follicular lesion of undetermined significance (8.16 %), and lastly follicular lesion or neoplasm and benign with 4.08 % and 2.04 % respectively. Of the forty-four thyroid nodules that underwent surgical intervention, pathology was remarkable for 19 papillary thyroid carcinoma (43.18 %) and 4 follicular thyroid carcinoma (9.09 %). Based on the analysis of our pediatric cohort in the southeast region at a single institution, adoption of the 2015 ATA guidelines could lead to an increased accuracy in detecting DTC while reducing the number of patients requiring interventions, such as FNA biopsy and/or surgeries. Further, based on our small cohort, it would be reasonable for thyroid nodules 1 cm or less to be monitored clinically with physical exam and ultrasonography, with further therapeutic or diagnostic intervention considered based on concerning features or parental shared decision making.

Macroscopic on‑site quality evaluation of biopsy specimens to improve the diagnostic accuracy of endoscopic ultrasound‑guided fine needle aspiration using a 22‑gauge needle for solid lesions: A single‑center retrospective study.

The present study aimed to evaluate the clinical value of macroscopic on-site evaluation (MOSE) of solid masses by endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) using a standard 22-gauge needle and to explore the cut-off length of macroscopic visible core (MVC) required to obtain an accurate histopathological diagnosis. In total, 119 patients who satisfied the inclusion and exclusion criteria and underwent EUS-FNA were divided into conventional FNA and FNA combined with MOSE groups. In the MOSE group, the presence of MVC was examined and its total length measured, after which the pathological results of FNA were compared with the final diagnosis. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of FNA in the two groups were calculated and the effect of MOSE on the FNA result was analyzed. The MOSE group had a higher diagnostic sensitivity (75.0% vs. 89.8%; P=0.038) and accuracy (74.5% vs. 90.6%; P=0.026). MVC was observed in 98.4% (63/64) of patients in the MOSE group. The median length of MVC was 15 mm. The optimal cut-off length of MVC for obtaining an accurate histological diagnosis was 13 mm, with a sensitivity of 90.2%. No statistically significant significance was observed in the specificity, PPV and NPV between the groups. Thus, MOSE helps to improve the diagnostic ability of FNA for solid masses and may be a useful alternative to assess the adequacy of puncture specimens in units where rapid on-site evaluation cannot be performed.

Abstract P3-05-47: Regional Lymph node percutaneous analysis in patients with breast cancer

Abstract Background: The evaluation of regional lymph nodes in patients with breast cancer is one of the main predictive and prognostic factors for treatment. The most frequently methods of percutaneous evaluation for suspicious lymph nodes are fine needle aspiration (FNA) and core needle biopsy (CNB). According to the international literature, CNB and FNA are considered diagnostic methods with high specificity (98% vs. 99%), however FNA can present up to 21% of inconclusive results due to insufficient material, which leads to recall and delay in treatment approach. Although CNB is well established as a percutaneous method for the diagnostic evaluation of suspicious breast lesions, the literature is still scarce regarding the use of this method for the evaluation of suspicious regional lymph nodes in patients with breast cancer. Objectives: To analyze the results of percutaneous biopsies performed in suspected lymph nodes according to the topography and the type of needle used, and to verify the preferred method used. Methods: This was a retrospective study evaluating a public Hospital in São Paulo – Brazil (Pérola Byington Hospital database). Patients who underwent ultrasound-guided percutaneous lymph node biopsy from May 2015 to November 2017 were included. Data were analyzed and the type of biopsy (FNA or CNB) and the results were analyzed. Results: 106 medical records of patients with previous breast cancer and that underwent lymph node biopsy were reviewed. The mean age was 54.7 years (SD±12.4) in the CNB group and 54.7 years (SD±10.8) in the FNA group. Most of the patients were submitted to CNB (66% - 71 patients) and 34% were evaluated with FNA (35 patients). According to the topography of the lymph nodes, 80% were in the axilla (n=84), 10% in the supraclavicular region (n=11) and 10% in the cervical region (n=11). When analyzing the FNA results, 31% did not present sufficient material (n=11), 37% were malignant (n=13), 20% were benign (n=7) and 12% showed cellular atypia (n=12). Among the CNB performed in suspected lymph nodes, 53% were malignant (n=38) and 31% were benign (n=33), and no one had insufficient material. There were no reports of complications related to the procedures. In the insufficient material group, 27% (n=3) of the patients underwent a new percutaneous biopsy (2 CNB with malignant result and 1 FNA with inconclusive result) and 73% (8) were maintained in follow-up. The mean follow-up time was 24 months, and clinical and imaging stability was confirmed after this period. In the CNB group with malignant result, 10% (4) were diagnosed with neoplasia of other sites (cervix, lymphoma, melanoma and gastrointestinal), 78% (30) presented immunohistochemistry in agreement with that of the breast, 3% (1) presented different immunohistochemistry and in 9% (3) this evaluation was not performed. Conclusion: CNB was the preferred diagnostic method in our Hospital (66% vs 34%), being considered a viable procedure to evaluate lymph nodes in various topographies and with low rates of inconclusive results. Besides that, immunohistochemistry was done in 91% of the cases showing the importance of this analysis in the treatment of the recurrence or even in the diagnosis of other primary tumors. In the future, studies that assess indirect costs may confirm the applicability of CNB in patients with suspicious lymph nodes in terms of achieving greater agility and resolution. Citation Format: Marina Diogenes, ANDRE MATTAR, Andressa Amorim, Maria Isabela Caldas Sawada, Luiz Henrique Gebrim, Jorge Shida. Regional Lymph node percutaneous analysis in patients with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-47.

Diagnostic Value of Artificial Intelligence-Assistant Diagnostic System Combined With Contrast-Enhanced Ultrasound in Thyroid TI-RADS 4 Nodules.

This study evaluated the diagnostic value of artificial intelligence-assistant diagnostic system combined with contrast-enhanced ultrasound in The American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) 4 category thyroid nodules. Thyroid nodules that were evaluated as ACR TI-RADS 4 by conventional ultrasound were selected, all of which had pathological or fine needle aspiration (FNA) results. All nodules were examined by contrast-enhanced ultrasound (CEUS) and artificial intelligence (AI) analysis. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of AI, CEUS and their combined diagnosis were compared; Analyzed and compared the diagnostic efficiency of AI, CEUS and their combined diagnosis. A total of 148 thyroid nodules were included in 140 patients, including 58 malignant nodules and 89 benign nodules. The sensitivity of combined diagnosis was significantly higher than that of AI or CEUS alone (P< .05). The NPV of AI, CEUS and combined diagnosis were statistically significant (P< .05). There was no significant difference in the diagnostic efficacy between AI and CEUS (P> .05), but there was a significant difference in NPV between AI and combined diagnosis (P< .05). The AUC of the combined diagnosis was 0.859, which was higher than that of AI, CEUS alone. AI has a high diagnostic efficiency, which was helpful for radiologists to make rapid assessment. AI combined CEUS can significantly improve the diagnostic sensitivity and NPV, which was beneficial for the early detection of malignant nodules.

Comparative Application of 5 mL Syringe and 22G PTC Needles in Thyroid Nodule Fine-Needle Aspiration

This study aims to compare the differences in sampling satisfaction rates between 5 mL syringe and 22G percutaneous transhepatic cholangiography (PTC) needles in fine-needle aspiration (FNA) to provide economical and reasonable needle selection. From January 2021 to March 2022, 187 patients with thyroid nodules (a total of 200 nodules) who underwent ultrasound-guided FNA were punctured using 22G PTC and 5 mL syringe needles once for each nodule, and the sample was sent for pathological examination. The sample satisfaction rate of the two methods was statistically analyzed, and factors affecting the sample satisfaction rate were determined. Results demonstrated that the overall sample satisfaction rates of 5 mL syringes and 22G PTC needles were 83% and 85% (P&gt;0.05), respectively. The satisfaction rates of the two specimens were 92.6% and 91.1% (P&gt;0.05) among 136 nodules with poor blood supply. For 64 nodules with rich blood supply, the satisfaction rate of both specimens was significantly lower than that of the nodule with poor blood supply (P&lt;0.05), and that of the 5 mL syringe needle was significantly lower than that of the latter (62.5% vs. 71.8%, P&lt;0.05). The results suggest that satisfactory sampling results can be obtained using either a 5 mL syringe or 22G PTC needles. The 22G PTC needle is more likely to yield FNA results if the nodule is rich in blood supply.