Fine-needle Aspiration Samples Research Articles

Next-Generation Sequencing Enhances the Diagnosis Efficiency in Thyroid Nodules.

BackgroundThough fine-needle aspiration (FNA) improved the diagnostic methods of thyroid nodules, there are still parts of nodules that cannot be determined according to cytology. In the Bethesda system for reporting thyroid cytopathology, there are two uncertain cytology results. Thanks to the development of next-generation sequencing technology, it is possible to gain the genetic background of pathological tissue efficiently. Therefore, a combination of the cytology and genetic background may enhance the accuracy of diagnosis in thyroid nodules.MethodsDNA from 73 FNA samples of thyroid nodules belonging to different cytology types was extracted and exome sequencing was performed by the ThyroLead panel. Test for BRAF mutation was also performed by ARMS-qPCR. Information including age, sex, preoperative cytology, BRAF mutation status tested by ARMS-qPCR, and surgical pathology was collected in electronic medical record system.ResultsA total of 71 single nucleotide variants, three fusion gene, and two microsatellite instability-high status were detected in 73 FNA samples. BRAF V600E mutation is the most common mutation in these malignant thyroid nodules. After combining the cytology and genetic background detected by next-generation sequencing, the diagnosis sensitivity was increased from 0.582 (95% CI: 0.441–0.711) to 0.855 (95% CI: 0.728–0.930) (P < 0.001) in our group, while the specificity, 1,000 (95% CI: 0.732–1.000) compared to 0.857 (95% CI: 0.562–0.975) (P = 0.25), did not get affected.ConclusionsNext-generation sequencing in thyroid nodules can enhance the preoperative diagnosis sensitivity by fine-needle aspiration alone. It can also provide genetic background for direction of medication. It is possible for clinicians to combine cytology with genetic alterations for a more precise diagnosis strategy of thyroid nodules.

Histopathological Parameters of Canine Bone Marrow in Cell-Block Preparations

Studies using the cell-block technique for bone marrow (BM) analysis are limited in the veterinary literature. This work assessed whether the histopathological analysis of canine BM was feasible using cell-block cytoinclusions prepared from fine-needle sternal aspirate samples. Eight clinically healthy young-to-middle-aged dogs underwent both fine-needle sternal aspiration for BM cell-block (BM-Cb) processing and iliac-crest BM core biopsy (BM-B). Histopathologic parameters were compared between the 2 methods. There were no statistically significant histopathological differences between hematopoietic tissue areas (P = .6294) in the BM-Cb and BM-B sections, and they had similar microscopic characteristics and microarchitecture. Cellularity and reticulin-fiber staining were equivalent in the BM-Cb and BM-B preparations in 87.5% (7/8) and 100% (8/8) of the sections, respectively. However, the quantitative results of the megakaryocytic series differed between BM-Cb and BM-B in 37.5% (3/8) of the sections, and the myeloid:erythroid (M:E) ratios differed between the 2 methods in 25% (2/8). These preliminary data indicate that cell-block preparations made from sternal fine-needle aspiration samples warrant continued evaluation in a larger number of animals, including those with various diseases affecting the bone marrow.

Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Findings in Consecutive Bethesda III-VI Thyroid Nodules

ContextBroad genomic analyses among thyroid histologies have been described from relatively small cohorts.ObjectiveInvestigate the molecular findings across a large, real-world cohort of thyroid fine-needle aspiration (FNA) samples.DesignRetrospective analysis of RNA sequencing data files.SettingClinical Laboratory Improvement Amendments laboratory performing Afirma Genomic Sequencing Classifier (GSC) and Xpression Atlas (XA) testing.ParticipantsA total of 50 644 consecutive Bethesda III-VI nodules.InterventionNone.Main Outcome MeasuresMolecular test results.ResultsOf 48 952 Bethesda III/IV FNAs studied, 66% were benign by Afirma GSC. The prevalence of BRAF V600E was 2% among all Bethesda III/IV FNAs and 76% among Bethesda VI FNAs. Fusions involving NTRK, RET, BRAF, and ALK were most prevalent in Bethesda V (10%), and 130 different gene partners were identified. Among small consecutive Bethesda III/IV sample cohorts with one of these fusions and available surgical pathology excision data, the positive predictive value of an NTRK or RET fusion for carcinoma or noninvasive follicular thyroid neoplasm with papillary-like nuclear features was >95%, whereas for BRAF and ALK fusions it was 81% and 67%, respectively. At least 1 genomic alteration was identified by the expanded Afirma XA panel in 70% of medullary thyroid carcinoma classifier–positive FNAs, 44% of Bethesda III or IV Afirma GSC suspicious FNAs, 64% of Bethesda V FNAs, and 87% of Bethesda VI FNAs.ConclusionsThis large study demonstrates that almost one-half of Bethesda III/IV Afirma GSC suspicious and most Bethesda V/VI nodules had at least 1 genomic variant or fusion identified, which may optimize personalized treatment decisions.

Evaluation of the Diagnostic Role of Gata3 Immunohistochemistry on Cytology Specimens for Metastatic Breast Carcinoma

Objective: Distinguishing of metastatic breast carcinoma from nonmammary metastatic carcinomas by cytological examination might have some difficulties. The sensitivity of traditional tumor markers for immunostaining might be not high enough . The role of GATA3 immunohistochemistry as a novel marker of primary and metastatic stages of breast carcinoma in specimens of fine needle aspiration was evaluated.Materials and Methods: Sections were taken from 73 cases of FNA samples of metastatic malignancies including 38 metastatic breast cancer and 35 nonmammary malignancies were stained with GATA3 immunohistochemical marker. Samples of FNA were taken from pleural effusion, ascetic fluid and lymph nodes. Results: Eighty-nine percent (34/38) of metastatic breast carcinoma cases were regarded as GATA3 positive expression , while all nonmammary adenocarcinoma samples were GATA3 negative . Most of GATA3 positive samples showed intense nuclear staining in the majurity of the malignant cells.Conclusions: GATA3 staining is an important addition to immunohistochemical panels for fine needle aspiration samples for distinguishing metastatic breast carcinoma from other malignancy.

Multiplex immune protein profiling of fine-needle aspirates from patients with non-small-cell lung cancer reveals signatures associated with PD-L1 expression and tumor stage.

Biomarker signatures identified through minimally invasive procedures already at diagnosis of non‐small‐cell lung cancer (NSCLC) could help to guide treatment with immune checkpoint inhibitors (ICI). Here, we performed multiplex profiling of immune‐related proteins in fine‐needle aspirate (FNA) samples of thoracic lesions from patients with NSCLC to assess PD‐L1 expression and identify related protein signatures. Transthoracic FNA samples from 14 patients were subjected to multiplex antibody‐based profiling by proximity extension assay (PEA). PEA profiling employed protein panels relevant to immune and tumor signaling and was followed by Qlucore® Omics Explorer analysis. All lesions analyzed were NSCLC adenocarcinomas, and PEA profiles could be used to monitor 163 proteins in all but one sample. Multiple key immune signaling components (including CD73, granzyme A, and chemokines CCL3 and CCL23) were identified and expression of several of these proteins (e.g., CCL3 and CCL23) correlated to PD‐L1 expression. We also found EphA2, a marker previously linked to inferior NSCLC prognosis, to correlate to PD‐L1 expression. Our identified protein signatures related to stage included, among others, CXCL10 and IL12RB1. We conclude that transthoracic FNA allows for extensive immune and tumor protein profiling with assessment of putative biomarkers of important for ICI treatment selection in NSCLC.

Incorporating cytologic adequacy assessment into precision oncology workflow using telepathology: An institutional experience

Tumor sample quality and quantity determine the success of somatic mutation analysis. Thus, a rapid on-site evaluation (ROSE) tumor cytology adequacy assessment was incorporated into the workflow of precision oncology at Weill Cornell Medicine in New York City. Optimal samples were obtained from 68 patients with metastatic cancer. Cytopathologists performed ROSE on fine-needle aspirate samples via telepathology, and subsequently core-needle biopsies were obtained. In a retrospective manner, the concordance between adequacy assessment and the success rate of the procedure was evaluated to obtain sufficient tumor tissue for next-generation sequencing (NGS). Out of the 68 procedures, 43 were documented as adequate and 25 were documented as inadequate. The diagnostic yield of adequate procedures was 100%. Adequacy evaluation predicted the success rate of molecular profiling in 40 of 43 procedures (93%; 95% CI, 80.9-98.5 procedures). The success rate of molecular testing was significantly higher in the adequate group: 93% compared with 32% in the inadequate group (P < .0005). Seven procedures that failed to provide quality material for mutational analysis and pathological diagnosis were evaluated as inadequate. Cell block provided sufficient DNA for NGS in 6 cases. In 2 cases, a core biopsy could not be performed; hence, the fine-needle aspirate material confirmed the diagnosis and was used for NGS testing. These results support the incorporation of ROSE into the workflow of precision oncology to obtain high-quality tissue samples from metastatic lesions. In addition, NGS testing of concurrent cytology specimens with adequate cellularity can be a surrogate for NGS testing of biopsy specimens.

Diagnosis of Buruli ulcer disease in Nigeria using IS2404-Based Nested PCR

Background: Buruli ulcer is a chronic, indolent, necrotizing infectious disease of the skin and soft tissues characterized by the formation of large ulcers, often in the arms or legs. Nigeria is a Buruli ulcer disease (BUD)endemic country with its control programme still in infancy. As a result, samples are sent to laboratories outside the country. Some patients go to neighbouring countries with more established programmes for polymerase chain reaction (PCR) as a basis of diagnosis and treatment. Hence, this study was embarked upon to assist the national control programme in overcoming the PCR diagnosis test challenge. Method: This was a cross-sectional and community-based type of study of Buruli ulcer patients from 15 states,mostly from southern Nigeria; Abia, Akwa Ibom, Anambra, Bayelsa, Cross Rivers, Delta, Ebonyi, Ekiti, Enugu, Imo, Lagos, Ogun, Ondo, Osun, Rivers and the Federal Capital Territory (FCT) Abuja. Swab and Fine Needle Aspiration (FNA) samples were received from January 2016 to June 2018. DNA was extracted, and each sample was subjected to IS2404-based nested PCR. Results: Out of 920 samples received, 427 (46.4% ) were IS2404-based nested PCR positive. Of which 204were males, and 223 were females. The patients’ mean age was 35.7 ± 19.94, with 172 (18.7%) being children ≤15 years, while 748 (81.3%) were ≥ 15 years. During the study period, the highest number of samples, 171(18.6%) and 170 (18.5%) were received from Cross Rivers and Delta states, respectively. In contrast, the least number of samples, 2 (0.2%) and 3 (0.3%), came from Ekiti and Lagos states, respectively. Conclusion: This is the first in-country PCR confirmed diagnosis of a large cohort of BU patients. The results show a high prevalence in southern Nigeria, which is an indicator of high transmission. Our findings suggest the need for a prompt intervention by the government by providing the needed health facilities and education for the communities.

Molecular alterations in Hürthle cell nodules and preoperative cancer risk.

Hürthle cell carcinoma (HCC) is a distinct type of thyroid cancer genetically characterized by DNA copy number alterations (CNA), typically of genome haploidization type (GH-type). However, whether CNA also occurs in benign Hürthle cell adenomas (HCA) or Hürthle cell hyperplastic nodules (HCHN), and have diagnostic impact in fine-needle aspiration (FNA) samples, remains unknown. To address these questions, we (1) analyzed 26 HCC, 24 HCA, and 8 HCHN tissues for CNA and other mutations using ThyroSeq v3 (TSv3) next-generation sequencing panel, and (2) determined cancer rate in 111 FNA samples with CNA and known surgical outcome. We identified CNA, more often of the GH-type, in 81% of HCC and in 38% HCA, but not in HCHN. Among four HCC with distant metastasis, all had CNA and three TERT mutations. Overall, positive TSv3 results were obtained in 24 (92%) HCC, including all with ATA high risk of recurrence or metastasis. Among 111 FNA cases with CNA, 38 (34%) were malignant and 73 (66%) benign. A significant correlation between cancer rate and nodule size was observed, particularly among cases with GH-type CNA, where every additional centimeter of nodule size increased the malignancy odds by 1.9 (95% CI 1.3-2.7; P = 0.001). In summary, the results of this study demonstrate that CNA characteristic of HCC also occur in HCA, although with lower frequency, and probability of cancer in nodules with CNA increases with nodule size. Detection of CNA, in conjunction with other mutations and nodule size, is helpful in predicting malignancy in thyroid nodules.

Cytopathology of chondromyxoid fibroma: a case series and review of the literature

Chondromyxoid fibroma is a rare bone tumor characterized by immature myxoid mesenchymal tissue showing early primitive cartilaginous differentiation. There have been limited case reports describing the cytologic features of chondromyxoid fibroma. Herein, we reported cytologic features of chondromyxoid fibroma on fine-needle aspiration (FNA). We performed a retrospective search in our cytopathology and surgical pathology database for cases diagnosed as chondromyxoid fibroma that had corresponding cytology specimens from three medical institutions. All available cytopathology specimens were reviewed. Eight cases were retrieved from patients aged 16-77 years (mean, 51 years), and M:F ratio of 1.7:1. Seven tumors (88%) were primary, and most (62%) occurred in flat bones. Cytologic diagnoses were made in 6 cases with cytologic slides not available to review in 1 case. All cases showed metachromatic matrix in the background, while hyaline cartilage fragments were absent. All cases had two cell populations comprising oval to round cells and stellate to spindle cells. The spindle to stellate cells were more commonly embedded in matrix material. Moderate atypia (hyperchromasia and moderate anisonucleosis) was present in 4 cases (80%), while no mitotic figure was present in all cases. Our study highlights common cytologic features of chondromyxoid fibroma, including the presence of the spindle or stellate cells embedded in matrix material. Hyaline cartilage is uncommon and, if present, diagnostic considerations should include enchondroma or low-grade chondrosarcoma. A specific cytologic diagnosis primarily using FNA samples can be challenging but possible when evaluated in conjunction with clinical and radiologic data.

Highly Sensitive Detection of Low-Abundance BRAF V600E Mutation in Fine-Needle Aspiration Samples by Zip Recombinase Polymerase Amplification.

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with high incidence in endocrine tumors, which emphasizes the significance of accurate diagnostics. Still, the commonly used cytological method (fine-needle aspiration (FNA) cytology) and molecular diagnostic methods (such as PCR and sequencing) are limited in terms of diagnostic time, sensitivity, and user-friendliness. In this study, we introduce a novel Zip recombinase polymerase amplification (Z-RPA) strategy to efficiently detect rare mutant alleles in PTC fine-needle aspiration samples, which is sensitive, fast, and simple to manipulate. Using Zip nucleic acid (ZNA) probes to clamp the mutation region, the phi 29 polymerase could selectively displace mismatched ZNA probes and start amplification, while leaving complementary ZNA probes untouched and blocking amplification according to genotype. We demonstrated the good sensitivity and specificity of this strategy with optimized conditions and design, which enabled detection of BRAF V600E mutation in a total 4 ng of genomic DNA within 40 min (≈1 copy). Robust behavior in clinical specimen analysis was also demonstrated. The Z-RPA strategy provides a pragmatic approach to rapidly, sensitively, and easily detect BRAF V600E mutation in clinical fine-needle aspiration samples, which is a promising method for early cancer diagnosis and treatment guideline.

Abstract PO-080: Deep learning-based analysis of heterogeneity of breast cancer cells using lens-free digital in-line holography

Abstract Lens-free digital in-line holography (LDIH) produces cellular diffraction patterns from a large field of view that lens-based microscopes cannot achieve. It is a promising diagnostic tool allowing comprehensive cellular analysis with high-throughput capability. Since these diffraction images are far more complicated to discern, conventionally computational algorithms are used to reconstruct cellular images for the diffraction patterns. However, it is inefficient and prone to errors. Here, we developed a deep learning architecture, HoloNet to directly analyze the diffraction patterns from LDIH. In addition to the standard CNN (Convolutional Neural Network), the HoloNet includes a holo-branch that extracts large features from holograms and integrate them with the small features from the standard CNN. Using HoloNet, we accurately predicted the intensity values of ER/PR and HER2 in breast cancer cells and classified four known subtypes of breast cancer cells. Moreover, we applied a HoloNet dual embedding, which learns high-level diffraction features related to breast cancer cell types and the intensities of ER/PR and HER2. This allowed us to identify potential subtypes of breast cancer cells from the cell lines and the fine needle aspiration samples from breast cancer patients. We demonstrate that our HoloNet can enable LDIH to perform more detailed and rapid analyses of subtypes of breast cancer cells. Citation Format: Tzu-Hsi Song, Mengzhi Cao, Jouha Min, Hyungsoon Im, Hakho Lee, Kwonmoo Lee. Deep learning-based analysis of heterogeneity of breast cancer cells using lens-free digital in-line holography [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-080.

Effect of the Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) Nomenclature Revision on Indian Thyroid Fine-Needle Aspiration Practice.

To analyze risk of malignancy (ROM) in Bethesda categories (BCs) and the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification on malignancy risk and surgical outcome. In this retrospective study based on fine-needle aspiration samples with histologic follow-up, ROM was analyzed in BCs. Possible cases of NIFTP were reviewed, followed by the analysis of impact of this reclassification on ROM in BCs. The incidence of NIFTP was 6.9% among excised thyroid nodules and 16.8% among all resected neoplastic lesions. ROM for BCs I to VI was 37.5%, 9.6%, 40.0%, 46.5%, 88.8%, and 96.8%, respectively. Risk of neoplasia was 50.0%, 13.8%, 55.0%, 71.2%, 88.8%, and 96.8% respectively. When NIFTPs were considered nonmalignant lesions, ROM decreased by 6.3%, 4.3%, 20%, 19.1%, 22.5%, and 1.5% in each Bethesda category (I-VI), respectively. Inability to diagnose NIFTP preoperatively led to overtreatment in 16.2%. Prevalence of NIFTP in Asian countries may be higher than expected. Substantial cases of NIFTP have a benign preoperative cytology; hence, cases of follicular adenoma and adenomatous colloid nodule should be included in the review. NIFTP reclassification has significantly reduced the ROM in indeterminate BCs, suggesting diagnostic lobectomy rather than total thyroidectomy. Countries should establish their own malignancy risk range and parameters.

Diagnostic performance of melanocytic markers for immunocytochemical evaluation of lymph-node melanoma metastases on cytological samples

AimsThe diagnosis of metastatic cutaneous melanoma (CM) on lymph node fine needle aspiration samples may be challenging and usually requires confirmation by immunocytochemistry. However, the cytological material could be too...

Should Liquid Based Cytology (LBC) be Applied to Thyroid Fine Needle Aspiration Cytology Samples?: Comparative Analysis of Conventional and LBC Smears.

Context:Liquid-based cytology (LBC) is a cyto-preparatory technique that may be applied to fine-needle aspiration (FNA) samples. However, its efficacy over conventional smears (CS) in thyroid is controversial.Aims:The aim of this study was to compare CS versus LBC (SurePath, BD) preparations in thyroid FNA samples for diagnostic efficacy.Settings and Design:Prospective case-control study using split sample analysis in 200 non-consecutive cases of thyroid FNA reported as per the Bethesda system.Methods and Material:Detailed cytomorphological features were evaluated in CS and LBC preparations. Cellularity was scored as 0–3. Based on diagnostic efficacy, they were categorized into three groups:(i) CS and LBC equivalent for diagnosis, (ii) CS better than LBC, and (iii) LBC better than CS for providing the diagnosis.Statistical Analysis Used:Paired t test for cellularity scores and descriptive for diagnostic efficacy.Results:There were 7 unsatisfactory, 118 benign, 10 atypia or follicular lesion of undetermined significance, 25 follicular neoplasms, 6 suspicious for malignancy, and 34 malignant thyroid FNA cases based on routine conventional smears. Cellularity of conventional smears was significantly higher than paired LBC smears (paired t test, P < 0.005). Comparison of overall diagnostic efficacy showed that LBC and CS were equivalent in 59% of cases; CS was superior to LBC in 37% cases and LBC was better than CS in 4% cases only. LBC smears showed higher unsatisfactory rate as compared to CS (18% vs. 3.5%). In category 2, the two techniques were equivalent in 87% of cases. In categories 4 and 6, CS were superior to LBC.Conclusions:In thyroid FNA cases, conventional smears are superior to LBC preparation in terms of cellularity and diagnostic efficacy and hence, LBC preparations should not replace conventional smears for making a routine cytomorphological diagnosis.

Evaluation of quality assurance in the cytopathology laboratory of a tertiary care hospital in Eastern India

Background: In this era of evidence-based medicine, clinical laboratories play a critical role in patient diagnosis and management. Aims: The present study aims to study the quality assurance in the cytopathology laboratory of a tertiary care hospital in the Eastern region of India. Materials and Methods: An observational, retrospective, and analytic study for 1 year was conducted. The sample size was 600. Simple random samples were selected including pleural fluids, ascitic fluids, cerebrospinal fluids, cervical cytology Pap smears, fine needle aspiration (FNA) cytology, and guided FNA samples. Results: Maintenance of authentication of reports and ISO accreditation showed no deficiency, whereas report generation, dispatch, and documentation of duplicate reports showed the highest deficiency (593, 98.8%) in maintaining quality assurance. Incomplete requisition was the most common cause of registration failure (3, 42.8%), whereas samples sent in wrong vials was the most common cause of sample collection failure (3, 37.5%). The presence of artifacts was the major factor affecting smearing technique (3, 50%). Lack of compliance to standardized protocol in manual staining and mechanical factors of automated strainers affected the staining quality (3, 37.5% each). Power cut and lack of adequate UPS backup affected the productivity of equipment mostly (3, 50%). Technical issues were the major factor affecting turnaround time (3, 50%). Lack of manpower at the report dispatch counter and logistics affected report generation and dispatch (2, 33.3% each). Randomly selected reports were crosschecked with histology and prediction accuracy measures were calculated. Conclusion: The preanalytical, analytical, and postanalytical factors have to be maintained adequately for ensuring quality assurance.

Isolated pancreatic tuberculosis: A diagnostic challenge!!

Isolated pancreatic tuberculosis (TB) is a very rare condition even in endemic areas. Pancreatic TB is seen in immunocompromised patients and usually occurs in association with miliary TB. Pancreatic TB can present as acute or chronic pancreatitis, a pancreatic abscess, and solid pancreatic masses. In a case of pancreatic mass, the possibility of TB should be considered in the list of differential diagnoses. Endoscopic ultrasound fine-needle aspiration sampling with an acid-fast smear is required for diagnosing pancreatic TB. Early diagnosis and prompt management of pancreatic TB will prevent unnecessary surgery and associated morbidity to the patient. Hereby, we report a very rare case of isolated pancreatic TB in a 26-year-old female who presented with a mass in porta-hepatis, which was adherent to the head of the pancreas.

Microbial Etiology to Thyroid Pathology

Introduction Microbial infections are normally cited as a main environmental factor involved in pathology. The current study aimed at determining frequency of occurrence of pathogens in thyroid pathology. Our study is focused on human data. We have reviewed thyroid Fine Needle Aspiration (FNA) samples for pathogens. Methods Biopsy by fine-needle aspiration was applied in investigating the nodule for microbial involvement. Two smears were prepared on slides from each sample. The first slide was processed through Ziehl Neelsen. The second slide was processed in gram stain, for the identification and classification of bacteria. Results Of the total 41 sampled patients, Evaluation of the presence of microorganisms in the thyroid FNA biopsies based on ZN and gram stains showed that a minimal percentage (12%) of the patients had a microbial aetiology. Among them, 2 cases (4.8%) had acid fast bacilli. Further 3 cases (7.2%) had gram negative rods. Conclusion The study findings suggested that the thyroid is less likely to suffer microbial infections. This is majorly due to the rich supply of the thyroid with both blood and lymphatic fluid and the presence of iodine which harbours some bactericidal properties.

Diagnostic utility of fine needle aspiration cytology and core biopsy histopathology with or without immunohistochemical staining in the subtyping of the non-small cell lung carcinomas: Experience from an academic centre in Turkey.

This retrospective morphological study compared the results of fine needle aspiration (FNA) cytology, haematoxylin-eosin (HE)-stained samples and immunohistochemical (IHC)-stained core needle biopsy (CNB) histology samples for primary non-small cell lung cancer (NSCLC) subtyping. We assessed the diagnostic utility of these methods to investigate the contribution of each method to NSCLC subtyping. We also identified the point at which NSCLC subtyping could be performed using histomorphology alone without IHC. Concurrent FNA and CNB specimens obtained via a single computed tomography-guided procedure and diagnosed as NSCLC in the Pathology Department of our university within 3years were reviewed. The results of FNA samples, HE-stained biopsies and IHC-stained biopsies were compared according to subtype. A total of 141 subjects were enrolled in the study. For subtyping, FNA provided an accurate diagnosis in 70 (55.1%) of 127 eligible subjects after the exclusion of 14 cases determined as not otherwise specified. CNB histology without IHC achieved a diagnosis in 53 (41.7%) of 127 subjects, which was a significant difference (P<.05). The compatibility rate between HE-stained biopsy samples and IHC-stained biopsy samples was 41.7% (53/127). The diagnosis rates achieved using FNA, HE-stained CNB samples and IHC-stained CNB samples were54.6% (77/141), 37.6% (53/141) and 90.1% (127/141), respectively. The subtype was identified in 55.1% of the subjects evaluated using FNA and 41.7% of subjects assessed using HE-stained biopsy samples without IHC. FNA provided a better result for squamous cell carcinoma than adenocarcinoma (55.1% vs 47.6%), but the diagnosing of adenocarcinoma and squamous cell carcinoma using HE-stained biopsy samples was similar (42% vs 41.7%).

The impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single center experience.

Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is the most controversial category of the Bethesda System. The present study was conducted to compare the histological findings in a series of thyroid nodules diagnosed with AUS/FLUS after single or repeat fine needle aspiration (FNA) cytology. Retrospective analysis of our institution's series of 514 patients with an initial diagnosis of AUS/FLUS between 11/2011 and 02/2020. Of 4887 FNA samples, 11.8% were classified as AUS/FLUS. Of patients with an initial AUS/FLUS diagnosis, 11.5% (59/514) underwent surgery after a single FNA, 55.4% (285/514) had a repeat FNA, and 32.7% (168/514) were either observed or lost to follow-up. Surgical pathology was available in 123 cases (23.9%), and malignancy was confirmed in 32.5% (40/123) cases, with similar rates in the single 32.2% (19/59) and repeat FNA 32.8% (21/64) groups. Repeat FNA reclassified 78.9% of the AUS/FLUS cases to a different category: 57.2% were reclassified as benign, 10.5% as follicular neoplasm, and 5.6% as suspicious for malignancy or malignant. The rates of nonneoplastic benign lesions were 52.5% (31/59) and 31.2% (20/64) in the single and repeat FNA groups, respectively (P = .018). The rates of follicular adenomas were higher when repeat FNA was performed (23/64, 35.9%) compared with a single FNA (9/59; 15.2%) (P = .013). In this series, a repeat FNA in cases of AUS/FLUS increased detection of follicular adenomas but not the detection of malignancy. Repeat FNA reduced the rate of benign nonneoplastic lesions by 40% in the surgical samples.

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.