Image-guided Fine-needle Aspiration Cytology Research Articles

Cytopathological profile of patients with hepatic lesion: A hospital-based cross-sectional study from North-east India

Background: Cancer is not a notifiable disease in India. The data pertaining to liver cancer and hepatic lesions are very limited in India. Aims and Objectives: The current study was intended to observe the proportion of different types of liver lesions reported from private hospitals in Mizoram and also to study the association of liver malignancies in relation to gender and age. Materials and Methods: This is a cross-sectional study design. The data were collected from the cytopathology data base of a private laboratory (Genesis Laboratory) in Aizawl, Mizoram. Data regarding 204 patients with hepatic lesions, who have been referred from three private hospitals to a private laboratory in Mizoram from January 15, 2018, to November 31, 2021, were included in the study. Details regarding cytopathology reports of image-guided fine needle aspiration cytology of liver mass, age, and gender were collected. Air-dried smears received at a private laboratory were routinely stained with Leishman-Giemsa and Papanicolaou stains, Ziehl-Neelsen staining was done wherever needed. From the cytopathological diagnosis made, the frequency and patterns of various hepatic lesions were then analyzed using SPSS Version 22. Results: Out of 204 cases, 15 (7.35%) cases were reported as inadequate samples and 4 cases (1.96%) were inconclusive in diagnosis. Hence, remaining 185 study participants were included in the final analysis. The mean age was 58. Majority 122 (65.40%) were males and in the age group 41–60 years (49.19%). Majority of the lesions were malignant 145 (78.37%) and remaining 40 (21.62%) were benign lesions. The most common malignant lesion found was hepatocellular carcinoma (HCC) 87 (47.02%), followed by metastatic carcinoma 31 (16.75%). Liver malignancies were found to be higher among males (74.5%) as compared to females (14.3%), but were not statistically significant (P=0.08). The proportion of males (52.5%) versus females (36.5%) diagnosed with HCC was statistically significant (P=0.03). Conclusion: The most commonly reported liver malignancy was HCC. The proportion of males diagnosed with HCC was higher than females in the present study.

Role of Pathologist in the Era of Image-Guided and EUS-Guided Aspirations: A 10-Year Study at a Single Tertiary Care Oncology Institute in North India

Background: With improved and readily accessible imaging techniques, the shift in fine-needle aspiration cytology (FNAC) from palpation-guided FNA (PGFNA) to image-guided FNA (IGFNA) and endoscopic ultrasound-guided FNA (EUS-FNA) became evident in last few decades. The present study evaluates the impact of IGFNA and EUS-FNA on the practice of cytopathology at our 300-bedded oncology institute. Study Design: A 10-year audit of three aspiration modalities PGFNA, IGFNA, and EUS-FNA was done. The number of aspirates, inadequacy rates, new patient registration numbers, and tissue biopsy numbers were compared. Results: A total of 29,610 FNAC were evaluated against a total 141,333 new patient registrations over a period of 10 years. The new cancer patient registration over last 10 years showed a 56% increase, with a comparable increase of 60% in diagnostic biopsies; whereas, the number of FNAC increased by only 6%. This reduction in the number of aspirates was mainly due to fall in the number of PGFNA to 18% of all procedures in the year of 2019 from a high of 44% in 2011. Further, PGFNA showed a reduction by 50% over 3 years. The inadequacy rates of PGFNA increased to 9.1% (in 2019) from 1.6% (in 2012). The IGFNA constituted 46%–60% of procedures, with inadequacy varying from 8.5% to 12.1% over years. The EUS-FNAC gradually increased from 3% to 22% from 2013, and the inadequacy rates were variable overtime showing parallelism with the use of rapid on-site adequacy evaluation (ROSE) by the endoscopist. Inadequacy rates ranged from 7.1% (2013) to 2.6% (2016), 7.7% (2017), and 5.4% (2019). Conclusion: The utility of ROSE and diminishing role of pathologist is highlighted in our study. Judicious ROSE improves diagnostic accuracy, decreases the rate of missed diagnosis and the repetition of procedures. The study sheds light on the ever-increasing lacuna in the training of pathologists for blind as well as in image-guided FNAC. Further, it enumerates the factors leading to the underutilization of ROSE, its undisputed advantages, operator variations in procedure, smear preparation, and screening.

Guided Needle Aspirations of Intra-Abdominal Masses: Analogy between Liquid-Based and Conventional Smear Preparation Methods

Objective: Image-guided fine needle aspiration cytology with conventional smear (CS) preparation offers onsite cellular adequacy evaluation; however, it still provides false negatives due to faulty smear preparations. Liquid-based cytology (LBC) can be advantageous in these scenarios. Hence, with an aim to investigate utility of LBC in these samples, we carried out the above study with objectives to find diagnostic accuracy of LBC and agreement of LBC with CS methods in guided aspiration samples from intra-abdominal masses. Methods: A prospective observational study, of 113 patients with clinical or radiological diagnosis of intra-abdominal masses, was carried out. SurePath BD™ was used for LBC smear preparation, and the standard protocol was used for CS preparation. Results: LBC alone was diagnostic in 80.8% of the cases, and CS alone was diagnostic in 71.2% cases (agreement was 83.7%, p = 0.03). Cellular morphology was better preserved in LBC; however, interpretation was easier in CS. Conclusion: CS may be complimented with LBC sample collection method to enhance the sensitivity of intra-abdominal FNA.

Isolated Myeloid Sarcoma and Intracardiac Thrombus Resulting in Superior Mediastinal Syndrome.

Superior mediastinal syndrome (SMS) is a relatively common emergency in the practice of Pediatric Oncology. It typically results from the compression of large airways and superior vena cava by a swiftly growing mass. T-lineage acute lymphoblastic leukemia or lymphoma, neuroblastoma, and germ cell tumor are the common etiologies of SMS in children. Occasionally, SMS can be an unexpected presentation of less common childhood cancers and a surprise for the diagnostic and treating teams. The present paper reports the diagnostic and therapeutic challenge of managing a 9-y-old boy with SMS resulting from mediastinal myeloid sarcoma. The presence of a sizeable intracardiac thrombus, in addition, contributed to the SMS. The initial pleural fluid cytology and image-guided fine-needle aspiration cytology of the mediastinal mass were nondiagnostic. A thoracotomy was subsequently performed to debulk the tumor for symptomatic relief and obtain tissue for diagnosis.

Spectrum of Adrenal Lesions on Fine-Needle Aspiration Cytology: A Tertiary Care Centre Experience.

Introduction Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to tertiary care centers. It helps in analyzing symptomatic, as well as incidental adrenal lesions with high sensitivity and specificity. Aim This study was conducted to determine the cytological spectrum of adrenal lesions in a tertiary care center. Material and Methods This was a retrospective study which included a total of 19 cases of adrenal FNAC received from June 2017 till June 2019 in a north Indian tertiary care university hospital. All the lesions were broadly classified into non-neoplastic and neoplastic categories. The non-neoplastic lesions were divided into infective causes and cystic lesions. Neoplastic lesions were further grouped into benign and malignant lesions. Immunohistochemical findings were retrieved from the hospital records wherever accessible. Results A total of 19 cases were aspirated, of which 16 cases (84.20%) yielded satisfactory material. Six cases (31.57%) showed non-neoplastic pathology of which one was a cystic lesion, three were infective (two histoplasmosis and one tuberculosis), and two showed only benign adrenal cortical cells in a setting of known extra-adrenal primary malignancy. The neoplastic group comprised of 10 cases (52.63%) of which 4 cases showed metastatic carcinomatous deposits from a known extra-adrenal primary malignancy and 6 cases showed primary adrenal neoplasm (one case of myelolipoma, one case of pheochromocytoma, and four cases of adrenal neoplasm) which were then subjected to biopsy and immunohistochemistry. A final diagnosis of pheochromocytoma was made in three cases, adrenocortical carcinoma in one case, and one case was inconclusive because of nonrepresentative biopsy. Conclusion Image-guided fine-needle aspiration cytology of adrenal lesions helps to determine the exact nature of the infection, avoids unnecessary surgery, and helps in targeted management. However, histopathological evaluation with immunohistochemistry remains the diagnostic modality of choice with regard to neoplastic lesions.

Utility of image-guided fine-needle aspiration cytology from neoplastic hepatic and gallbladder lesions

Introduction: Fine-needle aspiration cytology (FNAC) is an important and successful method for liver and gallbladder (GB) lesion diagnosis. Aspiration from liver and GB masses and its cytological evaluation differentiate whether it is benign or malignant. It is of huge help to the clinician for deciding on timely and appropriate management of the patient. Image-guided FNAC of liver lesions helps to know lesion localization whether it is multifocal, with the benefit of multiple passes for adequate sampling. Aims and Objective: This study aims at finding the importance and effectivity of image-guided FNAC of liver and GB masses with the main focus on the diagnosis of neoplastic lesions. Materials and Methods: The study was a prospective study conducted in the Cytology Section in the Department of Pathology, Gajra Raja Medical College, Gwalior, from January 2019 to March 2021. All the slides of liver and GB fossa mass aspiration done with help of image guidance were stained and examined. Results: There were a total of 86 cases, out of which six cases had unsatisfactory material, thus rendering them as nondiagnostic (7%). The diagnostic efficacy is 93%. Out of 80 cases, 71 (87.5%) were reported neoplastic and 9 (12.5%) were nonneoplastic. Among neoplastic lesions (71/80, i.e., 88.7%), 70 were malignant and one case was reported as suspicious for malignancy. Out of 71 neoplastic lesions, 39 were from liver mass and 32 were from GB fossa. Among 38 malignant neoplastic tumors of the liver, six cases were hepatocellular carcinoma (15.7%). Out of 32 metastatic lesions to the liver, 30 were of adenocarcinoma and one case each of small-cell morphology and lymphoma. Conclusions: Cytological evaluation is an important tool and can be applied as the first line of diagnostics in the management of liver masses and can characterize liver masses. GB lesion cytology has more diagnostic yields and accuracy of differentiating neoplastic lesions from nonneoplastic lesions. Hence, from the study, we can conclude that advanced techniques in the cytological study of liver and GB mass can give an early diagnosis.

English

BACKGROUND Fine-needle aspiration cytology (FNAC) is an easy, minimally invasive and useful investigation, and is considered important next to imaging in the rapid diagnosis of lung neoplasm for the last few decades. The purpose of this study was to evaluate the role of image-guided FNAC in pulmonary neoplasm, analyse the results and correlate with cell block histopathological findings. METHODS This is a cross sectional study conducted over a period of two years, involving fifty patients. All the clinical and radiological data were studied from the consenting patient. Then they underwent image-guided FNAC. The cytology smears and cell blocks were evaluated simultaneously to stick out a definitive diagnosis. RESULTS Out of all the 50 cases, we found the necessary FNAC smears and cell block material only in 41 cases. The age range varied from 18 to 90 years with a peak in the fifth to sixth decades. Benign lesions were 4 and malignant were 23 as shown by cytology study. Malignancy was proved in 27 cases in histopathology. The most common tumour was adenocarcinoma (41 %) followed by squamous cell carcinoma (19.5 %). Complications after the procedure were minimal and were noted only in two cases. CONCLUSIONS Image-guided fine needle aspiration cytology of lung tumours provide uncomplicated, cost effective, and a rapid method, for reaching a reliable diagnosis for lung neoplasms with minimum complication. KEYWORDS FNAC, Histological Correlation, Pulmonary Neoplasm

Fine Needle Aspiration Cytology with the Assistance of Radiological Tools in the Diagnosis of Deep-Seated Lesions

Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies.
 Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions.
 Method This was a descriptive cross-sectional study of 125 patients who underwent image-guided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope.
 Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%).
 Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.

Image-guided fine-needle aspirates in thoracoabdominal lesions with particular reference to liver malignancies

The present research has been conducted to find the utility of image-guided fine-needle aspiration cytology in the diagnosis of thoracoabdominal lesions. It also has attempted to study the frequency of distribution of thoracoabdominal lesions. At the same time tried to classify various thoracoabdominal lesions with the help of image-guided fine-needle aspiration cytology. The study of image-guided FNAC of thoracoabdominal lesions was carried out for twenty-four months, i.e. from MAY 2014 to APRIL 2016, which included 80 cases. Most patients (80%) were in the 5th-7th decade of life. All cases of ovarian lesions were diagnosed as malignant tumours on cytology, 08 were diagnosed as adenocarcinoma and one case of granulosa cell tumour. 06 out of 08 cases which diagnosed as adenocarcinoma on cytology, were confirmed on histology and diagnosed as mucinous cystadenocarcinoma(03 cases) and papillary serous carcinoma (03 cases). A case of malignant granulosa cell tumour was diagnosed on cytology and confirmed on histopathology. A case of mesenteric lymphadenopathy was diagnosed as granulomatous inflammation, suggestive of tuberculosis and was confirmed on histopathology with 100% accuracy. This was the only paediatric case in our study. A case of para-spinal abscess of thoracic vertebrae was diagnosed as chronic inflammation on guided FNAC, and the etiological agent was identified with histopathology as actinomyces.

A cytological comparison of efficacy of bronchioalveolar lavage, transbronchial needle aspiration and image guided fine needle aspiration for diagnosis of pulmonary lesions in a rural tertiary care centre

Introduction: Pulmonary lesions include a wide variety of benign and malignant conditions of lung, pleura, mediastinum and vertebrae. Lung cancer is a frequently diagnosed cancer worldwide.1 Although clinical data, location and radiological findings can narrow down the diagnostic possibilities, a cytological diagnosis is warranted before initiating the specific treatment for the malignant disease. Aims and Objectives: The present study was undertaken with the aim to compare the sensitivity and specificity of bronchioalveolar lavage (BAL), transbronchial needle aspiration cytology (TBNA) and image-guided fine needle aspiration cytology (FNAC) in the evaluation of patients with pulmonary lesions. Materials and Methods: The present study was conducted on 100 patients with pulmonary lesions coming to the department of pulmonary medicine at MMIMSR, Mullana. For diagnostic purposes various procedures like BAL, TBNA and image guided FNAC were performed. Cytological examination was carried out in the department of Pathology. Results: Among 100 cases, TBNA was done in 63 cases, BAL in 52 cases and image guided FNAC was performed in 37 cases. Using these cytological techniques, a diagnosis was obtained in 81% cases. The sensitivity and specificity of each technique was assesed. On cytological evaluation, 12% cases had a non-neoplastic diagnosis, whereas 69% cases, malignancy was diagnosed. However, in 19% cases no diagnosis was offered. The most common diagnosis amongst malignant lesions was non-small cell carcinomas. (Squamous cell carcinoma- 28%, Adenocarcinoma-23%) followed by small cell carcinoma (8%). Conclusion: Image-guided FNAC of pulmonary lesions is a simple, safe, economically viable technique with low morbidity and offers quick and early diagnosis. Our study revealed that TBNA and FNAC were comparatively better in the diagnosis when compared to BAL. Keywords: Image-guided Fine Needle Aspiration Cytology, Pulmonary Lesions, Squamous Cell Carcinoma.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

Context:Lung cancer is the most common cancer affecting males worldwide. Its incidence in females is also on an increasing trend. Other conditions affecting lung-like tuberculosis are on a rise in middle-east countries due to overcrowding and poor living conditions. In developing countries, image-guided fine-needle aspiration cytology (FNAC) of lung lesions is a cost-effective method for early detection and apt treatment of patients by physicians.Aim:The main aim of this study is to identify the importance of computed tomography (CT)guided FNAC as an accurate and cost-effective tool in early diagnosis of lung lesions.Settings and Design:It was prospective and retrospective study done in a government medical college of West Bengal, India.Material and Methods:Over a period of two years, 42 cases were included in the study. These were further subjected to evaluation of pulmonary mass lesions by CT guided transthoracic fine needle aspiration cytology.Results:Out of these 42 cases majority were males with cough being most common clinical presentation. On CT guided FNAC of pulmonary lesions 69% of cases were malignant. Cytoradiological correlation in this study was 90.4%.Conclusion:CT guided FNAC of lung lesions is an accurate, cost effective and quick technique for early diagnosis, referral and appropriate treatment of patients in developing countries.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

Fluorodeoxyglucose-avid thyroid incidentaloma

Positron emission tomography–computed tomography (PET-CT) has become a standard investigation oncology workup.18F-fluorodeoxyglucose (18F-FDG) is the main radiopharmaceuticals for most of the studies. Since malignant cells overexpress glucose transporter receptors, they internalize FDG, and FDG undergoes the first rate-limiting step of glycolysis to form FDG-6-phosphate. In a whole-body PET-CT study, a lot of incidental findings are noticed and often bear significant clinical relevance. A normal thyroid gland does not show any demonstrable FDG uptake. However, sometimes, a normal-looking thyroid gland shows up increased FDG uptake in a diffuse manner in both lobes without any obvious focal FDG-avid lesion. This is attributed to autoimmune lymphocytic thyroid diseases and hypothyroidism. A hyperthyroid gland may appear diffusely enlarged with intense FDG uptake throughout the gland suggesting the hyperfunctioning of its follicular cells. However, any focal FDG uptake in either lobe of the thyroid needs an evaluation, particularly if there is any hypodense nodule on corresponding CT study. It is observed that FDG-avid thyroid nodules can harbor malignancy in almost 33% of cases. Hence, any FDG-avid incidentaloma needs an image-guided fine-needle aspiration cytology to rule out occult malignancy.

Basic Interventional Procedures: Practice Essentials.

There has been an increasing demand in image-guided minimally invasive procedures and these have become an integral part of present-day clinical practice. Basic interventional radiology (IR) procedures have greatly reduced the need for invasive procedures for sampling as well as treating conditions like abscess and fluid collections. Owing to their minimally invasive nature, most of these procedures may be performed on the outpatient patients as daycare procedures. Some of these procedures in critically ill patients may be lifesaving. Basic interventional radiology (IR) procedures consist of image-guided fine-needle aspiration cytology and biopsy, tru-cut (core) biopsy, needle aspiration/drainage and percutaneous catheter drainage. This review aims to provide practice requisites for basic IR procedures.

Retroperitoneal Tumor: A Silent Trespasser – Role of Image-Guided Fine-Needle Aspiration Cytology with Histopathological Correlation in Early Diagnosis

Objective: Retroperitoneal lesions present a great diagnostic challenge. Here we analyze the spectrum of retroperitoneal lesions and the utility of cytohistopathological correlation in early diagnosis. Study Design: This 7-year study was undertaken in 338 patients with a retroperitoneal mass (kidney/adrenal/ pancreas/retroperitoneal lymph node, or soft tissue origin). In a prospective analysis, 81 patients underwent image-guided fine-needle aspiration cytology (FNAC) and 70 of the 81 underwent Tru-cut biopsy/histopathological evaluation. Clinical, radiological, and pathological details of 257 patients were retrieved from institutional records for retrospective analysis. A total of 119 patients, i.e., 70 in the prospective analysis and 49 in the retrospective analysis, had cytohistopathological correlation. Results: Of the 338 cases, 88.4% were malignant (n = 274), 2.6% were benign (n = 8), 9% were nonneoplastic (n = 28), and 9% were inadequate (n = 28). Most were renal in origin (n = 106; 34.2%), followed by retroperitoneal soft tissue (n = 96; 31%). The most common nonneoplastic lesion was tubercular lymphadenitis (42.85%) and the most common benign lesion was paraganglioma (42.85%). The most common malignancy was renal cell carcinoma (21.16%), followed by Wilms’ tumor (13.86%). In infancy and early childhood, Wilms’ tumor, neuroblastoma, and germ cell tumor were the most common malignancies, while in middle age it was renal cell carcinoma, followed by pancreatic adenocarcinoma, and in the elderly age group it was metastatic carcinoma. Most malignancies were noted in the 5th to 6th decades. The overall sensitivity, specificity, and diagnostic accuracy of image-guided FNAC was 98.02, 72.22, and 94.12%, respectively. Conclusion: Image-guided FNAC is highly sensitive and specific for early diagnosis of an otherwise silent retroperitoneal mass. It saves patient from meticulous surgical procedures for diagnostic reasons and allows more rational planning of management. Knowledge of the distribution of tumors by age group helps to narrow down differential diagnoses.

Fine-needle aspiration cytology of gallbladder with an attempt of cytomorphological classification.

Background:Image-guided fine-needle aspiration has emerged as an effective diagnostic tool for precise diagnosis of deep-seated lesions. Although occasional studies have made an attempt to classify the gallbladder carcinoma on cytology, literature lacks the standardized cytological nomenclature system used for it. The present study was conducted to study the role of fine-needle aspiration cytology (FNAC) in diagnosis of gallbladder lesions with an attempt of cytomorphological classification.Methods:The study included cases of image-guided FNAC of the gallbladder over a period of 3½ years. An attempt was made to categorize gallbladder lesions on basis of architectural and cytomorphological features along with analysis of management.Results:The study included 433 cases and lesions were categorized on FNAC into five categories ranging from Category 1 (inadequate), Category 2 (negative for malignancy), Category 3 (atypical cells), Category 4 (highly atypical cells suggestive of malignancy), and Category 5 (positive for malignancy). The most common architectural pattern observed on FNAC of neoplasm was sheets and acini with predominance of columnar cells and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 93 cases with cytohistopathological concordance of 94.4% in malignant cases.Conclusions:Image-guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. The cytomorphological classification of gallbladder lesions provides an effective base for accurate diagnosis and management. Category 3 and 4 are the most ambiguous category on FNAC which should be managed by either repeat FNAC or surgery in the light of worrisome radiological features. The vigilant examination of architectural pattern and cytomorphological features of the smears may be helpful in clinching the diagnosis and precisely subtyping malignant tumors along with prognostication of these tumors.

Image-guided Fine Needle Aspiration Cytology of Intrathoracic Lesions.

Background:Percutaneous, image-guided transthoracic fine needle aspiration cytology (TTFNAC) is a rapid, yet accurate, and well-established diagnostic method used in the cytological evaluation of intrathoracic lesions. The study was done to determine the utility of image-guided TTFNAC in diagnosis of intrathoracic lesions.Subjects and Methods:A retrospective analysis of all cases who underwent image-guided TTFNAC of a suspected intrathoracic lesion, in a tertiary care hospital was done over a period of 3 years.Results:During the study period, 124 cases of image-guided FNAC of intrathoracic lesions were obtained. The mean age at presentation was 60.5 years with M:F: 3.6:1. Neoplastic lesions (71.5%) outnumbered the nonneoplastic lesions (28.5%). The most common tumor was adenocarcinoma (25%) followed by squamous cell carcinoma (SCC, 11%), and small cell carcinoma (5%). There was one case each of anaplastic carcinoma, plasmacytoma, bronchoalveolar carcinoma, and non-Hodgkin lymphoma (NHL). Most of the lesions were found on the right side and upper lobe. Among the mediastinal lesions, we found two cases of thymoma and one case each of NHL)/primitive neuroectodermal tumor (PNET), NHL, and small cell carcinoma metastasis to lymph node followed by ten cases of inflammatory lesions and seven cases of tuberculosis (TB).Conclusion:Image-guided TTFNAC of intrathoracic lesions is a safe method when done by well-trained medical personnel with lesser rate of complications. An early accurate diagnosis of malignancy can be made based on the cytological features; however, further subtyping of the malignancy may sometimes be difficult due to overlapping cytological features. TTFNAC can be a diagnostic tool for identifying nonneoplastic lesion such as TB. Hence, image-guided FNAC aids in early diagnosis and management of patients with intrathoracic lesions.

Diagnostic Efficacy of Ultrasound-Guided Fine Needle Aspiration Combined with the Bethesda System of Reporting.

Background:Image-guided fine needle aspiration cytology (FNAC) is emerging as an important diagnostic tool in the evaluation of thyroid swellings.Aim:This study aims to assess the efficacy of ultrasound (US)-guided FNAC combined with “The Bethesda system' of reporting as a primary screening test for all thyroid lesions.Settings and Design:A prospective cohort study was made and all the US-guided FNACs done were followed up to find out the histopathological diagnoses wherever surgery was done.Materials and Methods:In all, 1050 patients who underwent US-guided FNAC were studied during a period of 1 year. Age, sex, cytological features, and histological diagnoses were analyzed. Statistical analyses of all the findings were done to derive conclusions.Results:Of the 1050 patients, only 10.5% underwent surgery. Higher than expected rate (as per the Bethesda system) of malignancy was noted with the so-called grey zone lesions. The test results revealed a high level of sensitivity, specificity, and diagnostic accuracy.Conclusion:The study showed that The Bethesda System of Reporting Thyroid Cytology provides effective communication between clinician and pathologists thereby enabling clear management strategies. We also concluded that US-guided FNACs offer better results compared with palpation-guided FNACs.

Diagnostic efficiency of image-guided fine-needle aspiration cytology for the evaluation of pancreatic mass lesions: a study based on the Papanicolaou Society of Cytopathology guidelines

Background Pancreatic cytology can actually make a difference in patients’ management. The Papanicolaou Society of Cytopathology has submitted new regulations for pancreatico–biliary cytology bringing up indications, methodologies, terminology, auxiliary tests, and postprocedural management.Objective This study aimed to determine the sensitivity, specificity, and positive and negative predictive values of image-guided fine-needle aspiration cytology (FNAC) in the evaluation of pancreatic masses, detect diagnostic pitfalls, and attempt to find explanations for these pitfalls.Materials and methods In this study, a retrospective review was performed of 139 cases of pancreatic lesions that were subjected to image-guided FNAC with subsequent correlation with histological diagnosis or clinic–radiological data between January 2013 and March 2016 in the Cytology Unit, Pathology Department, National Cancer Institute, Cairo University. Cytological diagnoses were stratified into six categories: (i) nondiagnostic, (ii) negative, (iii) atypical, (iv) neoplastic: benign or others, (v) suspicious, and (vi) malignant.Results The mean age was 54.09±12.8 years. After excluding nondiagnostic cases and the atypical case and in reference to histological diagnoses and clinic–radiological findings, 86.5% of cases were true-positive; 11.9% of cases were true-negative; 0.8% of cases were false-negative; and 0.8% of cases were false-positive. As a result, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the pancreatic cytology were 99.09, 93.75, 99.09, 93.75, and 98.41, respectively.Conclusion FNAC has high accuracy, sensitivity, and specificity in the diagnosis of pancreatic lesions, especially pancreatic adenocarcinoma, which may influence the treatment plans.

Miliary Tuberculosis.

Miliary tuberculosis (TB) results from a massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli and is characterized by tiny tubercles evident on gross pathology resembling millet seeds in size and appearance. The global HIV/AIDS pandemic and widespread use of immunosuppressive drugs and biologicals have altered the epidemiology of miliary TB. Considered to be predominantly a disease of infants and children in the pre-antibiotic era, miliary TB is increasingly being encountered in adults as well. The clinical manifestations of miliary TB are protean and nonspecific. Atypical clinical presentation often delays the diagnosis. Clinicians, therefore, should have a low threshold for suspecting miliary TB. Focused, systematic physical examination helps in identifying the organ system(s) involved, particularly early in TB meningitis, as this has therapeutic significance. Fundus examination for detecting choroid tubercles offers a valuable clinical clue for early diagnosis, as their presence is pathognomonic of miliary TB. Imaging modalities help in recognizing the miliary pattern, defining the extent of organ system involvement. Examination of sputum, body fluids, image-guided fine-needle aspiration cytology or biopsy from various organ sites, needle biopsy of the liver, bone marrow aspiration, and biopsy should be done to confirm the diagnosis. Cytopathological, histopathological, and molecular testing (e.g., Xpert MTB/RIF and line probe assay), mycobacterial culture, and drug susceptibility testing must be carried out as appropriate and feasible. Miliary TB is uniformly fatal if untreated; therefore, early initiation of specific anti-TB treatment can be lifesaving. Monitoring for complications, such as acute kidney injury, air leak syndromes, acute respiratory distress syndrome, adverse drug reactions such as drug-induced liver injury, and drug-drug interactions (especially in patients coinfected with HIV/AIDS), is warranted.