Interpretation Of Fine Needle Aspiration Cytology Research Articles

Implementation of Bethesda system for reporting thyroid cytology in an academic institution: A 2 year retrospective study

Thyroid diseases are the most common endocrine diseases in India. Both benign and malignant diseases present as thyroid nodules. Fine needle aspiration cytology (FNAC) has proven to be one of the most effective tools for evaluation of thyroid nodules. Interpretation of FNAC has been standardized by the Bethesda system for reporting thyroid cytopathology (TBSRTC). Aim: To categorize all the thyroid lesions utilizing TBSRTC, in an academic institution for a duration of 2 years and find its histopathological correlation. Materials and Methods: A 2 year retrospective study included all 229 patients who underwent thyroid FNAC in the institution. All the clinical and relevant radiological investigations were retrieved from hospital information system. All Papanicolaou and May Grunwald Giemsa stained smears were categorized under TBSRTC in to 6 categories. Results: Maximum number of cases were between the age group of 31-45yr. Male: Female ratio in our study was 1:13. There were 12 cases (5.2%) under Unsatisfactory/non diagnostic category, 196(85.5%) cases belonged to benign category, 1 case (0.04%) of Atypia of undetermined significance/follicular lesion of undetermined significance,10 cases (4.3%) belonged to follicular/ suspicious for follicular neoplasm,4 cases (1.7%) belonged to suspicious for malignancy & 6 (2.6%) belonged to Malignant category. Cyto histopathology discrepancy rate was 7.14%. Conclusions: TBSRTC brings about uniformity in reporting of thyroid cytology, thereby helping in better patient management and avoiding unwanted surgeries. Keywords: Bethesda system, Fine needle aspiration cytology, Follicular neoplasm, Malignant, Reporting, Thyroid.

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18-year review from a single sub-Saharan African institution.

There are many merits to fine needle aspiration cytology (FNAC) in evaluation of palpable breast lesions. We set out to determine the concordance of breast FNAC interpretation with subsequent surgical pathology in the resource-limited healthcare setting of rural Kenya. African Inland Church Kijabe Hospital electronic pathology files were retrospectively reviewed from 1/1999-9/2017. All breast FNAC cases and subsequent surgical pathology specimens were identified. FNAC interpretations were categorised according to the International Academy of Cytology Yokohama codes: insufficient; benign; atypical favour benign; suspicious favour malignant; and malignant. Surgical pathology results were categorised as benign or malignant. In total, 695 breast FNACs were identified. A total of 219 (31.5%) had subsequent surgical pathology. Average patient age was 39years (range 13-88); 95% were female. Nearly all (98%) lesions were palpable. FNAC interpretive categorisation was as follows: 20 (9%) insufficient, 103 (47%) benign, 16 (7%) atypical, 24 (11%) suspicious and 56 (26%) malignant. On histopathology, there were 141 (64%) benign cases and 78 (36%) malignancies (Table1). The sensitivity of FNAC for detecting malignancy was 85%; specificity was 75%. Positive and negative predictive values were 69% and 88%. Diagnostic concordance between FNAC and histopathology was 79%. For definitively diagnostic FNAC categories, diagnostic concordance was 89%. On histopathology, malignant diagnoses were given in 0 insufficient, 12 (12%) benign, 4 (25%) atypical, 11 (46%) suspicious and 51 (91%) malignant cases. There were five false-positive cytopathology interpretations and 12 false-negatives. FNAC remains a valuable tool in evaluation of palpable breast lesions in resource-limited healthcare settings.

Rapid Staining and Immediate Interpretation of Fine-Needle Aspiration Cytology for Palpable Breast Lesions: Diagnostic Accuracy, Mammographic, Ultrasonographic and Histopathologic Correlations

Objective: We investigated the role and turn around time of rapid staining and immediate interpretation of fine-needle aspiration cytology (FNAC) for women with palpable breast lesions. Study Design: A total of 408 FNAC specimens from 400 patients with palpable breast lesions was analyzed for immediate interpretation and preliminary cytologic diagnosis. All cytological diagnoses were correlated with subsequent alcohol-fixed Papanicolaou-stained slides, mammographic, ultrasonographic and histopathological findings. Results: Of the 408 specimens, 243 (59.6%) were interpreted as benign, 37 (9.0%) atypical, 22 (5.4%) suspicious, 68 (16.7%) malignant, and 38 (9.3%) unsatisfactory. 132 of 408 (32.4%) had subsequent surgical procedures; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.5, 100, 100, 81.9 and 92.4%, respectively. The average turn around time was 8.6 min. Mammographic results were available in 242 (59.3%) cases, with 112 (46.3%) undergoing surgical excision. In correlation with mammography and surgical pathology, the false-positive rate, false-negative rate, sensitivity, specificity and accuracy were 1.9, 10.5, 98.1, 89.5 and 95.8%, respectively. Conclusions: Rapid FNAC interpretation is a useful, effective diagnostic method for palpable breast lesions in our healthcare environment.

A case report of papillary parathyroid adenoma; The difficulty in fine needle aspiration cytology interpretation

Aim We report an extremely rare finding in a neck mass presenting with papillary oncocytic cells in fine needle aspiration cytology (FNAC). The differentiation of this lesion from papillary carcinoma of the thyroid, both cytologically and histologically, is discussed. Case report A middle-aged Malay lady presented with a diffuse neck swelling for 5 years. There was no associated with hoarseness of voice, swallowing difficulty or muscular weakness. Physical examination reviewed diffuse neck swelling moving with deglutition. A solitary area measuring 2 × 2 cm was noted on the right side. FNAC from the solitary mass showed cellular oncocytic cells arranged in fine papillary pattern. Occasional cytoplasmic pseudoinclusions and nuclear overlapping were observed. However, characteristic nuclear features such as ground-glass appearance and irregular nuclear outline with groove were not seen. Differential diagnoses of papillary oncocytic tumour, which include papillary thyroid carcinoma, Hurthle cell neoplasm and parathyroid adenoma, were considered. Later, total thyroidectomy showed a well circumscribed solitary lesion in the inferior pole of the right thyroid. The lesion was proven histologically to be a parathyroid adenoma with focal papillary features. Discussion The findings in FNAC of papillary parathyroid adenoma mimic the features of papillary thyroid carcinoma. In literature reviews no single or combination cytomorphological features are diagnostic of parathyroid adenoma. We report this case to illustrate occurrence of this unusual histological pattern that might create a diagnostic error in FNAC.

Problems in fine-needle aspiration cytology interpretation

Problems in fine-needle aspiration cytology interpretation

PROBLEMS AND LIMITATIONS WITH FINE NEEDLE ASPIRATION CYTOLOGY OF SOLITARY THYROID NODULES

Fine needle aspiration cytology (FNAC) is a widely employed tool in the investigative work-up of patients with single thyroid nodules. Although its advantages are well documented, the limitations and problems in interpretation of FNAC in this condition are not well known. Experience with FNAC in 150 patients with solitary thyroid nodules is presented, highlighting the pitfalls of this technique. There was an inadequate specimen rate of 22.7% which declined with increasing experience. Follicular carcinomas could not be differentiated from follicular adenomas by cytology. Difficulties may arise in the detection of papillary carcinomas due to occult lesions, mixed papillary and follicular carcinomas or due to associated thyroid pathology. False positivity is, however, much rarer and is generally due to cellular adenomatous goitres with marked papillary activity. In view of these cytologic limitations, care must be exercised by the treating physician in interpreting cytological results.

Role of fine-needle aspiration cytology in childhood malignancies.

During the last 4 yr, fine-needle aspiration cytology (FNAC) has been employed in 1,474 patients in 0-15-yr age group at our institute. Of these, 245 patients were found to have malignant disease, including primitive neuroectodermal tumors, hepatoblastoma, nephroblastoma, sarcoma, and epithelial malignancies. Four metastases from medulloblastoma and two each from astrocytoma and meningioma were confirmed without open biopsy. FNAC interpretation was easy when cytologic findings were correlated with relevant clinical and radiologic data.