Low Risk Of Malignancy Research Articles

De novo cancer avoidance after renal transplantation: A case-control study on low-dose sirolimus combined with a calcineurin inhibitor.

Full-dose sirolimus (SRL) therapy without a calcineurin inhibitor (CNI) reduces the incidence of malignancy after renal transplantation, but with significant side effects. We hypothesized that de novo therapy with low-dose SRL combined with a CNI could still prevent cancer in renal transplant recipients. A retrospective case-control study was performed to assess the cancer incidence among renal transplant patients who had undergone surgery in our transplant centers between January 2000 and June 2012. Patients who received low-dose SRL and a CNI (SRL group, n=189) were compared with patients receiving conventional CNI-based therapy in the same hospitals (Conventional group, n=271). The 5-year graft and patient survival rates were comparable between the two groups. Seven patients in the SRL group and 24 patients in the Conventional group developed malignancies during mean follow-up periods of 68.2±37.5 months and 81.7±51.4 months, respectively. The cancer incidence at 5 years was significantly lower in the SRL group (1.9%), than that in the Conventional group (6.7%; p=0.04). By multivariate analyses, SRL therapy (p=0.04), male sex (p=0.04), and younger age (p=0.01) were significantly associated with a lower risk of malignancy after kidney transplantation. De novo therapy with low-dose SRL combined with a CNI was associated with reduced risk of post-transplant cancer in renal transplant recipients. De novo cancer prevention using a low-dose proliferation signal inhibitor such as SRL could be effective for renal transplant recipients.

Timing of Gonadectomy in Patients with Complete Androgen Insensitivity Syndrome–Current Recommendations and Future Directions

This review highlights the controversy regarding timing of gonadectomy in patients with complete androgen insensitivity syndrome (CAIS). We will review the published literature regarding frequency of gonadal malignancy and summarize historical findings. Recent research suggests that gonadectomy may be deferred until adulthood due to the low risk of malignancy. An algorithm is also provided to help guide clinicians in management of patients with complete androgen insensitivity syndrome who have deferred gonadectomy.

Decision making among Veterans with incidental pulmonary nodules: A qualitative analysis

Among patients undergoing lung cancer evaluation for newly diagnosed, incidental pulmonary nodules, it is important to evaluate the shared power and responsibility domain of patient-centered communication. We explored Veterans' perceptions of decision making with regards to an incidentally-detected pulmonary nodule. We conducted semi-structured, qualitative interviews of 19 Veterans from one medical center with incidentally-detected pulmonary nodules that were judged as having a low risk for malignancy. We used qualitative description for the analysis, focusing on patients' perceptions of shared decision making with their primary care provider (PCP). Interviews were conducted in 2011 and 2012. Patients almost always played a passive role in deciding how and when to evaluate their pulmonary nodule for the possibility of malignancy. Some patients felt comfortable with this role, expressing trust that their clinician would provide the appropriate care. Other patients were not satisfied with how these decisions were made with some expressing concern that no decisions had actually occurred. Regardless of how satisfied they were with the decision, patients did not report discussing how they liked to make decisions with their PCP. Veterans in our study did not engage in shared decision making with their clinician. Some were satisfied with this approach although many would have preferred a shared approach. In order to reduce patient distress and improve satisfaction, clinicians may want to consider adopting a shared approach when making decisions about pulmonary nodule evaluation.

New classification of thyroid FNAB results - a three-year observation from one clinic.

Fine needle aspiration biopsy (FNAB) is the main examination in diagnostics of thyroid nodules. Yet, it does not allow the differentiation of follicular lesions (FL). A new classification of thyroid biopsy results (newC) might improve pre-operative diagnostics mainly due to the introduction of a new subcategory of 'follicular lesion of undetermined significance', as well as the clarification of definitions of other categories. The aim of this study was to analyse the impact of the newC on the distribution of the cytological results among main diagnostic categories and on the values of the parameters describing the effectiveness of FNAB in detecting malignancy. 34,371 FNABs outcomes and 3,557 results of surgical follow up were analysed. The frequencies of five main diagnostic categories in two periods: before (years: 2000-2009, 24,271 FNAB) and after the newC had been introduced (years: 2010-2012, 10,100 FNAB) were compared, as well as parameters describing the biopsy effectiveness, with a special focus on FL. In the second analysed period, the frequency of the 'suspicious for malignancy' results was three times lower, while diagnoses of 'malignant neoplasm' were 33% more frequent and the results corresponding to FL decreased by 10%. In respect to FL, specificity of FNAB increased (22.6% vs. 57.4%), but sensitivity decreased (78.8% vs. 50.0%). In respect to other diagnostic categories considered jointly, the sensitivity of FNAB (61.2% vs. 85.7%) and PPV (57.4% vs. 77.8%) increased, and the specificity was similar (95-97%) for both periods. NPV exceeded 95% irrespective of applied classification. Separation of FL with low risk of malignancy affects the values of the parameters describing the effectiveness of FNAB. The improved diagnostic effectiveness of FNAB is also a consequence of epidemiological changes and better selection of thyroid lesions for biopsy.

An Adult Choledochocele Case Presented with Acute Pancreatitis: Treatment by Endoscopic Sphincterotomy and Cyst Unroofing.

To the Editor: Choledochocele is a cystic dilatation of the intraduodenal portion of the common bile duct that can protrude into the duodenum. Although often classified as type III biliary cyst, choledochocele has distinctive demographic and anatomic features, and is associated with a lower risk of malignancy as compared to other types of choledochal cysts. Patients with this condition present with biliary colic, cholangitis, or pancreatitis.1,2 Until recently, transduodenal cyst excision with or without sphincterotomy had been the treatment of choice.3 At present, however, endoscopic sphincterotomy and cyst unroofing have become the treatment of choice.4 We present a case of choledochocele associated with acute pancreatitis that was treated with endoscopic sphincterotomy and cyst unroofing. A 38-year-old woman with a 24-hour history of severe abdominal pain, nausea, and vomiting was admitted to our clinic. On physical examination, mild upper abdominal tenderness was observed. On admission, her amylase level was 3,262 IU/L (reference range, 25 to 125) and her C-reactive protein level was 64 mg/dL (reference range, 0 to 0.8). Transabdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP) revealed a dilated main pancreatic duct, mild peripancreatic fluid collection, and a cystic lesion 4 cm in diameter that was localized to the second portion of the duodenum. Furthermore, MRCP revealed that the cyst had the same intensity as the biliary tract and that the cyst communicated with the main pancreatic duct and common bile ducts (Fig. 1). Duodenoscopy revealed a soft and pedicular mass covered with normal duodenal mucosa, approximately 4×3×3 cm in size, in the medial wall of the duodenum. Cholangiography revealed an intraduodenal cyst communicating with the common bile duct and main pancreatic duct (Fig. 2). The patient had no other symptoms during the 6-month follow-up. Fig. 1 A magnetic resonance cholangiopancreatography image showing that the cyst had the same intensity as the biliary tract and that the cyst communicated with the main pancreatic duct and common bile duct. Fig. 2 An endoscopic retrograde cholangiopancreatography image showing communication between the cystic dilatation of the intraduodenal common bile duct (white arrow) and the pancreatic duct (black arrow). In conclusion, choledochocele should be considered as a differential diagnosis of duodenal cystic lesion. Endoscopic unroofing may be considered as a simple and safe treatment option for choledochocele.

Colorectal microcarcinoids in association with long-term exposure to urinary content: a case report and review of the literature.

Long-term exposure of colonic mucosa to urinary content and its association with increased risk of infection, mechanical and biochemical irritation, and malignancy have been described in the literature. Existing case reports and studies depict the low but distinct risk of malignancy in gastrointestinal segments which come in contact with urinary content as a result of surgical correction of urinary tract abnormalities. However, these reports are largely limited to colonic adenocarcinoma and urothelial cell carcinoma. Late urointestinal carcinoma in patients with ileal incorporation into the urinary tract has also been reported. To the best of our knowledge, however, there is only one case report documenting neuroendocrine (NE) cell hyperplasia in colonic mucosa after long-term cystoplasty. Our case is the first to describe microcarcinoids and diffuse NE hyperplasia occurring in a patient with congenital anorectal anomalies, resulting in long-term exposure of colonic mucosa to fecal stream and urinary content. This case, in conjunction with the reported cases in the literature, raises the distinct possibility of an association between exposure of colonic mucosa to urine and long-term development of malignancy, including NE neoplasms.

Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?<br/>—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery

Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were p p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.

Natural history of incidental pulmonary nodules in children.

As there are no evidence based guidelines for the diagnosis and/or management of pulmonary nodules in children, there is an over reliance on the adult based algorithms when dealing with pulmonary nodules in children. We present our experience of pediatric patients evaluated for incidentally found pulmonary nodules. Retrospective chart review of patients diagnosed with a pulmonary nodule and evaluated at Goryeb Children's Hospital between January 2000 and December 2012. change in the size of the pulmonary nodule between the initial and follow-up imaging. Thirty six patients with pulmonary nodule (21 male/15 female; Median [range] age 15 [5-20] years.) were included in the study. Chest CT was obtained for respiratory symptoms and/or abnormal chest radiograph in 19 (52%). Nine pulmonary nodules (25%) were identified on abdominal CT obtained for abdominal symptoms. A total of 46 nodules were identified in 36 patients. Nine of the pulmonary nodules (9 patients) were ≤4 mm in size, 37 of the pulmonary nodules (27 patients) were >4 mm in size. Twenty-two of the 27 (81%) patients with nodule size >4 mm had follow-up CT: 14 nodules (54%) remained unchanged in size, 5 nodules (19%) decreased in size, and 7 nodules (27%) were not detected. Our review of 36 patients with pulmonary nodules shows no obvious growth of the nodules over the study period, suggesting low risk of malignancy. Routine follow-up chest computer tomography using ACCP/Fleischner Society guidelines may not apply in children without known malignancy.

Ultrasound-guided thyroid nodule biopsy: outcomes and correlation with imaging features

Background and purposeThyroid nodules are ubiquitous on ultrasound but have a low risk of malignancy. Hence, risk stratification is essential before biopysing them. We aim to (a) determine the frequency and predictors of nondiagnostic fine needle aspiration biopsy (FNAB) of thyroid nodules and (b) seek correlation between sonographic features and biopsy outcomes. MethodsBetween January 2010 and April 2013, 559 thyroid nodules underwent ultrasound-guided FNAB. Demographic information was obtained. Prebiopsy ultrasound images were reviewed for size, multiplicity, echotexture, shape, margins, vascularity, calcifications, cervical lymphadenopathy, and extrathyroid extension. Univariate and multivariate logistic regression analyses adjusting for the correlation between multiple nodules obtained from the same patient were performed. ResultsA total of 10.6% of the biopsies were nondiagnostic. Male gender [adjusted odds ratio (OR)=3.78, 95% confidence interval (CI) 1.87–7.66, P<.001] and a taller-than-wide shape (adjusted OR=3.22, 95% CI 1.34–7.75, P=.009) were independent predictors of a nondiagnostic FNAB. There was no significant association with cystic echotexture or a smaller nodule size. Well-defined irregular margins, microcalcifications, and coarse calcifications were independent predictors of malignancy, with specificities above 96% but low sensitivities (59.3%, 44.4%, and 11.1%, respectively). All nodules with cervical lymphadenopathy were malignant. If biopsy is performed when at least one of the above four features are present, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of predicting malignancy are 81.5%, 93.1%, 11.8 and 0.2 respectively. All purely cystic nodules and spongiform nodules were benign. ConclusionsMale gender and taller-than-wide thyroid nodules are independent risk factors for a nondiagnostic FNAB. Prudent use of a combination of sonographic features can help to risk-stratify thyroid nodules for FNAB and may reduce unwarranted FNABs.

The predictive value of structured ultrasonographic staging for thyroid nodules.

'R staging' is a new ultrasonographic scoring system developed and used by our specialist head and neck radiologist for reporting sonographic risk of malignancy to those at our thyroid multidisciplinary team meeting. This study aimed to: classify the R staging system, examine its relationship with the eventual histopathological diagnosis and define its clinical utility. The pre-operative ultrasound scans of 78 patients were assigned an R status by our specialist head and neck radiologist. The final histopathology report for each thyroid nodule was used as the 'gold standard' for analysis. When thyroid nodules were classified as low risk (R stages 1-3) or high risk (R stages 4-5) for malignancy, the sensitivity of R staging was 74.2 per cent and specificity was 80.9 per cent. An R5 status was 100 per cent predictive of malignancy. Our results compare favourably with other suggested ultrasonographic staging systems for thyroid nodules.

Factors associated with influenza vaccination among adult cancer patients: a case–control study

Influenza vaccination is recommended for cancer patients; however, adherence is low. We aimed to identify predictive factors for vaccination among cancer patients. We conducted a case–control analysis of a patient cohort in the 2010–2011 influenza season. We included adult cancer patients with solid malignancies undergoing chemotherapy, and haematological patients with active disease. Patients who died between October and November 2010 (N = 43) were excluded from analysis. Cases received the 2011 seasonal influenza vaccine, and controls did not. Data were obtained from patients' records, and validated through personal interviews. We collected socio-demographic information, and data on the malignancy and co-morbidities and triggers for vaccination and non-vaccination. We performed bivariate and multivariable analyses, in which vaccination status was the dependent variable. Of 806 patients included in analysis, 387 (48%) were vaccinated. Variables associated with vaccination on bivariate analysis were older age, higher socio-economic status, lower crowding index, marital status (widowed > married > single), malignancy type (haematological > solid tumours) and time from diagnosis, low-risk malignancy, diabetes, past vaccination, country of birth (non-Russian origin), and physicians' recommendations. Predictive factors found to be independently associated with vaccination on multivariable analysis were past vaccinations, low-risk malignancy, and country of birth. In the analysis conducted among interviewees (N = 561), recommendations from the oncologist (OR 10.7, 95% CI 5.4–21.2) and from the primary-care physician (OR 3.35, 95% CI 2.05–5.49) were strong predictors for vaccination. We conclude that ‘habitual vaccinees’ continue influenza vaccinations when ill with cancer. Physicians' recommendations, especially the oncologist's, have a major influence on patients' compliance with influenza vaccination.

Automated Screening of Conventional Gynecological Cytology Smears: Feasible and Reliable

Objectives: We tested the ability of automated screening in processing conventional gynecological cytology smears and its efficacy in assessing sample adequacy and stratifying cases for risk of malignancy. Study Design: Cases were retrospectively selected, including unsatisfactory samples and slides with various sorts of artifacts. Automated screening was performed using the FocalPoint GS Imaging System (Becton Dickinson, Franklin Lakes, N.J., USA), with classification into five quintiles. For agreement purposes, cases were grouped into high risk for malignancy (quintiles 1 and 2) and low risk for malignancy (quintiles 3, 4 and 5). Results: A total of 120 cases (median age 37.5 years, range 18-85) were included in the study. Eighty-three cases (69.2%) could be successfully classified into quintiles. When divided by risk, 31 cases were placed in the high-risk and 52 in the low-risk group. The overall sensitivity and specificity of the automated analysis was 100 and 70.3%, respectively. Conclusions: Automated analysis could analyze the majority of conventional smears, including one case previously screened as unsatisfactory. All malignant and high-grade lesions were correctly classified into the high-risk group. Broad use of this automation system could potentially decrease screening time and augment the efficacy in detecting precursor neoplastic changes in cervical cytology smears.

Pulmonary Nodule: A Comprehensive Review and Update

The incidental detection of solitary pulmonary nodules and ground-glass nodules has increased substantially with the use of computed tomography as a diagnostic modality and is expected to rise exponentially as lung cancer screening guidelines are more widely implemented by primary care physicians. The lesions should then be classified as low, indeterminate, or high risk for malignancy, depending on the clinical and radiological characteristics. Once classified, these lesions should be evaluated and managed as per expert consensus-based recommendations for performing follow-up computed tomography scans and tissue sampling depending on the pretest probability. When weighing the risks and benefits of further investigations, patient preference and suitability for surgery should be taken into consideration as well.

Evidence based imaging strategies for solitary pulmonary nodule.

Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.

Giant cell tumour of a temporomandibular joint presenting as a parotid mass: Case report and analysis of the 19 cases in the literature

Giant cell tumour (GCT) in the parotid region is a rare lesion whose origin can be divided into three compartments: giant cell tumour of the salivary gland (GCT-SG), giant cell tumour of the bone (GCT-bone) and giant cell tumour of the soft tissue (GCT-ST). A low risk of malignancy has been observed, in which all of them were GCT-SG.We present a case of GCT in the parotid region and review the features of GCT in origin, immunohistochemical characteristics, treatment of choice and disease outcome.

Incidence of unplanned oophorectomy at laparoscopic ovarian cystectomy for clinically benign cysts

Laparoscopic surgery is the preferred approach in women with ovarian cysts and a low risk of malignancy, and the aim in young women should be to preserve the ovary. We are not aware of any data on the success of conservative surgery in preserving the affected ovary and this is the reason why we decided to investigate the incidence of unplanned oophorectomy, when a woman is originally scheduled for laparoscopic ovarian cystectomy for clinically benign cysts. We reviewed the medical notes of the 123 women who underwent surgery for clinically benign ovarian cysts between November 2004 and May 2012. The operative procedures performed were ovarian cystectomies (n = 119), salpingo-oophorectomy (n = 2) and fenestration (n = 2). In total, 61 women underwent a concomitant procedure. In our study, we found that planned laparoscopic cystectomy was mostly successful, with only 1.6% of patients in our series requiring unplanned oophorectomy.

Salivary gland tumors: A review of 171 cases, with particular reference to histological types, site, age and gender distribution

Background: Salivary tumors are uncommon, being of low incidence worldwide. This study aimed to assess cases collected in this series of salivary gland tumors in regard to histopathological typing, in relation to age, site and gender. Materials and methods: This is a retrospective study; cases were collected from public and private laboratories. A total number of 171 cases were collected. The slides were reviewed and reclassified for histopathological typing according to WHO classification 2005. Results: Benign tumors were more common than malignant tumors. The most common histological type was benign mixed tumor, followed by Warthin’s tumor. The most common malignant tumor was adenoid cystic carcinoma. One hundred twenty three cases out of 171 cases developed in the parotid, the most common site for salivary tumors, with a low risk for malignancy, while minor salivary glands show higher risk for malignancy. Salivary tumors developed in females more than males with a ration 1.4:1, the peak incidence in the sixth and seventh decades for both benign and malignant tumors. There was no significant difference between right and left tumors, bilateral tumors were uncommon. Conclusions: The results of this study reveal similarity to the findings of other studies on salivary tumors done in Iraq and the neighboring countries.

An Unusual Intra-abdominal Calcification in a Plain Film

A65-year-old woman with a history of hypertension visited the orthopedic clinic for chronic low back pain. The physical examination showed nothing remarkable. A lateral spine radiograph revealed only slight degenerative changes of the lumbar spine but incidentally disclosed a huge calcification over the paraspinal region (Figure 1A, arrow). An abdominal computed tomography with contrast enhancement showed a 4.0 × 3.1 × 3.6-cm-sized soft tissue mass with a lobulated contour, heterogeneous enhancement, and thick and irregular calcifications, which was attached to the posterior wall of the gastric fundus, with loss of the intervening fat plane (Figure 1B, arrow). Meanwhile, a right hepatic cyst was also noted (Figure 1B, asterisk). The calcified mass depicted on the plain film was initially mistaken as a retroperitoneal lesion. The subsequent abdominal computed tomography confirmed its location in the stomach. Upper gastrointestinal endoscopy showed a smooth surfaced submucosal lobulated mass larger than 3 cm in the fundus without ulceration. Therefore, laparoscopic partial gastrectomy was performed. The pathology of the resected tumor revealed spindle-shaped neoplastic cells with low risk of malignancy and thick calcifications (Figure 2). 1. Fletcher C.D. Berman J.J. Corless C. et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002; 33: 459-465 Abstract Full Text Full Text PDF PubMed Scopus (2843) Google Scholar The tumor cells showed positive reactivity for CD117 and CD34 but showed negative reactivity for smooth muscle actin and S-100. The pathology confirmed the diagnosis of gastrointestinal stromal tumor (GIST). Figure 2 View Large Image Figure Viewer

Malignancy Rate of Thyroid Nodules Defined as Follicular Lesion of Undetermined Significance and Atypia of Undetermined Significance in Thyroid Cytopathology and Its Relation with Ultrasonographic Features

Fine-needle aspiration biopsy (FNAB) has been widely accepted as the most accurate, safe, and cost-effective method for evaluation of thyroid nodules. The most challenging category in FNAB is atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). The Bethesda system (BS) recommends repeat FNAB in that category due to its low risk of malignancy. In our study, we aimed to investigate the malignancy rate of thyroid nodules of AUS and FLUS and whether there were different malignancy rates among the different patterns in this category, and to evaluate the presence of biochemical, clinical, and echographic features possibly predictive of malignancy related to AUS and FLUS. Data of 268 patients operated for AUS and FLUS cytology were screened retrospectively. Ultrasonographic features and thyroid function tests, thyroid antibodies, scintigraphy, and histopathological results were evaluated. Of the 268 patients' results, 276 nodules are evaluated. Malignancy rates were 24.3 % in the AUS group, 19.8 % in the FLUS group, and 22.8 % in both groups. In the evaluation of all nodules, the predictive features of malignancy are hypoechogenicity and peripheral vascularization of the nodule. We determined that the malignancy rates in these nodules are higher than that in the literature rate. This high ratio may be due to the fact that we studied only patients who underwent surgery. The ultrasonographic features alone may be insufficient to predict the malignancy; therefore, all the clinical and ultrasonographic features must be considered in the evaluation of the thyroid nodules. In addition, we think that the recommended management of repeat FNAB in these groups must be reconsidered with the clinical and ultrasonographic features.

Improvement of the cytological diagnostic accuracy of follicular thyroid lesions by the use of the Ki‐67 proliferative index in addition to cytokeratin‐19 and HBME‐1 immunomarkers: a study of 61 cases of liquid‐based FNA cytology with histological controls

To evaluate HBME-1, cytokeratin-19 (CK-19) and Ki-67 immunomarkers in order to increase the diagnostic accuracy of preoperative thyroid fine needle aspiration (FNA) cytology. Immunocytochemistry against HBME-1, CK-19 and Ki-67 was performed on 123 thyroid FNAs processed by liquid-based cytology (LBC). Statistical analysis was carried out on 61 cases with histological control and sufficient material for one or more of the three markers. The Bethesda System was used for cytological diagnosis. Taking into account all the cytological categories, with a cut-off of 30% of positive cells, HBME-1 (n=47) and CK-19 (n=53) showed a sensitivity for malignancy of 66.7% (95% confidence interval, 53.2-80.1) and 90.5% (82.6-98.4) and a specificity of 90.6% (82.3-99) and 75% (63.3-86.7), respectively. For Ki-67 (n=54) with a cut-off of 1% of positive cells, the sensitivity was 85.0% (75.5-94.5) and the specificity 70.6% (58.4-82.7). In the follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) category (n=37), which was the focus of the study, papillary thyroid carcinomas (PTCs) were less numerous (four cases, three of which were the follicular variant), the positivity of the three immunomarkers combined showed an overall accuracy of 91% (21/23). The mean percentage of Ki-67-positive cells was increased in malignant lesions, with the exception of follicular variant PTCs: 16%±15.6% in two follicular carcinomas, 4.8%±3.2% in 13 classical PTCs, 1%±1.2% in five follicular variant PTCs and 0.5%±1.9% in 34 non-malignant lesions. Immunocytochemistry using HBME-1, CK-19 and the Ki-67 proliferative index increased the diagnostic accuracy of FNA in the FN/SFN category of the Bethesda System, which may help to distinguish lesions in this category with a low or high risk of malignancy. Thus, clinical management would be improved.