Negative Fine Needle Aspiration Cytology Research Articles

Diagnostic Accuracy of FNAC in Tuberculous Cervical Lymphadenitis- Experience from a Tertiary Care Centre

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tubercu- lous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospi- tal Karachi’s ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gen- der of the patients, the duration of disease noted down. The dominating nodes’ FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients’ average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was ob- served in 10 (20%) of patients. With a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis.

Determining the Best Thyroid Imaging Reporting and Data System: A Prospective Study Comparing the Diagnostic Performance of ACR, EU, and K TIRADS in the Evaluation of Thyroid Nodules.

Background Many different risk stratification systems have been formulated for thyroid nodules, differing in their fine-needle aspiration cytology (FNAC) indication, suggesting a lack of consensus around the world. Purpose This prospective study was conducted to find the best guideline for risk stratification, for a better malignancy yield, and with reduced rates of negative FNACs among three Thyroid Imaging, Reporting, and Data System (TIRADS) guidelines. Materials and Methods A total of 625 thyroid nodules with conclusive FNAC or histopathological diagnosis were included in the study. Various sonographic parameters were recorded. They were classified into categories as per the three guidelines and compared with FNAC diagnosis. The guidelines were evaluated in terms of sensitivity, specificity, predictive values, and diagnostic accuracy. Sensitivity and specificity were compared by McNemar's test. Results American College of Radiology (ACR) TIRADS had the highest diagnostic accuracy (56.8%), specificity (50.75%), positive predictive value (23.92%), lowest rates of negative FNACs (76.08%), and high negative predictive value (97.84 %). Korean (K) TIRADS had the maximum sensitivity (97.75%), highest negative predictive value (98.44%), and gross malignancy yield. European TIRADS was between the two other guidelines in most parameters with specificity like K TIRADS. Conclusion All the three guidelines are very good screening tools, with comparable high sensitivity. ACR TIRADS is better in terms of specificity and reduced rates of negative FNACs. Including the presence of a suspicious cervical lymph node as a criterion and more frequent follow-up might further improve the diagnostic performance of the guideline.

Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology.

The presurgical evaluation of cervical lymph nodes (CLNs) in the management of thyroid malignant lesions is crucial for the extent of surgery or detection of metastases. In these last decades, fine-needle aspiration cytology (FNAC) has been shown to have a central role in the detection of nodal thyroid metastases. It is adopted for the possibility of confirming suspected metastases either in the presurgical phase or in the follow-up of patients after thyroidectomy. However, FNAC from CLNs can be challenging, especially in cystic lesions. In this regard, the combination of FNAC with thyroglobulin measurement in the eluate from FNAC (Tg-FNAC) seems to increase the sensitivity of FNAC in the detection of CLN metastases. The role of FNAC and Tg-FNAC was investigated in this series. One hundred fifty-three prospective cytological samples of CLNs were studied along with surgical follow-up in the period between 2020 and 2022. Immunocytochemistry (ICC) was performed on liquid-based cytology-stored material. One hundred fifty-nine enlarged CLNs included 19 central lymph nodes and 140 CLNs. Forty-two thyroidal CLN metastases and 117 reactive lymph nodes were found. Thirty-one CLN dissections were performed in patients with a previous diagnosis of thyroid carcinoma (mostly papillary thyroid carcinoma [PTC]), whereas 128 CLNs with a concomitant suspicious and/or malignant thyroid nodule were found. There was one false-positive case among all the malignant histologically confirmed cases, and two of 117 reactive CLNs (1.7%) had a diagnosis of metastatic PTC. Markedly high Tg-FNAC was found in all metastatic CLNs, including 11 cystic metastatic CLNs detected by Tg-FNAC with a negative FNAC. ICC (including Tg, CK-19, and LCA) recognized nine cases with low Tg-FNAC and scant suspicious thyrocytes. Tg-FNAC plus FNAC diagnosed 94.2% of malignancies. FNAC represents a valid method for the evaluation of CLNs, especially combined with ICC. Tg-FNAC is an additional method with a useful role in FNAC.

TRU-CUT ISOLATED PAROTID METASTASIS FROM RENAL CELL CARCINOMA: AN UNUSUAL PRESENTATION AND REVIEW OF LITERATURE

Background: Renal cell carcinoma with isolated metastasis to the parotid gland is extremely rare. Slow growth, low level of suspicion and negative Fine needle aspiration cytology (FNAC) often delay the diagnosis. A high level of suspicion of metastatic disease from a specic site is important, otherwise can be missed for a benign swelling leading to delayed treatment and poorer prognosis. A 59-year-old Case presentation: male presented with a swelling in the right preauricular area 5 years post right radical nephrectomy for right renal cell carcinoma (RCC). The examination was suggestive of a benign swelling. FNAC was done twice, which was inconclusive. A Tru-cut biopsy of the lesion revealed metastatic RCC. MRI revealed a dumbbell type of tumor extending deep into the gland and encasing vessels. PET-CT was negative for metastasis to the rest of the body. The patient received targeted therapy followed by radiation therapy with imaging showing non-progression of the disease. Conclusion: Metastatic disease should be considered whenever a parotid mass is detected in patients with an RCC history. Examination ndings can be misleading; hence dedicated imaging is critical. Small parotid metastasis can be cured with surgery. A combination of chemotherapy and radiation therapy can palliate the unresectable disease.

Fine Needle Aspiration Cytology's Role in the Diagnosis of Ovarian Tumor.

Fine needle aspiration cytology (FNAC) is a cost-effective, minimally invasive technique for diagnosing a wide range of benign and malignant lesions. However, there are a number of reasons why its use is limited in the diagnosis of ovarian cancer, such as the fear of tumor cells spilling into the peritoneal cavity and the difficulty of subtyping with cytology alone. In experienced hands, FNAC is a safe, cost-effective procedure with acceptable diagnostic accuracy. In ovarian cystic lesions, secondary degenerative changes and the sample's low cellularity were the primary causes of false negative FNAC results. Preparing cell block can partially avoid this, so we recommend doing so. All of the clinical and sonographic findings, in addition to the FNAC findings, the preparation of the cell block, and the application of immunohistochemistry, need to be taken into consideration in order to arrive at an accurate diagnosis.

Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.

Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients. We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results. In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; p < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; p < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence. The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.

The accuracy of fine needle aspiration cytology in the clinical diagnosis of minor salivary gland tumours

The objective of this study was to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy for the clinical diagnosis of minor salivary gland tumours (MSGTs). This retrospective study of 32 MSGT cases was conducted over a 5-year period. Clinical features including age, sex, and location of the tumour were obtained from the patient clinical records. All cases were also assessed histologically according to the 2017 World Health Organization Classification of Head and Neck Tumours. The results of FNAC and biopsy were correlated with those of histopathology, and their sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as the gold standard. Eighteen malignant MSGTs (56.3%) and 14 benign MSGTs (43.8%) were diagnosed by pathological diagnosis. The most common malignant tumour was mucoepidermoid carcinoma (seven cases, 38.9%). Most benign cases were pleomorphic adenomas (13 cases, 92.9%). FNAC was performed for 23 cases and biopsy for 13 cases. The sensitivity and specificity of FNAC were 66.7% and 91.0%, respectively, while those of biopsy were 90.0% and 100.0%, respectively. Although FNAC is a minimally invasive and cost-effective procedure, it is less accurate than biopsy in the assessment of MSGTs. Repeated FNAC or biopsy should be considered in negative and unsatisfactory FNAC cases.

99mTc-MIBI SPECT/CT SCINTIGRAPHY AND ULTRASOUND OF THE ANTERIOR NECK REGION IN DIAGNOSING PARATHYROID GLAND PATHOLOGY IN PATIENTS WITH THYROID NODULES.

SUMMARYParathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.

Abstract P3-03-20: Which biopsy is preferred to stage the axilla under ultrasound guidance in early breast cancer patients: Fine-needle aspiration cytology or core needle biopsy?

Abstract Background: Preoperative axillary ultrasound (AUS) offers the potential to identify clinically axillary negative patients with axillary lymph node (ALN) metastasis directly to axillary lymph node dissection (ALND) with avoid of unnecessary sentinel lymph node biopsy (SLNB) except Z0011 candidates. Which biopsy should be preferred is pendent with lack of enough prospective studies. The purpose of our study was to compare the accuracy of ultrasound guided fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) for the designated ALN prospectively. Methods: Consecutive patients with histologically confirmed breast cancer from April, 2010 to December, 2014 were preliminary screened for our study. All the candidate patients were prospectively assessed by ipsilateral AUS before initial treatment regardless of clinical ALN status.Abnormal lymph nodes were characterized by round shape with uniform or eccentric thickening, focal bulging or irregularity of the cortex displacement, obliteration of the hilum; or total loss of recognizable lymph node architecture. If suspicious ALN was identified, both ultrasound-guided FNAC and CNB were performed for the same designated ALN.The diameter in longitudinal section, transverse section and maximum cortical thickness of the target node was recorded. When more than one abnormal lymph node was present, the most abnormal-appearing node was sampled. The target tissue for biopsy was hypoechoic thickened cortex. Patients with a positive FNAC/CNB underwent ALND, and those with a negative FNAC and CNB biopsy or without suspicious ALN by AUS underwent SLNB. The paired parameters of FNAC and CNB were compared using McNemar's exact test. Results: 705 consecutive patients were screened and 558 patients (561 axillae) underwent AUS evaluation with confirmed ALN pathological results.145 patients (146 axillae) with both FNAC and CNB were finally enrolled. Final histopathological results showed that 83.6% (122/146) were node positive (5 micro-metastases were considered negative). Sensitivity of FNAC and CNB was 67.2% (82/122) and 91.8% (112/122). Overall accuracy of FNAC and CNB was 72.6% (106/146) and 93.2% (136/146). Negative predictive value (NPV) of FNAC and CNB was 37.5% (24/64) and 70.6% (24/34). There was significant difference in sensitivity, overall accuracy and NPV between FNAC and CNB (p&amp;lt;0.001). 80.6% (29/36) FNAC negative and CNB positive patients have ALN cortical thickness of 3.3-7.2 mm. Conclusion: CNB is more sensitive and accurate than FNAC to stage the axilla under ultrasound guidance in operable breast cancer patients, especially in patients with ALN cortical thickness of 3.3-7.2 mm. Citation Format: Zhou M, Qiu J, Chen J, Hu Y, Deng Y, Zheng S. Which biopsy is preferred to stage the axilla under ultrasound guidance in early breast cancer patients: Fine-needle aspiration cytology or core needle biopsy? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-20.

Abstract P3-01-13: FNAC: A predictor of final number of involved nodes at axillary clearance

Abstract BACKGROUND: A vital part of pre-operative breast cancer assessment is axillary staging. Fine needle aspiration cytology (FNAC) is performed on clinically or radiologically positive axillary nodes in breast cancer. Our study looks at the sensitivity of performing FNAC in these patients and whether positive FNAC of axillary nodes can predict the final number of diseased nodes on completion axillary clearance (ANC). METHODS: All primary breast cancer patients undergoing FNAC between Oct 2009 to Oct 2011 were identified from electronic computer records. Data was collected on FNAC positivity, whether sentinel lymph node biopsy (SLNB) was performed, total number of nodes harvested at ANC and also the total number of diseased nodes at ANC. Patients who underwent neoadjuvant chemotherapy after a positive FNAC were analysed separately. RESULTS: Of the 230 patients who underwent FNAC, 130 were positive (56.5%). Of those who had a negative FNAC, 32% had a positive SLNB. We compared the ANC results of those who were FNAC positive (Group 1) with those who were FNAC negative but SLNB positive (Group 2). There was no significant difference in the mean number of harvested nodes at ANC between the two groups (mean= 17, p=0.14 on t-test). There was a significant difference in the number of diseased nodes in group 1 (mean = 7 nodes) compared with group 2 (mean = 3 nodes). In group 1, 56% of patients had 4 ≥ diseased nodes compared with 8.5% of patients in group 2. Neoadjuvant chemotherapy was given to 28 patients with a positive FNA. In this cohort, the mean number of positive nodes at axillary clearance was 2 and 10 % of patients had 4≥ diseased nodes on ANC. There was no significant difference in mastectomy versus breast conserving surgery rates between FNA positive and negative patients (p= 0.28 on Chi Square). The sensitivity of performing an FNAC was 81% in this study. Outcome of Patients undergoing Axillary Fine Needle Aspiration Cytology Group 1:FNAC positiveGroup2: FNAC negative, SLNB positive Mean No Harvested Nodes at ANC1816p=0.14Mean No of diseased nodes at ANC73p&amp;lt;0.05% of Patients with 4 or more diseased nodes at ANC568.5p&amp;lt;0.05% of Patients who had Breast Conserving Surgery5453p=0.28Key: FNAC:fine needle aspiration cytology, SLNB: Sentinel lymph node biopsy, ANC: Axillary clearance CONCLUSION: This study provides a predictor of the number of diseased axillary nodes in those with positive FNAC preoperatively. Over 50% of patients with a positive FNA have four or more diseased nodes compared with less than 10% in the FNAC negative but SLNB positive group. After neoadjuvant chemotherapy, FNA positive patients have a similar disease burden in the axilla as the FNAC negative but SLNB positive patients. This information can help to guide pre-operative discussions on the likely disease burden and need for adjuvant therapies such as chemotherapy and radiotherapy. Being able to predict the need for radiotherapy in particular can guide surgical decisions regarding type and timing of reconstructions to reduce the risk of surgical complications. Citation Format: Khan A, Hussain N, Irvine T. FNAC: A predictor of final number of involved nodes at axillary clearance [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-13.

The impact of axillary ultrasound with biopsy in overtreatment of early breast cancer

Purpose(a) To compare the axillary tumor burden detected by fine-needle aspiration cytology (FNAC) versus sentinel lymph node biopsy (SLNB). (b) To evaluate the relationship between axillary tumor burden and the number of suspicious lymph nodes detected by axillary ultrasonography (US). (c) To calculate the false-positive and false-negative rates for FNAC in patients fulfilling ACOSOG Z0011 criteria. MethodsRetrospective multicenter cross-sectional study of 355 pT1 breast cancers. SLNB and axillary lymph node dissection (ALND) were gold standards. Low axillary burden (≤2 positive lymph nodes); high burden (>2 positive lymph nodes). Patients ACOSOG Z0011: false-positive (positive FNAC+low burden), false-negative (negative FNAC+high burden). ResultsHigh axillary burden: in entire series 38.5% FNAC+ vs. 5.7% SLNB+ (p<0.0001). In subgroup fulfilling ACOSOG Z0011 criteria: 45.5% vs 6.7%, respectively (p<0.001).61 positive axillary US. With 1 suspicious node on axillary US: 95.6% had ≤2 involved nodes (including pN0); with 2 suspicious nodes: 60% had >2 involved nodes. In ACOSOG Z0011 patients, with 1 suspicious node, 93.7% had ≤2 involved nodes. Of the 37 FNAC in ACOSOG Z0011patients: 54.5% false-positives for high burden; 3.8% false-negatives. ConclusionsFNAC-positive tumors have greater axillary burden, even in patients fulfilling ACOSOG Z0011 criteria. Using axillary US/FNAC to triage patients meeting Z0011 criteria may result in axillary overtreatment. The number of suspicious nodes seen in axillary US is related with the final axillary burden and should be taken into account when deciding to do FNAC in patients fulfilling ACOSOG Z0011 criteria.

Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?

ObjectiveTo determine the diagnostic accuracy of ultrasound guided fine needle aspiration (FNA) cytology and core needle biopsy (CNB) of axillary lymph nodes pre-operatively in newly diagnosed operable primary breast cancer.MethodsAn observational study for all patients who underwent pre-operative FNA cytology or CNB during September 2013–August 2014 was conducted at our institution (County Hospital, Stafford, UK). The accuracy of pre-operative axillary staging was compared to the post-operative histology. For this sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated.ResultsA total of 81 consecutive patients were evaluated by axillary ultrasound. Patients identified with potentially abnormal axillary lymph nodes underwent definitive surgery. Seven patients had positive cytology/histology who did not undergo definitive surgery and were excluded (N = 74) from the study. CNB had a sensitivity of 100% versus 72% (p = 0.006) for FNA cytology. Both had 100% specificity and PPV. The NPV of CNB was 100% versus 72% for FNA cytology. Among 35% of patients that underwent FNA cytology required repeat procedure versus 2.6% of patients who underwent CNB. 0/38 patients that had CNB required a second operation while 7/43 patients with negative FNA cytology had positive lymph nodes identified at sentinel lymph node biopsy (SLNB) requiring surgical re-intervention with axillary node clearance.ConclusionCNB was superior to FNA cytology when interrogating the axilla. We recommend CNB to be adopted routinely in pre-operative axillary staging to reduce surgical re-intervention.

Long-term results of ultrasound guided fine needle aspiration cytology in conjunction with sentinel node biopsy support step-wise approach in melanoma

BackgroundUS-FNAC is a common diagnostic tool in the work-up of many cancers. Results in melanoma were initially poor (sensitivity 20–40%). Introduction of the Berlin Morphology criteria has shown potential improvement up to 65–80% in selected patients. AimThis cohort study evaluates the long-term survival outcome of melanoma patients undergoing Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) prior to sentinel node biopsy (SNB) or direct lymphadenectomy. MethodsBetween 2001 and 2010 over 1000 consecutive melanoma patients prospectively underwent targeted US-FNAC prior to SNB. The Berlin US morphology criteria: peripheral perfusion (PP), loss of central echoes (LCE) and balloon shape (BS) were registered. FNAC was performed if any factor was present. All patients underwent SNB or lymphadenectomy in case of positive FNAC. ResultsMedian follow-up was 61 months (IQR 40–95). SN positivity rate was 21%. Survival analyses demonstrated that patients with positive US-FNAC had poor survival. After adjustment for SN status and other known prognostic features, patients with positive US-FNAC (hazard ratio (HR) 1.80, 95% CI 1.10–2.96) had worse survival than patients with normal US (reference). Patients with suspicious US and negative FNAC (HR 1.13, 95% CI 0.71–1.78) had survival comparable to patients with normal US. ConclusionsThe long-term US-FNAC results support this step-wise approach to melanoma patients. Patients with positive US-FNAC have a poor survival and can be spared a SNB. Patients with suspicious US and negative FNAC should undergo SNB to detect microscopic occult disease. Completely US-FNAC negative patients might only require follow-up and no SN staging at all.

The value of preoperative ultrasound guided fine-needle aspiration cytology of radiologically suspicious axillary lymph nodes in breast cancer.

Background:Preoperative ultrasound (US) and eventually US-guided fine-needle aspiration cytology (FNAC) of suspicious axillary lymph nodes (ALN) is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB) procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure.Materials and Methods:A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN) FNAC cases were reviewed and possibly missed metastatic cases (2) were immunostained with the epithelial marker AE1/AE3.Results:There were no false positives, whereas 16 cases were FN. In all but one case the FN's represented sampling error. Half of the 16 FN cases in this series were macrometastases.Discussion:About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection.

Utility of Fine Needle Aspiration Cytology in the Evaluation of Breast Lesions

Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. A total of 222 breast aspirates were studied. Histo-cytopathological correlations were obtained in 91 cases. All the aspirates were stained with Haematoxylin and Eosin (H andE) stain. Among 222 patients, 217 were females and 5 were males. Benign breast lesions were found in 144 cases (64.87%); among which fibroadenoma (30.18%) was the commonest lesion which was observed. Malignancy was observed in 69 cases (31.08%); among them, ductal carcinoma was the predominant lesion (29.28%) which was seen. Histopathological confirmations were obtained in 90 cases out of 91 cases in which histo-cytopathological corrections were possible. All 45 malignant aspirates were confirmed by histopathology. Benign reports were confirmed in 45 out of 46 cases by doing histological examinations; except one case which was diagnosed as malignant by studying its histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 97.82% and 100% respectively, with 100% positive predictive value and 97.85% negative predictive value. Diagnostic accuracy of FNAC in the present study was found to be 98.90%. It is important to remember that a negative FNAC of a breast lesion does not preclude the diagnosis of a carcinoma, particularly in presence of a clinical suspicion of malignancy and/or an abnormal mammogram.

Effect of previous radiotherapy on cervical lymph node fine‐needle aspiration cytology diagnostic accuracy in head and neck cancers

It is not uncommon for head and neck surgeons to encounter patients with previous neck irradiation that require fine-needle aspiration cytology (FNAC) for assessment of neck mass. It had been observed that the diagnostic performance of FNAC appears to be poorer among patients with previous irradiation. However, to the best of our knowledge, the effect of previous irradiation on diagnostic performance of FNAC has never been studied. Retrospective study. A computer search was performed to identify all patients who had been treated under the Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, from January 2008 to December 2010. We retrospectively retrieved all FNAC of cervical lymphadenopathy procedures, and only cases with subsequent histologic confirmation were included. All patients with squamous cell carcinoma of the head and neck (HNSCC) were included. When compared to patients without previous irradiation, FNAC among patients with history of previous irradiation had comparable specificity (100% vs. 88%) and positive predictive value (100% vs. 89%) but significantly worse sensitivity (82% vs. 40%), negative predictive value (74% vs. 37%), and accuracy (88% vs. 54%). History of previous irradiation was found to be strongly associated with false-negative cytologic results among those with positive final histology (60% vs. 18%; P = .001). FNAC remains an important diagnostic tool in assessment of cervical nodal status in HNSCC. However, our study showed that false-negative rate is significantly higher among patients with previous neck irradiation. Negative FNAC results in this group of patients should be interpreted with caution.

Fine-Needle Aspiration Cytology: An Advancing Horizon

The current practice of “Fine Needle Aspiration Cytology (FNAC) has established itself as an important modality in the diagnosis and management of superficial and deep seated lesions throughout the body. With this wide employment of FNAC, the cytopathologists play a pivotal role in the management and therapeutic decisions that are based on the diagnosis of these limited FNAC samples. Furthermore, the use of FNAC samples for biomarker research is advancing rapidly and is being widely investigated and applied for the treatment and prognostic purposes. In this special issue, we have made an attempt to provide a “flavor” of the current practice of FNAC with an emphasis on correlation of tissue biopsies with PET results, FNAC of breast, liver, pulmonary, and head and neck lesions. Similarly, the use of FNAC in the diagnosis of Langerhans cell histiocytosis, neuritic leprosy, and granulomatous inflammation is also discussed. With the increasing use of image-assisted FNAC, pathologists are now an integral part in the diagnosis and management of the deep seated lesions. In lieu of this, it has become important for the pathologists to be aware of the limitations of different imaging techniques. The paper on the correlation of tissue biopsies with PET results discusses the limitations of an increased SUV value on PET scan. The use of fine needle aspiration cytology has been proven to give fast, economical, and valuable diagnosis of palpable breast lumps. In this issue, the role of FNAC in the evaluation of breast lump in a high patient volume center is addressed with emphasis on the importance of skill and training for both pathologists and technicians to prevent suboptimal sampling, thus, increasing the reliability of the procedure. Another important but not commonly discussed aspect of breast FNAC—the nonmalignant categories—is also addressed, with a review of the cytomorphology of benign breast lumps, some of which could be mistaken for malignancy due to the diaphanous appearance and overlapping cytologic features. The false negative and false positive FNAC is further discussed in detail so as to avert misinterpretation. These provide practical information for readers when dealing with FNAC of breast lesions. The paper on liver FNAC covers various aspects and discusses the role of FNAC in liver lesions. There is an active debate about the preoperative/pretransplantation diagnostic role of FNAC of hepatocellular carcinoma (HCC) and precursor lesions, especially in the face of advances in dynamic imaging techniques. New trends in personalized molecular targeted therapy require better characterization and prediction of HCC behavior. FNAC biopsy technique is still the most minimally invasive approach for the procurement of tumor and peritumoral tissue for molecular studies. Thus, in the near future, hepatic FNAC is likely to become a point of care in the management of HCC patients, especially inoperable cases. In the current era of personalized medicine, the FNAC diagnosis of nonsmall cell carcinoma for a pulmonary nodule is no longer considered an adequate diagnosis. Pathologists are often required to further subclassify these in to adenocarcinoma and squamous cell carcinoma. With the increasing use of image-assisted FNAC including endobronchial ultrasound guided FNAC (EBUS-FNA), cytologic or small biopsy material has become the only form of tissue available for diagnosis. The paper on FNAC of pulmonary lesions reviews the current concepts in the suitability and accuracy of FNAC in lung cancers including diagnosis, classification, use of ancillary techniques, and prognostic marker assessment. FNAC is a valuable technique in the workup of nodules and masses arising within the head and neck region. It is primarily utilized to confirm or exclude the diagnosis of malignancy involving head and neck organs especially lymph nodes, thyroid, and salivary glands. It has been shown that FNAC of salivary gland lesions is a valuable way to preoperatively assess lesional tissue, determine the need for surgical intervention, and assist in planning the appropriate surgical approach prior to resection. In this issue, the manuscript on cytologic diagnosis of mucoepidermoid carcinoma discusses the role of FNAC in the diagnosis of mucoepidermoid carcinoma (MEC), the common malignant tumor affecting parotid gland. In addition, it also brings forth how the rare and recently described oncocytic variant can pose problems in the diagnosis of MEC. In conclusion, this special issue includes a potpourri of topics which provides a thoughtful glimpse into various techniques, diagnostic ability, and limitations of the current practice of FNAC. Darshana Jhala Aileen Wee Gary Tse Zubair Baloch

Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy

In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/−FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer.Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47–64%) and 90% (84–93%) for US alone, and 76% (61–87%) and 100% (65–100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%.All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/−FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%.In this study, a positive pre-operative US+/−FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure.

Prognostic factors and follow-up of patients with differentiated thyroid carcinoma with false negative or nondiagnostic FNAC before surgery. Comparison with a control group

Since the clinical implementation of fine needle aspiration cytology (FNAC) to diagnose thyroid carcinoma, few patients remain misdiagnosed and little is known about their clinical outcomes. An observational retrospective study was carried out to analyse prognostic factors and follow-up of patients with differentiated thyroid carcinoma (DTC) not disclosed by FNAC before surgery, compared to a control group. From October 2003 to July 2010, 308 patients underwent surgery as treatment for nodular goitre and 53 had DTC. Cases were 12 subjects with DTC and benign (n=7) or nondiagnostic (n=5) FNAC. Controls were 39 subjects with DTC and suspicious (n=19) or malignant (n=20) FNAC. Prognostic factors, recurrence and survival rates were compared. Cases had longer time from FNAC to surgery than the control group (86.8±74.1 vs. 16.4±23.8weeks; P<0.001), higher prevalence of follicular carcinoma (33.3 vs. 2.6%; P=0.009), and of two-time total thyroidectomy (75 vs. 30.8%; P=0.016). Average follow-up was 42.7±25.3months (2-86months). There were no deaths. Disease-free survival for cases was 66.9±5.8months, and for controls 78.7±3.9months (P: ns). In patients with DTC, the result of the FNAC performed before surgery was not an independent predictor of recurrences or mortality in the first 7years of follow-up. Thus, false negative or nondiagnostic FNAC in a patient with DTC does not seem to be a primary prognostic factor, but it may reveal other adverse prognostic factors such as longer time to therapy and higher prevalence of follicular carcinoma that may influence long-term outcomes.

Rotterdam Criteria for Sentinel Node (SN) Tumor Burden and the Accuracy of Ultrasound (US) -Guided Fine-Needle Aspiration Cytology (FNAC): Can US-Guided FNAC Replace SN Staging in Patients With Melanoma?

Sentinel node (SN) status is the most important prognostic factor for overall survival (OS) for patients with stage I/II melanoma, and the role of the SN procedure as a staging procedure has long been established. However, a less invasive procedure, such as ultrasound (US) -guided fine-needle aspiration cytology (FNAC), would be preferred. The aim of this study was to evaluate the accuracy of US-guided FNAC and compare the results with histology after SN surgery was performed in all patients. Four hundred consecutive patients who underwent lymphoscintigraphy subsequently underwent a US examination before the SN procedure. When the US examination showed a suspicious or malignant pattern, patients underwent an FNAC. Median Breslow thickness was 1.8 mm; mean follow-up was 42 months (range, 4 to 82 months). We considered the US-guided FNAC positive if either US and/or FNAC were positive. If US was suggestive of abnormality, but FNAC was negative, the US-guided FNAC was considered negative. US-guided FNAC identified 51 (65%) of 79 SN metastases. Specificity was 99% (317 of 321), with a positive predictive value of 93% and negative predictive value of 92%. SN-positive identification rate by US-guided FNAC increased from 40% in stage pT1a/b disease to 79% in stage pT4a/b disease. US-guided FNAC detected SN tumors more than 1.0 mm in 86% of cases, SN tumors of 0.1 to 1.0 mm in 46% of cases, and SN tumors less than 0.1 mm in 23% of cases. Estimated 5-year OS rates were 92% for patients with negative US-guided FNAC results and 51% for patients with positive results. US-guided FNAC of SNs is highly accurate. Up to 65% of the patients with SN-positive results in our institution could have been spared an SN procedure.