On-site Cytologic Examination Research Articles

Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results

Background and objectiveUltrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda category I cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. Patients and methodA retrospective study was conducted of 279 nodules from 233 patients. Ultrasound-guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5 times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories Bethesda II and Bethesda VI. ResultsDiagnostic sensitivity and specificity were both 100%, 5.4% Bethesda category I results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1ml of volume). ConclusionsUltrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda category I, whose risk has been higher in older subjects and with larger nodules.

Punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con valoración citológica in situ: eficacia diagnóstica, prevalencia y factores predictores de los resultados de categoría Bethesda I

Background and objectiveUltrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda categoryI cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda categoryI results. Patients and methodA retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories BethesdaII and BethesdaVI. ResultsDiagnostic sensitivity and specificity were both 100%, 5.4% Bethesda categoryI results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). ConclusionsUltrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda categoryI, whose risk has been higher in older subjects and with larger nodules.

Impact of Endobronchial Ultrasound (EBUS) Training on the Diagnostic Yield of Conventional Transbronchial Needle Aspiration for Lymph Node Stations 4R and 7.

BackgroundThere is sparse literature on whether training in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) improves the diagnostic yield of conventional TBNA (cTBNA).ObjectivesThe aim of this study was to evaluate the diagnostic yield of cTBNA before and after the introduction of EBUS.MethodsThis was a retrospective analysis of patients who underwent cTBNA at our center. The study was divided into two periods, before and after the introduction of EBUS at our facility. The diagnostic yield of cTBNA was compared between the study periods. Rapid on-site cytological examination was not available.ResultsA total of 1,050 patients (61.6% men; mean age 45.6 years) underwent cTBNA during the study period (849 before EBUS; 201 after EBUS). Sarcoidosis (n = 527) followed by bronchogenic carcinoma (n = 222) formed the most common indications for performing cTBNA. There was a significant increase in both the success of obtaining a representative sample (from 71% to 85%), and the diagnostic yield (from 33% to 49.5%) of cTBNA, after the introduction of EBUS. The increase in the diagnostic yield of cTBNA after introduction of EBUS remained significant even after adjusting for years of performing cTBNA and the type of anesthesia (topical vs. sedation and topical) on a multivariate analysis.ConclusionThe diagnostic yield of cTBNA at our facility increased after the introduction of EBUS-TBNA. However, given the retrospective nature of the study, prospective studies are required to confirm our findings.

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions.

Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.

Mo1470 EUS-Guided Fine Needle Aspiration and Fine Needle Biopsy Under on-Site Cytopathological Evaluation for Gastric Subepithelial Tumor

Mo1470 EUS-Guided Fine Needle Aspiration and Fine Needle Biopsy Under on-Site Cytopathological Evaluation for Gastric Subepithelial Tumor

Endobronchial Ultrasound–guided Transbronchial Needle Aspiration for Non–Small Cell Lung Cancer Staging

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for invasive mediastinal staging of non-small cell lung cancer (NSCLC). Needle-based techniques are now recommended as a first-line diagnostic modality for mediastinal staging. Accurate performance of systematic staging with EBUS-TBNA requires a detailed knowledge of mediastinal anatomy. This examination begins at the N3 lymph nodes, progressing through the N2 and N1 lymph node stations, unless a higher station lymph node is positive for malignant cells by rapid on-site cytologic examination. Objective methods of identifying EBUS-TBNA targets include sampling any lymph node station with a visible lymph node or with a lymph node greater than 5 mm in short axis. Three passes per station or the use of rapid on-site cytologic examination with identification of diagnostic material (tumor or lymphocytes) up to five passes are well-established techniques. Obtaining sufficient tissue for molecular profiling may require performing more than three passes. The operating characteristics of EBUS-TBNA are similar to mediastinoscopy. However, mediastinoscopy should be considered in the setting of a negative EBUS-TBNA and a high posterior probability of N2 or N3 involvement.

Endoscopic Ultrasound-Guided Fine Needle Biopsy without Rapid On-Site Cytologic Examination: A Time to Change the Paradigm?

Endoscopic Ultrasound-Guided Fine Needle Biopsy without Rapid On-Site Cytologic Examination: A Time to Change the Paradigm?

Rapid on-site cytologic examination of 1500 breast lesions using the modified Shorr’s stain

Rapid on-site evaluation (ROSE) cytology enables sample quality assessment in the procedure room and facilitates the process of examination. While its use for mammary lesions in one-stop breast clinics has been reported, its usefulness as a cytologic diagnostic tool has not been fully explored. A total of 1500 examinations of core-needle biopsy imprint/fine-needle aspiration cytology were performed for outpatients with breast lesions. The slides were immediately processed with modified Shorr's stain, which can be completed within a few minutes yet produces specimens of similar staining quality as the Papanicolaou (Pap) stain. The adequacy of sampling was evaluated on site, and a cytologic diagnosis was also made. ROSE cytologic findings were classified into five grades: class 1, inadequate; class 2, benign; class 3, indeterminate; class 4, suspicious for malignancy; class 5, malignant. If enough epithelial cells could not be obtained despite repeated examinations, the sample was scored as ineligible. These scores were utilized for patient management. Final cytologic diagnoses were made with conventional Pap stains. Reproducibility of scores between both staining methods was excellent (weighted κ statistic=0.985). When compared class by class, concordance of cytologic diagnoses was particularly high in class 2 and 5 Shorr scores, in which the agreement with Pap diagnoses was 92.8 and 93.6%, respectively. Our modified Shorr's staining protocol was useful to reduce the time for the diagnosis and treatment planning of breast lesions suspected of being breast cancer. It is beneficial for both the patients and clinicians.

Focal Hepatic Lesions: US-guided Biopsy—Lessons from Review of Cytologic and Pathologic Examination Results

To retrospectively assess factors affecting the success of ultrasonographically (US)-guided core liver biopsy of focal lesions on the basis of experience when both cytologic and pathologic examination results were available. This HIPAA-compliant retrospective study was granted an exemption from the institutional review board. All percutaneous US-guided biopsies of focal liver lesions performed at one institution from January 2000 through February 2006 for which both cytologic and pathologic examination results were available were included. Specimen adequacy was determined with on-site cytologic examination performed with a "touch prep" technique. Of 1910 liver biopsies, 240 (12.6%) revealed focal lesions, and cytologic and pathologic examination results were available for 208 (86.7%) of these 240 lesions. The number of biopsy passes and concordance between cytologic and pathologic findings were evaluated, and correlation between lesion size, type, and location and the number of passes was assessed. The Pearson correlation chi(2) test and the Wilcoxon test were used. Biopsy specimens were diagnostic in 205 cases (98.6%) and were nondiagnostic in three cases (1.4%); 85.9% of the lesions were malignant. There was a single lesion in 89 patients (42.8%), and there were multiple lesions in 119 patients (57.2%). One biopsy pass was sufficient in 58 patients (27.9%); two passes were sufficient in 75 patients (36.1%); and three, four, five, and six passes were sufficient in 51 (24.5%), 17 (8.2%), five (2.4%), and two (1.0%) patients, respectively. There was no relationship between lesion size or location and the number of passes, according to the Pearson correlation and chi(2) test (P = .16 and P = .22, respectively). On average, 1.9 passes were required for metastatic lesions, versus 2.8 for nonmetastatic lesions (P < .001, Wilcoxon test). Cytologic and histopathologic findings were discordant in 25 cases (12.0%). The size and location of liver lesions sampled for biopsy do not influence the number of passes needed, while metastatic lesions require fewer passes. Without the on-site cytologic examination service, a predetermined number of three passes would be diagnostic in almost 90% of all cases.

Algorithm for Immediate Cytologic Diagnosis of Hepatic Tumors

Immediate cytologic assessment of hepatic lesions can help determine the adequacy of specimens and may yield a preliminary diagnosis. The purpose of this study was to analyze the diagnostic accuracy of on-site cytologic assessment compared with definitive cytologic examination in the detection and correct subtyping of malignant hepatic lesions. The study population included 472 consecutively registered patients with hepatic nodules who underwent sonographically guided fine-needle aspiration and core biopsies. During on-site cytologic analysis, the pathologist made a preliminary diagnosis of malignancy or negative for malignancy for each nodule. When a malignant lesion was diagnosed, immediate subtyping was attempted. With immediate cytologic analysis, 280 (80.9%) of 346 malignant nodules were correctly identified without false-positive cases. With immediate subtyping, 113 (68.1%) of 166 cases of hepatocellular carcinoma, 28 (77.8%) of 36 cases of cholangiocarcinoma, and 113 (85.0%) of 133 cases of metastasis were detected. High diagnostic accuracy for malignancy can be achieved with on-site cytologic evaluation of hepatic tumors. Specific diagnoses of hepatocellular carcinoma, cholangiocarcinoma, and metastasis also can be made on-site in most cases. The absence of false-positive diagnosis of malignancy at on-site cytologic examination may make additional biopsy unnecessary. We propose an algorithm for the cytohistopathologic management of hepatic tumors.

EUS-GUIDED FINE NEEDLE ASPIRATION DIAGNOSIS OF PULMONARY NOCARDIOSIS

We report a 60 year-old male with AIDS admitted to the hospital with cough and weight loss. CT chest showed a 3.5 cm mass in the medial portion of the right lung adjacent to the esophagus, suspicious for bronchogenic carcinoma, multiple nodules in both lungs suspicious for metastases and an enlarged lymph node in the AP window. Patient underwent an ultrasound-guided FNA of one of the lung nodules. Cytology of the aspirate did show any evidence of malignant cells. The patient then underwent a mediastinal EUS that showed 4 cm 2 cm hypoechoic mediastinal mass, with punctate echogenic foci, adjacent to the distal esophagus. FNA of the para-esophageal mass was performed and on-site preliminary cytological examination was consistent with an inflammatory process. Final results showed granulomatous inflammation and filamentous branching bacteria consistent with Nocardia. Patient was started on trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of nocardiosis. Nocardia is a genus of aerobic actinomycetes. Cases of human disease have increased substantially in the last 2 decades in association with an increasing population of immunocompromised hosts. Nocardia species are ubiquitous environmental saprophytes. Human infection usually arises from direct inoculation of skin or soft tissues or by inhalation. Pulmonary disease is the most common presentation of systemic nocardiosis and manifests as an endobronchial inflammatory mass, pneumonia or cavitary disease. Nocardia organisms are typically seen as gram-positive branching filaments on direct smears of the specimens. Sulfonamides have been the mainstay of therapy, although optimal antimicrobial regimens have not been established by controlled clinical trials. TMP-SMX is the formulation currently preferred by most clinicians. Duration of therapy is prolonged and in patients with AIDS, low-dose maintenance therapy should be continued for life.On review of literature, we did not find any similar reports and our patient is probably the first case of nocardiosis diagnosed by EUS-guided FNA. EUS-guided FNA's clinical utility continues to improve along with increasing sophistication of the equipment and growing experience of cytopathologists and endosonographers as they expand its applications beyond the detection of cancer in solid masses and lymph nodes.