Positive Fine Needle Aspiration Cytology Research Articles

Accuracy of Ultrasound Scans as Compared to Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules.

Thyroid nodules (TNs) are among the more common findings on physical examinations. Due to the fear of the TN harboring malignancy and with the increasing incidence of thyroid cancer, ultrasound (US) scanning is used as an important diagnostic tool in the assessment of a TN. The American College of Radiology's Thyroid Imaging Reporting and Data System (TI-RADS) was established based on specific patterns composed of two or more features. According to the TI-RADS guidelines, a suspicious nodule by US findings should undergo fine-needle aspiration cytology (FNAC), in which results would guide further management. This study was carried out to assess the accuracy ofUS as compared to FNACin the diagnosis of a thyroid nodule. This retrospective study involved 213 cases that were sent for FNAC after having done a US scan of the thyroid. Data was gathered from all patient files that were referred for FNAC thyroid between 01/02/2018 and 30/06/2021 in Al-Ahli Hospital in the state of Qatar. The US scans were interpreted and reported according to the TI-RADS criteria. The FNAC samples were interpreted and reported according to the Bethesda System for Reporting Thyroid Cytopathology. Data were tabulated and analyzed with Excel (Microsoft, Redmond, WA, USA) and SPSS version 25 (IBM Corp., Armonk, NY, USA). The study showed that US had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 73.9%, 72.6%, 24.6% and 95.8%, respectively, with a significant association between the results of US and the results of FNAC (X2 (1, n = 213) = 20.295, p < .001) and a significant positive correlation (phi coefficient = .309, p < .001). In addition, the data showed that the odds for having a positive FNAC were 7.519 (95% CI: 2.811, 20.112) times greater for cases with positive US compared with cases with negative US. The relative risk of having a positive FNAC when the US was positive was 5.913 (95% CI: 2.440, 14.332) times greater compared to when the US was negative. While our results showed that US cannot be solely relied on in diagnosing TNs, they did show that US can reliably rule out a malignancy in TNs. Recent studies have been showing increasing accuracy of US in diagnosing TNs and more studies are needed to explore this topic.

Clinical, biochemical and imaging characteristics of adrenal histoplasmosis in immunocompetent patients in a non-endemic area: A case series

Objective: To document the clinical, biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis. Methods: The clinical, biochemical and radiologic data of 18 immunocompetent patients [age: 45.00 (39.25, 56.25) years, median (IQR), m/f (16/2)] with adrenal histoplasmosis presenting in the Department of Endocrinology, BSMMU between 2014 and 2020 were retrospectively analyzed. Results: All patients were seronegative for HIV infection, and 27.8% (5/18) had well controlled diabetes mellitus. The median duration of the symptoms was 6.00 (IQR: 4.00, 11.25) months. All had significant weight loss, anorexia and weakness. Fever was present in 61.1% (11/18) patients and night sweat was present in 27.8% (5/18) cases. Hypotension and hyperpigmentation were present in 55.6% (10/18) and 66.7% (12/18) cases, respectively. Three of 18 patients presented with adrenal crisis. Hyponatremia occurred in 55.6% (10/18) cases, but none had hyperkalemia. Thirteen of 18 patients had adrenal insufficiency whereas 83.3% (15/18) had high adrenocorticotropic hormone. CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin. All were hypodense having radiodensity 21-90 hounsfield unit, and 11.1% (2/18) were heterogeneous in contrast enhancement. None had noticeable calcification whereas 1.1% (2/18) cases had central necrosis with peripheral rim enhancement. Hepatomegaly was present in 6 cases, splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy. Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue. Conclusions: Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.

In early-stage breast cancer, sentinel lymph node biopsy can save unnecessary axillary dissection compared with fine-needle aspiration cytology for indeterminate axillary lymph nodes

Introduction The most prevalent female cancer is breast cancer. A significant prognostic factor and determinant of treatment is the state of axillary lymph nodes (LNs). Axillary LNs can be classified into pathological, indeterminate, and benign by ultrasonographic (US) assessment. Aim In early-stage breast cancer, the indeterminate axillary LNs are measured. This offers the full advantage of the available diagnostic instruments, fine-needle aspiration cytology (FNAC), and sentinel lymph node biopsy (SLNB) technique driven by US, and thus prevents excessive dissection of the axillary lymph node. In a step-wise sequence, suggestions are made for the treatment of indeterminate axillary LNs. Patients and methods This is a randomized, controlled sample that is prospective. Between October 2017 and October 2018, 60 female patients diagnosed with early-stage breast cancer with indeterminate axillary nodes were admitted to the breast cancer unit at Kasr Alainy University Hospital, Cairo University. Sensitivity, accuracy, positive predictive value, and negative predictive value of preoperative US-guided FNAC versus upfront frozen indeterminate node intraoperative SLNB were contrasted, and both findings were correlated to the final histo-guided FNAC. Results Sensitivity of SLNB was 83.33%, whereas sensitivity of the FNAC was 75%, with the negative predictive value of 83.33%, specificity of 83.3%, and positive predictive value of 75%. Conclusion FNAC is only moderately sensitive (75%), and inadequate sampling and being an operator dependent are potential limits of it. In addition, positive FNAC may cost the patient unnecessary axillary lymph node dissection.

Analysing false negatives and false positives in cytopathology of breast masses along with cytohistopathological correlation

Introduction: Carcinoma of the breast is the leading cause of death in women due to malignancy. Approximately 1,000,000 cases occur worldwide annually. Evaluation of the breast masses is of utmost important for its timely management. Fine needle aspiration cytology is a simple and reliable diagnostic method. The present study aim ED to determine the diagnostic efficacy of the fine needle aspiration cytology along with evaluating the causes of false negative and false positive in breast cytology. Materials and Methods: The present retrospective study was conducted in G K General Hospital, Bhuj for a period of one year. Cases in which follow up histopathology was available were only included in the present study. A total 52 cases were included in the study. Results: Fine needle aspiration cytology findings and histopathology diagnoses were correlated. Statistical analysis was done. Out of the 52 cases, only one false positive and one false negative case was found. Hence, the sensitivity of the study was 98% and the positive predictive value was also 98%. Conclusion: Fine needle aspiration cytology is a reliable diagnostic method to evaluate the breast masses. A high sensitivity and a high positive predictive value proved that a positive fine needle aspiration cytology in the breast correlates very well with the corresponding final histopathology reports. Keywords: Fine needle aspiration cytology, Sensitivity, Positive predictive value.

A prospective study on clinicopathological study of cervical lymphadenopathy

Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. This study was done to know the correlation between clinical presentation of FNAC and histopathology of cervical lymphadenopathy, to emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in cervical lymphadenopathy. 50 patients with cervical lymphadenopathy were assessed clinically, by laboratory and by FNAC study over a period of two years. In the present study, results revealed that tuberculous lymphadenopathy is the commonest cause of cervical lymphadenopathy with 68% followed by chronic non-specific lymphadenopathy with 32. Of the 35 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 50 had subsequent surgery and histological confirmation of the cytological appearance. 34 had TBLN (Tuberculous Lymphadenopathy), thus the specificity of FNAC was 94 per cent in diagnosing tuberculosis related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be non specificity. Present study had cervical lymph node swelling. Other common presenting symptoms were loss of weight and loss of appetite (20%), fever (30%), axillary and inguinal swellings (4%), cold abscesses (8%), pain (6%), sore throat, cough, discharging sinus, old sinus scars, caries tooth (2%). there was only unilateral involvement of node in 72% of cases right side was affected in 32% and left side was affected in 40% of cases bilateral involvement was seen in 14% of the cases. The lymph nodes were associated with other groups of lymph nodes in 10% of cases. In our study the sensitivity and specificity of FNAC of tuberculous cervical lymphadenopathy is 77 and 94 respectively. The results concluded that tuberculosis is the most common cause of cervical lymphadenopathy in the Indian population followed by reactive lymphadenitis and metastatic deposits. Reactive lymphadenitis is the commonest cause of cervical lymph node enlargement in different age group, infective in 11-40 yrs. age group including tuberculous and suppurative lymphadenitis, neoplastic lesions in more than 40 age group including metastatic disease and nonhodgkins lymphomas. FNAC is an important diagnostic modality for the etiologic workup in significant cervical lymphadenopathy and is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.

False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

Axillary nodal status remains an important determinant of prognosis and of the therapeutic strategy in patients with a newly diagnosed breast cancer. The aim of this study was to assess the false-negative rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in axillary node staging at breast cancer diagnosis. All patients with a newly diagnosed breast cancer who had an indeterminate or suspicious axillary node sampled with an FNAC between 2007 and 2014 were included in the study. FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes. Patient demographics, tumor, and nodal characteristics were analyzed. Diagnostic accuracy tests were performed using IBM SPSS, version 22. A total of 3515 patients with breast cancer were identified, 675 of whom had ultrasound-guided FNAC of ipsilateral axillary lymph nodes (mean age: 55years; Range: 26-84). A benign (C2) result was observed in 52% (n=351) and a malignant (C5) result in 35% (n=238). C1 was obtained in 11% (n=76), C3 in 0.6% (n=4), and C4 in 0.9% (n=6). Of the 238 patients with a malignant (C5) FNAC, 99.6% had confirmed axillary lymph node metastatic disease on histopathology. Of the 351 patients with benign FNAC (C2), 31% (n=108) of patients had a positive lymph node on histology. The false-negative rate of preoperative FNAC remains too high (31%) to omit definitive surgical staging of the axilla. The high diagnostic accuracy when a positive FNAC is obtained allows appropriate tailored decisions regarding definitive therapy.

Ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management.

The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastatic LNs in patients with FNAC-positive patients. This study included 198 breasts of 196 patients with breast cancer who underwent FNAC and surgery for the primary and axilla without neoadjuvant chemotherapy from January 2010 to August 2016. Axillary nodal status was assessed by ultrasound (US), and whether FNAC-positive had three or more suspicious LNs on US imaging was examined. The results of FNAC were positive in 75 (38%), negative in 97 (49%), suspicious in 2 (1%), indeterminate in 5 (2.5%), and insufficient in 19 patients (9.5%). FNAC sensitivity, specificity, positive predictive value, and negative predictive value were 62.6%, 100%, 100%, and 62.0%, respectively. Whereas 53% (18/34) of patients with false-negative FNAC had one metastatic LN on final pathology, 61% (47/77) patients who were FNAC-positive had three or more metastatic LNs. In the FNAC-positive patients, all patients had ≥3 metastatic LNs if they had ≥3 suspicious LNs on US imaging. Patients with positive cytology were more likely to have ≥3 positive LNs compared to false-negative cytology patients. Patients with ≥3 abnormal LNs on US and positive FNAC might require axillary dissection.

FNAC positivity- A predictor of axillary disease burden in neoadjuvant chemotherapy patients

Background: Fine needle aspiration cytology (FNAC) is performed on radiologically positive axillary nodes as part of preoperative staging. We look at whether a positive FNAC can predict final number of diseased nodes on axillary clearance (ANC) in patients undergoing neoadjuvant chemotherapy (NAC) compared with those who do not have NAC.

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.

Correct extent of thyroidectomy is poorly predicted preoperatively by the guidelines of the American Thyroid Association for low and intermediate risk thyroid cancers

Recent guidelines from the American Thyroid Association recommend thyroid lobectomy for intrathyroidal differentiated thyroid cancers <4 cm. Our aim was to examine histology from patients with cytologic results that were positive or suspicious for malignancy to assess the extent of initial thyroidectomy based on criteria from the 2015 American Thyroid Association guidelines. We studied consecutive patients who had either a positive or suspicious for malignancy cytologic diagnosis and under prior American Thyroid Association guidelines underwent initial total thyroidectomy ± lymphadenectomy. Among 447 patients, high-risk features necessitating total thyroidectomy were present in 19% (72/380) of positive and 15% (10/67) of suspicious for malignancy patients (P = .5). Intermediate-risk features on histology were identified postoperatively in 46% (175/380) with positive and 15% (18/67) with suspicious for malignancy fine-needle aspiration results. In multivariable analysis, preoperative factors associated with intermediate-risk disease included age ≥45 years, women, larger tumor size, positive fine-needle aspiration cytology, and BRAF V600E or RET/PTC positivity. When patients are considered for lobectomy under the 2015 American Thyroid Association guidelines, ~ 60% with positive and 30% with suspicious for malignancy cytology would need completion thyroidectomy based on intermediate-risk disease. The cost and risk implications of the new American Thyroid Association strategy were substantial and better tools are needed to improve preoperative risk stratification.

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.

Study of Correlation of Preoperative Fine Needle Aspiration Cytology with Histopathological Examination in Thyroid Swellings

ABSTRACT Introduction Though fine needle aspiration cytology (FNAC) for thyroid is acclaimed as a gold standard before going for intervention, there are some limitations with respect to tissue availability, technique, skill of performer, etc. So, a cross-sectional study was conducted to determine the accuracy of FNAC in diagnosis of thyroid swelling and to assess the correlation between preoperative cytopathological diagnosis and postoperative histopathological diagnosis. Materials and methods Data collected from records in the time period of 3 years, i.e., from August 2012 to August 2015, were evaluated and analyzed. Results A total number of 93 cases were included in the study of which majority were females with frequency of 84.94%, most of the incidence of thyroid swellings occur in the age group of 40 to 50 years. Overall mismatch between histopathological examination and FNAC was 43 out of 93 and of which 7 were major and 36 were minor mismatch. Sensitivity of patients having malignancy with positive FNAC is 82.35% from the study and specificity of patients with nonmalignant thyroid disease and positive cytology is 95.18%. Conclusion It was observed that FNAC is a reliable, safe, and accurate method as a first line of evaluation in thyroid swelling before the surgery. Fine needle aspiration cytology is more sensitive in detecting thyroid gland malignancy but still correlation is always necessary and therefore, histopathological analysis still remains essential for final diagnosis. How to cite this article Bodepudi SL, Kalyan KASSN, Peddi R. Study of Correlation of Preoperative Fine Needle Aspiration Cytology with Histopathological Examination in Thyroid Swellings. Int J Phonosurg Laryngol 2017;7(1):16-19.

A prospective study of the palpable lesions of the breast and the role of FNAC in these lesions with available histopathology methods

Introduction: Benign as well as malignant breast lesions are quite common in Indian population. It is the second most common cancer site after cancer cervix. Fine-needle aspiration cytology (FNAC) is safe, reliable, and time saving outdoor procedure with little discomfort to the patient. Objective: The current study was aimed to study the frequency of various breast lesions on FNAC in a tertiary care center and its histopathological correlation. Methodology: Total of 217 cases of FNAC was conducted in the palpable lesions of the breast. Result: Most of the lesions were noted in the left breast (123) lesions out of which 29 were malignant. The various benign neoplastic lesions seen were 81 patients. Fibroadenoma were found mostly in the age group of 21-30 years. 41 cases of fibrocystic disease found mostly in the age group of 31 to 50 years. The lymph node metastasis was seen in 5 patients with 35 to 55yrs of age. There were 71 benign neoplastic lesions and 21 cases of malignancy available for histopathology. FNAC was 80.9% sensitive and 95.89% specific in diagnosing malignant lesions. Conclusion: A high sensitivity and a high positive predictive value proved that a positive FNAC in the breast means a definite diagnosis of the concerned pathology if compared with the final histology report. Thus, we have no hesitation in concluding that FNAC is a very important preliminary diagnostic test in palpable breast lumps and done by expert hands, the results show a high degree of correlation with the final histopathology report.

Axillary ultrasound and Fine-Needle Aspiration Cytology in the preoperative staging of axillary node metastasis in breast cancer patients

ObjectiveA prospective observational clinical study was undertaken to assess the accuracy of preoperative Axillary Ultrasound (AUS) plus Fine-Needle Aspiration Cytology (FNAC) as well as and its clinical utility, that is the capacity of the information supplied by the test to guide the clinical decision-making. Materials and methodsfrom January 2013 to August 2015, 400 female patients with pT1-3 cN0 operable breast cancer underwent AUS with FNAC at the Breast Unit of the “IRCCS San Martino-IST” in Genoa (Italy). Results127 out of 400 patients (31.7%) had axillary lymph node metastases; in 69 out of 127 node-positive patients (54.3%) AUS detected at least one abnormal lymph node, and in 56 out of 127 patients (44.1%) the abnormal sonographic pattern of the lymph node was coupled with a positive FNAC finding. No false-positive finding by both AUS-alone or combined AUS/FNAC was observed. AUS-alone had sensitivity of 54.3% (69/127), specificity of 100% (273/273), PPV of 100% (69/69), NPV of 82.5% (273/331), and accuracy of 85.5% (342/400). Combined AUS/FNAC had sensitivity of 44.1% (56/127), specificity of 100% (273/273), PPV of 100% (56/56), NPV of 79.4% (273/344), and accuracy of 82.2% (329/400). ConclusionsAUS-alone or combined AUS/FNAC had a high accuracy rate coupled with a more than satisfactory efficiency due to their low costs and easy access for the preoperative staging of the axilla. Notably, AUS-alone might be suggested for the preoperative staging of patients with early stage breast cancer because FNAC did not increased the specificity but reduced the sensitivity of the technique. Patients with negative findings might undergo either SLNB or close observation while waiting for the definitive results of ongoing SOUND randomized clinical trial.

Ultrasound of the sentinel node in melanoma patients: echo-free island is a discriminatory morphologic feature for node positivity.

Unlike breast and thyroid cancer, the use of ultrasound (US)-guided fine needle aspiration cytology (FNAC) for preoperative staging is limited in melanoma. New US morphology criteria have shown that US-FNAC can correctly identify 50% of all involved sentinel nodes (SN) in melanoma patients before surgical excision. The aim of this study was to examine a new criterion: the echo-free island (EFI). A total of 1000 consecutively staged melanoma patients (Breslow thickness>1 or<1 mm, but ulcerated, Clark IV/V or regressed) scheduled for SN staging underwent preoperative US. US morphology items were assessed: peripheral perfusion, loss of central echoes, balloon shape, and EFI. FNAC was performed in case of suspicious and malignant US patterns. All patients proceeded to undergo an SN biopsy or direct completion lymph node dissection (CLND) (in the case of positive FNAC). In all, 57% of the patients were men. The mean/median Breslow thickness was 2.58/1.57 mm. The mean/median follow-up was 56/53 months. SN was positive in 21%. EFI information was available in 95.3%. EFI was seen in 40 patients (4%). EFI sensitivity was 10.8%, specificity was 97.6%, positive predictive value was 50%, and negative predictive value was 80.2%. EFI was significantly correlated to peripheral perfusion (67.5%). There was no correlation to balloon shape or loss of central echoes. Five-year melanoma-specific survival of patients with EFI was significantly worse: 80% versus 92% when absent. The EFI can be useful in the early detection of SN melanoma metastasis. It is an early sign of involvement and thus associated with a decreased survival.

7. Positive pre-operative axillary ultrasound guided fine needle aspiration cytology is associated with higher axillary disease burden in breast cancer patients compared with those detected by sentinel lymph node biopsy

7. Positive pre-operative axillary ultrasound guided fine needle aspiration cytology is associated with higher axillary disease burden in breast cancer patients compared with those detected by sentinel lymph node biopsy

Preoperative assessment of the axilla by surgeon performed ultrasound and cytology in patients with breast cancer.

BackgroundPreoperative evaluation of the axilla, an important prognostic determinant for patients with invasive breast cancer, is achieved by non- or minimally invasive methods to avoid the potential hazards of operative intervention. The aim of this study was to determine statistical power of axillary ultrasound (US) and US-guided fine needle aspiration cytology (FNAC) for evaluating axillary status.MethodsAxillary lymph nodes were imaged for malignant involvement by high resolution US in 93 breast cancer patients with clinically negative axilla. Cytological samples were obtained by US-guided FNAC from image-suspicious lymph nodes. Cytology-positive patients directly underwent axillary lymph node dissection (ALND). Patients with US and/or cytology-negative axilla underwent sentinel lymph node biopsy (SLNB). Using statistical analysis, US findings and US combined with FNAC were compared with SLNB and final pathology to measure performance.ResultsUS was suspicious for metastasis in 38 patients (41%), of whom 16 (42%) were cytology-positive. Axilla was positive in 36/93 patients (38.7%). Sixteen patients with positive FNAC directly underwent ALND. SLNB and/or final pathology was positive in 13/55 patients (23.7%) with negative US (false negative of US) and in 7/22 patients (31.8%) with positive US but negative cytology (false negative of FNAC). SLNB and/or final pathology was negative in 15/38 patients (39.5%) with positive US (false positive of US). Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of US alone were 63.8%, 73.6%, 69.8%, 60.5% and 76.3%, respectively, and 69.6%,100%, 81.6%, 100% and 68.1%, respectively, for US combined with FNAC.ConclusionStatistical measures of the US alone did not achieve a satisfactory value for excluding operative biopsy. US-negative and US-positive but cytology-negative cases still require SLNB for accurate evaluation of axillary status. On the other hand, US-guided positive cytology can obviate SLNB proceeding directly to ALND and avoiding frozen section of sentinel node(s).

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.

Interobserver variability in ultrasound (US) guided fine needle aspiration cytology (FNAC) of sentinel nodes (SN): Experience in 1,000 melanoma patients.

9097 Background: FNAC is used to determine nature of suspected lesions that are either clinically apparent (palpable) or discovered by imaging (non-palpable) with the same high sensitivity (Voit et al.JNCI 2011). However, there seems to be interobserver variability. Methods: Morphology criteria (Voit et al. JCO 2010) were tested in 3 pre-SLNB-US examiners. US criteria, FNAC results were collected in a prospective database.Positive cytology was confirmed by histopathology. Examiner #1 had a long US-FNAC experience, 2 others were learners, #2 with a long US, but not FNAC experience, #3 new to both. Results: In 1,000 consecutive prospective patients mean/median Breslow thickness was 2.58/1.57mm. Mean/median follow-up was 56 / 53 months (1 – 132). SN positivity rate was 21%. Overall US-FNAC sensitivity was 71%(US only) and 51%(US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). #1 performed 724(72%), #2 202(20%), #3 74(7%). US validation of #1 was 431/724(59.9%) benign, in 227/724(31.4%) suspicious and in 66/724(9.1%) malignant. #2 estimated in 144/202(71.3%) benign, in 50/202(24,7%) suspicious and in 8/202(4%) malignant; #3 in 57(77%) benign, in 8/75 (10.8%) suspicious and in 9/74 (12.2%) malignant (p<0.001). #1 detects early sign peripheral perfusion(PP) in 32%, #2 in 21% and #3 in 22%. #1 performed FNAC in 291(40%), #2 in 55(25%) and #3 in17(15%)(p<0.001). #1 had sensitivity of 86/157(55%), spec of 99%, PPV of 99% and NPV of 89% (p<0.001). #2 had 34%,100%,100% and 88%,#3 56%, 100%,100% and 89% respectively(p<0.001). Detected sentinel node Tuburden <1mm was successfully FNACed in 45% by #1 and in 20% by #2 and#3 respectively. Conclusions: This largest database covering FNACs in SN of melanoma patients showed no difference between ultrasonographists with regard to performing a FNAC if a late sign, baloonshape (BS) or loss of central echoes (LCE), was seen. An examiner experienced in both US and FNAC sees more PP, performs more FNACs and has more positive FNACs. Examiners not used to FNAC tend to not perform FNACS. Interobserver difference is due to a significantly lower detection rate of PP.