Preoperative Fine-needle Aspiration Biopsy Research Articles

The importance of fine needle aspiration biopsy in the diagnosis of parotid tumors

L'objectif de ce travail était de déterminer la valeur diagnostique de la cytoponction à l'aiguille fine (CPAF) et son apport dans la prise en charge des tumeurs parotidiennes, à travers une étude rétrospective portant sur 47 patients opérés d'une tumeur parotidienne et ayant eu une cytoponction préopératoire. Quatre-vingt-un pourcent des malades présentaient une tumeur bénigne et 19% une tumeur maligne. La sensibilité et la spécificité de la CPAF étaient respectivement de 78% et de 92%. Les tumeurs parotidiennes ont été correctement classées comme malignes ou bénignes dans 89% des cas, le taux d'exactitude globale était de 64,4%. La CPAF est un examen fiable permettant une information préopératoire sur le planning thérapeutique et les suites postopératoires.

A cancer of undetermined significance: Incidental thyroid carcinoma.

The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non-incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non-complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

BRAFV600E Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration

Background and Objectives This study aimed to identify a reliable preoperative predictive factor for the development of thyroid cancer in patients with atypia of undetermined significance (AUS) identified by fine needle aspiration biopsy (FNAB). Subjects and Method This was a retrospective cohort study. Two hundred and ninety-nine patients diagnosed with AUS by preoperative FNAB who underwent curative thyroid surgery at our institution between September 2005 and February 2014 were analyzed. Clinical, radiological and molecular features were investigated as preoperative predictors for postoperative permanent malignant pathology. Results The final pathologic results revealed 36 benign tumors including nodular hyperplasia, follicular adenoma, adenomatous goiter, nontoxic goiter, and lymphocytic thyroiditis, as well as 263 malignant tumors including 1 follicular carcinoma and 1 invasive follicular carcinoma; the rest were papillary thyroid carcinomas. The malignancy rate was 87.9%. The following were identified as risk factors for malignancy by univariate analysis: BRAFV600E gene mutation, specific ultrasonographic findings including smaller nodule size, low echogenicity of the nodule, and irregular or spiculated margin (p＜0.05). Multivariate analysis revealed that only BRAFV600E mutation was a statistically significant risk factor for malignancy (p＜0.05). When BRAFV600E mutation was positive, 98.5% of enrolled patients developed malignant tumors. In addition, the diagnostic rate of malignancy in these cases was approximately 16-fold higher than BRAF-negative cases. Conclusion Patients with AUS thyroid nodules should undergo BRAFV600E gene mutation analysis to improve diagnostic accuracy and if the mutation is confirmed, surgery is recommended due to the high risk of malignancy. Key words: Atypia of undetermined significance ㆍ BRAFV600E ㆍ Fine needle aspiration biopsy ㆍ Thyroid cancer ㆍ Thyroid nodule

Medullary Thyroid Carcinoma With Exon 2 p.L56M RET Variant: Clinical Particular Features in Two Patients

RET (REarranged during Transfection) proto-oncogene variants are essential for the development of familial and sporadic forms of medullary thyroid carcinoma (MTC). The most frequent variants are usually located in exons 10, 11, and 13 through 16 of the RET gene. We report two cases of apparently sporadic MTC associated with the variant in exon 2 of RET gene. Patient 1, a 62-year old man who had undergone adrenalectomy for a 5 cm pheochromocytoma, was screened for type 2 multiple endocrine neoplasia (MEN 2) which showed elevated basal and post-intravenous calcium gluconate calcitonin levels. A fine needle aspiration biopsy (FNAB) confirmed the suspicion of MTC. The patient underwent total thyroidectomy and lymphadenectomy, and the histology showed C-cell hyperplasia with medullary microcarcinoma. Patient 2, a 57 years old woman, underwent total thyroidectomy for toxic multinodular goiter. Pre-operative FNAB had shown benign features, while basal calcitonin levels were only borderline increased. Final histology revealed medullary multifocal microcarcinoma. Genetic testing for RET protoncogene on DNA extracted from peripheral blood was performed in both patients and a missense variant on exon 2 (c.166C>A, p.L56M) was identified. To our knowledge, these are the first time two cases of MTC associated to RET p.L56M variant. Interestingly, one patient had also a pheochromocytoma suggesting a possible pathogenetic role of this variant in the genesis of MEN2A. While the association of this variant with MTC or MEN2A has been never reported, it has been described in association with Hirschsprung's disease.

Robot-assisted transaxillary thyroidectomy: our early experience

Objective:To evaluate the feasibility, effectiveness and safety of robot-assisted transaxillary thyroidectomy (RATT).Method: The clinical data of 66 patients undergoing RATT from November 2016 to May 2018 were prospectively collected and analyzed. The average age was (38.61±11.72) years, 57 cases were female and 9 cases were male. Preoperative fine needle aspiration biopsy revealed papillary thyroid carcinoma in 58 cases and follicular thyroid tumor in 8 cases.Result:All the patients successfully completed RATT, and there was no open operation, in which 54 cases of ipsilateral lobetomy and isthmus resection and ipsilateral central lymph node dissection, 8 cases with ipsilateral lobectomy and contralateral near-total lobectomy, and total thyroidectomy with ipsilateral central lymph node dissection and selective neck dissection combined with retroauricular approach in 4 cases. The mean operative time was (124.30±23.41) min, and the average bleeding volume was (17.73±8.28) ml. The mean diameter of thyroid papillary carcinoma was (0.71±6.22) cm, and the postoperative drainage volume was (67.57±25.11) ml. The average postoperative hospitalization time was (3.24±0.81) days. 3 cases (4.5%) had temporary laryngeal nerve palsy after operation, and 1 case (1.5%) had temporary hypocalcemia after operation, all recovered after one month. No postoperative bleeding, subcutaneous emphysema, drinking water cough and permanent hypocalcemia were observed. The average numbers of lymph node dissection in PTC patients were (6.26±4.76), of which 21 cases (36.2%) had lymph node metastasis, postoperative stage T1 54 cases, T2 4 cases, N1a 17 cases, N1b 4 cases. The follow-up time were 1-18 months. The postoperative cosmetic VAS score in January was (9.66±0.54). Ultrasound showed no residual glands in the affected thyroid gland, and there was no recurrence in the local and regional regions.Conclusion:RATT is safe and feasible with good aesthetic effect and can be used as an option for the treatment of thyroid diseases..

Exploring the Diagnostic Efficacy of Fine-Needle Aspiration Cytology in Thyroid Nodules ≥ 4 cm: Results from a Tertiary Health Care Center in Jharkhand

Abstract Background Any nodules of the thyroid, ≥ 4 cm, are generally associated with false-negative results for malignancy on fine-needle aspiration cytology (FNAC), which generally are confirmed cases of malignancy after histopathologic examinations. Methods A retrospective hospital-based study was done in which data of patients having thyroid lesions ≥ 4 cm were reviewed. We checked the FNAC and histopathologic examination done on these lesions. Ultrasonography (USG)–guided aspiration records were also assessed. Sensitivity and specificity of FNAC for the detection of neoplastic or malignant lesions was determined. Results A total of 192 patients (57 female) were included in study. Preoperative fine-needle aspiration (FNA) biopsies were categorized as negative for malignancy (n = 183, 63%), suspicious (n = 6, 4%), and malignant (n = 4, 2%). Final pathology of nodule was found to be benign in 157 (81.35%) patients, whereas in 36 (18.65%) patients, nodules were found to be malignant. Conclusion In this study, we found the malignancy rate of thyroid nodules ≥ 4 cm to be similar to the accepted malignancy rate of smaller thyroid nodules. We missed 32 cases of malignancy on FNAC. Because of high incidence of thyroid malignancy, all nodules ≥ 4 cm must undergo histopathologic examination.

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy

IntroductionFine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. ObjectiveWe aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. MethodsPatients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5±15.88 (7–82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ=0.52). The sensitivity was 54.54% in tumors less than 2cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. ConclusionFine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Comparision of preoperative and postoperative histopathology findings in patients undergoing thyroidectomy

To compare the histopathological findings on fine needle aspiration (FNA) biopsy of thyroid nodules and thyroidectomy surgical specimens, in order to determine the efficacy, specificity and sensitivity of FNA in the diagnosis of thyroid malignancy. The data on a series of 86 patients who underwent thyroidectomy for thyroid nodules were evaluated retrospectively. The demographic characteristics and imaging findings were reviewed, and the histopathological findings on the preoperative FNA biopsy and the surgical thyroid specimen were compared. The FNA findings on the thyroid nodules were: 32.1% benign, 12.2% malignant, 2.7% suspicion of malignancy, 6% atypia of undetermined significance, 15.7% follicular lesion and/or suspicion of follicular neoplasm, and in 31.3% the aspirate was inadequate. The postoperative histopathological specimens were evaluated as 31 malignant (36%) and 55 benign (64%). Statistically significant correlation was demonstrated between the FNA and the postoperative histopathological findings (p<0.05). In this series, the overall sensitivity of FNA biopsy was 10%, the specificity 70.9%, the positive predictive value 16% and the negative predictive value 58%. This study identified a high negative predictive value of FNA biopsy, and an increased rate of “nondiagnostic” and “microcarcinoma” outcomes, but the sensitivity of FNA in the preoperative diagnosis of thyroid malignancy was low.

Comparative diagnosis of canine mammary tumours by cytology and histopathology

The aim of the present study was to correlate cytological diagnosis after pre-operative fine needle aspiration biopsies from canine mammary tumours with that of histopathological findings. In prospective study, 40 fine-needle aspirate samples were obtained from 40 different cases, out of that, 15 cases were diagnosed mammary gland tumours. Histopathology results included four cystic papillary adenoma, three benign mixed mammary tumours, two each of papillary adenocarcinoma, solid adenocarcinoma, and mammary gland adenoma, and one each of benign mammary myoepithelioma and malignant myoepithelioma. The neoplastic cells in smears were round to caudate, exhibiting anisocytosis, spherical to oval nuclei, anisokaryosis, abnormal nuclear/nucleolar shapes, anisonucleoli, abnormal chromatin pattern, multinucleation and mitotic figures. In case of benign category cells were uniform and in large clusters, having clear cytoplasmic boundaries. On comparing results of cytological diagnosis with the histopathology revealed that 86.66% (13/15) cases of benign and malignant tumours had positive correlation.

65PD Significance of preoperative fine-needle aspiration biopsy for suspected cases of lymph node metastasis in primary breast cancer

65PD Significance of preoperative fine-needle aspiration biopsy for suspected cases of lymph node metastasis in primary breast cancer

65PD Significance of preoperative fine-needle aspiration biopsy for suspected cases of lymph node metastasis in primary breast cancer

Background In patients diagnosed with breast cancer, preoperative assessment of the lymph nodes is performed by palpation and ultrasonography (US). In suspected cases of metastasis, the lymph nodes are evaluated by fine-needle aspiration (FNA) biopsy. In recent years, in some cases, dissections are omitted even if metastasis to the lymph nodes is detected. Thus, among cases where dissection can be omitted even when metastasis is observed, there have been some cases where dissection was initially performed when metastasis was verified by preoperative FNA. The aim of this study was to evaluate the significance of performing preoperative FNA for suspected cases of lymph node metastasis. Methods The study involved 745 patients with cStage I/II primary breast cancer who had undergone axillary dissection. Patients were divided into four groups based on the presence or absence of palpable lymph nodes, US findings, and FNA results: (1) the cN0 group: non-palpable lymph nodes, normal US findings, and no FNA evaluation; (2) the cN?FNA (-) group: non-palpable lymph nodes, US revealed suspicion of metastasis, and FNA revealed no metastasis; (3) the cN?FNA (+) group: non-palpablelymph nodes, US revealed suspicion of metastasis, and FNA revealed metastasis; and (4) the Stage II group:non-palpableorpalpablelymphnodes,USrevealedmetastasis,andFNA revealed metastasis. Using the above four categories, we compared the number of lymph node metastasis in each group. Results The median number of lymph node metastasis in the cN0, cN?FNA (-), cN?FNA (+), and Stage II groups was 2,2,3, and 3, respectively. The percentage of 1-2 lymph nodes metastasis was 74%, 64%, 44%, and 46%, respectively. The percentage of > 10 lymph nodes metastasis was 2%, 3%, 15%, and 11%, respectively. Distribution of the number of lymph node metastasis between the cN0 and cN?FNA (-) groups, and between the cN?FNA (-) and cN?FNA (+) groups differed significantly. In contrast, the distribution of the number oflymph node metastasis in the cN?FNA (+) and Stage II groups showed no significant differences. Conclusions Our study reveals that cN1 patients can be accurately identified from amongthosesuspectedofhavinglymphnodemetastasisbasedonFNAfindings. Legal entity responsible for the study Cancer Institute Hospital, Tokyo, Japan Funding N/A Disclosure All authors have declared no conflicts ofinterest.

Prieryklinio tarpo navikų diagnostikos ypatybės ir sunkumai

ĮžangaPrieryklinio tarpo navikai, dažniausiai nepiktybiniai, sudaro apie 0,5 % galvos ir kaklo srities navikų. Jie yra reti, todėl daugelis gydytojų per savo praktiką su šia patologija susiduria nedažnai. Svarbu išskirti kelis prieryklinio tarpo navikų diagnostikos ypatumus: simptomai yra įvairūs ir nespecifiški, o objektyvūs požymiai pasireiškia, kai navikas yra vėlesnės stadijos.Medžiaga ir metodaiŠiame straipsnyje apibendrinami retrospektyviosios šešių prieryklinio tarpo navikų atvejų analizės diagnostiniai aspektai. Visi aptariami pacientai buvo gydyti Nacionaliniame vėžio institute nuo 2004 iki 2016 metų. Straipsnyje apžvelgiame mokslinę literatūrą ir nagrinėjame diagnostikos seką, atkreipdami dėmesį į prieryklinio tarpo navikų diagnozavimo ypatumus bei sunkumus.RezultataiBuvo diagnozuoti trys gerybiniai ir trys piktybiniai navikai. Pacientai skundėsi įvairiais, daugiausia nespecifiniais, simptomais.Daugumai pacientų buvo atlikta priešoperacinė aspiracinė biopsija plona adata, visiems – priešoperacinis radiologinis tyrimas (kompiuterinė tomografija ir (ar) magnetinio rezonanso tomografija.IšvadosVisi gydytojai, susiduriantys su šia patologija, turėtų atkreipti dėmesį, kad prieryklinio tarpo navikų simptomai dažniausiai būna nespecifiniai, o objektyvūs požymiai pasireiškia navikui jau pažengus. Kalbant apie diagnostikos seką, aspiracinė biopsija plona adata yra būtinas tyrimas, siekiant išvengti histologinių netikėtumų. Radiologinis tyrimas, ypač magnetinio rezonanso tomografija, yra naudingas vertinant naviko kilmę, dydį, iš dalies ir tipą.

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Fine-needle aspiration biopsy (FNAB) is widely used in the management of salivary gland masses. Its main advantage is its ability to differentiate benign from malignant disease. In this study, we aimed to evaluate the diagnostic ability of FNAB in salivary gland masses. The records of patients who had undergone FNAB before parotidectomy or submandibular gland excision between 2005 and 2013 were retrospectively analyzed. FNAB results were classified as negative, positive, suspicious for malignancy, and non-diagnostic. Preoperative FNAB results were compared with definitive histopathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB results were calculated. A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%). The sensitivity, specificity, PPV, NPV and accuracy of FNAB results were 76.9%, 95.4%, 75%, 95.9%, and 92.6%, respectively. The rate of a suspicious cytology was 5.2% (15 patients) and that of a non-diagnostic cytology was 8.8% (25 patients). FNAB is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counselling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results.

Impact of sex on the clinicopathological characteristics and prognosis of papillary thyroid cancer.

Papillary thyroid cancer (PTC) is the most common endocrine malignancy. Observed clinical and pathological differences between the sexes of PTC patients have been reported. There is currently no consensus regarding the impact of sex on PTC prognostication. We studied 566 PTC patients and observed that there was a higher PTC incidence in women, that PTC diagnosis was more challenging in women, and that men tended to present with larger cancers. However, once PTC is diagnosed, both sexes have a similar cancer prognosis, as evaluated using the MACIS (Metastasis, Age, Completeness of Resection, Invasion, Size) score. Our observations suggest that research efforts should be especially directed at improving the diagnostic yield of preoperative fine needle aspiration biopsy in women who present with nodular thyroid disease.

Feasibility of laparoscopic distal pancreatectomy for pancreatic solid tumors according to preoperative EUS-guided fine-needle aspiration biopsy

Feasibility of laparoscopic distal pancreatectomy for pancreatic solid tumors according to preoperative EUS-guided fine-needle aspiration biopsy

Pediatric thyroid FNA biopsy: Outcomes and impact on management over 24 years at a tertiary care center

Thyroid malignancy is rare in young children, although the incidence increases sharply during adolescence. Nodular thyroid disease and thyroid cancer in children differ substantially from those in adults, because the rates of malignancy among children are roughly 5-fold higher, and local and distant metastases as well as recurrences are more common. Even with the recent introduction of pediatric guidelines, there remains a paucity of pediatric data on which to base clinical decision making. The objectives of this study were to characterize the outcomes of fine-needle aspiration biopsy (FNAB) of nodular thyroid disease at a pediatric tertiary-care institution over a 24-year period and to relate cytopathology to histopathology and management decisions in this population. A retrospective review of patients who underwent preoperative FNAB and thyroid surgery between 1992 and 2015 was conducted. In total, 207 nodules were biopsied among 178 patients. Adequate FNAB samples were obtained in 74% of biopsies. Sixty-five patients underwent thyroidectomy after FNAB. In this group, the malignancy rates for lesions deemed benign, atypical, suspicious, and malignant on FNAB cytology were 16%, 67%, 71%, and 100%, respectively. Twenty-seven individuals underwent >1 biopsy; however, no malignancies were identified in these patients. Surprisingly, the rate of malignancy in patients who underwent preoperative FNAB was not significantly different from the rate in those who proceeded directly to surgery (n = 146). FNAB remains a valuable tool for preoperative assessment of pediatric thyroid nodules. When samples are adequate for assessment, cytology other than clearly "benign" merits referral for diagnostic or therapeutic thyroidectomy. In this series, FNAB did not reduce rates of surgery for benign disease. Cancer Cytopathol 2016;124:801-10. © 2016 American Cancer Society.

Prognostic Significance of TERT Promoter Mutations in Papillary Thyroid Carcinomas in a BRAF(V600E) Mutation-Prevalent Population.

The role of telomerase reverse transcriptase (TERT) promoter mutations in differentiated thyroid cancer has been well established. These mutations have a significantly higher prevalence in aggressive thyroid tumors, including widely invasive oncocytic carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas. Interestingly, in some studies, TERT mutations were found to be more common in tumors with a BRAF(V600E) mutation. However, mutational analysis of TERT promoter mutations in thyroid tumors has not been previously performed for patients in Korea, where the BRAF(V600E) mutation in papillary thyroid carcinoma (PTC) is particularly prevalent. This study analyzed TERT promoter mutations in various thyroid tumors and examined their relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases. Using 242 preoperative fine-needle aspiration biopsy specimens (including 207 PTCs) with confirmed histopathological diagnosis of the biopsied thyroid nodules, the TERT promoter status (C228T and C250T) was analyzed, and the relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases was examined. Of 242 patients, 14.5% (30/207), 26.7% (4/15), 50% (1/2), and 60% (2/5) of PTCs, follicular thyroid carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas harbored a TERT(C228T) mutation, respectively. The TERT(C228T) mutation was associated with recurrence (p = 0.03). However, no association with other clinicopathologic factors in PTC was found. Coexistence of TERT(C228T) and BRAF(V600E) mutations was found in 13.0% of PTCs and was significantly associated with older age and advanced stage compared with the group negative for either mutation. The TERT(C228T) mutation status was an independent prognostic factor for recurrence-free survival (hazard ratio = 3.08 [confidence interval 1.042-9.079]; p = 0.042) in patients with PTC in multivariate analysis. Identification of TERT promoter mutations in preoperative fine-needle aspiration biopsy specimens may help in better characterizing the prognosis and triaging thyroid cancer patients for appropriate treatment.

Thyroglobulin antibodies as a potential predictive marker of papillary thyroid carcinoma in patients with indeterminate cytology

BackroundWe investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC). MethodsThis retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination. ResultsUnivariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology. ConclusionsPreoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.

Radical Nephrectomy for Renal Cell Carcinoma: Its Contemporary Role Related to Histologic Type, Tumor Size, and Nodal Status: A Retrospective Study.

Staging for renal cell carcinoma (RCC) depends on tumor size and the status of the regional lymph nodes. Although lymph node involvement by tumor yields the most accurate staging and prognostic information in patients with carcinomas of various genitourinary organs, the role of lymph node sampling (LNS) in patients with RCC to definitively establish nodal metastases remains unsettled. In this retrospective study of 399 patients with RCC treated by total nephrectomy, 115 cases were subjected to lymph node dissection. The corresponding primary tumors averaged larger than 8 cm. Twenty-nine showed positive lymph nodes (25%). The present review confirms that primary tumor size is a key indicator of nodal involvement. Clear cell and papillary tumors larger than 4 cm involve lymph nodes more commonly than other types of RCC. Sarcomatoid differentiation occurred in all major cell types and existed in numbers too few to predict the likelihood of nodal metastases. LNS in RCC for staging purposes may be warranted based on tumor size (>4 cm) as determined by imaging as well as histologic cell type, the latter suggesting a selective role for preoperative fine needle aspiration or core biopsy.

Diagnostic value of fine needle aspiration biopsy in parotid gland neoplasm

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;The value of fine needle aspiration biopsy (FNAB) in the diagnosis of parotid masses remains unclear, considering current literature. The surgical procedure is not planned according to the FNAB results by the majority of the otorhinolaryngologists. Objectives of the study was to compare the results of FNAB and histopathological results in diagnosing malignancy and benign lesions of parotid gland and to determine the sensitivity, specificity and accuracy of FNAB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; It is a retrospective clinical chart review study. &lt;/span&gt;In total, 61 patients (28 females and 33 males; average age, 46.31±15.79 years; age range: 12-82 years) with parotid gland masses who underwent preoperative FNAB were included in this study. All patients underwent FNAB under ultrasound guidance following clinical examination. Histopathological results of the surgical specimens and preoperative results of FNAB were compared and, the sensitivity, specify, positive predictive value (PPV), negative predictive value (NPV), the diagnostic accuracy of FNAB was calculated. A P-value &amp;lt;0.05 was considered to reflect statistical significance. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;The specificity of FNAB was 100% and its sensitivity was 57.2%. Accuracy for benign lesion was 91.4%, accuracy for a malignancy was 42.8% and overall diagnostic accuracy was 92.0%, respectively. PPV for benign lesion was 91.4% and the NPV was 100%, respectively. PPV for malignancy was 100% and the NPV was 91.4%, respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt;We suggest that FNAB is a valid, safe, easy-to-use method for identifying of parotid gland neoplasms. We recommend FNAB for all potential surgical patients. In our opinion, good collaboration between the Otorhinolaryngologist and the pathologist provides the best results.&lt;/span&gt;&lt;/p&gt;