Preoperative Cytological Diagnosis Research Articles

Predicting tall-cell subtype of papillary thyroid carcinomas independently with preoperative multimodal ultrasound.

This study aimed to explore the differences between tall-cell subtype of papillary thyroid carcinoma (TCPTC) and classical papillary thyroid carcinoma (cPTC) using multimodal ultrasound, and identify independent risk factors for TCPTC to compensate the deficiency of preoperative cytological and molecular diagnosis on PTC subtypes. Forty-six TCPTC patients and 92 cPTC patients were included. Each patient received grey-scale ultrasound, colour Dopplor flow imaging (CDFI) and shear-wave elastography (SWE) preoperatively. Clinicopathologic information, grey-scale ultrasound features, CDFI features and SWE features of 98 lesions were compared using univariate analysis to find out predictors of TCPTC, based on which, a predictive model was built to differentiate TCPTC from cPTC and validated with 40 patients. Univariate and multivariate analyses identified that extra-thyroidal extension (odds ratio [OR], 15.12; 95% CI, 2.26-115.44), aspect ratio (≥0.91) (OR, 29.34; 95% CI, 1.29-26.23), and maximum diameter ≥14.6 mm (OR, 20.79; 95% CI, 3.87-111.47) were the independent risk factors for TCPTC. Logistic regression equation: P = 1/1+ExpΣ[-5.099 + 3.004 × (if size ≥14.6 mm) + 2.957 × (if aspect ratio ≥ 0.91) + 2.819 × (if extra-thyroidal extension). The prediction model had a good discrimination performance for TCPTC: the area under the receiver-operator-characteristic curve, sensitivity, and specificity were 0.928, 0.848, and 0.954 in cohort 1, and the corresponding values in cohort 2 were 0.943, 0.923, and 0.926, respectively. Ultrasound has the potential for differential diagnosis of TCPTC from cPTC. A prediction model based on ultrasound characteristics (extra-thyroidal extension, aspect ratio ≥0.91, and maximum diameter ≥14.6 mm) was useful in predicting TCPTC. Multimodal ultrasound prediction of TCPTC was a supplement to preoperative cytological diagnosis and molecular diagnosis of PTC subtypes.

Invasiveness of Upper Tract Urothelial Carcinoma: Clinical Significance and Integrative Diagnostic Strategy.

In this study, we aimed to determine the clinicopathologic, radiologic, and molecular significance of the tumor invasiveness to further stratify the patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) who can be treated less aggressively. Clinicopathologic and radiologic characteristics of 166 surgically resected HG UTUC (48 noninvasive, and 118 invasive) cases were evaluated. Six noninvasive UTUC cases with intratumoral tumor grade heterogeneity were selected for whole-exome sequencing (WES) to understand the underlying molecular pathophysiology. Barcode-tagging sequencing was done for validation of the target genes from WES data. Patients with noninvasive UTUC showed no cancer-specific death with better cancer-specific survival (p < 0.001) and recurrence-free survival (p < 0.001) compared to the patients with invasive UTUC. Compared to the invasive UTUC, noninvasive UTUC was correlated to a low grade (LG) on the preoperative abdominal computed tomography (CT) grading system (p < 0.001), histologic intratumoral tumor grade heterogeneity (p=0.018), discrepancy in preoperative urine cytology diagnosis (p=0.018), and absence of urothelial carcinoma in situ (p < 0.001). WES of the heterogeneous components showed mutually shared HRAS and FGFR3 mutations shared between the HG and LG components. HRAS mutation was associated with the lower grade on preoperative abdominal CT and intratumoral tumor grade heterogeneity (p=0.045 and p < 0.001, respectively), whereas FGFR3 mutation was correlated to the absence of carcinoma in situ (p < 0.001). According to our comprehensive analysis, HG noninvasive UTUC can be preoperatively suspected based on distinct preoperative radiologic, cytologic, histologic, and molecular features. Noninvasive HG UTUC shows excellent prognosis and thus should be treated less aggressively.

Is preoperative pancreatic juice cytology useful for determining therapeutic strategies for patients with intraductal papillary mucinous neoplasm of the pancreas?

We compared the results of preoperative pancreatic juice cytology (PJC) and final pathological diagnosis after resection in patients who underwent resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas to determine whether preoperative PJC can help determine therapeutic strategies. Of 1130 patients who underwent surgical resection IPMN at 11 Japanese tertiary institutions, the study included 852 patients who underwent preoperative PJC guided by endoscopic retrograde cholangiopancreatography (ERCP). The accuracy of preoperative PJC for differentiation between cancerous and noncancerous lesions were 55% for IPMN overall; 59% for the branch duct type; 49% for the main pancreatic duct type; 53% for the mixed type, respectively. On classifying IPMN according to the diameters of the mural nodule (MN) and main pancreatic duct (MPD), the corresponding values for diagnostic performance were 40% for type 1 (MN ≥5 mm and MPD ≥ 10 mm); 46% for type 2 (MN ≥5 mm and MPD < 10 mm); 61% for type 3 (MN < 5 mm and MPD ≥ 10 mm); 72% for type 4 (MN < 5 mm and MPD < 10 mm), respectively. PJC in IPMN is not a recommended examination because of its low overall sensitivity and no significant difference in diagnostic performance by type, location, or subclassification. Although the sensitivity is low, the positive predictive value is high, so we suggest that pancreatic juice cytology be performed only in cases where the patient is not sure about surgery.

Accuracy of prior cytology versus intraoperative consultation in predicting the final diagnosis of thyroid specimens

Abstract Introduction/Objective The aim of this study was to assess the accuracy of preoperative cytology and the additional contribution of intraoperative frozen section in predicting the final diagnosis of thyroid surgical specimens. Methods/Case Report A retrospective search was conducted for cases that underwent pre-surgical cytology of thyroid surgical specimens received from January 2017 to June 2022. A total of 99 cases were evaluated which were grouped into six categories according to the Bethesda system. The cytology results were compared with the corresponding frozen section and permanent section diagnoses. Indeterminate and discordant cases were further evaluated with molecular tests. Results (if a Case Study enter NA) Among the 99 cases, preoperative cytologic diagnoses were as follows: 1 was nondiagnostic, 9 were benign, 7 were AUS/FLUS, 3 were FN/SFN, 7 were suspicious for malignancy, and 72 were malignant. Using Bethesda categories V and VI as cytology “positive” cases and Bethesda category II as cytology “negative” cases, the sensitivity and specificity of cytology were 99% and 100%, respectively. The positive predictive value was 100%. The negative predictive value was 89%, which was affected by sampling error. Intraoperative frozen section was performed on 31 cases. In 4 indeterminate cytology cases (Bethesda III, IV), frozen section diagnosis was benign in 1 (confirmed on final) and remained indeterminate in 3 cases (3 benign on final). All 3 dual indeterminate cases showed a follicular pattern; molecular tests were predictive of the final diagnosis in these cases. All 21 malignant frozen section diagnoses had positive cytology. Conclusion Cytology has high sensitivity and specificity, making it a valuable preoperative tool in thyroid surgery. Practically, intraoperative frozen section has limited value in thyroid nodules classified as Bethesda categories V and VI. Additional evaluation may be helpful for cases classified as uncertain Bethesda categories. For follicular patterned lesions, frozen section may have less value.

Correlation of Fine Needle Aspiration Cytology and Histopathological Evaluation in Salivary Gland Masses: A Single Center Retrospective Study

Aim: Fine-needle aspiration cytology (FNAC) in the preoperative diagnosis of salivary gland (SG) masses is a very fast, inexpensive, and reliable diagnostic method. In our study, the correlation of cytological-histopathological diagnosis in cases diagnosed with fine needle aspiration cytology in our clinic was investigated, and possible causes of diagnostic entrapment in discordant cases were discussed. Material and Methods: Salivary gland FNAC cases with histopathological diagnosis between 2008 and 2019 were retrospectively analyzed.The age, gender, localization of the lesion, preoperative cytology, and postoperative histopathological diagnosis of the patients were recorded. Cytology results were analyzed in 5 categories: unsatisfactory, uncategorized, benign, suspected malignancy, and malignant. Histopathology results were recorded in 2 groups benign-nonneoplastic and malignant. Statistically significant difference level was accepted as p&amp;lt;0.05. The validity of the cytology result according to the biopsy result was evaluated by sensitivity, specificity, positive predictive value, and negative predictive value. Results: 316 cases of salivary gland fine needle aspiration were detected. 156 (49.4%) of 316 cases had histopathological diagnosis. When calculating the cytological-histopathological diagnosis, the cases that were found to be inadequate and uncategorized by cytology were not taken into consideration. The suspected malignancy group was evaluated within the malignant category. Therefore, diagnostic agreement was calculated in 124 cases. Of these 124 cases, 116 (93.6%) cytology-histopathology diagnosis were compatible, and 8 (6.4%) were not. In our series, the overall sensitivity and specificity were 83.3% and 97.7%, respectively. The positive predictive value was 93.7% and the negative predictive value was 93.4%. The accuracy rate was calculated as 93.5%. Conclusion: In our study, high sensitivity and specificity values were determined by FNAC in accordance with the literature. It should be kept in mind that there may rarely be differences between preoperative cytological and histopathological diagnoses, possibly due to experience, method, and lesion-related limitations and pitfalls.

Cytodiagnosis of multilobulated aggressive angiomyxoma clinically mimicking sarcoma – A case report

: Aggressive angiomyxoma is a rare but locally aggressive infiltrative mesenchymal tumour arising in the soft tissues of the lower genital tract. Incidence is very less (only about 350 cases have been recorded in the literature) with female to male ratio of 6:1. Average age at presentation is around 40 years.: A 32 years old female presented with multiple swelling in the vulval region for 1 and a half years associated with mild pain. The patient complains of dysmenorrhoea, pressure sensation, pelvic fullness, dyspepsia, weight loss and generalised weakness. She is married and has a 3-year old male child. Her menstrual cycle is regular with normal menses. FNAC of the vulval swelling was suggestive of angiomyxoma. The swelling was excised in the Gynaecological Operation Theatre and the specimen was sent to the Department of Pathology for Histopathological examination where it was diagnosed as aggressive angiomyxoma. On follow up, the patient was healthy with no complains of recurrence so far. : Aggressive angiomyxoma is an aggressive tumour because it has a high risk of infiltration and local recurrence. Therefore, it should be distinguished from other myxoid tumours. Preoperative cytological diagnosis helps in surgical management with appropriate wide local excision with clear margins.

A Prospective Study of Comparison Between Fine Needle Aspiration Cytology (FNAC) with Histopathological Diagnosis (HPE) in Neck Masses.

FNAC is easy to perform, is minimally invasive and is economical. It has better patient compliance and the cytological diagnosis can be made before any definitive treatment is planned. This prospective study was carried out in a tertiary care hospital of a medical college having 100 cases in study. The statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value. On cytological examination, 94/100 were benign, 6malignant or suspicious. On HPE, 92 were benign while 5malignant from suspicious and malignant cases leaving 3 discordant cases. Sensitivity, specificity, positive predictive value, negative predictive value which was 71.4%, 98.9%, 83.3%,97.8% respectively in our case series. FNAC is a safe, simple procedure. It gives a reliable pre-operative cytological diagnosis based on which surgical procedures or conservative management can be confidently executed. An attempt is made hereby to compare our results with worldwide documented literature. However pitfalls of this method should be kept in mind with careful observation and adequate clinical suspicion.

Primary Hydatid Breast Disease: A Case Report and Review of the Literature

ABSTRACT Mammary hydatid disease is extremely rare, accounting for 0.27% of all cases. The presentation of a palpable painless breast lump mimics several other benign breast lesions. The condition should be included in the differential diagnosis of breast lumps in cases from endemic areas. This is a case report of a young lady from an endemic area, with a preoperative cytology diagnosis of breast hydatid disease. The lack of specific clinical signs poses a diagnostic dilemma for the clinician. Classical ultrasound findings and a carefully done fine needle aspiration cytology procedure can aid in establishing a preoperative diagnosis. Definitive treatment includes surgical excision along with antihelminthics.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: its updated diagnostic criteria, preoperative cytologic diagnoses and impact on the risk of malignancy

Due to the extremely indolent behavior, a subset of noninvasive encapsulated follicular variant papillary thyroid carcinomas has been classified as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" since 2016 and is no longer considered carcinoma. Since the introduction of this new terminology, changes and refinements have been made in diagnostic criteria. Initially, the incidence of NIFTP was estimated substantial. However, the reported incidence of NIFTP varies greatly among studies and regions, with higher incidence in North American and European countries than in Asian countries. Thus, the changes in the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) differ inevitably among regions. Because more conservative surgery is recommended for NIFTPs, distinguishing NIFTPs from papillary thyroid carcinomas in preoperative fine-needle aspiration cytology became one of the major concerns. This review will provide comprehensive overview of updates on diagnostic criteria, actual incidence and preoperative cytologic diagnoses of NIFTP, and its impact on the ROM in TBSRTC.

Performance of Afirma Genomic Sequencing Classifier in Thyroid Nodules with Preoperative Cytologic Diagnosis of AUS/FLUS

Performance of Afirma Genomic Sequencing Classifier in Thyroid Nodules with Preoperative Cytologic Diagnosis of AUS/FLUS

Clinicopathological study of head and neck swellings in patients attending ENT OPD

A thorough clinical history and a good clinical examination including the findings of inspection and palpation are key factors for near accurate provisional diagnosis but histopathological examination is the only gold standard for confirmation of diagnosis till date for the head neck swellings. It has been observed that there was slightly higher ratio of female patients attending the OPD with complaints of neck swelling. Fine needle aspiration cytology is a quick, convenient, easy to perform, and fairly accurate method for cytological diagnosis on an outpatient basis. Importance of this study, particularly in the context of neck masses, lies in the fact that a preoperative cytological diagnosis of a benign lesion in a high-risk patient may obviate the need of a surgical intervention. Preoperative diagnosis of certain conditions like lymphoma and inflammatory pathology may also escape from unnecessary surgeries. It can be concluded that lymph node swellings are the most common amongst the neck swelling by far and on its cytological examination reactive lymphadenitis being the prevalent one. It can also be said that FNAC is the most reliable method for diagnosing the TB lymphadenitis and thyroid swellings.

Evaluation of Bethesda IV-V thyroid nodules: clinical experience

Introduction: The malignancy rate in cases operated for thyroid nodule is approximately 5-10%, and although this rate shows significant differences according to Bethesda categories, there is a high risk of malignancy in categories IV and V compared to other categories. In our study, we examined the clinicopathological factors affecting the success of cytological diagnosis in nodules diagnosed with Bethesda IV-V.&#x0D; Material and Method: A total of 780 patients who were diagnosed with thyroid nodules and underwent surgery at our center between 2011 and 2021 were included in the study. The preoperative cytological diagnoses of the patients were categorized using the Bethesda classification system. The demographic data of the patients, Bethesda classification of the nodules, and postoperative histopathological examination results were evaluated in subgroups, and their significance was determined.&#x0D; Results: The age group with the highest number of cases was 45-59 years, and the female/male ratio of the whole cohort was 3:1. The rate of palpable nodules was 41.8% for the malignant diagnosis group and 58.2% for the benign diagnosis group. In both malignant and benign groups,

Cytopathologic features of human papillomavirus–independent, gastric-type endocervical adenocarcinoma

BackgroundGastric-type endocervical adenocarcinoma (GEA) is unrelated to human papillomavirus (HPV) infection and is clinically aggressive compared with HPV-associated usual-type endocervical adenocarcinoma (UEA). The cytological diagnosis falls short of a definitive diagnosis of GEA and is often categorized as atypical glandular cells (AGCs). To improve cytologic recognition, cytological findings of HPV-independent GEA were analyzed and the results compared with HPV-associated UEA.MethodsCervical Papanicolaou (Pap) smears from eight patients with a histopathologic diagnosis of GEA and 12 control cases of UEA were reviewed. All slides were conventionally prepared and/or liquid-based prepared (ThinPrep) and stained following the Pap method. A mucinous background, architectural, nuclear, and cytoplasmic features were analyzed and compared with UEA.ResultsPreoperative cytologic diagnoses of the eight GEA cases were AGCs, favor neoplastic in three cases, adenocarcinoma in situ in one case, and adenocarcinoma in four cases. Cytologically, monolayered honeycomb-like sheets (p = .002) of atypical endocervical cells with vacuolar granular cytoplasm (p = .001) were extensive in GEA, and three-dimensional clusters (p = .010) were extensive in UEA. Although the differences were not statistically significant, background mucin (p = .058), vesicular nuclei (p = .057), and golden-brown intracytoplasmic mucin (p = .089) were also discriminatory findings for GEA versus UEA.ConclusionsAlthough GEA is difficult to diagnose on cytologic screening, GEA can be recognized based on cytologic features of monolayered honeycomb sheets of atypical endocervical cells with abundant vacuolar cytoplasm and some golden-brown intracytoplasmic mucin. UEA cases are characterized by three-dimensional clusters.

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study.

Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution. A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant. Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841). DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.

Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis

Background: A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. Objectives: The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. Method: An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. Results: Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5–5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8–1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9–10.8%) in benign, 29.2% (95% CI: 25.0–33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6–28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1–22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2–8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). Conclusions: Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.

Impact of Transoral Endoscopic Vestibular Approach Thyroidectomy on Pathologic Assessment.

Since 2016, transoral endoscopic thyroid resection with vestibular approach (TOETVA) has been increasingly performed in the United States. Although guidelines for the procedure are evolving, indeterminate and malignant preoperative cytopathologic diagnoses are not a contraindication. There are limited data related to the pathologic examination of these specimens. To examine the clinicopathologic features of TOETVA specimens with particular attention to limitations of interpretation of pathologic parameters and final diagnosis. We reviewed age, sex, preoperative imaging and cytologic diagnoses, surgical pathology, and clinical follow-up data in TOETVA resections from our institution for procedures performed between March 2016 and December 2019. Fifty cases of TOETVA were identified, comprising 48 women and 2 men with a mean age of 47 years. Preoperative cytologic diagnoses were available in 47 cases and included 19 nondiagnostic/benign (Bethesda I/II), 24 follicular lesion of undetermined significance/suspicious for follicular neoplasm (Bethesda III/IV), and 4 suspicious/malignant diagnoses (Bethesda V/VI). Thirty-four cases (68%) among the surgical resection specimens showed disruption and/or fragmentation. Thirty-nine cases were negative for carcinoma, including hyperplasias and benign/indolent neoplasms. Eleven cases exhibited papillary thyroid carcinoma. Final diagnoses were reached in all disrupted/fragmented cases. In 2 cases of papillary thyroid carcinoma, tumor size, microscopic extrathyroidal extension, and margin status could not be determined. A significant proportion of TOETVA specimens are disrupted/fragmented, which can compromise information about tumors, including size, number, margin status, and microscopic extrathyroidal extension. Given that these parameters inform treatment and follow-up, this should be considered when selecting patients for TOETVA.

NTRK-rearranged papillary thyroid carcinoma demonstrates frequent subtle nuclear features and indeterminate cytologic diagnoses.

The studies on the cytomorphologic features of NTRK-rearranged papillary thyroid carcinoma (PTC) are limited and some reported characteristics, such as frequent indeterminate diagnoses and presence of fibrotic fragments, are inconsistent in literature. NTRK gene rearrangements were detected in thyroidectomy specimens of PTC by either fluorescence in situ hybridization or next-generation sequencing. All the cytologic slides of NTRK-rearranged PTC were reviewed to evaluate the cytomorphologic features. The preoperative cytologic diagnoses of NTRK-rearranged PTC were compared with those of NTRK/BRAF wild-type and BRAFV600E -positive PTC. Fourteen PTC cases were identified to harbor NTRK gene rearrangements. Most of them showed a mixed architectural pattern of cell fragments (n = 13, 92.9%) and microfollicles (n = 9, 64.3%) with relatively rare papillary structures (n = 4, 28.6%). Nuclear grooving was frequently present (n = 11, 78.6%) but was mostly subtle and limited. Seven cases (50.0%) showed rounded nuclei without discernible nuclear elongation, and only 3 (21.4%) cases presented with nuclear pseudoinclusions. Among these cases, 7 (50.0%) were diagnosed as The Bethesda System for Reporting Thyroid Cytopathology (TBS) category III, 2 (14.3%) were diagnosed as TBS IV, and 5 (35.7%) were diagnosed as TBS V. The rate of TBS III-IV diagnoses for NTRK-rearranged PTCs was significantly higher (64.3%) than that for the 25 consecutive NTRK/BRAF wild-type PTCs (20.0%, P = .013) and the 70 consecutive BRAFV600E -positive PTCs (7.1%, P < .001) as selected. NTRK-rearranged PTC demonstrated intermediate nuclear features, such as subtle nuclear grooving, infrequent nuclear elongation, and rare pseudoinclusions, resulting in a significantly higher rate of TBS III-IV diagnoses compared to PTC with other molecular alterations.

Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

Background/objectiveThe diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm. MethodsThe records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. ResultsForty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). ConclusionsPreoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.

Cytological and molecular diagnosis of Hürthle cell thyroid tumors: Analysis of three cases.

The cytological diagnosis of Hürthle cell (oncocytic) thyroid tumors by means of fine-needle aspiration biopsy represents a challenge, as Hürthle cell polymorphism and atypia alone are not indications of malignancy. In our recent work, an original diagnostic algorithm was proposed, which identified and typed malignant thyroid tumors by analyzing the molecular markers of cytological preparations. The aim of the present study was to assess the effectiveness of this algorithm at detecting Hürthle cell thyroid tumors in clinical samples used for cytological examination. Cytological and histological examinations of the biopsy material were performed for three patients with nodular neoplasms. Biopsy material of these patients was analyzed by quantitative PCR using preselected molecular markers [normalized concentrations of High-mobility group AT-hook 2 mRNA, three microRNAs (miRNAs or miRs; miR-146b, miR-221 and miR-375) and the mitochondrial (mtDNA)/nuclear DNA ratio]. The results revealed that the molecular test determined the malignancy of three cases of Hürthle cell tumor. This method may therefore be used to complement the cytological diagnosis of fine-needle aspiration biopsy. In all three cases, there was an increased content of mtDNA, indicating Hürthle cell malignancies. Furthermore, in the first case [Hürthle cell carcinoma (HCC)], increased miRNA-221 content was detected, which also indicated malignancy. In the second case (Hürthle cell papillary thyroid carcinoma), an increased level of miRNA-146b was present, which indicated papillary carcinoma. In the third case (Hürthle cell adenoma), no markers of malignancy were identified. The present study demonstrated that molecular testing together with cytological analysis can reduce the isk of error in the preoperative cytological diagnosis of unclear or ambivalent cases.

Is there a Role for Frozen Section Evaluation of Parotid Masses After Preoperative Cytology or Biopsy Diagnosis?

Fine-needle aspiration (FNA) biopsy reliably diagnoses parotid gland lesions preoperatively, whereas intraoperative frozen section (FS) has the additional benefit of assessing surgical margins and refining diagnoses; however, the role of FS in the setting of prior FNA diagnosis is not well established. Our aim was to determine whether FS should still be performed after a prior FNA/ CNB diagnosis. Parotid gland resections from January 2009 to January 2020 were identified; however, only patients who had both FNA and FS constituted our study population. For the purpose of statistical analysis, FNA diagnoses were classified into non-diagnostic (ND), non-neoplastic (NN), benign neoplasm (BN), indeterminate, and malignant. FS diagnoses were classified into benign, indeterminate, or malignant. Resections were dichotomized into benign and malignant and regarded as the gold standard to subsequently calculate diagnostic accuracy of FNA and FS. A total of 167 parotid gland resections were identified, but only 76 patients (45.5%) had both FNA and FS. In 35 cases deemed as benign preoperatively, three (8.6%) were reclassified as malignant on FS. Out of 18 lesions reported as malignant on FNA, four (22.2%) were interpreted as benign on FS, with three of these benign lesions confirmed on permanent slides. In addition, in patients with both FNA and FS, compared to FNA, FS was able to provide a definitive diagnosis in all five ND cases and in 61.1% (11/18) of indeterminate tumors. Intraoperative assessment provided a relative increase of 33.3% in specificity and 38.5% in positive predictive value when compared to preoperative FNA. The addition of FS to FNA was helpful to further refine the diagnoses of parotid gland lesions, which may provide better guidance for surgical intervention.