Preoperative Fine-needle Aspiration Cytology Research Articles

Intraoperative Frozen Section in "Suspicious for Papillary Thyroid Carcinoma" after Adoption of the Bethesda System.

To evaluate the accuracy and utility of intraoperative frozen section examination (iFSE) in patients with a preoperative fine-needle aspiration (FNA) cytology of "suspicious for malignancy" (SFM)-Bethesda V, after the adoption of the Bethesda System for Reporting Thyroid Cytopathology. Case series with chart review. Tertiary medical center. All patients with SFM-Bethesda V who underwent thyroid surgery with iFSE between 2010 and 2015 were included. In cases where the iFSE was reported to be malignant, a total thyroidectomy was performed; otherwise, thyroid lobectomy (hemithyroidectomy) was performed. The current series included 47 patients diagnosed preoperatively with FNA cytology of SFM-Bethesda V. The malignancy rate was 74.5% (35 of 47). Twenty-four patients with nonmalignant iFSE results underwent lobectomy during their initial surgery: 12 were subsequently found with benign final histology and did not undergo completion thyroidectomy; the other 12 patients had malignant results on final histology, but only 4 of them underwent completion thyroidectomy. iFSE resulted in a sensitivity and specificity of 65.7% and 100%, respectively, with a positive predictive value of 100% (23 of 23) and a negative predictive value of 50% (12 of 24). Accuracy of the iFSE methodology was 74.5% (35 of 47). With no significant preoperative clinical or sonographic predictors for thyroid malignancy and given the high specificity of iFSE, our results support the use of iFSE for patients with preoperative FNA cytology of SFM-Bethesda V who are undergoing thyroid surgery, to determine the extent of required surgery.

İnce İğne Aspirasyon Biyopsisi Yönteminin Tiroid Nodüllerinde Cerrahi Kararındaki Etkileri

Background: We aimed to investigate the sensitivity of the frequently used preoperative diagnostic test FNAC (fine needle aspiration cytology) in thyroid diseases by analysing the correlation between this test and histopathological examination in the light of our clinical experience

The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors: Correlation With Preoperative Computerized Tomography Tumor Size.

The role of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses is still controversial, regarding its sensitivity and specificity that vary between 41% and 100% and between 86% and 100% respectively.The aim of this study was to identify the specificity and sensitivity of FNAC of parotid gland tumors in relation to the tumor size as characterized preoperatively by computer tomography. The medical files of 79 patients whom were referred to the MaxilloFacila Surgery Department, Rambam medical center, over a 10.5-year period (2000-2010) were analyzed retrospectively.The extensity of the operation was determined by the location of the tumor as presented in computed tomography (CT) radiography, and preoperative FNAC examination.The majority of the masses were located in the superficial lobe (88.52%), and only 11.48% of the patients were located in the deep lobe (8:1 ratio). FNAC results were nondiagnostic in 7 patients (8.86%), 62 patients were diagnosed as inflammatory and benign lesion in (78.48%), malignant tumors were diagnosed in 10 patients (12.65%).The sensitivity in our study was 90%, the specificity was 98%, positive predictive value was 90%, negative predictive value was 98%, and diagnostic accuracy was 88%. The positive predictive value was 90%, the negative predictive value was 98%.Analyzing the effect of the preoperative CT size upon the accuracy of the FNAC diagnosis, we found that lesion with preoperative CT size greater than 24 mm has a more accurate FNAC result (P = 0.034).

Fine Needle Aspiration Cytology in Warthin's Tumor: A Diagnostic tool

Warthin’s tumor, also known as papillary cystadenoma lymphomatosum or adenolymphoma, is the second most common benign tumor of the salivary glands. It is commonly seen in lower lobe of the parotid gland and affects mainly male in sixth or seventh decades of life. Studies have shown that there is a close association between Warthin’s tumor and cigarette smoking. Preoperative fine needle aspiration cytology (FNAC) of a parotid mass plays a pivotal role in differentiating neoplastic from inflammatory lesion as well as management of patients. We report a case of a 70 year old male chronic smoker who presented with painless swelling in the parotid region bilaterally.

Cervical Schwannoma- A Case Report

Schwannomas are benign, slow-growing, encapsulated tumours deriving from the peri neural cells located in the nerve sheath. They can arise from any peripheral, cranial or autonomic nerves, and show a predilection for the head and neck region. Extra cranial Head and Neck schwannomas are rare tumours. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. The preoperative diagnosis is difficult. Although preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis, they are inadequate. The definitive diagnosis is made by histopathological examinations.

Diagnostic role of FNAC in Salivary gland lesions and its histopathological correlation

Background: Fine needle aspiration cytology (FNAC) is the established first line investigation of mass lesions in the body. Kun was the first to describe the diagnostic use of FNAC in 1847. About 2-6.5% of all head and neck region neoplasm in adults are from salivary glands which are usually accessible for FNAC. It helps to distinguish salivary glands lesion as inflammatory, benign and malignant hence allowing proper planning for management. Material and Methods: It was a retrospective study carried for the period of Feb 2014 to Feb 2016. 68 cases of salivary gland swelling were included in which cytological and histological studies were done. 22 cases were excluded from the study on view of inadequate material or lack of either FNAC or histology correlation. All the patients were clinically evaluated and FNAC was done using 10 ml disposable syringe and 23/24-gauge needle without using local anesthesia. We classified our FNAC results as true-negative, true-positive, false-negative and false-positive. We also compared the histopathology of the surgical specimens and cytology of the FNAC specimens and evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Results: Parotid gland was commonest affected site. Out of 46 neoplastic lesions 39 (84.7%) were benign and 07 (15.3%) were malignant. An overall of 86.9% (40/46) concordance between FNAC and final histological diagnosis was established. A sensitivity of 97.4% and specificity was 71.4%, were observed with 93.4 % of accuracy. The positive and negative predictive values were 95% and 83.3%, respectively. Conclusion: FNAC is a safe and accurate diagnostic tool. Surgeon can plan treatment according the preoperative FNAC diagnosis and avoid unnecessary surgeries. Keywords: Cytology, FNAC, Parotid gland

Role of Scrape Cytology as an Adjunct to Fine Needle Aspiration Cytology in Diagnosis of Thyroid Lesions.

Scrape cytology is an important diagnostic tool. It has been used in many tissue types as an adjunct or replacement for frozen section/ intra operative consultation. This study was done to evaluate the role of scrape cytology in the diagnosis of thyroid lesions, its role as an adjunct to Fine Needle Aspiration Cytology (FNAC) and application of this technique for intra-operative consultation. A prospective study on 50 thyroid neoplasms received over a period of 18 months (Nov 2014- March 2016) was conducted. Scrapings obtained from the fresh cut surface of thyroid specimens before formalin fixation, were smeared uniformly on to glass slides, and immediately fixed in 95% ethyl alcohol for rapid Haematoxylin and Eosin (H&E). Cytological findings were compared with pre-operative FNAC findings and histopathological diagnosis. Variables taken in to consideration while assessing the smears included cellularity, nuclear, cytological details and amount of colloid. There were total of 50 patients. Out of the 50 patients, 15 were diagnosed as benign on scrape; of which 100% of cases were true negative for malignancy and five malignant cases were diagnosed as benign-false negative rate of 16.1%; four (8%) were deferred (non-diagnostic) with a true positive rate of 83.3%. Histopathological correlation was available in all cases. The overall diagnostic accuracy of scrape cytology was 89.1% with sensitivity and specificity of 83.87% (C.I.; 66.27% to 94.55%) and 100% (C.I; 76.84% to 100.00%) respectively. Fine Needle Aspiration results were available in 41 cases of which 2 were non-diagnostic. Of the remaining 39 cases 19 were benign and 20 were malignant with false negative rate of 40% and true positive rate of 60%. The overall diagnostic accuracy of FNAC was 64.1% with sensitivity and specificity of 60% (C.I.; 40.6% to77.3 %) and 77.78% (C.I; 39.9% to 97.1%) respectively. We conclude that scrape cytology can act as a useful adjunct to FNAC and is a good procedure for intra-operative consultation. It is especially helpful in neoplasms diagnosed as suspicious for papillary carcinoma on aspiration and may obviate the need for a second procedure for completion thyroidectomy.

Erratum: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Erratum: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Erratum: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Erratum: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Diffusion-weighted MR Imaging and ADC Mapping in Differentiating Benign from Malignant Thyroid Nodules.

To determine the diagnostic accuracy of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in differentiating benign from malignant thyroid nodules by taking histopathology as the gold standard. Across-sectional analytical study. Department of Radiology at Combined Military Hospital (CMH), Lahore, from August 2012 to July 2013. Thirty-five patients, who were referred to radiology department of CMH, Lahore, for ultrasound or Fine Needle Aspiration Cytology (FNAC) of thyroid gland, fulfilling the inclusion and exclusion criteria, were included in the study. They were evaluated on 1.5 Tesla MRI machine with T1- and T2-weighted imaging as well as fat-suppressed technique. DWI was done using b-values of 0 and 1000 s/mm2and ADC values were calculated for the thyroid nodules. All of these patients were subjected to ultrasound guided core biopsy and histopathology results were correlated with ADC values. The benign nodules showed facilitated diffusion while malignant nodules showed restricted diffusion. T-test was used to assess the difference in mean ADC values between benign and malignant nodules. The mean ADC value of the malignant thyroid nodules (0.94 ±0.16 x 10-3mm2/s) was significantly lower than that of the benign thyroid nodules (1.93 ±0.13 x 10-3mm2/s) (p-value < 0.05). ADC value of 1.6 x 10-3mm2/s was used as a cut-off, for differentiating benign from malignant thyroid nodules. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of DWI and ADC values in differentiating benign from malignant thyroid nodules were 93%, 95%, 93%, 95% and 92.3%, respectively. DWI is a non-invasive diagnostic tool for characterization and differentiation between benign and malignant thyroid nodules. It not only decreases the burden of unnecessary surgeries when pre-operative FNAC and biopsy are inconclusive, but is also helpful in reaching a definite diagnosis when a nodule is not amendable to biopsy due to any reason.

The clinical utility of combining pre-operative axillary ultrasonography and fine needle aspiration cytology with radionuclide guided sentinel lymph node biopsy in breast cancer patients with palpable axillary lymph nodes

PurposeClinically palpable lymph nodes (CPLN) are usually considered a contraindication to sentinel lymph node biopsy (SLNB) but one third of these patients are node negative. The aim of the present study is to evaluate the clinical usefulness of combining SLNB and preoperative axillary ultrasonography (AUS) with FNAC in patients with clinically palpable but indeterminate axillary lymph nodes. Materials and methodsFifty three patients with primary breast cancer and CPLN (mean age, 51.6 years; median age 51years; age range, 28–73 years) were included in the study. All patients underwent AUS and fine needle aspiration (FNAC) followed by SLNB in FNAC negative patients (Group A). Patients with proven metastasis subsequently had axillary lymph node dissection (ALND) (Group B). Standard SLN scintigraphy was performed 2–4h before surgery by injecting Tc-99m labeled nano-colloid intra-dermally in the periareolar region. ResultsNodal metastases were documented at FNAC in 26 (49%) of the 53 patients with subsequent ALND (Group B). All 27 patients (51%) with negative FNAC results (Group A) underwent SLNB, which revealed metastasis in 6 (11%) patients. The remaining 21 (40%) patients were tumor negative and all these patients remain disease free during the follow-up period of 12–36 months with NPV of 100%. SLN was identified in all patients (100% success rate). Preoperative AUS sensitivity was 78%, specificity 76%, PPV 83%, NPV 69% and accuracy 77% (p=0.001). In comparison, ultrasound guided FNAC sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 81%, 100%, 100%, 78%, 89% respectively (p=0.001). ConclusionsThe inaccuracy of clinical assessment allows widening of indication of SLNB. Preoperative ultrasonography and guided FNAC can help in selecting the patients suitable for ALND or SLNB. Patients who are FNAC positive can proceed to ALND whilst FNAC negative samples can undergo SLNB. This combination strategy may be helpful in avoiding unnecessary ALND.

Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section.

The aim of this study is to compare preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section (FS) for the correct identification of malignancy, histological grade, and histological type. FNAC was performed on all 105 patients and FS on 71 patients with parotid carcinoma. The rate of correctly determining the histological grade by FNAC and FS was 32% and 73%, respectively. The correct diagnosis rate for both the histological type and grade by FNAC and FS was 20% and 48%, respectively. The correct grading of both high and low/intermediate grade carcinoma is possible in 70-80% of patients by FS. If the histological grade is identified correctly, the extent of resection can usually be decided appropriately. Therefore, we should put emphasis on determining the histological grade.

Poorly differentiated carcinoma of thyroid: A cytological dilemma

Poorly differentiated thyroid carcinoma (PDTC) is a neoplasm of follicular cell that show limited evidence of structural follicular cell differentiation. They occupy both morphologically and behaviorally an intermediate position between differentiated (follicular and papillary) and undifferentiated (anaplastic) carcinomas. Preoperative fine-needle aspiration cytology can be helpful in planning treatment options and patient management. According to WHO, the occurrence is around 4-7% of all the clinically evident thyroid tumors. We report a case of PDTC with clinicopathological correlation.

Cytopathological diagnosis of gallbladder mass and mural thickening based on imaging findings: A prospective study of 51 cases.

Background:Image-guided fine-needle aspiration cytology (FNAC) serves as first-line diagnostic modalities for the assessment of mural thickening of the gallbladder (GB).Aim:The main objective of the present study was to correlate the diagnostic accuracy of preoperative image-guided FNAC of the thickened GB wall based on imaging findings to arrive at a final diagnosis in a tertiary care center.Materials and Methods:Fifty-seven image-guided fine-needle aspirations (FNAs) were performed from mural thickening of the GB over a period of 4 years and the smears prepared were stained with Leishman and Papanicolaou (Pap) stain. Out of 57 cases, 51 were included in the study for which follow-up histopathology was performed.Result:Out of 51 aspirations, 43 (84.3%) were adequate, 5 (9.8%) were inconclusive, and 3 (5.9%) were inadequate. Among the adequate aspirations, the most common was adenocarcinoma—36 (70.5%). The correlation between confirmatory cytological diagnosis and adequacy was significantly high (P = 0.0001). The overall diagnostic accuracy for adequate aspiration was 95.3%. The common diagnostic pitfalls were necrotic areas, aspiration of reactive hepatocytes adjacent to the GB mass, and mucus islands. No procedural complication was observed in any patient.Conclusions:Image-guided FNAC can be used as a safe, rapid, and successful diagnostic procedure with high sensitivity, specifically for supporting and confirming ultrasonography(USG)/computed tomography (CT) diagnosis of GB mass or mural thickening of the wall.

Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation.

Background:Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management.Materials and Methods:In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate.Results:There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings.Conclusion:Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.

Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

The preoperative evaluation prevent the postoperative complications of thyroidectomy.

ObjectiveThyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications.MethodsA nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics.ResultsEighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively.ConclusionsThe success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

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.

Efficiency of a preoperative axillary ultrasound and fine-needle aspiration cytology to detect patients with extensive axillary lymph node involvement.

BackgroundRecent studies have demonstrated that axillary lymph node dissection (ALND) does not affect patient survival, even in those with one or two positive sentinel lymph nodes (SLNs). On the other hand, patients with 3 or more metastatic lymph nodes are eligible for chemotherapy. Therefore, it is crucial to identify a priori patients at risk of having a high number of metastatic axillary lymph nodes for their surgical and/or clinical management. Ultrasound (US) guided Fine-Needle Aspiration (FNA) has been proven to be a useful and highly specific method for detecting metastatic axillary lymph nodes. However, only one recent study has evaluated the efficiency of this method in identifying patients with high metastatic nodal involvement. Our aim was to validate US-guided FNA as a reliable method to discriminate a priori patients with >3 metastatic lymph nodes.MethodsA retrospective series of 1287 breast cancer patients who underwent a simultaneous preoperative breast and axillary US to stage their axilla was collected. A total of 365 patients, with either positive SLNs (278) or positive axillary lymph nodes detected via US-guided FNA (87), underwent ALND. In these two subgroups, we compared the number of metastatic lymph nodes in the axilla.ResultsThe number of metastatic axillary lymph nodes in patients who underwent US-guided FNA was significantly higher (63% had >3 metastatic lymph nodes) than that in patients with SLNs positive for micro- or macrometastases (3% and 27%, respectively) (P<0.001, χ 2 = 117.897).ConclusionsPreoperative axillary US-guided FNA could act as a reliable tool in identifying breast cancer patients with extensive nodal involvement.