Repeat Fine Needle Aspiration Cytology Research Articles

Predictors of an informative or actionable cytological diagnosis on repeat breast aspiration after an insufficient aspirate: a multicentre retrospective review

An insufficient/inadequate diagnosis on fine-needle aspiration cytology (FNAC) of the breast is not an uncommon diagnostic dilemma. This study aims to review the rate and clinical features predicting an informative...

Evaluation of Recurrent Lymphadenitis after Six Months Anti-Tuberculous Therapy

Background: Recurrence or persistence of tuberculous lymphadenitis even after treatment occurs due to paradoxical immune response, non-tubercular mycobacterial (NTM) infection, drug resistance tuberculosis or because of misdiagnosis. In these situations sometimes the patients are asked to continue category-1 more than six months on the basis repeat fine needle aspiration cytology (FNAC) findings. This study evaluated the cause of persistence or appearance of new lymph node after anti-TB category-1. Methods: This observational study was done from January, 2013 to March, 2014 after getting ethical clearance from Bangabandhu Sheikh Mujib Medical University (BSMMU). Patients who had persistent or new lymphadenitis after completing anti-TB category-1 for six months were selected. After analysis of treatment records, patients were selected for either FNAC or biopsy with local surgical clearance. Cyto/histopathological analysis, AFB stain (LED fluorescent), AFB culture (MGIT and L-J media) and GeneXpert test was done. Follow-up of the patients were done after two weeks and six months of FNA/surgery. Results: Thirty-two patients (M/F=11/21) with mean age 25(±12) years were investigated. Altogether 26 cases (81.25%) Journal of Bangladesh College of Physicians and Surgeons Vol. 41, No. 4, October 2023 were confirmed as tuberculous lymphadenitis and six (18.75%) were non-tuberculous (03 lymphomas, 01 sarcoidosis, 01 reactive lymphadenitis and 01 pyogenic abscess). Among the TB patients, granuloma was present in 23 cases (88.46%) (FNA-07, biopsy-16). Twenty-three (88.46%) cases were GeneXpert positive, comprising 21 rifampicin sensitive and 02 rifampicin resistant. One rifampicin resistant case was confirmed by culture and the remaining 25 were culture negative. One case was AFB stain positive and no NTM was found in AFB culture. After surgery, rapid healing was observed within two weeks among tuberculous lymphadenitis patients. Conclusions: Persistent granuloma after anti-TB category-1 does not indicate active tuberculosis if it is culture negative. It may occur due to immunological reaction against dead bacilli in deep seated sinus. Local surgical clearance results rapid recovery and other diagnosis should be excluded without further continuation of anti-TB category-1. J Bangladesh Coll Phys Surg 2023; 41(4): 262-268

Risk stratification of cytologically indeterminate thyroid nodules with nondiagnostic or benign cytology on repeat FNA: Implications for molecular testing and surveillance.

Evidence guiding the management of cytologically indeterminate thyroid nodules with nondiagnostic (ND) or benign cytology on repeat fine-needle aspiration (FNA) is limited. This study evaluates the utility of molecular testing and estimates the risk of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and cancer among such nodules. This was a retrospective single-institution review of thyroid nodules from adults that were classified as atypia of undetermined significance (AUS) or follicular neoplasm (FN) on initial FNA and underwent repeat FNA for cytology and Afirma testing (June 2013-July 2021). The association between repeat FNA cytology and RNA yield for Afirma was determined. Histologic outcomes were integrated with Afirma results to define end points for each nodule. A total of 691 AUS and FN nodules underwent repeat FNA and Afirma testing. Diagnostic Afirma results were obtained in 98% of cases overall and in 91% of nodules with ND cytology on repeat FNA. Using combined molecular and histologic end points, the NIFTP and/or cancer prevalence for nodules with ND cytology on repeat FNA was 9% (95% confidence interval [CI], 0.042-0.182), falling between those nodules classified as benign (5%; 95% CI, 0.029-0.094) and those classified as AUS or FN (18%; 95% CI, 0.140-0.218) on repeat FNA, although not reaching statistical significance from either subgroup (p=.38 and .10, respectively). AUS and FN nodules that are ND on repeat FNA have low but nonnegligible risk of NIFTP and/or cancer and may benefit from molecular testing, given the low test failure rate in this subgroup. Conversely, AUS and FN nodules reclassified as benign on repeat FNA have a very low risk of NIFTP and/or cancer and are unlikely to benefit from molecular testing.

RETROSPECTIVE STUDY OF ULTRASONOGRAPHIC AND FNAC CORRELATION OF THYROID LESIONS WITH HISTOPATHOLOGY

INTRODUCTION: Thyroid diseases, a common clinical problem have prevalence rate of 4–7% in the general population. Fine-needle aspiration cytology (FNAC) is a minimally invasive, accurate diagnostic tool which can differentiate neoplastic from non-neoplastic lesions and reduces the number of unnecessary thyroidectomies, but has limitations . Our study was a retrospective an METHODOLOGY: alysis of 124 cases of thyroid lesions over a period of 3 years from April2019 to April 2022. The FNAC ndings were reviewed and data was compared with the histopathological, imaging ndings and data was analysed. Majority of the pat RESULTS: ients were females in the age group of 41–60 years with a mean age of 42 years and most were non-neoplastic lesions. 76 cases were diagnosed as colloid nodular goitre and benign cystic lesions by FNAC. 44 cases were diagnosed as neoplastic lesions (follicular neoplasm, papillary carcinoma, and suspected malignancy) by FNAC. 18 of these cases were non neoplastic lesions, 24 were papillary carcinoma, 2 were follicular carcinoma on histopathological examination . Statistical analysis of neoplastic lesions showed sensitivity, specicity, accuracy, false positive rate, false negative rate, positive predictive value, and negative predictive value of FNAC to be 69.09%, 90.7%, 80.8%, 9.2%, 30.9%, 86.3% and 77.6% respectively. Ultrasound was foun CONCLUSION: d to be more reliable than palpation, but denitive diagnosis can be reached only with FNAC/Biopsy. Bethesda system of reporting thyroid cytology should be meticulously followed to minimize errors and a repeat FNAC asked for discordant cases after a multidisciplinary team conference.

Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

BackgroundFine needle aspiration cytology has been established as a minimally invasive, non-tumour seeding investigation of choice in the initial diagnostic pathway of parotid lesions. The purpose of this study was to compare the accuracy of fine needle aspiration cytology performed with and without ultrasound to determine whether one method should be preferred to the other. A retrospective review of all patients undergoing fine needle aspiration cytology with and without ultrasound for parotid masses in a large district general hospital between 2012 and 2016 was performed. Specificity, sensitivity, accuracy, positive and negative predictive value, percentage of inconclusive fine needle aspiration cytology and percentage of second fine needle aspiration cytology were determined for each group.ResultsA total of 397 fine needle aspiration cytology results were available for analysis. The numbers performed with ultrasound guidance and free-hand were roughly equal (208 (52.3%) versus 189 (47.7%)). The number of inconclusive fine needle aspiration cytology reports was significantly higher in the free-hand group (65/189 (34.4%)) than the ultrasound group (25/208 (12%)) (p < 0.0001). A significantly higher number of repeated fine needle aspiration cytology were undertaken in the free-hand group vs ultrasound group (43 vs 15, p < 0.0001); overall 7.2% of ultrasound-guided fine needle aspiration cytology required a second fine needle aspiration cytology, compared to 22.8% in the free-hand group. The sensitivity, specificity, positive and negative predictive values were all higher in the ultrasound group versus the free-hand group.ConclusionsUltrasound-guided fine needle aspiration cytology is superior to free-hand fine needle aspiration cytology in the investigation of parotid tumours. There is a significant benefit in reducing the number of inconclusive results and repeat fine needle aspiration cytology, and a potential benefit in improving the sensitivity and positive predictive value, when immediate cytology assessment of the sample quality is not performed.

Clinical significance of repeat fine-needle aspiration in managing patients with suppurative lesion

Background: Fine-needle aspiration (FNA) has been challenged about its role in the management of patients with clinical suspicion of infective or neoplastic etiology but cytological picture showing features of acute suppuration. This study emphasizes the need to perform repeat FNA cytology (FNAC), especially if the mass lesion is indicating suppuration and has not responded to the initial course of antibiotics. Materials and Methods: All patients with a previously diagnosed suppurative lesion on cytology smears who have undergone repeat FNA were included in the study. Insufficient material on FNA and the nonavailability of slides were excluded from this study. Results: Repeat FNA assisted in the detection of malignant lesions (3), tubercular lesions (20), fungal lesions (9), and benign lesions (9) out of the 123 cases of previously diagnosed acute suppurative lesions. Comparison of FNAC findings with histopathological specimens was available for 52 cases, following which repeat FNA had a sensitivity of 66.67% (95% confidence interval 34.89%-90.08%) in detecting neoplastic, specificity was 100%, positive predictive value was 100%, negative predictive value was 90.91%, and the total diagnostic accuracy was 92.31%. Conclusion: Patients with acute suppurative lesions should be followed by repeat FNA, especially if the lesion is not responded to initial antibiotic therapy. Repeat FNA will enhance the diagnostic accuracy of malignant lesions and many other lesions, such as fungal or tubercular infections. It will reduce the need for surgical interventions and molecular detection of infectious diseases.

Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS.

Our institution (University Hospital “L. Vanvitelli” - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital “L. Vanvitelli” from January 2016 to December 2021 were retrospectively reviewed. Fleiss’ kappa (κ) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (κ=0.133). Changed FNAC results were significantly (p=0.0023) more frequent in nodules at intermediate/high-risk (i.e., EU-TIRADS 4/5) than in those at no/low risk (EU-TIRADS 2/3) [i.e., 32/48 (66.7%) and 28/76 (36.8%), respectively]. Downgraded FNAC results were significantly more frequent in EU-TIRADS 2/3 (p=0.001) while upgraded FNAC were present only in EU-TIRADS 4/5 (24/24, 100.0%). The inter-observer agreement among LV and HV thyroid services was poor. The EU-TIRADS 4 and 5 categories included all the malignant nodules with FNAC results reclassified as higher risk (i.e., TIR3B-TIR4-TIR5) by the high-volume cytology service.

Repeat Fine Needle Aspiration Cytology (FNAC) in Thyroid Does Not Help in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)

Repeat Fine Needle Aspiration Cytology (FNAC) in Thyroid Does Not Help in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)

Clinical utility of histogram analysis of grayscale sonograms in assessing sonographic suspicious malignant thyroid nodules.

BackgroundWhen sonographic suspicious malignant thyroid nodules initially proven to be inconsistent by aspiration, repeat fine-needle aspiration cytology (FNAC) is commonly recommended. Although FNAC is simple and reliable, it is also an invasive operation with inevitable false negative results. To determine which sonographic features and histogram parameters based on gray-scale ultrasonic images need repeat aspiration.MethodsAll of the nodules were suspicious for malignancy by preoperative ultrasound (US), and their initial FNAC findings indicated Bethesda category II, or III. Histogram analyses were performed for gray-scale ultrasonic images. Mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th), and sonographic features were compared between pathological benign nodules and malignant ones. Thereafter, receiver operator characteristic (ROC) curves were analyzed for the valuable indicators.ResultsOne hundred and nineteen consecutive patients with 123 histopathologically diagnosed focal thyroid nodules were included in the cohort. The factors associated with malignancy were taller-than-wide shape [odds ratio (OR) =15.165; 95% confidence interval (CI): 3.157–72.854], irregular margins (OR =11.492; 95% CI: 1.747–75.573), microcalcifications (OR =5.107; 95% CI: 1.455–17.927) and skewness (OR =25.800; 95% CI: 1.034–76.422). The skewness of malignant thyroid nodules is higher than that of benign thyroid nodules and has an area under the curve (AUC) of 0.776 in the diagnosis.ConclusionsFor thyroid nodules suspicious on US but not on cytology, skewness, together with taller-than-wide shape, irregular margins and microcalcifications might be a promising marker for clinicians to perform repetitive FNACs.

Tuberculosis Lymphadenitis in a Well Managed Case of Sarcoidosis

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.

Cytomorphology of Castleman’s Disease of Parotid Gland: Pitfalls and Diagnostic Dilemma in a Young Adult

Fine needle aspiration cytology (FNAC) is an easy, effective diagnostic tool that makes it the procedure of choice for all accessible swellings in the body. Castleman’s disease (CD) may present as unicentric or multicentric swelling hence is subjected to FNAC very frequently. CD mainly presents mediastinal nodes, nonetheless when present in salivary glands such as parotid, it is often diagnosed clinically as a salivary gland tumor. However, due to lack of adequate literature on its cytological features and non- specific radiological findings, the condition is often misdiagnosed. There are few case series on cytological features of CD and even fewer cases of CD in the parotid gland. Histopathology serves as the gold standard of diagnosis for CD. In superficial locations, these swellings are easily subjected to direct fine needle aspiration cytology (FNAC). Radiologically guided FNA can be performed for deeper locations. Hence, the authors present a case of 19 year old male patient, who presented with a small superficial, preauricular swelling for FNAC. The initial FNAC yielded no conclusive opinion. however a repeat FNAC and histopathological examination led to the final diagnosis. This case report aims to highlight the cytomorphological and histopathological features of CD in the Parotid gland and various difficulties encountered in making the final diagnosis.

Utility of White Blood Cell Diluting Fluid (Turk’s Fluid) in Evaluation of Haemorrhagic Thyroid Cytology Smears in a Tertiary Care Centre- A Novel Study

Introduction: Fine Needle Aspiration Cytology (FNAC) has been one of the safest and accurate diagnostic technique in diagnosing thyroid lesions. But due to the vascularity of thyroid tissue, diagnostic cells get entrapped in blood clot unless rapid smearing is done.This results in repeat FNAC which is inconvenient to the patient as well as time consuming to pathologist. Therefore, an alternative is required to avoid repeat FNAC procedure. Aim: To evaluate the role of Turk's fluid in haemorrhagic thyroid FNAC smears in comparison to conventional haemorrhagic smears. Materials and Methods: The present study was a prospective observational study, which was conducted for the period of six months (March-August 2021). A total of 30 cases were included in the study. FNA sampling was done on patients with thyroid swelling. After the needling was done on the swelling, four smears. One was stained using (H &amp; E). Rest of all the smears were stained by Conventional Giemsa (CG) method. One of these CG stained smears was immediately treated with Turk's fluid for 10-20 seconds. The CG stained smears were compared with the Turk's fluid Treated Giemsa (TTG) smears and evaluated for retention of Red Blood Cells (RBCs), visibility of nuclear and cytoplasmic details of thyroid follicular cells. Results: A total of 30 cases were included in the study. The retention of RBC was lesser in TTG compared to CG which was statistically significant (p-value&lt;0.05). The visibility of cytoplasmic and nuclear morphology on TTG was better than that of CG which was statistically significant (p-value&lt;0.05). Conclusion: TTG smears improves visibility of cytomorphological features by reducing background RBCs and hence avoids repeat FNAC.

Clinical Effects of Microwave Ablation in the Treatment of Low-Risk Papillary Thyroid Microcarcinomas and Related Histopathological Changes.

ObjectiveThis study aimed to evaluate the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) in the treatment of low-risk papillary thyroid microcarcinoma (PTMC), and to observe the histopathological changes after MWA.MethodsMWA was performed under ultrasound guidance for 73 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge (judged by contrast-enhanced US) to avoid marginal residue and recurrence. Ultrasound evaluation was performed at 1 day, 1, 3, 6, 12 and 24 months after treatment, and thyroid function evaluation at the first 6 months. Repeated fine needle aspiration cytology or core needle biopsy pathology was performed at 3 or 6 months after MWA to evaluate residual tumors. Any adverse event associated with MWA was evaluated.ResultsThe follow-up after MWA lasted 6 (6, 12) months. Tumor volume decreased significantly from 0.06 mm3 (0.04, 0.11 mm3) to 0.03 mm3 (0.00, 0.06 mm3) at 12 months after MWA (P< 0.001), with a median volume reduction ratio of 80.28% (-7.43, 100%) and 16 cases (21.92%) presenting complete remission. The largest diameter, volume and ablation energy were found to be different in patients with and without complete remission 12 months after MWA. On histopathological examinations, no atypical or malignant follicular cells were identified after thermal ablation. The most common pathological characteristics were fibroblastic proliferation (34/39, 87.18%) and chronic inflammation (32/39, 82.05%), followed by infarction (21/39, 53.85%). Five patients were transferred to thyroidectomy and 4 of them were confirmed with local recurrence and/or lymph node metastasis. Serum thyrotropin decreased transiently after MWA (P< 0.01) but normalized thereafter. No serious and permanent complications were reported.ConclusionsMWA is a safe and effective treatment for low-risk PTMC. Fibroblastic proliferation and chronic inflammation are the most common pathological changes after MWA of PTMC.

Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing.

Background: Molecular testing (MT) refines risk stratification for thyroid nodules that are indeterminate for cancer by fine needle aspiration (FNA) cytology. Criteria for selecting nodules for MT vary and remain largely untested, raising questions about the best strategy for maximizing the usefulness of MT while minimizing the harms of overtesting. We used a unique data set to examine the effects of repeat FNA cytology-based criteria for MT on management decisions and nodule outcomes. Methods: This was a study of adults (age 25-90 years; 281 women and 72 men) with cytologically indeterminate (Bethesda III/IV) thyroid nodules who underwent repeat FNA biopsy and Afirma Gene Expression Classifier (GEC) testing (N = 363 nodules from 353 patients) between June 2013 and October 2017 at a single institution, with follow-up data collected until December 2019. Subgroup analysis was performed based on classification of repeat FNA cytology. Outcomes of GEC testing, clinical/sonographic surveillance of unresected nodules, and histopathologic diagnoses of thyroidectomies were compared between three testing approaches: (i) Reflex (MT sent on the basis of the initial Bethesda III/IV FNA), (ii) SemiRestrictive (MT sent if repeat FNA is Bethesda I-IV), and (iii) Restrictive (MT sent only if repeat FNA is Bethesda III/IV) testing approaches. Results: Restricting MT to nodules that remain Bethesda III/IV on repeat FNA would have missed 4 low-risk cancers and 3 noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) (collectively 2% of the test population) but would have avoided diagnostic surgery for 42 benign nodules (12% of the test population). The Restrictive testing strategy was more specific (delta 0.126 confidence interval [CI 0.093 to 0.159] and 0.129 [CI 0.097 to 0.161], respectively) but less sensitive (delta -0.339 [CI -0.424 to -0.253] and -0.340 [CI -0.425 to -0.255], respectively) than the Reflex and SemiRestrictive approaches for detecting NIFTP or cancer. Conclusions: Repeat FNA cytology can guide the selection of cytologically indeterminate thyroid nodules that warrant MT. The Restrictive model of performing Afirma GEC only on nodules with two separate biopsies showing Bethesda III/IV cytology would reduce the rate of diagnostic surgery for histologically benign nodules while missing only rare low-risk tumors. Given the low but nontrivial risks of thyroidectomy, the higher specificity of the Restrictive testing approach disproportionately outweighs the potential harms.

Malignancy Rates of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) Cases: A Tertiary Center Study.

To evaluate the malignancy rates of Atypia of undetermined significance /follicular lesion of undetermined significance (AUS/FLUS) cases in the light of clinical and sonographic features. The percentage of AUS/FLUS cases, second fine needle aspiration cytology (FNAC) results, cyto-histopathological correlations and risk of malignancy were analyzed. 113 out of 1461 thyroid FNAC samples (7.7%) were diagnosed as AUS/FLUS and included in the study. Seventy three out of 113 cases (64.6 %) underwent repeat biopsies or surgery. From 45 cases repeat biopsies were taken and 28 had thyroidectomy or lobectomy. There was a significant relation between nodule size and underwent surgery or repeat FNAC (p=0.036). Malignancy rate was 24.6% for cases which had any managements. The malignancy rates were higher in AUS/FLUS cases with cytological atypia (28.8%). After surgery the most common malignancy was papillary thyroid carcinoma, followed by follicular carcinoma. The risk of malignancy of AUS/FLUS cases is quite high because of the heterogeneity of the group. The sub-classification of this category according to cytological or/and architecture atypia may be more useful in predicting malignancy risk. Further larger studies with ancillary techniques including molecular analysis may be more useful in determining the malignancy risk and appropriate management of this heterogeneous category.

Isolated soft-tissue aspergilloma at the right lateral side of nose mimicking as tuberculoma

Aspergilloma is a mycotic infection and is characterized by a mass with soft-tissue attenuation without tissue invasion. Aspergilloma at the lateral aspect of the nose is a very rare location and poses clinical and diagnostic challenge as cytological examination mimics tuberculoma. We report the case of an immunocompetent elderly male with painless nodular swelling at the right side of the nose for 3 months with fine-needle aspiration cytology (FNAC) reported elsewhere as granulomatous inflammation suggestive of tuberculosis. Subsequently, repeat FNAC cytological examination with the application of special stain and submission of aspirated material for microbiological 10% potassium hydroxide mounting and culture-confirmed fungal infection as Aspergillus flavus. A high index of clinical suspicion, the utility of FNAC, application of special stains, and communication with pathologist and microbiologist clinches the diagnosis. The patient was successfully treated with antifungal therapy (Voriconazole) and swelling completely resolved after 6 weeks of treatment.

Audit of repeat fine needle aspiration cytology – reasons demystified – a retrospective analytical study in a tertiary care hospital

Introduction: Fine needle aspiration cytology (FNAC) is a valuable diagnostic tool in evaluation of mass lesions. One of the major limitations of FNAC is the need for repeat aspiration which imposes workload on the laboratory and stress on the patient as well as on the aspirator. There are only few studies which have focused on the issue of repeat aspiration especially the factors associated with repeat FNAC. Aim: Present study was conducted with the aim to determine the factors associated with repeat FNAC. Materials and Methods: This was a retrospective, analytical laboratory audit of 350 repeat FNAC over a duration of two years. Age, sex, site of FNAC, reasons for repeat and outcome of repeats were recorded. Reason for repeat and final outcome of repeat FNAC were considered as outcome measures. Results: Repeat FNAC accounted to 20.94% (350/1671) of all FNAC performed. Maximum number of repeat FNAC were from thyroid 96/351 (27.4%) followed by soft tissue 86 (24.6%) and breast 81(23.1%). The outcome of repeat FNAC were diagnostic in 279 (79.7%), non-diagnostic 47 (13.4%) and loss of patient follow-up in 24 (6.9%) cases. Reasons for repeat were inadequate aspirates in 223 (63.7%), nonrepresentative material in 118 (33.7%) and suspicious cells to be repeated in 9 (2.6%). Logistic regression analysis revealed that organ of FNAC, month of FNAC and reason for repeat FNAC were independent variables linked with outcome of FNAC. Conclusion: FNAC as an investigative modality has immense diagnostic utility and this potential is fettered by inadequate aspirates and descriptive reporting in certain cases. The tricky cases were often encountered in thyroid, soft tissue and breast lesions. Regular audit of repeat FNACs gives us an insight into conditions where a diligent and meticulous approach is required. Keywords: Fine needle aspiration, Cytology cytology in low resource setting.

Comparison between Sonographic Features and Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule.

Background:High resolution ultrasonography (USG) is the first-line investigation in evaluation of euthyroid nodules. Thyroid imaging reporting and data system (TIRADS) is an USG-based risk stratification system for classifying thyroid nodules. Subjects with high-risk category of TIRADS undergo fine needle aspiration cytology (FNAC) and FNAC findings are reported according to Bethesda classification. Bethesda categories are used for determining risk of malignancy. Data regarding sonographic classification of thyroid nodule and its cytological association with respect to final histopathological diagnosis remains scarcely available in India.Aims and Objective:The study evaluated euthyroid nodules for risk of malignancy and compared sonographic features and FNAC (Bethesda classification) findings with histopathology of excised samples.Material and Methods:This was a single-center observational study on 137 consecutive subjects of solitary euthyroid nodule. All subjects underwent USG according to TIRADS and FNAC where applicable. Surgical biopsy report was used as a gold standard.Results:The sensitivity, specificity, accuracy, positive predictive and negative predictive value of FNAC were 80%, 90%, 85%, 86%, and 86.6% and TIRADS were 80%, 47.2% 61%, 51.3%, and 77.3%, respectively. FNAC classification was equally sensitive and more specific than TIRADS. Among individual USG parameters, micro-calcification was most sensitive (80%) and specific (86%). Irregular margin and taller-than-wider shape had a specificity of 89% and 92%, respectively. 3 patients (14.28%) with benign cytology and suspicious USG features (specifically TIRADS 4 & 5) undergoing surgery had malignancy in final HPE.Conclusions:USG and FNAC are equally sensitive in diagnosing malignant thyroid nodule but FNA is more specific (90%). It's a minimally invasive method which can be used to distinguish malignant from benign lesions with a high degree of accuracy (85%). In patient having high risk feature on USG, a benign cytology needs to be repeat FNAC and they should undergo surgical biopsy for confirmation.

Analysis of the outcome of repeat Fine Needle Aspiration Cytology for Thy3a thyroid nodules - a retrospective study of 4 year data in a district general hospital

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The values of shear wave elastography in avoiding repeat fine-needle aspiration for thyroid nodules with nondiagnostic and undetermined cytology.

To evaluate the value of shear wave elastography (SWE) in avoiding repeat fine-needle aspiration of thyroid nodules with nondiagnostic and undetermined cytology. A total of 232 thyroid nodules with nondiagnostic (n=132) and undetermined (n=100) cytology underwent ultrasound (US) and SWE, followed by repeat ultrasound (US)-guided fine-needle aspiration cytology (FNAC). The final diagnosis was based on cytological or pathological findings. The US and SWE characteristics of benign and malignant nodules were compared using the χ2 -test. The receiver operating characteristic (ROC) curves of the thyroid imaging reporting and data system (TI-RADS) categories from the US and the EMean and ESD from the SWE were graphed, and the areas under the curves (AUCs) were compared using a Z test. There were significant differences between the benign and malignant nodules in terms of the echogenicity, shape, margin, calcification and TI-RADS categories (all P<0.05). The differences were significant between the malignant and benign nodules for EMean [(34.57±14.81)kPa vs. (19.18±7.09)kPa] and ESD [(13.68±13.01)kPa vs. (3.97±2.58)kPa] (both P<0.001). Though the difference in the AUCs of EMean (0.864) and ESD (0.876) was not significant (P=0.745), they both had higher diagnostic performances in comparison with TI-RADS categories (0.762) (all P<0.05). Moreover, ESD attained a sensitivity of 100% with a relatively higher specificity of 49.75% when its cut-off value was 3.3kPa. Shear wave elastography is a promising imaging method for reducing repeat FNAC for benign thyroid nodules with nondiagnostic and undetermined cytology when using ESD as an index.