Fine Needle Aspiration Cytology Results Research Articles

The Incidence of Thyroid Cancer in Bethesda III Thyroid Nodules: A Retrospective Analysis at a Single Endocrine Surgery Center.

Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules, also known as Atypia of Undetermined Significance (AUS), varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow-up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age of 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34; 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi-square test). However, the female patients exhibited prognostically superior non-invasive tumors compared to male individuals (p = 0.02, chi-square test). This study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the first and third editions of the TBSRTC, particularly for female patients classified under category II.

Repetition of thyroid fine-needle aspiration cytology after an initial nondiagnostic result: Is there an optimal timing?

IntroductionIt is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous procedure. This study evaluated the influence of the interval between 2 FNACs in a cohort with a previous non-diagnostic (ND) FNAC. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in the second FNAC, based on the intervals between procedures. Patients and methodsRetrospective study (2017–2020) including thyroid nodules with a ND result, subjected to another FNAC. Demographic, clinical and echographic data, interval between FNACs and their results were collected. We considered the intervals: ≤/>3 months and ≤/>6 months. Second FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda categories). ResultsIncluded 190 nodules (190 patients – 82.1% women, mean age 60±13.7 years) with a first ND FNAC. The second FNAC results were: ND in 63 cases, AUS/FLUS in 9 and diagnostic in 118 cases. There were no statistical differences in FNAC results performed≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs >3 months (50 ND, 7 AUS/FLUS, 99 diagnostic; p=0.71). Similarly, there were no statistical differences considering a longer time interval: ≤6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs >6 months (31 ND, 6 AUS/FLUS, 59 diagnostic; p=0.61). ConclusionsTime interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS.

Effects of Implementation of European Thyroid Imaging Reporting and Data System Risk Stratification in a Thyroid Cancer Program in Western Sweden: A Retrospective Cohort Study

ObjectiveThe European Thyroid Imaging Reporting and Data System (EU-TIRADS) allows for selective fine needle aspiration cytology (FNAC). In 2017, EU-TIRADS was implemented as part of a nationwide standardized care bundle for thyroid cancer in Western Sweden with a population of approximately 1.7 million. The objective of this study was to investigate the clinical value of EU-TIRADS attempting to reduce the number of unnecessary FNACs in referred patients with thyroid nodules. MethodsThe study cohort consisted of all patients referred to Sahlgrenska University Hospital due to a palpable, newly detected or growing thyroid nodules or a positron emission tomography–positive finding for examination with thyroid ultrasound and selective cytology between 2018 and 2022. Medical records on EU-TIRADS classification, corresponding FNAC results, and histopathologic diagnosis were retrospectively collected. Adherence to the EU-TIRADS guidelines, use of selective FNAC, and rate of malignancy in patients who underwent surgery were assessed. ResultsIn total, 1246 thyroid nodules in 990 patients were evaluated. The distributions of EU-TIRADS 2 to 5 (number [percentage]) for all examined nodules were 63 (5%), 462 (37%), 443 (36%), and 278 (22%), respectively. FNAC was omitted in 7% of the investigated patients. FNAC was performed in 124 nodules (10%) despite not fulfilling the EU-TIRADS criteria or absence of positron emission tomography–positive findings. The rate of malignancy was 33% and 1/50 in patients who underwent “unnecessary” FNAC. ConclusionImplementation of EU-TIRADS in routine management of thyroid nodules led to the selective use of FNAC; however, the clinical impact was limited. This study provides real-world data on the value and magnitude of diagnostic improvement by implementing EU-TIRADS in clinical practice.

Evaluation of Sensitivity and Specificity of Ultrasound-Guided FNA of Suspicious Axillary Lymph Nodes in Patients with Breast Cancer

Background: The axillary lymph node status in breast cancer is a major prognostic factor in survival and establishing a personalized treatment scheme. The ultrasound-guided fine needle aspiration (US-FNA) is a method for taking a lymph node sample. It allows physicians to decide how to manage the axilla. Objectives: This study was conducted to investigate the sensitivity of the US-FNA technique on suspicious axillary lymph nodes with a thickness of 3 to 6 mm in breast cancer patients. Methods: In a cross-sectional study, all the patients were subjected to preoperative ultrasound evaluation of the axilla to determine the presence of lymph nodes suspicious of malignancy. In cases where the suspicious lymph node cortex size was between 3 and 6 mm, US-FNA was performed. After surgery, the frozen section of the biopsy sample was examined histologically and compared with fine needle aspiration (FNA) cytology results. Results: A total of 102 patients were examined in the study. FNA test results indicated that 46 subjects had axillary malignant tissue, and benign cases summed 56. Also, the final results of frozen section surgical histopathology identified 46.1% of patients with involved lymph nodes. The sensitivity and specificity of FNA were 93.62% and 96.36%, respectively. Also, the overall diagnostic accuracy was 95.1%. Conclusions: This study showed that the sensitivity, specificity, and accuracy were more than 90% for the ultrasound-guided FNA test in identifying involved lymph nodes in patients with breast cancer. Therefore, the results of this test can be considered clinically reliable. However, there is still a need to examine the sensitivity and specificity of this method in identifying lymph node involvement.

Assessing the use of the triglyceride-glycemic index (TyG), neutrophil-lymphocyte Ratio (NLR), and platelet-lymphocyte Ratio (PLR) in distinguishing benign and malignant tumors among patients with complaints of breast mass

IntroductionBreast cancer is a prevalent global health concern characterized by uncontrolled cell growth in breast tissue. In 2020, approximately 2.3 million cases were reported worldwide, with 162,468 new cases and 87,090 fatalities documented in India in 2018. Early diagnosis is crucial for reducing mortality. Our study focused on the use of markers such as the triglyceride-glycemic index and hematological markers to distinguish between benign and malignant breast masses. MethodsA prospective cross-sectional study included female patients with breast mass complaints. The target sample size was 200. Data collection included medical history, clinical breast examination, mammography, cytological assessment via fine-needle aspiration cytology (FNAC), and blood sample collection. The analyzed parameters included neutrophil-to-lymphocyte Ratio (NLR), platelet-to-lymphocyte Ratio (PLR), and triglyceride-glycemic index (TyG). Histopathological examination confirmed the FNAC results. Statistical analysis including propensity score matching, Kolmogorov–Smirnov tests, Mann–Whitney U tests, receiver's operator curve (ROC) analysis, and logistic regression models was conducted using SPSS and R Software. Additional validation was performed on 25 participants. ResultsThis study included 200 participants. 109 had benign tumors and 91 had malignant tumors. Propensity score matching balanced covariates. NLR did not significantly differ between the groups, while PLR and TyG index differed significantly. NLR correlated strongly with the breast cancer stage, but not with the BI-RADS score. PLR and TyG index showed moderate positive correlations with the BI-RADS score. ROC analysis was used to determine the optimal cutoff values for PLR and TyG index. Logistic regression models combining PLR and TyG index significantly improved malignancy prediction. ConclusionsTyG index and PLR show potential as adjunctive markers for distinguishing breast masses. NLR correlated with cancer stage but not lesion type. Combining TyG and PLR improves prediction, aiding clinical decisions, but large-scale multicenter trials and long-term validation are required for clinical implementation.

Diagnostic value of high-frequency ultrasound combined with fine needle aspiration cytology and BRAF gene for papillary thyroid microcarcinoma.

We attempted to evaluate clinical application value of high-frequency ultrasound (HFUS), fine needle aspiration cytology (FNAC), BRAF gene, and combination of HFUS, FNAC, and BRAF gene in diagnosing papillary thyroid microcarcinoma (PTMC). The 150 patients with thyroid minimal lesions who underwent HFUS, FNAC and BRAF gene testing before surgery in our hospital from June 2020 to December 2021 were selected as research subjects. Patients were divided into two groups based on postoperative pathological results. The consistency of diagnostic results of HFUS, FNAC, and BRAF gene and their combination with those of pathological examination, diagnostic efficacy of HFUS, FNAC and BRAF gene combined detection and individual detection for PTMC lymph node metastasis, and diagnostic value of HFUS, FNAC and BRAF gene combined detection and individual detection for PTMC lymph node metastasis received analysis and comparison. The consistency of diagnostic results of combined detection with pathological examination exhibited elevation relative to that of HFUS, FNAC and BRAF gene detection alone (P < 0.05). The negative predictive value, sensitivity and accuracy of combined detection exhibited elevation relative to individual detection (P < 0.05). The AUC of combined detection in diagnosing PTMC lymph node metastasis exhibited elevation relative to that of HFUS and BRAF gene alone (P < 0.05). HFUS combined with FNAC and BRAF genes possesses high diagnostic value, with high diagnostic sensitivity, specificity, and accuracy. Thus, combined detection for PTMC before surgery can accurately determine whether lymph node metastasis occurs, reduce occurrence of missed diagnosis and misdiagnosis, and thus improve diagnostic precision.

Thyroid nodule diagnosis: A comparative analysis of ultrasonography and fine-needle aspiration cytology

Objectives: This paper aimed to investigate the association between Ultrasonography (USG) results and fine-needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules (TNs) in private and public hospitals in Yemen. In addition, it aimed to determine the sensitivity, specificity of USG and FNAC in diagnosing thyroid nodules (TNs). Materials and Methods: The study utilized a retrospective comparative study design, analyzing medical records of patients diagnosed with TNs between June 01, 2022 and May 01, 2023, in four private and public hospitals in Yemen. USG and FNAC reports, along with demographic data were collected. The author categorized the USG findings based on the American Thyroid Association guidelines, while FNAC results were classified according to the Bethesda reporting system for thyroid cytopathology. Results: The study included 94 diverse participants with TNs. The average age was 39.96 years, with a majority of female participants (85.1%). The distribution of nodules revealed varying consistencies, sizes, and shapes. The association between USG and FNAC diagnoses showed a significant relationship (χ2 = 34.914, P &lt; 0.001), with a high proportion of benign cases in both USG and FNAC results. Validity analysis demonstrated a sensitivity of 88.68% and a specificity of 70.73% for USG in diagnosing thyroid carcinoma. The positive predictive value was 79.66%, and the negative predictive value was 82.86%. The overall accuracy of USG compared to FNAC was 80.85%. Conclusion: This study shows USG’s potential as a diagnostic tool for TNs in Yemen. Insights improve understanding of TN diagnosis in Yemen’s healthcare settings.

Comparison of Fine-Needle Aspiration Cytopathology with Histopathological Examination of the Thyroid Gland in Patients Undergoing Elective Thyroid Surgery: Do We Still Need Fine-Needle Aspiration Cytopathology?

Background: The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination. Methods: This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed. Results: This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively. Conclusions: Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.

Clinical, Radiological, and Pathological Analysis of Breast Lump

Background The occurrence of breast lumps is more prevalent in the present-day population. Eighty percent of breast lumps are benign. There is no definitive examination or clinical analysis for the diagnosis of breast lumps.Aim The present study aimed to investigate the individual and combined accuracy of clinical breast examination ultrasonography and fine-needle aspiration cytology in the early diagnosis of breast lumps related to histopathology.Methods All female patients aged gt18 years who presented with a palpable breast lump underwent clinical breast examination. Ultrasonography USG and fine-needle aspiration cytology FNAC of the breast lump and subsequent excision biopsy were included in the study. The final histopathological results were analyzed using the results of clinical breast examination ultrasonography and fine-needle aspiration cytology. A detailed history of the presenting complaints was obtained from all eligible patients.Results On analysis a larger breast lump was observed in the age group of 21-30 yrs. In 100 of cases individuals reported a breast lump as their primary concern accompanied by pain. Majority of these cases 60 involved lumps ranging from 3 to 5 cm in size. Fibroadenomas 58 were found to be common observations. Most cases presented with a lump on the right side 54. FNAC was performed in all cases and was diagnostic 92.25. USG suggested that if the lesion was cystic or solid further typing of the lesion had limitations even though fibroadenoma would be diagnosed accurately 72.4. There was a statistically significant correlation between the clinical diagnosis and USG diagnosis Plt0.05. Among 50 patients 40 80.0 showed a correlation between the clinical diagnosis and USG diagnosis. There was a statistically significant correlation between USG and histopathological diagnosis Plt0.05 however among 50 patients the diagnosis of lesions was correlated in 34 68.0. There was a statistically significant correlation between the clinical findings USG and histopathological diagnosis Plt0.05. Conclusion The accuracy of breast lump diagnosis increases when all three modalities that is clinical examination USG and FNAC are combined. Triple-modality diagnosis of breast lumps may avoid many unnecessary surgeries.

Serum MicroRNA-146b Expression for Malignancy Prediction in Euthyroid Patients with Indeterminate Thyroid Nodules

Thyroid nodules are frequently found, but the vast majority of them are benign. The difficulty in managing thyroid nodules is correctly diagnosing the minority of those who have malignancy. Thyroid fine-needle aspiration cytology (FNAC) with indeterminate cytology continues to raise doubts about the presence of thyroid cancer, leading to an unnecessary thyroidectomy. Circulating miRNAs may be useful as diagnostic and prognostic markers for a variety of cancers, including thyroid cancer. The goal of the present study was to determine the predictive value of serum miRNA-146b expression level for thyroid cancer by estimating its level in a group of euthyroid patients with thyroid nodules with indeterminate FNAC results. This cross-sectional study included 45 euthyroid patients with indeterminate thyroid nodules who visited the Endocrine Outpatient Clinic and Endocrine Surgical Ward at Ain Shams University Hospitals. For all patient thyroid profiles, ultrasound of the thyroid gland and FNAC of the thyroid nodule were performed. In addition, preoperative assessment of serum microRNA-146b expression by real-time PCR was achieved and the results correlated with post-operative thyroid histopathology. There was no difference in serum miRNA-146b expression between patients with benign thyroid nodules versus patients with malignant nodules (p= 0.789). The risk of malignancy increased with the increase in size of the dominant thyroid nodules, as larger nodules had a higher risk of malignancy (p= 0.027). In conclusion, in euthyroid patients with indeterminate thyroid nodules, serum miRNA-146b is a poor predictor of thyroid malignancy, however, the larger the nodule size, the higher the risk of cancer.

Classifying thyroid nodules with the American College of Radiology Thyroid Imaging Reporting and Data System: A simple and cost-effective approach for assessing malignancy risk

ABSTRACT Background: Thyroid nodules are common, with up to 68% of adults having them. Ultrasonography is commonly used to examine them, but cannot determine if they are benign or malignant. High-res ultrasonography can detect disease before diagnosis but confirmation requires an invasive procedure, fine-needle aspiration cytology (FNAC), which has risks. Thyroid Imaging Reporting and Data System (TI-RADS) classifies nodules based on ultrasound findings, providing objectivity and guidance. Aim: The aim of this study is to evaluate the ultrasound characteristics of thyroid nodules &amp; categorize them using the ACR-TIRADS category based on suspicious ultrasound findings, assess the malignancy risk and co-relate with the pathological(FNAC) findings. Materials and Methods: A study involving 50 participants was conducted in the department of radiodiagnosis at our institute to assess thyroid nodules using ultrasound. The patients underwent ultrasound examination and FNAC, and the results were analysed using Microsoft Excel 2016. Results: Out of the 50 cases, 88% had single nodules and 72% were classified as TI-RADS 3, 20% as TI-RADS 4 and 8% as TI-RADS 5. The FNAC results revealed benign and malignant nodules. All patients with TI-RADS 3 criteria were benign, 80% of those with TI-RADS 4 criteria were benign and all patients with TI-RADS 5 criteria were malignant. Conclusion: The study concludes that the American College of Radiology (ACR) TI-RADS scoring system is an effective and practical way to categorise thyroid nodules using ultrasound. It provides a level of certainty about the likelihood of malignancy and helps healthcare providers make informed decisions about which nodules require biopsy, monitoring or no further action based on their ultrasound characteristics. This system reduces the need for unnecessary biopsies and surgeries, making it a cost-effective solution.

A retrospective analysis of molecular testing in cytologically indeterminate thyroid nodules with histologic correlation: Experience at a heterogenous multihospital system.

Thyroid malignancy is one of the most common types of cancer in developed nations. Currently, fine-needle aspiration cytology (FNAC) is the most practical screening test for thyroid nodules. However, cytologically indeterminate samples comprise approximately 15%-30% of cases. These include cases classified as atypia of undetermined significance (AUS), follicular neoplasm (FN), and suspicious for malignancy (SFM). Indeterminate cases can be sent for molecular testing for more definitive classification to help guide management and prevent overtreatment of benign thyroid nodules. We conducted a retrospective review on molecular testing of indeterminate thyroid FNAC and reviewed subsequent histologic diagnoses in resection specimens to assess how molecular testing supported a diagnosis and its effect on clinical management of patients at our institution. A retrospective chart review was performed on all thyroid FNAC specimens, corresponding molecular testing, and subsequent surgical resection specimens over a 6-year period. A total of 10,253 thyroid FNAC were performed in our hospital system during our study period, of which 10% (n = 1102/10,253) had indeterminate FNAC results. Molecular testing was performed in 16% (n = 178/1102) of indeterminate cytology cases. Genetic alterations were identified in 39% (n = 69/178) of the cases sent for molecular testing. The majority of cytologically indeterminate cases sent for molecular testing were follicular-patterned lesions and their corresponding resection specimens revealed mostly low grade follicular derived neoplasms (i.e., follicular adenoma, non-invasive follicular thyroid neoplasm with papillary-like nuclear features, and follicular variant of papillary thyroid carcinoma). Of the cases with identified genetic alterations, 75% (n = 52/69) were treated surgically. In cases with no genetic alterations identified, only 18% (n = 20/109) were treated surgically. Molecular testing on cytologically indeterminate thyroid nodules can help provide a more accurate risk of malignancy assessment in patients with lesions that are difficult to diagnosis based solely on FNAC morphology. The types of genetic alterations identified in the resected thyroid lesions were consistent with what has been previously described in the literature. Additionally, we found that in the patients with indeterminate thyroid FNAC with adjunct molecular testing, more than half did not undergo surgical resection. This finding emphasizes the value of adding molecular testing in patients, particularly when attempting to reduce unnecessary surgical intervention.

SAT571 When Two Is Too Few: Bethesda IV Pathology On Repeat Thyroid Fine Needle Aspiration

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. M.K. Shakir: None. T.D. Hoang: None. Background: The 2015 American Thyroid Association Guidelines for Adult Patients with Thyroid Nodules provide a strong recommendation against routine ultrasound surveillance of thyroid nodules for which two benign fine needle aspiration (FNA) cytology results have been previously obtained. Strict adherence to these guidelines may hinder detection of malignancy, especially in large nodules where there is potential to miss heterogeneous pathology based on sampling technique. Clinical Case: A 36-year-old female was evaluated for surveillance of a large non-toxic multinodular goiter. Thyroid ultrasound demonstrated a dominant right thyroid nodule greater than 7 centimeters in size. The patient had undergone FNA of this nodule in 2014 and 2019 with Bethesda II (benign) cytopathology results. A chest x-ray showed tracheal deviation without evidence of narrowing. She noted a sensation of neck pressure without dysphagia or shortness of breath. She denied fatigue, heat or cold intolerance, hand tremor, or pretibial myxedema. She denied a family history of thyroid cancer or any history of neck irradiation. Due to new compressive symptoms a repeat FNA was performed. Three passes were performed with adequate samples, and the final FNA cytopathology demonstrated a Hurthle cell oncocytic-type follicular neoplasm with Bethesda IV classification. The sample was submitted for ThyGeNEXTTM and ThyraMIRv2TM molecular testing, which returned with NRAS q61R mutation of moderate-to-high risk of malignancy (65-75%). The patient was subsequently referred for total thyroidectomy with pending surgery date. Discussion: The current ATA guidelines offer a cost-effective surveillance strategy for the vast majority of patients with thyroid nodules. False negative FNA results are rare and are reported to occur in about 1% of cases1. As in this vignette, it is reasonable to perform an additional FNA after two consecutive Bethesda II results in nodules with clinically significant growth, new compressive symptoms, or if there is concern for incomplete sampling in nodules of large size. During an FNA, care should be taken to gently move the needle at various angles to capture follicular cells from different areas within a nodule. Large nodules should be sampled via multiple, separate skin entry points when feasible. Judicious use of repeat FNA along with these sampling techniques may help to prevent under-diagnosis in nodules containing multifocal areas of heterogeneous pathology. Reference: 1) Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Filetti S. 2015. The natural history of benign thyroid nodules. JAMA 313:926-935 Presentation: Saturday, June 17, 2023

SAT454 Repetition Of Fine Needle Aspiration Cytology After An Initial Nondiagnostic Result: Does An Optimal Timing Exist?

Abstract Disclosure: I. Cosme: None. E.L. Nobre: None. M.J. Bugalho: None. Background: The optimal time to repeat a fine-needle aspiration cytology (FNAC) of a thyroid nodule, after a nondiagnostic (ND) result, is not established. It has been proposed to wait at least 3 months for a 2nd FNAC, in order to mitigate the possible inflammatory cytological changes induced by a previous FNAC. This study aimed to evaluate whether the time between 2 consecutive FNACs, influences the final cytological result. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in the 2nd FNAC, in different repetition time intervals. Methods: Retrospective study (2017-2020) including thyroid nodules with a first ND FNAC, submitted to a 2nd FNAC. All FNACs were ultrasound-guided. Demographic data, time interval between FNACs and their results were collected. The 2nd FNAC results were analysed according to FNACs´ repetition interval. We considered 2 intervals: ≤ vs &amp;gt; 3 months and ≤ vs &amp;gt;6 months after the initial FNAC. The 2nd FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda FNAC categories). Results: Included 190 nodules (190 patients, 82.1% women, mean age 60±13.7 years) with a 1st ND FNAC submitted to a 2nd FNAC. The 2nd FNAC result remained ND in 63 cases, was AUS/FLUS in 9 and diagnostic in 118 (benign in 116 cases, follicular neoplasm/suspicious follicular neoplasm in 1 and malignant in 1 case). There were no statistical differences in 2nd FNAC result performed ≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs &amp;gt;3 months (50 ND, 7 AUS/FLUS, 99 diagnostic) - p=0.71. Considering a wider time interval between FNACs, there were also no statistical differences in the 2nd FNAC result: ≤ 6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs &amp;gt;6 months (31 ND, 6 AUS/FLUS, 59 diagnostic) - p=0.61. Conclusions: The time interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS. Presentation: Saturday, June 17, 2023

Diagnostic Value and Challenges of BRAF V600E Molecular Testing and Thyroid Fine-Needle Aspiration Cytology: A Retrospective Study from a Tertiary Institution in Southern Hunan Province, China

Introduction: Combined thyroid fine-needle aspiration (FNA) cytology and valine-to-glutamate substitution at codon 600 of B-Raf proto-oncogene, serine/threonine kinase (BRAF V600E) mutation detection are procedures used for diagnosing thyroid nodules in many Chinese tertiary institutions. This retrospective study at our institution aimed to explore the effectiveness and challenges of the combined approach in diagnosing thyroid nodules and the correlation between BRAF V600E mutation status and behavior of papillary thyroid carcinoma. Methods: Thyroid FNA cytology and BRAF V600E mutation detection results were reviewed between November 2020 and July 2022. A total of 623 patients, each of whom underwent thyroidectomy and final pathological examination after FNA cytology diagnosis, were included in the study. The relationship between the BRAF V600E mutational status and pathological parameters was analyzed using the χ² test. The effectiveness and challenges of FNA cytology alone and the combined procedure were also evaluated based on the final pathology. Results: Of 623 patients, 591 were diagnosed with papillary thyroid carcinoma (PTC), of which 456 were positive for the BRAF V600E mutation. It demonstrated near-perfect specificity for identifying PTC, and its incidence rate showed an age-specific curve with an inverted U-shaped distribution. The final pathological examination showed that the combined procedure had a higher sensitivity (83.91%) than FNA cytology alone (63.45%) for distinguishing PTC from other lesions (p < 0.001). Mutational status was associated with a larger maximum tumor diameter (p = 0.003) and a tendency of capsular invasion (p = 0.0542) but possibly unrelated to central lymph node metastasis (p = 0.1846). Nodular goiters accounted for most benign entities initially designated as Bethesda categories III–V. Conclusion: BRAF V600E mutational analysis complements cytopathology and improves the PTC detection rate in FNA cytology samples due to the high prevalence of the mutation in China. BRAF V600E mutation does not show a statistical correlation with tumor aggressiveness. Morphological pitfalls such as histocyte aggregation, cystic-lining cells in nodular goiters, and oncocytes in Hashimoto’s thyroiditis, were overwhelmingly found in BRAF V600E-negative specimens.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Comparative study of fine needle aspiration cytology and histopathology correlation of various thyroid lesions

Patients with anterior neck swelling constitute common problems encountered in the clinical practice. In all age groups, including children, thyroid cancer is the most prevalent endocrine system cancer. Initial diagnostic testing using fine needle aspiration cytology (FNAC) has been found to be quick and cost effective. Therefore, it is widely accepted and more thyroid cases are diagnosed at an early stage, but it is associated with pitfalls due to difference in correlations between FNAC and Histopathological Examination (HPE). The purpose of the study is to compare the results of FNAC with histopathological findings in order to evaluate the diagnostic efficacy of FNAC.The present study was performed over a period of two years in a tertiary care center. Included in the study were 100 cases of thyroid nodule, which underwent FNAC and the post-operative specimens of whom were subjected to histopathological examination. The results obtained by FNAC were compared with histopathological findings.Out of the 100 cases taken for the purpose of the study, 92 were benign whereas 8 were malignant. The cytological and histopathological diagnosis correlated with each-other in 89 cases. A partial correlation between the cytological and histopathological diagnoses was found in 5 cases. In 6 cases the FNAC diagnosis was not correlating with histopathological diagnosis. FNAC revealed a sensitivity of 62.50%, a specificity of 97.83%, an accuracy of 95%, a positive predictive value of 71.43% and a negative predictive value of 96.77%.FNAC of thyroid lesions is thus proved to be a simple, cost effective and accurate method to diagnose and to guide the management of palpable thyroid lesions Thus, we can see that the diagnostic accuracy of FNAC procedure is very high making it a very useful investigation in the work-up of thyroid patients. However final diagnosis and treatment pattern should be based upon histopathology.

Toxoplasmic Lymphadenitis of the Head and Neck Region.

We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery. A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled. All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period. It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Association of the Thyroid Nodules' Sonographic Features With Fine Needle Aspiration (FNA) Cytology Results

Thyroid nodules are a common finding in clinical practice. Although ultrasonography is an accepted method for evaluating these nodules, Fine Needle Aspiration (FNA) is the procedure of choice for assessing the risk of malignancy. This study aims to determine the association between sonographic features of thyroid nodules based on Thyroid Imaging Reporting and Data System classification and the cytology results. In this prospective cohort study, 147 patients from Tehran Medical Imaging Center who had thyroid nodules underwent ultrasonography-guided FNA, and their sonographic features were recorded. The pathologic findings were also obtained according to the Bethesda system. Finally, the association between sonographic features and cytological results was analyzed. Eighteen (12.3%) nodules were malignant, and 129 nodules (87.7%) were benign. The association of TIRADS categories with the risk of malignancy is as follows: TIRADS 1 (n=0, 0%), TIRADS 2 (n=10, 16.9%), TIRADS 3 (n=6, 10.5%), TIRADS 4 (n=2, 16.7%), and TIRADS 5 (n=0, 0%). The bloody lamellae of thyroid nodules were significantly correlated with the risk of malignancy (P&lt;0.05). However, there was no statistically significant association between the risk of malignancy and gender (P=0.47), calcification (P=0.9), firmness (P=0.19), halo sign (P=0.95), location of nodules (P=0.35), and nodules' echogenicity (P=0.058). Although there are trusted classifications such as TIRADS for categorizing thyroid nodules, there is still uncertainty in utilizing them, especially in the management of nodules classified as TIRADS 2, in which various sonographic features are shared between benign and malignant nodules.

Önemi Belirsiz Foliküler Lezyonda Malignitenin Prediktif Faktörleri

Follicular lesion of undetermined significance (FLUS) is defined in the same Group III with the atypia of undetermined significance according to Bethesda Classification but these subgroups have different malignancy rates and tumor characteristics according to the studies. In this study, the aim was to evaluate the preoperative clinicopathologic features of the patients with cytological Bethesda Category III/FLUS thyroid nodules. The 44 patients were divided into two groups based on fine needle aspiration cytology (FNAC) results as benign (pB) and malignant (pM) and compared the preoperative clinical, ultrasonographic findings and FNAC results of two groups. According to the univariate analyses the presence of hiopechogenicity and presence of microcalcification are found to be significantly higher in malignancy (p&amp;lt;0.05 for all). Also, the presence of microcalcifications (p=0.048), and hypoechogenicity (p=0.014) were found to be independent risk factors for malignancy according to logistic regression analysis. In patients with FLUS, it should be remembered that the incidence of malignancy increases and treatment should be considered in the forefront of surgery instead of recurrent FNAC in the presence of hypoechogenicity and microcalcification in ultrasonography, and in patients with nuclear membrane irregularity according to FNAC.