Fine-needle Aspiration Biopsy Results Research Articles

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

Histological patterns of thyroid lesions among different age groups in Mogadishu, Somalia

Background: Thyroid nodules are seen in 4-7% of the population which are more common in women. Excising all of these lesions is impractical and associated with certain risk factors as well. Fine needle aspiration (FNA) biopsy is the most relevant diagnostic procedure to decide those that need to be surgically excised or not. Methodology: The present study was conducted in Liban clinic, Mogadishu, Somalia. 220 patients whom were diagnosed with various types of tyroid lesions within 2 years of period were included in the study. Main objectives were to put forward the distribution of histological findings according to fine needle aspiration (FNA) biopsy results among different age groups, and to define the prevelance of certain subtypes of thyroid nodules in the region. Results: 207 patients had ‘benign’ nodules and 13 patients had ‘malignant’ nodules according histological evaluationof fine needle aspiration (FNA) biopsy results. ‘31-40’ years of age interval was found to have the highest percentage of histologically ‘benign findings’, while patients within ‘41-50’ years of age had the highest rate of ‘malignant lesions’ in count among the study population. ‘Papillary’ (n=8)(61.5%) and ‘medullary’ (n=5)(38.5%) carcinomas were most common malignant features.Mostly recorded benign lesions were ‘colloidal goiter, multinodular goiter (MNG), nodular hyperplasia and adenomatoid goiter’ (n=94)(45.4%). Conclusion: Characteristics of thyroidlesions in region of Mogadishu, Somalia show similar patterns based upon correlation of age with histological differences compared to recent literature. With the aid of FNA, majority of the population can be managed conservatively safely without need of surgical interventions. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 67-71

Parotid masses: The effectiveness of preoperative diagnostic methods on definitive diagnosis

Objective: 85% of neoplasms originating from the major salivary glands are seen in the parotid gland. The diagnosis of parotid masses can sometimes be made with a simple anamnesis and physical examination. However, despite all advanced examinations and biopsies, the preliminary diagnosis can be very different from the postoperative pathological diagnosis due to the unique embryological and anatomical features of the parotid gland. In our study, we aimed to evaluate the relationship between the accuracy of diagnostic tools and postoperative pathological diagnoses in patients who underwent parotidectomy. Materials and Methods: The files of patients who underwent surgery between 2014 and 2019 due to a parotid mass were evaluated. Preoperative neck ultrasound, computed tomography, magnetic resonance imaging, and fine-needle aspiration biopsies were evaluated. Postoperative pathological diagnoses and preoperative examination findings, imaging methods, and preliminary diagnoses obtained according to fine-needle aspiration biopsy results were compared and sensitivity, specificity, and accuracy rates were determined. Results: According to the postoperative pathologic diagnosis, 31 of the tumors were reported as benign (91.1%) and 3 as malignant (8.8%). Ultrasound defined 10 of 17 patients with benign pathology as benign (58.8%) and 7 as nondiagnostic (41.1%). Magnetic resonance imaging reported 11 of 15 benign cases as benign (73.3%), and defined 1 malignant case as nondiagnostic. It was observed that 20 of the patients who underwent fine-needle aspiration biopsy were reported as benign and 4 as nondiagnostic. Postoperative pathology results of 2 of 24 patients were reported as malignant, and 22 of them as benign. Conclusion: Although magnetic resonance imaging gives the most accurate information among the imaging methods evaluated for preoperative parotid masses, it cannot always make a definitive diagnosis. Although fine-needle aspiration biopsy is useful in distinguishing between malignant and benign tumors, malignant tumors can be reported as benign.

Amyloid deposit corresponds to technetium-99m-pyrophosphate accumulation in abdominal fat of patients with transthyretin cardiac amyloidosis

BackgroundRadionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue. MethodsChest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining. ResultsTwenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant. ConclusionsIn patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

THE ROLE OF CALCITONIN IN THE PREOPERATIVE STAGE AS THE PREDICTOR OF MEDULLARY THYROID CANCER METASTASES

the aim of the stydy was to analyze the detectability of medullary thyroid metastases in patients at treat-ment and diagnostic stages, to investigate the applicability of serum calcitonin level as predictor of possible pres-ence of medullary thyroid metastases. The study included data from 148 patients who underwent surgical treatment
 for the initial diagnosis of medullary thyroid cancer. The age of patients ranged from 12 to 83 years, the mean agewas 48,2±1,9 years; the distribution by gender was as follows: men – 34 (23%), women – 114 (77%). Patients were
 divided into two groups depending on the pathomorphological report: 1 group (100 (67,6%) – patients without me-tastases), 2 group (48 (32,4%) – patients with locoregional metastases). Among 148 studied patients with medullary
 thyroid cancer, as a result of the histopathological conclusion, in 48 (32,4%) metastases were detected in regionallymph nodes, among which 10 (6,7%) patients had metastases only in the central collector and 38 (25, 7%) –both inthe central and lateral collectors. At the preoperative stage, the level of undiagnosed metastases by ultrasound was64,58% (31 patients). Subsequently, at the intraoperative stage, during the rapid histological biopsy, the number ofundiagnosed metastases decreased to 37,5% (18 patients), and in the postoperative period, according to the results ofhistopathological examination, the remaining patients were diagnosed with the medullary thyroid cancer metastases.Ultrasound helped to detect metastases in 17 patients, which was 35,42% of all detected metastases. At the stage ofintraoperative study, the detection of metastases increased and amounted to 30 (62,5%), and in the postoperativeperiod as a result of histopathological examination metastases were confirmed in 48 patients (100%). Quantitative
 indicators of both detected and undiagnosed metastases at all stages of treatment and diagnostic search are statis-tically significant (p<0,01). The detection of metastases in the central lymphatic collector (N1a) at the preoperative
 stage was 2,08%, this index has doubled (to 4,16%) after intraoperative rapid histological conclusion, and after
 histopathological conclusion the index has increased more than 10 times (20,84 %). This tendency to grow of metas-taseses detection was followed also on lateral collectors: N1b and psilateral were observed at 15 (31,2%) patients
 at the preoperative stage, their number increased to 23 (47,9%) intraoperatively and to 31 (64,6%) postoperatively;
 N1b contralateral was observed in 1 (2,1%), 5 (10,4%) and 7 (14,6%), respectively. Such a low percentage of me-tastases detection at the preoperative stage by ultrasound prompted to CT level study as the predictor of possible
 metastases. We investigated the preoperative basal blood CT value as a marker of the medullary thyroid cancer me-tastases presence probability. Due to the small number of the group (n=10) with N1a, the association of CT (cut-off
 level 137 pg/ml) with the possible presence of metastases was not significant (AUC = 0.594), while in the group withN1b there was a more significant difference. Thus, CT cut-off levels of 358 pg/ml for N1b ipsilateral, and 498 pg/mlfor N1b contralateral detection of possible metastases in collectors, with AUC: 0.877 and 0.832, respectively, which
 justifies the importance of the lateral neck dissection in addition to the mandatory central dissection in order to re-mov possible medullary thyroid cancer metastases. Thus, ultrasound is insufficiently reliable method of metastases
 verifying in medullary thyroid cancer (DE = 35.4% at d mts <0.6 cm). In the absence of ultrasound data (or fineneedle aspiration (FNA) biopsy results) on the presence of metastases to raise awareness of the disease prevalence,to clarify the prognosis of its development it’s important to use the additional criterion – the calcitonin level. Basal
 calcitonin level is the reliable predictor of the medullary thyroid cancer metastases. Its cut-off level of 137 pg/ml indi-cates the possible presence of metastases in the central group (N1a) (AUC=0,594). The CT cut-off level – 358 pg/ml
 (AUC=0,793) suggests the presence of the medullary thyroid cancer metastases (N1a+N1b). CT cut-off levels – 358pg/ml for N1b ipsilateral, and 498 pg / ml for N1b contralateral (AUC: 0,877 and 0,832), respectively. The calculatedvalues of the countersensitivity test to detect metastases for different levels of basal CT in the preoperative stage in theclinical setting will help the practitioner in deciding on treatment tactics to determine the extent of surgery in patientsdiagnosed (or suspected) with the medullary thyroid cancer metastases.

The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy.

Objectives:Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category.Material and Methods:A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology.Results:The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively.Conclusion:FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

A Closer Look at "Taller-Than-Wide" Thyroid Nodules: Examining Dimension Ratio to Predict Malignancy.

To evaluate nodule height-to-width ratio as a continuous variable predicting likelihood of thyroid malignancy. Retrospective cohort study. All study information was collected from a single academic tertiary care hospital. Subjects included adult patients with thyroid nodules who underwent thyroid surgery between 2010 and 2020. The following variables were collected: patient demographics, nodule dimensions via ultrasound, fine-needle aspiration biopsy results, and surgical pathology results. Statistical analysis included logistic regression modeling malignancy with variables of interest. We used a receiver operating characteristic curve to assess the discriminatory value of variables. Height-to-width ratio, as a continuous variable, was associated with malignancy (with each 0.1 increase in ratio; odds ratio [OR], 1.25; 95% CI, 1.14-1.37). The same relationship was true for height-to-length ratio (OR, 1.36; 95% CI, 1.24-1.56). The area under the receiver operating characteristic curve for height-to-width ratio was 63.7%. In line with current emphasis on the transverse ultrasound view, we determined 4 different height-to-width ratio intervals: <0.8, 0.8 to <1.0, 1.0 to <1.5, and ≥1.5. Likelihood ratios of malignancy for each interval were 0.6, 1.0, 2.3, and 4.9, respectively. Our results support the association between greater height-to-width ratio and malignancy but suggest that a multilevel rather than binary variable improves prediction. The likelihood ratios at different intervals give a more nuanced view of how height-to-width ratio predicts malignancy. With continuing review of guidelines for thyroid nodule biopsy, it is important to consider these data for any point total attributed to shape.

Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules.

Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%). Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

A rare case: Covid-19 infection diagnosed by transthoracic fine needle aspiration biopsy

Covid 19 is an acute respiratory disease caused by a novel type of Coronavirus (SARS-CoV-2) that was first detected in Wuhan, Hubei Province of China. Its most common symptoms are fever, cough, and weakness; and in the early stages, there may not be findings on chest computed tomography. In pulmonary involvement, peripheral ground-glass areas, a cobblestone appearance, consolidated areas, and interlobular septal thickening, which are usually prominent in the lower lobes may be seen in thorax computed tomography. Consolidation, solid nodules, halo sign, inverted halo sign, vascular enlargement, subpleural line, air bronchograms, and bronchiectasis are other less common findings. In our case, we aimed to present our 69 years old female patient with bilateral nodular densities on thoracic CT and transthoracic fine-needle aspiration biopsy result was reported as lesions compatible with interstitial fibrosis due to Covid-19 inflammation.

Validity of Ultrasound Guided FNAB for the Diagnosis of Breast Carcinoma

Background: A number of biopsy techniques have been utilized to procure tissue samples from suspected malignant masses ofbreast. The availability and cost of these techniques varies but they are all associated with significant local trauma. Among them,the fine needle aspiration biopsy is a time-tested low-cost diagnostic test that has been in use for decades.Objective: This study was conducted with an aim to establish the sensitivity, specificity, positive predictive value and negativepredictive value of ultrasound-guided fine needle aspiration biopsy (FNAB) for diagnosis of malignancies of breast.Materials & Methods: This descriptive cross-sectional study was conducted at Radiology Department, in alliance with thedepartments of Surgery and Pathology (outdoor patient and indoor patient)Ayub Teaching Hospital, Abbottabad from 1st May 2019to 31 December 2019. Initially sixty patients were recruited however histopathology of ten patients were not available so they wereexcluded from final results. Data was collected from 50 females with suspected breast malignancy. The biopsy of breast massusing fine needle aspiration technique under ultrasound guidance was performed on each member of the cohort of fifty patient. Tovalidate the result, each member underwent surgical biopsy (incisional/excisional) thereafter.The results of FNAB was comparedwith the histopathology reports to determine accuracy of FNAB.Results: USG-FNAB was able to correctly diagnose 49 cases in 50 patients with an accuracy of 98%. 25 cases were declared asmalignant while 25 cases were categorized as benign lesion. Out of the 25 negative cases, on histopathology 24 cases werecorrectly diagnosed while 01 case was false negative, on histopathology it proved to be invasive papillary carcinoma.Conclusion: that FNAB is a key preliminary test for the diagnosis of the breast lumps, and when done under ultrasound guidance,the results show a significant correlation with the final histopathology report.Keywords: Biopsy, Carcinoma, Histopathology, Fibroadenoma

The impact of TI-RADS in detecting thyroid malignancies: a prospective study.

Thyroid ultrasonography (US) is the first-step noninvasive and easily accessible diagnostic method widely used in the detection and characterization of nodular thyroid disease. We aimed to develop a TI-RADS, which is easy to apply and only relies on the counting of suspicious criteria. In order to measure the reliability of the system, we investigated its correlation with fine needle aspiration biopsy (FNAB) and post-surgery histological results. In this prospective study, 242 patients who had undergone FNAB with simultaneous cytopathologist in the radiology department between April and August 2016 were analyzed. Before FNAB, the thyroid gland was re-evaluated with US, and TI-RADS classification was made. Demographic characteristics, family thyroid cancer history and radiotherapy history to the neck region were noted. Of the 242 patients, 17.3% were male (42 males/200 females). US-guided FNAB was applied to all patients. Mean age was 50 ± 13years (min: 19, max: 82). Both FNAB and final post-surgery histology results showed that sex and age were not statistically significantly associated with malignancy (p = 0.193) TI-RADS criteria and FNAB results revealed a statistically significant association between irregular contours, the state of anteroposterior diameter being longer than transverse diameter, microcalcifications, marked hypoechogenicity, and malignancy (p < 0,05). Thirty patients were TI-RADS ≥ 4, 206 patients were TI-RADS ≤ 3 and there was a significant correlation between TI-RADS and Bethesda classification (p = 0.001). In addition, statistically significant associations were found between malignancy and family history of thyroid cancer (p = 0.035) and radiotherapy history to the neck region (p = 0.01). TI-RADS system after nodule identification is based only on the counting of suspicious criteria. It will be safe and effective to recommend follow-up with low score TI-RADS, benign characters and insufficient FNAB results, and thus, unnecessary thyroidectomy operations will be prevented. It will be easier for surgeons to recommend surgery and persuade the patients for it when patients have high TI-RADS scores. TI-RADS has high power in detecting malignancy by recommending biopsy of suspicious nodules.

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology.

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine-needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cutoff in 23 (2.6%) patients ranging between 6.5 and 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, seven patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III), and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement.

The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors.

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.

Ultrasonography and ultrasound-guided fine-needle aspiration biopsy can predict a heavy nodal metastatic burden in early-stage breast cancer.

PurposeThis study aimed to predict a heavy nodal burden (≥3 metastatic axillary lymph nodes [LNs]) using axillary ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in patients with early-stage breast cancer.MethodsWe retrospectively reviewed the medical records of 403 women (404 cancers) who underwent US-guided FNAB for axillary LN staging from January 2006 to December 2015. US findings and US-guided FNAB results were reviewed and compared using pathology results as the reference. Diagnostic performance was analyzed, and clinicopathological and radiological findings were compared between patients with <3 metastatic LNs and ≥3 metastatic LNs.ResultsThe final pathology results revealed that 20.5% of cancers had heavy nodal metastases. US-guided FNAB showed significantly higher sensitivity (79.0% vs. 63.0%, P=0.009) and specificity (84.8% vs. 79.3%, P=0.036) in predicting heavy nodal metastases than did US. The presence of a larger number of suspicious LNs (two or more) on axillary US and positive FNAB results were significantly correlated with a heavy nodal burden in the multivariate analysis. The odds ratios were 4.20 (95% confidence interval [CI], 1.90 to 9.39) for two suspicious LNs, 9.40 (95% CI, 2.99 to 29.54) for three or more suspicious LNs, and 14.22 (95% CI, 6.78 to 29.82) for positive FNAB results.ConclusionThe number of suspicious LNs detected on axillary US and FNAB results can help predict a heavy axillary nodal burden in patients with early-stage breast cancer.

Non-Hodgkin’s Lymphoma in the Parotid Gland Similar to Benign Lymphoepithelial Lesion: A Case Indonesian Male

Background: Primary parotid non-Hodgkin’s lymphoma (NHL) is a very rare case. Case presentation: A66-year-old Indonesian male with a complaint of a lump in front of the right ear about 1 year with a history ofpostoperative primary parotid NHL 3 years ago. Patients underwent Fine Needle Aspiration Biopsy (FNAB)examination, showing a distribution of lymphoid cells with a diverse population (benign lymphoepitheliallesion / BLL) different from the results of FNAB 3 years ago. The patient underwent a right superficialparotidectomy, and the results of the histopathological examination revealed mature lymphocyte cells mixedwith histiocytes, forming foci of the follicle in part with an active germinal center. Conclusion: NHL reportsare necessary to minimize misdiagnosis between primary parotid NHL and BLL.

Makrokalsifiye Tiroid Nodüllerinde İnce İğne Aspirasyon Biyopsisi (İİAB) Sonuçlarının Değerlendirilmesi

Objective: Thyroid nodule is the most common disease of the thyroid gland and is closely associated with thyroid cancer. The gold standard method in diagnosis is Fine Needle Aspiration Biopsy (FNAB). Although the relationship between nodules containing microcalcification and malignancy is well known, there is no consensus on the relation of nodules with macrocalcification to malignancy and the adequacy of FNAB. In this study, it was aimed to compare the results of FNAB of nodules with and without macrocalcification in US examination. Methods: In this retrospective study, 466 nodules undergoing FNAB of 450 patients who applied for biopsy were included in the study. The demographic characteristics of the patients, US features of the nodules and cytopathology results of FNAB in the Bethesda classification were recorded. Nodules were divided into two main groups as calcified and non-calcified. US features and cytopathology results of the groups were compared. Results: Transverse sizes of calcified nodules were found to be larger than non-calcified ones (p = 0.003). In addition, solid composition, hypoechoic and prominent hypoechoic echogenicity, and irregular border feature were found with a higher rate in the calcified group (p &lt;0.001). No significant difference was found between insufficient sample/non-diagnostic cytology (Bethesda-1) ratios in both groups (19.2% and 14.7%). Cytopathologically, number of malignant and suspected malignant nodules (Bethesda 5 and 6) were found to be higher in the calcified group (p=0.05). Conclusion: According to the results of this study, detection of macrocalcification in thyroid nodules in US examination does not cause a significant increase in insufficient FNAB results. However, the presence of macrocalcification increases the risk of malignancy of the thyroid nodule.

Ultrasound Image-Based Classification Of TI-RADS Class-4 Thyroid Nodules Using Deep Learning Algorithm

According to the thyroid imaging reporting and data system (TI-RADS), class-4 thyroid nodules have three sub-classes, namely 4a, 4b and 4c with malignant risk ranging from 5% to 80%. Classification of TI-RADS class-4 thyroid nodules could be helpful to the clinical diagnosis of thyroid cancer. Therefore, the aim of this abstract was to classify TI-RADS class-4 thyroid nodules through deep learning algorithm. The study cohort consisted of 236 patients with TI-RADS class-4 thyroid nodules. Ultrasound images for the enrolled patients were obtained. Patients were classified into TI-RADS class-4a, 4b and 4c based on the result of ultrasound-guided fine-needle aspiration biopsy. Among the patients, there were 95 patients with TI-RADS class-4a thyroid nodules, 75 patients with TI-RADS class-4b thyroid nodules and 66 patients with TI-RADS class-4c thyroid nodules. A 224 × 224 crop with thyroid nodule was sampled from each ultrasound image by an experienced ultrasound doctor. Then manually induced artifacts were removed and data normalization was performed. The dataset was separated into training and validation set with a ratio of 4 to 1. A ResNet 50 model was configured and trained in the training set, and tested in the validation set. Learning rate was set from 2 × 10-6 to 1 × 10-3. To evaluate the performance of ResNet 50 deep learning model, accuracy, sensitivity, specificity and area under the curve (AUC) were calculated for each sub-class. After 100 epochs, the proposed ResNet model achieved a total classification accuracy of 84.7458%. Specifically, classification accuracy for TI-RADS class-4a, 4b and 4c thyroid nodules were 91.5254%, 67.7966%, and 83.0508% respectively. The following Table demonstrates the detailed result. The proposed deep learning approach with ResNet model had a high classification accuracy and a strong generalization ability. The results demonstrated potential clinical application of deep learning in the classification of thyroid nodules subclasses.Abstract 3917; TableTypeAccuracySensitivitySpecificityAUCTI-RADS class-4a91.5254%0.97220.86960.9505TI-RADS class-4b67.7966%0.58620.93330.7348TI-RADS class-4c83.0508%0.72550.87500.8358 Open table in a new tab

Classification Of TI-RADS Class-4 Thyroid Nodules Via Ultrasound-Based Radiomics And Multi-Kernel Learning

The diagnosis of thyroid nodules is mainly based on the thyroid imaging reporting and data system (TI-RADS). Among different classes, class-4 thyroid nodules are of great uncertainty with malignant risk ranging from 5% to 80%. Class-4 thyroid nodules have three sub-classes, namely 4a, 4b and 4c. Accurate classification of these three sub-classes is of clinical importance. Therefore, we aim to classify TI-RADS class-4 thyroid nodules based on radiomics features from ultrasound images and multi-kernel learning algorithm. The study cohort consisted of 59 patients with TI-RADS class-4 thyroid nodules. Patients were classified into TI-RADS class-4a, 4b and 4c according to ultrasound-guided fine-needle aspiration biopsy results. Two experienced doctors drew the region-of-interest for each nodule on the ultrasound images. Pyradiomics was used to extract shape features, texture features, Laplacian of Gaussian features, wavelet features, square features, square root features, logarithm features, exponential features, gradient features and local binary pattern features from original ultrasound images. The selected features were normalized to a range from -1 to 1. Sequential backward elimination approach was used to select features from different categories. A multi-kernel support vector machine (SVM) classifier was configured with 10 linear kernels to combine features from different categories for classification. Centered alignment method was used to calculate the coefficient of each kernel for kernel combination. Accuracy, sensitivity, specificity, area under the curve (AUC) were applied to evaluate the performance of the classifier for each sub-class, and permutation test was used to test whether the AUC acquired from the proposed multi-kernel classifier was greater than random guess. Pyradiomics extracted 1493 radiomic features from the ultrasound images of thyroid nodules. After feature selection, there remained 332 features. Classification results demonstrated that the configured multi-kernel SVM could accurately classify class-4 thyroid nodules with a total classification accuracy of 86.44%. The accuracy for each of the sub-class was 94.44%, 73.33% and 75%, respectively. The detailed result is shown in the Table below. The radiomic features in combination with fine-tuned machine learning models showed high accuracy in classification of TI-RADS class-4 thyroid nodules. The results demonstrated potential clinical application of radiomic features and multi-kernel learning in the diagnosis of thyroid nodules.Abstract 3978; TableTypeAccuracySensitivitySpecificityAUCp-valuenumber of featuresTI-RADS class-4a94.44%0.94440.82610.9263<0.001332TI-RADS class-4b73.33%0.63640.86670.7667<0.001332TI-RADS class-4c75%0.58820.87500.69120.039332 Open table in a new tab

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

Fine Needle Aspiration Biopsy of Peripheral Lymph Nodes in Children: Practical Experience in a Tertiary Hospital.

Peripheral lymphadenopathy occurs often in children; fine needle aspiration biopsy (FNAB) is a commonly performed diagnostic procedure. We describe FNAB use and outcome for peripheral lymphadenopathy in children in a routine clinical setting. A retrospective study done at Tygerberg Hospital, Cape Town of children (<13 years) who had an FNAB for lymphadenopathy from July 2012 to June 2014. Demographic, clinical, treatment and follow-up data were retrieved from patient folders; FNAB and special investigation results were obtained from the laboratory database. Of the 173 children, the median age was 37 (interquartile range 13-75) months; 20 (11.5%) were HIV positive. Most FNABs were done in the neck (131; 76%) and axillary areas (34; 20%). FNAB provided a result in 165 (95%) cases; in 8 (5%) children FNAB was insufficient for diagnosis. Mycobacterial aetiology was diagnosed in 84 (49%); 49 (58%) were culture-confirmed (37 Mycobacterium tuberculosis, 10 Mycobacterium bovis BCG, 1 both and 1 non-tuberculous mycobacterium). Reactive lymphadenopathy was diagnosed in 56 (32%), neoplastic disease in 6 (3.5%) and other pathology in 19 (11%) cases. Additional special investigations changed FNAB diagnosis or led to an additional diagnosis in 8 (5%) children. Overall, 70/84 (83%) with mycobacterial aetiology and all neoplastic disease cases received the correct treatment. Follow-up appointments were arranged in 144 (83%) patients. In a high tuberculosis burden area, a single FNAB provided a diagnosis in most cases in a routine referral setting; FNAB remains a safe and useful investigation. Follow-up of children to initiate appropriate treatment could improve. Large swollen lymph nodes, especially in the neck, are a common finding in children. Fine needle aspiration biopsy (FNAB) is a commonly used diagnostic procedure and we looked at how well this procedure works in everyday hospital practice. We identified all children <13 years of age over a 2-year period (2012-2014) who had an FNAB done at Tygerberg Hospital, Cape Town, South Africa, and looked how well this procedure performed and what the doctors did with these children. We found 173 children who had an FNAB done. They were generally young children of around 3 years old. With a single FNAB, we could make a diagnosis in 95% of these children. About half of the children had tuberculosis or complications of a BCG vaccine (both caused by mycobacteria), only 4% had a malignancy of some kind, about a third had reactive lymph nodes (usually other mainly local infectious causes) and the rest had other pathology like abscesses. All malignancies and >80% of the mycobacterial pathology cases were correctly managed; the latter could definitely improve.