Fine Needle Aspiration Cytology Results Research Articles

Clinical presentation and management of parotid gland tumors – A retrospective study in Northwestern Nigeria

Background: Parotid gland tumors are the most common major salivary gland tumors occurring in humans. Aim: This study aimed to evaluate the pattern of clinical presentation and management of parotid gland tumors in Northwestern Nigeria. Materials and Methods: In this retrospective study sociodemographics, nature of the lesion, fine-needle aspiration cytology result, surgical procedure, and complications of patients with parotid gland tumors were recorded and analyzed using SPSS version 25. Results: There were 31 (45.6%) males and 37 (54.4%) females in the age range of 17–72 years with a mean ± standard deviation of 49.03 ± 15.61 years. Benign tumors constitute the majority 50 (73.5%), with pleomorphic adenoma being the most common 46 (67.6%), whereas malignant tumors were 18 (26.5%), with adenoid cystic carcinoma being the most common 6 (8.8%). Superficial parotidectomy was the highest surgical procedure performed in 42 (70.6%) patients. Selective neck dissection was done in 5 (27.8%) cases and soft tissue reconstruction with deltopectoral flaps in 3 (16.7%) of the malignant cases. Transient facial nerve paralysis was seen in 14 (29.2%) and 8 (47.1%) of patients who had superficial and total parotidectomies, respectively. Permanent facial nerve paralysis was seen in all 5 (27.8%) patients who had radical parotidectomy. Conclusion: Pleomorphic adenoma was the most common parotid gland tumor, and superficial parotidectomy was the major surgical procedure performed. Facial nerve paralysis is an inevitable complication but can be minimized with meticulous surgical maneuver.

Fine Needle Aspiration Cytology's Role in the Diagnosis of Ovarian Tumor.

Fine needle aspiration cytology (FNAC) is a cost-effective, minimally invasive technique for diagnosing a wide range of benign and malignant lesions. However, there are a number of reasons why its use is limited in the diagnosis of ovarian cancer, such as the fear of tumor cells spilling into the peritoneal cavity and the difficulty of subtyping with cytology alone. In experienced hands, FNAC is a safe, cost-effective procedure with acceptable diagnostic accuracy. In ovarian cystic lesions, secondary degenerative changes and the sample's low cellularity were the primary causes of false negative FNAC results. Preparing cell block can partially avoid this, so we recommend doing so. All of the clinical and sonographic findings, in addition to the FNAC findings, the preparation of the cell block, and the application of immunohistochemistry, need to be taken into consideration in order to arrive at an accurate diagnosis.

Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.

Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients. We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results. In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; p < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; p < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence. The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.

The Evaluation of Malignancy Rates of Nondiagnostic Cases in Thyroid Fine-Needle Aspirations

Aim: In this study, it was aimed to investigate the malignancy rates of nondiagnostic (ND) thyroid fine-needle aspiration cytology (FNAC) material by evaluating either the result of the second FNAC or resection/biopsy materials.Method: Among the 1165 thyroid FNAC cases evaluated in the Pathology Department of Başakşehir Çam and Sakura City Hospital within 9 months (October 2020-June 2021), 102 cases (8,7%) diagnosed with ND were included in the study. At the end of the 6-15 months follow-up period after the diagnosis of ND, the results of the second FNAC or resection (thyroidectomy, lobectomy)/biopsy of the cases were evaluated. Diameter and sonographic features of thyroid nodules (solid, cystic, mixed) were also noted.Results: 49% of the cases (n:50) had a second FNAC. Resection/biopsy was performed in only 12 (11,8%) cases. Of these 62 cases, 39 were diagnosed by second FNAC and 7 by resection/biopsy as benign (74,1%), and 5 cases were diagnosed as malignant by resection/biopsy. 7 cases were diagnosed as nondiagnostic again after the second FNAC. Final diagnosis (by resection) of the case whose second FNAC result was reported as suspicious for malignancy was papillary microcarcinoma. This case was included in the group ‘diagnosed as malignant only by resection/biopsy. In other words, malignancy was detected in 5 of 62 patients who underwent a second FNAC or resection/biopsy. The risk of malignancy was found to be 8% in the patient population included in the study with the diagnosis of ND.Conclusion: A low rate of NE results were found in this ultrasound-guided thyroid series (8,7%). After the second FNAC or resection, malignancy rates was found to be 8%. Although this result is compatible with the results of some studies, it is considerably lower than others. It would be appropriate to follow up on ND nodules with their clinical/sonographic features. Additional studies with large series will be more helpful in determining the malignancy rates of the ND group.

Histopathologic Patterns and Cytohistologic Correlation of Thyroid Lesions among Patients with Thyroid Biopsies in Jimma Medical Centre, South West Ethiopia: A Retrospective Study

Introduction Thyroid diseases are major health problems that are manifested by alteration in hormone secretion, enlargement of the thyroid gland (goitre), or both. Identifying and characterizing lesions of the thyroid gland has a pivotal role since most of the lesions require medical or surgical management. Fine needle aspiration cytology (FNAC) is an important initial screening tool and histopathologic examination is the gold standard in the definitive diagnosis of thyroid disease. Objectives To assess histopathologic patterns and cytohistologic correlation of thyroid lesions among patients with thyroid biopsy. Methods A five-year retrospective study was conducted with a review of 581 biopsies submitted from thyroidectomy specimens at Jimma University Medical Centre (JUMC), Pathology Department from September 2015 to September 2020. This also includes a review of 286 cases in which fine needle aspiration was done prior to surgery. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 26. Descriptive and analytic studies were done. Cross tabulation, chi square (χ2 ) test and logistic regression with multivariate analysis were done to look for associations between the study variables. Results Majority of thyroid lesions were found to be non-neoplastic and 149 (25.6%) were neoplastic. Colloid goitre was found in 417 (71.8%) cases. Adenoma, carcinoma, and thyroiditis accounted for 54 (9.3%), 95 (16.3%) and 12 (2.1%) cases respectively. Among 286 FNAC results, cyto-histologic correlation was achieved in 233 (86.6%) cases. Sensitivity and specificity of FNAC were 71% and 92.7% respectively, with diagnostic accuracy of 86.6%. Conclusion Nodular colloid goitre is by far the most common thyroid lesion and papillary thyroid carcinoma (PTC) is the most frequent histologic type of malignancy. FNAC remains a sensitive, specific and accurate tool in the evaluation and management of thyroid lesions.

Evaluation of Fine Needle Aspiration Cytology in Thyroid Lesions with Histopathological Correlation

Background: Thyroid diseases are considered the commonest endocrine disorders worldwide. Fine needle aspiration cytology (FNAC) is the mosteasy, reliable screening test in diagnosing thyroid lesions. Objectives: To determine the frequency of Bethesda system diagnostic categories and cyto-histopathological correlation of FNAC results. Material and methods: This study comprised 488 thyroid FNA smears. cyto-histopathological correlation was conducted on surgically excised cases. Results: Out of 488 of thyroid FNAC smears, thyroidectomy was done for one hundred cases. Sensitivity, specificity, PPV, NPV and accuracy of FNAC were 82.8%, 94%, 88.9%, 90.4% and 89.9% respectively. Conclusion: FNAC is a highly sensitive and specific method in diagnosing different thyroid lesions.

Role of Sentinel Lymph Node Biopsy in Clinically Node Negative Carcinoma Penis - a Prospective Study.

Nodal metastasis is a strong prognostic indicator in carcinoma penis, with 25% difference in 5-year cancer-specific survival among node negative and node positive patients. This study aims to assess efficacy of SLNB in identifying occult nodal metastasis (seen in 20-25% of cases), thus avoiding morbidity of prophylactic groin dissection in rest. Study was conducted between June 2016 and December 2019 on 42 patients (84 groins). Primary outcomes assessed were sensitivity, specificity, false negative rates, positive predictive value, and negativepredictive value of sentinel lymph node biopsy (SLNB) compared to superficialinguinal node dissection (SIND). Secondary outcomes were to know prevalence of nodal metastasis, sensitivity, specificity, false negative rates, positive predictive value (PPV), negativepredictive value (NPV) of frozen section study, and ultrasonography (USG) compared to histopathologicalexamination (HPE) and to evaluate false negative results of fine needle aspiration cytology (FNAC). Patients with impalpable inguinal nodes were subjected to USG and FNAC of suspicious nodes. Only those with non-suspicious USG/negative FNAC were included. Patients who werenode positive, had prior chemotherapy/radiotherapy/prior groin surgery, or medically unfit for surgery were excluded. Dual-dye technique was used to identify sentinel node. Superficial inguinal dissection was done in all cases and both specimens were subject to frozen section. If ≥ 2 nodes were involved on frozen section, ilioinguinal dissection was done. SLNB had sensitivity, specificity, PPV, NPV, and accuracy of 100%, respectively. There were no false negative results of frozen section study among168 specimens. Ultrasonography hadsensitivity of 50%, specificity of 48.75%, PPV of 4.65%, NPV of 95.12%, and accuracy of 48.81%. We had 2 false negative results of FNAC. Sentinel node biopsy with frozen section study when done in properly selected cases using dual-dye technique in high volume centers by experienced professionals is a very reliable tool in establishing the nodal status, thereby facilitatingneed directedtreatment, thus prevent either over/under treatment.

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.

Diagnosis of parathyroid incidentaloma detected on thyroid ultrasonography: the role of fine-needle aspiration cytology and washout parathyroid hormone measurements.

The aim of this study was to assess the diagnostic role of fine-needle aspiration cytology (FNAC) and analyze factors associated with false-negative FNAC results in patients with parathyroid incidentaloma who were referred for ultrasonography (US)-guided fine-needle aspiration (FNA) of thyroid nodules. In this study, 121 patients with suspected parathyroid lesions were enrolled. The patients underwent US-guided FNAC with measurements of washout parathyroid hormone (PTH) between January 2015 and May 2020. The diagnostic performance of FNAC for the diagnosis of parathyroid lesions was assessed using surgical results and elevated washout PTH as a reference standard. The clinical and radiologic features associated with false-negative results on FNAC for the diagnosis of parathyroid lesions were evaluated. Among the 121 nodules assessed, 38 were parathyroid lesions (31.4%), and 83 were non-parathyroid lesions (68.6%). The diagnostic performance of FNAC for parathyroid incidentaloma showed a sensitivity of 31.6% (12/38), specificity of 100% (83/83), positive predictive values of 100% (12/12), negative predictive values of 76.1% (83/109), and accuracy of 78.5% (95/121). The FNAC results of non-parathyroid lesions included thyroid nodules, lymph nodes, neurogenic tumors, and fat tissue. True-positive results on FNAC were significantly associated with performing FNA twice (58.3% vs. 23.1%, P=0.043). Considering the low sensitivity of FNAC, measuring washout PTH in addition to FNAC may help accurately diagnose parathyroid incidentaloma on thyroid US. Further, the falsenegative rate for FNAC can be reduced by obtaining two or more FNA samples.

Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman.

BACKGROUND: Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling need to explore FNAC accuracy among Omanis.OBJECTIVE: Describe cytological features of FNAC and assess FNAC accuracy compared to the postsurgical histopathology report.DESIGN: Retrospective diagnostic accuracy studySETTING: Tertiary care center.PATIENTS AND METHODS: Our study included adult Omani adult patients with thyroid nodules who underwent FNAC from 2014 to 2017 and had final pathology results for patients who underwent thyroid surgery. The results were classified according to the UK Royal college of Pathologists ‘Thy’ categories. Accuracy of FNAC was calculated by determining false and true positive and negative results based on histopathology findings.MAIN OUTCOME MEASURES: FNAC accuracy (sensitivity and specificity) compared to the postsurgical histopathology.SAMPLE SIZE: 867 patients with 1359 ultrasound guided FNACs of thyroid nodule; 137 underwent surgery.RESULTS: The mean age of the 867 patients was 43.7 (13.3) years, with a median of 42 years, and 87.8% were females. Out of 1359 FNACs, 1001 (73.7%) were benign (Thy2), 119 (8.8%) were atypia of undetermined significance or follicular lesion of undetermined significance (Thy3a), 31 (2.3%) were follicular neoplasm or suspicious for a follicular neoplasm (Thy3f), 52 (3.8%) were suspicious for malignancy (Thy4), 55 (4%) were malignant (Thy5), 101 (7.4%) as Unsatisfactory (Thy1). Only 137 patients underwent thyroid surgery, and the FNAC reports were compared with their final histopathology reports. The sensitivity, specificity and total accuracy of FNAC were 80.2%, 98.9% and 89.9%, respectively. The positive and negative predictive values of FNAC were 98.6% and 84.3%, respectively.CONCLUSION: Our study findings confirmed that FNAC of the thyroid is a sensitive, specific, and accurate initial tool for the diagnosis of thyroid lesions. Most of the FNACs were benign with a very low malignancy rate. Due to the minimal chance of false negative results and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow-up.LIMITATIONS: Retrospective design and single-center study, and thyroid nodule size unavailable.CONFLICT OF INTEREST: None.

Application of the Milan System for Reporting Salivary Gland Cytopathology: A Single Institutional Experience of 354 Cases with Cytologic-Histologic Correlation

Background: Evaluation of salivary gland lesions is routinely done preoperatively by fine-needle aspiration cytology (FNAC). The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), with diagnostic categories I–VI, has been recommended to standardize the reporting of salivary gland lesions by FNAC. We aimed to reclassify archival salivary gland FNAC samples using MSRSGC, correlate the samples with surgical resections, and calculate the risk of malignancy (ROM) for each category. Methods: A total of 354 salivary gland FNAC samples (2013–2018) were reviewed. All FNAC results were retrospectively classified according to the MSRSGC. All cases had surgical follow-up. Histology was used to calculate the ROM, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Results: The 354 aspirates were classified as: nondiagnostic (ND) 17.0% (60), non-neoplastic (NN) 1.4% (5), atypia of undetermined significance (AUS) 11.0% (39), benign neoplasm (BN) 49.4% (175), salivary gland neoplasms of unknown malignant potential (SUMP) 10.7% (38), suspicious for malignancy (SM) 3.4% (12), and malignant (M) 7.1% (25). The ROM was as follows: ND 22%, NN 20%, AUS 15%, BN 2%, SUMP 53%, SM 75%, and M 96%. The diagnostic accuracy for separating benign versus malignant neoplasms was 96%. Cytologic-histologic correlation yielded a false-negative rate of 2.7%, false-positive rate of 10.5%, PPV of 89%, NPV of 97%, sensitivity of 87%, and specificity of 98%. Conclusion: MSRSGC helps standardize cytology reports, provides useful information for appropriate clinical management, and ensures the best care of patients with salivary gland lesions.

SCC Antigen Concentrations in Fine-Needle Aspiration Samples to Detect Cervical Lymph Node Metastases: A Prospective Analysis.

To determine the diagnostic value of measuring squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 15-3 (CA15-3) concentrations in fine-needle aspiration (FNA) samples for the detection of squamous cell carcinoma (SCC) metastases in cervical lymph nodes. A prospective study with patients consecutively included between November 2018 and May 2021. A tertiary head and neck oncologic center. Out of 138 patients, SCC-Ag concentrations were analyzed in 168 FNA cervical lymph node samples and CA15-3 in 152 samples. Results were compared with FNA cytology (FNAC) or definitive histology to establish sensitivity and specificity rates. For the detection of cervical SCC lymph node metastases, SCC-Ag measurement had an 89.4% sensitivity and 79.3% specificity at a cutoff concentration of 0.1 µg/L. Measurement of CA15-3 concentration in addition to SCC-Ag concentration did not lead to improved accuracy for the detection of SCC. In histology-confirmed cases, FNAC had an 80.0% sensitivity and 100% specificity, as opposed to 93.3% and 57.1%, respectively, for SCC-Ag. Measurement of SCC-Ag concentration for detection of SCC lymph node metastases has a sensitivity at least comparable to FNAC and could be used as a relatively cheap screening tool in samples with nondiagnostic or indeterminate FNAC results or when multiple lymph nodes are sampled. However, SCC-Ag in FNA samples has a lower specificity than FNAC assessed by pathologists experienced in head and neck oncology. Addition of CA15-3 measurement did not lead to improved accuracy.

Malignancy rates in thyroid nodules: a long-term cohort study of 17,592 patients.

ObjectivesUltrasound diagnosis of thyroid nodules has greatly increased their detection rate. Their risk for malignancy is estimated between 7 and 15% in data from specialized centers which are used for guidelines recommendations. This high rate causes considerable anxiety to patients upon first diagnosis. Here, we retrospectively analyzed the malignancy rate of sonographically diagnosed nodules larger than 1 cm from a primary/secondary care center when long-term longitudinal follow-up was included.Patients/methodsIn the study, 17,592 patients were diagnosed with a thyroid nodule larger than 1 cm, of whom 7776 were assessed by fine-needle aspiration cytology (FNAC) and 9816 by sonography alone. 9568 patients were initially discharged due to innocent results of FNAC and/or ultrasound. In 1904 patients, definitive histology was obtained, and 6731 cases were included in the long-term follow-up (up to 23 years, median 5 years).ResultsMalignancy was histologically confirmed in 189 patients (1.1% of all) when excluding accidentally diagnosed papillary microcarcinomas. 155 were diagnosed during the first year of management, 25 in years 2–5 of follow-up, 9 in years 6–10 and nil in 1165 patients followed beyond 10 years.ConclusionsThe malignancy rate of thyroid nodules from primary/secondary care was much lower than that previously reported. During follow-up for more than 5 years, their rate rapidly dropped to less than 1/1000 cases. This low malignancy rate may help to reassure patients first confronted with the diagnosis of a thyroid nodule, substantially reduce their anxiety and avoid unwarranted diagnostic and therapeutic procedures.

Comparison of diagnostic value of SWE, FNA and BRAF gene detection in ACR TI-RADS 4 and 5 thyroid nodules.

To compare the diagnostic value of shear wave elastography (SWE), fine needle aspiration (FNA) and BRAF gene detection (BRAFV600E gene mutation detection) in ACR TI-RADS 4 and 5 thyroid nodules. SWE images, FNA cytological results and BRAF detection results of ACR TI-RADS 4 and 5 thyroid nodules confirmed by pathology were analyzed retrospectively. The receiver operating characteristic (ROC) curve was drawn to determine the best cutoff value of SWE Emax. In the combined diagnosis of SWE, FNA and BRAF, firstly, the nodules with BRAF gene mutation were included in the positive ones, secondly, the nodules with benign and malignant FNA were included in the FNA + SWE or FNA + SWE + BRAF negative and positive ones respectively, finally, for FNA uncertain nodules: those whose SWE Emax were less than or equal to the cutoff value were included in FNA + SWE or FNA + SWE + BRAF negative ones, and those whose SWE Emax were greater than the cutoff value were included in positive ones. The diagnostic efficacy of SWE, FNA, SWE + FNA, FNA + BRAF and their combination in ACR TI-RADS 4 and 5 thyroid nodules were compared. The ROC curve showed that the best cutoff value of SWE Emax was 40.9 kpa, and the area under ROC curve (AUC) was 0.842 (0.800∼0.885). The sensitivity, specificity and accuracy of SWE were 76.3% (270/354), 75.5% (80/106) and 76.1% (350/460), respectively. The sensitivity, specificity and accuracy of FNA were 58.2% (206/354), 88.7% (94/106) and 65.2(300/460), respectively. The sensitivity, specificity and accuracy of FNA + BRAF were 95.5% (338/354), 88.7% (94/106) and 93.9% (432/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA were 85.9% (304/354), 98.1% (104/106) and 88.7% (408/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA + BRAF were 98.3% (348/354), 98.1% (104/106) and 98.3% (452/460), respectively. For the diagnostic accuracy, SWE + FNA + BRAF > FNA + BRAF > FNA + SWE > SWE > FNA, the difference was statistically significant (all P > 0.05). For ACR TI-RADS 4 and 5 thyroid nodules, SWE and FNA have high diagnostic efficiency. For the diagnostic accuracy, FNA + BRAF is better than FNA + SWE. FNA combination with BRAF gene detection further improves the diagnostic sensitivity and accuracy of FNA. The combined application of the three is the best.

Thyroid Cancer Detection in a Routine Clinical Setting: Performance of ACR TI-RADS, FNAC, and Molecular Testing in Prospective Cohort Study.

The aim of our study was to address the potential for improvements in thyroid cancer detection in routine clinical settings using a clinical examination, the American College of Radiology Thyroid Imaging Reporting and Database System (ACR TI-RADS), and fine-needle aspiration cytology (FNAC) concurrently with molecular diagnostics. A prospective cohort study was performed on 178 patients. DNA from FNA samples was used for next-generation sequencing to identify mutations in the genes BRAF, HRAS, KRAS, NRAS, and TERT. RNA was used for real-time PCR to detect fusion genes. The strongest relevant positive predictors for malignancy were the presence of genetic mutations (p < 0.01), followed by FNAC (p < 0.01) and ACR TI-RADS (p < 0.01). Overall, FNAC, ACR TI-RADS, and genetic testing reached a sensitivity of up to 96.1% and a specificity of 88.3%, with a diagnostic odds ratio (DOR) of 183.6. Sensitivity, specificity, and DOR decreased to 75.0%, 88.9%, and 24.0, respectively, for indeterminate (Bethesda III, IV) FNAC results. FNA molecular testing has substantial potential for thyroid malignancy detection and could lead to improvements in our approaches to patients. However, clinical examination, ACR TI-RADS, and FNAC remained relevant factors.

Correlating Fine Needle Aspiration Cytology Results of Mammary Malignancy with Corresponding Ultrasound BIRADS Score

Objective: Breast mass is a major complaint making women attending any breast clinic. About 10% of the lumps are usually malignant. Triple assessment techniques using clinical examination, ultrasound, and cytology are usually sufficient in reaching the final diagnosis, especially in specialized breast centers. The aim of this study was to assess how accurate ultrasound was in the diagnosis of definite breast cancer according to BIRADS (Breast Imaging Reporting and Data System), and correlate these radiological findings with the results of fineneedle aspiration cytology (FNAC). Methods: A retrospective study included 42 patients who presented with a self-detected breast lump and attending the Early Detection of Breast Tumors clinic in the Oncology Teaching Hospital, Medical City Complex, Baghdad during the period from May 2019 to August 2020. Their age ranged from 29 to 92 years. Patients underwent ultrasound examination after clinical examination and the reported BIRADS score was correlated with the corresponding cytology data. Results: the main ultrasound findings are masses that are either irregular in the majority of cases and this represents 55%, poorly demarcated lesions seen in (26%) while 14% of them were well defined. axillary lymphadenopathy with typical malignant features was noted in (50%). FNAC revealed mammary carcinoma in (93%); while severe atypia was seen in 7%, BIRADS V score was assigned in 76%, of breast exam BIRADS IV in 21% while the remaining 3% were in BIRADS III category. By correlating these ultrasound findings of BIRADS with FNAC results, the ultrasound accuracy in the diagnosis of breast cancer was reaching to 90%. Conclusion: Ultrasonography represents an accurate diagnostic radiological modality for any breast lesion and is thus considered a recommended method for assessment of underlying cause responsible for palpable breast mass or any presenting symptoms related to the breasts. Its value was demonstrated in characterizing the mass lesion, assessing its location, its echo texture, margin, and size, it has a major role in analyzing the axilla for normal or pathological lymph nodes.

Ultrasound Features and Estimated Risk of Malignancy in Thyroid Nodules

Introduction: A significant uncertainty surrounding the diagnostic accuracy of ultrasound (US) and the risk features in thyroid nodules exist to date which impacts clinical practice and guidelines. Methods: This retrospective descriptive observational study included patients with thyroid nodules with US reports over 10 years and either had a fine-needle aspiration (FNA) cytology result, a pathology report or both. Results: A total of 483 patients were included. Most of the patients were &lt;55 years old (67.3%) and the majority of them were females (91.3%). The FNA cytology results indicated that 311 (64.4%) of the thyroid nodules were benign and 32 (6.6%) were malignant. Overall, only 181 (37.5%) of the patients had a final histopathologic assessment; of these, 80 (44.2%) had malignant thyroid nodules, 78 (43.1%) had benign nodules, and 23 (12.7%) had microcarcinoma. multivariate logistic regression analysis revealed that having US features of hypoechogenicity (adjusted odd ratio 3.37; 95% confidence interval [CI] 1.03–11.00) and a microlobulated or irregular margin (aOR 3.65; 95% [CI] 1.13–11.79) were the only sonographic characteristics that had a statistically significant association with thyroid cancer based on final pathology. Conclusion: Thyroid nodules showing hypoechogenic echogenicity and microlobulated or irregular margin on US need to be closely followed and given the appropriate management based on their risk criteria.

Cytohistological Correlation of Palpable Breast Lesions in a Tertiary Care Centre – A Retrospective Study

Background: Breast cancer is one of the leading causes of death from cancer among women. WHO reported that around 1lakh new cases of carcinoma breast are diagnosed every year in India and about 70,218 deaths due to breast cancer was estimated in Indian women every year. Early diagnosis and prompt treatment plays an important role in decreasing the mortality due to breast cancer. Presenting complaint in majority of the cases is a palpable lump in the breast. Fine needle aspiration cytology (FNAC) is a simple, fast, inexpensive method and reliable. It is being used as a first line procedure for diagnosing breast lesions&#x0D; Aim: This study is aimed to examine the cytological features of FNAC done on palpable breast lesions and to correlate the results of these breast FNAC with the corresponding tissue biopsy reports. Thereby we are determining the accuracy of reporting FNAC breast lesions in our hospital.&#x0D; Material and Methods: This is a 1-year retrospective study of breast lumps seen in Department of Pathology, Saveetha Medical College, Chennai. All patients who had FNAC of breast lumps with subsequent histological confirmation over this period are included in this study. Cytological diagnosis was categorized as benign, inflammatory, suspicious for malignancy, positive for malignancy and inadequate and compared with histopathological diagnosis for correlation. Statistical analysis was done to test sensitivity specificity, positive predictive value and accuracy.&#x0D; Results: This is a 1-year retrospective study of breast lumps seen in Department of Pathology, Saveetha Medical College, Chennai. All patients who had FNAC of breast lumps with subsequent histological confirmation over this period are included in this study. Cytological diagnosis were categorized as benign, inflammatory, suspicious for malignancy, positive for malignancy and inadequate and compared with histopathological diagnosis for correlation. Statistical analysis was done to test sensitivity specificity, positive predictive value and accuracy&#x0D; Conclusion: FNAC is a quicker, easier, inexpensive, safe and readily acceptable procedure. Though definitive specific diagnosis may not be possible by cytology, but it can be categorized and differential diagnosis can be derived. So, to conclude, Aspiration cytology can be done as a first line procedure but cannot be considered as a substitute for histopathology.

Combined Application of Fine-Needle Aspiration Cytology with BRAFV600E Mutation Screening in the Detection of Different Grades of Papillary Thyroid Carcinoma

The present study aimed to evaluate the application of fine-needle aspiration cytology (FNAC) of the thyroid coupled with the screening of serine/threonine-protein kinase B-Raf (BRAF) gene mutation in the detection of papillary thyroid carcinoma (PTC). From October 2016 to June 2019, 1244, liquid-based specimens originated from the patients diagnosed with PTC and benign lesions were collected from the Pathology Department of First Central Hospital of Baoding. BRAFV600E mutation was screened in all the liquid-based specimens using quantitative fluorescence polymerase chain reaction. Combined with the pathological results after surgery, the results of FNAC alone and FNAC combined with BRAFV600E screening results in PTC of different grades were compared and analyzed. Of the 1244 cases, there were 818 cases with definite cytological diagnosis and 426 cases with uncertain diagnoses. Combined with BRAFV600E screening, 36 out of 90 cases with atypical cells and 150 out of 223 suspected PTC were diagnosed as PTC. In conclusion, coupled with BRAFV600E mutation screening, the pre-operative detection rate of PTC can be increased in patients with atypical cells and suspected PTC which cannot be confirmed by pre-operative FNAC.

Large thyroid nodules: should size alone matter?

The management of thyroid nodules ≥ 4cm is controversial due to conflicting evidence on the prevalence of malignancy and diagnostic accuracy of fine-needle aspiration cytology (FNAC). Some literature recommends routine excision of large thyroid nodules due to high cytology false negative rates (FNR). We aim to investigate the diagnostic accuracy of FNAC, prevalence of malignancy in large (≥ 4cm) thyroid nodules compared to nodules < 4cm, and the clinical and ultrasound characteristics of those large nodules with false negative cytology. This was a retrospective case-log review in a tertiary referral hospital. All thyroid nodules subjected to Ultrasound (US)-guided FNAC by the Interventional Radiology department between December 2011 and November 2017 were included. Data on patient demographics, thyroid US features, cytology findings, and surgical histology were collected and analyzed. Sensitivity, specificity, and FNR were calculated based on FNAC results and final post-operative histology. Factors associated with a false negative result were analyzed using univariate and multivariate analyses. A total of 4982 nodules were studied, including 4419 < 4cm and 563 ≥ 4cm. Malignancy rates were similar in both groups. For nodules ≥ 4cm, FNAC sensitivity was 40%, specificity 100%, and FNR 6.6% compared to 4.2% in nodules < 4cm. Within malignant nodules, there was a significantly higher proportion of follicular and Hurthle cell carcinomas in nodules ≥ 4cm. Amongst nodules ≥ 4cm, multivariate analysis revealed male gender to be an independent predictor of FNR (OR 3.32; 95% CI 1.29-8.59). Larger nodules ≥ 4cm have a similar malignancy rate as nodules < 4cm, and FNAC FNR is low at 6.6%. Management of large thyroid nodules should be individualized based on their clinical, sonographic and cytological features rather than routine surgery.