Fine Needle Aspiration Cytology Results Research Articles

Correlation of sonographic and cytologic patterns of thyroid nodules.

Introductionthyroid nodules are palpable in about 8% of adults. It is necessary to differentiate benign nodules from malignant ones by the non-invasive ultrasonography thereby reducing the frequency of the invasive fine needle aspiration cytology (FNAC). The study assessed the sonographic and FNAC patterns of thyroid nodules for benign and malignant features in a black African population.Methodsthis was a hospital-based, cross-sectional study design over a 1-year period in which one hundred and seven (107) consenting patients between 15 to 80 years of age with palpable thyroid masses by convenience sampling, were consecutively recruited to have both thyroid ultrasound scan and FNAC of their thyroid mass sequentially. Frequency, percentages and two-by-two contingency table were employed for data analysis.Resultsthe sonographic features of the thyroid nodules varied from round 80 (74.8%) to oval 25 (23.4%) masses, the presence of thin peripheral halo 83 (77.6%), heterogeneous echo-pattern 104 (97.2%) with cystic component and peripheral vascularity 75 (70.1%). One hundred and five (98.1%) study participants showed benign features on sonography while two had features suspicious of malignancy; however FNAC result in the same group of patients was suggestive of benign masses in all 107 (100%) patients. Histology however confirmed malignancy in the 2 participants with ultrasound features suggestive of malignant thyroid nodules.Conclusionultrasonography is very sensitive in the characterization of thyroid nodules into benign or suspicious for malignancy in black African population.

Fine Needle Aspiration Cytology Findings of Breast Lesions in Female Patients Presenting With Palpable Breast Lumps at Makerere University College of Health Sciences, Kampala-Uganda

Background: Palpable breast lumps are a common manifestation encountered by physicians during clinical practice. The use of fine-needle aspiration cytology (FNAC) method has proven to be quick, simple and cost-effective in the evaluation of these lumps for benign, atypical and malignant changes. This study aims to determine the type of breast lesions diagnosed by FNAC and to determine the age-wise distribution for such lesions. Methodology: A prospective study consisting of 291 females presenting with palpable breast lesions was carried out at Makerere College of Health Sciences (MakCHS) pathology laboratory from January 2019 to May 2019. FNAC results were grouped into tier five reporting categories as C1, C2, C3, C4 & C5 in accordance to the International Academy of Cytology (IAC). Results: Out of the 291 cases examined, 14 (4.8%) were insufficient (C1), 192 (66%) were benign (C2), 9 (3.0%) were atypical (C3), 15 (5.2%) were suspicious of malignancy (C4) & 61 (21%) were malignant (C5). In the benign category, lesions of fibroadenoma were the most commonly diagnosed constituting 110/192 (57.3%) whereas under the malignant category lesions of invasive ductal carcinoma were the most commonly diagnosed constituting 27/61(44.3%). The peak age group for benign lesions was 21-30 years whereas the peak age group for malignant lesions was 41-50 years. Conclusion: Fine-needle aspiration cytology (FNAC) was found to be an effective diagnostic tool in the categorization of palpable breast lumps into benign, malignant, atypical, suspicious and inadequate categories.

Solitary Thyroid Nodule: Clinical, Sonography and Pathological Evaluation Risk of Malignancy

Aim: To determined risk of increases Incidence of Thyroid cancer in solitary thyroid nodules so Preoperative distinction between benign and malignant in solitary thyroid nodules is important and helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury. Methods: Descriptive perspective analyzed data over a period of 6 years April 2015-April 2021 in Saudi Hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients, 135 patient’s diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. Patients with a clinically solitary thyroid nodule were included in the study group. Results: 135 cases of clinically detected solitary thyroid nodules, 126 female and 9 male patients, between 14 - 65 years age, median 41 years and mean 39.76 years, (94, 41) patients respectively Right side thyroid effect more than Left side, Fine needle aspiration cytology (FNAC) sensitivity, specificity and accuracy was (61%, 72%, 64%) respectively. Postoperative histopathology reported 100 (74%) patients as having benign thyroid nodules and 35 patients (26%) as having malignant thyroid nodules. Postoperative transient hypocalcemia was observed in 9 patients (7%), and temporary hoarseness was observed in 3 patients (2%). Conclusion: The incidence of malignancy in solitary thyroid nodules is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on Thyroid Ultrasound frequently in malignant nodules. Male risk factors for thyroid cancer but age, number and size of nodules not included as risk factor. Fine needle aspiration cytology (FNAC) is more helpful for diagnosing if aspiration under Ultrasound guidance and reading by experience histopathologists. The type of surgery depends on preoperative evaluation, including history, examination, ultrasound, fine needle aspiration cytology (FNAC) result, and intraoperative assessment of the nodule. There are fewer complications of thyroid surgery by experienced surgeons.

Fine-Needle Aspiration Cytology of Salivary Gland Tumors Before the Milan System: Ten Years of Experience at a Tertiary Care Center in Turkey.

ObjectiveThe role of fine-needle aspiration cytology (FNAC) is well established for preoperative evaluation of patients with salivary gland lesions. However, the lack of a uniform system for salivary gland FNAC has limited its effectiveness. In recent years, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been in use around the world to report the cytology results. We aimed to investigate the efficacy and accuracy of FNAC examined according to pre-MSRSGC era dichotomous benign/malignant classification in salivary gland tumors.MethodsPatients who underwent surgery between January 2011 and December 2020 due to major salivary gland tumors were retrospectively analyzed. Two hundred and four patients were included in the analysis. Preoperative FNAC results and final histopatological diagnoses were grouped as benign or malignant. Final histopatological diagnoses were compared with the preoperative FNAC results. Also, sensitivity, specificity, and accuracy of the preoperative FNAC results, as well as the agreement between both tests were investigated.ResultsThe sensitivity, specificity, accuracy, positive and negative predictive values of the preoperative FNAC for the diagnosis of malignancy were 59.09%, 97.85%, 93.75%, 76.47%, and 95.29%, respectively. There was a moderate agreement between the preoperative FNAC results and final histopatological diagnoses.ConclusionThe accuracy of the preoperative FNAC and the information given about malignancy risk are the most important criteria for patient management and decision-making. The MSRSGC, which consists of a six-tiered classification rather than a dichotomous “yes/no” system, may contribute to patient management and decision-making by increasing the efficacy and accuracy of FNAC.

Evaluation of diagnostic utility of Acridine orange staining using fluorescence microscopy in lung cancers: A diagnostic test evaluation

Lung cancer causes more deaths than most other cancers. Conventional sputum cytology (CSC) has low diagnostic yield for lung cancer. Thus, there is a need for rapid, accurate and cost-effective test for detecting lung cancers. 1). To study sensitivity, specificity and accuracy of Acridine Orange staining with fluorescence microscopy (AOFM) in detection of lung cancer against histo-pathology and fine needle aspiration cytology (FNAC) results. 2). To compare results of AOFM and CSC in diagnosis of lung cancer.It was a diagnostic test evaluation conducted at a tertiary care institute over a period of 24 months.Sputum samples of 60 patients suspicious of lung cancer were examined using AOFM. After staining with Acridine Orange, exfoliated cells in the sputum samples were categorized as benign or malignant based on the type of fluorescence they emitted when examined under a fluorescence microscope, and results were compared with histo-pathology and/or FNAC reports.Chi-square test, Cohen’s kappa statistic etc.AOFM had sensitivity, specificity and accuracy of 92.31%, 87.67% and 90.24% respectively when compared with histopathology and/or FNAC. P=0.0000026 implies significant difference between sensitivities of AOFM and CSC (30.77%). There was significant difference between AOFM and CSC in context of specificity [P=0.04] and accuracy [P=0.05].AOFM in the patients with suspected lung cancer is a useful ‘first diagnostic test’. It is a rapid pre-screening tool which will reduce cost of cyto-diagnosis in under-served and remote areas.

The Prevalence of Thyroid Papillary Microcarcinoma in Patients With Benign Thyroid Fine Needle Aspiration.

IntroductionThyroid nodules are a very common clinical finding in the general population. We use fine needle aspiration (FNA) as the gold standard workup test for a thyroid nodule, as it is capable of differentiating malignant nodules from benign in the majority of cases. Usually, FNA is done for nodules that are more than 1 cm; small malignant lesions that are less than 1 cm in size can be missed. That’s why the risk of having undiagnosed microcarcinomas in an otherwise benign FNA needs to be explored.AimTo estimate the prevalence of thyroid papillary microcarcinoma in patients with benign FNA and evaluate and correlate the FNA cytological results with the final histopathological diagnoses.MethodsThis was a retrospective study of 1543 post-thyroidectomy patients who underwent FNA cytology, were classified according to the Bethesda scoring system, and were admitted to two tertiary care hospitals in Riyadh, Saudi Arabia, from 2010 to 2019.ResultsSix-hundred-seven (607) out of 1543 FNA cytology results were reported as benign, 215 as malignant, and 73 as suspicious of malignancy. On final histopathology diagnosis, 81/607 (13.34%) of benign cases and 35/215 (16.28%) of malignant cases did not meet the initial cytology and were confirmed as papillary microcarcinoma. In patients with microcarcinoma after initial benign FNA (89.2%) found to have benign multinodular changes, compared to only (31%) of initial malignant FNA patients.Conclusion When non-surgical intervention is chosen in patients with benign FNA, the possibility of coexisting microcarcinoma with its variable prognosis should be taken into account and explained to the patient.

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories.

To compare the frequency of fine needle aspiration (FNA) cytological results between nodules 1cm or less and nodules greater than 1cm. All FNAs performed between January 2016 and December 2019 at an institute in Brazil were analysed. For each nodule, at least two conventional slides were produced (one stained by Giemsa and the other by hematoxylin and eosin). All cases were reviewed by two cytopathologists and were reported following the Bethesda System. Clinical information (gender and age) and ultrasound data (nodule size and location) were collected. The magnitude of association was measured using the prevalence ratio (PR) with 95% confidence intervals (CIs) considering two groups of nodules: 1.0cm or less, and greater than 1cm. A total of 3703 nodules were analysed from 3265 patients (2906 women [88.48%], 359 men [11.51%], with a combined mean age of 52years). Considering the prevalence ratio of Bethesda categories between these two groups of nodules, the nondiagnostic or unsatisfactory category (PR: 3.0, 95% CI: 2.2-4.2) and the suspicious for malignancy category (PR: 1.6, 95% CI: 1.1-2.4) were significantly associated with nodules measuring 1cm or less. Our results demonstrated that nodules 1cm or less are significantly associated with the nondiagnostic and suspicious for malignancy categories of the Bethesda System when compared to nodules greater than 1cm.

Fine Needle Aspiration Cytology (FNAC) in Thyroid Gland Lesions, How Accurate is it? A Correlation with Histopathology

Background: For the purpose of preoperative diagnosis of thyroid lesions, the Fine Needle Aspiration Cytology (FNAC) has now replaced many other conventional pathology tests. Objective: To know to what extent the FNAC results are accurate by correlating them with results of histopathology. Patients and Methods: In this retrospective study, ninety-four cases of thyroid gland lesions were collected from the Department of Histopathology at Rizgary Teaching Hospital, Erbil City, Iraq during the period of three years, from January 2015 to December 2017, and correlate their FNAC outcome with that of histopathology. Results: A total of 94 cases were included in this study, 70 cases (74%) were female. Fifty cases (53%) were between 21-40 years of age. FNAC and histopathological results were correspondent in 84 cases (89.4%). The most common thyroid gland lesion was nodular colloid goiter occurred in 72 cases (77%) as confirmed by histopathology. Conclusion: The FNAC is relatively safe, simple, and cost effective preoperative diagnostic tool for thyroid lesions. However, it has some limitations.

Comparative Evaluation of Echinococcus Serology with Cytology for the Diagnosis of Hepatic Hydatid Disease.

Objectives The purpose of this study is to determine the diagnostic efficacy of enzyme-linked immunosorbent assay (ELISA) in radiologically confirmed liver mass lesions for the diagnosis of hepatic hydatid disease (HHD) and to compare the diagnostic performance of ELISA with fine needle aspiration cytology (FNAC) (taken as standard) for HHD diagnosis. Materials and Methods This retrospective study included blood samples of 223 patients with radiologically confirmed liver mass lesions in which immunoglobulin G (IgG) anti- Echinococcus antibodies were tested using a commercial IgG ELISA (RIDASCREEN, R-Biopharm AG, Darmstadt, Germany). Results of ELISA, ultrasonography, FNAC, and liver function tests were obtained from the hospital information system. ELISA results were compared with those of FNAC to analyze the diagnostic efficacy of ELISA for HHD diagnosis. Statistical Analysis Comparison of the results obtained from ELISA was performed with respect to FNAC results (taken as standard) to analyze the diagnostic efficacy of ELISA for HHD detection. Data has been represented as median (range) or in frequencies. Wilson score was used to assess 95% confidence interval of diagnostic parameters. The analysis was performed using SPSS Version 22.0 (IBM Corp.) and Open Epi (version 3.01). Results Out of 223 cases with liver mass lesions, Echinococcus IgG was reactive in 62 (28%) cases and FNAC was positive in 16 (7.2%) cases. Since two cases were FNAC-positive but IgG-nonreactive, total HHD cases were 64 (28.7%). Echinococcus IgG reactive cases were seen more in the extremes of age group, that is, 1 to 10 years and 81 to 90 years. Taking FNAC as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ELISA were 87.5, 76.8, 22.6, and 98.7%, respectively. Cytology-positive cases demonstrated a mean ELISA optical density/cut-off (OD/CO) of 4.2 ± 3 standard deviation. Conclusion ELISA in radiologically confirmed liver mass cases is highly sensitive in detecting HHD and hence should be used along with ultrasonography for the screening of HHD followed by confirmation with cytology even in cases with a higher OD/CO of ELISA.

Grayscale, subjective color Doppler, combined grayscale with subjective color Doppler in predicting thyroid carcinoma: a retrospective analysis

IntroductionFine needle aspiration cytology is preferred for thyroid nodules preoperatively, but has disadvantages of false-negative and false-positive results. ObjectiveTo compare the diagnostic performance of grayscale ultrasound, subjective color Doppler ultrasound, and combined features of grayscale ultrasound and subjective color Doppler ultrasound in predicting thyroid carcinoma, using results of the fine needle aspiration cytology as the reference standard. MethodsData from gray-scale ultrasound images, subjective color Doppler ultrasound images, and the fine needle aspiration cytology of 325 nodules of 250 patients (age ≥ 18 years) were collected and analyzed. Hypo-echogenicity than adjacent strap muscle, micro-lobulated or irregular margins, micro- or mixed calcifications, and taller-than-wide shapes were considered as a suspicious malignant nodule in grayscale ultrasound. Marked vascularity was considered as a suspicious malignant nodule in color Doppler ultrasound. The Bethesda system for classification of thyroid nodules was used for cytopathology. ResultsWith respect to the results of fine-needle aspiration cytology for detecting suspicious malignant nodules, for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound, sensitivities were 0.564, 0.600 and 0.691, respectively and accuracies were 0.926, 0.919 and 0.959, respectively. Suspicious malignant nodules detectability for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound were 0.09–0.56 diagnostic confidence, 0.08–0.61 diagnostic confidence, and 0.063–0.7 diagnostic confidence, respectively. ConclusionsThe combined gray-scale with subjective color Doppler ultrasound-guided fine-needle aspiration biopsies are recommended for the diagnosis of thyroid carcinoma.Level of Evidence: III.

A Prospective Study of Ultrasonographic and FNAC Correlation of Thyroid Swellings with Histopathology.

The present study was undertaken to identify the complimentary role of high resolution ultrasonography and fine needle aspiration cytology (FNAC) in diagnosis of thyroid gland swelling pathology, also determine sensitivity, specificity and accuracy of both USG and FNAC and correlate it with histopathology report. Total 75 cases of thyroid swellings were evaluated in detail by taking history, doing clinical examination, USG, FNAC and histopathology. USG findings were correlated with the FNAC report. After thyroidectomy surgery, USG and FNAC results were followed up and correlated with histopathology report. Thyroid swellings were more common in the age group of 31-40years (34.66%) with female preponderance 70(93.33%). According to USG diagnosis, most common benign thyroid swelling was multinodular goitre (37.33). Amongst all the thyroid swellings, on FNAC, 17(18.67%) cases were diagnosed as a malignancy. 12(16%) cases were of follicular carcinoma which was the most common in this study. The sensitivity, specificity and diagnostic accuracy of USG was 86.66%, 91.66% and 90.66% respectively whereas sensitivity, specificity and diagnostic accuracy of FNAC was 93.3%, 95% and 94.66% respectively. USG and FNAC are simple methods of diagnosing thyroid gland swellings. The sensitivity, specificity and diagnostic accuracy of USG and FNAC for thyroid gland swellings was reasonably good. USG followed by FNAC increases the accuracy to diagnose various thyroid swellings so by which unnecessary thyroid gland surgery and hence complications can be avoided. However the most accurate and confirmatory diagnosis is given by histopathology.

Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6-year study.

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. We presented our experience with fine-needle aspiration cytology (FNAC) for the diagnosis of salivary glands lesions by applying the MSRSGC categorization to the cytological diagnoses, and determined risk of malignancy (ROM) for each category. Fine-needle aspiration cytology of salivary gland lesions performed over a 6-year period was retrieved. FNAC results were retrospectively categorized according to the MSRSGC criteria, and correlated with corresponding histologic follow-up. ROM for each diagnostic category was calculated. A total of 208 FNAC of salivary gland lesions were reviewed and retrospectively categorized as: non-diagnostic (ND) 23 (11%), non-neoplastic (NN) 54 (26%), atypia of undetermined significance (AUS) 10 (4.8%), benign neoplasms (BN) 77 (37%), salivary gland of uncertain malignant potential (SUMP) 13 (6.3%), suspicious for malignancy (SM) 7 (3.4%), and malignant (M) 24 (11.5%). Histopathological follow-up was available for 84 of 208 cases (40.4%). Overall concordance rate between FNAC and histology was 78.8%. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 93.3%, 94.6%, 82.4%, and 98.2%, respectively. Diagnostic accuracy to distinguish benign from malignant disease was 94.4%. ROM for each category was ND 0%, NN 0%, AUS 75%, BN 2.2%, SUMP 28.6%, SM 50%, and M 100%. Fine-needle aspiration cytology continues to be an accurate diagnostic tool for most salivary gland neoplasms showing classical morphologic features. However, difficult cases with unusual or overlapping features will occur. In these situations, the use of MSRSGC risk-stratification could be helpful to define appropriate management.

A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It’s the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery. Subjects and Methods: This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery. Results: 20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were 4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules 4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05). Conclusion: Thyroid nodules 4 cm are not risk factor of malignancy. Thyroid nodules 4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

A profile on parotid surgeries

<p class="abstract"><strong>Background:</strong> A study of the various parotid swellings that underwent surgery in a tertiary care hospital was conducted. Different parameters like preoperative investigations including fine needle aspiration cytology (FNAC) and radiological investigations, modified aesthetic incision, type of surgery and outcome following surgery were assessed.</p><p class="abstract"><strong>Methods:</strong> This was a prospective institutional based study. A total of 19 cases of parotid swellings were considered. A new aesthetically acceptable incision was used in all patients. Post operatively, facial nerve and other complications were assessed. A comparison between FNAC diagnosis and histopathology diagnosis was made. </p><p class="abstract"><strong>Results:</strong> The FNAC and histopathological examination results were same in 15 of the 19 cases considered. All patients were followed up for a period of 6 months and the post-operative scar was well accepted by all patients.</p><p class="abstract"><strong>Conclusions:</strong> Pleomorphic adenoma, one of the most common causes of parotid swelling, is well diagnosed by FNAC. Ultrasonography is a useful tool to diagnose benign parotid tumours. The modified incision used gives an imperceptible scar post operatively.</p>

Review and characteristics of 585 salivary gland neoplasms from a tertiary hospital registered in the Polish National Major Salivary Gland Benign Tumors Registry over a period of 5 years: a prospective study.

<b>Introduction:</b> A Polish National Major Salivary Gland Benign Tumors Registry (SGR) is a report of benign salivary gland neoplasms (SGNs) from 26 different centres in Poland, introduced in 2014. The aim of this study is to analyze demographic characteristics and clinico-pathological factors of benign SGNs treated in large tertiary institutions and to determine possible correlations between selected variables. <br><b>Material and method:</b> Analysis of 585 patients recorded in SGR and operated on for SGNs in the Department of Otolaryngology and Laryngological Surgery, University of Medical Sciences, Poznań, Poland, over a 5-year period. Patient age, sex, occupation, place of residence, tumor location, size, histology, recurrence, facial nerve function after surgery, wound healing, surgery procedure, availability of pre-operative imaging examinations, fine-needle aspiration cytology (FNAC) results were analyzed. <br><b>Results:</b> 338 females and 247 males with a mean age of 53 years were operated on. In total, 96.2% of tumors originated from the parotid and 3.8% from the submandibular gland. The most frequent primary tumor diameter was 2-4 cm (59.5%) followed by <2 cm (29.2%) and >4 cm (8.4%). Tumors of over 4 cm were frequently removed by partial superficial parotidectomy, while those under 2 cm - by extracapsullar dissection (ECD). Pleomorphic adenomas (PA) were predominant (58.8%), followed by Warthin's tumor (WT) - 37.1%. Patients with WT were on average 13.3 years older than patients with PA. <br><b>Discussion:</b> This research can be helpful to better understand the clinico-pathological features of SGNs. Long-termin hospital-based analysis is important for subsequent metaanalyses and comparisons with other centers. The reasons why not all patients' data are reported to the national SGR should be further precisely analyzed.

PAROTİDEKTOMİ YAPILAN OLGULARIN HİSTOPATOLOJİK VE CERRAHİ SONUÇLARI: TEK MERKEZ DENEYİMİ

ABSTRACT Objective; The aim of this study was to retrospectively evaluate the age, sex, pre-operative fine needle aspiration cytology and incisional biopsy diagnosis, surgical procedure and histopathological results of 67 patients who underwent parotidectomy. Material and Method; The study included 67 parotidectomy patients operated between 2011-2019 for different lesions in Namik Kemal University Faculty of Medicine. The patients’s age, sex, fine needle aspiration cytology and biopsy results, histopathological and postoperative histopathological results and tumor sizes were evaluated. Fine needle aspiration cytology and incisional biopsy results were compared with histopathological data and efficacy of these methods were compared. Results; According to the parotidectomy results of 67 patients, 58(%86.5) were diagnosed as benign (Pleomorphic adenoma, Whartin, Sebaceous lymphadenoma, Sialolithiasis) and nine (13.5%) were diagnosed as malignant. Twenty patients underwent fine needle aspiration cytology and 25 patients underwent incisional biopsy before surgery. Of the 20 patients who underwent FNAC, 16 (80%) were diagnostic and four were non-diagnostic. Of the 25 patients who underwent incisional biopsy, 21 (84%) were diagnostic and four were non-diagnostic. Conclusion; 80% of salivary gland tumors that occur in the parotid are benign. The majority of these benign tumors (61-90%) are pleomorphic adenomas. In our study, 86,5% of the parotidectomy cases were benign tumors similar to the literature. 52% of these benign cases are pleomorphic adenoma, the second most common benign tumor is whartin and constitutes 43% of benign tumors.

Tuberculous Mastitis in Females of South Punjab: A Clinicopathological Analysis of Ten Years from Pakistan

<p><strong>Background and Objective:</strong> Extrapulmonary tuberculosis occurring in breast is a rare disorder in West but is still present in developing nations where tuberculosis is endemic. Tuberculous Mastitis (TM) is difficult to diagnose as it has vague clinical symptoms and insufficient radiological findings. The objective of this study was to determine the frequency of tuberculous mastitis by accessible modalities for early diagnosis.<br /><strong>Methods:</strong> After the Institutional Ethical Board approvals, Pathology laboratory archives and medical records of 5000 patients from Ibn-e-Sina Hospital Research Institute, Multan and Multi Test Laboratory, were retrieved from the year 2008 to 2018. A retrospective analysis of fine needle aspiration cytology (FNAC) results of patients who presented with breast lumps was carried out. The interpretation of cytological findings and Ziehl Neelsen stained smears was carried out by cytopathologists and microbiologists respectively. Mycobacterium DNA was detected using polymerase chain reaction (PCR) in selected cases.<br /><strong>Results</strong>: Out of 5000 patients, tuberculosis was diagnosed in 264 (5.28%) cases on FNAC. Acid fast bacilli (AFB) positive smears were found in 79.5%patients while 20.45% cases were AFB negative. Among AFB negative smears, 38 cases were further analyzed by PCR, among which 32 (84.2%) cases showed PCR positive results for TM. An increased frequency of TM among all inflammatory breast lesions from 18% in 2008 to 47.19% in 2018 was observed.<br /><strong>Conclusion: </strong>Tuberculous Mastitis is an uncommon form of extra-pulmonary tuberculosis. It has non- specific clinical, radiological and varied histological findings that often mimic breast abscess or carcinoma. FNAC is essential to guide the patient to further tests including histochemistry and PCR that can be used as more sensitive and time effective detection modalities.</p>

Triple Assessment of Breast Lump: Should We Perform Core Biopsy for Every Patient?

IntroductionThe triple assessment for a lump in the breast is standard practice and the robustness of assessment towards the diagnosis of breast cancer is crucial. The combination of the modalities, physical examination, imaging (mammogram and ultrasound), and fine-needle aspiration cytology (FNAC) is more accurate than any modality alone.AimTo examine the combined and individual predictive values of physical examination (P), mammography (M), ultrasound (U), FNAC (C), with core biopsy (B) - triple assessment in the diagnosis of breast cancer.MethodsTo obtain the results of physical examination (P), mammography (M), ultrasound (U), FNAC (C), and core biopsy (B), we examined the records of 124 breast cancer patients seen between April 1, 2009, and March 30, 2010. To assess the diagnostic potential of the combination of the modalities (P, U, and M), we considered all cases with a score of 4 (probably malignant) and 5 (malignant) as positive for malignancy. All cases with a score of 3 (equivocal), 2 (benign), and 1 (normal) were considered negative for malignancy. For FNAC, a score of 1 (insufficient sample), 2 (benign), and 3 (atypia/probably benign) were considered. All the patients were diagnosed with breast cancer on excision biopsy. Among 124 patients, 12 were excluded, as they were unfit for intervention.ResultsThe accuracy of physical examination (P) as confirmed by core biopsy (B) is dependent on the experience of the surgeon. It has limitations in younger women and smaller lesions. In our study, P has a positive predictive value (PPV) of 58.9% when compared with surgical biopsy, which is comparable with other studies. Our results showed PPV 66.1% and after an ultrasound scan, the overall radiological grading (M & U) gives a PPV of 81.3%, reflecting the important role of ultrasound scans. Our results showed the sensitivity of FNAC to be 73.2%. Core biopsy was diagnostic in 107 (95.5%) patients, making it a reliable tool. Our results confirmed that a combination of the modalities (P, M, U, R, FNAC) is more accurate than any modality alone.ConclusionWhen all the three modalities are positive for a diagnosis of malignant breast disease, surgical biopsy confirms the breast cancer diagnosis with a PPV of 100% and a sensitivity of 95.5%.

Challenges with preoperative diagnosis of low/intermediate-grade carcinoma of the parotid gland: single-center study of 112 patients.

The malignancy of parotid carcinoma varies, and accurate preoperative assessment of malignancy is important for selecting the appropriate treatment. However, the preoperative diagnosis of low/intermediate-grade carcinoma is difficult, and surgery may sometimes be performed without any prior knowledge of malignancy. The results of fine-needle aspiration cytology (FNA), imaging studies (MRI and US), physical examination, and frozen section biopsy (FSB) were evaluated in 112 patients with low/intermediate-grade parotid carcinoma. The result of FNA was benign/inadequate specimen in 44.6% of the patients. In addition, the tumor was diagnosed as benign by MRI/US in 21.4% of the patients and 37.5% had no symptoms/signs of malignancy on physical examination. The rate of misdiagnosis as benign decreased when FNA was combined with imaging and physical findings. However, malignancy could not be diagnosed by FNA and FSB in 12.5% of the patients who were only found to have malignant tumors by the final pathological examination. FNA shows a high misdiagnosis rate of malignancy in patients with low/intermediate-grade cancer. Therefore, it is necessary to carefully evaluate the findings of imaging studies and physical examination, and FSB should be conducted if such findings suggest the possibility of malignancy.

Does a higher American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) score forecast an increased risk of malignancy? A correlation study of ACR TI-RADS with FNA cytology in the evaluation of thyroid nodules.

Ultrasound has become the initial approach to evaluating thyroid nodules, facilitating the distinction between benign and malignant nodules based on composition, echogenicity, nodule border or margin, shape, the presence of calcifications, and nodule dimensions. The American College of Radiology (ACR) recommended the Thyroid Imaging Reporting and Data System (TI-RADS) as a classification system to standardize thyroid ultrasound reports and to predict the probability of malignancy in thyroid nodules using a scoring system (TR1-TR5) based on multiple ultrasound characteristics and nodule size. Fine-needle aspiration (FNA) is recommended as the next step for nodules that warrant further workup. The authors assessed the accuracy of the ACR TI-RADS based on the corresponding FNA cytology results (Bethesda system diagnoses I-VI). ACR TI-RADS ultrasound reports and corresponding FNA cytology diagnoses from January 1, 2018 to August 30, 2018 were evaluated. From January 1, 2018 to August 30, 2018, 2306 thyroid ultrasound-guided FNAs were performed at our institution. Of 2306 cases, 361 had ACR TI-RADS reports available. The majority of FNAs were TR4 (180; 49.9%) or TR3 (108; 29.9%). No TR2 or TR3 nodules were associated with Bethesda category V or VI diagnoses. The majority of TR4 nodules (142 of 180; 78.9%) and TR5 nodules (42 of 65; 64.6%) exhibited benign (Bethesda category II) cytology. Fourteen TR5 cases (21.5%) had malignant (Bethesda category VI) cytology. Although there were no TR2 or TR3 malignant (Bethesda category VI) diagnoses, and there were only a few malignancies in the TR4 and TR5 categories, the current results reassert the notion that the ACR TI-RADS scoring system shows at least some correlation between benign or malignant cytology diagnoses, as illustrated by the greater number of malignant cases in the higher ACR TI-RADS categories.