Fine-needle Aspiration Results Research Articles

Cytopathological results of initial endoscopic ultrasound-guided fine needle aspiration for primary mass and prognosis in pancreatic cancer patients.

Clinical outcomes remain unclear in patients suspected of having pancreatic cancer with indeterminate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) results. This work aimed to investigate the prognosis of pancreatic cancer patients with indeterminate findings at initial EUS-FNA. Findings in all patients who underwent EUS-FNA for suspected pancreatic cancer between 2008 and 2015 at the National Cancer Center, Korea, were retrospectively reviewed. A final diagnosis of pancreatic ductal adenocarcinoma was based on pathology reports. Of the 144 patients evaluated, 113 (78%) were diagnosed as being positive/suspicious for malignancy on cytological evaluation and 31 (22%) as having atypia/negative/non-diagnostic findings at initial EUS-FNA but subsequently diagnosed with pancreatic ductal adenocarcinoma. Tumour size, clinical stage and treatment modalities did not differ significantly between these two groups. Median overall survival was significantly shorter in patients diagnosed (11.3±0.74months; 95% confidence interval [CI], 9.4-12.8months) than non-diagnosed (16.9±2.34months; 95% CI, 12.0-17.4months) on initial EUS-FNA (P=.024). Multivariate Cox regression analysis showed that a non-diagnosis on initial EUS-FNA was independently associated with better overall survival (hazard ratio, 0.58; 95% CI, 0.38-0.88; P=.011). Non-diagnostic results on initial EUS-FNA of a primary mass may be associated with better prognosis in patients with pancreatic cancer.

The role of repeat fine needle aspiration in managing indeterminate thyroid nodules

BackgroundThe Bethesda System is the most widely used for reporting fine needle aspiration (FNA) cytology. It recommends a repeat FNA (rFNA) when initial results are category I or III. It is unclear how often rFNA provides additional diagnostic information. We sought to investigate its utility at our institution.MethodsA retrospective chart review was performed of patients who had a category I or III FNA result and underwent rFNA of the same thyroid nodule between 2013 and 2015 at the QE II Health Sciences Centre in Nova Scotia, Canada. Results of initial FNA and ultrasound characteristics, rFNA, demographic data, surgical details, and pathology were collected.ResultsA total of 237 patients (474 thyroid FNAs) were included. Most initial FNAs were category I (82%), the remainder category III (18%). rFNA yielded a different category 60% of the time. However, 60% remained category I or III. rFNA results of benign or malignant were found in 40% of cases; 1% were SFN/SFM. Twenty-seven percent of patients had surgery after rFNA; of those 68% had category I or III rFNA results. Of all nodules that underwent surgery, 46% were malignant, including 32% with category I rFNA results, and 42% category III.ConclusionsrFNA for category I and III nodules provided a definitive diagnosis in only 40% of cases, which is important for patient counseling. Malignancy rates at our centre were higher for these categories than predicted by Bethesda. Clinical management should consider institution specific malignancy rates, patient factors, and ultrasound findings.

THE ROLE OF THYROID FINE-NEEDLE ASPIRATION CYTOLOGY IN THE TREATMENT AND FOLLOW-UP OF THYROID NODULES IN THE PEDIATRIC POPULATION.

Thyroid fine-needle aspiration (FNA) and cytology is a reliable diagnostic method used in the assessment of malignancy when evaluating thyroid nodules, in conjunction with clinical and ultrasonographic findings. The aim of this study is to compare clinical, ultrasonographic, cytological and histopathological findings in children who underwent thyroid FNA. Subjects comprised 80 patients (52 female) aged 13.7±2.8 years at the time of FNA who where evaluated for thyroid nodules. Clinical, ultrasonographic and cytological findings of patients were evaluated retrospectively. Autoimmune thyroiditis was present in 30% and history of radiotherapy to the head or neck in 10%. The cytological diagnosis of patients included: inadequate or hemorrhagic sample in 10%; benign in 42.5%; atypia or follicular lesion of undetermined significance (AUS/FLUS) in 15%; suspicion of follicular neoplasia (SFN) in 7.5%; suspicion of malignancy (SM) in 8.8%; and malignant in 16.3%. Thirty-seven patients underwent thyroidectomy. Malignancy rates for histopathologic follow-up were 75%, 85.7% and 100% for SFN, SM and malignant categories, respectively. Only one benign and two AUS/FLUS FNAs were found to be malignant on histopathological examination. Among patients who had received radioiodinetherapy, 87.5% had malignancy. In this study, the sensitivity of FNA was 96%, specificity 50%, positive predictive value 90.9%, negative predictive value 75%, and diagnostic value of FNA was 89.2%. Thyroid FNA results were highly compatible with histopathological examination. Sensitivity, positive predictive value and diagnostic value of FNA were high.

The Incidence and Clinicopathologic Characteristics of Patients Who Had False-Positive Fine-Needle Aspiration Results for Papillary Thyroid Cancer

Purpose: Fine needle aspiration (FNA) is a well-established method for diagnosis of thyroid tumors. However, FNA sometimes fails to distinguish benign thyroid nodules from papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the incidence and clinicopathologic characteristics of patients who had thyroidectomy due to consistent findings of PTC in FNA but turned out to bear no evidence of malignancy in surgically removed thyroids. Methods: We retrospectively reviewed 10,776 patients who underwent thyroid surgery from January 2009 to January 2019 due to suspicion for PTC, 40 of whom were diagnosed as benign in final histology. Results: We compared the clinical and pathologic characteristics of 2 groups, including subgroup analysis between Bethesda category V and VI. The false(+) rate for FNA was 0.4%. The ratio of patients aged ≥55 years was statistically higher in the false(+) group compared to the true(+) group. Age ≥55 years and Bethesda category V were risk factors for false(+) FNA in multivariate analysis. Conclusion: Although the false(+) rate is low (0.4%), surgeons should be aware of these circumstances and inform patients of the possibility of a false positive result in those with age >55 years, suspicion for malignancy on FNA (Bethesda category V), and low suspicion/benign for Korean thyroid imaging reporting and data system. To reduce unnecessary thyroidectomy, core needle biopsy or repeat FNA should be considered for a patient with these findings. Further large-scale studies are necessary to establish a firm conclusion.

Clinical analysis of false-negative fine needle aspiration cytology of head and neck cancers

ABSTRACTBackground: Fine-needle aspiration (FNA) cytology is frequently used for initial and/or preoperative diagnosis of tumors in the head and neck region. However, false-negative results can lead to misdiagnosis. The aim of this study was to investigate the diagnostic results of FNA in the head and neck region and the reasons for false-negative cases.Methods: The study population comprised 1,341 patients with pathologically confirmed head and neck tumors in whom FNA was performed before surgery or biopsy in the Otolaryngology Department at Numazu City Hospital between 2002 and 2016. We evaluated the false-negative FNA cytology rate as well as the site of the primary nodule, patient age and sex, sensitivity, accuracy, specificity, positive predictive value, negative predictive value, and the pathologic diagnosis after resection.Results: The rate of false-negative FNA results was 5.9% (78/1,315 cases). The main sites of false-negative cases were the thyroid gland (n = 50), the lymph nodes (n = 16), and the salivary glands (n = 9). The sensitivity of FNA for head and neck tumors was 82.0%, with specificity and accuracy rates of 94% and 92.0%, respectively.Conclusions: We have assessed the quality of preoperative FNA cytology in head and neck tumors. To avoid misdiagnosis by FNA, it is important that the target tumor is punctured accurately. If the specimen obtained is too small, FNA should be repeated.

Teaching FNA techniques and ultrasound guided FNA

Teaching FNA techniques and ultrasound guided FNA

A cancer of undetermined significance: Incidental thyroid carcinoma.

The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non-incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non-complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results.

Limitations of ultrasound-guided fine-needle aspiration include nondiagnostic, indeterminate cytology and false-negative results. The BRAF V600E mutation is a specific biomarker for papillary thyroid carcinoma. This study aimed to investigate the additional diagnostic role of the BRAF V600E mutation in high-risk thyroid nodules with benign cytology results. A total of 787 high-risk nodules in 720 patients underwent ultrasound-fine-needle aspiration. A subsequent BRAF V600E mutation test was performed on thyroid nodules with benign cytology. Final pathology confirmed thyroid nodules with benign cytology that were positive for the BRAF V600E mutation. Ultrasound was performed on thyroid nodules with benign cytology results that were negative for the BRAF V600E mutation. Fine-needle aspiration was repeated on thyroid nodules with enlarged size or changed ultrasound features. Among the 787 nodules, 292 thyroid nodules had benign cytology results with 256 nodules negative for the BRAF V600E mutation and 36 nodules positive for the BRAF V600E mutation. Thirty-one nodules positive for the BRAF V600E mutation were confirmed malignant, and 5 nodules were confirmed benign by pathology. Fine-needle aspiration was repeated on 11 enlarged thyroid nodules with benign cytology findings that were negative for the BRAF V600E mutation. The results of repeat fine-needle aspiration were 4 benign nodules, 2 follicular neoplasms or suspected follicular neoplasms, 3 suspected malignancies, and 2 malignant nodules. Among the 36 thyroid nodules positive for the BRAF V600E mutation, 25 (69.4%) had ≥2 suspicious ultrasound features and 11 (30.6%) nodules had 1 suspicious ultrasound feature. The BRAF V600E mutation test can detect papillary thyroid carcinomas that might be missed by fine-needle aspiration. We recommend that fine-needle aspiration be routinely accompanied by the BRAF V600E mutation test in high-risk thyroid nodules with ≥2 suspicious ultrasound features.

Fine needle aspiration cytology comparison of diagnosed thyroid nodules diagnosis with postoperative histopathology

Background: Around 2.5% of male cancer in Turkey, 12% of female cancers include cancers of the thyroid. Early diagnosis and correct treatment of thyroid cancers is therefore important. However, in addition to preventing the complications, patients not to be subjected to unnecessary thyroid procedure depend on the pre-detection of that whether the nodules are benign or malign. The objectives of the study were to investigate whether fine needle aspiration (FNA) cytology of thyroid nodules is sufficient for diagnosis. Thyroid FNA result is based on the standardized Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).Methods: FNA cytology reports of 1808 patients for the period between January 2011 and December 2017 in Atatürk City Hospital, which is located in Balıkesir province, in the western part of Turkey, were retrospectively analyzed. Cytology results were reported as follows: non-diagnostic, benign, atypia (AUS) or follicular lesion (FLUS) of undetermined significance, follicular neoplasm or suspected follicular neoplasm (FN), suspected malignity and malign. They were compared with postoperative histopathology result.Results: According to the thyroid FNA cytology, 409 patients were operated on, and the obtained specimens were histopathologically analyzed. The histopathological malignity rates of patients were detected to be as follows: 0.0%, 2.0%, 3.0%, 12.1%, 31.3% and 51.5%. It was detected that malign thyroid cancer was detected to be seen more in women and the age group of 31-60. The sensitivity value of the research was detected to be 92%, which was a significantly high ratio. Positive and negative predictive values were detected to be 97% and 92%, respectively.Conclusions: Where FNA cytology result is insufficient, FNA procedure should be repeated. FNA must be repeated with USG for cases with suspected AUS, FLUS and follicular neoplasm.

Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis.

Background: Management of large thyroid nodules is controversial, as data are conflicting regarding overall rates of malignancy (ROM) in all nodules and frequency of false-negative fine-needle aspiration results (FNR) in cytologically benign nodules. This meta-analysis aimed to evaluate and compare ROM and FNR in small versus large nodules published in the literature. Methods: Articles indexed in PubMed, written in English, published electronically or in print on or prior to December 8 2017 were searched for "false negative thyroid size or cm" and "malignancy rates benign thyroid nodules." Three hundred fifty-two unique citations were identified. Multiple reviewers selected a final set of 35 articles that contained nodules stratified by size (3, 4, or 5 cm), with benign or all cytologic diagnoses, and with postsurgical histologic diagnoses. Multiple observers extracted data, including numbers of total, cytologically benign, and histologically malignant nodules. Size cutoffs of 3, 4, and/or 5 cm were analyzed in 14, 24, and 1 article, respectively. Results: ROM in all nodules ≥3 cm (13.1%) and ≥4 cm (20.9%) was lower than those <3 cm (19.6%) and <4 cm (19.9%; odds ratio [OR] = 0.72 [confidence interval (CI) 0.64-0.81] and OR = 0.85 [CI 0.77-0.95]). FNR in nodules ≥3 cm (7.2%) was not different from smaller nodules (5.7%; OR = 1.47 [CI 0.80-2.69]). FNR in nodules ≥4 cm (6.7%) was slightly higher than those <4 cm (4.5%; OR = 1.38 [CI 1.06-1.80]). The most frequently reported false-negative diagnosis was papillary thyroid carcinoma. Conclusions: Rates of malignancy and false-negative FNA results vary but, in most studies, are not higher in larger nodules. Patients with large, cytologically benign thyroid nodules need not undergo immediate surgical resection, as false-negative FNA rates are low and are expected to decrease in light of nomenclature revision of a subset of follicular variants of papillary thyroid carcinoma.

Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan.

Background:Fine-needle aspiration (FNA) plays a fundamental role in determining the appropriate management for patients presenting with thyroid nodules.Aims:The aims of this study are to evaluate thyroid FNA test performance parameters through a cytohistological correlation.Materials and Methods:A retrospective analysis of all thyroid FNAs received over a period of 18 months was carried out. The findings were compared to their subsequent definite diagnoses on surgical specimens as well as to their follow-up repeat FNA results. A total of 499 thyroid FNAs were collected and reviewed against The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The percentage of each diagnostic category was calculated, and the implied risk of malignancy was determined by comparing the cytology results to their definite diagnoses obtained on the resection specimens. Analytical procedures were performed using Microsoft Excel.Results:Out of 499 thyroid FNAs, a benign interpretation was found in 273 patients (54.7%), atypia of undetermined significance in 81 (16.2%), follicular neoplasm in 20 (4%), suspicious for malignancy in 36 (7.2%), malignant in 32 (6.4%) and were nondiagnostic in 57 patients (11.4%). Only 101 patients (20.2%) underwent surgical resection and 47 (9.4%) underwent a follow-up FNA. After cytohistological correlation, FNA test performance, calculated by excluding the inadequate and undetermined categories revealed test sensitivity, specificity, and diagnostic accuracy of 95.6%, 54.8%, and 78.9%, respectively. The positive predictive value was 75.4%, and the negative predictive value was 89.5%.Conclusions:Our results are comparable to those previously published figures. The rate of atypia of undetermined significance/follicular lesion of undetermined significance is higher than what is currently recommended in TBSRTC.

Gastrointestinal Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Assessing Suspected Deep Pelvic or Abdominal Recurrence in Gynecologic Cancer: A Feasibility Study.

To assess the feasibility of gastrointestinal endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for histologic confirmation of cancer recurrence in women with gynecologic cancer. This work was a retrospective cohort study comprising 46 consecutive women treated for gynecologic cancer and suspected of having a deep pelvic or abdominal recurrence on ultrasound imaging, computed tomography, positron emission tomography-computed tomography, or magnetic resonance imaging, evaluated at our institution from January 2010 to December 2017. Primary cancer was ovarian (n = 22), cervical (n = 13), endometrial (n = 4), sarcoma (n = 4), and other (n = 3). All women underwent EUS examinations for locating the lesion and guiding FNA. The results of FNA (benign/malignant) were assessed. Procedure-related complications were recorded. The patients' mean age was 57.8 years. A total of 66 procedures were performed. Eleven women underwent 2 procedures; 2 women underwent 3 procedures; and 1 woman underwent 6 procedures at different times during the study period. In 1 case, no lesion was detected on the EUS assessment, and in 2 cases, FNA was not successful. Most lesions were located in the retroperitoneum or involved the intestine. Fine-needle aspiration could be performed in 63 cases (94.5%). Cytologic samples were adequate in 62 of 63 (98.4%). Recurrence was confirmed in 56 cases (90.3%) and ruled out in 6 (9.7%). No patient had any complication related to the procedure. Endoscopic ultrasound-guided FNA is a minimally invasive, feasible, and safe technique for confirming pelvic/abdominal recurrence of gynecologic cancer.

Ocular non-Hodgkin lymphoma: a report of two cases and review of the literature

In this article, two cases of non-Hodgkin lymphomas (NHL) occurring at an unusual site were reported. The first case was a male patient aged 60 years hailing from Debidwar, Comilla came with the complaint of gradually increasing mass in the left eyelid for two years. Fine-needle aspiration (FNA) and histopathology of his lesion revealed NHL, which on immunohistochemistry showed to be of B-cell origin. A debulking operation was done in National Institute of Ophthalmology &amp; Hospital, Dhaka and he was sent for chemotherapy. The second case was also a male aged 35 years from Muladi, Barisal who presented with gradually increasing bilateral masses on both the upper eyelids for six months. The results of FNA of the eyelid tumors were suggestive of NHL that was subsequently confirmed by histopathology. Immunohistochemistry showed the tumor to be of B-cell origin.Mediscope Vol. 5, No. 2: Jul 2018, Page 36-41

Design and Implementation of Near Real-time Release of Rapid On-site Evaluation of Fine Needle Aspiration Results

Design and Implementation of Near Real-time Release of Rapid On-site Evaluation of Fine Needle Aspiration Results

Malignancy Risk and Related Factors of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance in Thyroid Fine Needle Aspiration.

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in thyroid fine needle aspiration (FNA) is a challenging category. The malignancy risk is different by multiple factors and subsequent management strategy is inconclusive. Therefore, we analyzed the malignancy risk of AUS/FLUS according to radiological and clinical features. A total of 687 nodules that had been initially diagnosed as AUS/FLUS were retrospectively reviewed from 6365 thyroid FNAs between 2011 and 2014. The ultrasonographic (US) features were categorized using the Korean Thyroid Imaging Reporting and Data System. Radiological and clinical features were compared according to the second FNA results or histologically confirmed results from surgery. Repeat FNA was performed on 248 (36%) nodules, and 49 (7%) nodules underwent immediate surgery. Among the 248 nodules subjected to repeated FNA, 49 (20%) nodules were diagnosed again as AUS/FLUS, 123 (50%) were found to be benign, and 47 (19%) were diagnosed as follicular neoplasm, suspicious for malignancy or malignant. Among histologically confirmed nodules, the US features were more unfavorable in malignant nodules, and hypo- or anechogenicity was associated with a higher risk of malignancy after adjusting for age, size, and other US features (P < 0.01). In conclusion, we observed that malignant nodules tended to show unfavorable US features, especially hypo- or anechogenicity. Age, sex, and thyroid function were not significantly associated with malignancy risk. We also found out that malignancy risk was not different between the group which underwent immediate operation following the AUS/FLUS diagnosis and the group which underwent repeated FNA after the initial diagnosis.

SABIC and ExxonMobil form JV for global diversification

Objective: This study evaluated the prevalence of nondiagnostic results, diagnostic performance, and complications of core-needle biopsy (CNB) compared with repeat fine-needle aspiration (FNA) for thyroid nodules with previous nondiagnostic FNA findings.Methods: The Ovid-MEDLINE and EMBASE databases were thoroughly searched for studies evaluating CNB or repeat FNA for thyroid nodules with initially nondiagnostic FNA results. Pooled proportions of nondiagnostic results of CNB and repeat FNA were calculated. A meta-analysis was performed to evaluate the diagnostic accuracy of CNB and repeat FNA for a diagnosis of malignancy using a bivariate random-effects model. Complication rates were also evaluated.Results: A review of 52 articles identified 4 eligible articles, involving 1,028 patients with 1,028 thyroid nodules, which were included in the meta-analysis. CNB demonstrated significantly lower rates of nondiagnostic results (6.4%) than repeat FNA (36.5%) (P<.0001). In the 3 studies that analyzed the diagnostic accuracy of CNB in diagnosing malignancy, CNB demonstrated significantly higher summary estimates of sensitivity (89.8%) than repeat FNA (60.6%) (P = .022), but summary specificity did not differ between CNB (99.2%) and repeat FNA (99.0%) (P = .576). None of the patients who underwent CNB or repeat FNA experienced any major complications.Conclusion: CNB demonstrates lower rates of nondiagnostic results and higher diagnostic accuracy than repeat FNA. CNB, rather than repeat FNA, can be utilized to diagnose thyroid nodules previously nondiagnostic on FNA.Abbreviations:CI = confidence intervalCNB = core-needle biopsyFNA = fine-needle aspirationSROC = summary receiver operating characteristicUS = ultrasound

Bethesda Classification and Cytohistological Correlation of Thyroid Nodules in a Brazilian Thyroid Disease Center

Background: The Bethesda System has been used to classify thyroid cytology in 6 categories besides presenting malignancy rates and respective approaches. Reference centers have validated its use by comparing its proposed malignancy rates with those in in their populations. However, to the best of our knowledge, there has been no corresponding study in Brazil. Objectives: To evaluate the performance of the Bethesda classification in a Brazilian thyroid reference center and correlate the results with cytohistological reports in patients referred to surgery. Methods: Data records from 980 fine-needle aspiration (FNA) results were retrospectively analyzed, and, in patients who underwent surgery, the results were correlated with the cytohistological findings. Results: 980 FNAs and 585 patients were evaluated. The incidence of each cytological category was: 11% nondiagnostic (ND), 59.6% benign, 7.1% (atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 8.5% follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 5.1% suspicious for malignancy (SM), and 8.3% malignant. The surgery rate was 41.8% (245/585). The malignancy rate in each category was: 6% benign, 12% AUS/FLUS, 20.8% FN/SFN, 72.5% SM, and 97.3% malignant. For ND nodules, the malignancy rate was 25.7% (66.6% multifocal and papillary microcarcinomas), a higher rate than in the literature. In this category, surgery was performed in multinodular goiters presenting with another nodule > 3.0 cm and/or with an FN/SFN, SM, or malignant cytological result. Conclusion: The Bethesda System can be applied to the Brazilian population, since the frequency and malignancy rates of each category were similar to those described by its classification. It is noteworthy that a higher risk of malignancy was observed in the ND cytological category.

The surgery and repeat aspiration outcomes of the atypia of undetermined significance/follicular lesion of undetermined significance category in The Bethesda System for Reporting Thyroid Cytopathology

The atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category is one of six diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this study, we report the diagnostic distribution of thyroid fine needle aspiration (FNA) cytology and analyze the outcome of AUS/FLUS cases. A total of 29,937 thyroid FNA results, reported between April 2012 and December 2016, were retrieved from the database of a medical center. We reviewed the electronic medical records and analyzed the management of these patients. Overall frequency of AUS/FLUS is 3.1% in our laboratory, which is at the lower limit of the recommended range. Of these, 891 reports of AUS/FLUS from 770 patients were identified. Out of the 770 patients, 367 had surgical intervention. In these 367 patients, final surgical pathology yielded 204 (55.6%) malignancies, 12 indeterminateness (3.3%), and 151 (41.1%) benignity. Among these surgical patients, 113 (30.8%) had received a repeat FNA of the thyroid before thyroid resection. The difference between the malignancy rates among patients who directly received surgery after the first AUS/FLUS diagnosis (132 of 254, 52.0%) and patients having a repeat FNA before surgery (72 of 113, 63.7%) was not statistically significant. Our results are in agreement with AUS/FLUS diagnoses in less than 7% of specimens, and confirm that it is appropriate to perform either a repeat thyroid FNA or thyroid lobectomy, with the clinical decision being subject to the standardized management protocols of the second edition of TBSRTC in the AUS/FLUS category.

Transthoracic fine-needle aspiration versus tru-cut biopsy under computed tomography-scan guide in diagnosis of peripheral lung lesions

Background: Lung cancer is the number one cause of cancer-related death in the Western world. Intrapulmonary nodules are presenting either solitary or multiples. Primary bronchogenic carcinoma is the most common malignant tumor that presents as a solitary pulmonary nodule. Fine-needle aspiration (FNA) and Tru-cut biopsy are parts from several interventional procedures that need to reach to the final diagnosis. Aim: This study aims to assess the comparison between transthoracic FNA results and Tru-cut biopsy results in the diagnosis of peripheral pulmonary lesions and the possibility of depending on one of them in the diagnosis of these lesions. Materials and Methods: FNA and true cut biopsy under computed tomography scan guided were performed to patients had peripheral pulmonary lesion and sent to the cytological and histopathological laboratory for analysis. Results: All patients (20) that had pulmonary lesion were evaluated. Results of FNA were; 15/20 of them were adequate samples for diagnosis while 5/20 were inadequate. Results of Tru-cut biopsies were – 17/20 were adequate for histopathological assessment while 3/20 were inadequate. Thirteen out of 20 patients had malignancy, five patients diagnosed by both Tru-cut biopsy and FNA, other five diagnosed by Tru-cut biopsy only and three patients diagnosed by FNA only. One patient had benign lesion and diagnosed by both procedures. Six out of 20 patients had other results that diagnosed by both procedures. Squamous cells carcinoma was 5/13 patients (38.46%) and adenocarcinoma was the same percentage. The concordance of FNA results with Tru-cut biopsy results was 60%. Conclusion: The study demonstrated that Tru-cut biopsy is moderately superior to FNA in the evaluation of peripheral malignant lung lesions. Therefore, we advise not using the FNA alone in the evaluation of peripheral chest lesions that suspected of malignancy (except if large bullae or severe emphysema present) and Tru-cut biopsy is often required together to reach the diagnosis.

Thyroid Nodules Cytopathology Applying the Bethesda System with Histopathological Correlation.

Background:Fine-needle aspiration cytology remains a valuable screening tool for preoperative management of thyroid nodules. However, the rates of false-negative and false-positive diagnosis remain a challenge for pathologists.Objectives:To assess the value of thyroid fine-needle aspiration as a screening tool and its accuracy of diagnoses relative to final histological diagnoses.Patients and Methods:A chart review was conducted of all adult patients who underwent fine-needle aspiration of thyroid nodule(s) and were subjected to thyroid surgery at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between January 2007 and June 2014. The fine-needle aspiration results were correlated with final histopathology results.Results:Of the 408 aspirates from 373 patients, the Bethesda System for Reporting Thyroid Cytology (BSRTC) diagnostic categories were as follows: nondiagnostic in 26 aspirates (6.4%); benign in 128 (31.4%); atypia/follicular lesion of undetermined significance in 52 (12.7%); follicular neoplasm/suspicion for a follicular neoplasm in 83 (20.3%); suspicious for malignancy in 23 (5.6%) and malignant in 96 (23.5%). The comparative histopathological diagnoses were benign in 192 (47.1%) and malignant in 216 (52.9%) aspirates. The calculated risk of malignancy in the fine-needle aspiration categories was 34.6% in diagnostic category (DC) I, 15.6% in DC II, 50% in DC III, 52% in DC IV, 95.7% in DC V and 100% in DC VI. The sensitivity of fine-needle aspiration with BSRTC was 88.9%, specificity was 75.6%, positive predictive value was 79.7%, negative predictive value was 84.4% and accuracy was 81.5%.Conclusion:The results of this retrospective study demonstrated higher risks of malignancy in DC I, DC II, DC III and DC IV than that of the original BSRTC definition, along with a higher specificity and positive predictive value for cancer diagnosis, and a lower sensitivity and negative predictive value.