Single Fine-needle Aspiration Research Articles

The impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single center experience.

Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is the most controversial category of the Bethesda System. The present study was conducted to compare the histological findings in a series of thyroid nodules diagnosed with AUS/FLUS after single or repeat fine needle aspiration (FNA) cytology. Retrospective analysis of our institution's series of 514 patients with an initial diagnosis of AUS/FLUS between 11/2011 and 02/2020. Of 4887 FNA samples, 11.8% were classified as AUS/FLUS. Of patients with an initial AUS/FLUS diagnosis, 11.5% (59/514) underwent surgery after a single FNA, 55.4% (285/514) had a repeat FNA, and 32.7% (168/514) were either observed or lost to follow-up. Surgical pathology was available in 123 cases (23.9%), and malignancy was confirmed in 32.5% (40/123) cases, with similar rates in the single 32.2% (19/59) and repeat FNA 32.8% (21/64) groups. Repeat FNA reclassified 78.9% of the AUS/FLUS cases to a different category: 57.2% were reclassified as benign, 10.5% as follicular neoplasm, and 5.6% as suspicious for malignancy or malignant. The rates of nonneoplastic benign lesions were 52.5% (31/59) and 31.2% (20/64) in the single and repeat FNA groups, respectively (P = .018). The rates of follicular adenomas were higher when repeat FNA was performed (23/64, 35.9%) compared with a single FNA (9/59; 15.2%) (P = .013). In this series, a repeat FNA in cases of AUS/FLUS increased detection of follicular adenomas but not the detection of malignancy. Repeat FNA reduced the rate of benign nonneoplastic lesions by 40% in the surgical samples.

Cytopathology of Xp11 translocation renal cell carcinoma: a report of 5 cases

Xp11.2 translocation-associated RCC (Xp11RCC) defined by molecular alterations involving TFE3 genetic rearrangements constitutes a large percentage of primary renal neoplasms in children, but less than 4% of adult cases. Fewer than 10 single case reports constitute the English cytopathology literature regarding this neoplasm. Our objective is to describe and illustrate the cytopathology of this uncommon renal neoplasm from a series of 5 cases using cytologic imprints, effusion specimens, and fine-needle aspiration (FNA) cytology. Review was made of our cytopathology and surgical pathology databases. FNA biopsy smears and imprint smears were performed using a standard technique. Effusion samples were processed using liquid-based slides. Five cytologic specimens from 4 patients with histopathologically confirmed Xp11RCC were identified (mean age: 36 years) over a period of 7 years. All cases contained large cells with voluminous amounts of vacuolated cytoplasm arranged in non-descript clusters and as single forms. A "tigroid" pattern consisting of linear strips of detached cytoplasm was seen in both imprint smear cases and the single FNA case. Psammomatous calcifications, true papillary structures, and hyaline globules were absent in all cases. Four examples were diagnosed as Xp11RCC, but 3 represented metastatic disease, and 1 was diagnosed using both cytology and core needle tissue histopathology. The remaining case was diagnosed nonspecifically as a clear cell malignant neoplasm. The cytopathologic features of Xp1RCC are relatively nonspecific, and overlap with other renal cell carcinoma subtypes. A definitive diagnosis is only possible with ancillary immunohistochemistry with or without additional TFE3 fluorescence in situ hybridization.

Transaortic endoscopic ultrasound-guided fine needle aspiration in the diagnosis of lung cancers and mediastinal lymph nodes

Background:Obtaining a tissue diagnosis from a lung tumor or a mediastinal lymph node located lateral to aorta (para-aortal) is a diagnostic challenge. Invasive surgical procedures such as mediastinotomy, thoracotomy, or video-assisted thoracic surgery are required for the diagnosis of these lesions. Lymph nodes on the “far side” of major blood vessels can be visualized by endoscopic ultrasound (EUS); however, fine needle aspiration (FNA) is avoided due to concern for bleeding complications.Objectives:To evaluate the feasibility, yield, and safety of EUS-guided transaortic FNA of lung tumors and para-aortic lymph nodes.Methods:A retrospective case series of 12 consecutive patients with suspected lung cancer or tuberculosis who underwent transaortic fine needle aspiration cytology during a study period of 7 years. In all cases, the para-aortal lesion was the only site suspicious for malignancy/tuberculosis (other lesion/lymph node if present were negative). Seven patients had left-sided lung mass (mean size 30 mm). Four patients had enlarged para-aortic lymph node (mean size 18 mm, range 8–22 mm). All aspirates were obtained under real-time US-guided FNA using a 22/25-gauge needle. A single real-time FNA of the lung mass or lymph node was performed.Results:The final diagnosis was known in 11 patients (seven lung carcinoma, three tuberculosis, and one thymolipoma). EUS-FNA established diagnosis in 9 of 12 patients (75%). One aspirate revealed reactive nodal tissue, and one demonstrated nonrepresentative material. One procedure was abandoned due to complication.Conclusions:This case series demonstrates the feasibility and probable safety of single EUS-guided transaortic aspiration in para-aortic lesions. The diagnostic yield is 75%.

Transaortic fine needle aspiration of lung cancer and mediastinal lymph nodes

Background and Objectives:Obtaining a tissue diagnosis from lung tumor or mediastinal lymph node located lateral to the aorta (para-aortal) is a diagnostic challenge because of the interposition of the aorta. Invasive surgical procedures such as mediastinotomy, thoracotomy, or video-assisted thoracic surgery are required for the diagnosis of these lesions. Lymph nodes on the “far-side” of major blood vessels can be visualized by endoscopic ultrasound (EUS); however, fine needle aspiration (FNA) is avoided due to concern for bleeding complications. Tumors and mediastinal lymph nodes located in the para-aortic region can easily be visualized by esophageal EUS, because the aorta provides an excellent medium to transfer ultrasound waves. The objective of the study is to evaluate the feasibility, yield, and safety of EUS-guided transaortic FNA of lung tumors and para-aortic lymph nodes.Methods:A retrospective case series of 12 consecutive patients with suspected lung cancer or tuberculosis who underwent transaortic FNAC during a study period of 7 years. Based on computed tomography/positron-emission tomography imaging, a transesophageal FNAC performed through the aorta was considered as the only option to diagnose or stage these patients by means of a minimally invasive procedure. Seven patients had left-sided lung mass. Four patients has enlarged para-aortic lymph node, suspicious for IASLC Stations 5 (n = 1) and 6 (n = 3). EUS was performed with a linear echoendoscope. All aspirates were obtained under real-time US-guided FNA by using a 22/25-gauge needle. A single real-time FNA of the lung mass or lymph node was performed.Results:The final diagnosis was known in 11 patients (5 non-small cell lung carcinoma [SCLC], 2 SCLC, 3 tuberculosis, and 1 thymolipoma). EUS-FNA established diagnosis in 9 of 12 patients (75%). One procedure was abandoned due to complication.Conclusion:This case series demonstrates the feasibility and probable safety of single EUS guided transaortic aspiration in para-aortic lesions. The diagnostic yield is 75%. Clearly, further study and very careful selection by expert EUS operators are needed before this procedure can be routinely recommended. Advantages of this procedure include day care procedure, less invasive than surgical procedures, low-cost, good diagnostic yield and can be performed in poor surgical candidate. Limitations includes single-center study, requires EUS expertise, more data are required. At present, transaortic FNA should only be performed in the absence of alternative minimally invasive diagnostic procedures.

BRAF V600 co‐testing is technically feasible in conventional thyroid fine needle aspiration (FNA) cytology smears and can reduce the need for completion thyroidectomy

While fine needle aspiration cytology (FNAC) is the mainstay of diagnosis in thyroid nodules, molecular markers of thyroid cancer have recently been shown to be of value in improving the diagnosis and reducing the rates of unnecessary surgery. A technical method is presented for the assessment of the BRAF V600 gene mutation in thyroid cancer using a simple adaptation of a commercially available kit. After standard preparation and reporting of conventionally stained alcohol-fixed Papanicolaou or air-dried Giemsa-stained slides the coverslip is removed from one slide, the DNA is extracted and submitted for PCR analysis. Assessment of the BRAF V600 mutational status is feasible in very small quantities of DNA, requiring just greater than 5ng per case from a single pre-stained FNA slide using this method. From the 14 cases examined thus far, one Thy4/Bethesda Class V case (suspicious of malignancy) has been identified with a BRAF V600 mutation and this patient, after multidisciplinary discussion, received a total thyroidectomy. Based on this methodology and other published results for the BRAF mutation, we believe that it is now feasible and cost effective for the UK NHS to BRAF co-test all Thy4/Bethesda Class V thyroid FNAs, as the additional cost of BRAF testing will still be much less than the cost of submitting all Thy4 (Bethesda Class V) patients to a partial and then a later completion thyroidectomy.

Does Early Needle Exchange in EUS-FNA Improve the Diagnostic Yield of Cytopathological Evaluation in Pancreatic Adenocarcinoma? Preliminary Results from An Ongoing Randomized Trial

Introduction: Fine Needle Aspiration (FNA) under EUS (Endoscopic ultrasonography) guidance is a useful tool in pancreatic adenocarcinoma (PA) diagnosis. On-site evaluation of FNA specimens by a cytopathologist increases the diagnostic yield of EUS-FNA. Factors such as excessive bending or channel occlusion in the needle can impair the quality of the sample obtained in FNA. The aim of this study is to evaluate if early needle exchange improves the diagnostic yield of EUS-FNA in PA. Methods: An ongoing prospective randomized study to compare two techniques: Exchange Needle (EN = exchange FNA needle every two passes during first 6 passes) and Standard Method (SM = use of a single FNA needle unless malfunction is noted).

False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma.

Clinicians have become reliant on fine-needle aspiration (FNA) cytology in the diagnosis of thyroid nodules. We encountered several patients who had thyroid cancer at operation despite having had FNAs that never showed malignant or suspicious cells. Hence, we retrospectively studied 100 consecutive patients with histologically proven thyroid cancer who had undergone preoperative FNA. Fourteen of these patients had cancers that were not detected by FNA, three of whom developed widespread disease. The sensitivity of FNA was 79%, the false-negative rate 21%, and the inadequate rate 12%. FNA was less sensitive in detecting follicular and Hürthle cell carcinomas compared to papillary carcinomas. FNAs interpreted by cytopathologists at a major university center were more sensitive than those performed elsewhere. A single false-negative FNA delayed surgical treatment by 28 months, sometimes despite clinical evidence suggesting malignancy. Subjects whose tumors were not detected by FNA experienced delayed treatment, had higher rates of vascular and capsular invasion, and were more likely to have persistent disease at follow up (hazard ratio 2.28). False-negative results remain a concern in the cytologic diagnosis of thyroid cancer. Although FNA is a useful test, clinical findings should overrule cytologic data in order for timely treatment to occur.

Immunocytochemical Staining of Cytologic Specimens:How Helpful Is It?

The contribution of immunocytochemical (ICC) staining to the diagnosis of a range of cytologic specimens reported over a 20-month period was retrospectively assessed. A total of 194 cases (1.6% of total workload) were stained for diagnostic purposes in this period. Immunocytochemical staining was determined to be helpful in 75.8% of cases. In body fluid cases (105), staining was most often performed to assist with the discrimination of mesothelial cells and metastatic malignancy. Immunocytochemical staining was helpful in 82% of fluid specimens, with the preliminary diagnosis confirmed in 64%, refined in 8%, and revised in 10% of cases. In fine-needle aspiration (FNA) specimens, staining was helpful in 69%, resulting in a refinement of diagnosis in 55%, and confirming the preliminary diagnosis in 14%. The preliminary diagnosis was revised in a single FNA case. Immunocytochemical staining was particularly valuable in assisting the subclassification of poorly differentiated malignancies. A more precise diagnosis was possible following consideration of ICC results in 68% of cases with a preliminary diagnosis of poorly differentiated malignancy. Immunocytochemical staining was also helpful in identifying the primary site of metastatic carcinoma in six FNA cases. It is concluded that the selective use of well-chosen panels of antibodies can be very helpful in resolving diagnostic difficulties in cytologic specimens. In particular, ICC may be an invaluable aid to the diagnosis of difficult serous effusion specimens and in the sub-typing of poorly differentiated malignancy.

The accuracy of fine needle aspiration biopsy for flow cytometric determination of tumor DNA content

The use of fine needle aspiration (FNA) to obtain a diagnosis of malignancy is established in the practice of oncology, but there is little information on its accuracy in sampling tumor DNA content. We therefore compared flow cytometric DNA data obtained from FNA-derived samples with that obtained after digestion of the same murine tumor from which the aspirates had been taken. Fifteen female C3Hf/Kam mice were implanted with MCA-29 tumor cells from the same source tumor. MCA-29 is a multiploid mammary adenocarcinoma with two aneuploid populations (DNA Index of A = 1.67, B = 1.89). The tumors were grown to a mean size of 8.6 mm. After sacrifice, three FNAs were performed on each tumor, following which the whole tumor (WT) was excised and homogenized. All FNA and WT samples were digested with 0.04% pepsin and the nuclei stained with propidium iodide in preparation for flow cytometry. DNA histograms of the aspirates were compared with the corresponding WT histograms. Any single FNA detected population A in all (100%) cases and detected the less prominent population B in 94.3% of instances. Any single FNA was able to detect the same populations that were present in the whole tumor in 95.4% of cases, while the set of three aspirates matched the corresponding WT in 100% of cases. We conclude that FNA DNA histograms are accurate for the assessment of ploidy, but that in order to ensure detection of all tumor populations present, multiple aspirates are needed.