Specificity Of Fine Needle Aspiration Cytology Research Articles

Role of fine needle aspiration cytology (FNAC) in head and neck lesions in coastal population at a tertiary care hospital – A study of 500 cases

Head and neck swellings are a very common presentation encountered by clinicians and patients across all age groups. Various lesions give rise to head and neck lumps. Swellings can arise from soft tissues, lymph nodes, thyroid gland, salivary glands etc. FNAC being minimally invasive, quick and inexpensive helps in differential diagnosis of head and neck masses.A retrospective study was conducted at Karwar institute of medical sciences Karwar from January 2018 to December 2021 in coastal population, to evaluate the role of FNAC in palpable head and neck masses and also to study their distribution and To evaluate the diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing Head and neck lesions and cyto-histopathological correlation (wherever possible). 500 patients with head and neck swelling underwent FNAC. FNAC diagnosis was correlated with detailed clinical history and investigations. Out of 500 fine needle aspiration procedures 35.6% (178) were of lymph node, 33.8% (169) were of thyroid, 9.6% from salivary gland (48), 17.8% (89) from skin and soft tissue swellings and 3.2% (16) inconclusive. The present study concluded that most of the swellings in head and neck region are benign and affect females more than males. Overall accuracy rate more than 90% and diagnostic accuracy in differentiating non-neoplastic lesions from neoplastic lesions is well established. Our study found that fine needle aspiration cytology to be an easy, safe, rapid, convenient, least invasive, accurate and relatively complication-free outpatient method for diagnosis of lesions of the head and neck

A Comparison of Fine Needle Aspiration Cytology (FNAC) with Tru-cut Biopsy in Breast Lump Patients Taking Histopathology as Gold Standard

Objective: To compare sensitivity and specificity of FNAC with Tru-cut biopsy diagnosis of breast lump patients. Material and Methods: It was a cross sectional study conducted at surgical department of Gulab Devi Teaching Hospital Lahore from January 2022 to December 2022. Atotal of 122 patients presented in surgical OPD with complaints of breast lump of size between 2cm to 4 cm were included in the study with their consent. All these patients underwent FNAC, true cut biopsy and excisional biopsy. Sensitivity and specificity of both FNAC and true cut were calculated. Results: Mean age of patients included in this study was 35.4 ± 14.6 years. The sensitivity and specificity of FNAC in benign breast diseases was 98.2% and 74.2% respectively while in malignant diseases it was 72.7% and 98.8% respectively (p-value 0.00). The sensitivity and specificity of Tru-cut in breast diseases was 100% and 97.1% respectively while in malignant diseases it was 97% and 98.2% respectively (p-value 0.00). Conclusion: Breast lump is more common in females as compared to males. Breast carcinoma is more common in old females and benign breast diseases is common among young females. Tru-cut biopsy is better than FNAC in diagnosis of both benign and malignant lesions of breast lumps.

A comparative analysis of computed tomography and ultrasonography in diagnosis of neck masses

Background: Neck swellings constitute the chief complaint of many patients coming to ENT outpatient department. Adequate evaluation of all cases with assistance from radiological, cytopathological, and histopathological is necessary. Aims and Objectives: The present study aims to evaluate the role of clinical, radiological, and cytopathological evaluation to reach the diagnosis and the accuracy of these tools. Materials and Methods: The study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Radiodiagnosis, AMU, and included 100 patients with neck swelling. Results: Maximum number of patients were of lymph node masses (44%), followed by thyroid masses (26%) and salivary gland pathologies, congenital neck masses, and others. 78% were benign masses while only 22% were malignant. Out of all cases, the maximum were reactive lymphadenitis (16%), followed by metastatic lymph nodes (12%) and pleomorphic adenoma (10%). The correlation between clinical diagnosis and ultrasound (USG) was 70.93 with a diagnostic accuracy of 86%; with fine-needle aspiration cytology (FNAC) accuracy being 82%. 91% of metastatic lymph node swellings were accurately diagnosed by these two modalities alone. The sensitivity and specificity of FNAC with computed tomography (CT) were 62.25% and 98.59%, respectively; while with biopsy were 84.63% and 97.10%. Conclusion: Clinical evaluation remains the utmost important step in the management of patients with neck swellings. USG provides the necessary information to guide further management, followed by FNAC. Although CT and histopathological evaluation provide detailed information, it was rarely needed in our study to reach the clinical diagnosis however their need in the management of pathology could not be ruled out.

Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

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.

STUDY OF CYTOMORPHOLOGICAL FEATURES OF MYXOID SOFT TISSUE LESIONS BY FINE NEEDLE ASPIRATION CYTOLOGY

Fine needle aspiration cytology (FNAC) was initially conceived as a means to confirm a clinical suspicion of local recurrence or metastasis of known cancer without subjecting the patient to further surgical intervention.[1] In 1998, Akerman M highlighted the benefits of FNA when compared with core needle or open surgical biopsy.The most important were rapid preliminary diagnosis, no need for hospitalization and anaesthesia, negligible complications and fear for tumour cell spread.[2] Soft tissue can be defined as nonepithelial extra skeletal tissue of the body exclusive of the reticuloendothelial system, glia,and supporting tissue of various parenchymal organs.[3] Myxoid tumours of soft tissue are a heterogeneous group of tumours characterized by their abundant mucoid/myxoid extracellular matrix. [4] Soft tissue tumors (STT) is a very wide area of interest , but cytologically,relatively less discovered.[5] FNAC is relatively painless,produces a speedy result and is a cheap procedure and has a good sensitivity and specificity in diagnosing primary and metastatic STT.[6] Except to categorise STT, FNAC is proved effective in differentiating benign and malignant STTs.[7] Aim of the present study was to assess the spectrum of Soft tissue lesion with myxoid change on cytology and to estimate the sensitivity and specificity of FNAC in diagnosis of soft tissue lesions with myxoid change.

“Tuberculous and Nontuberculous Cervical Lymphadenitis: A Clinical Experience”

Introduction: Tuberculosis is one of the leading causes of death in adults. Tuberculous lymphadenitis continues to be a major health problem in our country. In patient with cervical lump, tuberculosis remains a common cause. Tuberculous cervical lymphadenitis is commonly encountered in clinical practice. Objective: To observe whether there are any differences in clinical characteristic between tuberculous and nontuberculous lymphadenitis and to evaluate the importance of fine needle aspiration cytology (FNAC) in the management of tuberculous cervical lymphadenitis. Materials & Methods: A prospective study was carried out among 101 patients of cervical lymphadenitis in ENT department of Mission General Hospital, Nilphamary, Bangladesh. The study period was from June 2019 to June 2019. Results: There were 53 male and 48 female. The age ranged from 9 to 68 years. Posterior triangles were found to be the most common involved site. The incidences of constitutional symptoms, like malaise, anorexia, weight loss and fever were similar between the two groups. Thirty nine patients were diagnosed as tuberculous lymphadenitis by FNAC, 53 patients diagnosed as reactive lymphadenitis and no definitive diagnosis were made for 8 patients. The excisional biopsy reported 42 patients as tuberculous lymphadenitis, 56 were diagnosed as reactive lymphadenitis and two patients were diagnosed as Non-Hodgkin’s Lymphoma. In this study sensitivity and specificity of FNAC in the diagnosis of the tuberculous lymphadenitis were 85.71% and 94.82% respectively. Conclusion: Patients with tuberculous and non-tuberculous lymphadenitis had similar clinical features and hence were difficult to differentiate clinically. FNAC is a highly specific tool in the diagnosis of tuberculous lymphadenitis.

The Role of Fine Needle Aspiration Cytology in the Diagnosis of Gallbladder Cancer: A Systematic Review.

Gallbladder cancer is the most common malignancy of the biliary tract. When diagnosed in an advanced stage it has a very poor prognosis. Therefore, early diagnosis and thorough assessment of a suspicious gallbladder polyp is essential to improve survival rate. The aim of this systematic review is to assess the role of fine needle aspiration cytology (FNAC) in the management of gallbladder cancer. For that purpose, a systematic review was carried out in the MEDLINE, EMBASE, Cochrane, Scopus and Google Scholar databases between 1 July 2004 and 22 April 2021. Six studies with 283 patients in total were included. Pooled sensitivity and specificity of FNAC were 0.85 and 0.94, respectively, while the area under the calculated summary receiver operating characteristic (SROC curve (AUC) was 0.98. No complications were reported. Based on the high diagnostic performance of FNAC in the assessment of gallbladder masses, we suggest that every suspicious mass should be evaluated further with FNAC to facilitate the most appropriate management.

Histopathological Study of Soft Tissue Lesions with Cytology Correlation

Soft tissue can be defined as non-epithelial extra skeletal tissue of the body, exclusive of the reticuloendothelial system, glia and supporting tissu e of various parenchymal organs. FNAC is a useful tool in distinguishing accurately between neoplastic and non-neoplastic lesions. To study the utility of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumours. To correlate FNAC with histopathological examination of soft tissue tumours with immunohistochemistry and / or histochemistry wherever required and assess the overall sensitivity and specificity of FNAC in diagnosing soft tissue tumours.

The accuracy of fine needle aspiration cytology in the clinical diagnosis of minor salivary gland tumours

The objective of this study was to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy for the clinical diagnosis of minor salivary gland tumours (MSGTs). This retrospective study of 32 MSGT cases was conducted over a 5-year period. Clinical features including age, sex, and location of the tumour were obtained from the patient clinical records. All cases were also assessed histologically according to the 2017 World Health Organization Classification of Head and Neck Tumours. The results of FNAC and biopsy were correlated with those of histopathology, and their sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as the gold standard. Eighteen malignant MSGTs (56.3%) and 14 benign MSGTs (43.8%) were diagnosed by pathological diagnosis. The most common malignant tumour was mucoepidermoid carcinoma (seven cases, 38.9%). Most benign cases were pleomorphic adenomas (13 cases, 92.9%). FNAC was performed for 23 cases and biopsy for 13 cases. The sensitivity and specificity of FNAC were 66.7% and 91.0%, respectively, while those of biopsy were 90.0% and 100.0%, respectively. Although FNAC is a minimally invasive and cost-effective procedure, it is less accurate than biopsy in the assessment of MSGTs. Repeated FNAC or biopsy should be considered in negative and unsatisfactory FNAC cases.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

<p><strong>Background: </strong>Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.</p><p><strong>Method</strong>: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15<sup>th </sup>November 2015 to 15<sup>th</sup> May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.</p><p><strong>Results</strong><strong>: </strong>The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.</p><p><strong>Conclusions: </strong>FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.</p>

Cytomorphological Spectrum of breast lesions and Diagnostic utility of Fine needle aspiration Cytology

Fine needle aspiration cytology (FNAC) was described and practiced by Martin and Ellis in 1930. It is a well-accepted procedure and is a valuable tool in the diagnosis and patient management of breast lesions. The sensitivity and specificity of FNAC as a diagnostic tool for palpable breast lumps are 65-99% and 96-100% respectively. Therefore, the study aimed to access the cytomorphological spectrum of breast lesions. The present study included thirty-seven consecutive female patients of palpable breast lesions who underwent fine needle aspiration cytology (FNAC). After obtaining a detailed history followed by clinical examination, the FNAC procedure was performed. All the slides were stained with Hematoxylin and Eosin (H & E). The stained smears were viewed under microscope and cytological findings were interpreted accordingly. The most common affected age group was 40-49 years with preponderance on right side. Considering the Cytomorphological spectrum, the most common lesion was Fibroadenoma followed by Ductal carcinoma, fibrocystic disease, acute suppurative inflammatory lesion, benign breast lesion, granulomatous mastitis and atypical ductal hyperplasia. The ductal carcinomas were more commonly seen in the age group of 40-49 years and Fibroadenoma were more common in age group of 20-29 years. Fine needle aspiration cytology of breast lesions is a valuable, cost effective, minimally invasive and a rapid investigation. Majority of the lesions in the younger age group are benign in nature and malignant in older age groups. Despite its high accuracy, some pitfalls may lead to confusion and misdiagnosis of breast lesions. Therefore, accuracy of diagnosis increases when aided with radiological investigations.

A study of correlation of pre-operative fine needle aspiration cytology and ultrasonography with post-operative histopathology in thyroid swellings

Background:Diseases of the thyroid gland can be due to inflammatory and neoplastic causes. Many diagnostic tests like ultrasound, thyroid nuclear scan and fine needle aspiration cytology (FNAC) are available for their evaluation. Histopathologically, they can be adenomas, colloid nodules, cysts, infectious nodules, lymphocytic or granulomatous nodules, congenital abnormalities or hyperplasia, or various types of malignancy. It is therefore crucial to have a clear diagnostic approach to ensure patients are managed appropriately and are not over or under-treated. Present study was done to evaluate FNAC and ultrasonography (USG) as a diagnostic method in thyroid swellings and to plan surgery accordingly.Methods: A prospective observational study was conducted among 60 adult patients undergoing thyroid surgery at Victoria and Bowring and Lady Curzon Hospital. They were investigated with FNAC and USG of thyroid, and were subjected to surgery and subsequent histopathological examination. The histopathological examination reports were correlated with the findings of FNAC and USG in order to evaluate their findings by statistical methods.Results:The sensitivity and specificity of FNAC was 87.5% and 98% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery. And the sensitivity and specificity of USG was 75% and 86% respectively. Therefore combination of both FNAC and ultrasonography will improve the diagnostic accuracy to higher level and helps in better management. Conclusions:FNAC has high sensitivity and specificity, so it is closest to ideal test. However, a combination of both FNAC and ultrasound will give desirable results and so that we can avoid mismanagement.

Clinical, pathological and radiological correlation of thyroid swellings

<p class="abstract"><strong>Background:</strong> The cause and type of thyroid swellings vary across geographical areas, lifestyles, and socioeconomic status of people. The incidence of palpable thyroid swellings is 4-7% out of which only 1% are malignant. Out of all thyroidectomy cases, histologically confirmed thyroid malignancy constitutes only 20%. Hence, we attempt to evaluate thyroid swellings based on clinical examination, ultrasonography (USG), Fine needle aspiration cytology (FNAC), and histopathological evidence to aide in arriving at proper diagnosis and treatment at an early stage.</p><p class="abstract"><strong>Methods:</strong> This was a prospective observational study conducted at the SSG Hospital, Vadodara from December, 2016 to September 2017 and included 30 patients. Following preliminary examination, we performed thyroid function tests, FNAC, and USG pre-operatively. Histopathological examination of excised tissue was performed within 4-5 hours after thyroid surgery, and later, post-op complications were noted. Results were derived after appropriate statistical tests. </p><p class="abstract"><strong>Results:</strong> 65% patients belonged to 2nd and 3rd decade with male to female ratio of 1:5 and all patients presented with an anterior neck swelling. Clinical examination was found to be 50% sensitive and 100% specific. The sensitivity and specificity of FNAC was 50% and 96% respectively while that of USG was 67% and 100% respectively. Out of 16% malignant cases, all were of papillary type. Most common post-op complication was related to wound care (3-5%).</p><p class="abstract"><strong>Conclusions:</strong> Correlation between clinical findings, ultrasonography findings, cytology, serum investigations and histopathological examinations are to be carried out for appropriate management of thyroid swelling.</p><p class="Default"> </p>

IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period.

Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.

Usefulness of second-look ultrasonography using anatomical breast structures as indicators for magnetic resonance imaging-detected breast abnormalities

BackgroundSecond-look ultrasonography (US) is commonly performed for breast lesions detected using magnetic resonance imaging (MRI), but the identification rate of these lesions remains low. We investigated if US methods using anatomical breast structures can improve the lesion identification rate of MR-detected lesions and evaluated the diagnostic performance of fine-needle aspiration cytology (FNAC) of the second-look US using the above-mentioned method.MethodsWe retrospectively assessed 235 breast lesions (hereinafter, “targets”) subjected to second-look US following MRI between January 2013 and September 2015. US was employed using the conventional methods, and this assessment measured the positional relationships of lesions with regard to surrounding anatomical breast structures (glandular pattern, Cooper’s ligaments, adipose morphology, and vascular routes). Associations were assessed among the following variables: the MRI findings, target size, identification rate, and main US indicators that led to identifying the target; FNAC results and MRI findings; MRI findings and histopathological findings; and FNAC results and histopathological findings. Moreover, the sensitivity and specificity of FNAC were determined.ResultsThe identification rate was 99%. The main US indicators leading to identification were a glandular pattern (28–30% of lesions) and other breast structures (~ 25% of lesions). FNAC was performed for 232 targets with the following results: sensitivity of 85.7%, specificity of 91.6%, PPV of 94.1%, NPV of 92.9%, false-negative rate of 14.3%, false-positive rate of 2.1%, and accuracy of 89.7%.ConclusionsSecond-look US using anatomical breast structures as indicators and US-guided FNAC are useful for refining the diagnosis of suspicious breast lesions detected using MRI.

A multicentre retrospective clinico-histopathological review of 250 patients after parotidectomy

A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n=211, 84.4%) were more prevalent than malignancies (n=39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.

Sensitivity and specificity of fine needle aspiration for the diagnosis of mediastinal lesions

Fine needle aspiration cytology (FNAC) of mediastinal masses allows for rapid on-site evaluation and the triaging of material for ancillary studies. However, surgical pathology is often considered to be the gold standard for diagnosis. This study examines the sensitivity and specificity of FNAC compared to a concurrent or subsequent surgical pathology specimen in 77 mediastinal lesions. The overall sensitivity for mediastinal mass FNAC was 78% and the overall specificity was 98%. For individual categories the sensitivity and specificity of FNAC was respectively as follows: inflammatory/infectious (33%, 99%), metastatic carcinoma (93%, 100%), lymphoma (84%, 97%), cysts (25%, 100%), soft tissue tumors (100%, 100%), paraganglioma (50%, 100%), germ cell tumor (100%, 99%), thymoma (87%, 94%), thymic carcinoma (60%, 100%), benign thymus (0%, 100%), and indeterminate (100%, 90%). For different locations within the mediastinum the sensitivity and specificity of FNAC was respectively as follows: anterosuperior mediastinum (80%, 98%), posterior mediastinum (33%, 95%), middle mediastinum (100%, 100%), and mediastinum, NOS (79%, 99%). Thus, mediastinal FNAC is fairly sensitive, very specific, and is a valuable technique in the diagnosis of mediastinal masses.

Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: a retrospective single centre study

Background: In order to avoid unnecessary thyroidectomies, it is important to predict the nature of thyroid nodules the more accurately possible. The size of the nodule as a predictive factor for malignancy is very controversial. Another point of debate is the accuracy of preoperative fine-needle aspiration cytology (FNAC) and frozen section (FS). The aim of our study is to correlate the nodule size with the final histological diagnosis and to estimate the accuracy of preoperative FNAC and FS.Methods: Retrospective study including 387 operated patients with ultrasound-detected solitary thyroid nodules from 01 January 2001 to 31 December 2013. The following data were collected: patient age and sex, nodule size, FNAC, FS and final histology results.Results: The odds ratio for malignancy within nodules <40 mm was 2.12 (95% CI: 1.104–4.084). The specificity of FNAC was 97.78% and the negative predictive value (NPV) was 97.78% for nodules ≥40 mm and 93.2% and 96.5% for nodules <40 mm, respectively. The observed specificity and NPV of FS ranged from 98% to 100% and from 87.4% to 98%, respectively. When combining FNAC and FS, the specificity and the NPV were 99% and 98%, respectively.Conclusions: The nodule size is not a predictive factor for thyroid cancer and therefore nodules ≥40 mm should not be routinely resected. A lege artis preparation and performance of FNAC along with an expertise on cytological interpretation can considerably diminish false-negative rate. FS can offer additional accuracy on FNAC results and should, therefore, be a part of patient treatment.

Prospective analysis of perinatal outcome of pregnant women with asymptomatic bacteriuria

Objective: Isolated case reports describing the utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of Lymphocutaneous sporotrichosis are available in the literature. Since Himachal Pradesh in India is a known endemic area for cutaneous sporotrichosis, this study was conducted to assess the utility of FNAC in the detection of fungal spores for the diagnosis of lymphocutaneous sporotrichosis. Methods: FNAC and biopsy were performed from the nodules and indurated ulcers of fifty clinically diagnosed cases of lymphocutaneous sporotrichosis. Smears were reviewed for cytomorphological findings and were correlated with the histopathological findings. Positive cases were further subjected to culture for confirmation. Results: In our study, the sensitivity and specificity of FNAC in diagnosing lymphocutaneous sporotrichosis were 35% and 100% respectively. The sensitivity and specificity of biopsy in diagnosing lymphocutaneous sporotrichosis were 10% and 100% respectively. All seven cases diagnosed on FNAC were confirmed on fungal culture. Conclusions: FNAC is an effective, useful and a minimally invasive procedure. FNAC is comparatively better than biopsy in detection of fungal spores in the diagnosis of lymphocutaneous sporotrichosis. With an experienced cytologist, it can be used routinely for the diagnosis for lymphocutaneous sporotrichosis.