Specificity Of Fine Needle Aspiration Research Articles

Evaluation of Sensitivity and Specificity of Ultrasound-Guided FNA of Suspicious Axillary Lymph Nodes in Patients with Breast Cancer

Background: The axillary lymph node status in breast cancer is a major prognostic factor in survival and establishing a personalized treatment scheme. The ultrasound-guided fine needle aspiration (US-FNA) is a method for taking a lymph node sample. It allows physicians to decide how to manage the axilla. Objectives: This study was conducted to investigate the sensitivity of the US-FNA technique on suspicious axillary lymph nodes with a thickness of 3 to 6 mm in breast cancer patients. Methods: In a cross-sectional study, all the patients were subjected to preoperative ultrasound evaluation of the axilla to determine the presence of lymph nodes suspicious of malignancy. In cases where the suspicious lymph node cortex size was between 3 and 6 mm, US-FNA was performed. After surgery, the frozen section of the biopsy sample was examined histologically and compared with fine needle aspiration (FNA) cytology results. Results: A total of 102 patients were examined in the study. FNA test results indicated that 46 subjects had axillary malignant tissue, and benign cases summed 56. Also, the final results of frozen section surgical histopathology identified 46.1% of patients with involved lymph nodes. The sensitivity and specificity of FNA were 93.62% and 96.36%, respectively. Also, the overall diagnostic accuracy was 95.1%. Conclusions: This study showed that the sensitivity, specificity, and accuracy were more than 90% for the ultrasound-guided FNA test in identifying involved lymph nodes in patients with breast cancer. Therefore, the results of this test can be considered clinically reliable. However, there is still a need to examine the sensitivity and specificity of this method in identifying lymph node involvement.

Myxoid Soft Tissue Tumors: A 20-Year Experience on Fine Needle Aspiration with Application of the Proposed WHO Reporting System for Soft Tissue Cytopathology

Introduction: Myxoid soft tissue tumors represent a heterogenous group of neoplasms. The study presented our experience on cytopathology of myxoid soft tissue tumors on fine needle aspiration (FNA) and aimed to apply the recently proposed WHO system for reporting soft tissue cytopathology. Material and Methods: We performed a 20-year retrospective search of our archives to identify all FNAs performed on myxoid soft tissue lesions. All cases were reviewed, and the WHO reporting system was applied. Results: 129 FNAs performed in 121 patients (62 males; 59 females) showed a prominent myxoid component, accounting for 2.4% of all soft tissue FNAs. The FNAs were performed on 111 (86.7%) primary tumors, 17 (13.2%) recurrent tumors, and one (0.8%) metastatic lesion. A spectrum of non-neoplastic and neoplastic lesions including both benign and malignant neoplasms was identified. Overall, the most common tumors identified were myxoid liposarcoma (27.1%), intramuscular myxoma (15.5%), and myxofibrosarcoma (13.1%). The sensitivity and specificity of FNA regarding the nature of the lesion (benign vs. malignant) were 98% and 100%, respectively. When the WHO reporting system was applied, the frequency of the categories was as follows: benign (7.8%), atypical (34.1%), soft tissue neoplasm of uncertain malignant potential (18.6%), suspicious for malignancy (3.1%), and malignant (36.4%). The risk of malignancy calculated in each category was as follows: benign (10%), atypical (31.8%), soft tissue neoplasm of uncertain malignant potential (50%), suspicious for malignancy (100%), and malignant (100%). Conclusion: A diverse group of non-neoplastic and neoplastic lesions can show a prominent myxoid component on FNA. The WHO reporting system for soft tissue cytopathology is easily applicable and appears to correlate well with the malignant potential of myxoid tumors.

Pediatric parotidectomy outcomes: A 14-year multicenter study.

Parotidectomy increases childhood challenges. This study aimed to determine the clinical profiles, investigations, and outcomes of pediatric patients who had undergone parotidectomy. A multicenter retrospective review of parotidectomy in pediatric patients between 2007 and 2020. In 108 parotidectomies, the final diagnoses were benign (47.22%), malignant (36.11%), and non-neoplastic (16.67%). The incidence of facial palsy was 37.03%, which was significantly lower in the superficial group than that in the total parotidectomy group (p=.021). The incidence of facial nerve palsy was significantly higher in the malignancy group than that in the benign group (p=.035). Magnetic resonance imaging (MRI) detected malignancy with 92.8% overall accuracy, 83.3% sensitivity, and 100% specificity. The sensitivity and specificity of fine-needle aspiration (FNA) were 54.2% and 92.7%, respectively. Parotidectomy is commonly performed for benign and non-neoplastic diseases in pediatric patients. Facial nerve palsy is significantly associated with malignant tumors and total parotidectomy. MRI is the most accurate imaging modality for diagnosing malignant lesions. FNA exhibits moderate agreement with the final pathology. Level IV.

Positive predictive values of ultrasound-guided fine-needle aspiration with parathyroid hormone assay and Tc-99m sestamibi scintigraphy in sporadic primary hyperparathyroidism

ObjectivesUltrasonography (US) and Tc-99m sestamibi scintigraphy (SS) are usually performed as preoperative imaging modalities for patients with sporadic primary hyperparathyroidism (SPHP). Fine-needle aspiration (FNA) under US guidance for parathyroid hormone (PH) assay can enhance the diagnostic accuracy of US. The main aim of the present study was to compare positive predictive values between US-FNA and SS. The secondary aim was to draw up a decision-tree for FNA and SS. MethodsThe single-center retrospective study included patients with previously non-operated SPHP. They underwent US-guided FNA, PET-CT SS, and 18 F-choline scintigraphy if the first two methods were inconclusive. PH washout level was considered pathological when greater than the serum PH level. Postoperative histology data were correlated to imaging data. ResultsIn total, 117 patients were included, with a mean age of 64 years (range, 26–89 years). A single adenoma was identified on pathology in 101 patients (89%). FNA findings were pathologic for 64 patients (55%), with a mean PH level of 2,604ng/L [range, 585–9,074ng/L], higher than the serum level of 179ng/L [range, 60–1,000ng/L]. US-guided FNA showed sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of respectively 72%, 92%, 99% and 28%, compared to 89%, 42%, 93% and 32% for SS. The rate of error in locating the parathyroid gland was 8% for US-guided FNA versus 12% for SS. Comparison of the two methods showed better sensitivity for SS (P=0.0052) and better specificity for FNA (P=0.0143), with no significant difference in PPV or NPV. 18 F-choline scintigraphy detected the hyperfunctioning parathyroid in 11 out of the 15 patients. ConclusionPPV did not significantly differ between FNA and SS. US-guided FNA performed by an experienced operator could be a simple first-line method for more than 50% of patients with non-operated SPHP, with 99% PPV. In case of negative or doubtful FNA findings, SS can be performed in second line.

Accuracy, predictability and prognostic implications of fine‐needle aspiration biopsy for parotid gland tumours: A retrospective case series

AbstractObjectiveTo evaluate the precision and utility of fine‐needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes.DesignRetrospective case series.SettingTertiary medical centre.ParticipantsAll adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014.Main outcome measuresDifferences in clinical management and outcomes of patients with parotid masses in light of FNA results.ResultsWe analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false‐positive and false‐negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low‐grade, conversely non‐diagnostic FNA for malignant tumours resulted in decreased survival.ConclusionsOur findings highlight the limitations of FNA as a decision‐making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.

Diagnostic renal mass biopsy is associated with individual categories of PADUA and RENAL nephrometry scores: Analysis of diagnostic and concordance rates with surgical resection

BackgroundRenal mass biopsy (RMB) is a safe and accurate method for diagnosis and clinical management of renal masses. However, the non-diagnostic rate is a limiting factor. We tested the hypothesis that imaging characteristics and anatomic complexity of the mass may impact RMB diagnostic outcome using the preoperative aspects and dimensions used for an anatomical (PADUA) classification and radius-exophytic/endophytic-nearness-anterior/posterior-location (RENAL) score. Material and methodsSingle institution, retrospective study of 490 renal masses from 443 patients collected from 2001 to 2018. Outcome measurements include (1) diagnostic and concordance rates amongst RMB types and RMB with surgical resection specimens; (2) association between diagnostic RMB and anatomical complexity of renal masses. The analysis was conducted in unselected masses and small renal masses (SRMs). ResultsRMB was performed by fine needle aspiration (FNA), core needle biopsy (CNB), or both (FNA+CNB). Non-diagnostic rate was significantly higher for FNA compared to CNB and FNA+CNB in both unselected and SRMs. Subset analysis in the FNA+CNB group showed similar diagnostic rates for FNA and CNB. In unselected masses, specificity for FNA, CNB, and FNA+CNB was 100%. Sensitivity was higher for CNB (90.1%, P = 0.002) and FNA+CNB (96.3%, P = 0.004) compared to FNA (66.7%). For unselected masses, endophytic growth predicted a non-diagnostic CNB. R.E.N.A.L location entirely between the polar lines (central) and entirely above the upper polar line predicted a diagnostic CNB. Sonography-guidance predicted a diagnostic FNA. For SRMs, non-diagnostic CNB was associated with endophytic growth, while diagnostic CNB was associated with renal sinus invasion and operator experience. More cystic masses were sampled by FNA, but diagnostic results were similar for FNA and CNB. ConclusionsEndophytic growth consistently predicted a non-diagnostic CNB in unselected and SRMs, whereas sonography-guidance predicted a diagnostic FNA. Cystic masses could be adequately sampled by FNA.

Accuracy of fine needle aspiration compared to core needle biopsy in breast masses

Background and aims: Breast cancer is one of the main causes of death in women, the early diagnosis of which is made by physical examination, mammography, ultrasound, and biopsy of breast masses. The aim of this study was to assess the diagnostic accuracy of fine needle aspiration (FNA) compared to core needle biopsy (CNB) in breast masses. Methods: The current descriptive study was conducted in Kashani and Hajar hospitals in 2015. And a total of 200 patients diagnosed with breast masses participated in this study. First, patients referred to the clinic, received local anesthesia in the area, and then underwent FNA using 10 cc syringes and 23G needles, and simultaneously CNB specimens were taken by a special needle for diagnosis. FNA and CNB specimens were transferred to the Pathology Department with a few day interval for cytological interpretation. Results: The sensitivity and specificity of FNA compared to CNB in the diagnosis of malignant breast masses were 83.9% and 89.9%, respectively. Moreover, the positive and negative predictive values of FNA for breast masses were 78.8% and 92.5%, respectively. The accuracy of FNA test for breast masses was also 0.88%. Conclusion: According to the results of this study, FNA test had a high sensitivity, specificity, and predictive value in the diagnosis of breast masses. Therefore, it could be used as an appropriate diagnostic tool, and could obviously save many costs as well.

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.

Rapid access clinic for unexplained lymphadenopathy and suspected malignancy: prospective analysis of 1000 patients

BackgroundIn patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care.MethodsWe analyzed a large dataset of 1000 consecutive patients with unexplained lymphadenopathy referred between 2001 and 2009 to the Royal Marsden Hospital (RMH) rapid access lymph node diagnostic clinic (LNDC).ResultsCancer was diagnosed in 14% of patients. Factors predictive for malignant disease were male sex, age, supraclavicular and multiple site involvement. Cancer-associated symptoms were present for a median of 8 weeks. The median time from referral to start of cancer therapy was 53 days. Fine needle aspiration (FNA) was performed in 83% of patients with malignancies. Sensitivity and specificity of FNA were limited (50 and 87%, respectively for any malignancy; 30 and 79%, respectively for lymphoma). The vast majority of cancer patients received diagnostic biopsies on the basis of suspicious clinical and ultrasound findings; the FNA result contributed to establishing the diagnosis in only 4 cases.ConclusionsIn conclusion, we demonstrate that Oncologist-led rapid access clinics are successful concepts to assess patients with unexplained lymphadenopathy. Our data suggest that a routine use of FNA should be reconsidered in this setting.

Diagnostic Accuracy of Fine Needle Aspiration for Solitary and Multiple Thyroid Nodules in a Tertiary Care Center

Background: Thyroid nodules are common in clinical practice. They are usually benign, but malignancy must be ruled out. Fine needle aspiration (FNA) biopsy of the thyroid is a rapid and cost-effective procedure in the initial evaluation of a thyroid nodule, but its results may be inaccurate in 10% to 30% of cases. This prospective observational study was conducted to determine the prevalence of thyroid cancer, its related findings, and the diagnostic accuracy of preoperative FNA in a tertiary care center. Methods: We prospectively studied the medical records of 345 subjects, who underwent thyroid resection in the university hospital setting over a 4-year period. Age, gender, FNA and pathologic reports, and whether the lesion was multinodular or a solitary nodule were determined. Results: The sensitivity and specificity of FNA were 64.96% and 62.76%, respectively. The positive predictive value of the test for the diagnosis of malignant nodules was 59.30% and its negative predictive value was 68.20%. In 63.5% of the patients, the preoperative FNA matched the surgical histopathology results. The presence of multinodular goiter was an important risk factor for thyroid malignancy. Fifty-two subjects had papillary microcarcinoma and the rate of aggressive behavior was considerable in this group. Conclusions: Although fine needle aspiration biopsy is the most important step in the workup of the thyroid nodules, it may miss a significant number of malignant lesions. Therefore, there is a mandatory need to evolve other clinical and laboratory adjuncts, which assists the clinicians with the interpretation of FNA more accurately.

The Sensitivity and Specificity of Fine-Needle Aspiration in Thyroid Neoplasia

Abstract Objective: To evaluate and demonstrate the accuracy of fine-needle aspiration (FNA) in thyroid lesions in our department and to highlight probable causes of errors leading to unsatisfactory sampling, which may depend on the characteristics of the nodule. Methods: This is a retrospective study conducted on 319 diagnosed cases of thyroid nodules referred to the Surgery Unit of Puls hospital, Tîrgu Mureș in the January 2014 – December 2015 period, who underwent fine-needle aspiration. Histological examination was considered to be the gold standard; therefore we compared the cytological diagnosis with the histological one. Results: Of the 319 cases, 289 (90.6%) were female and 30 (9.4%) male patients; 210 cases (69.3%) were interpreted as benign, 46 cases (15.2%) as follicular lesion of undetermined significance, 4 cases (1.3%) as suspect for malignancy, 1 case (0.3%) as malignant sampling, and 42 cases (13.9%) as unsatisfactory. We compared the results of fine-needle aspiration cytology (FNAC) with the corresponding histopathological results (49 in total). FNAC achieved a sensitivity of 76.47%, a specificity of 83.1%, a positive predictive value of 35.1%, a negative predictive value of 96.7%, a false positive rate of 16.9%, a false negative rate of 23%, and an overall accuracy of 82.3%. Conclusions: The results of our study demonstrate the accuracy of the FNA technique in the first-line diagnosis of thyroid nodules.

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst.

ObjectiveIn this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed.Study DesignThis study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012.MethodsOne hundred thirty‐five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually.ResultsOf the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine‐needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics.ConclusionThis study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast‐track cancer referral program.Level of Evidence2b.

Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis.

(1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA. Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts. Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I(2) statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios. The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I(2) point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509-0.982) and a specificity of 0.995 (95% CI, 0.960-0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030-0.075) and 0.147 (95% CI, 0.106-0.188), respectively. FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.

ارزش تشخیصی آسپیراسیون سوزنی ظریف (FNA) در مقایسه با نتایج پاتولوژی در تشخیص ندولهای تیروئید در بیمارستان شهید بهشتی بابل، شمال ایران، طی 22 سال

BACKGROUND AND OBJECTIVE: Recently, the efficiency of thyroid fine needle aspiration (FNA) as a method of choice in evaluation and management of thyroid nodules has been questioned. The aim of this study was to determine the diagnostic value of FNA as compared to pathology results in diagnosis of thyroid nodules in Shahid Behashti Hospital of Babol, Iran, within 22 years. METHODS: This cross-sectional study was performed on cytology samples of 225 patients who were undergoing thyroidectomy at Shahid Beheshti Hospital of Babol during 1990-2012. Patients' age and gender, physician's experience in performing FNA, type and location of surgery, FNA samples and pathology results were recorded. According to the pathology reports, FNA results were divided into four groups i.e. inadequate, benign, malignant and suspicious. The pathology results were divided into benign and malignant groups. The results of both methods were compared with each other. FINDINGS: The sensitivity and specificity of FNA in diagnosis of thyroid nodules were 60% and 96%, respectively. Also, its positive and negative predictive values and diagnostic accuracy were 65%, 95% and 81.8%, respectively. Among the 225 cytology samples, 127 (56.7%), 47 (20.9%), 27 (12%) and 24 (10.7%) were benign, suspicious, malignant, and inadequate, respectively. Additionally, pathology results were benign and malignant in 150 (66.7%) and 75 (33.3%) patients, respectively. CONCLUSION: FNA was comparatively effective in diagnosis of thyroid nodules.

The utility of molecular markers in pre-operative assessment of thyroid nodules.

The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.

The Diagnostic Accuracy of Fine‐Needle Aspiration for Parotid Malignancy

Objectives: Determine the sensitivity and specificity of fine-needle aspiration (FNA) in the diagnosis of parotid malignancy and analyze those histologies most often associated with false negative and false positive results. Methods: A retrospective chart review was performed for all patients who had a parotidectomy at the University of Wisconsin from 1994 to 2013. Patients who underwent preoperative FNA were identified, and FNA results were categorized as benign, malignant, or indeterminate. Surgical pathology was utilized as the gold standard. Results: A total of 771 patients underwent parotidectomy from 1994 to 2013, and 280 patients (36.3%) had a preoperative FNA. Based on surgical pathology, 178 (63.6%) patients had benign disease and 102 (36.4%) had malignant parotid neoplasms. 174 (62.1%) FNAs were benign, 94 (33.6%) were malignant, and 12 (4.3%) were indeterminate. Excluding indeterminate cases, the sensitivity and specificity for FNA in the diagnosis of parotid malignancy were 83.7% (95% confidence interval [CI]: (74.8%, 90.4%)) and 93.0% (95% CI: (88.0%, 96.3%)), respectively. Moreover, FNA correctly categorized malignancy in 83.7% (n = 82) and benign in 92.9% (n = 158) of cases. There were 16 false negatives (16.3%) with mucoepidermoid carcinoma having a diagnostic accuracy of 60% and acinic cell carcinoma 50%. Both were most commonly mistaken for pleomorphic adenoma. There were 12 false positives (7.1%), most commonly pleomorphic adenoma (n = 4) and warthins (n = 3). Conclusions: This study demonstrates that FNA has high sensitivity (83.7%) and specificity (93.0%) for the diagnosis of parotid malignancy. However, mucoepidermoid carcinoma and acinic cell carcinoma are more commonly associated with a false negative FNA.

In Reply to: Fine Needle Aspiration

Dear Editor, In reply to the Letter to the Editor by Prof. Wiwanitki (1) concerning my recent study, we stated that “FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses” (2). The author stated that FNA has 10.4% false negative results according to a recent study by Wharry et al.; however, this study was performed on thyroidal neck masses, while our study was conducted on nonthyroidal neck masses (3). As we demonstrated in Table 4 of the referred paper, we can see that the sensitivity and specificity of Fine Needle Aspiration (FNA) to diagnosis neck masses is high enough to consider it during the diagnostic process. Moreover, as we mentioned in our paper, the diagnostic properties of FNA depend on the properties of the mass. In masses suspicious for malignancy (such as larger masses, rapidly enlarged masses, masses in patients with history of malignancy or radiation, etc.) the cytology results and the FNA specimens should be more carefully interpreted (2). Also, as a limitation of our study we explained that pathologist experience can affect the cytology results. At our medical center, as a referral center in Iran, there is a group of pathologists who interpret the cytology results (4). There are two interesting comments that merit mentioning; the first is the rate of complications. Although many studies such as a review by Wu and Burstein declared that “FNA is used as one of the most cost-effective, complication-free, and rapid techniques for preoperative investigation of tumors and tumor-like conditions” (5, 6). Secondly, the role of radiologic modalities such as ultrasonography (US) in this paper is less discussed. Almost all studies conducted on the diagnostic accuracy of FNA, confirmed the role of Ultrasounds Imaging (US) to prepare a more useful specimen. Krishnappa et al. stated that “US-guided FNA provides a better representative sample and has a higher diagnostic rate in evaluation of thyroid lesions” (7). Also, some studies demonstrated that “the absence of suspicious US features did not reliably exclude malignancy”; others confirmed the usefulness of radiological properties to select a better site for FNA (8). For example, Moon et al. stated that “A taller-than-wide shape in either the transverse or longitudinal plane, was more accurate and sensitive in predicting thyroid malignancy” (9). Moreover, the size of the nodule is one of the most important US characteristics of a neck mass. There is a wide variety of size cut-off (between 1 to 4 cm) for neck masses suspicious for malignancy (3, 10). Moreover, US as a useful and safe radiologic modality can help find the largest, heterogeneous and more suspicious nodule for FNA.

Accuracy of fine‐needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically

Fine-needle aspiration (FNA) biopsy and imaging are commonly used in the preoperative assessment of salivary gland mass lesions. The goal of this retrospective study was to clarify the role of FNA and imaging in the workup of salivary gland masses. Retrospective cohort study. A computer search identified patients with an FNA of a salivary gland lesion with subsequent excision during a 10-year study period. Chart review of study patients was performed, and information on site of lesion, age, gender, radiologic diagnosis, pain in the tumor area, and facial paralysis was recorded and analyzed. There were 543 patients who had an FNA and subsequent histopathology. The majority of the tumors were in the parotid gland (n = 492, 90.9%), followed by submandibular gland (n = 45, 8.3%). The incidence of malignancy across all sites was 29.7%. The mean patient age was 54.1 years, and 54.1% were female. The sensitivity and specificity of FNA were 85.7% and 99.5%, respectively. Positive predictive value (PPV) was 98.6%, and negative predictive value (NPV) was 94.3%. A total of 464 patients had available radiologic studies. For the radiological diagnoses, sensitivity was 81.8% and specificity was 67.3%, whereas PPV and NPV were 52.7% and 89.3%, respectively. FNA is a reliable method of preoperatively assessing both benign and malignant salivary gland lesions. Preoperative imaging has a lower sensitivity and specificity than FNA in differentiating malignant from benign tumors. Older age, pain, and facial paralysis are clinical features independently associated with malignancy.

Fine Needle Aspiration Cytology Of Breast Lumps With Histopathological Correlation: A Four Year And Eight Months Study From Rural India.

Fine Needle Aspiration Cytology is known to be quick, simple and effective way of diagnosing Breast Lumps since long. It is also a very good financial alternative to the surgical biopsy. This study was undertaken with the aim to calculate sensitivity and specificity of fine needle aspiration cytology as diagnostic method by correlating it with histopathological findings. This was a retrospective study done in department of pathology, Maharaja Agrasen Medical College from Sept. 2007 to April 2012. Fine Needle Aspiration Cytology was performed on 454 cases of Breast lumps and out of these, 56 cases were received in the department for histopathological examination. We categorized the lesions as Inflammatory, Benign, Atypical, Suspicious and Malignant on Fine Needle Aspiration and compared the result with the histological findings. We found that sensitivity and specificity of Fine Needle Aspiration were 96.42% and 100% respectively in identifying Benign and Malignant Breast Lumps. In conclusion, we found that Fine Needle Aspiration Cytology is very efficacious, simple, easy and cost effective method in diagnosing breast lumps.

Diagnostic tests for tuberculous lymphadenitis: fine needle aspirations using tissue culture in mycobacteria growth indicator tube and tissue PCR

Abstract Background: The diagnosis of tuberculous lymphadenitis (TBLN) ranges from therapeutic diagnosis to open biopsy with tissue culture. The open biopsies are accepted as the gold standard to diagnose TBLN, but it requires skin incision that leaves unwanted scars. Objective: Test the sensitivity and specificity of fine needle aspiration (FNA) using tissue culture in mycobacteria growth indicator tube (MGIT) and tissue polymerase chain reaction (PCR) for comparison with open biopsy using tissue culture. Subject and methods: Forty patients with clinically suspected cervical tuberculous lymphadenitis were recruited at King Chulalongkorn Memorial Hospital. The patients underwent FNA followed by open biopsies either excisional or incisional. Specimens from FNA were collected for tissue culture in MGIT and for tissue PCR. The specimens from open biopsies were divided into two portions for tissue culture in MGIT (the gold standard) and for hispathology. Results: FNA for tissue culture in MGIT had a moderate sensitivity (65%) but high specificity (83%) (73% positive and 76% negative predictive value). FNA for tissue PCR had a moderate sensitivity (53%) but very high specificity (96%) (90% positive and 73% negative predictive values). Combination of either FNA for tissue culture or FNA tissue PCR revealed an increase in sensitivity and specificity to 83.6% and 80.0%, respectively. However, a combination of both FNA for tissue culture and FNA tissue PCR revealed a decrease in sensitivity (34.5%) but a highly increase in specificity (99.0%). Conclusion: Either the FNA using tissue culture in MGIT or tissue PCR had a moderate sensitivity but high specificity. FNA using tissue culture or FNA tissue PCR may be used as an alternative test for diagnosis TBLN. The techniques may replace the open biopsies because of its effectiveness and low complication rate.