Suspicious Categories Research Articles

Fine needle aspiration cytology of atypical (C3) and suspicious (C4) categories in the breast and its histopathologic correlation.

Background:In 1996, National Cancer Institute (NCI) proposed five categories for the diagnosis of breast cytology in order to bring a degree of uniformity to the diagnostic reporting. Of these, categories 3 and 4 were sparsely studied.Aims:The present study was undertaken for the evaluation of the fine needle aspiration cytology (FNAC) categories of C3 and C4 in the breast lump and its histopathological correlation.Materials and Methods:In the retrospective study, a total number of 728 FNACs were categorized according to the NCI; of these, 28 cases of category C3 and 65 cases of category C4 were compared with histopathological diagnoses.Results:On histopathological examination of category C3, 18 (64.3%) cases showed benign lesions and 10 (35.7%) cases showed malignancy and among the C4 category, benign lesions found in nine (13.8%) and malignancy found in 56 (86.2%) cases. There was a significant statistical difference between the number of benign and malignant diagnoses for cytological categories of C3 (64.3%) and C4 (86.2%) (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of C4 category in the diagnoses of malignancy were 84.8%, 66.7%, 86.2%, and 64.3%, respectively.Conclusion:FNAC of the breasts is a simple, cost-effective, accurate, quick, and relatively less painful procedure, and it continues to play an integral part in the management of breast lesions. Our study concluded that there was a statistically significant difference between the number of benign and malignant diagnoses for categories of C3 and C4.

Cytologic categorization of pancreatic neoplastic mucinous cysts with an assessment of the risk of malignancy: A retrospective study based on the Papanicolaou Society of Cytopathology guidelines.

Cytology plays a pivotal role in the preoperative diagnosis of pancreatic cysts. Here the Papanicolaou Society of Cytopathology (Pap Society) guidelines were used to reclassify and assess the malignancy risk of cytology diagnoses of histologically proven pancreatic neoplastic mucinous cysts. A database search (January 2000 to June 2014) was performed for pancreatic neoplastic mucinous cyst resections with endoscopic ultrasound-guided fine-needle aspiration within the preceding year. Histologic diagnoses were reclassified according to the 2010 Word Health Organization criteria. For atypical/suspicious/positive cytology diagnoses, the cytology slides were reviewed, blinded to the histologic diagnoses. The cysts were reclassified according to the Pap Society guidelines, and the findings were correlated with the histology. One hundred thirty-eight cases of pancreatic neoplastic mucinous cysts were retrieved. Eleven cases with atypical/suspicious cytology diagnoses with unavailable slides were excluded. The remaining 127 cases included 81 intraductal papillary mucinous neoplasms and 46 mucinous cystic neoplasms. The sensitivity of cytology for the diagnosis of neoplastic mucinous cysts was 76.4%. The sensitivity, specificity, and accuracy of cytology for the diagnosis of malignancy (high-grade dysplasia or worse) were 48.3%, 94.9%, and 84.3%, respectively. The risk of malignancy was 17.4% for the nondiagnostic category, 0% for the negative category, 13% for the neoplastic category, 63.6% for the atypical category, 80% for the suspicious category, and 100% for a positive diagnosis. This study reveals that the Pap Society guidelines allow the accurate categorization of pancreatic neoplastic mucinous cysts with cytology. The diagnostic categories (from negative to positive) are associated with an increasing risk of malignancy, and this can further aid in patient management and risk stratification.

Suspicious cytologic diagnostic category in endoscopic ultrasound-guided FNA of the pancreas: Follow-up and outcomes.

The objective of the current study was to assess how the suspicious category is followed up in a large endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) service, its outcomes, and the predictors that are likely to be associated with the subsequent diagnosis of a neoplastic process. For pancreatic EUS-FNA samples with the suspicious category diagnosis, the authors reviewed the electronic medical record for the method of follow-up and the risks associated with pancreatic malignancy. Logistic regression analysis was used to determine the risk factors that were likely to be associated with the diagnosis of a neoplastic lesion after a cytologic diagnosis of "suspicious." Of a total of 3832 EUS-FNA cases, 116 were diagnosed with suspicious cytology. A total of 90 of 98 neoplasms (92%) were identified, including 72 carcinomas (73%). Similar rates of neoplasia were detected after repeat FNA (34 of 37 neoplasms [92%]) and subsequent biopsy/surgical resection (44 of 46 neoplasms [96%]), but significantly fewer neoplasms were detected among patients with clinical follow-up (18 of 23 neoplasms [78%]). On multivariate analysis of the potential predictive variables listed above, the presence of a mass was found to be significantly associated with a higher rate of diagnosis of a neoplasm, whereas weight loss was significantly associated with a diagnosis of carcinoma. The diagnostic category of "suspicious" is associated with a high risk of benign and malignant neoplasms, regardless of the method of follow-up. The presence of a mass and weight loss are significant predictors of a subsequent diagnosis of a neoplasm after suspicious cytology. In patients with suspicious cytology and these findings, surgery is recommended for resectable masses and repeat FNA for unresectable masses.

Carryover of bovine leukemia virus antibodies in samples from shared milk meters

Screening for infectious diseases of cattle using milk from the dairy herd improvement (DHI) sampling process is very convenient. However, when samples from shared milk meters are used, carryover of antibodies or other diagnostic targets can complicate the interpretation of the diagnostic test results for diseases, including bovine leukosis. The objectives of this study were (1) to assess the potential for carryover of antibodies against bovine leukemia virus (BLV) in milk samples obtained from shared meters, and (2) to determine if adjustment of the diagnostic test cut-off value would improve the test characteristics for meter-collected milk ELISA results. Eight dairy farms were randomly selected from herds with a wide range of BLV prevalence levels in Prince Edward Island, Canada. Within each chosen farm, 2 to 4milk meters were randomly selected. During the routine procedures of DHI sampling, 2 simultaneous milk samples, 1 hand-collected at the beginning of milking (after udder preparation) and the other from the corresponding milk meter, were taken from all lactating cows (n=236) that were milked at the selected meters (n=26). The sequence of cows using each meter was recorded. All samples were tested for BLV antibodies using a commercial indirect ELISA. Antibody carryover potential was assessed in meter-collected samples which were preceded by other cows using the same meters. Applying the hand-collected sample results as our reference standard, a new cut-off was defined for meter-collected samples to optimize the test characteristics. At the standard cut-off value of the diagnostic test, 110 (46.6%) of the hand-collected and 136 (57.6%) of the meter-collected samples were positive. For low-titer cows (e.g., true negatives), the likelihood of antibody carryover significantly increased as the titer of preceding cows increased, whereas this change was not substantial for high-titer cows. The odds of obtaining false diagnoses in meter-positive samples became larger with increase in the titer of preceding cows. A suspicious category for meter ELISA results was defined, and a retest was recommended for the cows falling into this category. This strategy effectively assisted in reducing the number of consequent false-positive results. When DHI-collected samples are used, carryover can affect the interpretation of dichotomous test results and may require adjustment of assay cut-off values.

Tu1677 Long Term Follow-Up of Atypical and Suspicious Cytology Results for Endoscopic Ultrasound - Fine Needle Aspiration

Atypical and suspicious cytology results are not uncommon in Endoscopic Ultrasound Guided - Fine Needle Aspiration (EUS FNA), with some studies showing up to 6% of cytology being atypical. Few reports have accessed the true risk of malignancy for these indeterminate categories. Atypical and suspicious categories do not have standard criteria and vary depending on pathologist. The aim of this study was to determine the long term follow-up and risk of malignancy in patients with atypical or suspicious cytology.

The Frequency and Cancer Risk Associated with the Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided Fine-Needle Aspiration Specimens of Solid Pancreatic Lesions: A Meta-Analysis

The Frequency and Cancer Risk Associated with the Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided Fine-Needle Aspiration Specimens of Solid Pancreatic Lesions: A Meta-Analysis

Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) of the Pancreas: Follow-up and Outcomes

Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) of the Pancreas: Follow-up and Outcomes

Use of blue dye in sentinel lymph node biopsy: Time to reevaluate

Use of blue dye in sentinel lymph node biopsy: Time to reevaluate

Thyroid cytological and histopathological correlation study

Aims Fine needle aspiration cytology (FNAC) is considered the cost effective procedure that provides specific diagnosis with minimal complications. The aim of the present study was to correlate the FNAC findings with histopathological findings of excised specimens. Methods This was a retrospective study of FN As reported between 2006 and 2012. Records of patients who underwent thyroid FNA and subsequent surgery were reviewed. The data collected were the cytological and histopathological diagnoses and statistical analysis of malignant, suspicious and atypical categories was performed. Results FNAC was performed on 585 thyroid lesions, with the histological correlation being available in 62 cases, over a period of 5 years. These 62 cases had been divided into five categories based on our locally developed system. Ninety-two percent of the specimens were considered adequate for diagnosis. The sensitivity, specificity and positive predictive value for malignant and suspicious categories were analysed as 100%. The majority of the atypical category cases were found to be benign follicular or oncocytic adenomas. However, malignancy was identified in 18%. Discussion The FNA categorisation of benign and suspicious/ malignant in our institution was highly predictive. The atypical category was more diverse and emphasis should be laid on further investigation of these cases.

Generation and Evaluation of DEM from Cartosat-1 Stereo Data Using Ground Control Points from Topographical Maps

Generation and Evaluation of DEM from Cartosat-1 Stereo Data Using Ground Control Points from Topographical Maps Digital Elevation Model (DEM) is a basic input to find out the terrain characteristics and terrain parameters. It is also used for planning of infrastructural facilities of an area. There are several ways to generate a DEM and with the advances in spatial technologies, it becomes easy to generate a DEM from the satellite data. In the present paper, DEM has been generated using Cartosat-1 satellite stereo data with Ground Control Points (GCPs) taken from Survey of India (SOI) topographical map and mass points that are digitized after block triangulation. The generated DEM has been evaluated with elevation values of Survey of India (SOI) topographical map of the study area. The generated DEM has also been compared with the ASTER DEM of the study area and it is observed that Cartosat-1 extracted DEM shows better results when mapping at large scales. From the DEM quality map, it is seen that 86% pixels identified as excellent to good category and only 16% are identified as isolated to suspicious category. From the comparison of DEM prepared from block triangulation and contours, it is seen that 26% pixels have the elevation variation of less than 5 m and 30% pixels have the elevation variation of 5 m to 10 m. Elevation variation of less than 5m is seen for 23% pixels and 5 m to 10 m is seen for the 51% pixels between the ASTER DEM and DEM prepared from contours. DEM extracted from Cartosat-1 satellite data can be used for planning and implementation of infrastructural facilities, as it require more accurate and detailed terrain variations.

Evaluation and correlation of mammographically suspicious lesions with histopathology at Addington Hospital, Durban

Stereotactic core-needle biopsies (SCNBs) are a reliable alternative to surgical biopsy for microcalcifications. The positive predictive value (PPV) of SCNB has been shown to be reproducible in several studies using the Breast Imaging Reporting and Data System (BIRADS) classification, which is the current gold standard in mammographic reporting. At this stage, no study has been done in KwaZulu-Natal to assess local outcomes against BIRADS. The current standard of care utilises vacuum-assisted breast biopsy, but is not available in a resource-constrained environment such as ours. The need, therefore, is for constant evaluation of existing practice to ensure that it is optimised for the challenges and limitations facing local radiologists. To assess the PPV of SCNB in Addington Hospital, and to compare it with that of BIRADS. Material and methods. Mammographically detected lesions were assigned to 3 categories: benign, indeterminate and suspicious. A retrospective review of 67 SCNBs was performed for lesions falling within the suspicious category, and the PPV and rates of ductal carcinoma in situ (DCIS) were determined. Our study demonstrated a PPV of 20.9%. This correlated well with international studies for BIRADS 4 and 5 lesions. DCIS accounted for 21.4% of detected malignancies, which is in keeping with current literature. Despite resource limitations, local outcomes were comparable to those of BIRADS. Given our fairly general categorisation of lesions, however, it should be emphasised that BIRADS allows better organisation, consistency and clarity in breast imaging reporting, as well as accurate data comparison between centres facing limitations similar to our own.

Reproducibility of 'The Bethesda System for reporting Thyroid Cytopathology': A MultiCenter Study with Review of the Literature.

To achieve the standardization of the thyroid FNA reporting, the National Cancer Institute (NCI) hosted the "NCI Thyroid Fine Needle Aspiration State of the Science Conference", which led to the formation of 'The Bethesda System for Reporting Thyroid Cytopathology' (TBSRTC). The present study was undertaken by 2 experts in thyroid FNA, who in a double blinded fashion, examined and re-classified 80 random FNA cases according to the 6 levels of TBSRTC for an inter-observer review, to study and assess the new terminology for ease of reproducibility and to note the rate of disagreement overall or in any particular category. The FNAs were reclassified in a double blinded fashion according to the 6 levels of TBSRTC which are: non diagnostic (ND); benign; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), Hurthle cell type/suspicious for a follicular neoplasm, Hurthle cell type (FNHCT/SFNHCT); suspicious (SUS), and malignant. In the present study, the maximum number of cases was reclassified under the benign category (61.25% cases), followed by the FN/ SFN category and the AUS/FLUS category (11.25% and 10.00% respectively). An agreement was reached in 66 cases (82.5%); the experts disagreed in 14 cases-17.5% (where 1 expert did not agree with the other). Individually; a 93.87% agreement was noted for the lesions in the benign category, for 50% lesions in the AUS/FLUS category, for 66.66% lesions in the FN/SFN and the SUS categories, for 71.42% lesions in the FNHCT/ SFNHCT categories and for 100% lesions in the ND and the malignant categories. Thus, the maximum disagreement was noted in the AUS/FLUS category. The implementation of TBSTRC which stands for a unique, international and a universal terminology for reporting the thyroid cytology; should be encouraged in our country, because of its relative ease of reproducibility. Although there was a great deal of agreement in implementing TBSTRC in the present study; disagreements were seen in the categories of AUS/FLUS and FN/SFN in the study which was conducted at our centre. This corroborated with the findings of the studies which were done elsewhere.

Histopathological Correlation of Atypical (C3) and Suspicious (C4) Categories in Fine Needle Aspiration Cytology of the Breast

Introduction. According to the National Cancer Institute (NCI) guidelines in 1996, breast lesions are categorized as C1 to C5 on fine needle aspiration (FNA) cytology. Very few studies are available in the English literature analyzing histopathology outcome of C3 (atypical, probably benign) and C4 (suspicious, probably malignant) lesions. Our study aims to correlate FNA cytology of breast lump diagnosed as C3 and C4 lesion with histopathological examination. Methods. During a period of 2 years, 59 cases of C3 and 26 cases of C4 were retrieved from total 1093 cases of breast FNA. All the cases were reviewed by two cytopathologists independently. The final 24 cases of C3 and 16 cases of C4 categories were correlated with histopathological diagnosis. Result. Among C3 category, 37.5% revealed malignant findings, whereas of C4 category, 87.5% were malignant on histopathology. This difference was statistically significant (P = 0.0017). Sensitivity, specificity, positive predictive values, and negative predictive value of C4 category in diagnosing breast malignancy were 60.8%, 88.2%, 87.5%, and 62.5%, respectively. Conclusion. Although FNAC is simple, safe, cost-effective and accurate method for diagnosis of breast masses, one must be aware of its limitations particularly in C3 and C4 categories. Also, since both these categories carry different probabilities of malignancy and thus different management, we therefore, support maintaining C3 and C4 categories.

Review of Accuracy of Urinary Cytology with Risk of Malignancy Assessment per Cytology Categories in a Large Tertiary Health Care System

Pathology, University of Washington,Seattle, WashingtonIntroduction: Urothelial cancer is on the rise. The relatively longersurvival is attributed to timely diagnosis and effective clinical manage-ment. The role of urinary cytology is central in the continued surveillanceand cannot be over-emphasized. In literature urine cytology has a muchhigher sensitivity and specificity for high grade urothelial carcinomaapproaching 75%-98%, when compared to 8.5 to 50% for low-gradelesions.The objective of our study was to review and benchmark the accuracy ofurine cytology and risk of malignancy (predicted probability) for every urinecytology diagnostic category.Materials and Methods: A laboratory information system search (Cernerand Meditech) retrieved 443 GU biopsies along with their preceding 920urine cytologies from January 2008 to January 2011. Statistical analysiswas performed using the cytology specimen within 6 months and closestto biopsy date and more than 6 months and farthest from the biopsy date.Cytology diagnostic categories included negative for malignant cells(NMC) (N Z 183), reactive cellular change (RCC) (N Z 15), atypical(A) (N Z 77), suspicious(S) (N Z 38) and positive (P) (N Z 61). NMCand RCC were classified as negative. All other categories wereconsidered positive. Logistic regression was used to model malignancyas a function of urine cytology diagnostic category within 6 months frombiopsy.Results: The overall sensitivity and specificity of urine cytology was 62.8%and 74.2% respectively (Table 1). Sensitivity for high grade lesions wasgreater (71.6%) than that for low grade (46.3%). Sensitivity for both highgrade and low grade lesions was similar before and after 6 months but spec-ificity declined after 6 months (Table 3). The risk of malignancy was highfor positive, suspicious and atypical categories at 0.82, 0.82 and 0.7 respec-tively (Table 2).

344 New ISHLT Pathologic Diagnosis of Suspicious AMR (pAMR1) Confers Increased Risk of Cardiovascular Mortality

ISHLT pathology based schema for AMR (pAMR) was devised in 2011 by the pathology consensus group. Myocardial biopsies showing histologic (hist) or immunohistochemical(i) features are designated as suspicious (pAMR1hist or pAMRihc). Relationship between these suspicious categories and cardiovascular (CV) mortality has not been reported. Their relative significance is unknown.

Thyroid Bethesda reporting category, ‘suspicious for papillary thyroid carcinoma’, pitfalls and clues to optimize the use of this category

The Bethesda System of Reporting Thyroid Cytopathology classifies the indeterminate categories based on their differing risks of malignancy, as atypia of undetermined significance (AUS), follicular neoplasm/suspicious for follicular neoplasm (FLUS) and suspicious for malignancy. The vast majority of cases of the last category are suspicious for papillary thyroid carcinoma (PTC). The aim of the present study was to identify the pitfalls and clues to improve the usage of the suspicious category as well as improve its outcome of malignancy. We reviewed the cytological features on air dried Diff-Quik® and alcohol-fixed Papanicolaou smears from 54 thyroid fine needle aspirates (FNAs) with surgical follow-up that were originally diagnosed as suspicious. Procedure data/specimen adequacy was correlated and follow-up histology reports were reviewed after our cytological review was completed. Incidental PTC that was not the target of the FNA was excluded from the calculations for correlation. In our cytological review, we retained a diagnosis of suspicious in 18 of the 54 cases and the remaining 36 were re-categorized as follows: 6 malignant, 10 neoplasm (which is used in our centre instead of FLUS) and 20 AUS. The reasons for overcall of suspicious cases included pseudopapillae, syncytial sheets, nuclear grooves and pinpoint nucleoli in chronic lymphocytic thyroiditis and Hürthle cell neoplasms, and intranuclear inclusions in parathyroid adenoma, hyalinizing trabecular adenoma and mesenchymal repair. The primary reasons for undercall of PTC as suspicious included cystic aspirates with minor features of PTC such as histiocytoid cells, bubblegum colloid, syncytial sheets and cellular swirls. Cases with cytoplasm similar to Hürthle cells were also noted to cause difficulty in accurate classification. Recognition of these pitfalls and clues can help improve diagnosis, patient treatment and consequently reduce the number of unnecessary thyroidectomies.

Review of Molecular Markers for Thyroid Cancer

The incidence of thyroid cancer has been rapidly increased in Korea. Although fine needle aspiration cytology is recommended for diagnosis of cancer, there are some limitations. Patients with indeterminate or suspicious cytology category in which malignancy cannot be ruled out usually undergone a thyroidectomy, however, only 10∼25% of them finally diagnosed as cancer. According to the progress in understanding molecular mechanism, some mutations or other molecular alterations have been studied for the diagnostic and prognostic markers for thyroid cancer. The majority of papillary thyroid cancers have BRAF and RAS mutations or RET/PTC rearrangement, and approximately 80% of follicular thyroid cancers harbor a RAS mutation or PAX8/PPARγ rearrangement. These genetic alterations are mostly studied and current clinical guidelines suggested that these molecular markers may help management for patients with indeterminate cytology. In addition, recent studies demonstrated the high sensitivity and specificity of thyroid-stimulating hormone receptor mRNA in diagnosing cancer in patients with indeterminate cytology. For the detection of recurrent or residual thyroid cancer, serum thyroglobulin is the only circulating marker in clinical practice. However, it lacks sensitivity and is unreliable specifically in the presence of antibodies to thyroglobulin. Recent studies demonstrated a significant role of measuring the mRNA of thyroglobulin, thyroid peroxidase, thyroid-stimulating hormone receptor, and sodium/iodine symporter in peripheral blood for monitoring of the recurrence of thyroid cancer. (Ewha Med J 2012;35(1):3-10)

Cytodiagnosis through use of a z‐axis video by volunteer observers: a promising tool for external quality assessment

This study examined whether cytological diagnosis through the use of a video, which shows the changing depth of focus in the microscopic field, described as a z-axis video, is useful compared with a still image. From 17 cytology preparations of fine needle aspiration of the breast, we made six z-axis videos per case. A frame exhibiting the characteristic features was then extracted from each video and saved as a representative still image. One hundred and twenty-eight volunteer cytotechnologists were randomly divided into two groups of video observers and still image observers. The participants were asked to make a diagnosis of benign, indeterminate, suspicious or malignant without having any clinical information other than the age of the patient. Diagnoses were categorized as 'recommended' or 'unacceptable' according to degree of correlation with histology. The number of definitive diagnoses of 'benign' or 'malignant' were increased in video observers, and indeterminate or suspicious categories were decreased (P = 0.013). The distribution of diagnostic categories in three of the 17 cases was significantly different; the distribution in the remaining cases was similar between the two groups. The z-axis video observers may have selected the definite diagnoses with confidence because they observed valuable microscopic findings by 'focusing through observation'. The average number of 'recommended' diagnoses by individual observers was significantly higher in the video observer group than in the still image observer group (P = 0.016). In contrast, the average number of 'unacceptable' diagnoses was significantly lower (P = 0.019). A z-axis video is easy to obtain and is therefore expected to become a powerful diagnostic modality for the external quality assessment of clinical cytology and even in the field of primary cytodiagnosis.

Quantitative classification of breast fine needle aspirates using the AxioHOME system

Fine needle aspiration cytology is useful in the pre-operative assessment of patients with breast lumps. Lesions are reported as benign, suspicious or malignant. The number of suspicious categories is high in inexperienced hands thus limiting this useful diagnostic tool. The aim was to evaluate quantitative methods of classifying breast fine needle aspirates using the Highly Optimized Microscope Environment system. May- Grumwald Giemsa-stained archived slides were retrieved and smear quality assessed. Fifty epithelial cells corresponding to the cytological grading on each slide were measured using the system\'s general morphometry program. Generated data was exported to Microsoft Excel for analysis. A significant difference in the mean nuclear area, mean nuclear perimeter, mean largest nuclear diameter was found between the slides graded as benign, suspicious malignant and malignant. C2 & C4, D 1, P < 0.004. C4 & C5, Area P < 0.001. The means of the number count of nucleoli was able to distinguish between FNAC Benign and Malignant category C2/C5, P = 00440 and suspicious benign and malignant C3/C5 P = 0.00486. Morphometry could be useful in situations where experienced cytopathologists are unavailable especially when this program can also measure the degree of dispersion between cells Keywords: Morphometric image analysis, aspiration cytology, breast. International Journal of Biological and Chemical Sciences Vol. 2 (2) 2008: pp. 139-145

Does Routine Consultation of Thyroid Fine-Needle Aspiration Cytology Change Surgical Management?

Routine secondary cytologic review of thyroid gland fine-needle aspiration (FNA) specimens in patients referred from other institutions has been the recommended practice at some medical centers. We sought to determine the concordance rates between FNA interpretations at referring institutions and our center to determine if they alter surgical management. All thyroid gland FNAs referred to our center for cytopathologic opinion from June 2000 to August 2004 were reviewed. Patients in whom FNA biopsies were performed for thyroid cancer recurrences or core biopsies and patients in whom only a cytopathologic opinion was requested without a clinical consultation were excluded from the study. FNA results were divided into benign, indeterminate, suspicious, malignant, and nondiagnostic categories. FNA interpretations at our medical center and the referring institutions were compared with final histology results in patients who underwent operations. One hundred forty-seven patients had secondary review of their thyroid gland FNA specimens. The overall concordance was 82%, with the highest concordance rate in the malignant category (95%) and the lowest in the suspicious category (62%, p<0.001). The sensitivity (94% versus 92%), specificity (76% versus 56%), and positive (93% versus 87%) and negative (79% versus 69%) predictive values were all higher on secondary review. Twenty-seven patients were found to have discordant FNA interpretations. As a result of the discordant FNA result, four patients had their surgical management decisions changed. Another four patients had appropriate oncologic thyroid resection as a result of the secondary review. Our results suggest that routine secondary cytopathologic review of FNA specimens from referring institutions changes surgical management in some patients with thyroid neoplasms. We recommend this practice be widely used at other centers, especially for suspicious results.