Suspicious Cytology Research Articles

Colposcopically Directed Biopsy Before Ablative Treatment Versus Direct Ablative Treatment in Patients With Cervical Oncogenic HPV.

In the past, the standard of care for women with abnormal cervical cytology has been the performance of colposcopically guided biopsy, followed by conization or large loop excision of the transition zone (LLETZ) where biopsy revealed pre-cancerous or cancerous areas. More straightforward protocols are emerging which advocate performing LLETZ in all women with highly suspicious cytology, suspicious colposcopic impression, or the presence of high-risk oncogenic human papilloma virus (HPV) strains in their cervical swabs. This, theoretically, would reduce the rate of false-negative diagnoses, but at the price of overtreating a significant number of healthy women. We retrospectively analyzed cervical cancer screening protocols in two large cohorts of women with high-risk HPV. The study compared outcomes between patients undergoing a colposcopically directed biopsy before LLETZ (n=683) and those proceeding directly to LLETZ without a biopsy (n=136). The primary focus was to assess whether intervening biopsies would reduce unnecessary ablative procedures without compromising the detection of high-grade lesions. The biopsy group had a high false-negative rate, with several high-grade lesions (CIN3) and a case of invasive cancer initially underdiagnosed. Conversely, the direct-to-LLETZ approach, while ensuring no high-grade lesions were missed, led to overtreatment of lower grade lesions. These findings raise concern about the reliance on biopsy results for treatment decisions. Neither protocol was entirely satisfactory, although the more aggressive one avoided the potentially life-threatening consequence of false-negative results. Further research is mandatory to accurately diagnose all cases requiring aggressive treatment, without subjecting healthy women to ablative treatments they do not need.

Evolutionary analysis of indeterminate cytology and risk of malignancy in a thyroid nodule unit.

The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods. 3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006-2008, 2012-2014, 2017-2019). Distribution of diagnostic cytologies, risk of malignancy, diagnostic performance indices of FNA, and cytologic-histologic correlation in indeterminate cytologies were analyzed. only 2.2% of cytology tests were insufficient for a diagnosis. 86.9% cytologies were benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006-2008), 10.1% (2012-2014), and 10% (2017-2019). Surgery was performed in 13% of benign cytology, result-ing in malignant histology in 2.7%. All malignant and suspicious cytologies underwent surgery: malig-nancy confirmed in 98% and 77% of cases, respectively. All 'indeterminate with atypia' cytologies (2006-2008) and Bethesda IV (2012-2014; 2017-2019) un-derwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the 'inde-terminate without atypia' category (2006-2008) and Bethesda III (2012-2014; 2017-2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6% with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods. Bethesda system reduces indeterminate cytologies and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

Voided urine cytology is a useful tool predicting non-muscle-invasive bladder cancer risk before surgery

ObjectiveTo determine the accuracy of voided urinary cytology (VUC) in predicting of non-muscle-invasive bladder cancer (NMIBC) risk stratification before surgery. MethodsWe prospectively collected data from all patients diagnosed with bladder cancer in our institution over 2 years. We have analyzed VUC accuracy of positive and suspicious VUC in the detection of high-risk tumors and negative and atypical VUC in the detection of low-risk tumors. To test this accuracy, we assessed sensitivity, specificity, positive (PPV) and negative predictive values (NPV), diagnostic odds ratio (DOR), and generated ROC curves (receiver operating characteristic curve). ResultsWith 224 patients included, the positive VUC subcategory showed a specificity of 92.4% (95%CI: 83.2%–97.5%) and a PPV of 91.4 (95%CI: 81%–97.1%). DOR in this subgroup was 6.81. In the suspicious VUC, specificity was 90.9% (95%CI: 81.3%–96.6%), PPV was 88% (95%CI: 75.7%–95.5%) and DOR was 4.23. Combined analysis of positive and suspicious cytologies for detecting high-risk NMIBC showed a sensitivity of 65% (95%CI: 57.3%–73.2%) and a DOR of 9.51. Negative VUC showed high specificity in detecting low-risk (93.2% [95%CI: 87.9%–96.7%]) and a DOR of 6.90 (95%CI: 3.07–15.46). Atypical VUC was the least accurate and had rather low specificity and predictive values. ConclusionsVUC appears to be a good, inexpensive and easily available method to determine risk stratification before surgery. This can be useful in daily practice to determine which patients should receive a single instillation of MMC and to prioritize patients more likely to have a high- risk tumor.

Acu‐URO17 is a highly sensitive and specific bladder cancer biomarker

AbstractObjectiveThis study evaluates the efficacy of Acu‐URO17, a highly sensitive and specific immunocytochemistry (ICC) test targeting Keratin 17, in comparison to urine cytology and UroVysion™ fluorescence in situ hybridization (FISH) for detecting bladder cancer cells in voided urine specimens.MethodsAcupath conducted a large‐scale comparison study using 2378 voided urine specimens. Acu‐URO17, urine cytology and UroVysion™ FISH were performed on these specimens according to standardized protocols. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for Acu‐URO17 in comparison to urine cytology and UroVysion™ FISH.ResultsIn cases diagnosed with high‐grade urothelial cancer via urine cytology, Acu‐URO17 demonstrated a sensitivity of 96% and a specificity of 82%. When compared to UroVysion™ FISH results, Acu‐URO17 exhibited a sensitivity of 97.1% and a specificity of 77.8%, surpassing the sensitivity of UroVysion™ FISH (57.1%). Notably, Acu‐URO17 showed a high NPV of 99.9%, indicating its reliability in confirming negative urine cytology results and risk‐stratifying atypical and suspicious cytology results.ConclusionThe results of this large‐scale prospective study support Acu‐URO17 as a clinically relevant, non‐invasive and cost‐effective tool for detecting bladder cancer cells in voided urine specimens. Its high sensitivity, specificity and NPV make it a valuable adjunct to urine cytology and UroVysion™ FISH in the diagnosis and management of urothelial carcinoma (UC).

THU678 Real-world Performance Of Afirma Genomic Sequencing Classifier (GSC) In A Community Healthcare Setting

Abstract Disclosure: V. Master: None. J. Syeda: None. S. Charatz: None. D. Reidy: None. K. Clary: None. Introduction: Indeterminate thyroid nodules pose a significant clinical challenge due to their potential risk of malignancy. The Afirma GSC has emerged as a valuable tool for the non-invasive management of these nodules. However, its real-world performance in community healthcare settings remains poorly understood. Aim: Comparison of GSC performance in a community healthcare setting to the validation study (VS) metrics. Method: A retrospective study was conducted in a community endocrine practice, where 91 Afirma GSC samples were obtained from patients who had either suspicious cytology or atypia of undermined significance (AUS) between 1/1/2021 and 12/31/2022. Ten samples were excluded due to insufficient material. Surgical pathology was used as the gold standard for diagnosis. Molecular benign results without surgical pathology were considered true negatives, and 2 unoperated patients with suspicious results were excluded from analysis. We calculated observed positive predictive value (oPPV) and observed specificity (oSP) to account for these exclusions. Non-invasive follicular neoplasm with papillary-like features is considered malignant. The prevalence of thyroid cancer in the study population was 19%. Results are compared to previously published VS of 191 samples. Result: Our study showed a higher accuracy of 89% of the Afirma GSC in our community healthcare setting, with a sensitivity (SN) of 93%, oSP of 88%, oPPV of 63%, and negative predictive value (NPV) of 98%. In comparison, the VS had a SN of 91%, SP of 68%, PPV of 47%, NPV of 96%, and accuracy of 74%. Additionally, our study showed a higher benign call rate (BCR) of 70% compared to 54% in the VS. Conclusion: Our study provides evidence of the real-world performance of the Afirma GSC and supports its use as a non-invasive tool for the management of indeterminate thyroid nodules. Better oSP and oPPV are suggestive of higher yield of cancers for resected nodules based on suspicious GSC.

Do large thyroid nodules (≥4 cm) without suspicious cytology need surgery?

Fine-needle aspiration biopsy (FNAB) is a good diagnostic tool for thyroid nodules; however, its high false-negative rate for giant nodules remains controversial. Many clinicians recommend surgical resection for nodules >4 cm owing to an increased risk of malignancy and an increased false-negative rate. This study aimed to examine the feasibility of this approach and investigate the incidence of malignancy in thyroid nodules >4 cm without suspicious cytology based on medical records in our center. This was a retrospective analysis of 453 patients that underwent preoperative FNAB for nodules measuring >4 cm between January 2017 and August 2022 at Severance Hospital, Seoul. Among the 453 patients, 140 nodules were benign and 119 were indeterminate. Among 259 patients, the final pathology results were divided into benign (149) and cancerous (110) groups, and the prevalence of malignancy was 38.9% in the benign group and 55.5% in the indeterminate group. Among the malignancies, follicular carcinoma and follicular variants of papillary carcinoma were observed in 83% of the cytologically benign group and 62.8% of the indeterminate group. Preoperative FNAB had high false-negative rates and low diagnostic accuracy in patients with thyroid nodules >4 cm without suspicious cytologic features; therefore, diagnostic surgery may be considered a treatment option.

Prognostic Value of Preoperative Molecular Testing and Implications for Initial Surgical Management in Thyroid Nodules Harboring Suspected (Bethesda V) or Known (Bethesda VI) Papillary Thyroid Cancer

Molecular testing is commonly used in the diagnosis of thyroid nodules with indeterminate cytology. The role of molecular testing in prognosticating oncologic outcomes in thyroid nodules with suspicious or malignant cytology is unclear. To determine whether molecular profiling of Bethesda V (suspicious for thyroid cancer) and VI (thyroid cancer) nodules is associated with improved prognostication and whether it may inform initial treatment. This retrospective cohort study included consecutive patients with Bethesda V or VI nodules who underwent surgery, with histopathology showing differentiated thyroid cancer, between May 1, 2016, and July 31, 2019 in the University of California, Los Angeles health system. Data were analyzed between April 2, 2021, and January 18, 2023. Masked ThyroSeq, version 3 molecular analysis after completion of initial treatment and acquisition of follow-up data. Structural disease persistence or recurrence, distant metastasis, and recurrence-free survival were assessed using ThyroSeq Cancer Risk Classifier (CRC) molecular risk groups (low, RAS-like; intermediate, BRAF-like; high, combination of BRAF/RAS plus TERT or other high-risk alterations) using Cox proportional hazards regression models. In 105 patients with papillary thyroid cancer (median [IQR] follow-up, 3.8 [3.0-4.7] years), ThyroSeq identified genomic alterations in 100 (95%) samples (6 [6%] low risk, 88 [88%] intermediate risk, and 6 [6%] high risk; median [IQR] age, 44 [34-56] years; 68 [68%] female and 32 [32%] male). No patients with low-risk or negative results experienced recurrence. Of the 88 patients with intermediate risk, 6 (7%) experienced local recurrence, with 1 of them also developing distant metastasis. The 6 patients with high risk (all with BRAF V600E plus TERT mutation) underwent total thyroidectomy followed by radioactive iodine (RAI) ablation. Four patients with high risk (67%) experienced local recurrence, with 3 of them also developing distant metastasis. Thus, patients with high-risk alterations were more likely to experience persistence or recurrence and distant metastasis than patients with intermediate risk. In a multivariable analysis incorporating patient age, sex, cancer size, ThyroSeq molecular risk group, extrathyroidal extension, lymph node positivity, American Thyroid Association risk, and RAI ablation, only cancer size (hazard ratio, 1.36; 95% CI, 1.02-1.80) and ThyroSeq CRC molecular risk group (high vs intermediate and low: hazard ratio, 6.22; 95% CI, 1.04-37.36) were associated with structural recurrence. Among the 6% of patients with high-risk ThyroSeq CRC alterations in this cohort study, the majority experienced recurrence or distant metastasis despite initial treatment with total thyroidectomy and RAI ablation. In contrast, patients with low- and intermediate-risk alterations had a low recurrence rate. Preoperative knowledge of molecular alteration status at diagnosis may allow for deescalation of initial surgery and refining of the intensity of postoperative surveillance in patients presenting with Bethesda V and VI thyroid nodules.

ESTIMation of the ABiLity of prophylactic central compartment neck dissection to modify outcomes in low-risk differentiated thyroid cancer: a prospective randomized trial

BackgroundProphylactic central neck dissection in clinically low-risk cT1bT2N0 papillary thyroid carcinoma is controversial, due to a large number of conflicting retrospective studies, some showing an advantage in terms of locoregional recurrence, others showing no advantage. These previous studies all show high rates of excellent response. We aim to demonstrate the non-inferiority of thyroidectomy alone as compared to total thyroidectomy with prophylactic central neck dissection in conjunction with adjuvant RAI 30 mCi with rTSH stimulation in terms of excellent response at 1 year.Trial design and methodsProspective randomized open multicenter phase III trial including patients with 11–40-mm papillary thyroid carcinoma (Bethesda VI) or suspicious cytology (Bethesda V) confirmed malignant on intra-operative frozen section analysis, with no suspicious lymph nodes on a specialized preoperative ultrasound examination. Patients will be randomized 1:1 into two groups: the reference group total thyroidectomy with bilateral prophylactic central neck dissection, and the comparator group total thyroidectomy alone. All patients will receive an ablative dose of 30mCi of radioactive iodine (RAI) within 4 months of surgery. The primary outcome is to compare the rate of excellent response at 1 year after surgery between the groups, as defined by an unstimulated serum thyroglobulin (Tg) level ≤ 0.2 ng/mL with no anti-Tg antibodies, an normal neck ultrasound and no ectopic uptake on the post-RAI scintiscan. Non-inferiority will be demonstrated if the rate of patients with excellent response at 1 year after randomization does not differ by more than 5%. Setting the significance level at 0.025 (one-sided) and a power of 80% requires a sample size of 598 patients (299 per group). Secondary outcomes are to compare Tg levels at 8 +/− 2 postoperative weeks, before RAI ablation, the rate of excellent response at 3 and 5 years, the rate of other responses at 1, 3, and 5 years (biochemical incomplete, indeterminate, and structurally incomplete responses), complications, quality of life, and cost-utility.Discussion (potential implications)If non-inferiority is demonstrated with this high-level evidence, prophylactic neck dissection will have been shown to not be necessary in clinically low-risk papillary thyroid carcinoma.Trial registrationNCT 03570021. June 26,2018

MP63-07 SEQUENTIAL ENDOLUMINAL DOXORUBICIN AND GEMCITABINE ALTERNATING WITH SEQUENTIAL MITOMYCIN AND DOCETAXEL FOR MULTI-FAILURE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE UPPER AND LOWER URINARY TRACTS

You have accessJournal of UrologyCME1 Apr 2023MP63-07 SEQUENTIAL ENDOLUMINAL DOXORUBICIN AND GEMCITABINE ALTERNATING WITH SEQUENTIAL MITOMYCIN AND DOCETAXEL FOR MULTI-FAILURE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE UPPER AND LOWER URINARY TRACTS Ian M. Mcelree, Ryan L. Steinberg, Sarah L., Vignesh T. Packiam, and Michael A. O'Donnell Ian M. McelreeIan M. Mcelree More articles by this author , Ryan L. SteinbergRyan L. Steinberg More articles by this author , Sarah L. Sarah L. More articles by this author , Vignesh T. PackiamVignesh T. Packiam More articles by this author , and Michael A. O'DonnellMichael A. O'Donnell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sequential intravesical gemcitabine and docetaxel (Gem/Doce) has shown over 50% 2-year high-grade (HG) recurrence free survival in patients with BCG-unresponsive non-muscle invasive urothelial carcinoma (NMIUC) of the bladder. For those who recur, further bladder-sparing therapies are needed, particularly when cystectomy is refused or precluded. We report outcomes of patients treated with a novel regimen of sequential doxorubicin and gemcitabine alternating with sequential mitomycin C and docetaxel (Quad Chemo) as a rescue therapy for patients with recurrent high-grade (HG) NMIUC. METHODS: We retrospectively reviewed 27 patients (37 treated units; 27 lower tract, and 10 upper tract) treated with Quad Chemo from December 2007 to February 2021. Patients received 8 induction endoluminal instillations of sequential 50 mg doxorubicin and 1 g gemcitabine alternating weekly with sequential 40 mg mitomycin C and 37.5 mg docetaxel. Alternating monthly maintenance treatment was administered up to 24 months if disease free at 3-month surveillance. The primary outcome was recurrence-free survival (RFS) defined as no disease on bladder/upper tract wash cytology or for-cause biopsies. Progression events included development of muscle-invasive or metastatic disease and any death due to bladder cancer. Adverse events were reported per CTCAE v.5. RESULTS: Median follow-up was 36 months. Patients with lower tract disease had a median of 3 prior inductions and upper tract 1 prior induction course. Stage at induction was pure CIS or positive cytology in 29 (78%) units, CIS+papillary in 5 (14%), and pure HG papillary in 1 (2.7%). Two (5.4%) upper tract units received Quad Chemo following a suspicious cytology. Among all treated units, the 2-year RFS rate was 38%. If disease-free at first follow-up, median duration of response was 30 months. The 2-year cystectomy-free, progression-free, and cancer-specific survival rates were 82%, 87%, and 96%, respectively. Regarding adverse events, 7.4% (2/27) of patients had a grade 3 event, including bladder stone development, bladder ulceration, and de-novo hydronephrosis. 67% (18/27) of patients experienced a grade 1-2 event. Induction treatment was ended in 11% (3/27) of patients due to side effects. CONCLUSIONS: Quad Chemo shows efficacy in a heavily pretreated HG NMIUC cohort but with a more severe side effect profile. Further prospective evaluation is needed for this regimen and to evaluate the boundaries of intravesical therapy. Source of Funding: This work was supported by the John & Carol Walter Family Foundation and the Cancer Center Support Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e873 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian M. Mcelree More articles by this author Ryan L. Steinberg More articles by this author Sarah L. More articles by this author Vignesh T. Packiam More articles by this author Michael A. O'Donnell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-19 EFFICACY OF FISH ANALYSIS ON URINARY SPECIMENS DURING ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP69-19 EFFICACY OF FISH ANALYSIS ON URINARY SPECIMENS DURING ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Orel Carmona, Nir Kleinmann, Dorit E. Zilberman, Zohar A. Dotan, and Asaf Shvero Orel CarmonaOrel Carmona More articles by this author , Nir KleinmannNir Kleinmann More articles by this author , Dorit E. ZilbermanDorit E. Zilberman More articles by this author , Zohar A. DotanZohar A. Dotan More articles by this author , and Asaf ShveroAsaf Shvero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: FISH analysis (Fluorescence in-situ hybridization) is a laboratory technique used to detect chromosomal aberrations typical to malignant cells in body fluids. The EAU and NCCN guidelines on the management of upper tract urothelial carcinoma (UTUC) do not include recommendations relating to FISH analysis as part of the follow-up regimen of UTUC. The objective of this study was to examine the efficacy of FISH analysis on selective urine samples of patients undergoing endoscopic management for UTUC. METHODS: The medical records of all patients who managed endoscopically for UTUC at our institute between 2014-2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant if It showed more than 4 cells with hyperploidy of chromosomes 3, 7, 17 or more than 12 cells with deletion of 9p21 locus on chromosome 9. RESULTS: During the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up of UTUC. Cytology and FISH tests were performed in 376 and 273 cases, respectively. In 206 (75.4% of FISH studies) the FISH analysis was different from the cytology results: Out of the 58 cases found as benign in a cytology test, FISH analysis showed chromosomal aberrations in 9 (15.5%) cases. In all the 197 cases that a cytology test reported atypia, FISH analysis successfully classified the cells as benign (93 cases, 47.2%) or malignant (104 cases, 52.8%). Table 1 demonstrates the difference between cytology and FISH results in 133 cases in which the ureteroscopy showed no suspicious lesions, and both cytology and FISH analysis was performed. Out of the 217 endoscopies that resulted in biopsy-proven UTUC, cytology was taken in 143 cases and demonstrated malignant cells in 10 (7%) cases and atypical cells in 97 (67.8%) cases. FISH analysis was performed on 108 of these samples and successfully classified the cells as malignant in 59 (54.6%) cases. CONCLUSIONS: FISH analysis should be a part of the follow-up regimen of patients undergoing endoscopic management for UTUC. When cytology reported cellular atypia, FISH analysis successfully classified the cells as malignant or benign in all cases. There is an added value to perform FISH analysis when cytology test was performed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e972 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Orel Carmona More articles by this author Nir Kleinmann More articles by this author Dorit E. Zilberman More articles by this author Zohar A. Dotan More articles by this author Asaf Shvero More articles by this author Expand All Advertisement PDF downloadLoading ...

Randomized crossover trial of ‘Roll-over’ technique of abdominal paracentesis versus standard technique in suspected malignant ascites

ABSTRACT Background The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis (PC) varies from 40–70%. We hypothesized that rolling-over the patient before paracentesis might improve the cytological yield. Research design and methods This was a single center pilot study with a randomized cross-over design. We compared the cytological yield of fluid obtained by roll-over technique (ROG) with standard paracentesis (SPG) in suspected PC. In the ROG group, patients were rolled side-to-side thrice, and the paracentesis was done within 1 minute. Each patient served as their own control, and the outcome assessor (cytopathologist) was blinded. The primary objective was to compare the tumor cell positivity between SPG and ROG groups. Results Of 71 patients, 62 were analyzed. Of 53 patients with malignancy-related ascites, 39 had PC. Most of the tumor cells were adenocarcinoma (30, 94%) with one patient each having suspicious cytology and one having lymphoma. The sensitivity for diagnosis of PC was (31/39) 79.49% in SPG group and (32/39) 82.05% in ROG group (p = 1.00). The cellularity was similar between both the groups (good cellularity in 58% of SPG and 60% of ROG, p = 1.00) Conclusions Rollover paracentesis did not improve the cytological yield of abdominal paracentesis. Trial registration CTRI/2020/06/025887 and NCT04232384

AI: Can It Make a Difference to the Predictive Value of Ultrasound Breast Biopsy?

(1) Background: This study aims to compare the ground truth (pathology results) against the BI-RADS classification of images acquired while performing breast ultrasound diagnostic examinations that led to a biopsy and against the result of processing the same images through the AI algorithm KOIOS DS TM (KOIOS). (2) Methods: All results of biopsies performed with ultrasound guidance during 2019 were recovered from the pathology department. Readers selected the image which better represented the BI-RADS classification, confirmed correlation to the biopsied image, and submitted it to the KOIOS AI software. The results of the BI-RADS classification of the diagnostic study performed at our institution were set against the KOIOS classification and both were compared to the pathology reports. (3) Results: 403 cases were included in this study. Pathology rendered 197 malignant and 206 benign reports. Four biopsies on BI-RADS 0 and two images are included. Of fifty BI-RADS 3 cases biopsied, only seven rendered cancers. All but one had a positive or suspicious cytology; all were classified as suspicious by KOIOS. Using KOIOS, 17 B3 biopsies could have been avoided. Of 347 BI-RADS 4, 5, and 6 cases, 190 were malignant (54.7%). Because only KOIOS suspicious and probably malignant categories should be biopsied, 312 biopsies would have resulted in 187 malignant lesions (60%), but 10 cancers would have been missed. (4) Conclusions: KOIOS had a higher ratio of positive biopsies in this selected case study vis-à-vis the BI-RADS 4, 5 and 6 categories. A large number of biopsies in the BI-RADS 3 category could have been avoided.

The TNAPP web-based algorithm improves thyroid nodule management in clinical practice: A retrospective validation study.

The detection of thyroid nodules has been increasing over time, resulting in an extensive use of fine-needle aspiration (FNA) and cytology. Tailored methods are required to improve the management of thyroid nodules, including algorithms and web-based tools. To assess the performance of the Thyroid Nodule App (TNAPP), a web-based, readily modifiable, interactive algorithmic tool, in improving the management of thyroid nodules. One hundred twelve consecutive patients with 188 thyroid nodules who underwent FNA from January to December 2016 and thyroid surgery were retrospectively evaluated. Neck ultrasound images were collected from a thyroid nodule registry and re-examined to extract data to run TNAPP. Each nodule was evaluated for ultrasonographic risk and suitability for FNA. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of TNAPP were calculated and compared to the diagnostic performance of the other two algorithms by the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), which it was derived from the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). TNAPP performed better in terms of sensitivity (>80%) and negative predictive value (68%) with an overall accuracy of 50.5%, which was similar to that found with the AACE/ACE/AME algorithm. TNAPP displayed a slightly better performance than AACE/ACE/AME and ACR TI-RADS algorithms in selectively discriminating unnecessary FNA for nodules with benign cytology (TIR 2 - Bethesda class II: TNAPP 32% vs. AACE/ACE/AME 31% vs. ACR TI-RADS 29%). The TNAPP reduced the number of missed diagnoses of thyroid nodules with suspicious and highly suspicious cytology (TIR 4 + TIR 5 - Bethesda classes V + VI: TNAPP 18% vs. AACE/ACE/AME 26% vs. ACR TI-RADS 20.5%). A total of 14 nodules that would not have been aspirated were malignant, 13 of which were microcarcinomas (92.8%). The TNAPP algorithm is a reliable, easy-to-learn tool that can be readily employed to improve the selection of thyroid nodules requiring cytological characterization. The rate of malignant nodules missed because of inaccurate characterization at baseline by TNAPP was lower compared to the other two algorithms and, in almost all the cases, the tumors were microcarcinomas. TNAPP's use of size >20mm as an independent determinant for considering or recommending FNA reduced its specificity. TNAPP performs well compared to AACE/ACE/AME and ACR-TIRADS algorithms. Additional retrospective and, ultimately, prospective studies are needed to confirm and guide the development of future iterations that incorporate different risk stratification systems and targets for diagnosing malignancy while reducing unnecessary FNA procedures.

Suspicious Positive Peritoneal Cytology (Class III) in Endometrial Cancer Does Not Affect Prognosis.

Positive peritoneal cytology is a poor prognostic factor in patients with advanced endometrial cancer. Suspicious positive peritoneal cytology (class III) is commonly encountered in clinical practice. However, no standard treatment protocol exists for its management. Here, we investigated a possible relationship between suspicious positive peritoneal cytology, disease stage, risk factors, and endometrial cancer prognosis. We included patients diagnosed with endometrial cancer who underwent total hysterectomy and peritoneal cytology at the University of Tokyo Hospital between 2008 and 2022. Overall, 670 patients were included in the analyses; both demographic and clinical data of the patients were collected. The proportion of patients with lymph node metastasis was significantly different between peritoneal cytology groups, showing lymph node metastasis to be more extensive in patients with positive or suspicious positive peritoneal cytology than in patients with negative peritoneal cytology (p < 0.05). Thirty-nine patients had suspicious positive peritoneal cytology. Omental resection and biopsy were performed in 16 cases. No case of omental metastasis was found. Among patients with suspected ascites cytology, no patient experienced symptom recurrence or death. Therefore, monitoring lymph node metastasis in suspicious positive cases is essential. Moreover, a change of treatment method based on the finding of suspected positive peritoneal cytology is not necessary.

The clinical impact of endoscopic ultrasound-guided fine-needle aspiration on the patients with low-risk pancreatic cystic lesions.

Background and aimsEndoscopic ultrasound (EUS) is playing a more and more important role in the management of pancreatic cystic lesion (PCLs). The aim of our study was to evaluate the clinical impact of EUS and EUS guided fine needle aspiration (FNA) on patients with low-risk PCLs.Materials and methodsLow-risk PCL patients who underwent EUS-FNA in 2 edoscopic centers were retrospectively collected and analyzed. The clinical impact of EUS-FNA on these patients was analyzed and the predictors for significance EUS-FNA (defined by diagnosis and treatment method change, new high-risk feature identified after imaging scans) were analyzed by logistic regression analyses.ResultsFrom July 2004 to February 2017, 186 patients with low-risk PCLs were included. The study cohort had a mean age of 52.4 ± 15.9 years (range: 19-86 years) with 89 (47.8%) male patients included. The clinical significance of EUS-FNAs was observed in 74 patients (39.8%). The presumed diagnoses of PCLs by imaging were changed in 51 (51/74, 68.9%) patients. Nineteen (19/74, 25.7%) new high-risk features were identified by EUS-FNA, and four patients (4/74, 5.4%) underwent surgery due to suspicious or malignant cytology. Based on multivariate analysis, large cyst size [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.02–1.19, P = 0.033], young age (OR: 0.94, 95% CI: 0.91–0.99, P = 0.041) and BMI over 25 (OR: 3.15, 95% CI: 1.29–7.86, P = 0.013) were independent predictors of clinical significance for EUS-FNA. The optimal age and cyst size to predict significance EUS-FNA was 46.0 years and 2.3cm.ConclusionsOn the basis of a 2-center retrospective study, EUS-FNA was clinically significant in about 40% of low-risk PCLs, especially in young, large cyst size, and overweight patients.

Controversy on Positive Peritoneal Cytology of Endometrial Carcinoma.

Endometrial carcinoma (EC) is one of the most common gynecological malignancies. Its incidence rate has been increasing year by year. The prognostic factors and treatment strategies of EC have aroused wide concern. The effects of peritoneal cytology on the prognosis and treatment of EC remain controversial. Some factors, such as differentiation degree, muscle invasion, and tumor size, are related to positive peritoneal cytology. Hysteroscopy is commonly used in the diagnosis and treatment of endometrial cancer, but hysteroscopic surgery may cause the tumor to spread into the abdominal cavity, resulting in positive peritoneal cytology. In this review, we discuss the factors related to positive peritoneal cytology and the influence of positive peritoneal cytology on the prognosis of endometrial cancer. Suspicious positive peritoneal cytology may be an independent risk factor for endometrial cancer. The positive rate of peritoneal tumor cells in type II endometrial cancer is higher than other cells and is an independent risk factor for type II endometrial cancer. We also discuss the effects of peritoneal cytology on treatment decisions. Aggressive treatments seem to be more beneficial for patients with positive ascites cytology, but there is a lack of large-scale prospective clinical studies on their effectiveness and safety. The application of peritoneal cytology for endometrial cancer has been decreased in recent years. We believe that peritoneal cytology is necessary for this type of cancer. However, more studies on peritoneal cytology in endometrial cancer should be carried out.

Risk of malignancy in thyroid nodules selected for fine needle aspiration biopsy based on ultrasound risk stratification

Abstract Aim Risk stratification of thyroid nodules based on ultrasound scan (USS) features using the TIRADS- or U-scale has been widely adopted. However, management decisions for patients whose work-up provide conflicting information, remains challenging. The aim of this study was to assess the rate of malignancy among those with suspicious cytology after USS-evaluation. Methods Retrospective review of clinical, radiological and pathological data regarding patients presenting with a thyroid nodule. Results Between January 2018 and December 2020, a total of 214 patients underwent surgery after presenting with thyroid nodule(s) and a fine-needle aspiration (FNA) cytology report either suspicious (Thy3–4) or diagnostic (Thy5) for thyroid malignancy. The appearance on USS was stratified using the TIRADS-scale, either to select nodules needing FNA-assessment or to characterise palpable nodules. For Thy3a-cytology, the risk of malignancy remained low, irrespective of USS-appearance (2/15 in TIRADS2-3 versus 2/9 in TIRADS 4-5). For a Thy3f-cytology, the risk of malignancy was higher if the USS-appearance was also suspicious (11/75 in TIRADS2-3 versus 17/69 in TIRADS 4-5, p=0.03). High-risk USS-appearance (TIRADS 4-5) in the presence of suspicious/diagnostic cytology (Thy4-5) had a 95% positive predictive value (40/42) of malignancy. Future data collection should assess the risk of malignancy when USS-appearance is malignant (TIRADS 5) yet cytology is benign (Thy2). Conclusion The performance of USS and FNA in this cohort corroborates published data. Until genetic panels will complement the assessment of nodules with a Thy3-cytology, diagnostic thyroid lobectomy remains necessary, as the USS has limited ability to increase the yield of malignant nodules.

Kikuchi’s disease (KD); mimicking malignant lymphoma: A rare cause of cervical lymphadenopathy.

Objective: The aim of this study is to present six cases of cervical lymphadenopathy, diagnosed as Kikuchi’s disease and raise the index of suspicion for this disease. Study Design: Case Series. Setting: Histopathology and Otolaryngology/Head & Neck Surgery Department at Rehman Medical Institute (RMI) Peshawar. Period: July 2016 to March 2021. Material & Methods: Records of patients for cases diagnosed as “histiocytic necrotising lymphadenitis” were retrieved, their corresponding patient files accessed from the archive, and case notes analyzed. Results: In this series, a total of six cases of Kikuchi’s disease are presented. A female predominance is evident from the present data (2:1 female to male ratio). All patients presented with palpable lymph nodes in the neck, predominantly on the left (66.7%). Majority (66.7%) presented with neuralgic pain (on/off). Only one patient did not show weight loss and night sweating, the remaining had all the symptoms. All of the patients recovered spontaneously within 6 months (range 2 to 6 months) with symptomatic treatment for neuralgic pain. Conclusion: Kikuchi’s disease should be kept in the differential diagnosis in young females with persistent neck masses, palpable lymph nodes and suspicious fine needle aspiration cytology (FNAC).

Clinical Usefulness of Endometrial Cytology in Determining the Therapeutic Effect of Fertility Preserving Therapy

Introduction: The significance of endometrial cytology in determining the therapeutic efficacy of medroxyprogesterone acetate (MPA) therapy is unclear. This study aimed to evaluate the clinical usefulness of endometrial cytology during MPA therapy. Methods: Overall, 77 patients who underwent dilatation and curettage (D&C) to evaluate the therapeutic efficacy of MPA therapy at our hospital between January 2018 and December 2019 were retrospectively analyzed. The results of D&C, cytological evaluation, and other clinicopathological factors were analyzed based on the patients’ medical records. Results: The sensitivity and specificity of cytology were 61% and 92%, respectively, with D&C being the gold standard for diagnosis in 142 D&C/cytological examinations. Among patients with no residual disease on D&C, 5 (4%) had suspicious or positive cytology. Although MPA therapy was terminated in 3 of these patients, only 1 patient had early recurrence, and the frequency of recurrence was similar to that of patients who showed negative results in both D&C and cytology. Discussion/Conclusion: The sensitivity of endometrial cytology in determining the therapeutic effect of MPA therapy is low, and we confirmed that the omission of D&C is unacceptable. Our findings also suggested that the addition of cytological evaluation to D&C during MPA therapy had a low clinical significance.