Ultrasound-guided Fine-needle Aspiration Cytology Research Articles

Endoscopic ultrasound-guided fine-needle aspiration cytology in diagnosing intra-abdominal lesions.

Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is an effective method to acquire tissue from the mucosal, submucosal, and peri-intestinal structure with the pancreas being the most common organ to be targeted. This study is aimed to evaluate the role of EUS-FNAC in pancreatic lesions as well as other gastrointestinal (GI) structures including lymph nodes, upper GI tract, liver, and spleen. A total of 71 cases were taken in which EUS FNAC was performed over 19 months (2018-July 2019). The details analysis of the cytological features was performed in all these cases along with the clinical outcome. The diagnostic efficacy of the EUS-FNAC was evaluated in these cases. Out of 71 cases, 36 (50.7%) were male. The most common site being the pancreas 45 (60%) followed by intra-abdominal lymph nodes in 13(17.3%) cases and stomach 7 (9.3%). The neoplastic aspirate was noted in 38 (50.7%) cases. Among malignant lesion, adenocarcinoma was the most common; however, uncommon malignancies such as metastatic malignant melanoma and acinar cell carcinoma were also noted. Malignant lesion in pancreas includes adenocarcinoma (n = 11, 24.4%) followed by neuroendocrine tumor (n = 7, 15.6%). Tuberculosis was one of the common benign lesions to be reported. EUS-FNAC is an effective tool in the diagnosis of GI lesion particularly in the pancreas where it can avoid unnecessary surgical intervention in advanced malignancies. It can effectively obtain samples for molecular markers for pancreatic cancers. Nonetheless, diagnosing tuberculosis in inaccessible lymph nodes with its help is a lifesaving approach especially in developing countries.

Utilisation of specialist sonographers for head and neck ultrasound fine-needle aspiration cytology can help shorten waiting lists and improve efficiency of the service

Head and neck ultrasonography with fine-needle aspiration cytology (FNAC) is recommended by the National Institute for Health and Care Excellence (NICE) and the British Association of Head and Neck Oncologists (BAHNO) for investigating neck masses. Finite specialist radiologists and increased demands on services have increased waiting lists and breached targets. Many patients are on a two-week cancer pathway and accurate investigation cannot be delayed. The implementation of a sonographer trained in neck ultrasound-guided FNAC was analysed together with its impact on the service. Over a 21-month period we have demonstrated a fall in waiting lists from 310 to 28 patients, without compromise to diagnostic accuracy. Additionally, a cost-saving of £60,000 was made. Improvements in efficiency and waiting lists can be achieved through targeted specialist training for allied health professionals, liberating specialists for other duties.

CORRELATION BETWEEN HIGH-RESOLUTION ULTRASONOGRAPHY AND ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY FOR THE DETECTION OF MALIGNANT NODULES

Aims: Our study aims to evaluate the effectiveness of high-resolution real-time gray-scale ultrasonography with ultrasound-guided ne-needle aspiration cytology (FNAC) in identifying thyroid cancer nodules. Thyroid nodules are a frequent medical condition brought on by a number of thyroid problems. By palpating them, they can be detected in 4%–8% of adults, in 10%–41% of adults by ultrasonography (US), and in 50% of people by pathologic examination at autopsy. The thyroid gland's pathological states and thyroid gland morphology can be accurately assessed by using HRUSG. Our study's objective is to evaluate the reliability of HRUSG in identifying malignant nodules with the help of ultrasound-guided ne-needle aspiration cytology. It is a retrospective study of 50 Settings and Design: patients (aged 16–63 years) who were examined with high-resolution ultrasound (HRUSG) of the thyroid gland and for ultrasoundguided FNAC between January 2022 till August 31, 2022 This study comprised 5 Material and methods 0 patients with thyroid nodules identied by ultrasonography. Each nodule's properties were identied. Following that, the outcomes were differentiated with Ultrasound-guided FNAC. Sensitivity, specicity, positive pr Stastistical Analysis used: edictive value, negative predictive value and accuracy were used Out of 50 nodules examined, 10 (20%) were found to b Results: e malignant on cytology. In this study with the aid of Gray-scale ultrasound features of thyroid nodules Conclusions ,malignant thyroid nodules can be differentiated from those with benign ones. HRUSG ndings of hypoechogenicity, microcalcication, and poorly dened margins have high diagnostic accuracy for identifying malignant thyroid nodules as mentioned in our study.

Fine-needle aspiration cytology versus core needle lymph node biopsy in axillary staging of breast cancer

BackgroundAxillary lymph node status is an extremely important prognostic factor in evaluating and managing recently diagnosed breast cancer patients. So, preoperative evaluation of the lymph nodes in breast cancer patients with minimally invasive methods is of significant concern. Ultrasonography is the main modality used for this purpose, with advantages including the ability to help to guide the biopsy. This study aimed to compare ultrasound-guided fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in their ability to detect metastatic disease in the axillary lymph nodes, as well as to estimate the accuracy of preoperative ultrasound-guided axillary lymph node biopsy for staging in patients with breast cancer.ResultsIn total, 108 cases were included in the study, and 55.6% (60 cases) had metastases. The sensitivity for FNAC was 83.3%, and the specificity was 100%. The sensitivity for CNB was 100% and the specificity was 100%. The negative predictive value for FNAC was 81.5%, and that for CNB was 100%. The positive predictive value was 100% for both methods.ConclusionsCNB biopsy shows higher sensitivity and accuracy than FNAC in the characterization of benign and malignant lymph nodes. FNAC is a suitable substitute when a smaller node is encountered, a node in an inaccessible site, or even an uncorrectable bleeding diathesis of the patient.

Image guided fine needle aspiration cytology of hepatic lesions – Two year study in a Tertiary health care centre, Telangana (Hyderabad)

Mass lesions of liver are generally evaluated by Fine needle aspiration (FNA). Aim of present study was to assess the utility of ultrasound guided FNA cytology in the diagnosis of hepatic lesions and to study the cytomorphological features of these lesions and to categorise them as inflammatory, benign and malignantPatients who have been admitted during a period between 2018 to 2021 February with suspected liver diseases were subjected to ultrasound guided FNAC and cytological assessment.Fine needle aspirations of liver were performed on 39 patients. Out of which 26 were suspected by malignant lesions and 13 of non-neoplastic lesions. Of the 39 aspirations performed on patients with suspected malignancy, 26 were diagnosed as positive (66.66%). Among other 13 non- neoplastic lesions only 6 were diagnosed positive under cytological examination by FNAC (46.15%). This could be due to more yield of material in malignant lesions than non-neoplastic lesions of liver and technical expertise of FNAIn most of the cases Cytomorphological study of Hepatic masses by fine needle aspiration yields an accurate diagnosis but in some cases correlation with other investigations and ancillary studies are required for definitive diagnosis.

Diagnosis of parathyroid incidentaloma detected on thyroid ultrasonography: the role of fine-needle aspiration cytology and washout parathyroid hormone measurements.

The aim of this study was to assess the diagnostic role of fine-needle aspiration cytology (FNAC) and analyze factors associated with false-negative FNAC results in patients with parathyroid incidentaloma who were referred for ultrasonography (US)-guided fine-needle aspiration (FNA) of thyroid nodules. In this study, 121 patients with suspected parathyroid lesions were enrolled. The patients underwent US-guided FNAC with measurements of washout parathyroid hormone (PTH) between January 2015 and May 2020. The diagnostic performance of FNAC for the diagnosis of parathyroid lesions was assessed using surgical results and elevated washout PTH as a reference standard. The clinical and radiologic features associated with false-negative results on FNAC for the diagnosis of parathyroid lesions were evaluated. Among the 121 nodules assessed, 38 were parathyroid lesions (31.4%), and 83 were non-parathyroid lesions (68.6%). The diagnostic performance of FNAC for parathyroid incidentaloma showed a sensitivity of 31.6% (12/38), specificity of 100% (83/83), positive predictive values of 100% (12/12), negative predictive values of 76.1% (83/109), and accuracy of 78.5% (95/121). The FNAC results of non-parathyroid lesions included thyroid nodules, lymph nodes, neurogenic tumors, and fat tissue. True-positive results on FNAC were significantly associated with performing FNA twice (58.3% vs. 23.1%, P=0.043). Considering the low sensitivity of FNAC, measuring washout PTH in addition to FNAC may help accurately diagnose parathyroid incidentaloma on thyroid US. Further, the falsenegative rate for FNAC can be reduced by obtaining two or more FNA samples.

Diagnostic efficacy of ultrasonography-guided fine needle aspiration cytology on thyroid swellings

IntroductionPatients presenting with a thyroid nodule, if malignant, may call for removal. A good screening tool with high diagnostic value for preoperative evaluation is preferred. Through real-time visualization of the needle to aspirate from the suspicious site, ultrasonography-guided fine-needle aspiration cytology could be an excellent screening tool.Materials and methodA cross-sectional descriptive study was conducted at Ganesh Man Singh Memorial Academy of Ear Nose Throat–Head and Neck Studies, Kathmandu, Nepal, from September 2018 to November 2019. We included 59 subjects of 15–72 years meeting the inclusion criteria. All study participants underwent preoperative ultrasonography-guided fine-needle aspiration cytological evaluation of thyroid nodule, which was correlated with their histopathological findings to determine diagnostic values.ResultThe sensitivity, specificity, and accuracy of ultrasonography-guided fine-needle aspiration cytology of thyroid nodule was 96.96%, 61.53%, and 81.35%, respectively. On stratification according to size, high sensitivity of 100% was observed in evaluating lesions of size < 2 cm and > 4 cm. There was a good inter-rater agreement between findings of ultrasonography-guided fine-needle aspiration cytology and histopathology with a kappa coefficient of 0.607.ConclusionUltrasonography-guided fine needle aspiration cytology is a reliable procedure to evaluate thyroid lesions with high diagnostic value. It is an excellent tool for evaluating small, non-palpable nodules.

Ultrasound-Guided Fine Needle Aspiration of Deep Thyroid Nodule: Is There a Correlation between the Nodule's Depth and Nondiagnostic Results?

Objective To evaluate whether thyroid nodule depth correlates with nondiagnostic results in ultrasound-guided fine needle aspiration cytopathology. Background Many factors correlate with nondiagnostic ultrasound-guided fine needle aspiration cytology (FNAC) results, including older age, macrocalcification, small-sized nodules, aspirin medication, and cystic portion in more than 50% of the thyroid nodules. However, there are few studies which have examined whether there is a relationship between the depth of nodules and the percentage of nondiagnostic results in cytology (Bethesda category I). We conducted this study in order to investigate if such a correlation exists. Materials and Methods FNAC was performed on 283 thyroid nodules between January 2019 and December 2020. Cytological analyses of the nodules were reviewed and sorted as nondiagnostic and diagnostic according to the Bethesda score. Patient files and ultra sound (US) scans were reviewed for clinical information (such as age, sex, and ethnic group) and sonographic features of nodules (such as depth, size, cystic portion, type of calcification, and echogenicity) and were compared between the nondiagnostic and diagnostic nodule results. The depth of a nodule was calculated as the shortest distance from the skin to the most superficial border of the nodule in the axial plane, using our medical center's computer program, which allows reviewing all saved shots of the US scan. Results Age, sex, and ethnicity were not significantly different between the nondiagnostic group and the diagnostic group (p > 0.05). Nodule diameter, cystic portion, calcification, and echogenicity were also not associated with the frequency of nondiagnostic results. The depth of nodules ≥9 mm was correlated with nondiagnostic US-guided FNA cytological results (OR = 2.55, p=0.018). Conclusions Deep thyroid nodules correlated with nondiagnostic US-guided FNA cytological results. Further studies are needed for optimizing the approach to deep thyroid nodules in order to improve the efficacy of FNA in deep thyroid nodules.

ADC Values of Cytologically Benign and Cytologically Malignant 18 F-FDG PET-Positive Lymph Nodes of Head and Neck Squamous Cell Carcinoma.

Simple SummaryIn squamous cell carcinoma of the head and neck, 18F-fluordeoxyglucose positron emission tomography (FDG-PET), diffusion-weighted magnetic resonance imaging (DW-MRI) and ultrasound-guided fine needle aspiration are commonly used imaging tools for nodal staging (N-staging). Although FDG-PET has good performance in nodal detection, it is still difficult to distinguish between PET-positive reactive and malignant nodes for the purpose of selecting nodes to be aspirated. DW-MRI can help to detect small lymph node metastases, and an inverse correlation with FDG uptake is expected. We found a mild negative correlation between SUVmax and ADC. Comparing the apparent diffusion coefficient (ADC) values between PET-positive and PET-negative nodes, ADC was significantly higher in PET-negative nodes. Whereas no significantly lower ADC value of cytological malignant nodes could be found overall, in the subgroup of non-HPV-related nodes, the ADC values of cytologically malignant PET-positive nodes were significantly lower than in cytologically benign nodes. This finding might be helpful in selecting nodes for puncture.Nodal staging (N-staging) in head and neck squamous cell carcinoma (HNSCC) is essential for treatment planning and prognosis. 18F-fluordeoxyglucose positron emission tomography (FDG-PET) has high performance for N-staging, although the distinction between cytologically malignant and reactive PET-positive nodes, and consequently, the selection of nodes for ultrasound-guided fine needle aspiration cytology (USgFNAC), is challenging. Diffusion-weighted magnetic resonance imaging (DW-MRI) can help to detect nodal metastases. We aim to investigate the potential of the apparent diffusion coefficient (ADC) as a metric to distinguish between cytologically reactive and malignant PET-positive nodes in order to improve node selection criteria for USgFNAC. PET-CT, real-time image-fused USgFNAC and DW-MRI to calculate ADC were available for 78 patients offered for routine N-staging. For 167 FDG-positive nodes, differences in the ADC between cytologically benign and malignant PET-positive nodes were evaluated, and both were compared to the ADC values of PET-negative reference nodes. Analyses were also performed in subsets of nodes regarding HPV status. A mild negative correlation between SUVmax and ADC was found. No significant differences in ADC values were observed between cytologically malignant and benign PET-positive nodes overall. Within the subset of non-HPV-related nodes, ADCb0-200-1000 was significantly lower in cytologically malignant PET-positive nodes when compared to benign PET-positive nodes. ADCb0-1000 and ADCb0-200-1000 were significantly lower (p = 0.018, 0.016, resp.) in PET-negative reference nodes than in PET-positive nodes. ADC was significantly higher in PET-negative reference nodes than in PET-positive nodes. The non-HPV-related subgroup showed significantly (p = 0.03) lower ADC values in cytologically malignant than in cytologically benign PET-positive nodes, which should help inform the node selection procedure for puncture.

Radiofrequency Ablation of Recurrent Metastatic Papillary Thyroid Cancer to a Lymph Node

Radiofrequency Ablation of Recurrent Metastatic Papillary Thyroid Cancer to a Lymph Node

Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck

Cystic masses of the lateral neck are mostly benign. However, the incidence of metastatic squamous cell carcinoma (SCC) in cervical cystic masses initially diagnosed as benign is quite high in patients older than 40 years. The aim of this study was to compare the diagnostic accuracy of preoperative cytology and intraoperative frozen section (FS) in detecting malignancy in cystic masses of the neck. We reviewed 61 patients who underwent preoperative ultrasound-guided fine-needle aspiration cytology (FNAC) and neck biopsy of a cystic neck mass, and analysed the concordance between FNAC and intraoperative FS with respect to definitive histology. HPV status was also tested. Of 49 eligible cases, the accuracy of preoperative FNAC was 70.5% (weighted kappa 0.53), meaning moderate agreement between cytology and final diagnosis. Intraoperative FS consultations detected 16 cases of SCC metastasis while the remaining 33 cases were negative for SCC, showing perfect agreement with histology. Since FS results were useful in evaluating cystic neck masses, despite a moderate accuracy of cytology, we suggest intraoperative FS analysis for all cystic neck masses. This technique can allow us to switch to therapeutic neck dissection, multiple upper aerodigestive tract biopsies, tongue base mucosectomy, and bilateral tonsillectomy in the same surgical setting.

Diagnostic Accuracy of Strain Ultrasound Elastography in Thyroid Lesions Compared to Fine-Needle Aspiration Cytology.

IntroductionStrain ultrasound-guided elastography (USE) could be used to differentiate malignant from benign thyroid lesions if its sensitivity and specificity are significantly high. Data on whether to rely on USE in differentiating thyroid nodules are unavailable, and fine-needle aspiration cytology (FNAC) remains the gold standard. However, FNAC carries a significant financial burden on hospitals and psychological stress on patients. Therefore, we conducted this study to determine the diagnostic accuracy of strain USE in thyroid lesions.MethodologyWe conducted a descriptive cross-sectional study at the Radiology Department, Benazir Bhutto Hospital, Rawalpindi, from December 6, 2020, to June 5, 2021. The study included adult patients aged between 20 to 70 years who were referred with thyroid nodules or lesions found clinically or on routine neck ultrasound. The study excluded patients who had previous history of surgery or previously diagnosed with malignant thyroid lesions and recurrent thyroid nodules. Strain USE was performed on thyroid nodules, and the degree of strain was color-coded on a scale from red (soft, greatest elasticity) to green (intermediate, average strain) to blue (hard, no elasticity/strain). Lesions were given an elasticity score on a five-point scale. The lesion was given a score of one if the entire lesion was uniformly shaded in green. A lesion with mosaic pattern of green and blue was scored as two. A score of three denoted a lesion with green periphery and blue center on strain elastography. A score of four indicated uniform blue in the entire lesion, with green in the lesion's periphery. The highest score of five was given if the lesion and its surroundings demonstrated blue color. Ultrasound-guided FNAC of the thyroid nodules was performed following USE. Data was analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Mean ± standard deviation for calculating quantitative variables. Frequencies and percentages were calculated for qualitative variables. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of strain USE was calculated taking FNAC as gold standard. We also conducted a receiver operating characteristic curve analysis to quantify the diagnostic accuracy of strain USE in thyroid lesions.ResultsThe study included 207 adult patients (117 women, 56.52%; 90 men, 43.48%). The study population's mean age was 50.0 ± 11.8 years (range, 20 to 70 years). Most patients (56.52%) were aged 46 to 70 years. FNAC confirmed malignant thyroid nodules in 100 cases (true positive), and nine cases (false positive) had no malignant lesions on FNAC. In USE-negative patients, 91 were true negative, while seven were false negative. Strain USE's overall sensitivity was 93.46%, specificity was 91.0%, PPV was 91.74%, NPV was 92.86%, and diagnostic accuracy was 92.27% compared to the gold standard FNAC.ConclusionsStrain USE in thyroid lesions is a noninvasive modality of choice with high diagnostic accuracy and has dramatically improved our ability to diagnose malignant thyroid nodules preoperatively. Strain USE also helps the surgeons in proper decision-making. Strain USE should be used routinely in all patients with thyroid lesions to help diagnose malignant thyroid nodules preoperatively and inform proper surgical and treatment plans.

DIAGNOSTIC YIELD OF ULTRASOUND-GUIDED FNAC OF PERIPHERAL LUNG LESIONS WITH A SUSPICION OF MALIGNANCIES -A PROSPECTIVE OBSERVATIONAL STUDY.

Introduction: Lung cancer is the most common cancer among men with presenting diverse presentations. It can present as an incidental isolated nodule or mass to obstructive pneumonia, pleural effusions or lymphangitis carcinomatosis. Diagnosis is done by cytology or histologically obtained by bronchoscopy, pleural fluid analysis or CT-guided sampling of mass or nodules. CT has the advantage of accuracy at the cost of radiation, cost and need for technical skills. Ultrasound has recently emerged as important imaging of choice for not only pleural effusions but also for parenchymal lesions. Ultrasound has the advantage of portability, and non-radiation but needs skills in the identification and sampling of lesions. This study aimed to assess the diagnostic yield of ultrasound-guided FNAC /Biopsy of radiologically suspected peripheral lung lesions. An institution based prospective study was conductedMaterials and methods: over a span of 2 years on 62 patients with informed consent. FNAC was performed under USG guidance for peripheral lung nodules/masses, with clinical &amp; radiological suspicion of neoplasm in chest radiographs. All relevant medical records including history, USG, CT scan, histopathological diagnosis and bronchoscopic findings are collected and analysed. Out of 62 cases selected for the study (n=48, 77.41%) male preponderance was seen. The commonestResults: age group was (n=26, 41.93%) between 60 – 75 years. The commonest symptom (n=50, 80.64%) being cough and common site for lesion (n=20, 32.25%) was upper zone lesions, with an equal incidence of both right and left sides. Of the 62 patients 58 have histologically positive diagnosis of malignancy. Squamous cell carcinoma (n= 26, 41.93%) was the commonest. One patient suffered from pneumothorax with no mortality related to the procedure. USGConclusions: guided FNAC is an extremely valuable, safe imaging modality in the evaluation of peripheral nodules/masses with excellent diagnostic yield.

Ultrasound-guided fine-needle aspiration cytology significantly improved mycetoma diagnosis.

BackgroundUltrasound (US)‐guided fine‐needle aspiration cytology (US‐FNAC) has improved the diagnosis of many malignancies, infections and other diseases as it is safe, simple, quick and accurate. In mycetoma, it is assumed that this technique may have a better diagnostic yield than the conventional FNAC as it can accurately identify the optimal site for the aspiration.ObjectiveTo compare the diagnostic yield of conventional FNAC with US‐FNAC.MethodsThis descriptive cross‐sectional hospital‐based study included 80 patients with clinically suspected mycetoma.ResultsOf the 80 patients included, 35 proved to have actinomycetoma, and 37 had eumycetoma based on surgical biopsies, histopathological examination and the culture of grains. Eight patients appeared to have no mycetoma. For actinomycetoma diagnosis, the US‐guided FNAC improved sensitivity to 97% and negative predictive value (NPV) to 83% compared to the conventional FNAC, which had 63% sensitivity; and NPV of 28%. No improvement was found for specificity. For eumycetoma, the conventional FNAC had 86.5% sensitivity, 100% specificity, 100% PPV and 37.5% NPV. The US‐FNAC for the diagnosis of eumycetoma had 100% sensitivity and specificity.Conclusions and relevanceThe obtained results showed that US‐FNAC is better than the conventional FNAC with lower false‐negative results. It can accurately distinguish between the two types of mycetoma, allowing rapid initiation of proper treatment. The technique can be used in rural areas with low resources and for epidemiological surveys as a quick screening tool for patients suspected of mycetoma.

Outcome and Prognostic Factors in Cats Undergoing Resection of Intestinal Adenocarcinomas: 58 Cases (2008-2020).

The purpose of this multi-institutional retrospective study was to expand the available data pertaining to pre-operative clinical findings, progression-free and overall survival times, and potential prognostic factors for cats undergoing surgery for intestinal adenocarcinomas. Fifty-eight cats treated over a 12-year period were included in the study. Progression-free and overall survival times were estimated using Kaplan-Meier analyses. Potential prognostic variables were evaluated for associations with progression-free and overall survival using univariate Cox proportional hazards regression analyses. Prior to surgery, the intestinal mass was identified using ultrasonography in 89% of cats in which it was applied; however, imaging findings suggestive of intrathoracic metastases were observed in only 9% of cats. Among 22 cats undergoing ultrasound-guided fine needle aspiration cytology, the results agreed with the results of histopathology in only 10 cats. Discordant results were most commonly related to the presence of marked inflammation in cytology samples, which may have obscured the presence of neoplastic cells. Diffuse intestinal small cell lymphoma was identified as a comorbidity in 5 cats. Resection of the tumor with the objective of obtaining wide surgical margins was performed in each cat. On histopathology, 20 tumors were classified as mucinous adenocarcinoma and 28 were adenocarcinoma not otherwise specified. Intestinal transection site margins were complete in 94% of cats; however, complete mural margins were present in only 15% of cats. Local lymph node metastases were identified in 52% of cats and carcinomatosis was diagnosed in 81% of cats. Disease progression was documented in 32 of the 58 cats (55%). Of these 32 cats, 14 (43%) had local recurrence of the primary intestinal tumor. Median progression-free survival was 203 days (95% CI 130–299 days), and median overall survival time was 284 days (95% CI 200–363 days). Mitotic count was inversely associated with progression-free survival (HR 1.04; 95% CI 1.01–1.07, P = 0.005); however, none of the remaining potential prognostic factors, including administration of adjuvant chemotherapy, were significantly associated with progression-free or overall survival. Feline intestinal adenocarcinoma remains an aggressive and highly fatal disease. Large, randomized controlled clinical trials will be needed to improve the survival prospects for affected cats.

A Comparative Study of the Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology (EUS-FNA) versus Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB) in Pancreatic and Non-Pancreatic Lesions.

Objectives:Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the procedure of choice to obtain samples from pancreatic lesions. However, it still has limitations affecting its diagnostic yield. The endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed to allow acquisition of histological core. We conducted this study to compare the diagnostic yield of the Echotip 22Gauge FNA needle with the 22Gauge acquire FNB needle in pancreatic and non-pancreatic lesions. Materials and Methods:This prospective study was carried out on 100 cases of pancreatic and non-pancreatic lesions referred to El-Ebrashi unit of Gastroenterology and Hepatology, internal medicine department, Kasr Al-Aini hospital. The patients included were then randomized for sampling using either the standard Echotip 22Gauge FNA needle or 22Gauge acquire FNB needle. Results:Patients were 57 males and 43 females with a mean age of 58±15 years. Seventy-eight patients had pancreatic lesions, while twenty-two patients had non-pancreatic lesions. Half of the patients (50 cases) underwent EUS-FNA, and the other half (50 cases) underwent EUS-FNB. The presence of adequate tissue core was significantly higher in the FNB group. In contrast, smear cellularity was not significantly different between both groups. FNB had more sensitivity and accuracy depending on cell block/tissue core examination only for diagnosing pancreatic lesions. Blood contamination was higher in cell blocks of the FNA group. The sensitivity, specificity, and accuracy in the combined cytologic and histologic evaluation were 100%. Based on smear only or tissue only, the specificity was 100%, but the sensitivity and accuracy were decreased in both techniques. No complications were reported in both techniques. Conclusion:EUS-guided FNA and FNB are safe with comparable diagnostic accuracy in pancreatic and non-pancreatic lesions. FNB improved the histopathological quality of specimens with little blood contamination. Depending on tissue examination only in diagnosing pancreatic lesions, FNB had more sensitivity and diagnostic accuracy.

Development of “Mathematical Technology for Cytopathology,” an Image Analysis Algorithm for Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related death worldwide. The accuracy of a PDAC diagnosis based on endoscopic ultrasonography-guided fine-needle aspiration cytology can be strengthened by performing a rapid on-site evaluation (ROSE). However, ROSE can only be performed in a limited number of facilities, due to a relative lack of available resources or cytologists with sufficient training. Therefore, we developed the Mathematical Technology for Cytopathology (MTC) algorithm, which does not require teaching data or large-scale computing. We applied the MTC algorithm to support the cytological diagnosis of pancreatic cancer tissues, by converting medical images into structured data, which rendered them suitable for artificial intelligence (AI) analysis. Using this approach, we successfully clarified ambiguous cell boundaries by solving a reaction–diffusion system and quantitating the cell nucleus status. A diffusion coefficient (D) of 150 showed the highest accuracy (i.e., 74%), based on a univariate analysis. A multivariate analysis was performed using 120 combinations of evaluation indices, and the highest accuracies for each D value studied (50, 100, and 150) were all ≥70%. Thus, our findings indicate that MTC can help distinguish between adenocarcinoma and benign pancreatic tissues, and imply its potential for facilitating rapid progress in clinical diagnostic applications.

Lymphovascular and perineural invasion are risk factors for inguinal lymph node metastases in men with T1G2 penile cancer.

To analyse the risk of inguinal lymph node (ILN) metastases in T1G2 penile cancer stratified by lymphovascular invasion (LVI), perineural invasion (PNI) and tumour size. Retrospective study of men with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at six European institutional high-volume centres was performed. ILN involvement was defined as cancer detected during ultrasound-guided fine-needle aspiration cytology, core needle biopsy, dynamic sentinel lymph node biopsy, ILN dissection or inguinal recurrence during follow-up. Uni- and multivariable logistic regression analyses were performed. In the cohort of 554 men with T1G2 penile cancer, from 6 European institutions, ILN metastases were observed in 46/554 men (8%, 95% confidence interval (CI) 6-11%). Men with both, LVI- and PNI- primary cancers had the lowest risk of ILN involvement (6%) whereas men with LVI + or PNI + showed ILN metastases in 22% and 30%. In multivariable regression, men with LVI + or PNI + had higher odds for ILN metastases compared to men with LVI- and PNI- (OR 3.9, 95% CI 1.6-9.0, p value < 0.01) Tumour size was not associated with ILN risk (OR 1.01 95% CI 0.99-1.04, p = 0.17). Approximately, one out of ten men with T1G2 overall and one out of four men with either LVI + or PNI + still have ILN metastases despite being clinically node negative. Therefore, invasive ILN staging should strongly be recommended in T1G2 with LVI + or PNI + but importantly, must be discussed in patients with T1G2 with LVI- or PNI-.

Correlation of American College of Radiology (ACR)-Thyroid Imaging Reporting and Data System (TIRADS) findings in Ultrasonogram (USG) of thyroid nodules with FNAC or Biopsy findings

Thyroid Imaging Reporting and Data System (TIRADS) classifies the different ultrasound patterns of thyroid nodule into different TIRADS classes based on their malignant potential. And ultrasound-guided fine needle aspiration cytology (FNAC) is considered the most accurate method to evaluate thyroid malignancy. A prospective study was carried out during 2020 - 2021 in the Department of Radiology &amp; Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 115 patients underwent ultrasonography of the lesions in one or both lobes or isthmus of the thyroid gland. The patients underwent FNAC or biopsy for these thyroid lesions. This study was carried out to correlate ACR-TIRADS findings in USG of thyroid nodules with FNAC or Biopsy findings. The ages of the patients ranged between 13 years to 77 years, with 72 female patients and 43 male patients. Different varieties of USG features were found in all the different categories of the ACR-TIRADS scoring system. Of total 115 nodules, maximum cases were in TR 3 (33.0%), followed by TR 2 (28.7%), TR 4 (18.3%), TR 1 (13.9%) and TR 5 (6.1%). Cytopathological reports revealed 75.6% of cases to be non-neoplastic. Among neoplastic lesions, 14 (12.2%) were of the indeterminate type of lesions and 14 (12.2%) were malignant nodules. Colloid goiter constituted the majority of non-neoplastic thyroid nodules (39.9%) and papillary carcinoma constituted 8.6% of the cases. The risk of malignancy was 0% for TR 1 and TR2 nodules, 7.9% for TR 3 nodules, 23.9% for TR 4 nodules, and 85.7% for TR 5 nodules. TIRADS score and cytopathological findings correlated well for TR 1, TR 2, and TR 5 lesions but showed less agreement for TR 3 and TR 4 nodules. This might be because of the overlap of USG characteristics between benign and malignant thyroid nodules.

The Novel Role of Cytomorphology from Ultrasound-Guided Fine Needle Aspiration Cytology in Evaluating the Status of Prognostic Factors including Estrogen Receptor, Progesterone Receptor and HER2 in Breast Cancer.

It is well established that estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2) could be regarded as prognostic factors in breast cancer. Ultrasound-guided fine needle aspiration cytology (FNAC) has revolutionized the management of cancers, providing less invasive and quick diagnostic method. There are hardly any studies on the correlation between cytomorphology and prognostic biomarkers. We retrospectively analyzed the immunohistochemistry and the fluorescence in situ hybridization of breast cancer specimens from 252 patients, who have been diagnosed as breast cancer at our hospital. Morphological features of cytology smears were scored. The relationship between cytological features and three biomarkers were analyzed. Based on this, we developed a system to predict the status of biomarkers. The results indicated that some cytological parameters, especially the features of nucleoli, were distinctively related to the makers' expression. In the novel scoring system, a cutoff of 12.0 provided a statistical discrimination for cytological grading. We concluded that cytomorphological features were associated with prognostic factors. The HR+ neoplasms showed scattered micronucleoli, while HER2+ neoplasms demonstrated centered macronucleoli. We summarized a scoring system to predict the status of three factors. This may help us to broaden the application of breast cancer cytology.