Ultrasound-guided Fine-needle Aspiration Cytology Research Articles

Sensitivity of endoscopic ultrasound-guided fine-needle aspiration cytology and biopsy for a diagnosis of pancreatic ductal adenocarcinoma: A comparative analysis.

The utility of endoscopic ultrasound fine-needle aspiration cytology (EUS-FNAC) or endoscopic ultrasound fine-needle aspiration biopsy (EUS-FNAB) for diagnosis of small and large pancreatic ductal adenocarcinomas (PDACs) remains in question. We addressed this by analyzing 97 definitively diagnosed cases of PDAC, for which both EUS-FNAC and EUS-FNAB had been performed. We subclassified the 97 solid masses into small (n = 35) or large (n = 62) according to the maximum tumor diameter (<24 mm or ≥24 mm) and compared the diagnostic sensitivity (truly positive rate) of EUS-FNAC and of EUS-FNAB for small and large masses. Diagnostic sensitivity of EUS-FNAC did not differ between large and small masses (79.0% vs. 60.0%; p = 0.0763). However, the diagnostic sensitivity of EUS-FNAB was significantly higher for large masses (85.5% vs. 62.9%; p = 0.0213). Accurate EUS-FNAC-based diagnosis appeared to depend on the degree of cytological atypia of cancer cells, which was not associated with quantity of cancer cells. The accuracy of EUS-FNAB-based diagnosis appeared to depend on cancer cell viability in large masses and cancer volume in small masses. Based on the advantages or disadvantages in each modality, both modalities play an important role in the qualitative diagnosis of PDAC as a complementary procedure.

Primary thyroid tuberculosis mimicking papillary carcinoma of thyroid: a rare case report.

A 54-year-old female presented with recent onset dysphagia and foreign body sensation in the throat for 3 months, and anterior neck swelling since last 10 years. A single nodular firm anterior neck swelling was present which moves with deglutition. Thyroid function test was normal. Ultrasonography thyroid revealed TIRADS-3. Fine-needle aspiration cytology was suggestive of papillary carcinoma of thyroid. Total thyroidectomy with central compartment neck dissection was performed. Histopathology of the thyroid specimen revealed tubercular thyroiditis. Postoperatively, Mantoux test and interferon gamma radioassay were positive. Antitubercular therapy was given for total of 6 months. With ultrasonography-guided fine-needle aspiration cytology, preoperative diagnosis of primary thyroid tuberculosis is quite challenging even in tuberculosis endemic countries. So, it should be considered one of the differential diagnoses despite negative relevant history and without clinical cervical lymph nodes involvement with cytology proven suspicious papillary thyroid cancer before proceeding for surgical intervention.

Frequency and Type of Thyroid Carcinoma in Patients With Multinodular Goiter.

Background This study aimed to investigate the incidence and subtype of thyroid cancer in multinodular goitre (MNG) patients who underwent total thyroidectomy. Methodology A cross-sectional study was conducted at the Khyber Teaching Hospital, screening 207 MNG patients who received complete thyroidectomies between July and December 2022. The senior consultant diagnosed thyroid cancer based on a complete history, physical examination, and laboratory and radiological studies. Ultrasound-guided fine-needle aspiration cytology was performed by a senior consultant radiologist. Bethesda categories for all lesions were recorded. All patients underwent thyroidectomy, and the diagnosis of thyroid cancer was confirmed on histopathology. Results A total of 207 patients were included in the study, with a mean age of 45.55 ± 8.75 years. Out of 207 patients, 24 (11.59%) were diagnosed with thyroid cancer.Out of 62 male patients, 15 (7.25%) had thyroid cancer. Out of 145 female patients, only nine had cancer (p < 0.001). Nine patients with thyroid cancer had a body mass index (BMI) below 18, compared to only five patients with a BMI of more than 30 kg/m2.The difference in age distribution was not significant in our study (p = 0.102). Conclusion In conclusion, our study sheds light on the frequency and potential risk factors associated with thyroid cancer in patients with multinodular goiter. Our findings reveal that papillary thyroid carcinoma is the most commonly observed form of thyroid cancer in this patient population, with around 12 percent of patients diagnosed with thyroid cancer. Notably, our study highlights that male patients and those with a lower BMI may have a greater risk of developing thyroid cancer in the context of multinodular goiter.The findings of this study have important implications for the care and follow-up of MNG patients who receive total thyroidectomy. Further research is needed to investigate the type and prognosis of thyroid cancer in patients with MNG.

Cytopathological evaluation of thyroid by fine needle aspiration cytology and its association with thyroid function

Introduction: Fine needle aspiration cytology is a reliable method for thyroid nodule evaluation (FNAC). Thyroid nodules often cause abnormal thyroid function tests, which are used for diagnosis and therapy. Thyroid cancer and incorrect thyroid function testing are still debated. Objective: We aimed to evaluate the cytopathological features of thyroid nodules by FNAC and their association with thyroid function tests. Methods: This 12-month cross-sectional study was conducted in Peshawar, Pakistan. 350 thyroid nodule patients were referred to endocrinology. All research participants had a physical checkup and thyroid function testing. Thyroid function testing measured TSH and FT4 using conventional laboratory procedures. All individuals had 23-gauge ultrasound-guided thyroid nodule FNAC. Pathologists used the Bethesda System for Reporting Thyroid Cytopathology to evaluate FNAC samples. SPSS 25 analyzed the data. Descriptive statistics detailed the study population's clinical and demographic characteristics. Logistic regression was utilized to examine the relationship between thyroid function tests and thyroid cancer risk and FNAC's thyroid cancer detection effectiveness. Results: For this research, a total of 350 thyroid nodule patients were included having the median age 39.8 (20-60) years and the ratio of female to male participants was 3:1.

Clinical application of ultrasound-guided Core Needle Biopsy Histology and Fine Needle Aspiration Cytology in Cervical Lymph Nodes.

To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy. A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups. The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023). No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate.

ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY IN GALL BLADDER LESIONS: A RETROSPECTIVE STUDY IN TERTIARY CARE CENTER

Gallbladder carcinoma is the one of the most common malignancy, comprising of 80–95% of biliary tract cancers. Ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) seems to an effective diagnostic the tool for the accurate diagnosis of gallbladder lesions, however data on its diagnostic utility and cyto-morphological categorization of gallbladder lesions are still lacking. Aims: To study the diagnostic usefulness of USG-FNAC in gallbladder lesions. Materials and Methods: This is retrospective study, done in tertiary health care center in which USG FNC diagnoses were correlated with histo-pathological and clinical follow-up, to assess the diagnostic accuracy. A total of 104 USG -FNCs that were performed between 1st of January 2018 to 31st of March 2022 were reviewed. Results: Out of 105 cases, n=21 cases (10.5%) were -inadequate/non-diagnostic.The mean age was 52 years, with a range of 44–78 years. Women predominated over men (Male:Female=1:2). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 97.82, 89.23, and 98.31%, respectively. Conclusion:USG FNAC techniques ensures satisfactory diagnostic accuracy specially in malignant conditions of gallbladder lesion. Other advantages are such as minimum invasiveness, rapidity, and cost effectiveness. Hence, helps in appropriate management of patients thus avoiding unnecessary morbid surgeries.

Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

BackgroundFine needle aspiration cytology has been established as a minimally invasive, non-tumour seeding investigation of choice in the initial diagnostic pathway of parotid lesions. The purpose of this study was to compare the accuracy of fine needle aspiration cytology performed with and without ultrasound to determine whether one method should be preferred to the other. A retrospective review of all patients undergoing fine needle aspiration cytology with and without ultrasound for parotid masses in a large district general hospital between 2012 and 2016 was performed. Specificity, sensitivity, accuracy, positive and negative predictive value, percentage of inconclusive fine needle aspiration cytology and percentage of second fine needle aspiration cytology were determined for each group.ResultsA total of 397 fine needle aspiration cytology results were available for analysis. The numbers performed with ultrasound guidance and free-hand were roughly equal (208 (52.3%) versus 189 (47.7%)). The number of inconclusive fine needle aspiration cytology reports was significantly higher in the free-hand group (65/189 (34.4%)) than the ultrasound group (25/208 (12%)) (p < 0.0001). A significantly higher number of repeated fine needle aspiration cytology were undertaken in the free-hand group vs ultrasound group (43 vs 15, p < 0.0001); overall 7.2% of ultrasound-guided fine needle aspiration cytology required a second fine needle aspiration cytology, compared to 22.8% in the free-hand group. The sensitivity, specificity, positive and negative predictive values were all higher in the ultrasound group versus the free-hand group.ConclusionsUltrasound-guided fine needle aspiration cytology is superior to free-hand fine needle aspiration cytology in the investigation of parotid tumours. There is a significant benefit in reducing the number of inconclusive results and repeat fine needle aspiration cytology, and a potential benefit in improving the sensitivity and positive predictive value, when immediate cytology assessment of the sample quality is not performed.

Diagnostic Efficacy of Ultrasonography, Doppler Ultrasonography and Elastography in the Evaluation of Suspected Malignant Lymph Nodes.

In this prospective study, the efficiency of imaging findings was investigated by comparing the histopathological results of lymph nodes with Doppler and ultrasound features and elasticity scores. A total of 100 cervical or axillary lymph nodes with a suspected malignancy or whose size did not decrease after treatment were examined. In addition to the demographic data of the patients, B-mode ultrasound, Doppler ultrasound, and elastography features of the lymph nodes were evaluated prospectively. The irregular shape, increased size, pronounced hypoechogenicity, presence of micro/macro calcification, short axis/long axis ratio >2, increased size of the short axis, increased cortex thickness, obliterated hilus or increased cortex thickness >3.5 mm were evaluated on ultrasound. Resistivity index, pulsatility index, acceleration rate and time were evaluated for intranodal arterial structures on color. Doppler ultrasound, strain ratio value and elasticity score were recorded on ultrasound elastography. After sonographic examination, patients underwent ultrasound-guided fine needle aspiration cytology or tru-cutting needle biopsy. Histopathological examination results of the patients were compared with the B-mode ultrasound, Doppler ultrasound, and ultrasound elastography. When the individual and combined effects of the ultrasound, Doppler ultrasound, and ultrasound elastography were evaluated, the combination of all three imaging methods was found to have the highest sensitivity and the highest overall accuracy (90.4% and 73.9%). As an individual method Doppler ultrasound had the highest specificity (77.8%). B-mode ultrasound was found to have the lowest accuracy (56.7%) both in individual and combined evaluations. Addition of ultrasound elastography to the combination of B-mode and Doppler ultrasound findings increases diagnostic sensitivity and accuracy in the differentiation of benign and malignant lymph nodes.

Pancreatic tuberculosis

Pancreas is the least common site to be involved by tuberculosis infection. Tubercular pancreatic involvement occurs either through hematogenous, lymphatic, or direct spread from the adjacent organs. However, diagnosis of this rare entity is always challenging. Clinical, laboratory, and imaging features are often nonspecific and tissue analysis is the only way to confirm the diagnosis and avoid unnecessary surgery. Recently, endoscopic ultrasonography-guided fine needle aspiration cytology has emerged as the main modality to make a diagnosis with tissue analysis showing granulomas as the most common findings. Treatment is a standard weight-based antitubercular therapy (ATT) for a duration of 6 months. Occasionally, patients with obstructive jaundice require endoscopic retrograde cholangiogram-guided biliary drainage along with ATT.

The Correlation of Sonographic and Histopathologic Findings in the Diagnosis of Palpable Breast Masses in Zaria.

Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which is widely available in most hospitals. An assessment of its accuracy in diagnosing breast masses is necessary to minimize unwarranted biopsies. This study aims to correlate the ultrasonographic and histopathologic findings in the diagnosis of patients with palpable breast masses. This was a cross-sectional hospital-based study, which involved 100 consecutive patients who presented with palpable breast masses in Zaria. This was carried out for a period of 7 months (November 2016-June 2017). They had a clinical breast examination to identify the mass, which was then imaged and biopsied via ultrasound-guided fine needle aspiration cytology. The generated data were analysed using SPSS version 23.0 (Chicago, IL, USA). There were more benign masses (63%) than malignant masses (29%). On correlating the final diagnosis of ultrasound to that of histology, it was found to have a sensitivity of 89%; specificity of 94%; positive predictive value of 89%; negative predictive value of 94%; and accuracy of 92%. This study shows that there was a correlation between ultrasound and histology findings in differentiating between benign and malignant masses. This proves that ultrasound has a significant role to play in evaluating and diagnosing clinically palpable breast masses.

Streamlining Thyroidectomy Treatment with a Multidisciplinary Approach: A Case Report

Multiple Endocrine Neoplasia 2 (MEN2) is a rare genetic disorder that affects the endocrine glands and can lead to the development of tumours in the thyroid gland, parathyroid gland, and adrenal glands. Individuals with all subtypes of MEN2 syndrome {MEN2A, MEN2B, and familial Medullary Thyroid Cancer (MTC)} are at an increased risk of developing MTC. In the present case report, authors present the case of a 26-year-old female who presented to the Department of Surgery for family screening due to her mother’s diagnosis of MEN 2A syndrome. During the screening, a swelling was identified in the anterior neck region. The swelling was firm, non tender, and not fixed to the skin. Additionally, the patient had an elevated calcitonin level. Although the patient had no history of voice abnormalities, she occasionally experienced dysphagia. A Contrast-enhanced Computed Tomography (CECT) scan of the neck revealed involvement of both lobes of the thyroid gland. To confirm the diagnosis, a DOTA NOC scan (an imaging procedure involving the injection of a radiotracer dye known as DOTA and NOC, followed by Positron Emission Tomography (PET) or Computed Tomography (CT) scan and ultrasound-guided Fine Needle Aspiration Cytology (FNAC) of the thyroid were conducted. Based on the confirmed diagnosis, the patient underwent surgical management in the form of total thyroidectomy and central compartmental lymph node dissection. However, postoperatively, the patient experienced difficulty in speech and swallowing due to involvement of the Recurrent Laryngeal Nerve (RLN). These issues were managed through physiotherapy and speech therapy as part of a holistic approach, which proved to be crucial in improving the patient’s condition and preventing complications. Therefore, the management of thyroidectomy should adopt a patient-centric and multidisciplinary approach to enhance patient outcomes and minimise complications.

Radio-Pathological Correlation of Suspected Malignant Thyroid Nodules using Elastography strain ratio and Bethesda Classification for Thyroid Cytopathology

Objectives: To determine the diagnostic performance of elastography strain ratio (SR) for the diagnosis of malignant thyroid nodules taking fine needle aspiration cytology (FNAC) as the gold standard at a tertiary care hospital in Pakistan. Methods: This is a cross-sectional study. A total of 150 cases aged 20-60 years, of either gender, who presented with palpable/suspected malignant thyroid nodules of any size with Thyroid Imaging Reporting and Data System (TIRADS) category 3 or above on ultrasonography were included. These were further evaluated by elastography and ultrasoundguided fine needle aspiration cytology (FNAC). The elastography SR of the nodules was assessed. Final diagnosis was made using ultrasound-guided FNAC. Relevant clinical and demographic data were obtained from patient charts. The diagnostic sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated for elastography using FNAC as a gold standard. Results: The mean age of all patients was 41.8±8.6 years (range: 20-60 years). There were 97 (64.67%) males and 53 (35.33%) females. The majority of patients, 50 (33.33%), belonged to age category of 41 to 50 years. Taking elastography SR of > 2.32 as the cut-off, 69 (46.0%) nodules were positive, and 81 (54.0%) were negative. The FNAC results showed that 72 (48.0%) were positive, and 78 (52.0%) were negative. The diagnostic sensitivity of SR was 92.31%, specificity, 87.50%, positive predictive value, 88.89% and negative predictive value was 91.30%. The overall diagnostic accuracy was estimated to be 87.5%. Conclusion: The results from this study show that elastography and SR are highly valuable in discriminating benign from malignant thyroid nodules. These may serve as an affordable and reliable alternative diagnostic technique, particularly in the developing world. Keywords: Bethesda system for thyroid cytopathology, elastography, strain ratio, thyroid incidentalomas, thyroid nodules

The Current Status of Ultrasonography and Fine-Needle Aspiration Citology for the Management of the Axilla in Breast Cancer

Objetive: to analyze whether ultrasonography with fine-needle aspiration cytology of an axillary suspicious node, in patients with breast cancer, could help to differentiate between patients with low involvement of the axilla (up to 2 nodes with macrometastasis) of those with high involvement of the axilla (more than 2 lymph nodes with macrometastasis). Material and methods: A total of 115 consecutive patients with breast cancer (up to 5 cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound and ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy. Results: A total of 61 patients had positive axillary ultrasound and cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative axillary ultrasound and cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes. Conclusion: ultrasound and ultrasound-guided fine-needle aspiration citology was able to identify, in a preoperative stage, those patients with high axillary involvement (more than 2 lymph nodes with macrometastasis). The latter are the patients who would benefit from lymphadenectomy of the axilla, ignoring the sentinel lymph node biopsy stage.

Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.

Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients. We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results. In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; p < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; p < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence. The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.

Comparative study of Fine-Needle Aspiration Cytology and Histopathological diagnosis of salivary gland swelling

Introduction: Fine-needle aspiration cytology (FNAC) of salivary gland swelling helps differentiate benign and malignant lesions, thereby allowing clinicians to plan proper management. Ultrasound-guided FNAC is more accurate than other methods of FNAC. It is simple and safe and lacks significant complications. It is also inexpensive and can be repeated if needed.&#x0D; Methods: This study is a prospective study of 80 patients subjected to FNAC followed by surgery and histopathological examination, from September 2017 to July 2019. Histopathology reports were compared with the preoperative FNAC reports. In all 80 cases, informed consent was obtained prior to surgery.&#x0D; Results: True-positive, true-negative, false-positive, and false-negative rates for carcinomatous lesions of salivary gland swelling were assessed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.82%, 97.10%, 81.82%, 97.10%, and 95%, respectively for FNAC when compared against histopathology.&#x0D; Conclusion: FNAC is a sensitive, specific, and accurate diagnostic test used for the preoperative evaluation of patients with salivary gland swelling. FNAC is very commonly used as an initial routine investigation.

Ultrasonographic and cytological characterization of ultrasound-guided fine-needle aspiration cytology of cervical lymph nodes for false-negative and false-positive diagnosis.

The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency. The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency. The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results. Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.

Diagnostic Accuracy of Image-guided Biopsies for Diagnosis of Metastatic Melanoma in a Real-life Setting

Early detection of melanoma metastasis is essential in order to initiate treatment and improve patient prognosis. The aim of this study was to determine the diagnostic accuracy of different image-guided biopsy techniques in patients with melanoma. A cohort study of patients diagnosed with melanoma who had undergone image-guided biopsies (ultrasound-guided fine-needle aspiration cytology, ultrasound-guided core-needle biopsy, computerized tomography--guided fine-needle aspiration cytology and computerized tomography-guided core-needle biopsy) to detect melanoma metastasis between 2004 and 2021 was conducted. The reference standard was histological confirmation and/or clinical-radiological follow-up. Sensitivity, specificity, positive and negative predictive values were calculated. A total of 600 image--guided biopsies performed on 460 patients were included for analysis. Locoregional lesions represented 459 (76.5%) biopsies, and 141 (23.5%) were distant lesions. Of the included biopsies, 49 (8.2%) were insufficient for diagnosis. Overall, sensitivity and specificity were 92% (95% confidence interval 89-94) and 96% (95% confidence interval 91-99), respectively. Sensitivity sub-analyses revealed lower diagnostic accuracy values in the lung, inguinal lymph nodes, and computerized tomography-guided lesions under 1 cm. Limitations include spontaneous metastasis regression and arbitrary minimum follow-up period. Image-guided biopsies in patients with melanoma have high sensitivity and specificity for detection of regional or distant metastasis. Tissue type, location and tumour burden may influence the diagnostic accuracy of the test.

A Case of Thyroid Chondrosarcoma

We herein report a rare case of thyroid chondrosarcoma in which laryngeal preservation surgery was performed. The patient was a man in his 40s. A hard mass was palpated on the right lateral side of the thyroid cartilage. Enhanced computed tomography showed a tumor on the right lateral side of the thyroid cartilage with partial destruction of the thyroid cartilage. Ultrasonography-guided fine-needle aspiration cytology suggested the lesion was a tumor of cartilage origin. We therefore diagnosed a thyroid cartilage tumor. We performed partial laryngectomy. Intraoperative findings revealed a hard tumor contiguous with the thyroid cartilage deep in the right omohyoid muscle. The right two-thirds of the thyroid cartilage were cut longitudinally, and the tumor was removed. The pathological diagnosis was a grade 2 chondrosarcoma of thyroid cartilage origin. Two years after surgery, there was no recurrence. There have been 37 cases of laryngeal chondrosarcoma reported in Japan, and only 8 were of thyroid cartilage origin. Surgical treatment was selected in all cases, with 16 cases treated by total laryngectomy and 21 cases by partial laryngectomy. Recurrence was reported in five cases, including local recurrence in three cases, cervical recurrence in one case, and distant metastasis in one case.

KRAS Mutation Testing on Endoscopic Ultrasound-Guided Fine-Needle Aspiration Samples Improves the Diagnostic Accuracy of Pancreatic Cancer.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology was one of the investigations for pancreatic masses. While the specificity approached 100%, its sensitivity remained low because of high rate of indeterminate and false-negative results. Meanwhile, KRAS gene was frequently mutated in up to 90% of pancreatic ductal adenocarcinoma and its precursor lesions. This study aimed to determine whether KRAS mutation analysis could improve the diagnostic sensitivity in EUS-FNA samples for pancreatic adenocarcinoma. The EUS-FNA samples from patients with a pancreatic mass obtained between January 2016 and December 2017 were reviewed retrospectively. The cytology results were classified as malignant, suspicious for malignancy, atypical, negative for malignancy, and nondiagnostic. KRAS mutation testing was performed using polymerase chain reaction followed by Sanger sequencing. A total of 126 EUS-FNA specimens were reviewed. The overall sensitivity and specificity by cytology alone were 29% and 100%, respectively. When KRAS mutation testing was performed in cases with indeterminate and negative cytology, the sensitivity increased to 74.2%, and the specificity remained at 100%. KRAS mutation analysis, especially when performed in cytologically indeterminate cases, improves the diagnostic accuracy for pancreatic ductal adenocarcinoma. This may reduce the need to repeat invasive EUS-FNA for diagnosis.

ODP585 Occult metastatic medullary thyroid carcinoma without detectable primary tumor.

Abstract Background Occult thyroid cancer is a particularly rare type of thyroid carcinomas. The absolute majority is presented by papillary thyroid carcinoma. We report a case of a medullary thyroid carcinoma (MTC) that was detected as a primary tumor neither on preoperative ultrasound examination nor on postoperative morphological examination. Case A 57-year-old patient with no personal or family history of thyroid disease presented to the surgeon with the complaint of swelling in the cervical lymph nodes. Ultrasonography of the thyroid showed a hypoechoic 4 mm zone with peripheral calcification in the right lobe and two suspicious malignant lymph nodes 14×12 mm and 10×7 mm in the right paratracheal region. A blood test revealed no abnormalities in thyroid function (TSH 0.9 mUI/L, fT3 4.25 pmol/l, fT4 10.2 pmol/l). However, the calcitonin (CT) and the carcinoembryonic antigen (CEA) levels were significantly elevated – 144 pg/ml (N for male &amp;lt;12) and 28 pg/ml (N &amp;lt;5). We performed an ultrasound-guided fine-needle aspiration (FNA) cytology from the thyroid nodule with subsequent FNA-CT measurement which showed no signs of MTC (cells, adequate CT level). On the other hand, FNA of the lymph node revealed cytomorphology characteristics of MTC and according to FNA-CT measurement, the CT concentration exceeded the upper reporting range of 2000 pg/ml. We carried out the measurement of stimulated CT. Taking into account the significant CT level increase (0 min – 168 pg/ml, 2 min – 1050 pg/ml, 5 min – 857 pg/ml), we excluded the extrathyroidal CT production. Genetic analysis demonstrated the absence of usual RET mutation. Computed tomography was carried out showing multiple calcifications up to 6 mm in diameter in the lung. On the cervical scan: the right upper paratracheal lymph node (11 mm) and a 6 mm mass with calcification in the structure along the front line of the right main bronchus (at the level of the bifurcation), the rest of the lymph nodes were not enlarged. The patient underwent total thyroidectomy with central lymph node dissection. On the section in the middle third of the lobe, there was a dense, yellowish-grey knot of 5 mm in size and 8 lymph nodes 5-15 mm. Surprisingly the right lobe node was represented by colloid goiter with foci of fibrosis and calcifications. In two of the eight cervical nodes, we identified nodal metastases that contained a component of MTC. The primary tumor was not detected even after thorough and complete pathologic examination and immunohistochemical study of the thyroid. Postoperative CT level (third day after surgery) has fallen to 5.45 pg/ml. Conclusion Metastatic medullary thyroid carcinoma without detectable primary tumor is a rare but real occurrence that might be encountered in practice. The lack of malignant findings in the thyroid gland during preoperative examination complicates the diagnostic. Presentation: No date and time listed