Ultrasound-guided Fine-needle Aspiration Cytology Research Articles

Primary Adrenal Neuroblastoma in an Adult: A Rare Case Report

ABSTRACT Neuroblastoma (NB), an embryonal malignancy originating from neural crest cells, is predominantly a pediatric disease, making adult cases exceedingly rare. This case report documents the presentation and diagnostic process of a 23-year-old female diagnosed with adrenal NB, a condition scarcely encountered in adults. The patient presented with abdominal pain and a palpable mass. Imaging through computed tomography scan revealed a large necrotic mass in the left adrenal region. Ultrasound-guided fine-needle aspiration cytology (FNAC) showed round cells with scant cytoplasm and characteristic nuclear features, suggesting a round cell tumor, potentially NB. Surgical excision confirmed the diagnosis of poorly differentiated NB with low mitotic-karyorrhectic index. Adult NB, with an incidence of 1 in 10 million per year, has a notably worse prognosis compared to pediatric cases. The literature lacks consensus on optimal treatment protocols for adult patients, though a multimodal approach including surgery, chemotherapy, and possibly radioactive iodine therapy is often employed. This case underscores the utility of FNAC in preliminary diagnosis and highlights the clinical challenges posed by adult NB, emphasizing the need for more comprehensive studies to develop standardized treatment guidelines.

Diagnostic sensitivity of fine-needle aspiration cytology in thyroid cancer

Introduction Fine-needle aspiration cytology (FNAC) is an effective tool in the diagnostic work-up of patients with thyroid nodules. The aim of our study was to assess the diagnostic sensitivity of FNAC in thyroid cancer (TC) in Sweden by correlating the findings of preoperative FNAC with those obtained through final histology of the surgical specimen. Methods A Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing patient FNAC and histology reports. Results Among the 2519 cases operated with a final diagnosis of TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%), included in the present study. Among these, 1679 patients (72%) were female and the median age at TC diagnosis was 52.3 years (range 18-94.6). In 353 cases (15.1%) FNAC was not performed at all; whereas in the remaining 1965 cases, the diagnostic sensitivity of FNAC was 81.6%. In lesions > 1 cm, FNAC diagnostic sensitivity reached 86.5%, whereas in lesions < 1 cm, FNAC yielded a sensitivity of 61.5%. Approximately 85% of FNACs (n = 1981/2332) were performed using ultra-sonographic (US) guidance. In TC lesions > 1 cm, the diagnostic sensitivity of US-guided FNAC (n = 1504) was 86.9% as compared to 76.9% in clinically applied FNAC without US utilization (n = 118). Conclusions FNAC is performed in most patients operated for TC in Sweden (85%) and retains its value as a tool in TC diagnostic work-up with an overall sensitivity of 82%, reaching 87% in lesions > 1 cm, that harbor clinically relevant TC.

Diagnostic performance of ultrasound vs. ultrasound-guided FNAc in thyroid nodules: data from the ElaTION trial.

ElaTION is a large multi-centre pragmatic randomised controlled trial, performed in 18 secondary/tertiary hospitals across England, comparing elastography ultrasound-guided fine needle aspiration cytology (EUS-FNAC) with ultrasound-guided FNAC (US-FNAC) alone in the diagnostic assessment of thyroid nodules. Secondary trial outcomes, reported here, assessed the accuracy of ultrasound-alone (US) compared with US-guided FNAC to inform and update current practice guidelines. Adults with single or multiple thyroid nodules who had not undergone previous FNAC were eligible. Radiologists assessed all thyroid nodules using US alone, thereby enabling assessment of its accuracy (sensitivity and specificity) versus US-FNAC. Of the 982 participants, a final definitive diagnosis was obtained in 688, who were included in the final analyses. The sensitivity of US-alone was the same as US-FNAC (0.91, [95% CI 0.85, 0.97] vs 0.87 [95%CI 0.80-0.95], p=0.37). US alone had statistically significant lower specificity than US-FNAC alone (0.48 vs 0.67 respectively, p<0.0001). The malignancy rate on histology in a nodule classified as benign on ultrasound (U2) was 9/263 (3.42%) and on cytology (Thy2) was 15/353 (4.25%), whereas the malignancy rate in a nodule that was benign on both (U2, Thy2) was 3/210 (1.43%). Malignancy risk for U3, U4, and U5 nodules was 68/304 (22.4%), 43/83 (51.8%), and 29/38 (76.3%) respectively (p<0.0001). Yet 80/982 (8%) patients were discharged despite having U3-U5 scans with Thy1 (non-diagnostic) FNAC and no definitive diagnosis.Malignancy risk was higher in smaller nodules: <10mm 23/60 (38.3%), 10-20mm 46/162 (28.4 %), and >20mm 80/466 (17.2%) (p<0.0001). Nodules with indeterminate cytology with atypical features (Thy3a) carried a similar malignancy risk to those with indeterminate cytology (Thy3/3f): 27/95 (28.4%) versus 42/113 (37.2%) respectively (p=0.18). Ultrasound alone appears to be an effective diagnostic modality in thyroid nodules, confirming the recommendations of recent guidelines and the BTA classification. However, findings also suggest caution regarding existing recommendations for conservative management of non-diagnostic (Thy1/Bethesda I) and atypical (Thy3a/Bethesda III) nodules. In those cases, ultrasound (U3-5) features may help identify high-risk subgroups for more proactive management.

Evaluation of US Elastography in Thyroid Nodule Diagnosis: The ElaTION Randomized Control Trial.

Background There is variable evidence and no randomized trials on the benefit of US elastography-guided fine-needle aspiration cytology (FNAC) over conventional US-guided FNAC alone for thyroid nodules. Purpose To compare the efficacy of US elastography-guided FNAC versus US-guided FNAC in reducing nondiagnostic rates for thyroid nodules. Materials and Methods A pragmatic, multicenter randomized controlled trial was performed at 18 secondary and tertiary hospitals across England between February 2015 and September 2018. Eligible adults with single or multiple thyroid nodules who had not previously undergone FNAC were randomized (1:1 ratio) to US elastography FNAC (intervention) or conventional US FNAC (control). The primary outcome was the proportion of patients who have a nondiagnostic cytologic Thy1 (British Thyroid Association system) result following the first FNAC. Results A total of 982 participants (mean age, 51.3 years ± 15 [SD] [IQR, 39-63]; male-to-female ratio, 1:4) were randomized. Of the 493 participants who underwent US elastography, 467 (94.7%) were examined with strain US elastography. There was no difference between the two arms in the nondiagnostic (Thy1) rate following the first FNAC (19% vs 16%; risk difference [RD], 0.03 [95% CI: -0.01, 0.07]; P = .11) or in the median time to reach the final definitive diagnosis (3.3 months [IQR, 1.5-6.4] for US elastography FNAC vs 3.4 months [IQR, 1.5-6.2] for US FNAC). All sensitivity analyses supported the primary analysis. Fewer participants in the US elastography FNAC arm underwent diagnostic hemithyroidectomy than in the US FNAC arm (183 of 493 [37%] vs 196 of 489 [40%]), but this was not statistically significant (adjusted RD, 0.02 [95% CI: -0.06, 0.01]; P = 0.15). There was no evidence of a difference in malignancy rates between the two arms: 70 of 493 (14%) in US elastography FNAC arm versus 79 of 489 (16%) in US FNAC arm (P = .39). There was also no difference in the rate of benign histologic findings between the groups (RD, -0.01 [95% CI: -0.04, 0.03]; P = .7). Conclusion Strain US elastography does not appear to have additional benefit over conventional US FNAC in the diagnosis of malignancy in thyroid nodules. Clinical trial registration no. ISRCTN18261857 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Isikbay and Harwin in this issue.

Spectrum of Renal Tumors Other Than Renal Cell Carcinoma with Emphasis on Cytomorphological, Immunohistochemical, and Cytogenetic Study

Abstract Background: The role of fine needle aspiration cytology (FNAC) in the diagnosis of renal malignancies is established and has been getting more precise and important over a period of time. Knowledge of the pathology of uncommon renal neoplasms along with radiological and clinical correlations often aids in correct diagnosis. Aims: The present study aims to describe the cytomorphological and immunohistochemical findings in the varied spectrum of renal tumors, other than renal cell carcinomas (RCC). Materials and Methods: Data of 238 cases of ultrasound-guided renal FNAC performed in our tertiary cancer institute over 4 years were collected from the department registry. All nondiagnostic cases and cases diagnosed as RCC were excluded from the study, so 57 cases of renal tumors were reviewed along with the cell blocks and ancillary studies. Results: Out of the 57 cases, 35 cases were primary renal neoplasms, which included renal oncocytoma (3.5%), angiomyolipoma (3.5%), rhabdoid tumor (1.8%), Wilms tumor (28.0%), Ewing sarcoma (3.5%), urothelial carcinoma (8.8%), and small round cell tumor unclassified (12.3%). Twenty two cases were metastatic tumors, which included hematolymphoid neoplasm (14%) and metastatic carcinomas (24.6%) from various other primary carcinomas. Conclusion: Our study shows that renal FNAC is safe and fairly accurate in diagnosing a wide spectrum of renal tumors and has high diagnostic accuracy, when performed along with cell block and immunohistochemistry. Awareness of the pathology of uncommon renal tumors along with relevant clinical history and radiological findings may aid in identifying the type of tumor for further appropriate management.

Complications after fine-needle aspiration cytology and core-needle biopsy in benign head & neck neoplasms

IntroductionBenign neck masses are one of the most common causes of clinical consultation in head & neck (H&N) clinics. Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) have become among the main strategies for the diagnostic work-up of palpable and non-palpable neck lumps. Moreover, numerous studies have established the safety, high diagnostic yield, and added value of image-guided H&N biopsies, which play an important role in diagnosis, staging, and treatment planning, and can obviate the need for surgery for many patients. Nonetheless, despite the success of both techniques, there is a lack of recent studies regarding their safety and associated complication rates. Material & methodA retrospective analysis was performed of prospective data on patients undergoing ultrasound-guided FNAC or CNB for benign H&N disease (e.g., salivary gland benign tumors, branchial cleft cyst, thyroglossal duct, cyst, lipoma, or neurinoma) between June 2016 and June 2021 in a tertiary university hospital. ResultsOverall, 192 patients were included (105 [54.7%] men and 87 [45.3%] women). The Kolmogorov-Smirnov test indicated that our data were normally distributed (p = 0.452). The mean age of enrolled patients was 54 ± 10 (range: 18–87). The anatomical site most commonly affected was a major salivary gland (74%). Regarding incidence and type of complications, nine (4.7%) patients experienced complications, infection being the most common problem. The risk of complications was highest in patients with branchial cleft cysts who had undergone FNAC (p = 0.028). Overall, the risk of complications was not associated with the type of technique (p = 0.603; OR: 0.942; 95% confidence interval = 0.245–3.624). ConclusionAccording to our results, FNAC and CNB are generally safe and reliable procedures in the diagnostic work-up of H&N lumps. Nevertheless, physicians should be aware of certain risks associated with these procedures.

Cytomorphological Spectrum of Hepatic Lesions on Ultrasonography (USG) or CT-Guided Fine-Needle Aspiration Cytology (FNAC) in a Tertiary Care Centre, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India.

Background Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of the liver is a primary diagnostic procedure for primary and metastatic hepatic lesions. Despite histopathology being the gold standard, the outcomes of ultrasound-guided fine needle aspiration cytology are encouraging. Aims and objective The purpose of the study is to determine the diagnostic utility of ultrasonography (USG) or computerized tomography (CT)-guided FNAC in the detection of liver lesions, to investigate cytomorphological patterns of liver lesions identified by guided FNAC, and, wherever feasible, to correlate FNAC diagnosis with histopathology and imaging modalities. Materials and methods This was a hospital-based observational study of 62 patients carried out in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS) Ranchi during a period of 1.5 years from August 2020 to February 2022. The patients with suspected hepatic lesions were subjected to ultrasound-guided or CT-guided fine needle aspiration cytology (FNAC) following clinical and radiological evaluation and cytomorphological features were analyzed. Results Cyto-morphological diagnosis of 62 cases was categorized into 19 (30.64%) non-neoplastic lesions and 43 (69.35%) malignant neoplastic lesions. The different neoplastic lesions were 17 (27.41%) hepatocellular carcinoma, 1 (1.61%) hepatoblastoma, 1 (1.61%) cholangiocarcinoma, 23 (37.09%) metastatic adenocarcinoma and one case (1.61%) of unclassified malignancy. Histopathological correlation for confirming the diagnosis could be done in 33 malignant neoplastic lesions and the concordance rate of FNAC with respect to histopathological examination (HPE) was 92.11%. Overall diagnostic accuracy of the FNAC of liver to detect malignant lesions was 98.39%. Conclusion Compared to ultrasonography alone, ultrasound or CT-guided fine needle aspiration of the liver has a more promising role in the diagnosis and classification of hepatic lesions as it demands a higher level of precision to achieve diagnostic accuracy.

Role of ultrasound‑guided fine‑needle aspiration cytology combined with thyroid peroxidase and thyroglobulin antibodies in evaluating cervical lymph node metastasis in thyroid cancer.

The present study was designed to explore the role of ultrasound-guided fine-needle aspiration (FNA) cytology combined with thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) in evaluating cervical lymph node metastasis in thyroid cancer. The aim was to propose more effective diagnostic strategies for cervical lymph node metastasis in patients with thyroid cancer. Firstly, the present retrospective case-control study selected 294 patients with thyroid cancer treated at Changzhou Second People's Hospital (Changzhou, China). High-resolution ultrasound equipment was used for ultrasound and FNA examinations. Additionally, a retrospective analysis of the patient's comprehensive thyroid function tests, including TPO-Ab and Tg-Ab levels, was conducted. Subsequently, univariate and multivariate logistic regression models were employed to analyze the association between various factors and cervical lymph node metastasis. The overall diagnostic accuracy of the model was evaluated using the receiver operating characteristic curve and its area under the curve. Finally, the performance of the diagnostic model was quantitatively assessed through calculating sensitivity, specificity, positive predictive and negative predictive values. According to the experimental results, sex, tumor stage and the levels of thyroid autoantibodies were associated with the risk of cervical lymph node metastasis in thyroid cancer. Moreover, ultrasound features, such as cystic lesions, loss of hilum of the lymph nodes, abundant vascular supply, heterogeneous echo and microcalcification were also closely related to cervical lymph node metastasis. Logistic regression analysis also showed that tumor stage, serum levels of TPO-Ab and Tg-Ab, and cystic lesions were independent predictors of cervical lymph node metastasis. Furthermore, the combined use of ultrasound, FNA, TPO-Ab and Tg-Ab significantly improved diagnostic sensitivity and specificity. Overall, ultrasound-guided FNA combined with TPO-Ab and Tg-Ab may have a significant role in the evaluation of cervical lymph node metastasis in thyroid cancer. This combined diagnostic approach could significantly enhance diagnostic accuracy, providing a more effective strategy for the clinical management of cervical lymph node metastasis in thyroid cancer.

Real-time ultrasound elastography in the diagnosis of newly identified thyroid nodules in adults: the ElaTION RCT.

Strain and shear wave elastography which is commonly used with concurrent real-time imaging known as real-time ultrasound shear/strain wave elastography is a new diagnostic technique that has been reported to be useful in the diagnosis of nodules in several organs. There is conflicting evidence regarding its benefit over ultrasound-guided fine-needle aspiration cytology alone in thyroid nodules. To determine if ultrasound strain and shear wave elastography in conjunction with fine-needle aspiration cytology will reduce the number of patients who have a non-diagnostic first fine-needle aspiration cytology results as compared to conventional ultrasound-only guided fine-needle aspiration cytology. A pragmatic, unblinded, multicentre randomised controlled trial. Eighteen centres with a radiology department across England. Adults who had not undergone previous fine-needle aspiration cytology with single or multiple nodules undergoing investigation. Ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology (intervention arm) - strain or shear wave elastography-guided fine-needle aspiration cytology. Ultrasound-only guided fine-needle aspiration cytology (control arm) - routine ultrasound-only guided fine-needle aspiration cytology (the current standard recommended by the British Thyroid Association guidelines). The proportion of patients who have a non-diagnostic cytology (Thy 1) result following the first fine-needle aspiration cytology. Patients were randomised at a 1 : 1 ratio to the interventional or control arms. A total of 982 participants (80% female) were randomised: 493 were randomised to ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology and 489 were randomised to ultrasound-only guided fine-needle aspiration cytology. There was no evidence of a difference between ultrasound shear/strain wave elastography and ultrasound in non-diagnostic cytology (Thy 1) rate following the first fine-needle aspiration cytology (19% vs. 16% respectively; risk difference: 0.030; 95% confidence interval -0.007 to 0.066; p = 0.11), the number of fine-needle aspiration cytologies needed (odds ratio: 1.10; 95% confidence interval 0.82 to 1.49; p = 0.53) or in the time to reach a definitive diagnosis (hazard ratio: 0.94; 95% confidence interval 0.81 to 1.10; p = 0.45). There was a small, non-significant reduction in the number of thyroid operations undertaken when ultrasound shear/strain wave elastography was used (37% vs. 40% respectively; risk difference: -0.02; 95% confidence interval -0.06 to 0.009; p = 0.15), but no difference in the number of operations yielding benign histology - 23% versus 24% respectively, p = 0.70 (i.e. no increase in identification of malignant cases) - or in the number of serious adverse events (2% vs. 1%). There was no difference in anxiety and depression, pain or quality of life between the two arms. The study was not powered to detect differences in malignancy. Ultrasound shear/strain wave elastography does not appear to have additional benefit over ultrasound-guided fine-needle aspiration cytology in the diagnosis of thyroid nodules. The findings of the ElaTION trial suggest that further research into the use of shear wave elastography in the diagnostic setting of thyroid nodules is unlikely to be warranted unless there are improvements in the technology. The diagnostic difficulty in distinguishing between benign and malignant lesions still persists. Future studies might examine the role of genomic testing on fine-needle aspiration samples. There is growing use of targeted panels of molecular markers, particularly aimed at improving the diagnostic accuracy of indeterminate (i.e. Thy3) cytology results. The application of these tests is not uniform, and their cost effectiveness has not been assessed in large-scale trials. This study is registered as ISRCTN (ISRCTN18261857). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/19/04) and is published in full in Health Technology Assessment; Vol. 28, No. 46. See the NIHR Funding and Awards website for further award information.

Liquid-based cytology features of pancreatic acinar cell carcinoma: comparison with other non-ductal neoplasms of the pancreas.

Acinar cell carcinoma (ACC) is a rare malignant epithelial neoplasm, which shares many cytomorphological features with other non-ductal pancreatic neoplasms such as pancreatic neuroendocrine neoplasm (PanNEN) and solid-pseudopapillary neoplasm (SPN). Due to the relative rarity of these tumors, pathologists are less familiar with the cytological features, especially on liquid-based cytology (LBC) which has been relatively recently introduced for endoscopic ultrasound-guided fine needle aspiration specimens. We evaluated the detailed cytological features of 15 histologically confirmed ACC (7 conventional smears [CS], 8 LBC), and compared them with the LBC features of SPN (n = 9) and PanNEN (n = 9). Compared with CS, LBCs of ACC demonstrated significantly less bloody background. All ACCs demonstrated prominent nucleoli and macronucleoli on LBC. On comparison with the LBC features of SPN and PanNEN, most ACCs demonstrated a necrotic background with apoptotic debris while PanNEN and SPN did not show these features. Acinar structures were predominantly observed in ACC, while frequent pseudopapillary structures were seen only in SPN. Prominent nucleoli and macronucleoli were only seen in ACC. ACC had characteristic cytological features that could be observed on LBC preparations, such as high cellularity, necrotic/apoptotic background, nuclear tangles, acinar arrangement of cells, and macronucleoli. These findings also help distinguish ACC from PanNEN and SPN on LBC. It is important to be familiar with these features, as an accurate diagnosis on endoscopic ultrasound-guided fine needle aspiration cytology would have impact on the management of the patient.

A huge retroperitoneal liposarcoma mimicking ovarian teratoma: A case report

Retroperitoneal liposarcoma is a malignant, primitive, and rare mesenchymal tumor. It can grow usually asymptomatic until large enough to compress the surrounding organs. We report an observation of a retroperitoneal liposarcoma mimicking an ovarian tumor. A 50-year-old, P1+0 postmenopausal female, presented to our Department of Obstetrics and Gynecology, with abdominopelvic mass and pressure symptoms for 2 months. Her magnetic resonance imaging abdomen and pelvis, ULTRASOUND-guided fine needle aspiration cytology, and tumor markers were done to make the provisional diagnosis after which, the patient underwent exploratory laparotomy. Complete removal of mass along with the right ovary was done in spite of mass encasing the right iliac vessels and the right ureter. Along with this, a hysterectomy with the left salpingo-oophorectomy and the right salpingectomy were done. A very huge ovarian tumor 22×15×28 cm weighing 5.5 kg was removed. Histopathological examination showed myxoid/well-differentiated liposarcoma with heterologous differentiation. Retroperitoneal liposarcomas are rare; however, they require an aggressive surgical approach, including multi-organ resection, if necessary, or multiple resections in the case of recurrence.

Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features.

Fine-needle aspiration cytology (FNAC) is a reliable method for preoperative evaluation of thyroid nodules particularly if ultrasound-guided (USG-FNAC). The main purpose of this study is to evaluate the efficacy of USG-FNAC and its accuracy. We retrospectively studied 212 thyroidectomy cases with preoperative ultrasonography and FNAC data during the period 2015-2022 using TI-RADS for final ultrasound diagnosis and Bethesda system for cytological diagnosis. The studied cases were 200 females and 12 males. Thyroid cancer was more prevalent under 20 years old (78.5%). Papillary thyroid carcinoma comprises 84% of all cancer cases. Significant ultrasound features (p-value <0.05) favour malignancy were hypoechogenicity (66%), mixed echogenicity (84%), irregular border (61%), microcalcification (68%) and rim halo (63.6%). Malignancy was found in 21% of TI-RADS-2, 65% of TI-RADS-4 and 100% of TI-RADS-5. There is a significant difference between different categories of Bethesda system. All cases in Cat-VI were malignant (100%). Malignancy was also found in 81% of Cat-V, 20% of Cat-IV, 33% of Cat-III, 16% of Cat-II and 43% of Cat-I. Cytological features consistent with malignancy were as follows: grooving (94%), nuclear irregularities (89%), nuclear pseudoinclusion (89%) and little colloid (82%). In our study, USG-FNAC sensitivity was 83%, specificity 85%, PPV 85%, NPV 83% and accuracy 84%. Ultrasound features in favour of malignancy in thyroid nodules are hypoechoic or complex echogenicity, irregular border, punctuate calcification and presence of rim halo. Cytological features in favour of malignancy are grooving, nuclear irregularities, nuclear pseudoinclusion and little or absent colloid.

Diagnostic value of ultrasound-guided fine-needle aspiration cytology in the pathological natures of thyroid nodules: A retrospective study.

Thyroid nodules, a clinical disease with high incidence, include benign and malignant types. This study aims to evaluate the diagnostic value of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in determining the pathological nature of thyroid nodules and to conduct an in-depth analysis of its diagnostic efficacy across nodules of varying sizes. This retrospective study identified 116 patients undergoing thyroidectomy in Zibo Central hospital from January 2022 to March 2023, with 98 meeting the study's inclusion criteria. All patients received ultrasound and US-FNAC examinations before surgery to analyze the ultrasonic features of thyroid nodules. The diagnosis results of pathological natures obtained by US-FNAC were analyzed with the result of post-operative pathological examination as the gold standard. The patients were divided into four groups according to the median and quartile of nodular diameters to explore the diagnostic efficacy of US-FNAC for the pathological natures of thyroid nodules with various diameters and comprehensively evaluate its application value. The evaluation tool of diagnostic efficacy was the receiver operator characteristic (ROC) curve. A total of 98 puncture nodules were evaluated, with a diameter of 0.8-5.2 cm. Post-operative pathological examination showed 10 (10.20%) benign and 88 (89.80%) malignant lesions. The ultrasound examination showed 14 (14.29%) benign and 84 (85.71%) suspected malignant lesions. The US-FNAC results showed 2 cases (2.04%) of type I, 9 cases (9.18%) of type II, 3 cases (3.06%) of type III, 29 cases (29.59%) of type IV, 39 cases (39.80%) of type V, and 16 cases (16.33%) of type VI, including 9 (9.18%) benign and 84 (85.72%) malignant lesions and 5 (5.10%) uncertain pathological natures. According to the median and quartile of nodular diameters, specifically, 1.90 (1.60, 2.30) cm, 93 nodules with decided pathological natures were divided into groups Q1 (n = 24, ≤1.6 cm), Q2 (n = 26, 1.7-1.9 cm), Q3 (n = 24, 2.0-2.3 cm), and Q4 (n = 19, >2.3 cm). The results of ROC analysis showed that the area under the curve (AUC), sensitivity, and specificity of US-FNAC diagnosis were 0.894, 98.80%, and 80.00%, respectively. The AUCs of US-FNAC in groups Q1, Q2, Q3, and Q4 were 0.978, 1.000, 0.977, and 0.971. The AUCs of Q1 group, Q2 group, Q3 group and Q4 group were all > 0.9, and US-FNAC had high diagnostic efficiency for the pathological properties of thyroid nodules with different diameters. US-FNAC has a high diagnostic efficiency for the pathological properties of thyroid nodules. Whether the nodule diameter has an effect on the accuracy of this method requires more clinical evidence.

Intraoperative ultrasound guided wire (IOUS-wire) localization biopsy with frozen section versus preoperative fine needle aspiration cytology (FNAC) for the evaluation of clinically positive nodes in patients with early breast cancer in China real-world clinical practice.

e12600 Background: Appropriate biopsy procedure for clinically positive (suspicious) lymph nodes (LN) plays a key role in accurate axillary staging of early breast cancer. Fine needle aspiration (FNA) is a recommended method for clinically suspicious nodes in the National Comprehensive Cancer Network (NCCN) guidelines. However, the false negative rate (FNR) of FNA remains too high. Therefore, it is valuable to explore an alternative and appropriate procedure in clinical practice. We conducted a retrospective review to compare the feasibility and diagnostic efficiency of using a novel procedure, the intraoperative ultrasound guided wire (IOUS-wire) localization biopsy with frozen section, to FNA for assessment of clinically positive nodes in patients with early breast cancer. Methods: Data on consecutive primary breast cancer patients with documented axillary ultrasound results who had clinically positive lymph nodes (cN1) between January 2015 and September 2023 either utilization of IOUS-wire localization or ultrasonography-guided fine-needle aspiration cytology (US-FNAC) for clinically positive lymph nodes were retrospectively analyzed. Sentinel lymph node biopsy (SLNB) was performed in patients with negative histopathological or cytological results. The false negative rate (FNR) of histopathology between two groups was calculated. Results: Eligible patients (n=198) referred to axillary biopsy by IOUS-wire localization biopsy(n=100) and US-FNAC(n=98) in this study. The FNR of clinically positive lymph nodes biopsy was 12.8 percent in the IOUS-wire localization group and 87.5 percent in the US-FNAC group.IOUS-wire failed in 5 patients. Among the remaining 32 successful identifications, 26 were IOUS-wire-node positive by intraoperative frozen section. 42 patients with additional lymph node metastases were found in FNAC-LN-negative patients by SLNB. The accuracy rate was respectively 95% and 57.1%. No significant difference was observed in complications and median number of SLNs harvested (5.3 versus 5.5; P=0.631) between the groups. Sufficient tissue samples can be obtained for intraoperative frozen pathology so the FNR is potentially reduced. In addition, the interval of waiting time for pathological results is reduced. Conclusions: Intraoperative US-guided wire localization biopsy is a feasible and alternative procedure compared to preoperative FNA for clinically node-positive patients with early breast cancer. This novel method is suitable for China's national conditions and should be further pursued as a potential biopsy method for evaluation of axillary node status in clinical practice.

Correlation between ultrasonographic and cytologic features of thyroid nodules: a single-center cross-sectional study.

A thyroid nodule is managed according to the clinical context, ultrasound (US) findings, and fine needle aspiration (FNA) results. Most thyroid nodules are benign; however, nodule classification is crucial to avoid unnecessary thyroid surgery. We conducted this study to compare the findings of fine-needle aspiration cytology (FNAC) expressed using the Bethesda system with the features of thyroid US classified using the EU-TIRADS classification to assess the risk of malignancy. A descriptive and analytical study involving 99 patients with thyroid nodules followed up in the Department of Endocrinology-Diabetology and Nutrition. Data were collected from medical records and analyzed using SPSS software V21. FNA was performed on 121 nodules using the BETHESDA system. These nodules were classified as malignant, suspicious for follicular neoplasm, and suspicious for malignancy in 5.8%, 5%, and 1.7% of cases, respectively. As for the EU-TIRADS 2017 classification, 59.5% of benign nodules were classified as EU-TIRADS III, whereas 66.7% of malignant nodules were classified as EU-TIRADS V and significantly related to malignant prediction (P = 0.000). The size of nodules was significantly correlated to the risk of malignancy (P = 0.013). Seventy-five percent of nodules with central vascularity were malignant (P = 0.012). Irregularity of nodule contours was significantly associated with the risk of malignancy, as 30% of nodules with irregular contours were Bethesda VI (P = 0.003). Hypoechogenicity was found in 77.8% of malignant nodules (P = 0.004). Additionally, only 9.2% of the nodules were taller than wide, of which 37.5% were malignant (P = 0.012). For a safe management strategy, US-guided FNAC should be performed on each suspicious thyroid nodule, given the correlation between EU-TIRADS classification features and the risk of malignancy.

The Incidence of Thyroid Cancer in Bethesda III Thyroid Nodules: A Retrospective Analysis at a Single Endocrine Surgery Center.

Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules, also known as Atypia of Undetermined Significance (AUS), varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow-up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age of 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34; 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi-square test). However, the female patients exhibited prognostically superior non-invasive tumors compared to male individuals (p = 0.02, chi-square test). This study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the first and third editions of the TBSRTC, particularly for female patients classified under category II.

Utility of EUS-Guided FNAC in the Diagnosis of Spindle Cell Lesion of the GI Tract: A Case Report

ABSTRACT Gastrointestinal (GI) tumors pose a diagnostic challenge due to their diverse histology and location. EUS was first used clinically in 1980. Since its inception, it has emerged as a valuable diagnostic tool for GI lesions, to a versatile therapeutic modality, encompassing a wide range of indications. EUS faces challenges in distinguishing benign from malignant lesions. The partnership between cytopathologists and endoscopists, coupled with rapid on-site evaluation (ROSE), has become crucial in patient management. Recent technical advancements along with the addition of FNAC have greatly increased its diagnostic accuracy. Endoscopic ultrasonography-guided fine-needle aspiration cytology (EUS-FNAC) has become a routine practice in many healthcare facilities, aiding in the diagnosis of mediastinal, GI, and pancreatic malignancies. EUS-FNAC offers several advantages, such as multi-site aspiration and lower cost as compared to other procedures. Even its potential in the area of molecular studies has been recently investigated. In this case study, a 45-year-old man who underwent EUS-FNAC is presented. The combination of histology, immunohistochemistry, and EUS-FNAC allowed us to make a conclusive diagnosis of GI stromal tumors (GIST).

Parotid squamous cell carcinoma metastases: Application of human papillomavirus-DNA test on liquid-based cytology to recognize oropharyngeal origin of the neoplasm.

Malignancies of the parotid gland are relatively uncommon and in most cases are primary neoplasms; intraparotid metastases are rare. Oral and oropharyngeal squamous cell carcinoma (O- and OP-SCC) can potentially metastasize to the parotid gland or intraparotid lymph nodes. Fine-needle aspiration cytology (FNAC) serves as the initial diagnostic approach for this purpose. HPV status in FNAC specimens is relevant and can guide the diagnostic workup, indicating a potential oropharyngeal origin of the primary tumor. A small series of occult SCC metastases is presented below, in which HPV-DNA testing of FNAC specimens helped identify primary neoplasms located in the oropharynx. US-guided FNAC of parotid nodules was conducted by an experienced interventional cytopathologist in three cases. Each patient underwent assessment of direct smears, cell blocks, and liquid-based samples for HPV testing. The morphological and immunocytochemical features of SCC were documented, and real-time PCR was employed for the detection and genotyping of HPV. The role of HPV testing on FNAC specimens in pinpointing the primary neoplasms in the oropharynx is highlighted. Consequently, FNAC samples emerge as valuable diagnostic and prognostic tools in this context, providing essential insights for patient management.

Cyto-Histological Profile of MicroRNAs as Diagnostic Biomarkers in Differentiated Thyroid Carcinomas.

The repertoire of microRNAs (miRNAs) in thyroid carcinomas starts to be elucidated. Among differentiated thyroid carcinomas (DTCs), papillary thyroid carcinoma (PTC) is the most frequent. The assessment of miRNAs expression may contribute to refine the pre-surgical diagnosis in order to obtain a personalized and more effective treatment for patients. This study aims to evaluate (1) the miRNAs in a series of DTCs, and their association with the presence of selected genetic mutations in order to improve diagnosis and predict the biologic behavior of DTC/PTC. (2) The reliability of molecular tests in Ultrasound-guided Fine Needle Aspiration Cytology (US-FNAC) for a more precise preoperative diagnosis. This series includes 176 samples (98 cytology and 78 histology samples) obtained from 106 patients submitted to surgery, including 13 benign lesions (controls) and 93 DTCs (cases). The microRNA expression was assessed for miR-146b, miR-221, miR-222, and miR-15a through quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). The results were analyzed by the 2-ΔΔCT method, using miR16 as an endogenous control. Regarding PTC diagnosis, the discriminative ability of miRNAs expression was assessed by the area under the Receiver Operating Characteristic Curve (AUC). In PTCs, the association of miRNAs expression, clinicopathological features, and genetic mutations (BRAF, RAS, and TERTp) was evaluated. All the analyzed miRNAs presented a tendency to be overexpressed in DTCs/PTCs when compared with benign lesions, both in cytology and histology samples. In cytology, miRNAs expression levels were higher in malignant tumors than in benign tumors. In histology, the discriminative abilities regarding PTC diagnosis were as follows: miR-146b (AUC 0.94, 95% CI 0.87-1), miR-221 (AUC 0.79, 95% CI 0.68-0.9), miR-222 (AUC 0.76, 95% CI 0.63-0.89), and miR-15a (AUC 0.85, 95% CI 0.74-0.97). miR-146b showed 89% sensitivity (se) and 87% specificity (sp); miR-221 se = 68.4, sp = 90; miR-222 se = 73, sp = 70; and mi-R15a se = 72, sp = 80. MicroRNAs were associated with worst-prognosis clinicopathological characteristics in PTCs (p < 0.05), particularly for miR-222. Our data reveal a significant association between higher expression levels of miR-146b, miR-221, and miR-222 in the presence of the BRAF mutation (p < 0.001) and miR-146b (p = 0.016) and miR-221 (p = 0.010) with the RAS mutation, suggesting an interplay of these mutations with miRNAs expression. Despite this study having a relatively small sample size, overexpression of miRNAs in cytology may contribute to a more precise preoperative diagnosis. The miRNAs presented a good discriminative ability in PTC diagnosis. The association between the miRNAs expression profile and genetic alterations can be advantageous for an accurate diagnosis of DTCs/PTCs in FNAC.

Assessment of Pre-analytical Errors and Fostering Strategies to Enhance Accurate Results and Efficient Turnaround Times in the Cytology Laboratory of a Tertiary Care Hospital.

Introduction Pre-analytical errors in cytology laboratories can significantly impact the accuracy of diagnostic results and turnaround times, ultimately affecting patient care. This article presents an evaluation of pre-analytical errors and proposes fostering strategies to enhance accuracy and efficiency in the cytology laboratory of a tertiary care hospital. The background discusses the importance of pre-analytical processes in ensuring reliable cytological diagnoses and the common errors encountered in specimen collection, handling, and transportation. Strategies for error reduction and improvement in turnaround times include staff education, standardization of procedures, utilization of appropriate collection and transport devices, implementation of quality control measures, and utilization of automation technologies. By addressing pre-analytical errors and implementing fostering strategies, cytology laboratories can optimize diagnostic accuracy, improve patient care outcomes, and enhance overall laboratory efficiency. Aims and objectives This study aims to assess the prevalence and nature of pre-analytical errors in the cytology laboratory of a tertiary care hospital to understand the extent of the issue, identify the specific factors contributing to pre-analytical errors like specimen collection, handling, and transportation processes, and pinpoint areas for improvement. It seeks to evaluate the impact of pre-analytical errors on the accuracy of cytological results and the efficiency of turnaround times, highlighting the consequences for patient care. Furthermore, the study aims to develop targeted strategies to minimize pre-analytical errors and enhance the accuracy of cytological results. Materials and methods This study was conducted at the Cytology Laboratory of our hospital from January 2023 to December 2023 after getting proper approval from the Institutional Review Board (IRB approval number 101/02/2024/PG/SRB/SMCH). It is a retrospective analytical study, and a total of 5412 samples from patients of the outpatient (OP) department, inpatient (IP) department, and community health outreach program facilities received in the cytology laboratory were analyzed during the study period. The inclusion criteria were the test samples sent specifically for cytological analysis. The samples sent for biochemical or microbiological examination were excluded. The frequency of sample distribution and rejected samples were calculated and the results were correlated. Results A total of 5,412 samples received in the cytology laboratory were analyzed during the study period. The majority of the samples were Papanicolaou smears (2,352, 43.5%), followed by fluid cytology (1,008, 18.6%) and ultrasound-guided fine-needle aspiration cytology (FNAC, 984, 18.2%). Of the total number of samples, 225 (4.16%) were repeated and 27 (0.5%) were rejected. Conclusions Pre-analytical, analytical, and post-analytical processes are the three key factors that determine the dependability and precision of cytological test results. Detecting critical alerts such as the positivity of malignancy underscores the paramount importance of result accuracy. Implementing good laboratory practices and conducting both external and internal audits can reduce the frequency of preventable errors in a cytology laboratory, thereby ensuring enhanced precision and expedited outputs.