Use Of Fine-needle Aspiration Biopsy Research Articles

Utility of fine-needle aspiration biopsy (FNAB) in parotid pleomorphic adenoma diagnosis and management.

Pleomorphic adenoma (PA), the most common benign tumour of the parotid gland, requires accurate preoperative diagnosis owing to its capacity for malignant transformation. The aim of this study was to evaluate our experience with ultrasound-guided fine-needle aspiration biopsy (FNAB) in the diagnostic algorithm for patients with PA and to assess clinical outcomes for those with different surgical approaches. We carried out a retrospective analysis of patients treated for parotid gland mass between 2010 and 2016. These had had preoperative FNAB and had undergone subsequent surgery. 165 patients had FNAB with the result of PA and the definitive histology confirmed PA in 159 cases (96.4%). On the other hand, in 179 patients, the definitive histology showed PA and the preoperative FNAB result corresponded in 159 cases (88.9%). The measured sensitivity, specificity and accuracy of ultrasound-guided FNAB in the diagnosis of PA were, respectively, 88.83%, 96.23% and 92.31%. Most of the patients underwent superficial or partial superficial parotidectomy, followed by extracapsular dissection which was associated with statistically lower risk of facial nerve injury (P=0.04). Ultrasound-guided FNAB is simple, accurate and valuable in the diagnosis of PA and provides results that can lead to the choice of less invasive operative treatment.

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy in Diagnosing Breast Cancer

Objectives: The primary objective is to determine the accuracy of fine-needle aspiration biopsy (FNAB) in breast lesions reported according to the International Academy of Cytology (IAC) Yokohama system for reporting breast FNAB. The participants include any patient presenting with any breast lesion found suitable for FNAB. The target condition was breast cancer. The secondary objective was to study the proportion of inadequate FNAB in the selected studies. Methods: PubMed/MEDLINE and Embase were searched for studies having all the following key search terms: Breast AND FNAB AND Diagnostic Accuracy published in the time frame of 2017 to May 16, 2022. The Cochrane and PROSPERO databases, citations of selected articles and articles citing the selected articles were also searched. Studies assessing the diagnostic accuracy of breast FNAB in diagnosing breast cancer, which had at least 75 subjects (and at least 20 subjects each in the benign and malignant FNAB groups), were selected. The reference standard was histopathology (or adequate clinical follow-up for benign disease). Studies were screened independently by two researchers, with a consensus reached among the authors in cases of conflict. The risk of bias and applicability were assessed using the QUADAS-2 tool. Sensitivity and specificity at each diagnostic cut-off were assessed by bivariate generalized linear mixed-model meta-analysis. The area under the receiver operating characteristics curve (AUC) and inadequacy rate were assessed by random-effects meta-analysis. The confidence intervals of sensitivity, specificity, and AUC were examined against a value of 0.95. Results: Twenty-two studies, all of which were cross-sectional single-gate studies, were selected with a total of 10,886 subjects with a primary breast lesion having concurrent FNAB and reference standard reports. Sensitivity and specificity, with 95% confidence intervals, were 0.978 [0.968, 0.985] and 0.832 [0.76, 0.886] for the diagnostic cut-off of “Atypical considered positive for malignancy,” 0.916 [0.892, 0.935] and 0.983 [0.97, 0.99] for the cut-off of “Suspicious of Malignancy considered positive,” and 0.763 [0.706, 0.812] and 0.999 [0.994, 1] for the cut-off of “Malignant considered positive.” The overall AUC was 0.975 [0.962, 0.984]. FNAB sampling without imaging guidance was associated with lower inadequacy. Discussion: There is strong evidence that the overall accuracy, sensitivity for “Atypical category considered positive” and specificity when “Suspicious or Malignant categories are considered positive” of FNAB are high when using the categories of the IAC Yokohama Reporting System, demonstrating the usefulness of FNAB in diagnosing breast cancer.

Metastatic risk of prognostic fine-needle aspiration biopsy in u veal melanoma patients

Despite the widespread u se of fine-needle aspiration biopsy (FNAB) of uveal melanoma (UM) for prognostic purposes, there are still doubts about the safety of this procedure. No analysis of such data can be found in domestic literature, and foreign authors have published only a few papers on this issue.The purpose of this study is to analyze the risk of metastasis in patients with UM during FNAB.Two groups of patients were formed: the main group, where FNAB was performed during brachytherapy (BT) (BT + FNAB) (n = 70), and the control group, where only BT was performed (n = 144).According to the obtained data, the probability of metastases during a 3‑year follow-up period did not significantly differ between the two groups (p = 0.22 by Fisher's exact test and p = 0.11 by log-rank test when assessing survival using the Kaplan – Meier method), the relative risk (RR) was 1.43 [95 % CI 0.79 to 2.24]. In addition, there was no significant difference in the main clinical outcomes of local treatment associated with worse prognosis: the degree of tumor regression (p = 0.46), extrascleral growth, the need for additional brachytherapy (p = 0.32) or secondary enucleation (p = 0.99).The absence of a significant difference in patient survival between the BT and BT + FNAB groups opens up prospects for a more extensive use of FNAB in patients with UM for prognostic purposes.

Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules

Fine-needle aspiration biopsy (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. FNA results are useful for stratifying the risk of malignant neoplasms and provide key information to determine the appropriateness of an operation. However, we should keep in mind that FNA is an invasive diagnostic method, sothere is a possibility of complications. There is a likelihood of nondiagnostic, false positive and false negative results that can lead to a late or unnecessary operation. We see a growing incidence of thyroid nodules, associated mainly with the increased availability of ultrasound diagnostic of this organ. So the leading organizations involved in the development of clinical guidelines for diagnostics and treatment of thyroid pathologies suggest limiting the conduct of FNA. The use of this method in some cases is not necessary and at times can be even dangerous to apatient. When making clinical decisions, sonographic patterns of thyroid nodules and individual anamnestic and clinical factors ofthe patient should be considered. For small thyroid nodules, the FNA in most cases is not necessary. It is more rational to make a decision based on sonographic patterns rather than be guided by a threshold node size of 1 cm. The specific sonographic patterns of malignancy are: presence of calcifications, irregular margins, hypoechoic nodule, taller-than-wide shape, metastases to the cervical lymph nodes, and extrathyroidal extension. The totality of these signs is useful for stratifying the risk of malignancy of the thyroid nodules and deciding on the need for FNA.

European perspective on the use of molecular tests in the diagnosis and therapy of thyroid neoplasms.

Thyroid nodules are frequently observed, particularly in individuals of over 60 years of age. On the other hand, most of the detected changes are benign and they do not require surgery. Therefore, differentiation between benign and malignant lesions in preoperative diagnosis is of crucial importance. Currently, the use of fine-needle aspiration biopsy (FNAB) and cytological assessment are the gold standard in the diagnosis of thyroid nodules. This procedure significantly reduces the need for diagnostic surgical intervention. However, approximately 15-30% of cytological results are classified as indeterminate. This is mainly due to the lack of specific cytomorphologic features that would facilitate the diagnosis based on cell evaluation under microscopic assessment. For the diagnoses of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), the assessment of invasion is crucial. Such an evaluation is not possible in cytology. Recently, molecular tests have been developed. They improve cytological diagnosis, particularly in the case of indeterminate results. Commercially available tests are developed based on the North American population. It is important to assess whether such tests can be used in the evaluation of e.g., European population.

Teaching and learning FNA biopsy: An update for the modern audience

Teaching and learning FNA biopsy: An update for the modern audience

Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience

Objective: The objective is to study the efficacy of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) in the diagnosis of lymphoma in a single institution. Study Design: We retrospectively reviewed 635 FNAB/CNB cases performed in our institution to rule out lymphoma during a 4-year period and collected the relevant clinical and pathological information for statistical analysis. Results and Conclusions: This cohort comprised 275 males and 360 females, with a median age of 57 years. Among the 593 cases with adequate diagnostic materials for lymphoma work-up, 226 were positive for lymphoma, 286 were negative for lymphoma, and 81 were nondiagnostic. Each case had an FNAB, and 191 cases also underwent a CNB. The subclassification rate according to the WHO (2008) was 67% overall, 81% for the FNAB with CNB group, and 40% for the FNAB group. In the FNAB with CNB group, the subclassification rates for cases with and without a history of lymphoma were not significantly different. A definitive diagnosis of lymphoma relied on ancillary studies, but was not affected by location, or the needle gauge of CNB. Follow-up data revealed a high diagnostic accuracy of FNAB with CNB. In conclusion, the use of FNAB and CNB with ancillary studies is effective in providing a definitive diagnosis of lymphoma in our experience at the Northwell Health System.

The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy.

The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB). This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions. Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments. Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.

Comparison of ultrasound and fine needle aspiration biopsy in terms of determining of preoperative malignancy in thyroid nodules

To reveal the diagnostic efficacy and accuracy, compared with postoperative histopathological diagnosis, preoperative ultrasonography (US) and fine needle aspiration biopsy (FNAB) in determining benign and malignant disease in patients undergoing thyroidectomy in our clinic. Materials and methods: The research was designed with records of 95 patients who were examined thyroidectomy at our hospital Ear, Nose and Throat Clinic for five years. Preoperative ultrasound findings, FNAB results, postoperative histopathological findings, blood groups, age and sex were recorded. These data were each compared with the histopathological results in order to determine which technique was superior in distinguishing malignant from benign thyroid nodules. Ninety-five patients, aged between 21 and 76, 27 male and 68 female, were included. Mean age of male patients was 51.11±13.54 and mean age of female patients 49.18±11.92. Total thyroidectomy was performed in 82 (86.3%) cases, left lobectomy in 3 (3.2%), right lobectomy in 4 (4.2%) and total thyroidectomy plus neck dissection in 6 (6.3%). Of the cases thought to be benign at US, 76.4% were actually benign, and 83.33% of the cases thought to be malignant were actually malignant. The level of cases incorrectly identified as benign or malignant was 23.16%. Validity (test power) of US on the basis of postoperative diagnosis was 76.84%. In terms of FNAB findings, 27.78% of cases suspected of being malignant were malignant, and 72.73% of the group assessed as having benign cytology was actually benign. The level of cases incorrectly identified as being malignant or benign was 35.79%. FNAB test reliability (test power) on the basis of postoperative diagnosis was 56.1%. In addition, only US findings were significant when compared with histopathological findings in preoperative determination of malignant or benign disease (p=0.001), all other data being not significant (p˃0.05). The use of US findings in differentiating malignant from benign thyroid nodules and in accordingly planning treatment is more effective than use of FNAB.

20-23-Submental hydatid cyst in 16 year-old girl (Case report)

Hydatid cyst in the head and neck region is a very rare even where the echinococcus infestation is endemic. The diagnosis is quit challenging. We report the case of a 16-old-female patient presenting with a hydatid cyst in the submental region. The diagnosis of hydatid cyst is made mainly with the help of imagining methods and review of the patient’s history. The diagnostic use of fine-needle aspiration biopsy generally has not been advised because of the potential to precipitate acute anaphylaxis or to spread a daughter cyst. Treatment is surgical albendazole therapy is suggested especially when there is perioperative contamination risk.

Free thyroxine in needle washout after fine needle aspiration biopsy of toxic thyroid nodules.

The main diagnostic tool for toxic adenomas (TA) is radionuclide imaging indicated in patients with evidence of thyroid nodules in combination with thyrotoxic syndrome. Thyroid ultrasound and fine-needle aspiration biopsy (FNAB) are widely used for the valuation of thyroid masses. There is no literature data concerning the utility of FNAB and related tests for the diagnosis of hyperfunctioning thyroid nodules. The purpose of this study is to determine the levels of free thyroxine (FT4) in the needle washout after FNAB of hot thyroid nodules. The results of our study show that the FT4 levels in needle washout from TA were significantly higher than the surrounding parenchyma and correlated with the hormonal changes in patients with thyroid hyperfunctioning nodules. Further studies on a large number of patients are needed to refine the diagnostic value of this method and evaluate its importance in quantitative risk assessment of thyroid autonomy.

Clinic‐Based Decision Making for Head and Neck Endocrine Disease

Program Description: Patients with thyroid and parathyroid disease are commonly encountered in a head and neck surgery practice. While the evaluation and management of many patients is relatively straightforward, others are significantly more complicated. The goal of this session is to discuss complex clinical scenarios encountered in the outpatient clinic. The cost-effective use of diagnostic testing as well as the factors critical in treatment planning will be outlined. The entities reviewed will include fine-needle aspiration for thyroid nodules, surveillance of patients with well-differentiated thyroid cancer, and evaluation and decision for surgery in hyperparathyroidism. Educational Objectives: (1) Describe the appropriate use of fine-needle aspiration biopsy with a focus on implementing the use of molecular markers into the diagnostic evaluation. (2) Explain the indications for adjuvant radioactive iodine therapy in patients with low-, intermediate-, and high-risk well-differentiated thyroid cancer. (3) Implement a cost-effective approach to preoperative imaging in a patient with primary and recurrent hyperparathyroidism.

The cytological diagnosis of metastases to the brest from extramammary malignancies; a cytomorphologic study with emphasis on ancillary techniques

Metastatic neoplasm to the breast is a rare and heterogeneous event which can mimic primary breast carcinoma or benign neoplasm. Distinguishing metastasis from primary breast carcinoma is very important because of the difference in treatment options. This study aimed to investigate the diagnostic utility of fine-needle aspiration biopsy (FNAB) in differentiating breast metastases from primary breast neoplasm. FNAB of 50 metastases to the breast were evaluated for the following: cytomorphology, influence of clinical history and adjunctive methods on the final diagnosis. Reliable cytological criteria of malignancy were found in all 50 smears. These criteria, correlated with clinical data or complemented by ancillary techniques in selected cases, allowed correct diagnosis in 48 patients. Of the remaining two cases, wrongly diagnosed as primary carcinoma, one patient presented with a breast mass and the other had a history of intestinal carcinoid. FNAB plays an important role in the separation of metastatic neoplasm in the breast from primary breast carcinoma. Recognition of unusual cytomorphologic patterns, awareness of patient history and, in selected cases, ancillary techniques, are necessary in rendering a correct diagnosis of breast metastasis in FNAB smears.

The Accuracy of Thyroid Nodule Ultrasound to Predict Thyroid Cancer: Systematic Review and Meta-Analysis

Significant uncertainty remains surrounding the diagnostic accuracy of sonographic features used to predict the malignant potential of thyroid nodules. The objective of the study was to summarize the available literature related to the accuracy of thyroid nodule ultrasound (US) in the prediction of thyroid cancer. We searched multiple databases and reference lists for cohort studies that enrolled adults with thyroid nodules with reported diagnostic measures of sonography. A total of 14 relevant US features were analyzed. We included 31 studies between 1985 and 2012 (number of nodules studied 18,288; average size 15 mm). The frequency of thyroid cancer was 20%. The most common type of cancer was papillary thyroid cancer (84%). The US nodule features with the highest diagnostic odds ratio for malignancy was being taller than wider [11.14 (95% confidence interval 6.6-18.9)]. Conversely, the US nodule features with the highest diagnostic odds ratio for benign nodules was spongiform appearance [12 (95% confidence interval 0.61-234.3)]. Heterogeneity across studies was substantial. Estimates of accuracy depended on the experience of the physician interpreting the US, the type of cancer and nodule (indeterminate), and type of reference standard. In a threshold model, spongiform appearance and cystic nodules were the only two features that, if present, could have avoided the use of fine-needle aspiration biopsy. Low- to moderate-quality evidence suggests that individual ultrasound features are not accurate predictors of thyroid cancer. Two features, cystic content and spongiform appearance, however, might predict benign nodules, but this has limited applicability to clinical practice due to their infrequent occurrence.

Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision

Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision Ku Sang Kim, Ra Mi Kim, Hyun Ee Yim, Doo Kyoung Kang, Tae Hee Kim, Hyun-Joo Shin, Ji Young Kim, Yongsik Jung Departments of Surgery and Biomedical Informatics, Ajou University School of Medicine, Suwon; Department of Surgery, Dongtan Jeil Hospital, Hwasung; Departments of Pathology and Radiology, Ajou University School of Medicine, Suwon, Korea

Characterization of thyroid cancer in mouse models using high-frequency quantitative ultrasound techniques.

Currently, the evaluation of thyroid cancer relies on the use of fine-needle aspiration biopsy, as non-invasive imaging methods do not provide sufficient levels of accuracy for the diagnosis of this disease. In this study, the potential of quantitative ultrasound methods for characterization of thyroid tissues was studied using a rodent model ex vivo. A high-frequency ultrasonic scanning system (40 MHz) was used to scan thyroids extracted from mice that had spontaneously developed thyroid lesions (cancerous or benign). Three sets of mice were acquired having different predispositions to developing three thyroid anomalies: C-cell adenoma, papillary thyroid carcinoma (PTC) and follicular variant papillary thyroid carcinoma (FV-PTC). A fourth set of mice that did not develop thyroid anomalies (normal mice) were used as controls. The backscatter coefficient was estimated from excised thyroid lobes the different mice. From the backscatter coefficient versus frequency (25-45 MHz), the effective scatterer diameter (ESD) and effective acoustic concentration (EAC) were estimated. From the envelope of the backscattered signal, the homodyned K distribution was used to estimate the k parameter (ratio of coherent to incoherent signal energy) and the μ parameter (number of scatterers per resolution cell). Statistically significant differences were observed between cancerous thyroids and normal thyroids based on the ESD, EAC and μ parameters. The mean ESD values were 18.0 ± 0.92, 15.9 ± 0.81 and 21.5 ± 1.80 μm for the PTC, FV-PTC and normal thyroids, respectively. The mean EAC values were 59.4 ± 1.74, 62.7 ± 1.61 and 52.9 ± 3.42 dB (mm(-3)) for the PTC, FV-PTC and normal thyroids, respectively. The mean μ values were 2.55 ± 0.37, 2.59 ± 0.43 and 1.56 ± 0.99 for the PTC, FV-PTC and normal thyroids, respectively. Statistically significant differences were observed between cancerous thyroids and C-cell adenomas based on the ESD and EAC parameters, with an estimated ESD value of 21.3 ± 1.50 μm and EAC value of 54.7 ± 2.24 dB mm(-3) for C-cell adenomas. These results suggest that high-frequency quantitative ultrasound may enhance the ability to detect and classify diseased thyroid tissues.

Clinic‐Based Decision Making for Head and Neck Endocrine Disease

Program Description: Patients with thyroid and parathyroid disease are commonly encountered in a head and neck surgery practice. While the evaluation and management of many patients is relatively straightforward, others are significantly more complicated. The goal of this session is to discuss complex clinical scenarios encountered in the outpatient clinic. The cost-effective use of diagnostic testing as well as the factors critical in treatment planning will be outlined. The entities reviewed will include: 1) Fine-needle aspiration (FNA) for thyroid nodules; 2) Evaluation and decision for surgery in hyperthyroidism; 3) Surveillance of patients with well differentiated thyroid cancer; 4) Evaluation and decision for surgery in hyperparathyroidism. Educational Objectives: 1) Describe the appropriate use of FNA biopsy and other diagnostic studies with a focus on patients with suspected or known Hashimoto’s thyroiditis. 2) Interpret the diagnostic evaluation and decision making for patients with functional thyroid disease with a focus on hyperthyroidism. 3) Outline the evaluation and treatment plan for patients’ hyperparathyroidism with a focus on non-localizing disease and recurrent disease.

Letter: Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and the Risk of Malignancy

1. Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK: Fine-needle aspiration of thyroid: an institutional experience. Thyroid 8:565-569, 1998 2. DeMay RM: Follicular lesions of the thyroid. W(h)ither follicular carcinoma? Am J Clin Pathol 114:681-683, 2000 3. Haugen BR, Woodmansee WW, McDermott MT: Towards improving the utility of fine-needle aspiration biopsy for the diagnosis of thyroid tumours. Clin Endocrinol (Oxf) 56:281-290, 2002 4. Sapio MR, Posca D, Raggioli A, Guerra A, Marotta V, Deandrea M, Motta M, Limone PP, Troncone G, Caleo A, Rossi G, Fenzi G, Vitale M: Detection of RET/PTC, TRK and BRAF mutations in preoperative diagnosis of thyroid nodules with indeterminate cytological findings. Clin Endocrinol (Oxf) 66:678-683, 2007

Fine-needle aspiration biopsy of ameloblastic carcinoma of the mandible: a case report

The use of fine-needle aspiration biopsy (FNAB) in the diagnosis of odontogenic tumors seems to have attracted little attention. The presence of a firm preoperative diagnosis helps preventing suboptimal surgery, contributing to avoid recurrence of these tumors. A case of ameloblastic carcinoma of the mandible diagnosed by FNAB is presented in this report, illustrating its effectiveness for preoperative diagnosis of odontogenic tumors. A 74-year-old female presented with a painless swelling in the right mandibular angle. A panoramic radiograph revealed a radiolucent lesion in the body of the mandible. Cytological smears from FNAB in the area revealed basaloid cells with a palisade arrangement and presence of stellate-shaped cells. These cytological features lead to the diagnosis of ameloblastoma. However, when there are atypical cells and atypical mitoses, as in the present case, diagnosis of ameloblastic carcinoma may be established. The patient underwent chemotherapy, showing remission of the lesion after treatment. FNAB is a minimally invasive, safe, fast and inexpensive method for diagnosing benign and malignant ameloblastomas, which ensures that patients have a proper treatment without the need of performing an incisional biopsy, especially in neoplastic cases.

Ocular Melanoma

Abstract Context—Intraocular melanoma of the ciliary body and choroid is the most common primary ocular malignant tumor in adults and the most common noncutaneous melanoma. Objective—To describe the most salient clinical features, histopathologic findings, and treatment modalities of intraocular melanoma, as well as the novel therapies currently being tested. Data Sources—Clinically, it is important to determine which lesions carry a worse prognosis so as to offer patients the best treatment modalities available. Tumor location, size, histopathology, cytogenetic abnormalities, and tumor profiling are all used in determining the risk of death from metastatic disease of uveal melanocytic lesions. Despite successful local tumor control, up to 50% of patients have metastatic disease within 15 years of diagnosis; there is no effective treatment for metastatic disease. Conclusions—Pathologists should be aware of the importance of tumor gross description, cellular histopathology classification, the use of fine-needle aspiration biopsy coupled with cytogenetics, and the new classification of uveal malignant melanomas that is based on chromosome 3 status.