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Background: 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. Methods: 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. Results: 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%. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid disorders are common in Indian adult population. Current management guidelines from the American Thyroid Association (ATA) recommend diagnostic ultrasonography for all patients with thyroid nodules. However, suspicious and few overlapping characteristics of benign and malignant thyroid nodules makes FNAC unquestionable. Unwanted suspicion leads to excessive unnecessary biopsies and insufficient lower suspicion leads to under-diagnosis or missing of thyroid malignancies. Hence, making accurate decision of whether a nodule is potentially malignant or not is crucial. Aims and objectives: To study the USG features of thyroid lesions in patients with thyroid disorders and correlate these USG findings with FNAC in the diagnosis of thyroid lesions. Methods: The cross-sectional study was done for 18 months among patients of thyroid disorders coming to the Radio-diagnosis department of Muzaffarnagar Medical College for routine USG scan for thyroid lesions. A sample of 50 patients was taken among the age group of 10-75years who gave consent for FNAC and did not have any bleeding disorders. Sonographic evaluation of the thyroid gland was done by characterising its size, shape, echogenicity, vascularity and presence or absence of nodules. The respective nodules were assed for suspicious patterns and FNAC of the nodules was done to correlate the radiological with pathological diagnosis. Results: As per the study, with good sensitivity and specificity, radiological examination of thyroid lesions by USG showed significant correlation with pathological evaluation of thyroid lesions by FNAC examination. A strong positive correlation between the two diagnostic procedures was seen. The correlation was statistically significant, with a P < 0.05. Conclusion: Thyroid gland ultrasound is a non-invasive, cost-effective and patient compliant technique in assessing and diagnosing thyroid swellings which can be performed as the initial investigation before FNAC examination for quickly assessing thyroid nodules, their vascularity and identifying benign from malignant lesions. This would avoid unnecessary invasion and its related complications like puncturing an highly vascular nodule which could be determined on USG itself. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aims to investigate the clinicopathological profile of cervical lymphadenopathy in a tertiary referral centre. The findings will contribute to a deeper understanding of the disease spectrum, aid in accurate diagnosis, and help in improving patient treatment and outcomes. Methodology: This is a prospective study conducted in the Department of ENT, Head and Neck Surgery, Apollo Hospital, Chennai, between June 2022 and May 2023. The clinicopathological profile of all patients was analysed. The final histological diagnosis and the preoperative Fine Needle Aspiration Cytology (FNAC) were correlated. The primary tumour was identified in cases with metastatic secondary tumours in the neck. Results: Among the 80 patients in our study, 67% had a benign aetiology (most common was tuberculosis), and 33% had a malignant aetiology (most common was Hodgkin's Lymphoma). Gender distribution was equal, with those between the ages of 35 and 60 more frequently affected. The nasopharynx (30%) was the most likely location of the occult primary, followed by the thyroid (20%) and larynx (20%). In detecting TB, FNAC had a sensitivity of 75.5% and a specificity of 98%; in detecting lymphomas, it was 64% and 100%; in detecting metastatic secondaries, it was 80% and 100%; and in detecting reactive lymphadenitis, it was 79% and 86%. Conclusion: Cervical lymphadenopathy is a common entity requiring careful evaluation and treatment. PET scans prove invaluable in detecting occult primary tumours. FNAC is an initial, cost-effective diagnostic tool. However, biopsy is indicated in specific conditions to obtain accurate diagnosis to enable prompt treatment. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Conclusion Striated duct adenoma is a benign salivary gland tumour recently recognized by the World Health Organization. To date, no report has described the cytological features of this entity.We report the case of a 60‐year‐old woman with a tumour in the right parotid gland with a diameter greater than 2.4 cm confirmed by imaging tests.Two fine‐needle aspiration cytologies (FNAC) were performed with inconclusive results, reporting epithelioid and spindle‐shaped cellularity, with little stroma, and nuclei with abundant pseudoinclusions. Myoepithelioma and Schwannoma were proposed as differential diagnoses. An immunocytochemical panel was performed, showing positivity for S‐100, SOX10, CK7 and vimentin, and negativity for both myoepithelial (p63 and calponin) and thyroid markers. In the absence of a conclusive diagnosis, the patient accepted surgery. The biopsy results confirmed diagnosis of striated duct adenoma, with immunohistochemical features superimposable to cytology.Little information is available in the literature, both on biopsy and, more strikingly, on cytology of this neoplasm. The aim of this work is to provide cytological characteristics that allow diagnosis of this entity with FNAC and thus avoid unnecessary surgeries. [ABSTRACT FROM AUTHOR]

Aim: To study the spectrum of lesions in the mediastinum. Methodology: This is a prospective study of various types of lesions in the mediastinum. The specimens included CT guided biopsies, excision biopsies and tissue biopsies obtained from the departments of Cardiothoracic and Surgical Oncology at Andhra Medical College & General Hospital, Vishakapatnam from June 2022 to May 2024. Results: There were 50 cases of mediastinal lesions, both non neoplastic and neoplastic lesions during the study period of two years. Neoplastic lesions were the majority in number 35(70%) with benign being 15 (30%) and malignant are 20 (40%). Non-neoplastic lesions were 15 (30%) in number with the most common age group affected being 21-30 years and 41-50 years and the commonest lesion was chronic nonspecific lymphadenitis constituting to 6 cases (40%). Of the benign lesions, The common age group affected benign lesions was 41-70 years with female preponderance and majority being schwanomma. Among the malignant neoplasms, the common age group affected was 41-60 years and commonest lesion was metastatic deposit. As most non-neoplastic and neoplastic lesions of the mediastinal lesions have similar clinical manifestations and radiological appearances, only provisional diagnosis can be made in these cases. Many of these lesions are inaccessible to FNAC and in some FNAC is not recommended for fear of hemorrhage. Conclusion: The study concluded that correct and final diagnosis can be made only by histopathological examination. Therefore, histopathological diagnosis is mandatory for proper early treatment and to assess the prognosis of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Cryptococcosis is a fungal disease affecting the respiratory and central nervous system in HIV-infected individuals, causing life-threatening symptoms and necessitating prompt diagnosis, with approximately 5% of infected individuals developing it. Case Report: A 35-year-old HIV-positive male patient presented with abdominal pain, fever, and cough, without cervical lymphadenopathy. USG revealed multiple enlarged lymph nodes, and FNAC was performed. Result: Cytological examination revealed lymphocytes, histiocytes, granulomas, and necrotic material, along with budding yeast of Cryptococcus neoformans. PAS, GMS, Indian ink, CSF, and bone marrow tests confirmed Cryptococci. Conclusion: FNAC is a safe and efficient technique for early diagnosis of Cryptococcal lymphadenitis, a rare presentation in lymphadenopathy, highlighting its potential for rapid treatment. [ABSTRACT FROM AUTHOR]

Introduction: In developing countries the detection of TBLN is a major challenge. The clinical parameters for the diagnosis of TB in lymph nodes are not specific for some cases and the absence of lymphadenitis does not rule out TB involvement. Aim: Diagnosis of tubercular lymph node by CBNAAT on lymph node tissue taken by excisional biopsy in case of suspected palpable tubercular lymphadenopathy and comparison of CBNAAT with FNAC and histopathology examination. Methods: This was a Prospective observational study, conducted on 50 suspected and confirmed case of tubercular lymphadenopathy, attending outpatient department or admitted during January 2021–December 2022 in the department of surgery JLN Hospital Ajmer. Results: Mean age of study population was 29 ± 15.64 yearrs. The most common presenting complaint was swelling (100%) followed by loss of weight (50%) and loss of appetite (40%). Mean ESR was 43 ± 24.01 per hr. 54% of the patients had positive mantoux test for TB. On histopathology, 60% cases were diagnosed as Tubercular. 2 (4%) male and 3 (6%) female had rifampicin resistance on CBNAAT. CBNAAT the true positive were 23 whereas true negative were 20. FNAC the true positive were 27 whereas true negative were 18. CBNAAT, PPV (66.66), NPV(100), Sensitivity= 100%, and Specificity= 74.07%. FNAC, Positive Predictive Value = 90%, Negative Predictive Value = 90%, Sensitivity= 93.1%, and Specificity= 85.71%. Conclusion: With high sensitivity and average specificity of CBNAAT and FNAC they are a good tool for diagnosis in combination with other testing modality like culture and histopathology examination. [ABSTRACT FROM AUTHOR]

Background In settings with high burden of extrapulmonary tuberculosis, the use of various diagnostic modalities can result in superior and quick diagnosis leading to prompt initiation of treatment. Objective This study assessed the diagnostic performance of the fine-needle aspiration cytology (FNAC), Ziehl–Neelsen (ZN) stain, fluorescence microscopy (FM) and cartridge-based nucleic acid amplification test (CBNAAT) in patients with suspected tuberculous lymphadenitis (TBLN). Methods This cross-sectional studyodes, who underwent FNAC. The FNAC samples were subjected to cytomorphological examinati involved 255 patients clinically suspected of TBLN with palpable lymph non, ZN stain, FM and CBNAAT. The diagnostic performance of each modality was compared with CBNAAT, and combined performance was determined. The diagnostic performance of CBNAAT was determined by comparing it with composite reference standard. Results Of 255 patients, 148 (58.04%) showed features of TBLN on FNAC. The presence of epithelioid cell granulomas with caseous necrosis (67.57%) was the predominant cytomorphological pattern. On ZN stain, FM and CBNAAT, 31 (20.95%), 63 (42.57%) and 100 (67.57%) patients were found to be positive for TBLN, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT was 58.59%, 91.83%, 92% and 58.06%, respectively. Finally, the combination of ZN stain, FM and CBNAAT led to the detection of 88.51% patients with TBLN. Conclusion Combined use of ZN stain, FM and CBNAAT leads to superior and swift diagnosis of patients with clinically suspected TBLN.

Background: Neck swellings are frequently found and can present the vast pathological spectrum from simple benign to highly malignant, which sometimes can pose a diagnostic dilemma. They are broadly classified as developmental, inflammatory, and neoplastic on the basis of etiology. The aim of the study is to assess the distribution of neck swelling according to etiology and its relation to age groups, as well as to assess their clinicopathological correlation as benign and malignant. Materials and Methods: The study was conducted from January 2020 to February 2023 on the basis of retrospective and prospective sampling. All the patients with neck swellings, except thyroid, who had undergone an excisional or incisional biopsy, were included in this study. Data was collected from in-patient records for retrospective sampling, and fine-needle aspiration cytology (FNAC), radiological investigation, and excisional or incisional biopsy were performed for prospective sampling after proper history and examination. Cytological and pathological correlation was analyzed as benign and malignant. Sensitivity and specificity were calculated. (P value

Objective: Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size. Methods: Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS. Results: Forty-eight AFTNs were included of which 37.5% had FNAC indication according to TIRADS. The FNAC indication rate in the case of TSH lower than 0.4 mIU/L was significantly higher than in other cases (P = 0.0078). The most accurate TSH cut-off and AFTN size associated with UN-FNAC were ≤ 0.41 mIU/L and > 22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR of 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped to 4.16%. Conclusion: Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.

Abstract Introduction Proper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis. Methods Fine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25. Results The sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785). Conclusion The fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.

Background: Tuberculosis (TB) remains the number one cause of adult deaths by a curable infectious disease. Mycobacterium tuberculosis bacilli (MTB) is the most common causative organism isolated from mycobacterial lymphadenitis. Accurate and speedy diagnosis is required, especially in paucibacillary extrapulmonary TB. In this study, we compared the efficacy of CBNAAT with line probe assay and liquid culture in the evaluation of tubercular lymph node abscesses. Materials and Methods: This is a hospital-based observational cross-sectional study conducted at Gandhi Medical College and Hospital, Secunderabad, TS, in patients who presented with lymph node abscesses over a period of 18 months after obtaining clearance from the ethics committee and obtaining informed consent. Each sample was evaluated and analyzed in association with the clinical findings, AFB staining, CBNAAT, LPA, and AFB culture, and the results were compared. Results: Fifty patients with TB lymph node abscess diagnosed through FNAC were included in the present study. AFB smear was positive in 29 samples, CBNAAT was positive in 43 samples, LPA was positive in 44 samples, and liquid culture was positive in 39 samples. CBNAAT could detect TB in 16 smear-negative cases, 10 liquid culture-negative cases, and one LPA-negative case. In our study, CBNAAT was more effective in diagnosing TB lymph node abscess than AFB smear. No significant results were obtained when comparing CBNAAT with LPA and liquid culture. Conclusion: This study demonstrates excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis, with a sensitivity of 86%, specificity of 83.33%, negative predictive value of 95.56%, and positive predictive value of 58.82%. Thus, it can be a rule in testing for lymph node TB. These efforts will contribute to the attainment of the TB elimination goal.

Background: Thyroid is superficially located gland, makes it easily approachable for examination. FNAC (Fine Needle Aspiration Cytology) is cost effective and OPD (Out Patient Department) based technique. Histopathological examination is gold standard. Aim: To compare the cytological and histopathological results of thyroid lesion in tertiary care center. Settings and Design: It is a cross-sectional analytical study conducted at department of pathology and ENT (otorhinolaryngology) at MGM medical college and hospital, Aurangabad. Methods and Material: 83 cases were included over a period of 1 year and 9 months. Patients presenting with thyroid lesions were included in the study while previously diagnosed cases were excluded from the study. FNAC was done on the patients and slides were reported according to Bethesda system of reporting thyroid cytopathology. Post-surgery specimen of the same patient received in the department of pathology, routine paraffin sectioned and hematoxylin and eosin stained (H & E stained) slides were reported. FNAC results were compared with histopathology results. Statistical analysis: The collected data entered in Microsoft excel and analyzed using SPSS version 24.0. Mean and SD(Standard deviation) will be calculated for quantitative variables and proportions will be calculated for categorical variables. Also, data represented in form of visual impression like bar-diagram, pie diagram etc. Results: Sensitivity of the FNAC for diagnosing malignant lesion was 50%. Specificity, PPV (Positive Predictive Value) and NPV (Negative Predictive Value) was 97%, 67% and 95% respectively. Conclusion: This study suggests preoperative diagnosis of FNAC is useful to plan the further management of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Filariasis, a parasitic infection caused by several types of nematode worms, is a matter of great concern for public health in India, The disease is caused by microfilaria, which are released into the peripheral blood circulation with periodicity during the night. However, identifying microfilaria in routine peripheral blood smears, Fine Needle Aspiration (FNAC) smears, and body fluids is challenging due to their scarce nature. Our study aimed to underscore the significance of having a heightened suspicion of filarial infection in patients with swelling, particularly those from endemic regions. Furthermore, the study emphasised the importance of using FNAC as an economical and effective diagnostic tool for detecting microfilaria. Materials and Methods: This retrospective study was conducted in the Pathology Department of ESIC Medical College and Hospital Gulbarga over a period of ten years (2013-2023). A 22-23 gauze needle made aspiration smears were stained by Papanicolaou and May-Grünwald Giemsa stain. Results: In this study, 24 cases showed the presence of microfilaria, a type of parasitic worm, despite the lack of clinical suspicion. Of these cases, eight involved breast lumps, eight involved thyroid swelling, and eight involved lymph nodes. In fifteen of these cases, fragments of adult worms were also reported, indicating a potentially more severe infection. These findings suggest the need for more diligent screening and testing to detect and treat parasitic infections before they can cause further harm. Conclusion: Filariasis is a rare disease that requires thorough screening of FNA smears, particularly in asymptomatic patients from endemic regions, to avoid missing incidental findings. Moreover, the study emphasises the cost-effectiveness and efficacy of FNAC in diagnosing microfilaria. [ABSTRACT FROM AUTHOR]

Aims and Obctives: To compare FNAC, microscopy (ZN staining), histopathology and CBNAAT for diagnosis of head and neck tuberculosis, and to evaluate efficacy of CBNAAT in early diagnosis of tuberculosis in head and neck region. Materials and methods: This prospective study was carried out in the department of otorhinolaryngology, JLN Medical College and attached hospital, Ajmer from August 2020 to September 2022. Thorough history and clinical examination of all patients presented with neck swelling was done. All relevant investigations including chest x-ray, mantoux test, ESR, FNAC, ZN staining, CBNAAT and histopathology were done and their efficacy was compared. Results: Sensitivity and specificity of CBNAAT in detecting extra pulmonary tuberculosis was 85.19% and 91.30% respectively, and diagnostic accuracy was consistent with findings of FNAC and ZN staining (p < 0.001) for diagnosis of cervical lymphadenopathy. Conclusion: CBNAAT has a promising role in early diagnosis of head and neck tuberculosis as well as other cases of smear negative tuberculosis such as MDR TB and TB-HIV and is optimal for the diagnosis of lymph node tuberculosis and helps in early identification and initiation of treatment. Sensitivity of CBNAAT scored twice as high in comparison with microscopy thus doubling the proportion of rapid diagnoses with important effect on the patient's outcome. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a rare type of ovarian tumor called Sertoli-Leydig cell tumor (SLCT). SLCTs are composed of Sertoli and Leydig cells and make up less than 0.5% of all ovarian tumors. The article describes the cytomorphologic features of an SLCT found in an uncommon metastatic site in a young female. The study highlights the importance of accurate cytologic diagnosis and clinical correlation in determining the prognosis and appropriate treatment for SLCTs. [Extracted from the article]

LCH has a distinct site predilection and cytological feature. However, it can cause diagnostic difficulties at unusual sites or deviated cytomorphology. FNAC is a minimally invasive procedure that can be performed in any organ (parotid and thyroid where biopsy is not commonly indicated) and multiple sites/organs simultaneously for diagnosis. FNA sampling can also help with cell block preparation for performing immunohistochemistry and molecular studies if necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: Breast lump is one of the common surgical problems encountered in female patients. The goal of pathological diagnosis is to distinguish between aggressive carcinomas requiring aggressive treatment and benign lesions that allow for a more conservative approach. METHOD: A cross-sectional study was conducted in which the cytological diagnosis of palpable lesion of the breast was compared with histopathological diagnosis to find sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of FNAC in breast lumps. A total number of 62 fine needle aspiration cytology were performed. Every patient subjected to FNAC underwent a definitive surgical procedure and was subjected to histopathology. RESULTS: Statistical analysis was performed on the tabulated data and sensitivity and specificity with PPV and NPV were obtained. Of all 62 patients selected, only 2 were false negative for malignancy i.e., they were detected as benign lesions on FNAC but found to be malignant on histopathology. Hence, the sensitivity of the study was 92.3% and the specificity for malignant lesions was 100%. The PPV was 100% and the NPV was 94.7% CONCLUSION: Histological correlation indicated FNAC to be a good diagnostic tool as the p-value turned out to be 0.001, considered extremely significant. It gives a good histological correlation. [ABSTRACT FROM AUTHOR]

The present study was carried out to investigate cytological, histopathological and immunohistochemically expression of diagnostic marker (HER-2), proliferative marker (PCNA) and apoptotic marker (Bcl-2). A total of 30 canine mammary tumors (CMTs) samples were collected from TVCC, Bihar Veterinary College and in and around from Patna, India from the over period of September 2023 to February 2024. cytological findings of 24 cases out of 30, 16 cases were malignant, 6 cases were benign and 2 cases were inconclusive. Among Histological characterization of 30 CMTs, 24 were malignant, consisting of 14 carcinomas, 7 carcinosarcomas, 2 lipid-rich carcinomas and 1 fibrosarcoma, while 6 were benign. Histological diversity of CMTs provide little prognostic information, hence use of a Histological grading systems may be helpful for prognosis of CMTs. The malignancies were histologically graded as grade I, II, or III based on tubular structure formation, nuclear pleomorphism and mitotic index. Tumor-detectable biomarkers have potential applications in early diagnosis, prognoses, and evaluation of therapy response. Immunohistochemically analysis revealed HER-2 overexpression in 8% of cases, with weak or moderate membrane staining in 20.83% of cases. PCNA displayed weak nuclear staining in benign tumors and strong staining in most malignant tumors. Bcl-2 exhibited weak cytoplasmic staining in benign tumors and moderate to strong staining in higher-grade malignancies. The IHC expression of Her 2/neu, PCNA and BCL-2 were found to be positive/overexpressive in higher Grades of canine mammary tumours irrespective of their histo-subtypes. Immunohistochemically markers HER-2 overexpression in canine mammary tumors correlates with more aggressive behaviour, higher tumor grade, larger tumor size and poorer prognosis, PCNA and Bcl-2, associated with cell proliferation and apoptosis, respectively are frequently used in assessing CMTs. They aid in understanding the proliferative activity and apoptotic index of tumor cells. [ABSTRACT FROM AUTHOR]

Introduction: Proper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis. Methods: Fine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25. Results: The sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785). Conclusion: The fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains the number one cause of adult deaths by a curable infectious disease. Mycobacterium tuberculosis bacilli (MTB) is the most common causative organism isolated from mycobacterial lymphadenitis. Accurate and speedy diagnosis is required, especially in paucibacillary extrapulmonary TB. In this study, we compared the efficacy of CBNAAT with line probe assay and liquid culture in the evaluation of tubercular lymph node abscesses. Materials and Methods: This is a hospital‑based observational cross‑sectional study conducted at Gandhi Medical College and Hospital, Secunderabad, TS, in patients who presented with lymph node abscesses over a period of 18 months after obtaining clearance from the ethics committee and obtaining informed consent. Each sample was evaluated and analyzed in association with the clinical findings, AFB staining, CBNAAT, LPA, and AFB culture, and the results were compared. Results: Fifty patients with TB lymph node abscess diagnosed through FNAC were included in the present study. AFB smear was positive in 29 samples, CBNAAT was positive in 43 samples, LPA was positive in 44 samples, and liquid culture was positive in 39 samples. CBNAAT could detect TB in 16 smear‑negative cases, 10 liquid culture‑negative cases, and one LPA‑negative case. In our study, CBNAAT was more effective in diagnosing TB lymph node abscess than AFB smear. No significant results were obtained when comparing CBNAAT with LPA and liquid culture. Conclusion: This study demonstrates excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis, with a sensitivity of 86%, specificity of 83.33%, negative predictive value of 95.56%, and positive predictive value of 58.82%. Thus, it can be a rule in testing for lymph node TB. These efforts will contribute to the attainment of the TB elimination goal. [ABSTRACT FROM AUTHOR]

Cytological evaluation through microscopic image analysis of fine needle aspiration cytology (FNAC) is pivotal in the initial screening of breast cancer. The sensitivity of FNAC as a screening tool relies on both image quality and the pathologist’s expertise. To enhance diagnostic accuracy and alleviate the pathologist’s workload, a computer-aided diagnosis (CAD) system was developed. A comparative study was conducted, assessing twelve candidate pre-trained models. Utilizing a locally gathered FNAC image dataset, three superior models-MobileNet-V2, DenseNet-121, and Inception-V3-were selected based on their training, validation, and testing accuracies. Further, these models underwent evaluation in four transfer learning scenarios to enhance testing accuracy. While the outcomes were promising, they left room for improvement, motivating us to create a novel deep convolutional neural network (CNN). The newly proposed model exhibited robust performance with testing accuracy at 85%. Our research concludes that the most lightweight, high-accuracy model is the one we propose. We’ve integrated it into our user-friendly Android App, “Breast Cancer Detection System,” in TensorFlow Lite format, with cloud database support, showcasing its effectiveness. Implementing an artificial intelligent (AI)-based diagnosis system with a user-friendly interface holds the potential to enhance early breast cancer detection using FNAC. [ABSTRACT FROM AUTHOR]

Hereditary Multiple Exostoses (HME) is a rare autosomal dominant bone disease. It is characterized with numerous benign osteochondromas, which grow outward from the metaphyses of long bones. In many cases it is asymptomatic but can lead to considerable number of complications, like pressure symptoms, limb deformities, and can cause psychosocial problems. Malignant transformation is rarely seen. Surgery is the main modality of treatment.This paper aims to highlight the role of FNAC in diagnosis of HME.

Objective: Abdominal wall masses often pose diagnostic challenges for clinicians due to their nonspecific symptoms. They include a wide spectrum of lesions ranging from inflammatory to tumor-like masses and malignancies. The majority of the malignant nodules are metastatic in origin and may be the initial presentation of a primary malignancy; hence, an early diagnosis is important. Fine-needle aspiration cytology (FNAC) is a valuable diagnostic tool in the evaluation of such lesions. This was a retrospective study of the cytomorphological spectrum of abdominal wall masses, conducted at a tertiary health care centre over a three-year period. Material and Methods: The study included patients of all age groups presenting with an abdominal wall mass. These lesions were assessed by FNAC. The diagnosis was made on cytology smears and subsequently correlated with the histopathological diagnosis, wherever possible. Results: Of the 70 cases, 21 were non-neoplastic and 49 neoplastic. A benign neoplasm was the most common lesion (52.9%), followed by non-neoplastic lesions (30%) and malignant neoplasms (17.1%). Lipoma was the most common benign neoplasm and metastasis was the commonest malignant neoplasm. The most common type of tumor metastasising was adenocarcinoma and the primary tumors were predominantly intra-abdominal. No false-negative results were seen. Conclusion: Most of the abdominal wall masses display a characteristic cytomorphology, which needs to be identified and recognized by a cytopathologist for an accurate diagnosis. FNAC plays an invaluable role in the detection of metastases, especially at sites such as the umbilicus, which may be the only manifestation of an underlying advanced malignant disease.

Abstract Background Fine-needle aspiration cytology (FNAC) of the breast is a well-established technique that aids in the preoperative identification and differentiation between nonneoplastic and neoplastic breast lesions. Breast lesions can be efficiently categorized into different cytological groups using the International Academy of Cytology (IAC) Yokohama System. The aim of this study was to classify breast lesions based on the proposed Yokohama system of reporting breast cytology and identify the need for a unified system of reporting breast lesions. Materials and methods This retrospective descriptive study was performed in the Department of Pathology, Government Medical College, Datia, M.P. from January 2019 to June 2023. A total of 762 FNAC slides reported during this period were retrieved, re-examined and reclassified according to the IAC Yokohama System. Histopathological diagnoses were also retrieved and correlated with the cytological findings wherever available. Results In the present study, a total of 762 smears of breast fine needle aspirations were included and categorized using the IAC Yokohama System. There were 3.8% cases (29/762) in the C1 category (insufficient), 71.6% cases (545/762) in the C2 category (benign), 6.3% cases (48/762) in the C3 category (atypical), 3.1% cases (24/762) in the C4 category (suspicious for malignancy) and 15.2% (116/762) cases in the C5 category (malignant). Conclusion FNAC is a reliable diagnostic technique for the evaluation and management of breast lesions prior to surgery. Implementing the IAC Yokohama System for reporting breast cytopathology enhances the accuracy of diagnosing breast lesions, reduces missed diagnoses, and offers reliable estimates of risk of malignancy. Adopting the Yokohama system is a crucial first step in boosting the overall effectiveness of breast cytology reporting among clinicians and pathologists, which will ultimately lead to improved communication and patient care.

Introduction: The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. Aims and Objectives: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Materials and Methods: Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Results: Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). Conclusion: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

Introduction: Fine needle aspiration cytology of head and neck region is well-accepted as a diagnostic procedure. It is a safe, simple, rapid, cost-effective, and minimally invasive way of diagnosing inflammatory, noninflammatory and neoplastic lesions. Aim : To study the role of FNAC in diagnosing head & neck lesions in the paediatric age group. Material and Method: This is the hospital-based study of 120 lesions of the head and neck region belonging to the age group of 0-18 years. Cytological results are interpreted and analyzed according to anatomical site and then categorized based on interpretation. Result: Out of 120 cases 20 % cases belong to the age group 0-5yrs, 24.16% belong to 6-10yrs & 55.83% belong to the 11-18yrs age group. According to the anatomical distribution of lesions maximum cases accounting for 81.67% are lymph node lesions followed by thyroid lesions, miscellaneous, and then least salivary gland lesions which account for 2.5%. In the lymph node, thyroid, salivary gland, and miscellaneous lesions predominant lesions are respectively reactive lymphoid hyperplasia (71.42%), thyroiditis (42.85%), sialadenitis (33.34%) &epidermal cyst (40%) Conclusion: FNAC in resource-limited settings, healthcare providers should realize the importance of FNAC as an initial screening tool for superficial lesions in paediatric population. The presumptive diagnosis after FNAC of palpable lesions in paediatric age group avoids the unnecessary definitive operative procedure. Thus, FNAC is an easy, simple, rapid, and cost-effective diagnostic procedure for paediatric age group.

Abstract Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results.

Abstract Background Thyroid nodules were widely encountered in the population, and the selection of thyroid nodules for fine needle aspiration cytology (FNAC) remains confusing. It is essential to investigate the risk factors associated with thyroid nodules. Aim of work This study aimed to evaluate the accuracy of the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) scoring system in distinguishing malignant thyroid nodules from benign ones and its association with cytological examination of the FNAC of the thyroid nodules. Additionally, we seek to investigate any potential association between thyroid nodules and some metabolic derangements. Patients and methods The study included 111 Egyptian patients with euthyroid nodules whom were subjected to history taking, clinical examination, and laboratory investigations including thyroid profile, fasting blood sugar (FBS), glycosylated hemoglobin A1c (HbA1c), and lipid profile. Thyroid ultrasound and FNAC were done for all patients. Categorization of each nodule was done according to the TIRADS. Cytopathological diagnosis was done by Bethesda system cytology classification. Results There were 19 malignant and 92 benign nodules. There was a statistically significant difference between benign and malignant nodules regarding TIRADS classification, taller-than-wide shape, solidity, border, presence of peripheral calcifications, or punctuate echogenic foci (p < 0.05). Taller-than-wide shape had the highest specificity followed by irregular margin (94.6% and 92.6%, respectively). Sensitivity, specificity, PPV, and NPV for ACR-TIRADS versus cytopathology were 73.7%, 57.6%, 26.4%, and 91.4% respectively with overall accuracy of 60.4%. The high sensitivity and NPV of the US-based TIRADS classification system have excellent utility for correctly classifying nodules as positive for malignant disease. As regards risks for thyroid nodules, results showed that most of the study population were obese [Body Mass Index (BMI) = 31.6 ± 6.3, Waist circumference (WC) = 107.4 ± 13.9]. TSH and hypercholesterolemia did not show a significant association with thyroid malignancy. Conclusion ACR-TIRADS classification is of high significant value in classifying nodules as positive for malignant disease and for predicting the absence of malignant disease, reducing unnecessary nodule FNAC. Hypercholesterolemia and TSH value were not significantly associated with malignant thyroid nodules.

Background: 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. Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: Abdominal wall masses often pose diagnostic challenges for clinicians due to their nonspecific symptoms. They include a wide spectrum of lesions ranging from inflammatory to tumor-like masses and malignancies. The majority of the malignant nodules are metastatic in origin and may be the initial presentation of a primary malignancy; hence, an early diagnosis is important. Fine-needle aspiration cytology (FNAC) is a valuable diagnostic tool in the evaluation of such lesions. This was a retrospective study of the cytomorphological spectrum of abdominal wall masses, conducted at a tertiary health care centre over a three-year period. Material and Methods: The study included patients of all age groups presenting with an abdominal wall mass. These lesions were assessed by FNAC. The diagnosis was made on cytology smears and subsequently correlated with the histopathological diagnosis, wherever possible. Results: Of the 70 cases, 21 were non-neoplastic and 49 neoplastic. A benign neoplasm was the most common lesion (52.9%), followed by non-neoplastic lesions (30%) and malignant neoplasms (17.1%). Lipoma was the most common benign neoplasm and metastasis was the commonest malignant neoplasm. The most common type of tumor metastasising was adenocarcinoma and the primary tumors were predominantly intra-abdominal. No false-negative results were seen. Conclusion: Most of the abdominal wall masses display a characteristic cytomorphology, which needs to be identified and recognized by a cytopathologist for an accurate diagnosis. FNAC plays an invaluable role in the detection of metastases, especially at sites such as the umbilicus, which may be the only manifestation of an underlying advanced malignant disease. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary neoplasm of the pancreas is a rare tumour with distinct clinicopathological features. The tumour most commonly occurs in younger women and has low malignant potential with an excellent overall prognosis. [ABSTRACT FROM AUTHOR]

The cytological features of undifferentiated embryonal sarcoma of the liver in a child are described in this report. It is important to be aware of this entity and its cytological features in order to avoid misdiagnosis with more common entities such as the hepatoblastoma. [ABSTRACT FROM AUTHOR]

Nodular fasciitis (NF) is a benign, self-limiting, proliferative myofibroblastic lesion typically seen in subcutaneous tissues, muscles, and fascia. NF of the parotid gland is rare, frequently misdiagnosed as a malignant tumour, with the misdiagnosis resulting in inappropriate treatment such as wide surgical resection, radiation therapy, or chemotherapy with sometimes poor aesthetic outcomes. We present the case of a 44-year-old woman with a 2-cm-diameter, solid, mobile nodular swelling with well-defined edges over the superior margin of the right parotid gland. She has no facial nerve palsy, and the mass was not fixed to the overlying skin. Preoperative ultrasonography, magnetic resonance imaging (MRI), and fine needle aspiration cytology (FNAC) all suggested a pleomorphic adenoma. The postoperative histopathological findings revealed NF. Cytological diagnosis is crucial for NF diagnosis and management. Preoperative FNAC should be accompanied by immunocytochemical evaluation; if analysis is inadequate and/or suspicious, it should be repeated in a high-volume centre with experience in salivary gland lesions. Comprehensive MRI including diffusion-weighted imaging and perfusion sequences aid differential diagnosis. As NFs are benign and self-limiting, accurate preoperative diagnosis is essential to avoid unnecessary extensive treatment. [ABSTRACT FROM AUTHOR]

Background: Breast malignancy is the major cause of cancer-related deaths among women globally. Therefore, early diagnosis is the primary requisition for an effective treatment plan. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of fine needle aspirate cell blocks made by the HistoGel-tube method in patients with breast cancer. Methods: This cross-sectional study was carried out at the Department of Pathology, King Edward Medical University/Mayo Hospital, Lahore. The study duration was six months. 62 patients with breast lumps, of all ages, both genders, having easily accessible breast lesions and C III, C IV, C V smears on rapid onsite evaluation were included while patients who had received neo-adjuvant chemo- or radiotherapy and those reported as C I, C II smears on ROSE were excluded. FNA was performed and HistoGel cell blocks were made in addition to the conventional smears. Data was entered in SPSS version 26. Results: The mean age of patients included in the study was 47 ± 13 years. 61(98.4%) patients were female while only 1(1.6%) patient was male. Sensitivity, Specificity, Positive predictive value, Negative predictive value and diagnostic accuracy came out to be 96%, 69%, 92%, 81%, and 90% respectively. Conclusion: HistoGel cell blocks have overall good diagnostic accuracy for the evaluation and diagnosis of breast malignancy. [ABSTRACT FROM AUTHOR]

Background: The enlargement of Cervical lymph nodes is quite significant in that there are so many etiological agents and is an index spread of infections, malignancy, autoimmune disorders, and some other miscellaneous conditions etc. is very much difficult to diagnosis. So the purpose of our study is to systematically identify the many pathogenic conditions presenting with enlarged lymph nodes in the neck, as well as the scenario of different ways of presentation of these disorders both clinically and pathologically with the help of FNAC and Ultrasonography diagnostic techniques there by better management services could be rendered to the affected individuals in our set up. Research Question: What is the scenario of different ways of presentation of cervical lymphadenopathy both clinically and pathologically in our set up? The setting of the study was at department of General Surgery, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one year observational study was conduct during the period from October 2022 to September 2023 on about 60 Cervical lymphadenopathy cases visited General Surgery OPD during the above period by studying their socio-demographic profiles, histopathological examination of Lymphadenopathy, distribution of presenting complaint, distribution of primary cancerous site with neck secondaries and treatment & outcome of the study subjects etc. Results: It was observed that the majority about 35% of cases were belongs to the age group 41-50 years followed by 23.5% between 21-30 years, 16.6% between both 31-40 years & 51years and above and 8.5% between 12-20 years of age group with the mean age was 58.3 years. And regarding the sex males were more in number significantly when compared to females that was 1.7:1. Regarding histopathological diagnosis and categorisation, majority of the cases were Tuberculosis lymphadenopathy (43.5%) followed by Secondaries (28.3%) Reactive lymphadenopathy (23.3%), Hodgkin's lymphoma (3.3%) and Non-Hodgkin's lymphoma (1.6%). Related to distribution of presenting complaint almost all the cases were visited the hospital with the complaint h/o neck swelling and among the other symptoms fever was the common one (33.3%) followed by cough (30%), decreased appetite (26.6%), weight loss, pain (20%), painful swallowing (3.3%) and voice change (1.6%). With reference to Primary cancerous sites with neck secondaries, Oral cavity occupies major position (23.5%) followed by Larinx (11.7%), Stomach (11.7%), Esophagus (5.8%) and Thyroid (5.8%) respectively and regarding histopathology Squamous cell carcinoma was the commonest one observed. The overall recovery rate was 65% and the complete recovery (100%) was observed among Tubercular cervical lymphadenitis and Reactive lymphadenitis and the maximum number of cases missed for the followup was observed in Secondaries neck and mortality was observed in Secondaries neck and Hodgkin's lymphoma. [ABSTRACT FROM AUTHOR]

Introduction: The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. Aims and Objectives: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Materials and Methods: Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Results: Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). Conclusion: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs. [ABSTRACT FROM AUTHOR]

Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules were widely encountered in the population, and the selection of thyroid nodules for fine needle aspiration cytology (FNAC) remains confusing. It is essential to investigate the risk factors associated with thyroid nodules. Aim of work: This study aimed to evaluate the accuracy of the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) scoring system in distinguishing malignant thyroid nodules from benign ones and its association with cytological examination of the FNAC of the thyroid nodules. Additionally, we seek to investigate any potential association between thyroid nodules and some metabolic derangements. Patients and methods: The study included 111 Egyptian patients with euthyroid nodules whom were subjected to history taking, clinical examination, and laboratory investigations including thyroid profile, fasting blood sugar (FBS), glycosylated hemoglobin A1c (HbA1c), and lipid profile. Thyroid ultrasound and FNAC were done for all patients. Categorization of each nodule was done according to the TIRADS. Cytopathological diagnosis was done by Bethesda system cytology classification. Results: There were 19 malignant and 92 benign nodules. There was a statistically significant difference between benign and malignant nodules regarding TIRADS classification, taller-than-wide shape, solidity, border, presence of peripheral calcifications, or punctuate echogenic foci (p < 0.05). Taller-than-wide shape had the highest specificity followed by irregular margin (94.6% and 92.6%, respectively). Sensitivity, specificity, PPV, and NPV for ACR-TIRADS versus cytopathology were 73.7%, 57.6%, 26.4%, and 91.4% respectively with overall accuracy of 60.4%. The high sensitivity and NPV of the US-based TIRADS classification system have excellent utility for correctly classifying nodules as positive for malignant disease. As regards risks for thyroid nodules, results showed that most of the study population were obese [Body Mass Index (BMI) = 31.6 ± 6.3, Waist circumference (WC) = 107.4 ± 13.9]. TSH and hypercholesterolemia did not show a significant association with thyroid malignancy. Conclusion: ACR-TIRADS classification is of high significant value in classifying nodules as positive for malignant disease and for predicting the absence of malignant disease, reducing unnecessary nodule FNAC. Hypercholesterolemia and TSH value were not significantly associated with malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid diseases affect approximately 42 million people in India. The majority (15%--40%) of these cases remain asymptomatic and benign and warrant special investigations such as ultrasonography (USG) and fine-needle aspiration cytology (FNAC) for diagnosis. Early diagnosis and management of thyroid disorders determine the disease course in many patients. Objective: To determine the role of USG and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC. Methods: We did a cross-sectional analytical study over 2 years, where we recruited 108 patients with thyroid swelling attending the OPD. We used a semi-structured data collection proforma that captured information on sociodemographic details, clinical symptoms, physical examination, and all ne cessary laboratory investigations. All patients underwent USG, color Doppler, and FNAC as a part of the investigation of thyroid nodules. The diagnostic value of ultrasound and Doppler parameters was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of malignancy in comparison to FNAC. Results: Approximately 155 nodules were identified from the selected 108 cases, and the prevalence of malignancy among the selected thyroid nodule patients was found to be 9.1%. We observed that malignant tumors were likely to be solitary with lobulated margins, >2 cm in size with <50% peripheral halo, with markedly hypoechoic, predominantly solid, with nodal involvement and extrathyroidal extension, microcalcifications, and central vascularity. We also observed that tumors that had USG characteristics of being taller than wide (91%), poorly defined margins (92%), marked hypoechoic (95%), and microcalcifications (96%) had the highest diagnostic accuracy in detecting malignancy when compared to FNAC. Conclusion: Thus, through our study findings, we conclude that USG and color Doppler can serve as vital tools for the evaluation of thyroid nodules with high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Background: FNAC is a safe, reliable, cost-effective, and efficient method for initial screening of patients with cervical lymphadenopathy. Aims: The purpose of this study was to identify cytomorphological features and to evaluate the diagnostic efficacy of FNAC as a screening tool for cervical lymphadenopathy. Materials and Methods: A study included 952 cases of FNAC, with 215 cases being compared to histological diagnosis. Subsequently, discordant cases, including both false negatives and false positives, were retrospectively re-evaluated. Additionally, a thorough review of previous research on the factors that contribute to misdiagnosis was conducted. Results: Discordance was found more in benign lesions (12.4%) as compared to malignant lesion aspirates (4.9%). When suspected malignant and malignant group are all classified as cytologically positive, the sensitivity and specificity are 97.3% and 95.8% respectively. Overlapping cytological features, heterogeneity, unsampled areas and error in interpretation were the primary factors contributing to false positive and false negative diagnosis. Conclusion: FNAC of cervical lymphadenopathy is a precise, sensitive, and specific initial diagnostic procedure. However False-negative diagnoses are mainly due to issues with the specimens obtained, while false-positive diagnoses are primarily caused by errors in interpretation. Experienced cytopathologists are expected to analyze the outcomes of FNAC while considering the accompanying clinical, radiographic, and laboratory information. In cases where there is ambiguity in the interpretation of these results, additional investigations and ancillary technique are essential to address potential misdiagnoses. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid diseases affect approximately 42 million people in India. The majority (15%–40%) of these cases remain asymptomatic and benign and warrant special investigations such as ultrasonography (USG) and fine-needle aspiration cytology (FNAC) for diagnosis. Early diagnosis and management of thyroid disorders determine the disease course in many patients. Objective: To determine the role of USG and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC. Methods: We did a cross-sectional analytical study over 2 years, where we recruited 108 patients with thyroid swelling attending the OPD. We used a semi-structured data collection proforma that captured information on sociodemographic details, clinical symptoms, physical examination, and all ne cessary laboratory investigations. All patients underwent USG, color Doppler, and FNAC as a part of the investigation of thyroid nodules. The diagnostic value of ultrasound and Doppler parameters was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of malignancy in comparison to FNAC. Results: Approximately 155 nodules were identified from the selected 108 cases, and the prevalence of malignancy among the selected thyroid nodule patients was found to be 9.1%. We observed that malignant tumors were likely to be solitary with lobulated margins, >2 cm in size with

Background: The incidence of thyroid tumor is increasing, and preoperative diagnosis of hyalinizing trabecular tumor (HTT) is difficult. Aim: To investigate the cytological features of HTT of the thyroid gland. Settings and Design: A retrospective observational study. Materials and Methods: Ultrasonography, preoperative needle aspiration cytology, postoperative histopathology, immunohistochemistry, and BRAF V600E gene test were performed in five patients with HTT to analyze the pathological characteristics of the patients and review the relevant literature. Results: Four female and one male patients with HTT were recruited. Fine-needle aspiration cytology (FNAC) showed bloodstained background tumor cells with multiple morphologies. The tumor cells exhibited ovoid nuclei, abundant cytoplasm, fine chromatin, nuclear crowding and overlapping, and small nucleoli. Focal nuclear pseudoinclusions and grooves were present. No papillary structures or psammoma bodies were observed. In all cases, tumor cells were radially distributed around the eosinophilic extracellular matrix. In 40% (2 in 5) of cases, trabecular patterns of elongated tumor cells were present, with their nuclei staggered along the longitudinal axis of tumor cells in the trabeculae. FNAC suggested two cases of HTT and three cases of papillary thyroid cancer. Post-operational biopsy indicated they were HTT cases. Conclusion: HTT is a rare thyroid tumor with non-specific clinical manifestations. It can be misinterpreted as papillary thyroid carcinoma by FNAC. However, its cytomorphological traits are helpful in the diagnosis. In combination with FNAC, immunohistochemistry, and molecular testing, HTT can be accurately diagnosed.

Background: Neck swelling is one of the commonest presentations in otorhinolaryngological practice. Study aimed to analyze the demographics and symptomatology of cervical masses, the degree of accuracy of clinical examination as well as the correlation between the clinical diagnosis and pathological results in patients presenting with neck masses. Material & Method: The present prospective observational study is conducted among the patients attending the out-patient and in-patients setting of ENT department with complaints of neck mass/ masses either primarily or in conjunction with other complaints, for more than 3 weeks duration. The patients with complaints of neck mass of acute inflammatory origin of less than 3 weeks and patients with inflammatory causes of lymphadenopathy including those secondary to upper aero-digestive tract infection and those of tubercular origin on initial assessment were excluded. Following a thorough clinical examination appropriate radiological investigations were advised, followed by cytological evaluation. FNAC was performed, either guided or unguided as per the discretion of the pathologist. Further Histopathogical evaluation was conducted in tissue specimens, wherever required, after either surgical excision of the entire mass or a biopsy. Histopathology involves the examination of sampled whole tissues under the microscope. Results: Age distribution placed majority of females in the young adult (16-40 yrs) category and males in the late adult (> 40 yrs) group. The majority of neck masses were thyroid swellings (42%) followed by lymph nodal masses (29%) and salivary gland lesions (14%). Of all the neck masses in females 87% were benign whereas amongst males 62% were malignant. The accuracy of clinical pre-diagnosis was seen to be 93.4%. The sensitivity for thyroid lesions for suspicion of malignancy however, was seen to be only 33% as papillary carcinoma thyroid essayed no symptoms or signs of malignancy. FNAC as an investigation for pre-diagnosis, the accuracy on the whole was seen to be 84.7% with a sensitivity of 82.5% which is comparable to other Indian studies. For thyroid lesions however the sensitivity was very low, 33.3%. This may be due to the inconsistent use of guidance systems and inexperience of our junior aspirators which act as confounding factors. Conclusion: Accuracy of FNAC in comparison to the definitive diagnosis was 84.7%. Inconsistent use of guidance systems, inexperience of junior aspirators and aspiration from representative node/ part of the lesion may act as confounding factors resulting in the discordance between clinical pre-diagnosis and FNAC accuracy with respect to the definitive diagnosis

Background: Parathyroid cysts (PCs) are rare, constituting less than 0.5% of parathyroid lesions. PCs are often asymptomatic or present with non-specific symptoms, posing challenges for accurate diagnosis. Case Presentation: We report a case of a 22-year-old female presenting a painless, growing left-sided neck mass. Imaging, including contrast-enhanced neck computed tomography, magnetic resonance imaging, and high-resolution ultrasound (US), revealed a purely cystic lesion in the anterior upper mediastinum. Subsequent US-guided fine needle aspiration cytology (FNAC) confirmed the cystic nature. In situ parathyroid hormone (PTH) levels were elevated, leading to the diagnosis of a nonfunctioning PC. Surgical intervention was avoided, and symptomatic relief was achieved through US-guided cyst aspiration. Conclusion: This case emphasizes the rarity of non-functioning PCs and underscores the importance of a comprehensive diagnostic approach, including imaging studies and FNAC with in situ dosage of PTH levels. [ABSTRACT FROM AUTHOR]

The high incidence of breast cancer and its slow evolution before diagnosis have led to search for new diagnostic techniques. Sonographic elasticity imaging offers the potential to non-invasively characterize breast lesions. This study aimed to assess the role of ultrasonographic elastography in the differential diagnosis of breast masses. A total of 50 patients with palpable and non-palpable breast masses were examined by B-mode ultrasonography then sonographic elastography was done for evaluation of benign and malignant criteria of masses followed by FNAC or True-cut biopsy histopathology as a confirmatory test. All age groups presented with breast mass (palpable or nonpalpable). All patients who have documentary cytology or histopathology. FNA was performed in 29 women (54%), and true cut in 21(42%). Furthermore, FNA revealed 10(34.5%) malignant lesions (breast cancer) and 19(65.5%) were benign (fibro adenoma and breast abscess), on the other hand the true cut biopsies revealed 18(85.7%) malignant lesions and 3(14.3%) benign, these findings giving a total of 28 malignant lesions (56%) and 22(44%) benign among the studied group. There was a statistically significant association between the BIRAD score and malignancy, where the frequency of malignant lesions increased with the advanced BIRAD score, (P value<0.001). Furthermore, the BIRAD II and III were considered as benign and the BIRAD IV and V were considered as malignant and when compared to biopsy it had been found that sensitivity of BIRAD had a sensitivity of (82.1%), specificity (95.5%), PPV (95.8%), NPV (80.7%) and accuracy of (88%). Also when there is comparison of validity test of SR according to different cutoff point where it appear that the cutoff point 2.5 had the higher sensitivity (78.6%) & specificity (95.5%). From other point of view, the sensitivity, specificity, PPV, NPV and accuracy of BIRADs were (82.1%, 95.5%, 95.8%, 80.7% and 88%) respectively and when compared to that of SR with cut-off point 2.5 no statically significant difference had been formed in validity test between SR at this cut off point and BIRAD score. Ultrasound elastography is a simple, fast, and non-invasive technique, which can be performed immediately after conventional sonography. Used as a complementary technique in addition to B-mode sonography, it increases the diagnostic specificity for breast lesions, thus reducing the false-positive rate. Ultrasound elastography has a sensitivity and specificity equal or higher than conventional B-mode US examination. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim is to study the spectrum and cytomorphological features of bone lesions and find out the diagnostic accuracy of Fine needle aspiration cytology (FNAC) on the same. Materials and Methods: The study was a cross-sectional study conducted in the Department of Pathology and Orthopedics in a tertiary institute in north India over a period of 1 year in 55 patients. All the patients were subjected to FNAC of bone lesions followed by tru-cut or open bone biopsy. Cytosmears were stained with May Grunwald Giemsa and Hematoxylin and Eosin were done on biopsy specimens. Sensitivity and specificity were calculated in percentage with a 95% confidence interval with reference to biopsy specimens. Results: Two peaks were observed; one between 11 and 40 years with 32 cases and another at 51 and 60 years with 12 cases. The male to female ratio was 1.4:1. In the present study, inflammatory lesions were present in 17 (31%) cases, 2 were tumor-like conditions; 10 (18%) cases of primary benign tumors, 26 (47.2%) cases were malignant. Out of these, 15 (27.2%) were primary malignant bone tumors and 11 (20%) were secondary in nature. The sensitivity, specificity, and diagnostic accuracy of the FNA of bone lesions were 55.17%, 79.04%, and 73.46%, respectively. Conclusion: Although there are a few limitations of FNAC such as low cellularity, small representative sample, and hemorrhagic aspirate, it can still be used as an initial diagnostic modality with proper clinical context for the management of bone lesions. [ABSTRACT FROM AUTHOR]