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Primary thyroid lymphoma is one of the rare and distinct type of extra nodal lymphomas originating within the thyroid gland. It accounts for less than 5% of all thyroid malignancies and 2% of extra nodal lymphomas. It predominantly affects older adults, with a higher incidence in women. Patients typically present with a rapidly enlarging thyroid mass, accompanied by clinical symptoms of compression such as dysphagia, dyspnea, and hoarseness. Diagnosis is established through a combination of fine-needle aspiration, core needle biopsy, and advanced imaging techniques. Standard treatment involves a multimodal strategy of chemotherapy, often with the addition of radiotherapy and surgical intervention. Herein presented is the first reported case of diffuse large B-cell lymphoma treated with Pola-R-CHP.

Background: The cutoff value for stereomicroscopic on-site evaluation (SOSE) in endoscopic ultrasound-guided tissue acquisition (EUS-TA) has high diagnostic sensitivity when a Franseen needle is employed for upper gastrointestinal subepithelial lesions (SELs) (stereomicroscopically visible white core [SVWC] ≥ 4 mm). Aim: We aimed to determine whether high diagnostic sensitivity could be obtained when EUS-TA was performed using a Fork-tip needle. Methods: Twenty-one patients were prospectively registered. Patients underwent EUS-TA using a Fork-tip needle for upper gastrointestinal SELs at Kitasato University Hospital between January and November 2022. Punctures were made twice using the needle, and SOSE was conducted for each specimen. Blood and physical examination were performed to assess adverse events. Pathological diagnosis was made using hematoxylin and eosin-stained sections and immunohistochemical staining. Statistical comparisons were completed using Fisher's exact tests. Results: The diagnostic rate of EUS-TA was 100% (21/21 cases). The final diagnosis was gastrointestinal stromal tumor in 17 (81.0%) and leiomyoma in 4 (19.0%) patients. SOSE was conducted on all 42 punctures, and the tissue sampling rate was 100% (42/42 punctures). Specimens with SVWC ≥ 4 mm were collected in 97.6% punctures (41/42 punctures) and the diagnostic sensitivity for these specimens was 100% (41/41 punctures), which is significantly higher (p < 0.0238) compared to the absence of cutoff value (diagnostic sensitivity of 0%). No EUS-TA-related adverse events occurred. Conclusions: EUS-TA combined with SOSE for upper gastrointestinal SEL using a fork-tip needle had a high diagnostic rate, and the cutoff value of SVWC ≥ 4 mm had high diagnostic sensitivity. [ABSTRACT FROM AUTHOR]

Small-volume biopsies (SVBs) including fine-needle aspiration (FNA), cell block, and needle core biopsies (NCB) are increasingly utilized to diagnose and guide the clinical management of lymphoma. We established a multi-institutional interdisciplinary collaboration of cytopathologists, hematopathologists, and oncologists focused on the role of SVB in the management of patients with follicular lymphoma (FL). To assess the performance characteristics of SVB in this setting, we evaluated all consecutive SVBs performed for clinical indications of initial diagnosis, recurrence, or transformation of FL over a 5-year period and focused on the 182 that had at least one subsequent biopsy within 3 months as part of the same clinical work-up. The most common outcome of a subsequent biopsy as part of the same clinical work-up was a more specific diagnosis usually assigning the pathologic grade (111/182, 61%), followed by a complete agreement with the SVB (24/182, 13%), and change from nondiagnostic on initial biopsy to diagnostic on subsequent biopsy (21/182, 12%). A minority resulted in a diagnostic change from benign to lymphoma (17/182, 9%), a change in FL grade (5/182, 3%), or change in the lymphoma diagnostic category (4/182, 2%). There were no cases where an initial diagnosis of lymphoma was overturned. The distribution of discrepancies was similar across initial SVB types (FNA, FNA + cell block, NCB with or without FNA). Tissue limitations were noted in a minority of cases (53/182, 29%) and were enriched among initially nondiagnostic biopsies (16/21, 76%). Flow cytometry immunophenotyping was performed in the majority of cases both at the first and last biopsy (147/182, 81%). SVB can be a powerful method to detect FL in various clinical indications, with discrepant cases mostly resulting from a refinement in the initial diagnosis.

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Endoscopic ultrasonography (EUS) is an important diagnostic technique to accurately diagnose diseases originating from organs near the gastrointestinal tract. EUS-guided fine-needle aspiration (FNA) has improved the histopathological diagnosis. EUS-FNA has been further developed over a long period of 40 years. The history of the development of endosonographic scopes, ultrasonographic observation systems, puncture needles, and puncture methods will provide a springboard for future development. [ABSTRACT FROM AUTHOR]

SignificanceFollicular thyroid carcinoma carries a substantially poor prognosis due to its unique biological behavior and less favorable outcomes. In particular, fine-needle aspiration (FNA) biopsies, which play a key role in screening thyroid nodules, cannot differentiate benign from malignant follicular neoplasm.AimWe report on the use of hyperspectral Raman microscopy in combination with chemometric analysis for identifying and classifying single cells obtained from clinical samples of human follicular thyroid neoplasms.ApproachWe used a method intended to simulate the FNA procedure to obtain single cells from thyroid nodules. A total of 392 hyperspectral Raman images of single cells from follicular thyroid neoplasms were collected.ResultsMalignant cells were identified based on their intrinsic Raman spectral signatures with an overall diagnostic accuracy of up to 83.7%.ConclusionsOur findings indicate that hyperspectral Raman microscopy can potentially be developed into an ancillary test for analyzing single cells from thyroid FNA biopsies to better stratify "indeterminate" nodules and other cytologically challenging cases.

Background: Cytopathological evaluation of thyroid fine-needle aspiration biopsy (FNAB) specimens can fail to raise preoperative suspicion of medullary thyroid carcinoma (MTC). The Afirma RNA-sequencing MTC classifier identifies MTC among FNA samples that are cytologically indeterminate, suspicious, or malignant (Bethesda categories III-VI). In this study we report the development and clinical performance of this MTC classifier. Methods: Algorithm training was performed with a set of 483 FNAB specimens (21 MTC and 462 non-MTC). A support vector machine classifier was developed using 108 differentially expressed genes, which includes the 5 genes in the prior Afirma microarray-based MTC cassette. Results: The final MTC classifier was blindly tested on 211 preoperative FNAB specimens with subsequent surgical pathology, including 21 MTC and 190 non-MTC specimens from benign and malignant thyroid nodules independent from those used in training. The classifier had 100% sensitivity (21/21 MTC FNAB specimens correctly called positive; 95% confidence interval [CI] = 83.9-100%) and 100% specificity (190/190 non-MTC FNAs correctly called negative; CI = 98.1-100%). All positive samples had pathological confirmation of MTC, while all negative samples were negative for MTC on surgical pathology. Conclusions: The RNA-sequencing MTC classifier accurately identified MTC from preoperative thyroid nodule FNAB specimens in an independent validation cohort. This identification may facilitate an MTC-specific preoperative evaluation and resulting treatment.

Objectives Fine-needle aspiration (FNA) is a microinvasive method to diagnose lymph nodes. This study aims to determine the capability of lymphatic contrast-enhanced ultrasound (LCEUS)-guided FNA in predicting the axillary metastasis with the target of one lymph node (LN) in patients with breast cancer. Methods LCEUS was prospectively performed in 105 patients with breast cancer. The most suspicious LN was targeted based on the characters of LCEUS. FNA was performed in the LN, followed by localization using a guide wire. The detection of lymph cells and/or tumour cells was recognized as a puncture success. Cytologic diagnosis was compared with histologic diagnosis of wire-marked LN for diagnosing accuracy and compared with histologic diagnosis of axillary LNs for predicting accuracy. Results LCEUS-guided FNA was performed in all 105 female patients who underwent axillary dissection. The puncture success rates were 74.3%, 91.4%, and 97.1% for three sequential groups (P  =  .010). In diagnosing LN metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 89.7%, 100%, and 95.7%, respectively. In predicting axillary metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 81.4%, 100%, and 91.3%, respectively. Conclusions The microinvasive LCEUS-guided FNA of one lymph node can be an accurate method and may help predict axillary metastasis in patients with breast cancer. Advances in knowledge This study presented that LCEUS combined with FNA would be practical in clinic. The characters of LCEUS could indicate the suspicious LNs and promote the accuracy in predicting axillary metastasis. [ABSTRACT FROM AUTHOR]

Objectives: To correlate the screening ability of ultrasound-based TIRADS with the FNAC-based Bethesda system when the latter is kept as a gold standard. Material and methods: A cross-sectional study was conducted in the Histopathology department, Rehman Medical Institute, Peshawar 15th June 2022-14th June 2023. A total of 363 patients from any age group of either gender diagnosed with thyroid nodules were included in the trial. All the participants underwent ultrasound followed by ultrasound-guided fine needle aspiration of thyroid nodules. TIRADS and Bethesda grading was done for each participant. Demographics and grading scores were recorded. Keeping Bethesda scoring as gold standard diagnostic performance of TIRADS grading was calculated. Results: Mean age of the patients was 46.68 ± 12.28 years with a female-to-male ratio of 2.3:1. TIRADS grading revealed 210 (69.8%) from TIRADS 2 while 70(82.4%), 12(50%), and 09(23.7%) patients were from TIRADS 3, 4 and 5 categories respectively. Bethesda grades were 301(82.9%), 21(5.8%), 09(2.5%), 28(7.7%), and 04(1.1%) from Bethesda 2, 3, 4, 5, and 6 categories respectively. The sensitivity of the TIRADS was 93.8%, specificity 89.1%, positive predictive value 45%, negative predictive value 99.3%, and a diagnostic accuracy of 89.5%. Conclusion: TIRADS grading has a high diagnostic ability when Bethesda scoring is kept as the gold standard. It can be used effectively in segregating benign from malignant nodules and is recommended for screening patients presenting with thyroid nodules. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ObjectivesSmall-volume biopsy-fine-needle aspiration biopsy (FNAB) with or without core biopsy-is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out.MethodsThis study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated.ResultsMost respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma.ConclusionsThis survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.

BackgroundMolecular testing can refine the risk of malignancy in cytologically indeterminate thyroid nodules and can reduce the need for diagnostic thyroidectomy. However, quality of life (QOL) in patients mananged with molecular testing is not well studied.ObjectiveWe aimed to assess the QOL of patients undergoing surveillance after a benign molecular test result, or thyroidectomy after a suspicious molecular test result.MethodsThis prospective longitudinal follow-up of the Effectiveness of Molecular Testing Techniques for Diagnosis of Indeterminate Thyroid Nodules randomized trial utilized the Thyroid-Related Patient-Reported Outcome, 39-item version (ThyPro-39) to assess the QOL of patients with indeterminate cytology on thyroid fine needle aspiration (FNA) biopsy. All patients underwent molecular testing at the time of initial FNA. A mixed-effect model was used to determine changes in QOL over time.ResultsOf 252 eligible patients, 174 completed the assessment (69% response rate). Molecular test results included 72% (n = 124) benign and 28% (n = 50) suspicious. ThyPro-39 scores of benign molecular test patients were unchanged from baseline (following initial FNA and molecular test results) to 18 months of ultrasound surveillance. Baseline symptoms of goiter, anxiety, and depression were more severe for patients with suspicious compared with benign molecular test results. At a median of 8 months after thyroidectomy, suspicious molecular test patients reported improved symptoms of goiter, anxiety, and depression.ConclusionA benign molecular test provides sustained QOL throughout ultrasound surveillance, without worsening anxiety or depression relating to the risk of malignancy. Definitive surgery results in improvement of QOL in patients with suspicious molecular tests.

Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time‐to‐treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. Methods: Data regarding fine‐needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. Results: Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. Conclusions: The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands. The median time‐to‐treatment initiation for the atypia of unknown significance (AUS) (MSRSGC III), salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), nondiagnostic (MSRSGC I), and nonneoplastic (MSRSGC II) categories are long. There is significant interhospital variation in the time‐to‐treatment initiation for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. Until 2021, the MSRSGS classification was only implemented on a limited scale in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: Prior studies evaluating thyroid fine needle aspiration biopsies (FNABs) have limited the calculation of risk of malignancy (ROM) to cytologic specimens with corresponding histologic specimens, and clinical follow-up for those patients who do not undergo immediate surgery has been largely disregarded. Moreover, there is marked variability in how researchers have approached thyroid FNAB statistical analyses. This study addresses the urgent need for information from a large cohort of patients with long-term clinical follow-up to more accurately determine the performance of thyroid FNAB and ROM for each diagnostic category. Methods: A retrospective review of the University of California, San Francisco (UCSF), pathology database for thyroid FNABs from January 1, 1997, to December 31, 2004, was performed. Diagnoses were coded using the 2017 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and patients were matched to both the UCSF cancer registry and California Cancer Registry. Data were analyzed using the Kaplan-Meier method, and stratified by TBSRTC diagnostic category. Kaplan-Meier curves were used to estimate incidence rates of malignancy, stratified by FNAB category. Cox proportional hazards models were used to determine the instantaneous ROM. Results: Initial FNABs from 2207 patients were included. Median follow-up period after the first thyroid FNAB was 13.9 years (range: 10.5-18.4 years). During follow-up, there were 279 confirmed diagnoses of thyroid malignancy. Estimates derived from Kaplan-Meier curves demonstrated that the risk of having a thyroid malignancy was low for nondiagnostic and benign categories, intermediate for atypia of undetermined significance (AUS), follicular lesion of undetermined significance (FLUS), AUS/FLUS combined, and follicular neoplasm, and high for suspicious and malignant categories. A total of 52/1575 false-negative cases (3.2%) were identified. Excluding papillary microcarcinomas, the false-negative rate was 1.5% (23/1575). No patients with a false-negative diagnosis died of thyroid cancer during the follow-up period. Conclusions: Asymptomatic patients with low-risk clinical and radiologic features and initially benign or unsatisfactory biopsy are unlikely to develop thyroid malignancy and highly unlikely to die of thyroid cancer. FNAB is highly accurate in detecting malignancy. Additional studies evaluating similar large data sets after the adoption of TBSRTC and the integration of molecular testing are needed.

Context.—Breast cancer biomarker assessment is critical in determining treatment and prognosis. In Tanzania, immunohistochemistry (IHC) is limited to surgical specimens and core biopsies. However, performing IHC on fine-needle aspiration biopsy cell blocks would offer numerous advantages.Objective.—To compare the performance between estrogen receptor (ER) IHC performed at Muhimbili National Hospital (MNH) in Tanzania and ER IHC performed at University of California, San Francisco (UCSF), to demonstrate feasibility of performing IHC using cell blocks in Tanzania.Design.—Patients with breast masses were recruited prospectively from the fine-needle aspiration biopsy clinic at MNH. Estrogen receptor IHC results on cell blocks, performed at both MNH and UCSF, and corresponding tissue blocks, performed at MNH, were compared to determine concordance.Results.—Eighty-six cell blocks were evaluated by ER IHC at MNH, with 41 of 86 (47.7%) positive and 45 of 86 (52.3%) negative. Among 65 UCSF and MNH cell block pairs, overall ER IHC concordance was 93.8% (61 of 65) and positive concordance was 93.5% (29 of 31) (κ = 0.88, P > .99). Among 43 paired UCSF cell blocks and MNH tissue blocks, overall ER IHC concordance was 88.3% (38 of 43) and positive concordance was 90.5% (19 of 21) (κ = 0.77, P > .99). We compared 62 MNH cell block and tissue block pairs. Overall ER IHC concordance was 90.3% and positive concordance was 87.9% (κ = 0.81, P = .69).Conclusions.—Pairwise comparisons between ER IHC at MNH, on cell blocks and tissue blocks, with ER IHC at UCSF on cell blocks showed excellent concordance. We demonstrate that ER IHC on fine-needle aspiration biopsy specimens can be implemented in resource-constrained settings.

ObjectivesThe Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of the categories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category.MethodsWe retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined.ResultsA total of 171 patients were included with 203 cytological samples. Average age at initial FNA was 14.7 years (range 6.9-18.6 years). The numbers of nodules reported for Bethesda categories I-VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8, 4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014.ConclusionsThe risk of malignancy for thyroid nodules in this pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.

Endoscopic ultrasound-guided fine-needle aspiration is currently the gold standard in the diagnosis of solid pancreatic lesions, with high diagnostic accuracy. However, this technique is demanding, as its diagnostic yield and efficacy are affected by several factors, including the rapid on-site cytologic evaluation, sampling techniques, needle size and type, use of a stylet, suction techniques, number of needle passes, and novel techniques. This article provides information on up-to-date advances and considerations for maximizing the diagnostic yield of endoscopic ultrasound-guided fine-needle sampling in solid pancreatic lesions, especially from a technical perspective.

Objective: Rare disease. Background: Various neoplasms, including neuroendocrine neoplasms (NENs), can arise from the presacral space. Most presacral lesions are detected due to symptoms arising from tumor growth. However, diagnosing small, asymptomatic presacral tumors is challenging because of their unique location. Case Report: A 63-year-old woman with chronic hepatitis C underwent follow-up after achieving a sustained virological response. Abdominal ultrasonography revealed multiple new hyperechoic masses in the liver. Physical and laboratory examinations, including tumor marker analysis, yielded unremarkable results. Computed tomography (CT) and magnetic resonance imaging (MRI) indicated metastatic liver tumors but failed to identify the primary site of these lesions. The hepatic mass was biopsied, leading to a diagnosis of grade 2 neuroendocrine tumor. 111In-pentetreotide somatostatin receptor scintigraphy revealed significant radiotracer accumulation in multiple hepatic masses, several bones, and a small presacral space lesion. Pathological examination of the presacral lesion confirmed a grade 2 neuroendocrine tumor, similar to the hepatic mass. Review of a CT scan performed 4 years earlier indicated a small cyst-like lesion in the presacral space suspected of being a developmental cyst; however, the presence of cystic components was not confirmed pathologically. The patient was diagnosed with a primary presacral neuroendocrine tumor, which might have originated from a developmental cyst, with multiple liver metastases. Chemotherapy with everolimus was initiated, and the clinical course has been uneventful. Conclusions: We report a rare neuroendocrine tumor arising from the presacral space with multiple liver metastases. The presacral space should be examined when a NEN with an unknown primary site is found. [ABSTRACT FROM AUTHOR]

BACKGROUND: To assess the incidence of benign and malignant peri-implant fluid collections and/or masses on magnetic resonance imaging (MRI) in women with silicone implants who are being screened for silent implant rupture. METHODS: The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women who underwent silicone implant oncoplastic and/or cosmetic surgery and postoperative implant-protocol MRI from 2000 to 2014 were included. Peri-implant fluid collections and/or masses were measured volumetrically. A benign peri-implant fluid collection and/or mass was pathologically proven or defined as showing 2 years of imaging and/or clinical stability. A malignant peri-implant fluid collection was pathologically proven. Incidence of peri-implant fluid collections and/or masses and positive predictive value (PPV) were calculated on a per-patient level using proportions and exact 95% confidence intervals (CIs). Fishers exact test was used in the analysis to test statistical significance pre-defined as P-value

The incidence of human papillomavirus (HPV)-related head and neck squamous cell carcinoma continues to increase. Accurate diagnosis of the HPV status of a tumor is vital, as HPV+ versus HPV- tumors represent two unique biological and clinical entities with different treatment strategies. High-risk HPV subtypes encode oncoproteins E6 and E7 that disrupt cellular senescence and ultimately drive tumorigenesis. Current methods for detection of HPV take advantage of this established oncogenic pathway and detect HPV at various biological stages. This review article provides an overview of the existing technologies employed for the detection of HPV and their current or potential future role in management and prognostication.

Background/Aims: A high-quality sample allows for next-generation sequencing and the administration of more tailored precision medicine treatments. We aimed to evaluate whether heparinized wet suction can obtain higher quality samples than the standard dry-suction method during endoscopic ultrasound (EUS)-guided biopsy of pancreatic masses.Methods: A prospective randomized crossover study was conducted. Patients with a solid pancreatic mass were randomly allocated to receive either heparinized wet suction first or dry suction first. For each method, two needle passes were made, followed by a switch to the other method for a total of four needle punctures. The primary outcome was the aggregated white tissue length. Histological blood contamination, diagnostic performance and adverse events were analyzed as secondary outcomes. In addition, the correlation between white tissue length and the extracted DNA amount was analyzed.Results: A total of 50 patients were enrolled, and 200 specimens were acquired (100 with heparinized wet suction and 100 with dry suction), with one minor bleeding event. The heparinized wet suction approach yielded specimens with longer aggregated white tissue length (11.07 mm vs 7.96 mm, p=0.001) and less blood contamination (p=0.008). A trend towards decreasing tissue quality was observed for the 2nd pass of the dry-suction method, leading to decreased diagnostic sensitivity and accuracy, although the accumulated diagnostic performance was comparable between the two suction methods. The amount of extracted DNA correlated positively to the white tissue length (p=0.001, Spearman̕s ρ=0.568).Conclusions: Heparinized wet suction for EUS tissue acquisition of solid pancreatic masses can yield longer, bloodless, DNA-rich tissue without increasing the incidence of adverse events (ClinicalTrials.gov. identifier NCT04707560).

In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is a pattern-based, US malignancy risk stratification system that can easily diagnose nodules during real-time ultrasound examinations. The 2021 K-TIRADS clarified the US criteria for nodule classification and revised the size thresholds for nodule biopsy, thereby reducing unnecessary biopsies for benign nodules while maintaining the appropriate sensitivity to detect malignant tumors in patients without feature of high risk thyroid cancer. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care.

Objective: To compare the diagnostic accuracy and uses of fine needle aspiration cytology with histopathology in the diagnosis of lesions of oral cavity. Method: The single-centre, prospective, non-randomised controlled trial was conducted at the departments of Oral and Maxillofacial Surgery and Pathology of Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan, from January 10 to August 10, 2021, and comprised patients of either gender aged >10 years having superficial or deep well-established mass, palpable, nodular, ulcerative lesions, swellings of the oral cavity or of major or minor salivary glands having intraoral presence or manifestation with size >1cm. Data was analysed using SPSS 20. Results: Of the 43 patients, 22(51.2%) were males and 21(48.8%) were females. The overall mean age was 40.5+/-15 years (rang: 13-70 years). On cytological examination, 6(14%) samples were excluded for being insufficient aspirate. Of the remaining 37(86%) samples, 20(51.4%) were detected with malignancy on histopathology. The accuracy of fine needle aspiration cytology was 33(89.19%). Conclusion: Fine needle aspiration was found to be a reliable and cost-effective technique in the diagnosis of oral cavity lesions. Key Words: Carcinoma, Squamous cell, Fine-needle, COVID-19, Minimally invasive surgical procedures, Mouth neoplasms.

BackgroundThis retrospective study evaluated and compared the diagnostic accuracy and suitability of tissue specimens for advanced molecular diagnostic testing obtained via 2 different techniques for percutaneous biopsy of primary and metastatic liver tumors.Patients and methodsSamples from 137 patients with liver masses who underwent concurrent fine-needle aspiration biopsy with cell block (FNAB-CB) and core needle biopsy (CNB) at 2 hospitals were assessed for diagnostic accuracy, tumor fraction, and tumor cellularity. A subset of FNAB-CBs, that were deemed to have less or equal tumor cellularity compared with CNBs, had level sections performed and were reassessed for tumor cellularity.ResultsDiagnostic accuracy was 96% for FNAB and 93% for CNB (P=.267). In FNAB-CBs, tumor fraction was significantly higher than in CNB samples (67% vs 36%; P

Palpable thyroid lesions are common, and although mostly benign, lethal malignant nodules do occur and may be difficult to differentiate. Here, we introduce the use of a piezoelectric system called Smart-touch fine needle (or STFN) mounted directly onto conventional biopsy needles, to evaluate abnormal tissues, through quantitative real-time measurements of variations in tissue stiffness as the needle penetrates tissue. Using well-characterized biomaterials of known stiffness and explanted animal tissue models, we first established experimental protocols for STFN measures on biological tissues, as well as optimized device design for high signal-to-noise ratio. Freshly excised patient thyroids with varying fibrotic and malignant potential revealed discrete variations in STFN based tissue stiffness/stiffness heterogeneity and correlated well with final histopathology. Our piezoelectric needle sensor reveals mechanical heterogeneity in thyroid tissue lesions and provides a foundation for the design of hand-held tools for the rapid, mechano-profiling of malignant lesions in vivo while performing fine needle aspiration (FNA).

Aim Results of ultrasound guided fine needle aspiration cytology (FNAC) as the compatibility of cytological findings with histopathological diagnoses (the "gold standard") in the diagnosis of nodular thyroid lesions are inconsistent. The aim of this prospective study was to determine the validity of FNAC, as well as the compatibility of findings with histopathological diagnoses. Methods The study included 92 patients who underwent FNAC and later surgery and histopathological assessment with a final diagnosis. Results FNAC showed 95% specificity, 78% sensitivity and 90% accuracy. The compatibility of the cytological and histopathological findings was good (Kappa coefficient of 0.756; 95% CI). The cytology results proved to be very good at predicting malignant histopathological findings, (OR=72.33; p˂0.001). Also, the result of ROC analysis (AUC=0.866) confirmed FNAC as a very good method of distinguishing benign and malignant thyroid nodules. Conclusion The results confirmed the correctness of the algorithm in which, following clinical or ultrasound confirmation of nodular thyroid lesions with suspicious changes, FNAC is indicated. The FNAC results should guide a clinician to further diagnostic and therapeutic procedures. Certainly, in case of suspected follicular/ Hurthle cell lesions one should be vigilant and aware of the fact that in these cases malignancy is defined by the invasion of blood vessels and/or the capsule, which FNAC is unable to detect.

Background and objectives: Lesions of the head and neck region are routinely encountered by clinicians, in patients across all age groups. Diagnoses range from reactive inflammatory conditions to malignancies. Cancer is among the leading causes of death in India. Head and neck cancers account for 23% of all cancer incidents in males and 6% of all incidents in females in India,. Fine needle aspiration cytology (FNAC) of cervical masses is an easy, effective, and relatively inexpensive technique. The aim of this study was to determine occurrence of various head and neck swellings and classify them under various categories. Methods: The present study included 100 cases of palpable cervical swellings who had been referred to the AMC MET Medical College, Ahmedabad (India) from June 2018 to October 2020. Results: The majority of cases were lymph node swellings (57%), followed by thyroid swellings (23%), salivary gland swellings (12%), and soft tissue swellings (8%). Among all cervical region swellings, tuberculous lymphadenitis and thyroid lesions were the most prevalent. Conclusion: The findings suggest that lymph node swellings are most commonly observed in the cervical area, and that the majority of them are inflammatory, requiring medical treatment rather than surgery. Moreover, FNAC is a straightforward, quick, and cost-effective way to distinguish between non-neoplastic and metastatic malignant lesions, which could help timely surgical interventions.

The fine-needle aspiration (FNA) cytopathology of pleomorphic hyalinizing angiectatic tumor (PHAT) is the subject of a very limited number of reports. We undertook a review of our FNA experience with this neoplasm. A search was made of our files for PHAT FNA cases with histopathologic confirmation. FNA biopsy smears and cell blocks were performed and examined using standard techniques. Two primary cases of histologically proven PHAT [both male, ages 56 and 60 years] met study inclusion. FNA sites included buttock and foot. A misdiagnosis of sarcoma was made in each case. Ancillary immunohistochemical testing performed in 1 case suggested angiosarcoma. Cytologic smears showed only modest cellularity with a dual population of bland spindle cells and isolated large pleomorphic cells, many harboring nuclear pseudoinclusions. Smear background was clean, and mitoses absent. The imitative cytopathology of PHAT with a pleomorphic sarcoma remains a pitfall in FNA specimens. Awareness of this entity and its lack of hypercellularity, necrosis, and cohesive groups of atypical cells in smears should assist the cytopathologist in avoiding a misdiagnosis of malignancy. • Pleomorphic hyalinizing angiectatic tumor (PHAT) has only rarely been the subject of single fine-needle aspiration (FNA) biopsy cytology reports. • Due to the presence of large pleomorphic cells and unlike whole tissue sections the inability to recognize ectatic blood vessel clusters in smears, FNA of PHAT is typically mistaken for a sarcoma. • The lack of distinctive cytomorphology and a specific immunoprofile precludes a specific interpretation unless molecular testing for TGFBR3 and/or MGEA5 gene rearrangements are performed. • The imitative cytopathology of PHAT with pleomorphic sarcomas remains a pitfall in FNA specimens. [ABSTRACT FROM AUTHOR]

Background: There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB. Methods: Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers. Results: Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate. Conclusion: FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications. [ABSTRACT FROM AUTHOR]

Introduction. An arteriovenous fistula is one of the complications that can occur during percutaneous liver biopsy (PLB). Hepatic arteriovenous fistula with chronic bleeding from the puncture site on the skin is an extremely rare complication following PLB. Case report. We present a 35-year-old woman with secondary anemia caused by chronic bleeding at the site of a granuloma caused by a previous liver biopsy performed 7 years ago. The patient was examined and treated for several years due to anemic syndrome. The pathological communication between the right hepatic vein, the anterior sectional branch of the portal vein, and the posterior arterial sectional branch were detected on a computed tomography scan and proven by fistulography. Due to the failed embolization, a laparotomy was performed, where a tumor mass was found in the VI and VII segment of the liver, which communicates with the skin. The tumor mass was removed by atypical resection of the VI and VII liver segments. Due to hemorrhage, reexploration was performed, where the bleeding was found from the surface of the resected liver parenchyma. The patient was released for home treatment two weeks after the last operation. Conclusion. Although PLB is a safe procedure, a complication in the form of bleeding sometimes occurs but with spontaneous cessation. In the presented patient, there was a complicated intrahepatic arteriovenous-portal fistula with the formation of communication with the puncture site on the skin. That is the first published case of complications of this type after PLB. [ABSTRACT FROM AUTHOR]

In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is a pattern-based, US malignancy risk stratification system that can easily diagnose nodules during real-time ultrasound examinations. The 2021 K-TIRADS clarified the US criteria for nodule classification and revised the size thresholds for nodule biopsy, thereby reducing unnecessary biopsies for benign nodules while maintaining the appropriate sensitivity to detect malignant tumors in patients without feature of high risk thyroid cancer. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care. [ABSTRACT FROM AUTHOR]

Background: The tall cell variant papillary thyroid carcinoma (TCV‐PTC) shows aggressive behaviour. Thus far, the diagnosis of TCV‐PTC can only be confirmed using the postoperative specimen. This study aims to evaluate whether fine‐needle aspiration (FNA) or core needle biopsy (CNB) could diagnose TCV‐PTC preoperatively. Methods: This is a retrospective cohort study. We included adult patients diagnosed with TCV‐PTC or PTC with tall cell features (TCF) at final surgical pathology between January 2015 and December 2018. Preoperative histology was reviewed for six cytomorphologic features suggesting TCV‐PTC in FNA or the percentage of tall cells in the CNB specimen. The postoperative pathology was also reviewed to confirm the percentage of tall cells. Results: A total of 119 patients were included in this study; 35 (29%) patients with PTC with TCF served as controls. The most frequent cytomorphological feature in FNA samples of TCV‐PTC was tall columnar cells, including single tombstone‐like cells (70%). Among 43 TCV‐PTC evaluated by FNA, 3 FNA (7%) revealed the absence of any of the six cytomorphologic features suggesting TCV‐PTC. When we defined 30% of tall cells in CNB specimens as a cutoff suggesting TCV‐PTC, only 16 (41%) TCV‐PTCs could be preoperatively detected, and 3 (7%) TCV‐PTCs did not have any tall cells. The proportion of tall cells was not associated with the postoperative percentage of tall cells. Conclusion: Both cytomorphologic features in FNA and the percentage of tall cells in CNB present limitations for use as accurate preoperative diagnostic tools of TCV‐PTC. [ABSTRACT FROM AUTHOR]

Fine-needle aspiration (FNA) and small tissue biopsy of chordoma have been reported in several small series, but no large series exists. We undertook an examination of 47 cases (with concurrent core needle biopsy in a subset) to analyze diagnostic accuracy, cytomorphology, and immunohistochemistry. Our cytopathology files were searched for examples of chordoma with histopathologic verification. FNA biopsy smears and core needle were performed using standard techniques. Forty-seven cases of chordoma were retrieved from 44 patients [M:F; 1.8:1; age range 5-81 years; mean age 55 years]. Twenty-seven presented with primary, 10 with locally recurrent, and 7 with metastatic tumors. Two aspirates were from the appendicular skeleton, 2 from the trunk, 1 from neck lymph node, and 42 aspirates (89%) from axial and peri-axial skeleton and surrounding soft tissues. Four were cytologic touch imprints while the remainder were FNA biopsy specimens. Specific cytologic diagnoses were chordoma/consistent with chordoma (44 cases, 94%), suspicious for chordoma (2), and malignant neoplasm (1). Along with a single case of benign notochordal tumor misdiagnosed as chordoma, our diagnostic accuracy was 91%. Concurrent tissue biopsy was performed in 51% of cases. Immunohistochemical staining of tumor in 29 (62%) cases showed expression of brachyury in 23 of 24 (96%) instances. Cytopathology consisted of cellular smears populated by large cells possessing enormous amounts of vacuolated and non-vacuolated cytoplasm with an abundant background myxoid/chondromyxoid stroma. FNA and small tissue biopsy specimens show a very high degree of diagnostic accuracy in recognition of chordoma. • A cytologic diagnosis was correctly issued in 91% of 46 cases of conventional chordoma and a single case of benign notochordal cell tumor. • Chordoma cytopathology is composed of a rich myxoid/chondromyxoid stroma coupled with a variable number of physaliferous cells. • Review of the cytology literature shows chordoma can be added to a growing list of sarcomas specifically recognizable using cytopathology and judicious immunohistochemical staining. • Brachyury should be considered in a panel of immunostains when encountering myxoid bone or soft tissue lesions using fine-needle aspiration/core needle biopsy. [ABSTRACT FROM AUTHOR]

Background and objectives: Soft tissue is a non-epithelial extraskeletal tissue of the body. Soft tissue tumors (STTs) are the most commonly diagnosed neoplasms. Fine needle aspiration cytology (FNAC) is minimally invasive, quick, and a definitive diagnostic modality. Biopsy for histopathology is the gold standard method for diagnosis but is invasive. The aims of this study were to determine the utility of FNAC in the diagnosis of STTs and correlate it with histopathology and to evaluate factors that cause discrepancies between FNAC and histopathology. Methods: This retrospective, record-based study was done on STTs received for FNAC and histopathology examinations at the Department of Pathology, MIMS, Mandya from January 2018 to June 2021. Results: A total of 74 cases of FNAC with histopathological correlation were available. Seventy one cases (95.9%) were benign and three (4%) were malignant according to FNAC. Discordance was seen in one case of low grade myxofibrosarcoma, which was diagnosed as benign spindle cell tumor on FNAC. The sensitivity, specificity, positive predictive value, and accuracy of FNAC in diagnosing malignancy were 75%, 100%, 100%, and 98.6%, respectively. Conclusion: Our findings indicate that FNAC is beneficial preoperatively as it differentiates between benign and malignant lesions in most cases. In the case of low grade myxofibrosarcoma, bland tumor cells led to a benign diagnosis on FNAC, but histopathology allowed sampling of a larger area of the tumor and the right diagnosis was made. Biopsy is the gold standard, but FNAC has high specificity in diagnosing malignant tumors and prevents unnecessary extensive, radical surgery for benign lesions.

Background: Tissue sampling using endoscopic ultrasound-guided fine-needle aspiration is the gold standard for diagnosing malignant pancreatic tumors; however, its sensitivity and specificity are highly variable. Thus, fine-needle biopsy using cutting needles has been developed to overcome current limitations and improve diagnostic yield. Our study compared two fine-needle biopsy needles for tissue sampling for pancreatic solid lesions. Materials and Methods: Samples obtained from patients with pancreatic solid lesions using the 22-gauge fine-needle biopsy needles (Franseen needle or reverse bevel needle) were retrospectively analyzed. The primary outcomes were diagnostic yield and sample adequacy. The secondary outcome was diagnostic performance. The analysis was performed using 2 × 2 tables to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for each needle type. Proportions were compared using the Z test. For quantitative variables, a comparative analysis was performed using Student’s t test. Qualitative and unpaired outcome variables were described using Fisher’s exact test. Results: Sixty-three patients with pancreatic lesions were included in the analysis. The fine-needle biopsy Franseen and reverse bevel groups included 33 and 30 patients, respectively. An adequate sample was obtained in 97% of patients in the Franseen needle group versus 80% in the reverse bevel needle group; the diagnostic yields in these groups were 93.9 and 66.7%, respectively. Neither differences between needle passes nor complications were noted. The sensitivity and specificity were 93.5 and 100%, respectively, in the fine-needle biopsy Franseen group, versus 71 and 100%, respectively, in the reverse bevel needle group. Conclusions: The Franseen needle was more effective for sampling pancreatic tumors than the reverse bevel needle.

BackgroundPreoperative breast and lung markers have significant drawbacks, including migration, patient discomfort, and scheduling difficulties. SignalMark is a novel localizer device with a unique signal on Doppler ultrasound.ObjectiveWe aimed to evaluate intraoperative identification of SignalMark microspheres compared with HydroMARK® clips. We also assessed the safety and efficacy of SignalMark in the lung.MethodsTwelve breasts of lactating pigs were injected with SignalMark or HydroMARK® by a breast radiologist, and subsequently identified using a standard ultrasound machine by three surgeons blinded to marker location. Time to identification of each marker was recorded, with a maximum allotted time of 300 s. To further demonstrate efficacy in lung parenchyma, a second cohort of pigs underwent lung injections.ResultsA total of eight SignalMark markers and four HydroMARK® clips were placed in pig breasts. Overall, the surgeons correctly identified SignalMark 95.8% of the time (n = 23/24) and HydroMARK® clips 41.7% of the time (n = 5/12) within 300 s (p

BackgroundFine-needle aspiration biopsy (FNAB) is a minimally invasive, cost-effective diagnostic tool that can be used in low-resource settings. However, adequacy and accuracy of FNAB is highly dependent on the skills of the operator and requires specialized training. Poor technique can preclude definitive diagnoses because of insufficient quality or quantity of FNAB samples. We evaluated the efficacy of an intensive training experience in Tanzania on improving ultrasound-guided FNAB techniques.MethodsA 2-day workshop offered didactic lectures, demonstrations, and hands-on practicum on fundamentals of ultrasound imaging and FNAB technique. A prospective interventional study design was used with pre- and postintervention surveys and assessments to measure the effect of the workshop on specific skills related to slide smearing and ultrasound-guidance among participants.ResultsTwenty-six pathologists and radiologists, including trainees in each specialty, participated in the workshop. Pre- and postworkshop assessments demonstrated that most participants improved significantly in nearly all technical skills for slide smearing and ultrasound-guided FNAB. After the workshop, most participants demonstrated substantial improvements in ability to prepare the ultrasound equipment, measure the lesion in three dimensions by ultrasound, target lesions in one pass using both parallel and perpendicular approaches, and prepare high-quality aspirate smears.ConclusionAn in-country 2-day workshop in Tanzania was efficacious in transferring basic skills in FNAB smear preparation and ultrasound-guided FNAB, resulting in skills enhancement among participating pathologists and radiologists. Although mastery of skills was not the goal of this short workshop, participants demonstrated proficiency in most technical elements after workshop completion, and the workshop generated interest among select participants to pursue additional intensive training in cytopathology.

Determine the positive predictive value (PPV) of biopsy of palpable masses following mastectomy (MX). Determine if there are patient characteristics, tumor, or imaging features more predictive of cancer. IRB-approved retrospective review of 16 396 breast ultrasounds June 2008-December 2015 identified patients with MX presenting with palpable masses. Medical records and imaging studies were reviewed. Statistical analysis was performed using Fishers exact test. 95% confidence intervals (CI) were calculated. In all, 117 patients presented with palpable masses on the MX side. 101/117 patients who had a palpable mass on physical examination had a true sonographic mass to correlate with the clinical findings. 91/101 (90%) underwent biopsy: 19/91 (21%, 95% CI; 13-31) biopsies were malignant. 72/91 (79%) were benign. All 19 cancers were on the original cancer side. Recurrences ranged from 0.4 to 4.5 cm maximum diameter, mean 1.3 cm. Prophylactic vs therapeutic mastectomy was very statistically significant (P = .01). The use of tamoxifen or an AI was also statistically significant (P = .04). Patient age (P = 1.0), radiation therapy (P = 1.05), chemotherapy (P = .2), immediate breast reconstruction (P = .2), or implant vs flap (P = .2) had no statistically significant association with finding cancer on biopsy. Lesion shape (irregular vs oval/round) was highly statistically significant (P = .0003) as was non-parallel orientation on ultrasound (P = .008). Circumscribed vs non-circumscribed margins was also statistically significant (P = .008). The PPV of biopsy of palpable masses on the side of MX was 21% (95% CI; 13-31). All recurrences were on the original cancer side and this was very statistically significant.

ImportanceUse of next-generation sequencing of RNA and machine learning algorithms can classify the risk of malignancy in cytologically indeterminate thyroid nodules to limit unnecessary diagnostic surgery.ObjectiveTo measure the performance of a genomic sequencing classifier for cytologically indeterminate thyroid nodules.Design, setting, and participantsA blinded validation study was conducted on a set of cytologically indeterminate thyroid nodules collected by fine-needle aspiration biopsy between June 2009 and December 2010 from 49 academic and community centers in the United States. All patients underwent surgery without genomic information and were assigned a histopathology diagnosis by an expert panel blinded to all genomic information. There were 210 potentially eligible thyroid biopsy samples with Bethesda III or IV indeterminate cytopathology that constituted a cohort previously used to validate the gene expression classifier. Of these, 191 samples (91.0%) had adequate residual RNA for validation of the genomic sequencing classifier. Algorithm development and independent validation occurred between August 2016 and May 2017.ExposuresThyroid nodule surgical histopathology diagnosis by an expert panel blinded to all genomic data.Main outcomes and measuresThe primary end point was measurement of genomic sequencing classifier sensitivity, specificity, and negative and positive predictive values in biopsies from Bethesda III and IV nodules. The secondary end point was measurement of classifier performance in biopsies from Bethesda II, V, and VI nodules.ResultsOf the 183 included patients, 142 (77.6%) were women, and the mean (range) age was 51.7 (22.0-85.0) years. The genomic sequencing classifier had a sensitivity of 91% (95% CI, 79-98) and a specificity of 68% (95% CI, 60-76). At 24% cancer prevalence, the negative predictive value was 96% (95% CI, 90-99) and the positive predictive value was 47% (95% CI, 36-58).Conclusions and relevanceThe genomic sequencing classifier demonstrates high sensitivity and accuracy for identifying benign nodules. Its 36% increase in specificity compared with the gene expression classifier potentially increases the number of patients with benign nodules who can safely avoid unnecessary diagnostic surgery.

PURPOSE:Prior studies have shown that nuclear reactivity for BRCA1-associated protein-1 (BAP1) yields prognostic information for paraffin-embedded uveal melanomas. Lacking are immunocytochemical studies of BAP1 on fine needle aspiration biopsies of uveal melanoma that correlate with prognosis or other markers of prognosis. Our purpose was to fill this gap. DESIGN:Experimental laboratory study. METHODS:Fine needle aspiration biopsies were performed prospectively on 113 patients with uveal melanomas, garnering limited subsets of cases for comparison. Agreement between immunocytochemistry for BAP1 nuclear staining vs chromosome 3 ploidy analysis and gene expression profiling was assessed by 2 × 2 contingency table analysis. RESULTS:The presence or absence of suppression of nuclear expression of BAP1 was strongly associated (73%, P = .000002) with monosomy and disomy chromosome 3, respectively. BAP1 nuclear expression was also correlated with gene expression profiling. Chromosome 3 ploidy analysis correlated with gene expression profiles. CONCLUSION:When adequate material is obtained, immunocytology using BAP1 is a potentially informative tool for prognostication of uveal melanoma.

The increasing prevalence of high-risk human papillomavirus (HR-HPV)-associated head and neck squamous cell carcinoma (HNSCC) has prompted strong clinical demands for detecting HR-HPV directly in the tumor. Although p16 immunohistochemistry (IHC) has been the standard testing method, it has limitations including false positivity, lack of sensitivity in low tumor cell samples such as fine-needle aspirate (FNA), and its subjectivity. We developed a modified method based on a commercial automated HR-HPV PCR assay and evaluated the performance characteristics and the diagnostic utility of this assay for direct HR-HPV detection in the HNSCC samples. HNSCC formalin-fixed, paraffin-embedded blocks were retrieved from archives including 44 excisions, 63 biopsies, and 16 FNAs. Tissue slices were trimmed from the blocks, deparaffinized, lysed, and loaded on the commercial automated platform for HR-HPV PCR. All specimens had a concurrent p16 IHC performed. The PCR assay showed high concordance with the p16 IHC (96%; 99/103) and excellent positive agreement (91.5%) and negative agreement (100%). In addition, the PCR assay provided more conclusive results in samples with equivocal p16 IHC results. The modified commercial automated HR-HPV PCR test is a labor-efficient, quick, reliable, sensitive, and specific method for detecting HR-HPV in formalin-fixed, paraffin-embedded samples. This assay also showed excellent diagnostic utility in samples with equivocal p16 IHC results, including FNA cell blocks.

Objective　To explore the diagnostic significance of FNA-Tg for lymph nodes with suspected cervical thyroid papillary carcinoma metastasis on the basis of ultrasonic detection and guidance and accurate biopsy of FNA，and establish the threshold of FNA-TG. Methods　74 lymph nodes with suspected metastasis of thyroid cancer were evaluated by fine needle aspiration and analysed pathologically. Lymph nodes were evaluated by comparing FNA alone，FNA-TG value with serum Tg，and drawing ROC to obtain the best diagnostic value of FNATG， and the sensitivity， specificity and accuracy of positive results were evaluated. Results　There were significant differences in calcification，cortex-medullary boundary，abnormal blood supply and aspect ratio in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma （P < 0.05）. The above four indexes had the highest sensitivity in the diagnosis of lymph node metastasis of thyroid cancer. Calcification，multiple hyperecho，cystic changes and elastic imaging had higher hardness specificity，and the accuracy of cortex-medulla boundary and aspect ratio was the highest. The sensitivity，specificity and accuracy of FNA were 75%，100% and 87.84%. The sensitivity，specificity and accuracy of FNA-Tg/ serum Tg value > 1 were 97.22%，100% and 98.65%. ROC curve was drawn to obtain the optimal diagnostic threshold of FNA-Tg as 0.575 ng/mL. Conclusion　FNA-Tg/ serum Tg > 1，as the diagnostic criteria for lymph node metastasis of papillary thyroid cancer，can better avoid the disadvantages caused by many factors and effectively reduce the error rate，and should be the first choice for the auxiliary diagnosis of lymph node metastasis of papillary thyroid cancer. [ABSTRACT FROM AUTHOR]

The Milan system for reporting salivary gland cytopathology (MSRSGC) is a novel standardized classification tool for salivary gland cytology specimens based on the use of direct smears. Formalin-fixed paraffin-embedded (FFPE) cell blocks facilitate the use of ancillary studies, leading to improved diagnostic accuracy. However, the application of the MSRSGC with only cell blocks has not been well established. Consecutive cohort of all parotid gland cytology specimens between 01/01/2018 and 30/06/2021 was performed. All cytology specimens were processed into cell blocks only. Cytologic diagnoses were classified prospectively according to the MSRSGC categories. The risk of malignancy (ROM) for each diagnostic category and the diagnostic performance were calculated. A total of 230 FNA samples from 221 patients were identified, including 47% and 78.4% with surgical or clinical follow-up, respectively. The ROMs based on surgical follow-up for the non-diagnostic, non-neoplastic, AUS, neoplasm: benign, SUMP, SFM and malignant categories were 21.4%,0%,50%,0%,30%,100% and 100%, respectively. The ROMs based on the clinical follow-up for these categories were 7.3%,0%,37.3%,0%,27.3%,100% and 100%, respectively. Following surgical excision, all Milan IVa category samples were confirmed as benign, and all Milan V and VI category samples were confirmed as malignant. This study validates the application of the MSRSGC with the sole use of FFPE cell blocks. The diagnostic accuracy of MSRSGC is high and compares favorably to other institutions using traditional cytology assessment methods. Furthermore, FNA results using this technique enabled to provide optimal patient management based on the ROM of the different Milan system categories. [ABSTRACT FROM AUTHOR]

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Aim Results of ultrasound guided fine needle aspiration cytology (FNAC) as the compatibility of cytological findings with histopathological diagnoses (the "gold standard") in the diagnosis of nodular thyroid lesions are inconsistent. The aim of this prospective study was to determine the validity of FNAC, as well as the compatibility of findings with histopathological diagnoses. Methods The study included 92 patients who underwent FNAC and later surgery and histopathological assessment with a final diagnosis. Results FNAC showed 95% specificity, 78% sensitivity and 90% accuracy. The compatibility of the cytological and histopathological findings was good (Kappa coefficient of 0.756; 95% CI). The cytology results proved to be very good at predicting malignant histopathological findings, (OR=72.33; p˂0.001). Also, the result of ROC analysis (AUC=0.866) confirmed FNAC as a very good method of distinguishing benign and malignant thyroid nodules. Conclusion The results confirmed the correctness of the algorithm in which, following clinical or ultrasound confirmation of nodular thyroid lesions with suspicious changes, FNAC is indicated. The FNAC results should guide a clinician to further diagnostic and therapeutic procedures. Certainly, in case of suspected follicular/ Hurthle cell lesions one should be vigilant and aware of the fact that in these cases malignancy is defined by the invasion of blood vessels and/or the capsule, which FNAC is unable to detect. [ABSTRACT FROM AUTHOR]

Background and objectives: Lesions of the head and neck region are routinely encountered by clinicians, in patients across all age groups. Diagnoses range from reactive inflammatory conditions to malignancies. Cancer is among the leading causes of death in India. Head and neck cancers account for 23% of all cancer incidents in males and 6% of all incidents in females in India,. Fine needle aspiration cytology (FNAC) of cervical masses is an easy, effective, and relatively inexpensive technique. The aim of this study was to determine occurrence of various head and neck swellings and classify them under various categories. Methods: The present study included 100 cases of palpable cervical swellings who had been referred to the AMC MET Medical College, Ahmedabad (India) from June 2018 to October 2020. Results: The majority of cases were lymph node swellings (57%), followed by thyroid swellings (23%), salivary gland swellings (12%), and soft tissue swellings (8%). Among all cervical region swellings, tuberculous lymphadenitis and thyroid lesions were the most prevalent. Conclusion: The findings suggest that lymph node swellings are most commonly observed in the cervical area, and that the majority of them are inflammatory, requiring medical treatment rather than surgery. Moreover, FNAC is a straightforward, quick, and cost-effective way to distinguish between non-neoplastic and metastatic malignant lesions, which could help timely surgical interventions. [ABSTRACT FROM AUTHOR]

Objective The Bethesda system is widely used to evaluate aspiration of thyroid nodules. The aim of the study is to evaluate the usability of the system by the correlation between cytology and final histopathology results and to review the literature. Materials and Methods Fine needle aspiration of thyroid nodules reported using Bethesda system were analyzed. Malignancy rates were calculated by the results of thyroidectomies. To analyze the power of the Bethesda system six distinct subgroups were designed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated separately in these subgroups. The data were analyzed using SPSS 20 for Windows. Results The distribution of thyroid nodules according to the Bethesda was 2212 (33.5%), 3163 (47.9%), 720 (10.9%), 67 (1%), 361 (5.5%) and 75 (1.1%), respectively. Of 873 nodules that underwent thyroidectomy, 254 (29.9%) were diagnosed as malignant. The diagnostic categories according to thyroidectomies were 233 (26.7 %), 277 (31.7%), 137 (15.7%), 23 (2.6%), 163 (18.7%) and 40 (4.6%), respectively. The malignancy rates of each Bethesda category were 14.5%, 6.8%, 32.8%, 52.1%, 66.8% and 97.5%. The sensitivity, spesifity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of fine needle aspiration was calculated and ranged from 61.8% to 89.3%, 79.6% to 99.6%, 70.4% to 97.5%, 84.5% to 93.1% and 79.5% to 93.6%, respectively. Conclusion The limitation of this study is that the B1 category is very high. However, since the data are evaluated by only one pathologist and it is one of the first three studies with the highest number of cases, it makes a significant contribution to the literature in terms of all categories except B1. The Bethesda system is a classification that provides the clinician with appropriate clinical follow-up and the accurate treatment approach, and a high interobserver agreement for pathologists. [ABSTRACT FROM AUTHOR]