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Objective: The American College of Radiology Thyroid Imaging Reporting and Data System (TI‐RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI‐RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children. Methods: Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI‐RADS. Management recommendations based on TI‐RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children. Results: Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI‐RADS for predicting malignancy was 0.78. Adult TI‐RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow‐up. Modifications to TI‐RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%. Conclusions: TI‐RADS can risk‐stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children. [ABSTRACT FROM AUTHOR]

The article discusses a case of CD20-negative Diffuse Large B Cell Lymphoma presenting as an anterior neck mass. The importance of prompt diagnoses in cases of high-grade lymphoma of the neck, which can lead to airway compromise, is highlighted. Fine Needle Aspiration Cytology (FNAC) played a crucial role in differentiating lymphoma from other malignancies, emphasizing the significance of using multiple B cell markers to assess lymphocyte lineage. The case study underscores the utility of FNAC in rapid diagnostic workup and the challenges in diagnosing CD20-negative DLBCL. [Extracted from the article]

Langerhans cell histiocytosis (LCH) is a group of diseases that cause damage by local or widespread accumulation of atypical histiocytes in various tissues such as skin, bone, lung, liver, lymph nodes, mucocutaneous tissues, and endocrine organs. LCH was detected as a result of a total thyroidectomy biopsy performed on a 43-yearold female patient with a solitary euthyroid nodule following weight loss and an increase in the size of the thyroid nodule during outpatient clinic checks. Patient's whole body positron emission tomography. The case of LCH with isolated thyroid involvement is very rare, and a limited number of cases have been presented on this subject. In addition, it will contribute to the literature since there are fewer than ten LCH cases with thyroid involvement. [ABSTRACT FROM AUTHOR]

Wnt family member 9b (Wnt9b) has been demonstrated as a valuable marker for breast cancer diagnosis in surgical pathology. In this study, we examined the utility of Wnt9b in diagnosing metastatic breast carcinoma in cytology samples. Cell blocks from fine needle aspirations (FNA) and fluid specimens of 96 metastatic breast carcinomas and 123 primary and metastatic non-breast neoplasms from various organ systems were evaluated by Wnt9b and GATA3 immunohistochemistry (IHC). Wnt9b and GATA3 were positive in 81.3% and 92.7% of metastatic breast carcinomas, respectively. Conversely, 93.5% and 90.0% of non-breast, non-urothelial carcinomas were negative for Wnt9b and GATA3, respectively. Wnt9b expression was positive in rare gastrointestinal, gynecological, lung, pancreas, and salivary gland tumors. All twenty-eight urothelial carcinomas were negative for Wnt9b, while twenty-six (92.9%) were positive for GATA3. Wnt9b was slightly less sensitive but more specific than GATA3 in diagnosing metastatic breast cancer in cytology samples. Particularly, Wnt9b shows higher specificity in differentiating breast and urothelial primaries. The combined use of Wnt9b and GATA3 may increase diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Fine needle aspiration biopsy is accepted as a safe, reliable, minimally invasive, and cost-effective method. Fine needle aspiration biopsy aims to assist clinicians in handling patients. The purpose of this study is to evaluate the validity of fine needle aspiration biopsy as a diagnostic tool in salivary gland tumors compared to histopathological examination at Dr. Saiful Anwar Malang Hospital for the period of 2018-2022. Methods: Fine needle aspiration biopsy examination was performed before surgery, then compared with the results of histopathological examination after surgery as gold standard and retrospectively reviewed. Fine needle aspiration biopsy results and histopathological results are classified as neoplasm or non-neoplasm and benign or malignant. Validity is determined from sensitivity, specificity, positive conjecture value, negative conjecture value and accuracy. As a result, there were 33 cases of salivary gland tumors that met the inclusion criteria in the period 2018-2022 were reviewed, then classified into neoplasms or non-neoplasms and benign or malignant neoplasms. The sensitivity, specificity, accuracy, positive presumptive value, and negative presumptive value of cytological diagnosis of fine needle aspiration biopsy of salivary gland tumors for the neoplasm or non-neoplasm category were 93.1%, 100%, 93.9%, 100%, 66.7% and for the benign or malignant category 94.4%, 88.9%, 92.6%, 94.4%, 88.9%. This study shows that salivary gland fine needle aspiration biopsy cytology is a reliable and accurate diagnostic method for the diagnosis of salivary gland lesions. Conclusions: Fine needle aspiration biopsy is a useful method for diagnostics in salivary gland tumors but cannot replace histopathological examination as the gold standard for diagnostics. [ABSTRACT FROM AUTHOR]

Abstract Objectives To investigate the value of conventional ultrasonography (US) combined with quantitative shear wave elastography (SWE) in evaluating and identifying target axillary lymph node (TALN) for fine needle aspiration biopsy (FNAB) of patients with early breast cancer. Materials and methods A total of 222 patients with 223 ALNs were prospectively recruited from January 2018 to December 2021. All TALNs were evaluated by US, SWE and subsequently underwent FNAB. The diagnostic performances of US, SWE, UEor (either US or SWE was positive) and UEand (both US and SWE were positive), and FNAB guided by the above four methods for evaluating ALN status were assessed using receiver operator characteristic curve (ROC) analyses. Univariate and multivariate logistic regression analyses used to determine the independent predictors of axillary burden. Results The area under the ROC curve (AUC) for diagnosing ALNs using conventional US and SWE were 0.69 and 0.66, respectively, with sensitivities of 78.00% and 65.00% and specificities of 60.98% and 66.67%. The combined method, UEor, demonstrated significantly improved sensitivity of 86.00% (p < 0.001 when compared with US and SWE alone). The AUC of the UEor-guided FNAB [0.85 (95% CI, 0.80–0.90)] was significantly higher than that of US-guided FNAB [0.83 (95% CI, 0.78–0.88), p = 0.042], SWE-guided FNAB [0.79 (95% CI, 0.72–0.84), p = 0.001], and UEand-guided FNAB [0.77 (95% CI, 0.71–0.82), p

Objective: The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods. Methods: In total, 3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006– 2008, 2012–2014, 2017–2019). The distribution of diagnostic cytology, risk of malignancy, diagnostic performance indices of fine needle aspiration (FNA), and cytologic–histologic correlation in indeterminate cytology were analyzed. Results: Only 2.2% of cytology tests were insufficient for a diagnosis. About 86.9% cytology was benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006–2008), 10.1% (2012–2014), and 10% (2017–2019). Surgery was performed in 13% of benign cytology, resulting in malignant histology in 2.7%. All malignant and suspicious cytology underwent surgery, with malignancy confirmed in 98% and 77% of cases, respectively. All ‘indeterminate with atypia’ cytology (2006–2008) and Bethesda IV (2012–2014; 2017–2019) underwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the ‘indeterminate without atypia’ category (2006–2008) and Bethesda III (2012–2014; 2017–2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6%, with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods. Conclusion: The Bethesda system reduces indeterminate cytology and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.

Objectives: To investigate the value of conventional ultrasonography (US) combined with quantitative shear wave elastography (SWE) in evaluating and identifying target axillary lymph node (TALN) for fine needle aspiration biopsy (FNAB) of patients with early breast cancer. Materials and methods: A total of 222 patients with 223 ALNs were prospectively recruited from January 2018 to December 2021. All TALNs were evaluated by US, SWE and subsequently underwent FNAB. The diagnostic performances of US, SWE, UEor (either US or SWE was positive) and UEand (both US and SWE were positive), and FNAB guided by the above four methods for evaluating ALN status were assessed using receiver operator characteristic curve (ROC) analyses. Univariate and multivariate logistic regression analyses used to determine the independent predictors of axillary burden. Results: The area under the ROC curve (AUC) for diagnosing ALNs using conventional US and SWE were 0.69 and 0.66, respectively, with sensitivities of 78.00% and 65.00% and specificities of 60.98% and 66.67%. The combined method, UEor, demonstrated significantly improved sensitivity of 86.00% (p < 0.001 when compared with US and SWE alone). The AUC of the UEor-guided FNAB [0.85 (95% CI, 0.80–0.90)] was significantly higher than that of US-guided FNAB [0.83 (95% CI, 0.78–0.88), p = 0.042], SWE-guided FNAB [0.79 (95% CI, 0.72–0.84), p = 0.001], and UEand-guided FNAB [0.77 (95% CI, 0.71–0.82), p < 0.001]. Multivariate logistic regression showed that FNAB and number of suspicious ALNs were found independent predictors of axillary burden in patients with early breast cancer. Conclusion: The UEor had superior sensitivity compared to US or SWE alone in ALN diagnosis. The UEor-guided FNAB achieved a lower false-negative rate compared to FNAB guided solely by US or SWE, which may be a promising tool for the preoperative diagnosis of ALNs in early breast cancer, and had the potential implication for the selection of axillary surgical modality. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical manifestations, histopathological characteristics, diagnosis, treatment, and prognosis of simultaneous unilateral primary tumors of different pathological types in the parotid gland. Methods A case of simultaneous unilateral primary parotid gland tumors, i.e., adenolymphoma and basal cell adenoma, was reviewed and analyzed in combination with the literature. Results The patient discovered a lump in the right parotid gland area one month prior to presentation, and a tumor was palpated in the shallow lobe of the right parotid gland before surgery. According to MR images, the initial diagnoses were tumors of the shallow and deep lobes of the right parotid gland. The tumors of the deep and shallow lobes were excised with part of the gland, and the facial nerves were dissected under general anesthesia. Postoperative pathology revealed an adenolymphoma in the shallow lobe of the right parotid gland and a basal cell adenoma with cystic transformation in the deep lobe. The surgical effect was good, with no complications, and there was no recurrence after 1 year of follow-up. A review of the relevant literature showed that multiple primary tumors of the parotid gland can manifest as the simultaneous presence of two or more types of tumors on both sides or on one side, and the disease is mainly treated with surgery. Conclusion Multiple unilateral primary parotid gland tumors are rare. Imaging examinations need to be combined with clinical evaluations to prevent missed diagnoses. Surgery is the first treatment option, and patients with benign tumors have a good prognosis.

Purpose: The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Methods: This prospective study included 370 thyroid nodules in 308 patients aged 18–70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. Results: One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). Conclusion: This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU 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.)

Introduction: Ultrasound-guided fineneedle aspiration biopsy (FNAB) remains the primary method for diagnosing thyroid nodules, providing adequate information for definitive diagnosis and treatment decisions in most cases. However, cytological examinations sometimes yield inconclusive or non-diagnostic results. For rapidly growing tumours with suspected malignancy, a swift and accurate diagnosis is crucial to initiate timely treatment. Cases suggestive of anaplastic thyroid cancer (ATC) or poorly differentiated cancer present unique challenges in obtaining satisfactory diagnostic material through FNAB, due to advanced necrosis or extensive inflammatory components. In these instances, core needle biopsy (CNB) emerges as a complementary diagnostic tool when FNAB results are ambiguous. This study aimed to evaluate the effectiveness of CNB in diagnosing rapidly growing thyroid tumours with clinical indication of ATC. Material and methods: Between 2019-2023, 31 CNBs were performed on large, rapidly expanding thyroid tumours. Results: All cases exhibited clinical signs of malignancy, with previous FNAB outcomes being either equivocal or inconclusive. The subsequent CNBs demonstrated accurate results with minimal complications among the patients. While reservations about CNB for thyroid nodules persist, it offers a valuable diagnostic alternative, potentially preventing unwarranted surgical biopsy or removal of the thyroid. Conclusions: Core needle biopsy deployment should be judicious, reserved for select cases, and carried out in a hospital environment to ensure diagnostic precision with the least risk of complications. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Prevention & Treatment For Stomatological Diseases is the property of Journal of Prevention & Treatment For Stomatological Diseases Editorial Office 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.)

Eccrine spiradenoma (ES) is an uncommon and benign adnexal tumour originating from sweat glands. The cytological examination of ES poses a diagnostic challenge, as it can be mistaken for various benign and malignant basaloid skin neoplasms. The cytomorphologic features of ES are infrequently documented in existing literature. This study seeks to present a thorough exploration of the cytomorphologic traits associated with ES, accompanied by an analysis of ancillary testing that contribute to the accurate identification of this entity in cytological specimens. Eccrine spiradenoma is infrequently encountered in fine needle aspiration (FNA) cytopathology, and the available literature on its cytomorphologic features is limited. The challenge arises from its similarity to other benign and malignant dermal basaloid neoplasms, emphasizing the critical role of clinicopathologic correlation and immunohistochemical staining in achieving a precise diagnosis. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB) is a well established diagnostic method in adult patients, but is rarely used in the paediatric population. The Clinical Department of Gastroenterology at the University Clinical Centre Ljubljana and the Department of Cytopathology at the Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia, have been closely collaborating on EUS FNAB since the introduction in 2010. The aim of the study was to review the cases of EUS FNAB of pancreatic neoplasms in children. In the digital archive of the Institute of Pathology (IP), Faculty of Medicine (FM), University of Ljubljana (UL), we found 6 cases of EUS FNAB in children, 3 had EUS FNAB of the pancreas, 2 of whom had a cytopathologic diagnosis of a tumour. In the first case, the lesion was ultrasonographically solid, and the cell sample contained branching papillary structures surrounded by aggregates of small cells with nuclear grooves. In the second case, the lesion was ultrasonographically cystic, and predominantly necrosis was seen, with only single preserved cells. Positive nuclear reaction for β-catenin was found in both cases by immunohistochemical staining. In both cases, the cytopathological diagnosis of solid pseudopapillary neoplasm of the pancreas was made, the cases represent the totality of paediatric cases of pancreatic neoplasms from the Children's Hospital Ljubljana since 2010. There were no adverse events during and after EUS FNAB. A histopathological examination of the tumour resection specimens confirmed the cytopathological diagnosis. Our experience indicates that EUS FNAB is a safe and effective method for diagnosing pancreatic neoplasms in the pediatric population, as supported by the findings in the literature. [ABSTRACT FROM AUTHOR]

Cytopathologists have assumed a progressively pivotal role in diagnosing lymphoproliferative disorders. This review outlines a concise approach to the work-up of suspected lymphoma in cytopathology practice, emphasizing the integration of cytomorphologic evaluation with ancillary studies. These include the application of rapid onsite evaluation (ROSE) for proper specimen triage, immunophenotyping through flow cytometry (FC) and immunohistochemistry (IHC), and molecular studies on cytology/small biopsy specimens. Furthermore, the review provides a brief introduction to the forthcoming WHO Reporting System in Lymph Node Cytopathology.

The upcoming World Health Organization (WHO) Reporting System in Liver Cytopathology marks the first internationally applicable system for diverse medical infrastructure settings. This system categorizes cases into five groups: Insufficient/Inadequate/Nondiagnostic, Benign, Atypical, Suspicious for Malignancy, and Malignant. Each category is associated with a risk of malignancy (ROM), guiding recommendations for further diagnostic testing to achieve specific diagnoses or refine differential diagnoses and follow-up management. The primary goal is to enhance and standardize cytopathology reporting, improve communication between cytopathologists and clinicians, and ultimately elevate patient care. The online WHO System provides direct access to the WHO Classification for Tumours 5th Edition. This review delves into the latest classification guidelines, addresses terminology standardization, navigates diagnostic complexities, and aligns patient management options with cytopathological interpretations, contributing to an overall enhancement of patient care.

Objective: Tumor molecular genotyping plays a key role in improving the management of advanced thyroid cancers. Molecular tests are classically performed on formalin-fixed, paraffin-embedded (FFPE) carcinoma tissue. However alternative molecular testing strategies are needed when FFPE tumoral tissue is unavailable. The objective of our study was to retrospectively assess the performance of targeted DNA and RNA-based next-generation sequencing (NGS) on the fine needle aspirate from thyroid cancer cervical recurrences to determine if this strategy is efficient in clinical practice. Design/Methods: A retrospective study of 33 patients who had had DNA and/or RNA-based NGS on ultrasound (US)-guided fine needle aspirates of cervical thyroid cancer recurrences in our Department from July 2019 to September 2022. Results: In total, 34 DNA and 32 RNA-based NGS analyses were performed. Out of the 34 DNA-based NGS performed, 27 (79%) were conclusive allowing the identification of an oncogenic driver for 18 patients (53%). The most common mutation (n = 13) was BRAF c.1799T>A. Out of the 32 RNA-based NGS performed, 26 were interpretable (81%) and no gene fusion was found. The identification of a BRAFV600E mutation was decisive for one patient in our series, who was prescribed dabrafenib and trametinib. Conclusion: NGS performed on fine needle aspirates of neck lymph node metastases enabled the identification of an oncogenic driver alteration in 53% of the cases in our series of advanced thyroid cancer patients and could significantly alter patient management. Significance statement This paper shows that thyroid cancer genotyping on the fine needle aspirate (FNA) of a metastatic neck lymph node recurrence can be performed efficiently. This strategy of genotyping appears particularly effective and safe when FFPE tissue is unavailable and when the spread of the disease requires systemic treatment. To the best of our knowledge, our data regarding DNA and RNA next generation sequencing on FNA of metastatic neck recurrences are the first ever published.

Background: Sclerosing mucoepidermoid carcinoma of the thyroid gland was first reported in 1991. This type of a tumor may develop in connection with Hashimoto's thyroiditis. There are two variants of mucoepidermoid carcinoma of the thyroid gland: the normal and sclerosing types. Sclerosing mucoepidermoid carcinoma of the thyroid gland has recently been recognized by the World Health Organization as a separate disease. Сlinical case description: We present a clinical case of a 51-year-old woman who was observed for 2 years for autoimmune thyroiditis with nodulation. The patient had no symptoms or signs of compression. The level of thyroid–stimulating hormone was 15.8 (range 0.4–4.0), the level of antibodies to peroxidase was 150 IU/ml. Thyroid scintigraphy revealed a dominant cold node (1.5×2 cm) in the right lobe of the gland. During the control ultrasound examination of the neck, negative dynamics was observed, then a fine needle aspiration biopsy of the thyroid node was performed. A follicular tumor was found against the background of Hashimoto's thyroiditis, which was the reason for a timely treatment. In the described case, the patient underwent a total thyroidectomy without neck lymph node dissection, no postoperative radiotherapy or other auxiliary treatments were performed. A full-body scintigraphy showed no recurrence of the disease in 10 months after the initial treatment. Conclusion: Given the rarity of the disease and the impossibility to differentiate it from other thyroid tumor’s, a more thorough examination of the nearby lymphatic collectors is necessary to exclude metastatic lesions, and in the presence of altered lymph nodes, additional diagnosis by fine-needle aspiration biopsy with subsequent determination of the scope of surgical treatment and postoperative management of this category of patients is indicated.

Background: With the growing incidence of breast cancer, efficient and correct staging is essential for further treatment decisions. Axillary ultrasound (US) remains the most common method for regional nodal involvement assessment. The aim of this study was to evaluate whether high-risk US features can accurately predict axillary lymph node metastasis. Methods: A total of 150 early-stage breast cancer patients (T1 or T2) were prospectively included in the study. Based on axillary US, patients were classified as normal, low-risk, or high-risk, with all patients in the low-risk and high-risk groups undergoing fine-needle aspiration (FNAB) and core-needle biopsies. Results: For the low-risk US group, a lower prediction rate of axillary nodal metastasis was achieved than for the group with high-risk features, recording a sensitivity of 66.6% vs. 89.2%, a specificity of 57.1% vs. 100%, a positive predictive value (PPV) of 26.6% vs. 100%, a negative predictive value (NPV) of 88% for both groups, and an accuracy of 58.9% vs. 94%, respectively. FNAB resulted in more false-negative results compared to core-needle biopsy in both low-risk and high-risk US groups. Conclusions: Our findings suggest that high-risk US features can predict axillary lymph node metastasis with high accuracy. [ABSTRACT FROM AUTHOR]

Background: Core needle biopsy (CNB) is a relatively new technique for the diagnosis of thyroid nodules, and there are currently no large clinical series available. CNB results from 3000 cases are presented in this article. Methods: A spring-loaded 20-gauge needle was used for CNB under local anesthesia and ultrasonography guidance for 3000 patients with nodular goiter (584 males, 2416 females, mean age: 48.5). One physician performed all biopsy procedures without conducting on-site pathological examinations. Results: There were non-diagnostic 22 (.7%), benign 2620 (87.4%), atypia of undetermined significance and/or, follicular lesion of undetermined significance 90 (3%), follicular neoplasms and/or suspicious for follicular neoplasm 53 (1.7%), suspicious for malignancy 160 (5.4%), and malignant 55 (1.8%) cases. The CNB procedure was repeated in 19 non-diagnostic cases, and 17 of these patients were benign and two had malignancy. Thyroidectomy was performed on patients who had malign CNB results. All final pathology reports, except for one, were malignant for the patients who had malignant CNB results. The specificity and the sensitivity of CNB were found to be 99.9% and 100%, respectively. There were no serious complications. Conclusion: In thyroid nodules, core needle biopsy is a highly sensitive, specific, and reliable method that could be performed by a single physician. It does not require on-site pathological analysis and has a low incidence of complications and non-diagnostic rates. [ABSTRACT FROM AUTHOR]

Background. medullary thyroid carcinoma (mtc) produces serum markers including calcitonin (ct) and carcinoembryonic antigen (cea). The measurement of ct in fine-needle aspirate washout fluid (FNA-CT) improves the cytological diagnosis of mtc. However, no data are available about cut-off values for FNA-CT using currently immunoassay. The measurement of cea in the needle washout fluid (FNa-cea) in mtc has not been studied.Objective: to assess the diagnostic value and propose cut-off values for FNA-CT and FNacea in the thyroid nodule to diagnose mtc.Material and Methods. We conducted a retrospective analysis of 164 samples of fine-needle aspirate washout fluid collected from 92 patients with thyroid nodules, who underwent FNa followed by cytological examination and measurement of FNA-CT. seventeen cases with mtc and 41 with non-mtc nodules were histologically verified. one hundred and six nodules identified as non-mtc by cytology were not operated on. FNa-cea was additionally studied in 29 samples. The cut-off value was determined by Roc analysis.Results. The FNA-CT level was >2000 pg/ml in all mtc nodules, except for one, in which the FNA-CT level was 638 pg/ml. In non-mtc nodules, the FNA-CT levels were 500 pg/ml in 5 %, and >1000 pg/ml in 2 %. At a cut-off value of 590 pg/ml, the sensitivity and specificity of FNA-CT were 100 % and 96 %, and at a cut-off of 1721 pg/ml, the corresponding values were 94 % and 99 %. The false positive FNA-CT values were 3.7 % and 1.2 % at the cut-off values of 590 pg/ml and 1721 pg/ml, respectively. The median levels of FNa-cea in mtc and non-mtc nodules were 59.3 ng/ml and 1.5 ng/ml, respectively. At a cut-off value of 7.5 ng/ml, the sensitivity of FNa-cea was 86 % and specificity was 100 %. Additional measurement of FNa-cea prevented all false-positive results of FNA-CT, but did not detect 2 mtcs with low FNa-cea levels (false-negative rate of 6.9 %). Among samples with FNA-CT value of >590 pg/ml and negative cytology (n=9), FNa-cea differentiated mtc with 100 % sensitivity and specificity.Conclusion. The maximum sensitivity of FNA-CT in the thyroid nodule was at a cut-off value of 590 pg/ml (100 %), the maximum specificity was at a cut-off value of 1721 pg/ml (99 %). Risk of false positive result is the major challenge of FNA-CT. to reduce false-positive results, we recommend to measure FNa-cea in the nodules with negative cytology and high level of FNA-CT. At a cut-off value of 7.5 ng/ml, FNa-cea allows the false-positive FNA-CT to be excluded.

Background: With the growing incidence of breast cancer, efficient and correct staging is essential for further treatment decisions. Axillary ultrasound (US) remains the most common method for regional nodal involvement assessment. The aim of this study was to evaluate whether high-risk US features can accurately predict axillary lymph node metastasis. Methods: A total of 150 early-stage breast cancer patients (T1 or T2) were prospectively included in the study. Based on axillary US, patients were classified as normal, low-risk, or high-risk, with all patients in the low-risk and high-risk groups undergoing fine-needle aspiration (FNAB) and core-needle biopsies. Results: For the low-risk US group, a lower prediction rate of axillary nodal metastasis was achieved than for the group with high-risk features, recording a sensitivity of 66.6% vs. 89.2%, a specificity of 57.1% vs. 100%, a positive predictive value (PPV) of 26.6% vs. 100%, a negative predictive value (NPV) of 88% for both groups, and an accuracy of 58.9% vs. 94%, respectively. FNAB resulted in more false-negative results compared to core-needle biopsy in both low-risk and high-risk US groups. Conclusions: Our findings suggest that high-risk US features can predict axillary lymph node metastasis with high accuracy.

Background. Sclerosing mucoepidermoid thyroid carcinoma (SMTC) is a recently recognized malignant neoplasm of the thyroid. SMTC was frst reported in 1991. It arises in a background of Hashimoto thyroiditis (HT). There are two variants of mucoepidermoid carcinoma of thyroid gland: the conventional and sclerosing variants. SMTC has recently been recognized as a separate disease entity by World Health Organization (WHO). Description of the clinical case. We present the case of a 51-year-old woman with a 2-year history of autoimmune thyroiditis with a thyroid nodule. The patient had no symptoms or signs of compression. The level of thyroid–stimulating hormone (TSH) was 15.8 (range 0.4-4.0), antibodies to peroxidase: 150 Iu/ml. Scintigraphy of the thyroid gland revealed a dominant cold nodule (1.5×2 cm) in the right lobe of the gland. The control ultrasound examination showed negative fndings. Fine needle aspiration cytology of the nodule revealed follicular lesion in a background of TH. Extrafascial thyroidectomy was performed. The patient was followed up for 10 months.

Myoepithelial carcinoma (MECA) is an infrequently recognized salivary gland (SG) neoplasm that commonly develops within a preexisting pleomorphic adenoma (MECA ex PA). Fine-needle aspiration (FNA) biopsy reports of this neoplasm are largely restricted to small series and single case reports. Our cytopathology files were searched for examples of SG MECA/MECA ex PA having confirmatory histopathologic verification. Conventional FNA biopsy smears were performed, and exfoliative specimens processed using standard techniques. Thirteen cases from 9 patients (M:F = 3.5:1; age range: 36 to 95 years, mean age = 60 years) met inclusion criteria. FNA biopsy sites included parotid gland (4), trunk (2), scalp (2), and neck (2). Exfoliative specimens included pleural fluid (1), bronchial brushing (1), and bronchoalveolar lavage (1). Most cases were metastatic deposits (8; 62%), 4 were primary neoplasms, and 1 a local recurrence. FNA diagnoses were MECA ex PA (6; 46%), myoepithelial neoplasm (2), PA (2), basaloid neoplasm (1), atypical myoepithelial cells (1), and myxoma (1). Ancillary testing in 2 cases showed positive staining for myoepithelial markers. Cytologic features were that of a low-grade neoplasm composed principally of epithelioid/polygonal cells exhibiting minimal if any cytologic atypia. Myxoid and chondromyxoid stroma was often the dominant feature in MECA ex PA aspirates. In the primary setting, a cytologic diagnosis of MECA/MECA ex PA is extremely challenging if at all possible. Due to overwhelming amounts of stroma, the diagnosis may be challenging in some cases of metastatic MECA ex PA. • Only a limited number of reports of the FNA biopsy and exfoliative cytopathology of salivary gland (SG) myoepithelial carcinoma (MECA)/myoepithelial carcinoma ex pleomorphic adenoma (MECA ex PA) exist. • Cytomorphology from this series of 13 cases from 9 patients showed a predominantly uniform epithelioid cell type with minimal cytologic atypia largely indistinguishable from cellular PA and myoepithelioma. • Aspirates of metastatic MECA ex PA often contained voluminous amounts of stroma and variable cellularity. • Combining our series with that of the literature shows cytologic recognition of this tumor as malignant occurred in only half of cases, thereby justifying its placement into the SG tumor of uncertain malignant potential category of the Milan classification of SG neoplasms. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules (TN) are localized morphological changes in the thyroid gland and can be benign or malignant. Objective: The present study investigates the relationships between biochemical markers in serum (s) and their homologs in washout (w) after fine-needle aspiration biopsy (FNAB) of the TN of interest and their correlation with cytology specimen findings. Methods: We investigated the relationships between serum biochemical markers nitric oxide (NO), thyroglobulin (TG), and calcitonin (CT), their homologs in washout after FNAB of the TN of interest, and cytology findings of biopsy samples classified according to the Bethesda system for thyroid cytopathology in this study, which included 86 subjects. Results: Washout TG (TGw) level positively correlates with the cytology finding of the biopsy. A higher level of TGw correlates with higher categories of the Bethesda classification and indicates a higher malignant potential. The levels of serum NO (NOs), serum TG (TGs), serum CT (CTs), and washout CT (CTw) do not correlate with the cytology finding of the biopsy, and the higher levels of washout NO (NOw) correspond to the more suspicious ultrasound findings. Conclusion: The findings of our study suggest that TGw and NOw could be used as potential predictors of malignancy in TN. [ABSTRACT FROM AUTHOR]

Introduction:Solid and/or cystic lesions of the pancreas can range from benign to malignant, and the differential diagnosis of pancreatic carcinoma (PC) is of uttermost importance. Endoscopic ultrasonography (EUS) is frequently used and is helpful in detecting small (37 U/mL, and partial atrophy in the pancreas were independently associated with PC. For solid lesions, age and size >24 mm; and for cystic lesions, male gender and mucinous pathology were independently associated with PC. Thirty-six of the cystic lesions had mucinous pathology. Cyst and serum CEA, string sign, wesung connection, and tail location was associated with mucinous pathology. Cyst CEA cut-off for mucinous pathology was 80 ng/mL (AUC: 0.89). CEA >80 ng/mL was found to be associated with mucinous pathology in multivariate analysis.Conclusion:High CA19-9, solid lesion, and lesion-related partial atrophy of the pancreas are associated with PC, and these should be alarming for clinicians in practice. The mucinous character, which is a significant risk of PC for cystic lesions, can be optimally defined with the CEA cut-off value of 80 ng/mL.

Abstract Background Microcalcifications are suggested to be an indicator of thyroid malignancy, especially for papillary thyroid carcinoma (PTC), nonetheless, the association between macrocalcification and PTC is underexplored. Furthermore, screening methods like ultrasonography and ultrasound-guided fine needle aspiration biopsy (US-FNAB) are limited in evaluating macro-calcified thyroid nodules. Thus, we aimed to investigate the relationship between macrocalcification and PTC. We also explored the diagnostic efficiency of US-FNAB and proto-Oncogene Proteins B-raf V600E (BRAF V600E) mutation in macro-calcified thyroid nodules evaluation. Methods A retrospective research of 2645 thyroid nodules from 2078 participants was performed and divided into three groups as non-, micro-, and macro-calcified for further PTC incidence comparison. Besides, a total of 100 macro-calcified thyroid nodules with both results of US-FNAB and BRAF V600E mutation were screened out for subsequent evaluation of diagnostic efficiency. Results Compared to non-calcification, macrocalcification showed a significantly higher incidence of PTC (31.5% vs. 23.2%, P

Background/Aims: Thyroid fine needle aspiration biopsy (TFNAB) is an effective and convenient evaluation method. It is the gold standard in preoperative evaluation. The Bethesda System for Reporting Thyroid Cytopathology is a standardized evaluation system that has been widely used all over the world. In this study, we aimed to investigate the compatibility of the TFNAB results, which we evaluated according to the Bethesda System for Reporting Thyroid Cytopathology. Methods: The data of 333(236 female, 97 male) patients, who underwent TFNAB between January 2020 and January 2022, were collected retrospectively. Their Bethesda categories, ages, and gender characteristics were recorded. Results: The mean age for the 333 patients included in the study was 46.46 ± 14.53 for the female patients and 50.19 ± 10.06 for the male patients. When all patients were examined, Nondiagnostic (B1), Benign (B2)were the most common cytologies. While benign cytology was observed at an earlier age, the suspicion of malignancy or the incidence of malignant cytology increased as the mean age of the patients increased. Conclusion: The Bethesda System for Reporting Thyroid Cytopathology is a widely accepted and reliable benchmark around the world in the evaluation phase of the cytopathological examination. In this study, we examined the cytopathological evaluation results of the patients who underwent thyroid FNAB at our center according to the Bethesda System for Reporting Thyroid Cytopathology. In terms of diagnostic cytology, we recommend aultrasonography-guided biopsy performed by an experienced clinician.

BackgroundThyroid nodules (TN) are localized morphological changes in the thyroid gland and can be benign or malignant.ObjectiveThe present study investigates the relationships between biochemical markers in serum (s) and their homologs in washout (w) after fine-needle aspiration biopsy (FNAB) of the TN of interest and their correlation with cytology specimen findings.MethodsWe investigated the relationships between serum biochemical markers nitric oxide (NO), thyroglobulin (TG), and calcitonin (CT), their homologs in washout after FNAB of the TN of interest, and cytology findings of biopsy samples classified according to the Bethesda system for thyroid cytopathology in this study, which included 86 subjects.ResultsWashout TG (TGw) level positively correlates with the cytology finding of the biopsy. A higher level of TGw correlates with higher categories of the Bethesda classification and indicates a higher malignant potential. The levels of serum NO (NOs), serum TG (TGs), serum CT (CTs), and washout CT (CTw) do not correlate with the cytology finding of the biopsy, and the higher levels of washout NO (NOw) correspond to the more suspicious ultrasound findings.ConclusionThe findings of our study suggest that TGw and NOw could be used as potential predictors of malignancy in TN.

Objectives: To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary. Methods: We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model. Results: Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%. Conclusion: In conclusion, 5 independent predictors of positive FNAB, including age (≥45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: Fine needle aspiration biopsy (FNAB), accompanied by classification systems for cytology, can offer a cheap and convenient option for the diagnosis of breast cancer in women with suspicious breast lumps. In this study, we aimed to assess the accuracy of the International Academy of Cytology (IAC) Yokohama system in a Vietnamese oncology centre. Methods: A retrospective cross‐sectional study was conducted from November 2021 to April 2022 at Vietnam National Cancer Hospital. We included patients with full hospital records regarding breast lesions for which FNAB was indicated. A total of 803 patients' FNAB specimens were assessed according to the IAC Yokohama system. The basic characteristics were summarised using the appropriate summary measurements. The risk of malignancy (ROM) was calculated for each classification category. Results: The median age was 42.7 years (range: 14‐85). The mean size of the lesions was 17.9 mm (range: 4‐123 mm). We had 215 histopathological reports. The most common benign and malignant diagnoses were fibroadenoma and invasive carcinoma, respectively. The ROM for categories II, III, IV, and V was calculated as 3.4%, 37.5%, 95%, and 99.2% respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.4%, 97.2%, 98.5%, and 93.2%, respectively. Conclusion: The IAC Yokohama system offers a good option with which to predict underlying breast pathology using a simple and cheap procedure. However, pathologists require continuous training to ensure accurate interpretation of the slides. [ABSTRACT FROM AUTHOR]

Introduction: Atypical spindle cell/pleomorphic lipomatous tumour (ASPLT) is an infrequently appreciated benign lipomatous neoplasm newly accepted into the most recent WHO classification of soft tissue tumours. Materials and Methods: Our cytopathology files were searched for examples of ASPLT and spindle cell/pleomorphic lipoma (SCPL) having histopathological verification. Conventional fine needle aspiration (FNA) biopsy smears were performed using standard techniques. Results: Eleven patients including three cases of ASPLT and eight of SCPL (M:F = 4.5:1; age range: 39‐97 years, mean age = 60 years) met the inclusion criteria. FNA biopsy sites included extremity (5, 45%), trunk (3, 27%), and head/neck (3, 27%). All aspirates were from primary neoplasms. FNA diagnoses of ASPLT cases were spindle cell lipomatous neoplasm, fibrotic low‐grade SC neoplasm, and myxoid lipomatous neoplasm. Eight SCPL cases were diagnosed as spindle cell neoplasm (3), spindle cell lipoma (SCL) (1), pleomorphic lipoma (1), suspicious for SCL (1), benign adipose tissue (1), and benign spindle cells and connective tissue (1). Ancillary testing in two ASPLT cases showed positive CD34 and negative MDM2 immunostain in one, and negative FISH results for MDM2 and DDIT3 in another. Conclusion: ASPLT is a novel lipomatous neoplasm simulating primarily SCPL and atypical lipoma/well‐differentiated liposarcoma. Diligent cytomorphological observation, clinical information, and ancillary testing may allow for its specific recognition using FNA biopsy. [ABSTRACT FROM AUTHOR]

Background: Improved molecular diagnosis is needed in prostate cancer (PC). Fine needle aspiration (FNA) is a minimally invasive biopsy technique, less traumatic compared to core needle biopsy, and could be useful for diagnosis of PC. Molecular biomarkers (BMs) in FNA‐samples can be assessed for prediction, eg of immunotherapy efficacy before treatment as well as at treatment decision time points during disease progression. Methods: In the present pilot study, the expression levels of 151 BM proteins were analysed by proximity extension assay in FNA‐samples from 16 patients, including benign prostate lesions (n = 3) and cancers (n = 13). An ensemble data analysis strategy was applied using several machine learning models. Results: Twelve potentially predictive BM proteins correlating with International Society of Urological Pathology grade groups were identified, among them vimentin, tissue factor pathway inhibitor 2, and integrin beta‐5. The validity of the results was supported by network analysis that showed functional associations between most of the identified putative BMs. We also showed that multiple immune checkpoint targets can be assessed (eg PD‐L1, CD137, and Galectin‐9), which may support the selection of immunotherapy in advanced PC. Results are promising but need further validation in a larger cohort. Conclusions: Our pilot study represents a "proof of concept" and shows that multiplex profiling of potential diagnostic and predictive BM proteins is feasible on tumour material obtained by FNA sampling of prostate cancer. Moreover, our results demonstrate that an ensemble data analysis strategy may facilitate the identification of BM signatures in pilot studies when the patient cohort is limited. [ABSTRACT FROM AUTHOR]

Phantoms and simulators are widely accepted methods to gain valuable experience and confidence for inexperienced trainees prior to seeing their patient and for refining their skills. A phantom model that is durable, simple, and inexpensive to produce and use would be ideal to train practitioners in ultrasound-guided fine-needle aspiration biopsy (USFNA) technique. In this study, we systematically compared several low-cost phantom models including gelatin, extra firm tofu, canned cooked pork, ballistics gel, and chicken breast for their haptic properties, echogenicity, teaching utility, and overall performance based on a Likert scale (1-5; 5 = best). Nine cytopathologists and cytopathology fellows who perform FNA regularly evaluated these models and completed the survey. The gelatin phantom, with a gelatin to water ratio of 1:8 by weight, was found to be the best for USFNA practice and overall performance, followed by the 1:10 gelatin phantom. Tofu and chicken breast phantoms were also good low-cost alternatives that needed only a few minutes of total preparation time. Low-cost, homemade phantoms can serve as excellent alternatives to commercial phantoms for practicing and teaching USFNA. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to determine the specificity and sensitivity criteria of parotid fine needle aspiration biopsy in the diagnosis of parotid gland masses in our institution and guide the physician by using FNAB before surgery. Methods: Retrospective analysis was conducted by comparing the fine needle aspiration biopsy results of 80 patients with complete data and postoperative histopathological diagnoses of 90 patients who underwent fine needle biopsy in our clinic between 2015 and 2022 and were subsequently operated. The correlation of preoperative FNAB results to final surgical pathology was performed, and measures of diagnostic accuracy were computed. Results: Of all patients, 56.3% were male, and 43.7 were female. The mean age was 48 (range 19-87). 56.2% of them were right-sided, and 43.8% were left-sided. When the fine needle aspiration biopsies of the patients were examined, 47 were reported as benign (58.8%), 2 as malignant (2.5%), 21 as suspicious (26.3%), and 10 as insufficient (12.5%). Of 80 patients, 34 were diagnosed as pleomorphic adenoma, 14 as Whartin tumor, and 7 as sialoadenitis. Conclusion: FNAB is one of the most important diagnostic tools in the diagnosis of parotid gland masses when applied, knowing its advantages and given treatment without ignoring the deficiencies. It should be kept in mind that subtyping with FNAB in cases with a malignant histopathological diagnosis will reduce the secondary surgical needs of the cases. [ABSTRACT FROM AUTHOR]

This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach.

Background: Fine needle aspiration biopsy (FNAB) is usually used to distinguish the malignant and benign nodules. Applying a biopsy needle evokes a sense of fear and pain in the patients. Although some studies refute the usefulness of local anesthesia (LA) prior to fine needle aspiration biopsy, it is still debatable. This prospective cross-sectional study intended to evaluate the effect of LA prior to fine needle aspiration biopsy on pain and anxiety considering nodule size. Methods: Amongst the patients who were referred to Shiraz Shahid Fagihi Hospital for Thyroid fine needle aspiration biopsy from August 2017 to January 2018, 114 patients participated in this study. LA was performed for 41 patients, and 73 underwent the thyroid nodule fine needle aspiration biopsy without LA. Patients' pain and anxiety were scored using the visual-analog-score and Spielberger anxiety scale. The nodules were categorized into five groups. Pain and anxiety of patients were compared considering their nodule sizes to assess the effects of LA in the reduction of pain and anxiety considering the nodule size. Results: The patients undergoing LA had a mean age of 44.69 years old and average body mass index (BMI) of 26.7, the patients who performed thyroid nodule fine needle aspiration biopsy without LA had a mean age of 48.17 years old with an average BMI of 26.0. The patients with the maximum nodule size of

Background: Microcalcifications are suggested to be an indicator of thyroid malignancy, especially for papillary thyroid carcinoma (PTC), nonetheless, the association between macrocalcification and PTC is underexplored. Furthermore, screening methods like ultrasonography and ultrasound-guided fine needle aspiration biopsy (US-FNAB) are limited in evaluating macro-calcified thyroid nodules. Thus, we aimed to investigate the relationship between macrocalcification and PTC. We also explored the diagnostic efficiency of US-FNAB and proto-Oncogene Proteins B-raf V600E (BRAF V600E) mutation in macro-calcified thyroid nodules evaluation. Methods: A retrospective research of 2645 thyroid nodules from 2078 participants was performed and divided into three groups as non-, micro-, and macro-calcified for further PTC incidence comparison. Besides, a total of 100 macro-calcified thyroid nodules with both results of US-FNAB and BRAF V600E mutation were screened out for subsequent evaluation of diagnostic efficiency. Results: Compared to non-calcification, macrocalcification showed a significantly higher incidence of PTC (31.5% vs. 23.2%, P<0.05). Additionally, when compared with a single US-FNAB, the combination of US-FNAB and BRAF V600E mutation showed better diagnostic efficiency in diagnosing macro-calcified thyroid nodule (area under the curve (AUC) 0.94 vs. 0.84, P=0.03), with a significantly higher sensitivity (100.0% vs. 67.2%, P<0.01) and a comparable standard of specificity (88.9% vs. 100.0%, P=0.13). Conclusions: Occurrence of macrocalcification in thyroid nodules may suggest a high risk of PTC, and the combination of US-FNAB and BRAF V600E showed a greater value in identifying macro-calcified thyroid nodules, especially with significantly higher sensitivity. Trial registration: The Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University (2018-026). [ABSTRACT FROM AUTHOR]

Introduction: Solid and/or cystic lesions of the pancreas can range from benign to malignant, and the differential diagnosis of pancreatic carcinoma (PC) is of uttermost importance. Endoscopic ultrasonography (EUS) is frequently used and is helpful in detecting small (<2 cm) lesions and provides information about the extralesional pancreas. EUS also facilitates tissue diagnosis and allows the cyst fluid examination. Our aim was to evaluate the role of EUS findings and cyst characteristics of pancreatic lesions in predicting PC. Methods: Records of patients with pancreatic lesions were retrospectively assessed. EUS findings, serum C19-9 levels, CEA levels, and cyst biochemistry of the patients were noted. The relationship between PC, mucinous pathologies, EUS findings, cyst characteristics, and serum biochemistry was evaluated. Results: Two-hundred-four patients had EUS-guided biopsy for a pancreatic lesion (48% solid). Eighty-nine patients had PC. The serum CA19-9 cut-off value for PC was 37 U/mL (AUC: 0.81). In multivariate analysis, solid lesions, age, CA19-9>37 U/mL, and partial atrophy in the pancreas were independently associated with PC. For solid lesions, age and size >24 mm; and for cystic lesions, male gender and mucinous pathology were independently associated with PC. Thirty-six of the cystic lesions had mucinous pathology. Cyst and serum CEA, string sign, wesung connection, and tail location was associated with mucinous pathology. Cyst CEA cut-off for mucinous pathology was 80 ng/mL (AUC: 0.89). CEA >80 ng/mL was found to be associated with mucinous pathology in multivariate analysis. Conclusion: High CA19-9, solid lesion, and lesion-related partial atrophy of the pancreas are associated with PC, and these should be alarming for clinicians in practice. The mucinous character, which is a significant risk of PC for cystic lesions, can be optimally defined with the CEA cut-off value of 80 ng/mL. [ABSTRACT FROM AUTHOR]

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Fine needle aspiration cytology (FNAc) plays a vital investigative tool in the diagnostic and management pathway of the benign and malignant salivary pathologies. The current practice guidelines dictate acquirement of the nature of the salivary gland disease prior to embarking on definitive surgery. FNAc is a rapid, relatively easy, non-invasive diagnostic tool with minimal complications that achieves this goal. The diagnostic adequacy and the accuracy of FNAc sampling depends on a variety of factors including the operator aptness, lesional characteristics and patient factors. Hence the reported sensitivity of salivary cytology is variable and broad. However, the reported specificity is >90%. The diagnostic accuracy of benign salivary gland lesions is very high globally, but the figures for malignant lesions are comparatively low. This may be attributed to the inherent complexity of the salivary malignant pathologies, mostly related to their heterogeneous histological make-up. Certainly, the rarer entities would provide further diagnostic challenges. This article aims to provide a thorough but concise account of the challenges in routine salivary cytology in obtaining a near precise diagnosis and explores how the understanding of salivary histology can play an important role in increasing the diagnostic accuracy of the routine salivary FNAc reporting. [ABSTRACT FROM AUTHOR]

Objective: Thyroidectomy is not a common procedure performed in childhood. The aim of this study is to evaluate the clinical data and postoperative results of pediatric patients who underwent thyroidectomy in our center performed by a pediatric and an endocrine surgeon working in collaboration. Method: Patients under the age of 18 who underwent thyroidectomy between 2008-2020 were included in this study. Demographic data, clinical data, preoperative evaluation results and postoperative complications were reviewed retrospectively. Results: A total of 21 patients were included in the study. Postoperative bleeding, surgical site infection, transient and permanent recurrent nerve palsy, and permanent hypocalcemia were not detected in any patient. Transient hypocalcemia developed in only 2 patients (9.5%) in the postoperative period. Conclusion: Small sample size and avoiding central neck dissection may also be effective in our low postoperative complication rate. However, it was thought that pediatric thyroidectomy procedure performed by a general surgeon and a pediatric surgeon experienced in endocrine surgery in collaboration may change the postoperative complication rate.

Introduction. Fine needle aspiration biopsy followed by cytological examination is the gold standard in the diagnosis of thyroid nodules. However, up to one third of cases represent an indeterminate result (Bethesda Thyroid Classification, 2017) III—V). Among such cases, category IV is the most common and most difficult to interpret (Bethesda, 2017). The study objective is to determination of the diagnostic and prognostic significance of the molecular genetic study of the fine needle aspiration biopsy material in patients with thyroid nodules with the cytological category Bethesda, IV.Materials and methods. The study included surgical thyroid samples obtained from patients whose cytological examination revealed pathology of cytological category IV according to the Bethesda classification (2017). group 1 included surgical samples from 143 patients with thyroid lesions, and group 2 - cytological material from 45 patients. Determination of the BRAF V600E mutation, mutations in the RAS genes (KRAS, HRAS, NRAS) was carried out using allele-specific polymerase chain reaction, and the RET / PTC1, RET / PTC3 and PAX8 / PPARG translocations were determined using reverse transcription polymerase chain reaction. Sanger sequencing was used to detect mutations in the promoter region of the TERT gene.Results. In group 1, an overall prevalence of the studied mutations in thyroid cancer was 35.1 %: 8.8 % of cases were mutation BRAF V600E, 24.6 % - mutations in the RAS genes, 1.8 % - mutation C228T in the TERT gene. The C228T mutation in the TERT gene was found in 1 case of widely invasive Hurtle cell carcinoma. The prevalence of mutations in benign formations was 4.7 %. mutations in RAS genes were also found in them in group 1, mutation BRAF V600E was associated with the presence of extrathyroid invasion (p = 0.024), vascular invasion (p = 0.018), and lymph node metastases (p = 0.018). In group 2, using the genetic panel sensitivity and specificity were equal: 36.4 and 93.9 %, respectively. positive and negative predictive values were 66.7 and 81.6 %, respectively. No RET / PTC and PAX8 / PPARG translocations were found in groups 1 and 2.Conclusion. The investigated molecular genetic panel, having a high specificity for carcinomas, will make it possible to supplement the cytological diagnostics of material in the category Bethesda, IV. BRAF V600E was associated with an aggressive morphological pattern.

A Killian-Jamieson diverticulum potentially mimicking a thyroid nodule: A case report highlighting the cytology of a pharyngoesophageal diverticulum Fine-needle aspiration of a pharyngoesophageal diverticulum mimicking a calcified thyroid nodule on ultrasonography. Details of oesophageal content on fine needle aspiration biopsy (FNAB) of the thyroid to discern PED from thyroid nodules have been described in reports.[[1], [3], [5], [7]] Although radiological imaging is needed to differentiate diverticula from thyroid nodules, FNAB has been shown to be a useful initial test to evaluate and diagnose pretenders of thyroidal lesions. Keywords: Bethesda nondiagnostic; fine needle aspiration biopsy; oesophageal diverticulum; paraesophageal; pharyngoesophageal; thyroid nodule EN Bethesda nondiagnostic fine needle aspiration biopsy oesophageal diverticulum paraesophageal pharyngoesophageal thyroid nodule 72 76 5 12/13/22 20230101 NES 230101 The authors highlight the important contribution of rapid on-site evaluation by the cytopathologist of a pharyngoesophageal diverticulum in a mass initially interpreted clinically as thyroidal in origin. [Extracted from the article]

Objective: Cervical lymphadenopathy (LAP) is one of the most common pathologies in adults and children. While ultrasonography (USG) and fine needle aspiration biopsy (FNAB) are the two methods used as diagnostic tests, excisional biopsy is the gold standard method for diagnosis. In this study, we aimed to show the relationship between USG findings and FNAB results with malignancy in patients with LAP. Materials and methods: Patients who visited our clinic with the complaint of cervical LAP between March 2020 and September 2022 and underwent excisional biopsy were included in this retrospective study. The number, distribution, side, size, cortical thickness, conglomeration, and necrosis characteristics of LAP were evaluated on USG. The sensitivity and specificity of the FNAB were calculated in patients in accordance with the histopathological results. Results: Of the patients included in the study, 45 were female and 42 were male. The overall mean age was 32.72 ± 20.02. The sensitivity of the FNAB was 43.5% and the specificity was 90.0%. Advanced age, presence of conglomeration, unilateral LAP, and generalized LAP were found to be statistically significant in terms of malignancy, while cortical thickness, the number and size of LAPs, and necrosis were not statistically significant. Conclusion: FNAB was not found to be a reliable test to rule out malignancy due to low sensitivity for determining malignancy and but was found to be a highly selective test, and the malignancy-suspected result detected the real patients quite successfully. The advanced age, unilateral LAP, generalized distribution, and conglomeration were the parameters supporting malignancy. [ABSTRACT FROM AUTHOR]

A case report is presented of a 72-year-old woman with monophasic synovial sarcoma of the buttocks, diagnosed four years before. The tumor was treated with surgical removal followed by radiotherapy. The patient regularly underwent follow-up examinations and the last chest computed tomogram (CT) showed a left-sided pleural mass and ipsilateral effusion. The patient was admitted in hospital to obtain a specific histological diagnosis before treatment of chest pathology was initiated. An ultrasound (US)-guided fine needle aspiration biopsy (FNAB) of the pleural lesion and US-guided thoracentesis with drainage of blood serum pleural fluid were performed. The pathological examination of the lesion revealed a definitive diagnosis of synovial sarcoma of the pleura. For pleural-based lesions, the diagnostic accuracy of US-guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate, the absence of radiation exposure to patients, and a significantly reduced procedural time. The presence of pleural effusion creates a favorable acoustic window for US-guided biopsy of pleural lesion, which is useful for the diagnosis. [ABSTRACT FROM AUTHOR]