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Background and Objective: Pilomatrixoma is a rare, benign, slow-growing tumor of the hair matrix. Excisional biopsy is often the preferred method of diagnosis for cutaneous masses including pilomatrixoma. However, fine-needle aspiration is also performed on these lesions. There are very few reports on the cytologic features of pilomatrixoma in fine-needle aspiration. In this study, we aimed to evaluate the clinical and cytological features of six cases of pilomatrixoma, which were confirmed histopathologically. Materials and Methods: The study includes six cases of pilomatrixoma, which were diagnosed by two cytopathologists in 2019 and 2022. A detailed cytological analysis was done by a semiquantitative method. Cellularity, basaloid cells, squamous cells, giant cells, shadow cells, naked nuclei, calcium deposits, inflammation, and debris were semiquantified from 0 to 3+. Results: The ages of patients ranged from 8 to 63 years old. The male-to-female ratio was 2:1. All cases occurred in the head and neck area. The cytological diagnosis was pilomatrixoma in five cases and epidermoid/dermoid cyst in one case. The surgical excision was performed in all patients. The diagnosis of pilomatrixoma was confirmed histologically in all cases. Conclusıon: Fine-needle aspiration biopsy (FNAB) of pilomatrixoma can be a diagnostic challenge. There are very few reports on the cytologic features of pilomatrixoma in FNAB smears. The presence of ghost cells and basaloid cells should suggest the possibility of pilomatrixoma. The presence of giant cells, fibrillary matrix, calcium deposits, squamous cells, naked nuclei, inflammation, and debris are cytological findings supporting the diagnosis.

Kanker paru merupakan penyebab kematian nomer 2 setelah kanker payudara dengan insiden 11,4% dari penyakit keganasan. Pengambilan spesimen untuk menegakkan diagnosis kanker paru oleh dokter spesialis Patologi Anatomik dapat dilakukan melalui prosedur Fine Needle Aspiration Biopsy (FNAB) menggunakan jarum halus melalui tuntunan imaging dari USG atau CT scan. Berbasis integrasi teknologi 3D Printer dengan manekin berbasis elektronik peneliti melakukan penelitian eksperimental dengan tujuan membuat e-mannequin yang dilengkapi dengan tumor paru untuk pelatihan keterampilan prosedur FNAB oleh mahasiswa Pendidikan Dokter Spesialis Patologi Anatomik sebelum melakukan tindakan pada pasien. Pembuatan e-mannequin menggunakan bahan filamen, tumor berbahan Thermoplastic Polyurethane (TPU) diletakkan pada lokasi paru kiri dan kanan dengan konsistensi kenyal yang dapat dimasukkan jarum halus dan dipasang sensor lampu sebagai validator ketepatan tindakan FNAB pada tumor paru.

Simple Summary: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aids clinicians in determining the necessity of fine-needle aspiration biopsy (FNAB) for thyroid nodules suspected of malignancy. This study evaluated the effectiveness of EU-TIRADS criteria in real-world surgical settings. Results indicated that the EU-TIRADS demonstrates reliable diagnostic accuracy in identifying thyroid cancer, facilitating improved clinical decision-making regarding patient management. Enhanced adherence to EU-TIRADS guidelines can mitigate the risk of an overdiagnosis and overtreatment, particularly for low-risk thyroid cancer cases, thereby optimizing patient care. Background: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. Method: We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low–moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. Results: We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low–moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low–moderate risk, 21% high risk, and only 0.7% minimal risk. Conclusion: The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC. [ABSTRACT FROM AUTHOR]

Background: Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. Materials and methods: Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA‐PTH assay) and/or GATA3/PTH/chromogranin‐A immunostainings. Results: Sixty‐four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA‐PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA‐PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three‐dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid‐like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. Conclusions: High cellularity scattered naked nuclei, cribriform and three‐dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA‐PTH assay and/or GATA3, PTH, and chromogranin‐A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma is the second most common skin cancer case. The incident increase 2-4% every year. Squamous cell carcinoma has a predilection on sun-exposed areas with red scaly plaque appearance. Dermatofibroma is a benign tumor that can appear in all parts of the body especially on extremities. The etiology of dermatofibromas still unknown, but suspected due to punctures or trauma. A male patient, 71 years old with sole mass on left thigh suspected of dermatofibroma with a differential diagnosis of SCC. Preoperative laboratory examinations by FNAB found dermatofibroma results and postoperative histopathological examination result found SCC. Small sampling and inaccurate areas, especially in SCC with poorly differentiated histology, can confound histopathological results. Excision biopsy preferred because the wide sample is needed. All skin tumors with large sizes, either in exposed UV areas or not, FNAB examination is not prefered, excision biopsy advisable to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

ABSTRACTAim The objective of this study is to evaluate the analgesic efficacy of local anesthetic (LA) agents on pain severity among patients undergoing thyroid fine needle aspiration biopsy (FNAB).Design A systematic review and meta-analysis of randomized controlled trials (RCTs).Methods Digital databases, including PubMed, Scopus, Cochrane, Web of Science, and Google Scholar, were systematically screened from inception till December 2022. The Cochrane risk of bias tool (ROB 2) was used to evaluate the quality of each RCT. The primary outcome (pain severity) was gathered as a mean difference (MD) with a 95% confidence interval (Cl), under the random-effect model.Results Overall, 444 patients were enrolled in five RCTs. Regarding pain severity via the visual analogue scale (VAS) assessment tool, the overall effect size showed no substantial difference between LA and control groups (n = 4 RCTs,MD = −8.45, 95% CI [−27.41, 10.52], p = 0.38). Regarding pain severity via the numerical rating scale (NRS) assessment tool, the overall effect size showed no substantial difference between LA and control groups (n = 3 RCTs,MD = −0.85, 95% CI [−3.14, 1.45], p = 0.47).Conclusion We have found that the pain levels between the LA and control-receiving groups were comparable. Hence, we concluded that LA before FNAB provides no benefit, especially for one needle puncture and sampling.

Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to evaluate the analgesic efficacy of local anesthetic (LA) agents on pain severity among patients undergoing thyroid fine needle aspiration biopsy (FNAB). Design: A systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Digital databases, including PubMed, Scopus, Cochrane, Web of Science, and Google Scholar, were systematically screened from inception till December 2022. The Cochrane risk of bias tool (ROB 2) was used to evaluate the quality of each RCT. The primary outcome (pain severity) was gathered as a mean difference (MD) with a 95% confidence interval (Cl), under the random-effect model. Results: Overall, 444 patients were enrolled in five RCTs. Regarding pain severity via the visual analogue scale (VAS) assessment tool, the overall effect size showed no substantial difference between LA and control groups (n = 4 RCTs, MD = -8.45, 95% CI [-27.41, 10.52], p = 0.38). Regarding pain severity via the numerical rating scale (NRS) assessment tool, the overall effect size showed no substantial difference between LA and control groups (n = 3 RCTs, MD = -0.85, 95% CI [-3.14, 1.45], p = 0.47). Conclusion: We have found that the pain levels between the LA and control-receiving groups were comparable. Hence, we concluded that LA before FNAB provides no benefit, especially for one needle puncture and sampling. [ABSTRACT FROM AUTHOR]

Background: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. Method: We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low–moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. Results: We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low–moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low–moderate risk, 21% high risk, and only 0.7% minimal risk. Conclusion: The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

Objective. This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. Methodology. One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. Results. The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. Conclusion. The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

In endocrine pathology, frozen section (FS) examination is most commonly used for the intraoperative evaluation of thyroid and parathyroid tumors, as well as cervical lymph nodes. In the past, frozen section was considered a fundamental tool in thyroid surgery. However, with advancements in preoperative ultrasound and fine-needle aspiration biopsy (FNAB), there have been increasing queries about its routine use due to the improved preoperative diagnosis. Nowadays, while the use of FS during thyroidectomy has decreased, it is still used as an additional method for different purposes intraoperatively. FS may not always provide definitive results. If FS will alter the surgical plan or extent, it should be applied. Routine FS is not recommended for evaluating thyroid nodules. But in addition to FNAB, if FS results may change the operation plan or extent, they can be utilized. FS should not be applied for thyroid lesions smaller than 1 cm, and the entire lesion should not be frozen for FS. For the assessment of thyroid nodules, the use of FS is recommended based on the Bethesda categories of FNAB. In Bethesda I category nodules, FS may contribute to distinguishing between malignant and benign lesions and guide surgical treatment. In Bethesda II nodules, where the malignancy rate is low, the performance of FNAB and FS can be compared, but it's not recommended due to the lack of a significant contribution to the surgical strategy. The sensitivity of FS in Bethesda III and IV nodules is low; its contribution to the diagnosis is limited, and it does not provide an apparent benefit to treatment; therefore, it is not recommended. In Bethesda V nodules, FS can effectively confirm the malignancy diagnosis, contribute to the surgical strategy, and reduce the possibility of completion thyroidectomy, and accordingly, it is recommended for use. Nonetheless, in Bethesda V nodules with a benign FS report, the malignancy rate remains high, so it should not be used to rule out malignancy. In Bethesda VI nodules, the performance of FS is lower or comparable to FNAB and does not significantly contribute to the treatment strategy; hence, it is not recommended. Particularly in patients with papillary thyroid cancer, intraoperative FS can be effective in detecting extrathyroidal extension and can assist the surgeon in determining the extent of thyroid surgery and central neck dissection. FS has high sensitivity and specificity in evaluating the lymphatic status of the central region intraoperatively and can be used to determine the extent of central compartment node dissection. During thyroidectomy, FS examination can be used in recognizing parathyroid tissue and distinguishing it from fatty tissue, thymus, thyroid, lymph nodes, especially in differentiating metastatic lymph nodes. [ABSTRACT FROM AUTHOR]

Background. The latest WHO classification of tumours of endocrine organs defines new units of borderline thyroid tumours (BTT). The aim of our study was to evaluate ultrasonographic and cytological features, mutation profile and surgery treatment in rare thyroid tumours. Methods. An analysis of 8 BTT out of 487 patients, who underwent thyroid surgery between June 2016 and June 2020. The definitive diagnosis was made postoperatively by extensive histopathological examination. Molecular genetic analysis of genes associated with thyroid oncology (BRAF, HRAS, KRAS, NRAS, TERT, TP53, fused genes) were performed from one FNAB, and 7 formalin-fixed paraffin-embedded (FFPE) samples. Results. BTT were found in a total of 8 patients (1.6%), with a predominance of men with respect to other operated patients. FNAB samples were classified in the Bethesda system as Bethesda I, Bethesda II and Bethesda III in one, four and three cases, respectively. Hemithyroidectomy and total thyroidectomy were performed equally in four patients. The histopathological diagnosis revealed non-invasive encapsulated follicular neoplasm with papillary-like nuclear features (NIFTP) in three patients, follicular tumour of uncertain malignant potential (FT-UMP) in three patients, well differentiated tumour of uncertain malignant potential (WDT-UMP) in one patient, and hyalinizing trabecular tumour (HTT) in one case. In NIFTP cases mutation in HRAS gene in one patient together with probable pathogenic variant in TP53 gene and in NRAS gene in two patients were detected. In HTT patient PAX8/GLIS3 fusion gene was detected. Conclusion. The surgical treatment of BTT is necessarily individual influenced by preoperative clinical, ultrasonographic, cytological and molecular genetic findings, and the presence of other comorbidities.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues. [ABSTRACT FROM AUTHOR]

Purpose: False negative results of fine needle aspiration biopsies (FNAB) remain one of the most important problems in the management of thyroid nodules. The aim of this study was to evaluate the factors affecting the false negative results of FNAB, especially in thyroid nodules with indeterminate cytology. Materials and Methods: Patients with thyroid nodules who underwent FNAB and subsequent thyroidectomy between January 2017 and January 2020 were included in the study. FNAB was performed on suspicious nodules according to the TIRADS classification. Nodules with "atypia/follicular lesion of undetermined significance (AUS/FLUS)", "non-diagnostic (ND)" cytology or "follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)" according to FNAB were defined as "indeterminate cytology (IC)". Nodules were analyzed in two groups. Nodules with false negative FNAB were included in Group-1, while nodules with true positive and true negative FNAB were included in Group-2. Demographic and clinical data, pathologic results and genetic profiles of the patients were statistically compared for all patients and IC group separately. Results: The results of FNAB and final pathology were discordant in 94 patients (Group-1) and concordant in 233 patients (Group-2). In the IC subgroup, 56 of 95 patients were in IC/Group-1 and 39 patients were in IC/Group-2. The accuracy of FNAB was statistically significantly higher in the presence of extrathyroidal extension (71.4% vs. 30.8%), perineural/lymphovascular invasion (60.0% vs. 29.6%), classical variants (68.5% vs. 50.7%), nonencapsulated tumors (67.9% vs. 50.0%) and multicentricity (47.2% vs. 24.1%). In the IC group, the presence of thyroiditis (75.0% vs. 49.2%) and high serum Anti-TPO levels (60.0% vs. 30.7%) increased the rate of false negativity on FNAB. High serum Neutrophil to Lymphocyte Ratio (NLR) and small tumor size also increase the false negativity of FNAB, especially in IC group patients. Conclusion: The diagnostic accuracy of FNAB is increased in classical variant tumors and in tumors expected to be aggressive due to presence of extrathyroidal extension, perineural/lymphovascular invasion, non-encapsulated tumors and multicentricity. It should be kept in mind that the false negative results of FNAB increase in the presence of thyroiditis, high level of serum anti-TPO and high level of NLR. [ABSTRACT FROM AUTHOR]

Objective Thyroid cancer is the most common endocrine Malignancy, and nodules characterize its clinical presentation. 'Atypia of undetermined significance' (AUS) in biopsies performed for thyroid pathologies is an essential concern for clinicians due to different malignancy rates in the literature. In this study, we aimed to discuss the malignancy rates in patients who underwent thyroid surgery for AUS. Material and Method The demographic and histopathologic data of 174 patients diagnosed with AUS on fine needle aspiration biopsy (FNAB) and who underwent thyroid surgery in our clinic between 2016 and 2021 were retrospectively analyzed. According to histopathologic features, patients were divided into two groups, malignant and benign, and the relationship with age, gender, and nodule diameter was investigated. Statistical significance between groups was determined using Chi-square and Student t-tests. P value <0.05 was accepted. Results The mean age was 47.9±12 years (range, 20-81). The malignancy rate was 43.5%. Malignancy was detected in 42.1% of females and 50% of males. The mean nodule diameter was 19.1±13.7 mm (range, 1-97 mm). There was no statistically significant difference between gender, age, nodule diameter, and Malignancy (p>0.05). Conclusion According to the Bethesda classification, the malignancy rate for AUS is 15-30%. In our study, the malignancy rate was 43.5%, similar to studies published in our country. Because of the high malignancy rate, total thyroidectomy should be considered an alternative to lobectomy in cases planned for surgery with a diagnosis of AUS. [ABSTRACT FROM AUTHOR]

Background. The latest WHO classification of tumours of endocrine organs defines new units of borderline thyroid tumours (BTT). The aim of our study was to evaluate ultrasonographic and cytological features, mutation profile and surgery treatment in rare thyroid tumours. Methods. An analysis of 8 BTT out of 487 patients, who underwent thyroid surgery between June 2016 and June 2020. The definitive diagnosis was made postoperatively by extensive histopathological examination. Molecular genetic analysis of genes associated with thyroid oncology (BRAF, HRAS, KRAS, NRAS, TERT, TP53, fused genes) were performed from one FNAB, and 7 formalin-fixed paraffin-embedded (FFPE) samples. Results. BTT were found in a total of 8 patients (1.6%), with a predominance of men with respect to other operated patients. FNAB samples were classified in the Bethesda system as Bethesda I, Bethesda II and Bethesda III in one, four and three cases, respectively. Hemithyroidectomy and total thyroidectomy were performed equally in four patients. The histopathological diagnosis revealed non-invasive encapsulated follicular neoplasm with papillary-like nuclear features (NIFTP) in three patients, follicular tumour of uncertain malignant potential (FT-UMP) in three patients, well differentiated tumour of uncertain malignant potential (WDT-UMP) in one patient, and hyalinizing trabecular tumour (HTT) in one case. In NIFTP cases mutation in HRAS gene in one patient together with probable pathogenic variant in TP53 gene and in NRAS gene in two patients were detected. In HTT patient PAX8/GLIS3 fusion gene was detected. Conclusion. The surgical treatment of BTT is necessarily individual influenced by preoperative clinical, ultrasonographic, cytological and molecular genetic findings, and the presence of other comorbidities. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense. [ABSTRACT FROM AUTHOR]

Splenic hamartoma is a rare benign vascular lesion of the spleen. A splenic mass was incidentally detected in an asymptomatic 65-year-old male during an abdominal ultrasound scan. The workup of the splenic lesion included an abdominal CT angiography (CTA), contrast-enhanced ultrasound (CEUS), and microvascular flow imaging Doppler sonography. The CT scan confirmed that the splenic mass had benign characteristics, and its contrast enhancement was similar to the spleen. The CEUS was able to rule out the possibility of hemangioma. Meanwhile, chronic compression of the celiac trunk and the filling of the splenic artery from collaterals were also detected on CTA. The imaging studies suggested a splenic hamartoma, and the diagnosis was confirmed by the result of a fine needle aspiration biopsy. [ABSTRACT FROM AUTHOR]

Background: Metastatic breast carcinoma (mBC) is frequently encountered and may be challenging to diagnose as the tumor cells can morphologically resemble carcinomas of other primary origins. An additional challenge is that direct smears are often the only sample type available for immunostaining studies in cytology. Trichorhinophalangeal syndrome GATA‐binding type 1 1 (TRPS1) is a highly sensitive marker for BC compared to the commonly used marker GATA3, especially in triple‐negative BC (TNBC), in histologic samples. However, its sensitivity and specificity in mBC and other GATA3‐positive tumors have not been studied. Methods: The authors identified the following cytology cases: 37 GATA3‐positive mBC cases and 19 available cases that were deemed mBC but were GATA3‐negative during the original case workup and five cases of each of eight epithelioid entities known to have high rates of GATA3 positivity and commonly seen in cytology practice. Immunostainings of TRPS1 and GATA3 were performed on the chosen smears following standard protocols. Results: TRPS1 was positive in all 37 GATA3‐positive mBC cases and in 18 of the 19 GATA3‐negative mBC cases. TRPS1 was negative in all five of the seven frequently GATA3‐positive epithelioid entities, with the exception of salivary duct carcinomas where GATA3 was positive in a rate ranging 60%–100% among them. Conclusions: TRPS1 is as sensitive as GATA3 in GATA3‐positive mBC and is more sensitive than GATA3 in TNBC. TRPS1 is negative in most GATA3‐positive nonbreast tumors. Thus, the combination of TRPS1 and GATA3 could be used to differentiate breast primary from others in most situations. TRPS1 is more sensitive than GATA3 in triple‐negative breast carcinoma and is more specific than GATA3 in entities reportedly positive for GATA3 on cytology smears. [ABSTRACT FROM AUTHOR]

Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome. Coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world. Asymptomatic infection is highly contagious, potentially leading to viral spread. We aimed to determine the rate of patients positive for COVID-19 PCR performed for safety measures before thyroid fine-needle aspiration biopsy (FNAB). METHODS: The patients applied to Ankara City Hospital, Endocrinology and Metabolism Clinics between 15.03.2020 and 15.08.2020 and underwent routine COVID-19 PCR test before FNAB were evaluated retrospectively. Age, gender, history of hypertension and Type 2 Diabetes Mellitus (T2DM), use of levothyroxine (LT4) or antithyroid drug, 25-hydroxyvitamin D3 [25(OH)D3], TSH, freeT3 (fT3), free (fT4) levels, FNAB results were obtained from the records. RESULTS: Asymptomatic COVID-19 infection was detected in 29 (2.43%) of 1195 patients who underwent FNAB. There was no statistically significant difference between patients with COVID-19 PCR test positive asymptomatic and negative patients in terms of age, gender, median values of 25(OH)D3, TSH, fT3, fT4, the ratio of hypertension and T2DM. DISCUSSION AND CONCLUSION: The healthcare professionals work devotedly against COVID-19 infection, demonstrating a great example of struggle worldwide. FNAB is an invasive procedure requiring close contact. It should be known by the clinician that COVID-19 infection is associated with a high risk of transmission in asymptomatic patients. The rate of 2.43% in the population can not be underestimated and indicates the importance of the use of personal protective equipment and taking infection prevention measures.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a “multiparametric” diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

Objectives: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome. Coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world. Asymptomatic infection is highly contagious, potentially leading to viral spread. We aimed to determine the rate of patients positive for COVID19 PCR performed for safety measures before thyroid fine-needle aspiration biopsy (FNAB). Materials and Methods: The patients applied to Ankara City Hospital, Endocrinology and Metabolism Clinics between 15.03.2020 and 15.08.2020 and underwent routine COVID-19 PCR test before FNAB were evaluated retrospectively. Age, gender, history of hypertension and Type 2 Diabetes Mellitus (T2DM), use of levothyroxine (LT4) or antithyroid drug, 25-hydroxyvitamin D3 [25(OH)D3], TSH, freeT3 (fT3), free (fT4) levels, FNAB results were obtained from the records. Results: Asymptomatic COVID-19 infection was detected in 29 (2.43%) of 1195 patients who underwent FNAB. There was no statistically significant difference between patients with COVID-19 PCR test positive asymptomatic and negative patients in terms of age, gender, median values of 25(OH)D3, TSH, fT3, fT4, the ratio of hypertension and T2DM. Conclusion: The healthcare professionals work devotedly against COVID-19 infection, demonstrating a great example of struggle worldwide. FNAB is an invasive procedure requiring close contact. It should be known by the clinician that COVID-19 infection is associated with a high risk of transmission in asymptomatic patients. The rate of 2.43% in the population cannot be underestimated and indicates the importance of the use of personal protective equipment and taking infection prevention measures. [ABSTRACT FROM AUTHOR]

Background: Prognostic cytological and molecular features of uveal melanoma have been well researched and are essential in management. Samples can be obtained in vivo through fine needle aspirate biopsy, vitrector cutter, forceps or post-enucleation for off-site testing. This study aims to examine cytological and chromosome microarray yields of these samples. Methods: A retrospective cohort analysis of 119 uveal melanoma biopsies submitted to our laboratory. Samples included those taken in vivo (n = 57) and post-enucleation (n = 62). Patient and tumour features were collected including age, sex, primary tumour location, basal diameter and tumour height. Prognostic outcomes measured include cell morphology, chromosomal status and immunohistochemistry. Results: Post-enucleation biopsies accounted for just over half of our samples (52%). Post-enucleation samples had a more successful genetic yield than in vivo biopsies (77% vs. 50%, p = 0.04) though there was no difference for cytological yields. There was no difference in cytological or microarray yields between instruments. The vitrector biopsy group had the smallest tumour thickness (5 mm vs. 10 mm [fine-needle aspirate biopsy], p = 0.003). There was a strong correlation between monosomy 3, BAP1 aberrancy and epithelioid cell type in post-enucleation samples (Tb = 0.742, p = 0.005). However, epithelioid morphology was not associated with either monosomy 3 (p = 0.07) or BAP1 aberrancy (p = 0.24) for in vivo biopsies. Conclusions: All three biopsy instruments provide similar cytological yields as post-enucleation sampling, although post-enucleation samples had a more successful chromosome microarray yield. Epithelioid cytomorphology alone is insufficient for prognostication in in vivo biopsies, immunohistochemistry would be a useful surrogate test. [ABSTRACT FROM AUTHOR]

Purpose: The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. Methods: Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000–2020. Results: The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4–TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. Conclusions: The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts. [ABSTRACT FROM AUTHOR]

Objective: We aimed to detect if there were any radiologic, demographic, or clinical findings that were valuable for differentiating benign nodules from malignant nodules in old aged patients, when the results of the first fine-needle aspiration biopsy (FNAB) were reported as atypia of undetermined significance (AUS). Materials and Methods: Patients aged 65 years and older who were biopsied from thyroid nodules were analyzed retrospectively in this study. A total of 1264 patients with 1374 nodules were enrolled and of these, 203 patients with 216 nodules were recorded to have diagnosis of AUS in pathological evaluation. We excluded 104 nodules on which FNAB had been performed only once and included 112 nodules, on which FNAB had been performed twice. Out of these included patients, a total of 43 patients were thyroidectomized. Preoperative ultrasonographic nodular findings, echogenicity, marginal [ir]regularity, calcification, exophytic configuration, and halo were recorded. Results: The median patient age was 69 years. There was no statistically significant difference between the results of the first and second FNABs. Hypoechogenicity was the only statistically significant different characteristic found in thyroid nodules that could effectively discriminate between malignant and benign groups. Conclusion: The second FNAB does not increase the likelihood of diagnosing malignancy in old aged patients and there is no need for this procedure when recommending surgery. Suspicious USG findings are more frequent among malignant nodules, as reported in the histopathological evaluation of the old aged patients. A multidisciplinary team should take part in the decision-making process for the treatment of old aged patients after the first FNAB, with due consideration of the history, physical examination, USG, FNAB laboratory findings, and patient preference.

Background and Objective: Pilomatrixoma is a rare, benign, slow-growing tumor of the hair matrix. Excisional biopsy is often the preferred method of diagnosis for cutaneous masses including pilomatrixoma. However, fine-needle aspiration is also performed on these lesions. There are very few reports on the cytologic features of pilomatrixoma in fine-needle aspiration. In this study, we aimed to evaluate the clinical and cytological features of six cases of pilomatrixoma, which were confirmed histopathologically., Materials and Methods: The study includes six cases of pilomatrixoma, which were diagnosed by two cytopathologists in 2019 and 2022. A detailed cytological analysis was done by a semiquantitative method. Cellularity, basaloid cells, squamous cells, giant cells, shadow cells, naked nuclei, calcium deposits, inflammation, and debris were semiquantified from 0 to 3+., Results: The ages of patients ranged from 8 to 63 years old. The male-to-female ratio was 2:1. All cases occurred in the head and neck area. The cytological diagnosis was pilomatrixoma in five cases and epidermoid/dermoid cyst in one case. The surgical excision was performed in all patients. The diagnosis of pilomatrixoma was confirmed histologically in all cases., Conclusıon: Fine-needle aspiration biopsy (FNAB) of pilomatrixoma can be a diagnostic challenge. There are very few reports on the cytologic features of pilomatrixoma in FNAB smears. The presence of ghost cells and basaloid cells should suggest the possibility of pilomatrixoma. The presence of giant cells, fibrillary matrix, calcium deposits, squamous cells, naked nuclei, inflammation, and debris are cytological findings supporting the diagnosis., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Cytology | Indian Academy of Cytologists.)

Purpose: A non-surgical therapeutic option requires assurance that a cystic thyroid nodule with non-diagnostic cytology is benign. This work was undertaken to determine whether Tc-99 m-MIBI scan (MIBI) findings can guide the best therapeutic option with confidence. Material and Methods: We studied 81 cystic non-functioning thyroid nodules with non-diagnostic fine-needle aspiration biopsy (FNAB) report classified according to ATA 2015 ultrasonography (US) patterns for suspicion of malignancy. All had a MIBI to assess metabolic activity within the nodule as well as histopathological diagnosis. Diagnostic value analysis of MIBI as compared to the US pattern was determined. Results: None of the 11 patients with US pattern of benign showed positive MIBI, and all had a histopathological report of benign. Diagnostic value of MIBI on US pattern of very low suspicion showed sensitivity, specificity, PPV, and NPV of 100%, 78.9%, 42.9%, and 100%, respectively. Conclusion: Our data shows that the only approach to a safe non-surgical treatment option in a cystic nodule with non-diagnostic FNAB is when no metabolic activity is seen on MIBI. [ABSTRACT FROM AUTHOR]

Two fixation methods can affect the quality of cytological staining derived from fine-needle aspiration biopsy, but both fixation methods have drawbacks. Dry fixation can cause cell rupture, while wet fixation requires a longer time and costs more, so dry fixation is more often used. The purpose of this study was to compare the results of the Diff-Quick staining of cytological preparations that were fixed with the dry fixation method and the wet fixation method on FNAB samples. This study was an experimental study with 36 samples of cytology preparations from FNAB, divided into three groups, the control group, dry fixation group, and wet fixation group. Staining dry fixation preparations gave four poor results, five good preparations, and three very good preparations while staining wet fixation preparations gave 0 poor results, eight good preparations, and four very good preparations. This shows that the staining results of wet-fixed preparations tend to be of better quality and more consistent than the staining results of dry-fixed preparations. Even though statistically through the test Post-Hoc showed no difference, the quality of Diff-Quick staining of cytological preparations fixed by wet fixation method was better than dry fixation, so the wet fixation method was more recommended for cytological preparations than FNAB.

Background: Thyroid carcinoma generally has a good prognosis. The main focus of current research on thyroid carcinoma is to increase the accuracy of preoperative diagnosis of thyroid nodules. When the result of fine needle aspiration biopsy (FNAB) is indeterminate, clinicians often have doubts in determining the surgical management. Objective: Protein BRAF expression analysis can help improve the accuracy of FNAB and optimize the management of differentiated thyroid carcinoma. Methods: This study is a diagnostic test performed from October 2016 at Sanglah General Hospital with 38 patients as subjects who fulfilled the inclusion criteria. Data is being presented in descriptive form before diagnostic test is done to determine sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of immunocytochemistry test for BRAF on indeterminate thyroid nodule. Results: Thirty-eight samples met the inclusion criteria during the study period. Three samples were male (7.9%) and 35 samples (92.1%) were female. The mean age of the sample was 45.21 years (SD ±10.910 years) with ages ranging from 23 to 66 years. Of the 12 samples undergoing isthmolobectomy, 7 samples (58.4%) were determined to be malignant from histopathological results. The sensitivity value of BRAF immunocytochemistry test is 45.45% with a specificity value of 81.25%, a positive predictive value of 76.92%, a negative predictive value of 52% and an accuracy of 60.50%. Analysis of the receiver operator (ROC) curve shows the area under the curve (AUC) of 63.4% with a confidence interval of 45.5–81.2%. Conclusion: Immunocytochemistry BRAF test have a reliable diagnostic value and can be taken into consideration in the preoperative diagnosis of thyroid malignancies.

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Metastatic prostatic adenocarcinoma (PAC) has mostly involved the pelvic lymph nodes; metastases to the cervical lymph nodes are exceedingly rare. A retrospective review of cytopathology files (January 1990 to March 2019) identified 13 cases of metastatic PAC to cervical lymph nodes diagnosed using fine-needle aspiration biopsy (FNAB). The clinical and demographic information were collected from the electronic medical records, and the slides were reviewed. A total of 13 male patients with a mean age at FNAB 69 years (range, 61-86 years); 12 patients had a known history of PAC. In the patient without a history of PAC, the FNAB finding had been misinterpreted as papillary thyroid carcinoma. The interval between the original diagnosis and cervical lymph node metastasis was 98.5 months (range, 1-288 months). Most involved the left side (85%). Most smears had a clean background with few lymphocytes (46%) and numerous cellular clusters in flat sheets and acini (62%) and were composed of polygonal cells (46%) with round-oval shaped nuclei and indistinct cell borders (92%). The cytoplasm was granular (61%) or scanty (46%). The nuclei were uniform, size ≥2 times that of a neutrophil (69%). Prominent nucleoli and anisonucleosis were seen in 54% of cases; cellular pleomorphism was infrequent (30%). Immunostains confirmed the prostate origin in 7 tissue cores. Metastatic PAC to the cervical lymph nodes occurs infrequently. If the history is unknown, cases can be misdiagnosed as metastases from cervical neoplasms. The findings indicating metastatic PAC to the cervical lymph nodes on FNAB include involvement of left-sided cervical lymph nodes in elderly male patients and cellular smears composed of uniform polygonal cells, arranged in flat sheets and acini, with granular cytoplasm, indistinct cell borders, and round-oval nuclei with prominent nucleoli. • Prostate adenocarcinoma (PAC) rarely metastasizes to cervical lymph nodes. • Cytopathologists need to consider this possibility if the patient is an older male (>50 years) with left-sided involvement of cervical lymph nodes. • The cytomorphology of most of our cases shows cellular clusters arranged in flat sheets and acini with uniform round-oval nuclei with prominent nucleoli and indistinct cell borders. • Establishing this diagnosis in a head and neck lymph node implies a poor prognostic outcome. [ABSTRACT FROM AUTHOR]

Objective: To assess consistency and long-term progress in thyroid biopsy performed by trained sonographers under supervision of a radiologist.Methods: Trained sonographers started performing thyroid biopsy at our institute in August 2011. The data for this study were extracted from a prospectively maintained database for ultrasound guided thyroid biopsy and included the number of thyroid fine needle aspiration biopsy procedures performed between August 2011 and 2016 and the final cytopathology report as per the Bethesda Classification. For the analysis, the study was divided into two time periods: initial postimplementation period (August 2011 to 2013) and late postimplementation period (2014-2016).Results: In all, 5,538 thyroid biopsies were performed by trained sonographers in the period, 2,561 in the initial implementation period and 2,977 between 2014 and 2016. The unsatisfactory rates dropped from 21% to 10% in the two periods (P < .001), and the proportion of malignant nodules on cytopathology increased from 6% to 7% in the two periods (P = .010). Wait times for thyroid biopsies remained low during the period.Conclusion: Sonographers trained to perform ultrasound guided thyroid biopsies provide persistent improved patient care over a long-term period. This reinforces the role of physician extenders in targeted scopes of practice. [ABSTRACT FROM AUTHOR]

Abstract Background The American Thyroid Association published revised guidelines in 2015 on the management of differentiated thyroid cancer in adults. One of the key changes introduced in the revision proposes that diagnostic biopsy be based on ultrasound findings (i.e. size and nodule characteristics). The overall effect of these changes results in fewer nodules requiring biopsy. This study was conducted to determine if the changes to the guidelines will result in overlooked thyroid cancers, specifically malignancies with aggressive characteristics measuring between 1 and 1.49 cm. Methods Patients (n = 2083) with thyroid nodules who underwent total or subtotal/hemi thyroidectomy with or without neck dissection by a single surgeon between 2006 and 2016 were retrospectively enrolled. Demographic information and nodule characteristics were collected for all patients. Ultrasonography and final pathology reports were reviewed for patients with thyroid nodules between the sizes of 1–1.49 cm (n = 155). Results 45% (n = 70) of patients with nodules between 1 and 1.49 cm were “low suspicion” nodules according to ultrasound. 47 of these nodules contained malignancies on final histopathological examination, 100% of which were of the papillary subtype. 21% (n = 10) of these malignant nodules demonstrated extrathyroidal extension and 34% (n = 16) were associated with regional metastases. Conclusions Reliance on sonographic patterns alone could result in missed cancer diagnoses in patients with thyroid nodules measuring between 1 and 1.49 cm. Moreover, a portion of these malignancies may be associated with aggressive features. The effect of this finding on long-term outcomes is unclear.

Lymphadenopathy is a non-specific enlargement of lymph nodes which may be caused by infection, cancer, or autoimmune disease. To date, only a few studies reported the diagnostic value of fine-needle aspiration biopsy (FNAB) in lymphadenopathy. This study was performed to evaluate diagnostic reliability of FNAB for benign and malignant lymphadenopathy. This was a retrospective cross-sectional study. The obtained data were statistically analyzed for its sensitivity, specificity, and accuracy. Out of 126 collected FNAB cases with histopathological confirmed results in Dr. Sardjito General Hospital, Yogyakarta, 85 (67.4%) were malignant lymphadenopathy, consisting of 42 metastatic tumor cases, 38 non-Hodgkin lymphoma (NHL) cases, and 4 Hodgkin lymphoma (HL) cases.The overall diagnostic sensitivity, specificity, and accuracy of FNAB in lymphadenopathy was 85.88, 70.73, and 80.95%, respectively. In diagnosing metastatic tumors, FNAB had sensitivity of 83.33%; specificity of 89.28%; and accuracy of 87.3%. The sensitivity, specificity, and accuracy of FNAB in diagnosing NHL was 60.52, 94.31, and 84.12%, respectively. FNAB had a sensitivity of 25%, specificity of 95,90%, and accuracy of 93.65% to diagnose HL. Meanwhile, the accuracy of FNAB in diagnosing malignancies in generalized lymphadenopathy, head-neck lymphadenopathy, and inguinal lymphadenopathy was 90.90; 81.39 and 44.44%, respectively. In conclusion,FNAB has moderate diagnostic value in diagnosing overall malignant lymphadenopathy, including metastatic tumors. FNAB also has some limitations in diagnosing NHL and HL, with sensitivity less than 70% for both diseases. However, it has high accuracy to diagnose generalized lymphadenopathy.

Objective To compare the value of ultrasound TI-RADS classification and FNAB in the differential diagnosis of benign and malignant thyroid nodules. Methods The Kwak version of TI-RADS classification and FNAB data of 1034 thyroid nodules were retrospectively analyzed，and compared based on postoperative pathological results. Results The classification results of FNAB and TI-RADS in 1034 nodules were compared with pathological results，and the differences were statistically significant（P< 0.001）. The sensitivity of TI-RADS diagnosis was 60.94%，the specificity was 67.08%，the positive predictive value was90.94%，the negative predictive value was 24.05%，and the accuracy rate was61.90%. The FNAB diagnostic sensitivity was 86.48%，the specificity was 67.70%，the positive predictive value was 93.56%，the negative predictive value was 48.02%，and the accuracy rate was 83.56%. The combined diagnosis had a sensitivity of93.81%，a specificity of 44.72%，a positive predictive value of 90.80%，a negative predictive value of59.09%，the accuracy rate was 86.75% . Conclusion The combination of TI-RADS and FNAB has high diagnostic value for benign and malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Purpose: The treatment strategy of parotid gland tumours depends mainly on the histopathological type of the lesion. Fine-needle aspiration biopsy (FNAB) is recommended in preoperative diagnostics. The aim of the study was to evaluate the FNAB standing in the diagnostic algorithm of parotid gland lesions and to correlate FNAB results in relation to the definitive histopathological diagnosis. Material and methods: The retrospective analyses of 651 examined and consequently surgically treated parotid gland lesions at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague between 2006 and 2016 were used. Preoperative cytological results were consequently evaluated in relation to the definitive histopathological diagnosis. Results: The cohort consisted of 367 women and 284 men (average age 58 years). FNAB was diagnostic in 604 (92.8%) patients and non-diagnostic in 47 (7.2%) patients. The result of FNAB was positive (suspicious for malignant tumour) in 89 (14.7%) patients and negative (benign) in 515 (85.3%) patients. Sensitivity of the examination was 80.00%, specificity was 93.82%, PPV 62.92%, NPV 97.28%, and LR + and LR− were 12.95 and 0.21, respectively, with an accuracy of 92.22%. Conclusion: Our results confirm the significant role of FNAB in the diagnostic algorithm of parotid gland lesions. [ABSTRACT FROM AUTHOR]

Objective: We aimed to detect if there were any radiologic, demographic, or clinical findings that were valuable for differentiating benign nodules from malignant nodules in old aged patients, when the results of the first fine-needle aspiration biopsy (FNAB) were reported as atypia of undetermined significance (AUS). Materials and Methods: Patients aged 65 years and older who were biopsied from thyroid nodules were analyzed retrospectively in this study. A total of 1264 patients with 1374 nodules were enrolled and of these, 203 patients with 216 nodules were recorded to have diagnosis of AUS in pathological evaluation. We excluded 104 nodules on which FNAB had been performed only once and included 112 nodules, on which FNAB had been performed twice. Out of these included patients, a total of 43 patients were thyroidectomized. Preoperative ultrasonographic nodular findings, echogenicity, marginal [ir]regularity, calcification, exophytic configuration, and halo were recorded. Results: The median patient age was 69 years. There was no statistically significant difference between the results of the first and second FNABs. Hypoechogenicity was the only statistically significant different characteristic found in thyroid nodules that could effectively discriminate between malignant and benign groups. Conclusion: The second FNAB does not increase the likelihood of diagnosing malignancy in old aged patients and there is no need for this procedure when recommending surgery. Suspicious USG findings are more frequent among malignant nodules, as reported in the histopathological evaluation of the old aged patients. A multidisciplinary team should take part in the decision-making process for the treatment of old aged patients after the first FNAB, with due consideration of the history, physical examination, USG, FNAB laboratory findings, and patient preference. [ABSTRACT FROM AUTHOR]

Copyright of Revista ADM is the property of Asociacion Dental Mexicana 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.)