scholarly journals Cyto-Morphological Correlation of Indeterminate C3 (Atypical) and C4 (Suspicious) Categories in Fine Needle Aspiration Cytology of the Breast

2021 ◽  
Author(s):  
Dixit Nutan ◽  
Bansal Vikas Kumar ◽  
Bharti Rajni ◽  
Sharma Priyam

In 1996, to harmonize the reporting system of breast lesions on fine-needle aspiration cytology (FNAC), National Cancer Institute (NCI) proposed five categories from C1-C5. C3 and C4 categories are noted to be ambiguous during histopathological correlation, hence “grey-zoned.” There have been limited researches regarding its usefulness and its histopathological correlation. This study was undertaken to evaluate C3 and C4 categories and to correlate with histopathological examination. This perspective and retrospective study was undertaken for two years. Forty cases of C3 and 32 cases of C4 were retrieved from a total of 602 cases of breast FNAC. Histopathological follow-up and correlation were available in 30 cases of C3 and 15 cases of category C4 and were selected for further study. On the histopathological correlation of the C3 category, 22 (73.3%) cases turned out to be benign, and 8 (26.7%) cases revealed malignant diagnosis, and among the C4 category, 2 (13.3%) cases revealed benign findings, and 13(86.7%) of the cases showed malignancy. This difference was statistically significant (P<0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C4 category in the diagnosis of malignancy were 61.9%, 91.6%, 86.6%, and 73.3%, respectively. FNAC is a simple, rapid, cost-effective, and accurate method to diagnose easily accessible breast swellings. However, one should be aware of its limitations as well. Our study supports maintaining C3 and C4 categories, as there was a statistically significant difference in benign & malignant diagnosis for these categories.

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Rajneesh Madhok ◽  
Ashish Gupta ◽  
Lalit Singh ◽  
Tanu Agarwal

INTRODUCTION: The study is an attempt to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, p Value and complications of CT guided thoracic interventions fine needle aspiration cytology and core biopsy which are used for diagnosing benign and malignant thoracic lesions. MATERIAL AND METHODS: Study included 102 Patients (87 males and 15 females) with age group ranged from 15 to 87 years.A total of 143 CT guided interventions (84 FNAC’s and 59 core biopsies) were performed in 102 patients. The tissue obtained was sent to the laboratory for histopathological and cytological analysis for a final diagnosis which would contribute to patient management. RESULTS: All( 59) core biopsies were successful in procuring adequate tissue for histopathological analysis and the yield of core biopsies was 100% .However out of 84 FNAC’s only 4 were unsuccessful in procuring adequate tissue with a failure rate of 4.8%. Post procedural biopsy complications were only three (2.1%) which were small pneumothorax. There were 75 malignant lesions and 23 benign lesions based on cytology and histopathology (4 were excluded due to inadequate sample). There was good agreement between benign and malignant lesions diagnosed on CT and that diagnosed by pathology. The most common benign and malignant lesions were granulomatous lesion and squamous cell carcinoma. CONCLUSION: Percutaneous CT guided interventions like core biopsy and fine needle aspirations cytology are simple minimal invasive procedures with good patient acceptance and low morbidity and almost negligible mortality. CT guided interventions should be performed early for diagnosis of thoracic lesions.


2009 ◽  
Vol 27 (30) ◽  
pp. 4994-5000 ◽  
Author(s):  
Christiane A. Voit ◽  
Alexander C.J. van Akkooi ◽  
Gregor Schäfer-Hesterberg ◽  
Alfred Schoengen ◽  
Paul I.M. Schmitz ◽  
...  

Purpose Sentinel node (SN) status is the most important prognostic factor for overall survival (OS) for patients with stage I/II melanoma, and the role of the SN procedure as a staging procedure has long been established. However, a less invasive procedure, such as ultrasound (US) -guided fine-needle aspiration cytology (FNAC), would be preferred. The aim of this study was to evaluate the accuracy of US-guided FNAC and compare the results with histology after SN surgery was performed in all patients. Patients and Methods Four hundred consecutive patients who underwent lymphoscintigraphy subsequently underwent a US examination before the SN procedure. When the US examination showed a suspicious or malignant pattern, patients underwent an FNAC. Median Breslow thickness was 1.8 mm; mean follow-up was 42 months (range, 4 to 82 months). We considered the US-guided FNAC positive if either US and/or FNAC were positive. If US was suggestive of abnormality, but FNAC was negative, the US-guided FNAC was considered negative. Results US-guided FNAC identified 51 (65%) of 79 SN metastases. Specificity was 99% (317 of 321), with a positive predictive value of 93% and negative predictive value of 92%. SN-positive identification rate by US-guided FNAC increased from 40% in stage pT1a/b disease to 79% in stage pT4a/b disease. US-guided FNAC detected SN tumors more than 1.0 mm in 86% of cases, SN tumors of 0.1 to 1.0 mm in 46% of cases, and SN tumors less than 0.1 mm in 23% of cases. Estimated 5-year OS rates were 92% for patients with negative US-guided FNAC results and 51% for patients with positive results. Conclusion US-guided FNAC of SNs is highly accurate. Up to 65% of the patients with SN-positive results in our institution could have been spared an SN procedure.


2020 ◽  
Vol 19 (2) ◽  
pp. 84-89
Author(s):  
Shova Kunwar ◽  
Barsha Bajracharya ◽  
Kavita Karmacharya ◽  
Amar Narayan Shrestha

Introduction: Fine needle aspiration cytology is considered as the gold standard for the diagnosis of thyroid nodules. This study aimed to evaluate and compare the accuracy of fine-needle aspiration cytology in the diagnosis of thyroid lesion by comparing it with the corresponding histopathologic diagnosis after thyroidectomy. Methods: This is a retrospective study conducted over five years at a teaching hospital in Kathmandu. Eighty-nine cases of FNAC of thyroid nodule with subsequent histopathological reports were reviewed. The corresponding reports were compared and the accuracy of FNAC diagnosis was evaluated. Results: 87% of the cases were females and the majority of cases were in the age group 41 to 50 years. Among 89 cases, 55 were reported as benign on cytology and 34 were reported as malignant. On histopathological examination, out of 55 cases diagnosed as benign on cytology, 47 cases were diagnosed as benign whereas eight cases were diagnosed as malignant. HPE of 34 cases diagnosed as malignant on cytology showed that 29 were malignant and five were benign. The false-positive rate was 9.6% and the false-negative rate was 21.6%. The sensitivity was 78.3% and specificity was 90.3%. The positive predictive value and negative predictive value were 85.2% and 85.4% respectively. The accuracy of FNAC in differentiating benign from malignant thyroid lesions was 85.3%. Conclusions: The findings of this study showed that FNAC is a sensitive method for the diagnosis of a solid thyroid lesion


2015 ◽  
Vol 3 (4) ◽  
pp. 37-41
Author(s):  
Suman Poudel ◽  
Sudeep Regmi ◽  
Anita Shahi ◽  
Ashok Samdurkar

INTRODUCTION: Fine Needle Aspiration Cytology (FNAC) of the thyroid gland is now a well-established, first line diagnostic test for the evaluation of thyroid lesions. An FNA is performed along with Thyroid Function Test (TFT) profile to correlate cytology with hormonal function in symptomatic or asymptomatic patients. MATERIALAND METHODS: Total of 117 cases of FNAC of thyroid lesions were selected who had undergone TFT profile. The lesions were evaluated cytologically and categorized according to Bethesda System of classification and correlated with TFT profile. RESULTS: Out of 117 cases studied, the middle aged (20-49 years) females were most commonly affected by thyroid diseases. The predominant lesions cytologically were Benign Follicular Nodule (BFN) with frequency of 51.3%.With respect to hormonal status most of the lesions were Euthyroid (53.8%). The study showed no significant difference in mean of TFT profile with regard to various FNAC diagnoses. CONCLUSION: The study showed that FNAC and TFT profile both are essential for the proper management of thyroid lesions and, there is no significant difference between FNAC diagnosis and mean TFT profile.


KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 780-786
Author(s):  
Shaheen Akter ◽  
Md Jahidul Islam ◽  
Md Shariful Haque

Background: With the advent of fine needle aspiration cytology (FNAC), the approach to diagnosis and management of breast lumps has been revolutionized and it has high sensitivity and specificity.Aim: In this study we analyze the spectrum of FNAC diagnoses in breast lumps and compare the diagnostic accuracy of fine FNAC in differentiating the benign and malignant lesions of breast lumps with histopathological correlation.Materials & Methods: Two years prospective study was conducted in our institution and in that 490 aspirations, including 6 bilateral were performed. Suppurative and inflammatory lesions were excluded from the total aspirates. The cytological diagnosis was classified into 3 groups benign, suspicious and malignant. After this reporting all the available 94 cases were later subjected to mastectomy or open/excision biopsy and followed-up by histopathological confirmation. Later diagnostic accuracy of cytology reporting was compared with that of histopathology.Results: A total of 490 FNAC cases were reported including 373 as benign, 4 as suspicious for carcinoma and 113 as carcinoma. Majorities were premenopausal females and commonest age group was 31-40 years. Among them only 94 cases were followed-up by histopathologic confirmation. In histopathological correlation study, we had accuracy rate of 100% for benign lesion and 92.10% for malignant lesion with false negative rate of 7.90% and false positive rate of zero with fine needle aspiration cytology in the diagnosis of palpable breast lump. The overall sensitivity of fine needle aspiration in diagnosing the palpable breast lump is 92.10%, specificity is 100%, positive predictive value is 100% and negative predictive value is 94.91%.Conclusion: FNAC in experienced hands is a very useful tool with very high specificity and rare false positive result. Sensitivity can be further improved with clinical and imaging correlation.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 780-786


2018 ◽  
Vol 90 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Ewa Machała ◽  
Jan Sopiński ◽  
Iulia Iavorska ◽  
Krzysztof Kołomecki

ABSTRACT Fine needle aspiration cytology (FNAC) is considered as the gold standard diagnostic test for the diagnosis of thyroid nodules. It is a cost-effective procedure that provides specific diagnosis rapidly with minimal complications. It plays an important role in the determination of treatment- patients with suspected malignancy diagnosis can be subjected to surgery. On the other hand it can decrease the rate of unnecessary surgeries. Aims: The aim of this study was to evaluate and compare the correlation, accuracy of fine needle aspirational cytology (FNAC) in the diagnosis of thyroid lesions with the final histopathologic diagnosis in the surgical specimens. Materials and Methods: In our study we have performed a retrospective analysis of a case series of patients who were admitted to the Department of Endocrine, General and Oncological Surgery of Hospital of M. Kopernik in Łodź (Poland) between May 2016 and December 2017 and underwent FNAC with subsequent surgery. Cytological diagnosis was classified into six Bethesda categories. Results: On cytological examination 1070/1262 were reported as benign, 49 malignant and 143 suspicious. On histopathological examination, 956/1070 cases were confirmed as benign but there were 114 discordant cases. Among the other cases histopathology diagnosis of malignancy matched in 45/49 and 128/143 cases.The sensitivity and specificity were 60,28% and 98,05% respectively. False positive rate was 1.95% and false negative rate was 39.72%. The positive predictive value was 90.1% and negative predictive value was 89.35%. Accuracy of FNA in differentiating benign from malignant thyroid lesions was 89,46%. Conclusions: Fine needle aspiration cytology is a simple, cost-effective and popular procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of thyroid lessions.


2013 ◽  
Vol 98 (12) ◽  
pp. 4790-4797 ◽  
Author(s):  
Flavia Magri ◽  
Spyridon Chytiris ◽  
Valentina Capelli ◽  
Margherita Gaiti ◽  
Francesca Zerbini ◽  
...  

Context: Ultrasound (US) elastography (USE) was recently been reported as a sensitive, noninvasive tool for identifying thyroid cancer. However, the accuracy of this technique is hampered by the intra- and interoperator variability, some US features of the nodule, and the coexistence of autoimmune thyroid disease (ATD). Objectives: The purpose of this article was to assess the accuracy of USE findings in the differential diagnosis of thyroid nodules compared with other US features to evaluate its feasibility in the presence of ATDs and identify the strain index (SI) cutoff with the highest diagnostic performance. Design: We evaluated 528 consecutive patients for a total of 661 thyroid nodules. All nodules underwent fine-needle aspiration cytology (FNAC) and USE evaluation. The SI was calculated as a ratio of the nodule strain divided by the strain of the softest part of the surrounding normal tissue. Results: The median SI value was significantly higher in THY4 and THY5 than in THY2 nodules in ATD-positive, ATD-negative, and ATD-unknown patients. The cutoff of SI for malignancy was estimated to be 2.905 by receiver operating characteristic curve analysis in a screening set (379 FNAC results), and then tested in a replication set (252 FNAC results). In all cases, a SI value of ≥2.905 conferred to the nodule a significantly greater probability of being malignant. This SI cutoff had the greatest area under the curve, sensitivity, and negative predictive value, compared with the conventional US features of malignancy. Conclusion: The elastographic SI has a high sensitivity, specificity, and negative predictive value for the diagnosis of thyroid malignancy both in the presence and in the absence of ATD. If our data on USE are also confirmed in THY3 nodules, FNAC could be avoided in a number of thyroid nodules with certain features.


Author(s):  
Farzana Manzoor ◽  
Arif R. Sheikh ◽  
Bilal A. Sheikh

Background: Thyroid fine needle aspiration cytology (FNAC) is an important screening tool and thereby dictates clinical management. The exclusion of non-invasive follicular variant of papillary carcinoma (NIFVPTC) from thyroid malignancies and its reclassification as non-malignant entity i.e., non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) has added a new dimension. Aim of this study was to study the role of fine needle aspiration cytology in screening thyroid lesions by correlation with histopathological examination and to calculate diagnostic accuracy of FNAC considering NIFTP as non-malignant and compare it with pre NIFTP era.Methods: It was an observational study done over a period of 2 years (2017-2018). It included the cases where FNAC was followed subsequently by histopathology. FNAC results were correlated with histopathological diagnosis established thereof.Results: A total of 107 patients were included in this study. Considering NIFTP as non-malignant, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 92.97%, 100%, 100%, 92.73% and 96.23% respectively, that is significantly higher if authors considered NIFTP as malignant.Conclusions: FNAC plays an indispensable role in making preliminary diagnosis in thyroid lesions. There is a notable increase in diagnostic accuracy of FNAC in thyroid lesions and significant decrease in risk of malignancy by considering NIFTP as non-malignant.


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