Online ISSN: 2515-8260

Keywords : FNAC


Cytomorphological and histopathological correlation with imaging findings in breast lumps: A retrospective study from a tertiary cancer centre

Sasmita Panda, Mamita Nayak, Sagarika Samantaray

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2097-2103

Background: Breast cancer is the most common cancer in the Indian women accounting for 27.7% of all the female cancers in india. Breast lumps are common which require appropriate workup consisting of clinical examination, imaging and fine needle aspiration cytology. Imaging and cytopathology are crucial in categorising these lesions into benign and malignant. There is a requisite to determine the concordance of these these findings and evaluate the diagnostic efficacy. The objectives is to find  the correlation  of cytopathological diagnosis with imaging findings for provisional diagnosis of breast lumps and to evaluate the utilisation  of fine needle aspiration as a cheap, safe method for preoperative assessment of breast lumps.
Materials and methods: All Fine needle aspiration (FNAC) of breast lumps were included in the study from Jan 2019 to Dec 2020.Their imaging findings were retrieved from the records. Only those with imaging findings were included in this study.
Results: 275 patients came for FNAC for breast lesions, out of these breast Ultrasound/ Mammography findings were available in 255 cases which were included in our study. Cytohistological correlation was obtained in 243 cases. In this sudy the sensitivity-90.3%, specificity=87.41%,positive predictive value (PPV) was 83.18%,negative predictive value (NPV) was 92.9%, with diagnostic accuracy of 88.6% for imaging findings in diagnosis of breast lesions(in comparison with histopathology considered to be gold standard for diagnosis). The Sensitivity was 99.02%, specificity was 99.29%, PPV was 99.02%, NPV was 99.29%, and the diagnostic accuracy was 95.29%for FNAC in diagnosis of breast diseases (considering histopathology as gold standard).
Conclusion: Cytological evaluation is a standardised ideal cheap ancillary method in evaluating the breast lumps which many a times masquerades breast cancers.

Bethesda System Based Classification of Thyroid Lesions Diagnosed By FNAC

Jyothi Boda; N Praneetha; Manasa Takkallapelli; Mamula Shaik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 1919-1929

Background: The objective of this study was to analyse the thyroid cytology smears by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), to determine the distribution of diagnostic categories and subcategories, to analyse cytological feature, and to correlate cytopathology with histopathology wherever surgery was done. Materials and Methods: In an institution based cross sectional study of FNAC done on 200 patients at pathology department at CAIMS, Karimnagar, 2017 to 2019 presenting with thyroid lesion were examined and categorized as per TBSRTC. Observation and Results: FNAC was done on 200 patients with thyroid lesions studied over a period of 2 years. Majority of patients were females accounting for 82 % and males were 18 %.Among the total thyroid lesions, Non- neoplastic constituted 92 %, neoplastic lesions were 3 % and 5 % were Non-diagnostic. Conclusions: TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow up FNA or surgery and also the extent of surgery

Correlation of fine needle aspiration cytology and histopathological examination in palpable breast lumps

Dr. Dastayya, Dr. Shekappa CM, Dr. Somashekar Samangandi, Dr. Shabbeer Pasha, Dr. Y Gurubasavana Gouda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2120-2127

A palpable breast lump is defined as a dominant mass if it is 3-dimensional, distinct from surrounding tissues and asymmetrical relative to the other Breast. A method of definitive diagnosis of patients who present with palpable breast lump at the outpatient department is needed. It must be accurate, easy to perform affordable and acceptable to the patient. This study was conducted to correlation of the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation.
A Prospective descriptive study done in 50 patients presenting with palpable lump in the Breast to Surgery department, history taken, clinically examined and sent to Central Diagnostic Lab, cytopathology section for FNAC. Patient underwent Surgical procedure after correlating with clinical examination and radiological investigations. Post-operative specimen sent for Histopathological examination. Cytological diagnosis was compared with Histopathology. Specificity, sensitivity, accuracy, and predictive values were calculated using standard formulas. Diagnostic accuracy of FNAC was 94% and overall sensitivity of FNAC in diagnosing the palpable breast lump was 94%, specificity was 100%, positive predictive of 100% and negative predictive value of 93%. Study concludes that the diagnostic efficacy, sensitivity and specificity of FNAC were comparable to Histopathological examination. Hence FNAC becomes a very important diagnostic tool in palpable breast lumps as it shows a high degree of correlation with the final histopathology report.

A Prospective Study to Evaluate the Accuracy of Fine Needle Aspiration Cytology (FNAC) and Touch Imprint Cytological Study in Correlation with Histopathological Study of Thyroid Lesions at Tertiary Care Center

Mukesh Kumar Khinchi, Ashish Bagaria, Subhash Chandra Sharma, Kamlesh Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 531-538

Background: Fine Needle Aspiration Cytology has been established as the investigation of choice in thyroid lesions. Different imaging techniques are now used for preoperative diagnosis of thyroid nodules like radionuclide scanning, high-resolution ultrasonography (USG). The present study aims at diagnosing various thyroid diseases based upon cytomorphological features in FNAC and wherever possible with its histopathological correlation, which is the gold standard.
Material & Methods: A prospective study done on 100 specimens from thyroid were received in the Department of pathology, SMS Medical College, Jaipur for histopathological examination from SMS hospital, Jaipurduring one year period. Out of these 100 cases imprint cytology was done for 48 cases. A correlative study between Fine Needle Aspiration Cytology and histopathology was done for these 100 cases. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2002).
Results: Our study showed that mean age of patients was 40.2 years and maximum patients were seen in 21 to 30 years of age group. There is a female preponderance with a Female to Male ratio of 13.28:1. Out of these 100 lesions 61 cases were non neoplastic lesions and 39 were neoplastic lesions. Among the 61 non neoplastic lesions 45cases were reported as nodular goiter, 15 cases as hashimato thyroiditis and 1 case as Granulomatous thyroidits. Out of the 39 neoplastic lesions 21 cases were reported as benign neoplastic lesions and 18 as malignant neoplastic lesions. A correlation done between Fine Needle Aspiration cytology with imprint cytology and histopathology showed the following results. 31 Fine Needle Aspiration cytology reports (64.58%) were correlated with histopathological diagnosis.
Conclusion: High rate of diagnostic accuracy can be achieved by use of ultrasound guidance with strict adherence to adequacy criteria and meticulous examination of all the smears. Touch Imprint Cytology alone may provide a correct diagnosis in vast majority of cases with minimal expense and without the need of sophisticated cryostat machine thus making it quite suitable when cryostat machines are not available.

Role of Milan system for reporting salivary gland lesions on fine needle aspiration cytology

Dr. Athmashri Shikkeri; Dr. Pratibha Patil; Dr. Shantala M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1436-1441

Background and Objectives: Salivary gland swellings are frequently encountered in OPD. Being situated in accessible location, Fine Needle Aspiration Cytology (FNAC) is awell‑established technique for evaluation of theselesions. A prospective study done in patients presenting with swelling of salivary glands, FNAC was performed with 23G needle, smears were stained with H&E. Clinical data, radiological findings were noted. Cytological features were evaluated and classified. Total 50 cases were evaluated. Distribution of cases into different categories was as follows ND (2%), NN (60%), AUS (2%), NB (20%), SUMP (2%), SM (2%)and M (12%). Non-neoplastic lesions were the most common cases observed in this study, whereas Pleomorphic adenoma and Mucoepidermoid carcinoma were the common benign and malignant lesions respectively.

CHC CORRELATION AGAIN, - THIS TIME NON GYNAEC CYTOLOGY EXCLUSIVELY!!

Dr. Ashwini Rege-Gundawar, Dr. Sneha Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 887-920

Introduction: Fine needle aspiration cytology (FNAC) is a popular preoperative tool to plan treatment preoperatively. Therefore, validation of its reliability and usefulness is critical. Cyto-histological correlation (CHC) is a recommended quality indicator (QI) for cytopathology reporting. CHC is underutilised, though it identifies individual reporting deficit.
Aim: To evaluatereliability of non-gynaecological FNAC, using one-year data, from a rural tertiary care teaching hospital and CHC as QI.
Objective: To use the one-year retrospective CHC exercise, as a clinical audit to evaluate the usefulness of institutional cytology reporting.
Materials and methods: Retrieval of non-gynaecological FNAC and surgical pathology data for the same one-year period to find matching CHC pairs.
Results: A total of 181 non-gynaecological FNACs were done in the given time period. These were from ‘Lymph node enlargements’ (57), ‘Breast’ (39), ‘Thyroid’ (24) and ‘Salivary glands’ (12). The rest “Others” (23) were mostly soft tissue. 26 Aspirates were ‘inadequate for opinion’ and excluded during analysis.
FNACs were grouped into:

Inflammatory, including granulomatous lesions.
Neoplastic-benign/malignant.
Inadequate for opinion.

Histological correlation was possible for 45 cases (29%) (45/155). Concurrence rate for CHC was 62% (28/45) with 38% (17/45) non-concurrence. The nonconcurrence was 11% (17/155) of the total FNAC workload. These were: 29% (5/17)- ‘change in categoric interpretation’, 35% (6/17)- ‘change within the same category’, 6% (1/17) due to lack of clinical information and 29% (5/17)due to preanalytical causes of error.All non-concurrences were congruent with known limitations of FNAC leading to sampling errors and hence posed methodological queries.
 
Conclusions:

The inherent limitations of the FNAC procedure may lead to non-concurrences in CHC.
When hierarchical reporting is the standard protocol in an institute, this incurs a blinding artefact to the deficits of individual reporting.
CHC exercise done at regular time intervals can serve as an internal clinical audit.

 

A CLINICOPATHOLOGICAL STUDY OFBREAST LUMPS

Dr. P. Swarnalatha, Dr. R.Swarupa Rani , Dr. S.Rajasekhar Reddy , Dr. Shaik. Raja Husne Kalam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 12-39

Breast cancer affects women more than men. From puberty to death, breasts go through
constant physical and physiological changes related to menstruation, pregnancy, and
menopause. The goal was to classify different types of breast lesions and conduct a
clinicopathological study on them.Methodology: In the present study carried out at the
department of Pathology of ACSR Govt Medical College, Nellore AP during the period
from January 2019 to June 2021 (18 months) a total number of 150 FNAs were performed
on patients with breast lumps. Results: The youngest patient in this study was 12 years
and the oldest 79 years. Majority of the patients were in the age group of 21-40 years. In
majority of the patients i.e. From 150 aspirates, 65 were from the right breast and 70 from
the left. 15 cases involved both breasts.Upper outer quadrant of right and left breast had 39
and 35 cases of breast lumps, respectively. Lower outer quadrant of the right breast had 11
cases and upper medial had 11 cases. Two breast cases showed diffuse all-quadrant
involvement. 2 of the 45 cases were clinically suspected of malignancy and 1 of
fibroadenosis, but FNAC showed fibroadenoma. Three clinicocytologically discordant cases
lacked excision biopsy. 15 cases of breast cancer were in the right breast and 9 in the left.
Upper outer quadrant is most common for breast lumps. Side and quadrant distribution are
shown below. All 20 cases were confirmed by excision biopsy. FNAC diagnosed 18 IDC
NOS cases and 2 IDC Mucinous cases.CONCLUSION: FNAC is the procedure that is most
commonly used since it is an initial outpatient procedure that is straightforward, risk-free,
quick, and dependable. Additionally, it contributes to an early preoperative diagnosis of any
lump in the breast.

SPECTRUM OF LYMPHNODE LESIONS ON CYTOLOGY :A RETROSPECTIVE STUDY

Srilakshmi Gollapalli,M.P Akarsh,Nadhiya .U ,Naval Kishore Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 696-713

Objective
Fine Needle Aspiration Cytology (FNAC) is first line of investigation in diagnosing a variety of superficial and deep lesions. It is a easy, quick, cost effective,well tolerated  and reliable technique done  as a  outpatient department  procedure. Lymphadenopathy is clinically important in a myriad of conditions ranging from simple reactive lymphadenitis to neoplastic etiology. In this study, we explain the  utility of FNAC in  lymph node lesions ranging from infectious etiology to malignant lesions and we highlight Tuberculous Lymphadenitis.
Methods: This was a retrospective study and includes a total of  256patients of  all age groups and both sexes presenting with palpable lymphnodes at FNAC clinic of our institute over a period of 3 years .FNAC was conducted with 22-24 Gauge disposable needles attached to  5/10c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Hematoxylin and Eosin stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required.
Results: Out of a total of 256 patients with   lymphadenopathy subjected to FNAC the commonest site was cervical lymphnodes(57.03%) .Females(54.68%)
 outnumbered males(45.31%) in our study .The commonest lesion  was found to be Granulomatous lymphadenitis(51.95%,followed by reactive
lymphadenitis(23.82%),non suppurative lymphadenitis(10.1%),acute suppurative lymphadenitis(6.25%),Metastatic deposit(5.07%),chronic suppurative lymphadenitis(1.95%) and HodgkinsLympoma(0.78%).
Conclusion: FNAC is a easy to perform,reliable in expensive method in diagnosing lymphadenopathy.In our study the predominant cause of lymphadenopathy was Tuberculous lymphadenitis,followed by reactive lymphadenitis.

STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY IN LYMPHADENOPATHY WITH SPECIAL REFERENCE TO ACID FAST STAINING IN CASES OF TUBERCULOUS LYMPHADENITIS

Dr P R D Ganesh Basina, Dr Siva Kumar Vulava, Dr BVVD Kiranmayi, Dr. Krishna SwaroopD. S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1135-1145

Fine needle aspiration cytology (FNAC) is a simple, safe, reliable rapid and
inexpensive method of establishing the diagnosis in lymph node lesions. The value of FNAC, besides making a
diagnosis lies in early detection, direction of appropriate investigations and treatment options. The present study is
undertaken to study the usefulness of FNAC in diagnosing various lymph node lesions in patients presenting with
lymphadenopathy. Also to determine the pattern of diseases affecting lymph nodes and to study the spectrum of
lesions with respect to age, sex and site of occurrence. To study the distribution of Acid fast bacilli in tuberculous
lymphadenitis using Ziehl Neelsen stain.

Role of FNAC For Cytological Evaluation of Peripheral Palpable Lesions in People Living with HIV/AIDS

Preeti Pathak, Mayank Sharma, Vinny Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2347-2351

Introduction: AIDS, the acquired immuno deficiency syndrome (sometimes called “Slim disease”) is a fatal illness caused by a retro-virus known asthe Human Immuno- deficiency Virus (HIV) which breaks down the body’s immune system, leaving the victim vulnerable to a host of life-threatening opportunistic infections, neurological disorders or unusual malignancies.
Aim: To evaluate the role of FNAC as a cytological investigative tool in the diagnosis of various superficial and palpable lesions in people leaving with HIV/AIDS.
Methods: This was a randomized and double-blind study conducted on 57 patients suffering for HIV/AIDS who presented with superficial and palpable lesions and subjected to fine needle aspiration using 22 or 23 gauge needle with all aseptic universal precautions to the Dept. of Pathology, Govt. Medical College Kota (Rajasthan) and associated group of hospitals between August 2015 to January 2018.
Results: Male to female ratio was 3.3:1. Cervical and Axillary group of lymph nodes were the predominant peripheral palpable lesions accounting for 59.66% cases. Commonest cytodiagnosis were Tubercular lymphadenitis in 43.86% cases followed by Reactive lymphadenitis in 21.05% cases.
Conclusion: FNAC is a reliable, safe and cost effective for the diagnosis of peripheral palpable lesions in HIV infectedindividuals.

Clinical profile of patients with benign parotid disease at a tertiary care hospital

Dr. Arunkumar Tukaram,Dr. Md. Zaheeruddine Ather,Dr. Arunkumar Bhavikatti,Dr sharankumar Jabshetty

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 184-189

The analogue of the parotid gland is the first gland to form in humans. Lesions of the parotid
gland are fairly easy to recognize mainly because of the location and limited number of
structures present here. Tumors of parotid gland are believed to represent approximately 2%
of head and neck tumors. Parotid gland tumors account for 70- 80% of all tumors of salivary
glands. Patients visiting to surgery department with parotid swelling were subjected to careful
history taking, complete clinical examination, and examination of facial nerve integrity.
Clinical diagnosis made was confirmed with USG (ultra sonography) parotid and FNAC (fine
needle aspiration cytology). 14(70%) patients in antegrade group vs. 13(76.47%) patients in
retrograde group had pleomorphic adenoma, 5 (25%) patients in antegrade group vs.2
(11.76%) patients in retrograde group had Warthin’sTumor,1(5%) patients in antegrade group
vs.2 (11.76%) patients in retrograde group had Recurrent Pleomorphic Adenoma.

SERUM MICRORNA-222 EXPRESSION for MALIGNANCY PREDICTION in SAMPLE of EGYPTIAN EUTHYROID PATIENTS with INDETERMINATE THYROID NODULE

Sherihan AboElyazed Mohamed; Mohamed Reda Halawa; Yara Mohamed Eid; Maram Mohamed Maher; Lamyaa Salem; Salah Hussein Elhalawany

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 9, Pages 325-334

Background: The Prevalence of thyroid nodules is rising nowadays, luckily most of
them are benign. The risk of malignancy 5-15%, which necessitates the ultimate need to
accurately distinguish benign from malignant nodule to avoid unnecessary
thyroidectomy with risk of recurrent laryngeal nerve injury, postoperative
hypothyroidism and lifetime thyroid replacement therapy, and other complications
related to surgery and anaesthesia. Recent evidence suggests that circulating miRNA
might have probable advantage as diagnostic or prognostic markers for numerous
cancers. Given their reproducible and constant presence in sera, miRNA profiles have
emerged as a non-invasive method to categorise a wide variety of human cancers. This
study aimed to evaluate a possible relationship between the expression level of
circulating miRNA-222 and the histological outcome of euthyroid patients undergoing
thyroidectomy for thyroid nodules with indeterminate FNAC. This study included 45
euthyroid patients with inderteminate thyroid nodules diagnosed with ultrasound and
FNAC which planed for thyroidectomy. Quantitative assay of serum micro RNA-222
expression by quantitative Real-Time polymerase chain reaction (qRT-PCR) performed
preoperatively, and results compared with postoperative histopathology.
Results: The incidence of thyroid nodules was predominant in female gender in benign
group and malignant group. Risk of malignancy increases as TI-RADS and Bethesda
scores increases. Also, larger nodule in size has a more risk of malignancy (p= 0.027).
Expression level of circulating miRNA-222 in serum can’t differentiate between benign
and malignant patients where there was no significant difference between them
statistically (p=0.905). Circulating miRNA-222 was a poor predicator for malignant
nodules with sensitivity of 50%, specificity of 32.43%, with high negative predictive
value (NPV=75%).
Conclusion: Although circulating miRNA-222 has been identified as novel minimally
invasive biomarker for preoperative prediction of malignant nodules, but in our study,
it did not show a value as a tool for discrimination of malignant nodules. Ultrasound
remained important procedure in preoperative prediction and management of thyroid
nodules especially when correlating to nodule size which had positive correlation with
malignancy in our study.

Marking the eye of the tiger: A Prospective Study Comparing USG aided surface marked FNAC versus blind FNAC in thyroid swellings

Dr. Ashwin Varghese Alexander; Dr. George Thomas; Dr. Karuna Sandra Thomas; Dr. Avinash Abraham Alexander; Dr. Jathin Sam Thekkethil

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 6492-6497

Introduction: Thyroid swellings are one of the most common clinical findings in the neck region. It is important to diagnose the exact pathology prior to treating such conditions. FNAC is now an inexpensive, dependable and safe diagnostic test for the assessment of diffuse thyroid pathologies and thereby, avoiding the redundant surgeries. Ultrasound guided FNAC has the potential to reduce insufficiency rates and is considered as the optimal cytological method for diagnosis. Hence in our study we intend to compare the results of marked FNAC and ultrasound-guided FNAC of thyroid swellings and find out the diagnostic reliability of marked FNAC and ultrasound-guided FNAC using histological conclusion as the gold standard. Methods: 100 subjects with thyroid swelling were selected. They were randomly divided into two groups - marked FNAC and ultrasound-guided FNACs were performed in them respectively. The obtained findings were compared with the histopathological diagnosis. These patients subsequently underwent surgery and followed up for over 2 and half years. Results: Ultrasound guided FNAC results revealed 64% benign lesions and 29 % of malignant lesions, and marked FNAC revealed 54% benign and 20% malignant cases. Histological gold standard diagnosis included 57 % benign and 43 % malignant cases. Conclusion: Marked FNAC of thyroid swellings is more expedient and economic as related to ultrasound guided FNAC. Nevertheless, the diagnostic output in ultrasound guided FNAC is significantly more in terms of accurateness