ABSTRACT
Objective:To investigate the occurrence of inadequate specimens of thyroid nodule fine needle non-aspiration cytology and its possible influencing factors.Methods:Clinical data of 1571 patients with FNAC of 1638 thyroid nodules were analyzed retrospectively, according to whether the FNAC specimen were adequate or not, all cases were divided into adequate group and inadequate group. The related influencing factors on inadequate specimen were analyzed by univariate analysis and multivariate logistic regression.Results:Inadequate specimens occurred in 301 of 1638 (18.4%) nodules. Logistic regression analysis showed that the influencing factors of overall specimen adequacy included operator experience ( P=0.00) , nodules size≤0.5 cm ( P=0.00) , eggshell calcification ( P=0.00) , and cystic ( P=0.00) . Excluding the impact of operator experience, the influencing factors of specimen adequacy included nodules size≤0.5 cm ( P=0.00) , eggshell calcification ( P=0.00) , and cystic ( P=0.00) . Conclusions:Operator experience, nodules size≤0.5 cm, cystic, together with eggshell calcification are influencing factors of specimen adequacy of fine needle non-aspiration cytology in thyroid nodules. For experienced operators, what restrict specimen adequacy is the limitation of FNAC technique. For inexperienced operators, what restrict specimen adequacy is operator’s experience.
ABSTRACT
Background@#Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method to evaluate thyroid nodule for possible malignancy. However, an adequate specimen is required for proper examination by a pathologist. Rapid on-site evaluation (ROSE), a service typically provided by pathologists, is the real-time evaluation for adequacy of FNAB smears which can help improve adequacy rates by allowing the submission of additional thyroid samples when the submitted samples are inadequate. This study aims to investigate if ROSE done by trained Endocrinologists can improve specimen adequacy in our patients.@*Methods@#A total of 192 patients were included in this study and were divided in two groups: a ROSE group (n=96) and a non-ROSE group (n=96). In the ROSE group, the smear of thyroid aspirate was evaluated for adequacy by a trained Endocrinologist in real time. In the non-ROSE group, specimens are directly sent to the Pathologist.@*Results@#ROSE done by Endocrinologists had 94% sensitivity, 46% specificity and 82% accuracy compared to a Pathologist. The adequacy rate under the ROSE group was 84.38% and 81.25% in non-ROSE group.@*Conclusion@#Our study showed that ROSE can improve adequacy rate in our center. ROSE can also be used by physicians in the provinces who are performing FNAB of the thyroid without ultrasound guidance to improve specimen adequacy and lessen repeat biopsy.
Subject(s)
Rapid On-site EvaluationABSTRACT
The Banff classification was introduced to achieve uniformity in the assessment of renal allograft biopsies. The primary aim of this study was to evaluate the impact of specimen adequacy on the Banff classification. All renal allograft biopsies obtained between July 2010 and June 2012 for suspicion of acute rejection were included. Pre-biopsy clinical data on suspected diagnosis and time from renal transplantation were provided to a nephropathologist who was blinded to the original pathological report. Second pathological readings were compared with the original to assess agreement stratified by specimen adequacy. Cohen's kappa test and Fisher's exact test were used for statistical analyses. Forty-nine specimens were reviewed. Among these specimens, 81.6% were classified as adequate, 6.12% as minimal, and 12.24% as unsatisfactory. The agreement analysis among the first and second readings revealed a kappa value of 0.97. Full agreement between readings was found in 75% of the adequate specimens, 66.7 and 50% for minimal and unsatisfactory specimens, respectively. There was no agreement between readings in 5% of the adequate specimens and 16.7% of the unsatisfactory specimens. For the entire sample full agreement was found in 71.4%, partial agreement in 20.4% and no agreement in 8.2% of the specimens. Statistical analysis using Fisher's exact test yielded a P value above 0.25 showing that - probably due to small sample size - the results were not statistically significant. Specimen adequacy may be a determinant of a diagnostic agreement in renal allograft specimen assessment. While additional studies including larger case numbers are required to further delineate the impact of specimen adequacy on the reliability of histopathological assessments, specimen quality must be considered during clinical decision making while dealing with biopsy reports based on minimal or unsatisfactory specimens.
Subject(s)
Humans , Male , Female , Allografts/classification , Allografts/pathology , Graft Rejection/pathology , Kidney/pathology , Biopsy , Observer Variation , Reproducibility of Results , Retrospective Studies , Kidney Transplantation/adverse effectsABSTRACT
A importância do câncer do colo uterino envolve sua epidemiologia, fatores sócioeconômicos econômicos e, sobre maneira as lesões precursoras que o antecedem. Identificá-las, mediante elementos da zona de transformação, foi um legado de Bethesda. Objetivos: identificar casos de anormalidade citológica quando presentes elementos representativos da zona de transformação do colo uterino ( presença de células endocervicais e/ou me taplásicas) na adequação da amostra. Método: Estudo descritivo, observacional corte transversal com coleta retrospectiva dos dados, baseou-se em laudos de colpocitologia oncológica emitidos de 1° de janeiro a 31 de dezembro de 2006 no Laboratório de Anatomia Patológica de um hospital privado da região norte catarinense. Foram definidos como representativos aqueles que contivessem células endocervicais e/ou metaplásicas e Não Representativos os demais. Comparou-se a proporção de esfregaços com presença de células metaplásicas e/ou endocervicais, com o diagnóstico de anormalidade, indeterminados ou com lesão intraepitelial. Resultados: Houve representatividade (presença de células metaplásicas e/ou endocervicais)em 96.6% dos laudos emitidos e 3.4% com ausência (p< 0.001). Quanto menor a idade da mulher, abaixo de 50 anos, maiores foram as possibilidades de se detectar células metaplásicas e/ou endocervicais (Teste exato de Fisher p<0.001), bem como de se encontrar algum tipo de anormalidade citológica como ASCUS ou neoplasia intraepitelial. Conclusão: Houve relação direta entre a presença de células metaplásicas e/ou endocervicais e o diagnóstico citológico.
The magnitude of the uterine colon cancer implicates its epidemiology, social economic coefficients and, exceptionally the precedent wounds that foregoes it. To identify them, through transmutation zone constituents, was a Bethesda bequest. Objectives: Recognize cytologic abnormality events when representative uterine colon transmutation zone elements (endocervical and/or metaplasic cells carriage) are found in the sample adequation. Method: Descriptive, observational study, transversal incision with reminiscent data collect, was based in oncologic colpocytology reports launched from january 1st to december 31st 2006 in the Pathological Anatomy Laboratory of a privative hospital of the catarinense north region.Were determined as representative those which embraced endocervical and/or metaplasic cell and non-representative the others. The proportion of smears with metaplasic and/or endocervical cells were compared, with the abnormality diagnosis, indefinite or with intrapitelial wound. Results: There was representativity (metaplasic and/or endocervical cells carriage) in 96.6% of the launched reports and 3.4% with absence (p<0.001). The younger the woman, under 50, the bigger the possibilities to detect metaplasic and/or endocervical cells (exact Fisher p< 0.001), as well as to discover any kind of cytologic abnormality as ASCUS or intraepithelial neoplasy. Conclusion: There was a direst relation between the metaplasic and/or endocervical cells carriage and the cytologic diagnosis.
ABSTRACT
OBJECTIVE: The purpose of this study is to evaluate the histologic correlations and the clinical significance among patients with atypical squamous cells of undetermined significance (ASCUS), atypical glandular cells of undetermined significance(AGUS) and benign endometrial cells identified on cervical Pap smear screening. MATERIALS & METHODS: The computerized files of the Department of Pathology at Samsung Cheil Hospital were searched from 1991 to 1997 to evaluate the annual statistics of cytologic diagnoses including normal/benign, ASCUS, AGUS, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion(HSIL) and cancer classified by the Bethesda System(TBS). Cytohistologic correlations on follow-up were separately analysed in ASCUS(190 cases), AGUS(268 cases) and benign endometrial cells(169 cases), respectively. Additionally, post-menopausal squamous atypia(83 cases) were also included in this study. TBS terminology was used in both cytologic and histologic diagnoses. RESULTS: During 7-year period (1991-1997), 447,049 cervicovaginal smears were evaluated. The median rate of abnormal cytology was 4.4%, with 2.1% of ASCUS, 2.06% of squamous intraepithelial lesion(SIL), and 0.08% of AGUS. The median ratio of ASCUS versus SIL was 1.24. Specimen adequacy was evaluated on 47,525 cases, of which categories of "satisfactory for evaluation but limited by" and "unsatisfactory for evaluation" were 28.3% and 0.03%, res-pectively. Follow-up of 190 patients with ASCUS cytology showed 30%(57 cases) with SIL on biopsy; 18%(35cases) with LSIL, 11%(21cases) with HSIL, and 1%(1case) with microinvasive squamous cell carcinoma. On histologic examination, 77%(37/48cases) with ASCUS favoring SIL revealed SIL in contrast to 14%(20/142cases) with ASCUS favoring reactive change, which is statistically significant.(Chi-Square test, P<0.0001). Of 83 cases of post-menopausal squamous atypia(PSA), smears with LSIL showed 34.9%(15/43cases) with LSIL on biopsy. 268 patients with AGUS smears had 25%(67cases) with clinically significant cervical or endometrial lesions on histologic examinations. Among 17.9%(48cases) with cervical lesions, squamous abnormalities were 10.5%(28cases); including 1.5%(4cases) with LSIL and 9.0%(24cases) with HSIL. Glandular lesions in cervix were 7.5%(20cases); 3.0%(8cases) of glandular atypia or dysplasia, 1.9%(5cases of adenocarcinoma in situ, 1.1%(3cases) of microinvasive adenocarcinoma and 1.5%(4cases) of adenocarcinoma. Of 7.1%(19cases) of endometrial lesions, 2.2%(6cases) was endometrial hy-perplasia, 4.1%(11cases) endometrial carcinoma, 0.4%(1case) MMMT and 0.4%(1case) metastatic adenocarcinoma from stomach were verified. The pathologies of 169 cases with benign endometrial cells shed in cervicovaginal smears were confirmed to be endometrial polyp(8.3%), endometrial hyperplasia(4.1%) and endometrial carcinoma(5.9%). CONCLUSION: The results of this study indicates that clinicians should communicate with pathologists for proper management of abnormal cytology. Further evaluation and decision of management should be made based on input from pathologists as well as on clinical setting and professional guidelines.