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Background: Ultrasound-guided fine-needle aspiration (FNA) is a safe, simple, accurate, rapid, and an effective method for approaching a hepatic lesion. Objectives: The objectives of this study were as follows: (1) To assess the utility of ultrasound-guided FNA cytology (FNAC) in the diagnosis of hepatic mass, (2) to categorize hepatic masses into benign and malignant lesions to assess the nature of mass, and (3) to study the cytomorphological features of various liver lesions. Materials and Methods: The study was conducted in the department of pathology between January 2014 and April 2016. Ultrasound-guided FNAC was performed on 62 patients with hepatic mass lesions. The patients with hemangioma and hydatid disease of the liver diagnosed by ultrasonography were excluded to prevent undue complications. Results: There were 39 (62.9%) males and 23 (37.09%) females with a mean age of 52.5 years ranging from 10 to 85 years. Samples were adequate in 57 (93.5%) and inadequate in 5 (6.5%). Of 57 adequate samples, five show inflammation, two were benign, and 50 were malignant. Of the inflammatory lesions, pyogenic liver abscesses in 3 (5.26%) and amoebic liver abscesses in 2 (3.51%). Benign lesion included hepatic adenoma in 2 (3.51%). Of the malignant lesions, metastatic adenocarcinomas was in 22 (38.60%), hepatocellular carcinomas was in 10 (17.54%), metastatic deposits of poorly differentiated carcinoma was in 10 (17.54%), metastatic squamous cell carcinoma was in 5 (8.78%), hepatoblastoma was in 2 (3.51%), and cholangiocarcinoma was in 1 (1.75%) case. All the hepatocellular carcinomas in our study occurred in males (4 of 4). Conclusion: Ultrasound-guided FNAC of the liver has a significant role in diagnosis of palpable and non-palpable hepatic mass. It is a rapid, highly accurate, safe, and cost-effective diagnostic method which avoids invasive diagnostic procedures.
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Objective@#To explore the correlation of ultrasound-guided fine-needle aspiration(US-FNA) combined with BRAF V600E mutation detection and ultrasound features and central cervical lymph nodes metastasis of classic papillary thyroid cancer(PTC) for providing a reliable molecular basis for clinical preoperative evaluation of patients.@*Methods@#Ninty-three cases of patients collected from October 2017 to November 2018 in Gansu Province Hospital were enrolled, who underwent general ultrasonic examination TI-RADS ≥4a, the US-FNA highly suspicious of PTC, thyroid surgery including total thyroidectomy and central cervical lymph node dissection, with the postoperative pathologic results of classical PTC and whether the central cervical lymph node metastasis happened in the patients. Part of the specimen applied HE staining for cytological diagnosis, the other part of specimen was used real-time for detection of BRAF V600E gene mutation by fluorescent quantitative polymerase chain reaction (PCR) method.@*Results@#Univariate analysis showed that the occurrence of cervical lymph node metastasis for classic PTC were significantly correlated with gender(χ2=10.303, P=0.002), BRAF V600E mutation(χ2=31.204, P=0.000) and extrathyroidal invasion(χ2=12.848, P=0.000). Multi-logistic regression analysis showed that BRAF V600E mutation(OR=13.324, 95%CI=4.058-43.744, P=0.000) and extrathyroidal invasion(OR=5.738, 95%CI=1.766-18.643, P=0.004) were the risk predictors of cervical lymph node metastasis of classic PTC. Gender(OR=0.385, 95%CI=0.112-1.324, P=0.130) was not the risk predictor.@*Conclusions@#US-FNA combined with BRAF V600E mutation and extrathyroidal invasion are the risk factors in predicting central cervical lymph node metastasis in classic PTC. Patients with these two risk factors should be elected to undergo prophylactic central cervical lymph node dissection.
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Objective To explore the correlation of ultrasound-guided fine-needle aspiration(US-FNA) combined with BRAF V600E mutation detection and ultrasound features and central cervical lymph nodes metastasis of classic papillary thyroid cancer(PTC)for providing a reliable molecular basis for clinical preoperative evaluation of patients.Methods Ninty-three cases of patients collected from October 2017 to November 2018 in Gansu Province Hospital were enrolled,who underwent general ultrasonic examination TI-RADS ≥4a,the US-FNA highly suspicious of PTC,thyroid surgery including total thyroidectomy and central cervical lymph node dissection,with the postoperative pathologic results of classical PTC and whether the central cervical lymph node metastasis happened in the patients.Part of the specimen applied HE staining for cytological diagnosis,the other part of specimen was used real-time for detection of BRAF V600E gene mutation by fluorescent quantitative polymerase chain reaction (PCR) method.ResultsUnivariate analysis showed that the occurrence of cervical lymph node metastasis for classic PTC were significantly correlated with gender(χ2=10.303,P =0.002),BRAF V600E mutation(χ2=31.204,P =0.000)and extrathyroidal invasion(χ2=12.848,P =0.000).Multi-logistic regression analysis showed that BRAF V600E mutation(OR=13.324,95％CI=4.058-43.744,P =0.000) and extrathyroidal invasion(OR=5.738,95％CI=1.766-18.643,P=0.004)were the risk predictors of cervical lymph node metastasis of classic PTC.Gender(OR=0.385,95％CI=0.112-1.324,P =0.130) was not the risk predictor.Conclusions US-FNA combined with BRAF V600E mutation and extrathyroidal invasion are the risk factors in predicting central cervical lymph node metastasis in classic PTC.Patients with these two risk factors should be elected to undergo prophylactic central cervical lymph node dissection.
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BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC) is currently the most commonly used procedure for obtaining cytologic specimens of the pancreas. It is accurate, minimally invasive, safe and cost-effective. However, there is discrepancy between cytological and surgical diagnoses. This study was aimed at evaluating the diagnostic accuracy of EUS-FNAC of the pancreas. METHODS: We performed a retrospective review of 191 cases of pancreatic lesions initially diagnosed by EUS-FNAC with subsequent histological diagnosis between 2010 and 2012 in the Department of Pathology, Seoul National University Hospital. Cytologic and surgical diagnoses were categorized into five groups: negative, benign, atypical, malignant, and insufficient for diagnosis. Subsequently, 167 cases with satisfactory yield in both surgical and cytology specimens were statistically analyzed to determine correlations with diagnosis. RESULTS: In comparison to surgical diagnoses, cytologic diagnoses were true-positive in 103 cases (61.7%), true-negative in 28 cases (16.8%), false-positive in 9 cases (5.4%), and false-negative in 27 cases (16.1%). The diagnostic accuracy was 78.4%, sensitivity was 79.2%, and specificity was 75.7%. The positive predictive value was 92.0%, and negative predictive value was 50.9%. CONCLUSIONS: EUS-FNAC has high accuracy, sensitivity, specificity and positive predictive value. Overcoming the limitations of EUS-FNAC will make it a useful and reliable diagnostic tool for accurate evaluation of pancreatic lesions.
Subject(s)
Diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Pancreas , Pathology , Retrospective Studies , Sensitivity and Specificity , SeoulABSTRACT
We report here a case of a gastrointestinal stromal tumor (GIST) in the stomach that was diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA). A 67 year old male patient underwent regular check-ups for five years due to the presence of a submucosal tumor that was found in the fundus of the stomach incidentally. EUS-FNA was performed to evaluate the tumor, which had increased in size from 1cm to 2.8cm. A cytologic smear revealed cohesive sheets or clusters of spindle cells with elongated nuclei. Immunohistochemical staining revealed a strong positive reaction for c-kit and CD34, without any reaction for smooth muscle actin and Ki-67. Therefore, a diagnosis of GIST was made.
Subject(s)
Humans , Male , Actins , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endoscopy , Gastrointestinal Stromal Tumors , Immunohistochemistry , Muscle, Smooth , StomachABSTRACT
BACKGROUND: The introductian of highly sensitive imaging techniques has made it possible to detect many nonpalpable nodules, or incidentaloma. Because these nodules are small sized or deep seated, the diagnostic approach is difficult with conventional methods but it is easy with ultrasound-guided fine needle aspiration (FNA). However, the role of ultrasound-guided FNA on the incidentalomas has been poorly evaluated, so we tried to assess the diagnostic value of high resolution ultrasound-guided FNA in the incidentalomas. METHODS: One hundred forty-nine patients who underwent high resolution ultrasound-guide FNA for nonpalpable nodules that was smaller than 1.5 cm in diameter at Kosin Medical Center from June, 1996 to April, 1998 were included in the study. Ultrasound-guided FNA was performed with a 22-guage needle attached to 10 mL syringe with 10 MHz linear transducer in a free hand fashion. The aspirated materials were smeared and stained with Papanicolaou stain. For those who underwent surgery histopathologic diagnoses were compared to cytological diagnoses. RESULTS: The mean age of the patients was 45 and most of them were middle aged. Male to female ratio was 1:11.4. Of 149 patients 16 were involutional change, 55 hyperplasia, 42 Hashimotos thyroiditis, 8 follicular neoplasm, 19 papillary carcinoma, 1 subacute thyroiditis, and 6 inadequate specimen. Of the 149 nodules, 123 cases were solid, 11 cystic, and 15 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. Ten of 93 cases (10.7%) measured less than 1 cm and nine of 56 cases (16.1%) between 1.0 cm to 1,5 cm were malignant nodules. The difference of incidence rate of malignant nodules between each group was not significant. The incidence of malignancy was 13.6% (12/88) in solitary nodule and 11.5% (7/61) in multiple nodules. The difference of incidence rate of malignant nodules between each group was not significant. Eighteen cases including 14 malignancies diagnosed by FNA underwent operation. Of those 13 were papillary carcinoma and 5 adenomatous goiter. Upon the correlation of ultrasound-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 92.3% and overall diagnostic accuracy was 80.0%. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain was noted during this study. CONCLUSION: High resolution ultrasound-guided FNA cytology may be useful for the diagnosis of thyroid cancer in the thyroid incidentalomas and also useful for early detection of recurrence of thyroid cancer .