[The value of cytological studies in nodular goiter: results in 495 patients]. / De waarde van cytologisch onderzoek bij nodulair struma: resultaten bij 495 patiënten.

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in a total of 495 patients of whom 183 were operated upon within 6 months after FNAB and 312 were not. Operated patients were divided into three subgroups with high, moderate or low suspicion of malignant neoplasms on clinical grounds. Histological examination revealed an overall malignant neoplasm rate of 23%. The rate, i.e. the positive predictive value, was 74% for the subgroup with high clinical suspicion, vs 14% and 10% respectively for the subgroups with moderate and low clinical suspicion. The sensitivity of a high clinical suspicion was 60% and the specificity 93%. The overall sensitivity of FNAB was 93% in the operated group and probably not less than 87% in all patients studied; specificity was 71% and 84% respectively for these groups. The overall positive predictive value of a positive cytology result (malignant or uncertain) was 48%. In the subgroups with moderate or low clinical suspicion which are more representative of a non-university setting, the average predictive value was 27%. In our opinion all patients in the group with high clinical suspicion need surgical treatment, regardless of the FNAB result; those with lower degrees of clinical suspicion and malignant or uncertain FNAB result should also undergo diagnostic surgical exploration.

The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds.

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in 169 patients surgically treated for nodular thyroid disease. Patients were divided into three groups with high, moderate, or low suspicion of malignant neoplasms on clinical grounds without previous knowledge of cytologic or histologic results. Histologic examination revealed an overall malignant neoplasm rate of 23%; the rate was 71%, 14%, and 11% for the groups with high, moderate, and low suspicion, respectively. The FNAB diagnostic interpretations of malignant and uncertain were considered positive. Overall sensitivity, specificity, and accuracy for FNAB were 92%, 71%, and 75%, respectively. Sensitivity in the high-, moderate-, and low-suspicion groups was 95%, 89%, and 88%, respectively; specificity was 88%, 72%, and 67%, respectively; and accuracy was 93%, 75%, and 69%, respectively. In our opinion, all patients in the group with high clinical suspicion need surgical treatment whatever the FNAB result; those with lower degrees of clinical suspicion and malignant or uncertain FNAB result [corrected] should also undergo surgery.

Tumor markers for ovarian cancer. A comparative immunohistochemical and immunocytochemical study of two commercial monoclonal antibodies (OV632 and OC125).

A comparative immunohistologic and immunocytologic study was performed to assess the immunoreactivity of the monoclonal antibodies OC125 and OV632, both directed at antigens present on epithelial ovarian tumors. OC125 reacted with 53 of 59 ovarian carcinomas, 20 of 20 uterine carcinomas, and 25 of 111 nongynecologic tumors (including 20 of 38 breast carcinomas). OV632 was demonstrated in 47 of 59 ovarian carcinomas, 11 of 20 uterine carcinomas, and only 7 of 111 nongynecologic tumors. With OV632 no reactivity was found in carcinomas of the breast or the gastrointestinal tract. Cytologic preparations of malignant effusions of patients with ovarian cancer showed reactivity with OC125 in 32 of 35 cases, and OV632 with positivity in 34 of 35 cases. Mesothelial cells in reactive effusions were OC125 positive in 16 of 20 cases but never showed positivity with OV632. The authors conclude that for histopathology a combination of OC125 and OV632 offers high sensitivity (0.86) and specificity (0.89) for ovarian cancer. For cytology, OV632 is the most specific tumor marker available.

Malignant melanoma in fine needle aspirates and effusions. An immunocytochemical study using monoclonal antibodies.

The value of monoclonal antibodies (MAbs) for the immunodetection of keratin, vimentin and two melanoma-associated antigens recognized by NKI/C3 and NKI/Bteb for the diagnosis of malignant melanoma has been previously established on histologic preparations. In the present study, cytologic preparations from 20 fine needle aspirates and effusions from patients with malignant melanoma were evaluated using these antibodies. Twenty of 20 smears were negative for keratin, and 20 of 20 smears were positive for vimentin. Positivity for NKI/C3 was seen in 12 of 12 cases studied, and for NKI/Bteb in 12 of 13 cases. These results indicate that a panel of MAbs consisting of anti-keratin, anti-vimentin, NKI/C3 and NKI/Bteb is useful for a more accurate diagnosis of malignant melanomas on cytologic preparations. The expression of these antigens in melanoma cells in cytologic smears can be a valuable aid in the detection of primary (noncutaneous) and metastatic melanomas by fine needle aspiration.