ABSTRACT
BACKGROUND: Core needle biopsy (CNB) has been suboptimal in the subclassification and grading of mesenchymal tumors. Recent advances in molecular diagnostics have shown promise in improving this area. The institutional experience with CNBs of soft tissue lesions on cytology cases and correlated histologic follow-up has been evaluated. It also addressed the advantageous use of ancillary techniques, including immunohistochemistry and molecular studies. METHODS: Archived cytologic CNB material and reports of patients with soft tissue lesions were retrieved and CNB results with final resection results were compared. Cases were re-reviewed and data were analyzed with descriptive statistics. RESULTS: From archived data, 215 cases were extracted of 99 female and 116 male patients (mean [range] age, 59.9 [12-95] years). Categories were malignant (n = 157), suspicious (n = 16), and benign (n = 42). In total, 161 (74.9%) had subsequent surgical resection-130 were malignant; 8, suspicious; and 23, benign. Of the malignant or suspicious cases, 138 had follow-up histologic resections, with 97.9% concordance. The most common malignant tumor was liposarcoma (n = 41; 29.7%), followed by undifferentiated pleomorphic sarcoma (30; 21.7%). Of benign tumors, 23 (54.8%) had follow-up surgical resection. Low-grade gastrointestinal stromal tumor was the most common benign tumor (26.1%), followed by fibromatosis (21.7%). Cytohistologic correlation for all categories showed 96.9% concordance. Molecular ancillary studies correctly classified malignant tumors in 37 (26.8%) of the 138 cases. CONCLUSION: CNB is a reliable modality for evaluating soft tissue neoplasms, with high histologic concordance rate.
Subject(s)
Fibroma/diagnosis , Gastrointestinal Stromal Tumors/diagnosis , Liposarcoma/diagnosis , Neoplasms/diagnosis , Sarcoma/diagnosis , Soft Tissue Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle , Child , Diagnosis, Differential , Female , Fibroma/pathology , Fibroma/surgery , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/surgery , Humans , Immunohistochemistry , Liposarcoma/pathology , Liposarcoma/surgery , Male , Middle Aged , Neoplasms/pathology , Neoplasms/surgery , Retrospective Studies , Sarcoma/pathology , Sarcoma/surgery , Sensitivity and Specificity , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgeryABSTRACT
BACKGROUND: Thyroid fine-needle aspiration (FNA) is used to assess appropriate management of nodular thyroid lesions safely, but Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) and category IV (follicular neoplasm/suspicious for follicular neoplasm) lesions are problematic. This study aimed to evaluate the Afirma Gene Expression Classifier (GEC) results for lesions in those categories. METHODS: Medical records of patients with thyroid FNA and GEC results were obtained from archived material. Results were compared to thyroidectomy histologic diagnoses. RESULTS: Among 66 patients with FNA results (47 women and 19 men aged 26-89 years [mean, 59.4 years]), surgical reports were available for 38. Afirma GEC results were "nondiagnostic" for 10 of 66 (15.2%), "benign" for 22 (33.3%), and "suspicious" for 34 (51.5%). Surgical diagnosis was available for 38 of 66 patients (57.6%); GEC results for 6 (15.8%) of these were "nondiagnostic," 27 (71.0%) were "suspicious," and 5 (13.2%) were "benign." One of 6 (16.7%) samples with "nondiagnostic" results, 1 of 5 (20%) with "benign" results, and 15 of 27 (55.6%) with "suspicious" results were malignant on histology. Papillary carcinoma was the most common tumor type (15 of 38; 39.5%). CONCLUSIONS: Afirma GEC results minimize the number of unnecessary operations. Afirma GEC testing may be reserved for FNAs with a category III diagnosis on follow-up cytologic examination. We recommend a conservative approach for "suspicious" Afirma GEC results if Hürthle cells are seen with FNA.
