A Comparative Study of the Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology (EUS-FNA) versus Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB) in Pancreatic and Non-Pancreatic Lesions.

OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the procedure of choice to obtain samples from pancreatic lesions. However, it still has limitations affecting its diagnostic yield. The endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed to allow acquisition of histological core. We conducted this study to compare the diagnostic yield of the Echotip 22Gauge FNA needle with the 22Gauge acquire FNB needle in pancreatic and non-pancreatic lesions. MATERIALS AND METHODS: This prospective study was carried out on 100 cases of pancreatic and non-pancreatic lesions referred to El-Ebrashi unit of Gastroenterology and Hepatology, internal medicine department, Kasr Al-Aini hospital. The patients included were then randomized for sampling using either the standard Echotip 22Gauge FNA needle or 22Gauge acquire FNB needle. RESULTS: Patients were 57 males and 43 females with a mean age of 58±15 years. Seventy-eight patients had pancreatic lesions, while twenty-two patients had non-pancreatic lesions. Half of the patients (50 cases) underwent EUS-FNA, and the other half (50 cases) underwent EUS-FNB. The presence of adequate tissue core was significantly higher in the FNB group. In contrast, smear cellularity was not significantly different between both groups. FNB had more sensitivity and accuracy depending on cell block/tissue core examination only for diagnosing pancreatic lesions. Blood contamination was higher in cell blocks of the FNA group. The sensitivity, specificity, and accuracy in the combined cytologic and histologic evaluation were 100%. Based on smear only or tissue only, the specificity was 100%, but the sensitivity and accuracy were decreased in both techniques. No complications were reported in both techniques. CONCLUSION: EUS-guided FNA and FNB are safe with comparable diagnostic accuracy in pancreatic and non-pancreatic lesions. FNB improved the histopathological quality of specimens with little blood contamination. Depending on tissue examination only in diagnosing pancreatic lesions, FNB had more sensitivity and diagnostic accuracy.

Risk Assessment of Salivary Gland Cytological Categories of the Milan System: A Retrospective Cytomorphological and Immunocytochemical Institutional Study.

OBJECTIVE: The Milan System for Reporting Salivary Gland Cytology (MSRSGC) has been recently published to help communication between cytopathologists and clinicians. The aim was to assess our institutional experience with salivary gland fine needle aspiration cytology (FNAC) and the potential applicability of the MSRSGC for the estimation of the risk of neoplasm (RON) and risk of malignancy (ROM) for each category. MATERIAL AND METHOD: Salivary gland FNAC procedures performed at NCI, Cairo University in a three-year period from 2016 to 2018 and had a corresponding histopathological diagnosis were included in the current study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated. Histopathological final diagnosis was the gold standard. Cytological diagnoses were re-stratified according to MSRSGC with estimation of RON and ROM for each category. RESULTS: A total of 118 cases were included in the current work. Sensitivity, specificity, PPV, NPV and accuracy were 84.6%, 88.2%, 78.6%, 91.8% and 87%, respectively. Cytological diagnoses were re-classified as non-diagnostic (2.5%), non-neoplastic (14.4%), atypia of undetermined significance (AUS) (6.8%), benign neoplasm (40.7%), salivary gland neoplasm of uncertain malignant potential (SUMP) (7.6%), suspicious for malignancy (8.5%), and malignancy (19.5%). The RON and ROM for each category were as follows: non-diagnostic (100%, 33.3%), non-neoplastic (17.6%, 11.8%), AUS (50%, 37.5%), benign neoplasm (97.9%, 2.1%), SUMP (88.9%, 44.4%), suspicious (90%, 60%), and malignancy (100% for each). CONCLUSION: The Milan System for Reporting Salivary Gland Cytology is a helpful classification system. The calculated ROM for each category of the studied cases was slightly above the published MSRSGC rates but still supported the recommended management for the patient.

Inter-observer reproducibility of the Royal College system for reporting thyroid cytology: Experience of the Egyptian National Cancer Institute.

PURPOSE: To assess the inter-observer agreement between 3 cytopathologists of thyroid FNAC using Royal College of Pathology reporting system. PATIENTS AND METHODS: The study is a retrospective one conducted on 204 cases retrieved from the archives of the Cytology Unit, Pathology Department, National Cancer Institute, Cairo University during the time period from January 2016 to December 2016. Cases were diagnosed separately by 3 cytopathologists using the Royal College of Pathology classification system (RCPath), where Thy1, nondiagnostic; Thy2, nonneoplastic; Thy3a, atypical, Thy3f, follicular lesion; Thy4, suspicious of malignancy; and Thy5, malignant. Kappa statistics were used where combination of the agreement between the 3 observers simultaneously was done. RESULTS: There was a good overall agreement between the three observers regarding all categories (kappa statistics was 0.679). Perfect agreement was reported for Thy5 category (κ = 0.874), good agreement was observed for Thy1 and Thy2 (κ = 0.784 and 0.719, respectively). For Thy3a, Thy 3f and Thy 4, a moderate agreement was reported (κ = 0.407, 0.446 and 0.453 respectively). Combination of surgical categories (Thy3f, Thy4, and Thy5) achieved a good agreement (κ = 0.701) as well as for non-surgical categories (Thy1, Thy2, and Thy3a) (κ = 0.712). CONCLUSION: RCPath reporting system for thyroid FNAC is clinically applicable and can be used for differentiation between benign cases needing observation and follow up on one hand, and malignant cases requiring surgical intervention on the other. The least inter-observer agreement (moderate agreement) was detected for Thy3a, Thy3f and Thy4 categories, necessitating multidisciplinary team meeting before any clinical decision.