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Caputo A, Fraggetta F, Cretella P, Cozzolino I, Eccher A, Girolami I, Marletta S, Troncone G, Vigliar E, Acanfora G, Zarra KV, Torres Rivas HE, Fadda G, Field A, Katz R, Vielh P, Eloy C, Rajwanshi A, Gupta N, Al-Abbadi M, Bustami N, Arar T, Calaminici M, Raine JI, Barroca H, Canão PA, Ehinger M, Rajabian N, Dey P, Medeiros LJ, El Hussein S, Lin O, D'Antonio A, Bode-Lesniewska B, Rossi ED, Zeppa P. Digital Examination of LYmph node CYtopathology Using the Sydney system (DELYCYUS): An international, multi-institutional study. Cancer Cytopathol 2023; 131:679-692. [PMID: 37418195 DOI: 10.1002/cncy.22741] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND After a series of standardized reporting systems in cytopathology, the Sydney system was recently introduced to address the need for reproducibility and standardization in lymph node cytopathology. Since then, the risk of malignancy for the categories of the Sydney system has been explored by several studies, but no studies have yet examined the interobserver reproducibility of the Sydney system. METHODS The authors assessed interobserver reproducibility of the Sydney system on 85 lymph node fine-needle aspiration cytology cases reviewed by 15 cytopathologists from 12 institutions in eight different countries, resulting in 1275 diagnoses. In total, 186 slides stained with Diff-Quik, Papanicolaou, and immunocytochemistry were scanned. A subset of the cases included clinical data and results from ultrasound examinations, flow cytometry immunophenotyping, and fluorescence in situ hybridization analysis. The study participants assessed the cases digitally using whole-slide images. RESULTS Overall, the authors observed an almost perfect agreement of cytopathologists with the ground truth (median weighted Cohen κ = 0.887; interquartile range, κ = 0.210) and moderate overall interobserver concordance (Fleiss κ = 0.476). There was substantial agreement for the inadequate and malignant categories (κ = 0.794 and κ = 0.729, respectively), moderate agreement for the benign category (κ = 0.490), and very slight agreement for the suspicious (κ = 0.104) and atypical (κ = 0.075) categories. CONCLUSIONS The Sydney system for reporting lymph node cytopathology shows adequate interobserver concordance. Digital microscopy is an adequate means to assess lymph node cytopathology specimens.
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Affiliation(s)
- Alessandro Caputo
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Filippo Fraggetta
- Department of Pathology, Gravina and Santo Pietro Hospital, Caltagirone, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Immacolata Cozzolino
- Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano, South Tyrolean Health Care Service-South Tyrol Health Authority, Bolzano-Bozen, Italy
| | - Stefano Marletta
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | | | - Elena Vigliar
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Gennaro Acanfora
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Karen Villar Zarra
- Pathology Department, Hospital Universitario Del Henares, Coslada, Spain
| | | | - Guido Fadda
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, Messina, Italy
| | - Andrew Field
- Department of Anatomical Pathology, St Vincent's Hospital, University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia
| | - Ruth Katz
- Department of Pathology, Tel HaShomer Hospital, Tel Aviv, Israel
| | | | - Catarina Eloy
- Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | | | - Nalini Gupta
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mousa Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Nadwa Bustami
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Tala Arar
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Maria Calaminici
- Specialist Integrated Hematological Malignancy Diagnostic Service, Department of Cellular Pathology, Barts Health National Health Service Trust, England, UK
- Center for Hemato-Oncology, Barts Cancer Institute, London, UK
| | - Juliet I Raine
- Specialist Integrated Hematological Malignancy Diagnostic Service, Department of Cellular Pathology, Barts Health National Health Service Trust, England, UK
| | - Helena Barroca
- Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal
| | | | - Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Nilofar Rajabian
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Pranab Dey
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Siba El Hussein
- Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University Rome, Rome, Italy
| | - Pio Zeppa
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
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Song Y, Xu G, Wang T, Zhu Y, Zhang Y, Zhang B. Surgeon‐performed fine‐needle aspiration for lymph nodes behind the big cervical vessels in papillary thyroid cancer. Laryngoscope Investig Otolaryngol 2022; 7:646-651. [PMID: 35434341 PMCID: PMC9008158 DOI: 10.1002/lio2.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective This study aimed to describe the technique of surgeon‐performed ultrasound (US)‐guided fine‐needle aspiration (FNA) of cervical retrovascular lymph nodes in papillary thyroid cancer (PTC) patients and analyze its efficacy. Methods This study included consecutive patients with retrovascular suspicious lymph nodes who had FNA performed by surgeons. The technique and efficacy of four different puncture routes were assessed. Results A total of 102 lymph node FNAs were performed on 100 patients. None yield insufficient aspiration, while 2% of FNA cytology result in an indeterminate diagnosis. No severe complication was observed. Cytologic testing plus thyroglobulin washout indicated sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing nodal metastasis were 99%, 93%, 97%, and 97%, respectively. There was no significant difference in the test accuracy of FNA through different routes. Conclusions In PTC patients, suspicious lymph nodes behind the big cervical vessels should not be considered a contraindication to FNA. They can be diagnosed safely and accurately using appropriate puncture routes. Level of evidence: 4.
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Affiliation(s)
- Yuntao Song
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
| | - Guohui Xu
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
| | - Tianxiao Wang
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
| | - Yanli Zhu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
| | - Yabing Zhang
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
| | - Bin Zhang
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Peking University Cancer Hospital and Institute Beijing China
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Donmez M, Aydin H, Kose E, Kahramangil B, Erten O, Gokceimam M, Akbulut S, Jin J, Krishnamurthy V, Shin J, Siperstein A, Berber E. Standardization of thyroid fine needle aspiration procedure and outcomes within an endocrine surgery department. Gland Surg 2021; 10:567-573. [PMID: 33708540 DOI: 10.21037/gs-20-630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fine needle aspiration (FNA) biopsy is an essential procedure for thyroid nodules. Although, the efficacy of surgeon-performed thyroid FNA biopsies has been demonstrated in the literature, there are insufficient data regarding how to establish an efficient program with a low insufficiency rate within a group practice. Methods An endocrine surgery thyroid FNA biopsy program was established in 2000 by one surgeon, with training of additional partners during fellowship and upon recruitment. The results within 18 years were analyzed. The FNA biopsies were performed by endocrine surgeons under ultrasound guidance without on-site pathologist review. Results A total of 5,469 FNA biopsies were performed by 7 surgeons. The total number of FNA biopsies performed by each surgeon varied between 291-1,378. FNA biopsies were performed in 2 passes using 22-gauge needles under constant suction. The overall insufficiency rate was 4.3%, with individual surgeon rates ranging between 2.7% and 7.2%. The insufficiency rate for the whole team ranged between 3.3% and 5% when examined in 5-year blocks. Conclusions This study shows that an establishment of a highly efficient thyroid FNA biopsy program within a group practice is possible with a structured endocrine surgical training and adoption of a standard technique.
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Affiliation(s)
- Mustafa Donmez
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Bora Kahramangil
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mehmet Gokceimam
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
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Kahramangil B, Kose E, Donmez M, Aydin H, Reynolds JP, Krishnamurthy V, Jin J, Shin J, Siperstein A, Berber E. Thyroglobulin washout from cervical lymph node fine needle aspiration biopsies in patients with differentiated thyroid cancer: an analysis of different expressions to use in post-total thyroidectomy follow-up. Surgery 2019; 167:34-39. [PMID: 31495510 DOI: 10.1016/j.surg.2019.05.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although frequently used as an adjunct to cytology in patients with differentiated thyroid cancers, interpretation of thyroglobulin washout remains unclear. We aim to compare the utility of different analytic tools to develop recommendations for use in post-total thyroidectomy follow-up. METHODS This is an institutional review board-approved retrospective study of patients who underwent lymph node fine needle aspiration biopsy with thyroglobulin washout between 2012 and 2018, during the post-total thyroidectomy follow-up of differentiated thyroid cancer. The utilities of thyroglobulin washout concentration, thyroglobulin washout/serum thyroglobulin ratio, and absolute thyroglobulin content were compared. RESULTS Sixty-four patients underwent 79 fine needle aspirations with thyroglobulin washout of cervical lymph nodes. Fifty-two lymph nodes were found to be metastatic and 27 benign. One patient had a pathologically confirmed lymph node metastasis despite a thyroglobulin washout of 0. The optimal cutoffs of thyroglobulin washout, thyroglobulin washout/serum thyroglobulin ratio, and absolute thyroglobulin content to predict metastatic involvement were 2.5 ng/ml (94% sensitive, 100% specific), 0.1 (100% sensitive and specific), and 12.5 (94% sensitive, 100% specific), respectively. The second measure lacked utility in patients with undetectable serum thyroglobulin. CONCLUSION The use of thyroglobulin washout concentration or thyroglobulin washout/serum thyroglobulin ratio has drawbacks based on variations in technique and clinical scenario. Absolute thyroglobulin content is an alternative that may be a more objective expression of thyroglobulin washout.
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Affiliation(s)
- Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, OH; Department of General Surgery, Cleveland Clinic Florida, Weston, FL
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | | | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, OH.
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