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Shah Y, Gandhi S. A Prospective Study of Comparison Between Fine Needle Aspiration Cytology (FNAC) with Histopathological Diagnosis (HPE) in Neck Masses. Indian J Otolaryngol Head Neck Surg 2023; 75:1447-1453. [PMID: 37636617 PMCID: PMC10447841 DOI: 10.1007/s12070-022-03461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/29/2022] [Indexed: 02/27/2023] Open
Abstract
Background FNAC is easy to perform, is minimally invasive and is economical. It has better patient compliance and the cytological diagnosis can be made before any definitive treatment is planned. Materials and methods This prospective study was carried out in a tertiary care hospital of a medical college having 100 cases in study. The statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value. Result On cytological examination, 94/100 were benign, 6 malignant or suspicious. On HPE, 92 were benign while 5 malignant from suspicious and malignant cases leaving 3 discordant cases. Sensitivity, specificity, positive predictive value, negative predictive value which was 71.4%, 98.9%, 83.3%,97.8% respectively in our case series. Conclusion FNAC is a safe, simple procedure. It gives a reliable pre-operative cytological diagnosis based on which surgical procedures or conservative management can be confidently executed. An attempt is made hereby to compare our results with worldwide documented literature. However pitfalls of this method should be kept in mind with careful observation and adequate clinical suspicion.
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Affiliation(s)
- Yesha Shah
- Department of ENT, SVP Hospital, NHL Municipal Medical College, Ashram Road, 380006, Ahmedabad, Gujarat, India
| | - Saurabh Gandhi
- Department of ENT, SVP Hospital, NHL Municipal Medical College, Ashram Road, 380006, Ahmedabad, Gujarat, India
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2
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Amoedo MK, Tyng CJ, Barbosa PNVP, de Melo RAB, Almeida MFA, Chojniak R, Bitencourt AGV. Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications. Radiol Bras 2021; 54:295-302. [PMID: 34602664 PMCID: PMC8475163 DOI: 10.1590/0100-3984.2020.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 01/24/2023] Open
Abstract
Objective To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.
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Affiliation(s)
| | - Chiang Jeng Tyng
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | - Rubens Chojniak
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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4
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Ultrasound core biopsies of neck lumps: an experience from a tertiary head and neck cancer unit. The Journal of Laryngology & Otology 2021; 135:799-803. [PMID: 34266504 DOI: 10.1017/s0022215121001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Traditionally, fine needle aspiration cytology was the primary diagnostic investigation for head and neck lumps; however, ultrasound-guided core biopsy offers the advantage of preserving tissue architecture with increased tissue yield. This study reviews the diagnostic utility of ultrasound-guided core biopsy for investigating head and neck lumps. METHODS Overall, 287 ultrasound-guided core biopsies were reviewed between May 2017 and April 2019 at a single tertiary site for head and neck cancer. RESULTS On initial ultrasound-guided core biopsy, a diagnostic sample was obtained in 94.4 per cent of patients and in 83.7 per cent of patients with lymphoma. Where the initial ultrasound-guided core biopsy was non-diagnostic, 50 per cent of samples were diagnostic on repeat ultrasound-guided core biopsy. Overall, five complications were seen related to ultrasound-guided core biopsy, and all were managed conservatively. No cases of disease recurrence were identified at the biopsy site. CONCLUSION Ultrasound-guided core biopsy is a safe procedure with a high diagnostic yield when investigating head and neck lumps. Patients whose ultrasound-guided core biopsies were non-diagnostic should be considered for excisional biopsy over repeat ultrasound-guided core biopsy.
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5
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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6
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Soumya, Whitehorn A, Ooi EH, Lockwood C. Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of neoplasm in patients with suspected head and neck cancers: a systematic review protocol of diagnostic test accuracy. JBI Evid Synth 2020; 18:1602-1608. [PMID: 32813401 DOI: 10.11124/jbisrir-d-19-00225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this review is to determine the difference in diagnostic accuracy of core needle biopsy and fine needle aspiration for patients with a head and neck mass using surgical histopathology as a reference test. The risks and adverse events associated with each technique will also be compared. INTRODUCTION Tissue diagnosis is critical in evaluation of head and neck lesions to guide management. Options for tissue biopsy include surgical biopsy, fine needle aspiration and core needle biopsy. INCLUSION CRITERIA Studies that compare ultrasound-guided core needle biopsy and/or fine needle aspiration to investigate lumps in the thyroid, cervical lymph nodes, or salivary glands for malignancy in adult patients will be included. The comparator test will be definitive histology in form of surgical biopsy/excision. METHODS MEDLINE, Emcare, Embase, Web of Science and Cochrane Register of Diagnostic Accuracy Studies will be searched. Studies will be critically appraised by two independent reviewers for methodological quality, using the modified critical appraisal instrument QUADAS-2 and JBI SUMARI software. Two independent reviewers will extract data from papers included in the review using the standardized data extraction tool available in the JBI Reviewer's Manual. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020140005.
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Affiliation(s)
- Soumya
- 1Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Australia 2JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 3Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia 4Department of Surgery, Flinders University, Bedford Park, Australia
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7
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Wilczynski A, Görg C, Timmesfeld N, Ramaswamy A, Neubauer A, Burchert A, Trenker C. Value and Diagnostic Accuracy of Ultrasound-Guided Full Core Needle Biopsy in the Diagnosis of Lymphadenopathy: A Retrospective Evaluation of 793 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:559-567. [PMID: 31584214 DOI: 10.1002/jum.15134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Whole surgical lymph node excision (SNE) is considered the standard diagnostic method in the primary diagnosis of lymphadenopathy (LA) suspected of malignancy. Ultrasound-guided full core needle biopsy (UFCNB) offers an alternative method to SNE. This study examined the accuracy of UFCNB in the diagnosis of unexplained LA in 793 cases. METHODS From January 2006 to June 2015, a total of 793 cases of LA of unknown origin received a UFCNB. The lymph nodes were located peripherally (68%) or abdominally (32%). The final diagnoses from histopathologic examinations were non-Hodgkin lymphoma (n = 245), Hodgkin lymphoma (n = 53), solid nonlymphocytic lymph node metastases (n = 359), and benign LA (n = 136). The results of the biopsies were retrospectively evaluated with regard to sensitivity, specificity, and diagnostic accuracy. RESULTS In the total collective of 793 biopsies, the sensitivity of UFCNB was 94.4%; the specificity was 97.8%; and the diagnostic accuracy was 95.0%. In the subgroups, the following results were obtained: non-Hodgkin lymphoma (sensitivity, 97.2%), Hodgkin lymphoma (sensitivity, 88.7%), metastases (sensitivity, 93.3%), and benign LA (specificity, 97.8%). In 17 cases (2.2%), an additional rebiopsy of the lymph node was needed, and in 85 cases (10.7%), an additional SNE was performed. CONCLUSIONS Due to the diagnostic accuracy of 95.0% in the total collective, UFCNB seems to be an alternative diagnostic procedure to the standard procedure of SNE for LA of unknown origin. A prospective comparative study to definitively clarify the diagnostic value of UFCNB compared to SNE in the unexplained LA is warranted.
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Affiliation(s)
- Alexandra Wilczynski
- Department of Internal Medicine, Divisions of Gastroenterology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Christian Görg
- Department of Internal Medicine, Divisions of Gastroenterology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Nina Timmesfeld
- Institute for Medical Biometry and Epidemiology, Bochum, Germany
| | - Annette Ramaswamy
- Department of Pathology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Corinna Trenker
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
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8
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Wagner JM, Monfore N, McCullough AJ, Zhao L, Conrad RD, Krempl GA, Alleman AM. Ultrasound-Guided Fine-Needle Aspiration With Optional Core Needle Biopsy of Head and Neck Lymph Nodes and Masses: Comparison of Diagnostic Performance in Treated Squamous Cell Cancer Versus All Other Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2275-2284. [PMID: 30593702 DOI: 10.1002/jum.14918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of ultrasound (US)-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses, with attention to differences between biopsy of treated squamous cell carcinoma (SCC) and biopsy of other lesions. METHODS Institutional Review Board approval was obtained, and the need for consent was waived for this retrospective study. All 861 US-guided biopsies of head and neck lymph nodes and masses performed between March 1, 2012, and May 16, 2016, were reviewed. RESULTS Of the 861 biopsies, 53 targeted SCC with residual masses after treatment. The biopsy procedures yielded benign or malignant pathologic results in 71.7% (38 of 53) of treated SCC and 90.7% (733 of 808) of all other lesions (P < .001). A reference standard based on subsequent pathologic results or clinical and imaging follow-up was established in 68.4% of procedures. In cases with benign or malignant biopsy results and a subsequent reference standard, the sensitivity values for malignancy were 87.5% (95% confidence interval, 64.0%-96.5%) in treated SCC and 98.3% (95% confidence interval, 96.0%-99.3%) in all other cases (P = .047), and the specificity values were 63.6% (95% confidence interval, 35.4%-84.8%) in treated SCC and 99.5% (95% confidence interval, 97.3%-99.9%) in all other cases (P < .001). There were no major complications related to the biopsy procedures. CONCLUSIONS Excluding treated SCC, US-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses has excellent diagnostic performance. Needle biopsy of head and neck SCC with a residual mass after therapy has a high rate of nondiagnostic samples, suboptimal sensitivity, and poor specificity.
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Affiliation(s)
- Jason M Wagner
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Natosha Monfore
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Austin J McCullough
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lichao Zhao
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dr Zhao is now affiliated with Pathology and Laboratory Medicine Services, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Rachel D Conrad
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Greg A Krempl
- Departments of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Anthony M Alleman
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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9
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Crous H, Gillam A, Kalokerinos M, Knezevic S, Hobson P, Papadimos DJ, Shield PW. Investigation of lymphoid lesions of the head and neck using combined fine needle aspiration cytology and flow cytometry: Accuracy and pitfalls. Cytopathology 2019; 30:370-377. [DOI: 10.1111/cyt.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Crous
- Cytology Department Sullivan Nicolaides Pathology Bowen Hills Queensland Australia
- Faculty of Health School of Biomedical Sciences Queensland University of Technology Brisbane Queensland Australia
| | - Amanda Gillam
- Immunology Department Sullivan Nicolaides Pathology Bowen Hills Queensland
| | | | - Sasenka Knezevic
- Immunology Department Sullivan Nicolaides Pathology Bowen Hills Queensland
| | - Peter Hobson
- Immunology Department Sullivan Nicolaides Pathology Bowen Hills Queensland
| | - David J Papadimos
- Cytology Department Sullivan Nicolaides Pathology Bowen Hills Queensland Australia
| | - Paul W Shield
- Cytology Department Sullivan Nicolaides Pathology Bowen Hills Queensland Australia
- Faculty of Health School of Biomedical Sciences Queensland University of Technology Brisbane Queensland Australia
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10
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Campanelli M, Cabry F, Marasca R, Gelmini R. Peripheral lymphadenopathy: role of excisional biopsy in differential diagnosis based on a five-year experience. MINERVA CHIR 2019; 74:218-223. [DOI: 10.23736/s0026-4733.18.07752-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kühnl A, Cunningham D, Hutka M, Peckitt C, Rozati H, Morano F, Chong I, Gillbanks A, Wotherspoon A, Harris M, Murray T, Chau I. Rapid access clinic for unexplained lymphadenopathy and suspected malignancy: prospective analysis of 1000 patients. BMC HEMATOLOGY 2018; 18:19. [PMID: 30128155 PMCID: PMC6092787 DOI: 10.1186/s12878-018-0109-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 06/25/2018] [Indexed: 11/25/2022]
Abstract
Background In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care. Methods We analyzed a large dataset of 1000 consecutive patients with unexplained lymphadenopathy referred between 2001 and 2009 to the Royal Marsden Hospital (RMH) rapid access lymph node diagnostic clinic (LNDC). Results Cancer was diagnosed in 14% of patients. Factors predictive for malignant disease were male sex, age, supraclavicular and multiple site involvement. Cancer-associated symptoms were present for a median of 8 weeks. The median time from referral to start of cancer therapy was 53 days. Fine needle aspiration (FNA) was performed in 83% of patients with malignancies. Sensitivity and specificity of FNA were limited (50 and 87%, respectively for any malignancy; 30 and 79%, respectively for lymphoma). The vast majority of cancer patients received diagnostic biopsies on the basis of suspicious clinical and ultrasound findings; the FNA result contributed to establishing the diagnosis in only 4 cases. Conclusions In conclusion, we demonstrate that Oncologist-led rapid access clinics are successful concepts to assess patients with unexplained lymphadenopathy. Our data suggest that a routine use of FNA should be reconsidered in this setting. Electronic supplementary material The online version of this article (10.1186/s12878-018-0109-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Kühnl
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - David Cunningham
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Margaret Hutka
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Clare Peckitt
- 2Department of Computing, Royal Marsden NHS Foundation Trust, London, Surrey UK
| | - Hamoun Rozati
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Federica Morano
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Irene Chong
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Angela Gillbanks
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Andrew Wotherspoon
- 3Department of Histopathology, Royal Marsden NHS Foundation Trust, London, Surrey UK
| | - Michelle Harris
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Tracey Murray
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Ian Chau
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
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12
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Sinnott JD, Mortimer R, Smith J, Skelton E, Drinkwater K, Lipscomb D, Howlett DC. The effect of routine radiological reporting of thyroid incidentalomas on rates of thyroid needle biopsy, thyroid surgery and detection of thyroid malignancy. Clin Endocrinol (Oxf) 2017; 87:825-831. [PMID: 28718944 DOI: 10.1111/cen.13424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study looked at the effect of a changing radiology reporting policy to routinely review the thyroid gland where visible and report on any thyroid lesion, recommending further investigation as appropriate. CONTEXT Incidentaloma is a term used to describe a lesion found on imaging unrelated to the clinical issue under investigation. There is variability in the radiological reporting of thyroid incidentalomas and conflicting recommendations as to how these lesions should be managed. DESIGN Data were collected retrospectively during a two-year period, including 12 months before and 12 months after the change in reporting policy and categorized according to whether the lesion under investigation was a thyroid incidentaloma or a symptomatic thyroid lesion. PATIENTS All patients undergoing ultrasound-guided fine-needle aspiration cytology or core biopsy were included. MEASUREMENTS The effects of the change in policy were analysed including rates of needle biopsy, rates of malignancy and subsequent surgical intervention. RESULTS There was a 122% increase in thyroid incidentalomas undergoing needle biopsy, the majority of these were detected on computed tomography. The number of malignancies increased from 1 to 4 from year 1 to year 2. All patients were >35 years old. One patient had a positron emission tomography (PET)-detected cancer, two of four of the non-PET-detected malignancies were <1.5 cm. CONCLUSION This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.
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Affiliation(s)
- J D Sinnott
- Department of ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - R Mortimer
- Department of Accident and Emergency, Eastbourne District General Hospital, Eastbourne, UK
| | - J Smith
- Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Eastbourne, UK
| | - E Skelton
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK
| | - K Drinkwater
- Audit Officer, Royal College of Radiologists, London, UK
| | - D Lipscomb
- Department of Endocrinology, Eastbourne District General Hospital, Eastbourne, UK
| | - D C Howlett
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK
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13
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Lo WC, Cheng PW, Shueng PW, Hsieh CH, Chang YL, Liao LJ. A real-time prediction model for post-irradiation malignant cervical lymph nodes. Clin Otolaryngol 2017; 43:477-482. [PMID: 28981204 DOI: 10.1111/coa.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish a real-time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation. METHODS One-hundred forty-four irradiation-treated patients underwent ultrasonography and ultrasound-guided fine-needle aspirations (USgFNAs), and the resultant data were used to construct a real-time and computerised predictive scoring model. This scoring system was further compared with our previously proposed prediction model. RESULTS A predictive scoring model, 1.35 × (L axis) + 2.03 × (S axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) were 0.89 and 0.81, respectively (P < .05). CONCLUSIONS A real-time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.
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Affiliation(s)
- W-C Lo
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-H Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y-L Chang
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-J Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Carter MD, Moore DP, MacIntosh RF, Bullock MJ. Impact of routine cell block preparation on results of head and neck fine needle aspirates. Diagn Cytopathol 2016; 44:880-887. [DOI: 10.1002/dc.23597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Michael D. Carter
- Department of Pathology and Laboratory Medicine; QE II Health Sciences; Halifax Nova Scotia Canada
| | - David P. Moore
- Department of Pathology and Laboratory Medicine; QE II Health Sciences; Halifax Nova Scotia Canada
| | - Rebecca F. MacIntosh
- Department of Pathology and Laboratory Medicine; QE II Health Sciences; Halifax Nova Scotia Canada
| | - Martin J. Bullock
- Department of Pathology and Laboratory Medicine; QE II Health Sciences; Halifax Nova Scotia Canada
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15
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Tirelli G, Cova MA, Zanconati F, Makuc E, Bonazza D, Tofanelli M, Di Lenarda R, Gardenal N. Charcoal suspension tattoo: new tool for the localization of malignant laterocervical lymph nodes. Eur Arch Otorhinolaryngol 2016; 273:3973-3978. [PMID: 27142619 DOI: 10.1007/s00405-016-4075-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/27/2016] [Indexed: 02/03/2023]
Abstract
We present a retrospective study to evaluate safety and effectiveness of ultrasound (US)-guided tattooing with charcoal of suspicious laterocervical lymph nodes. When an open biopsy of a laterocervical lymph node is needed, the choice of the lymph node to excise and examine is fundamental to avoid rebiopsy. Surgeons tend to choose the most surgical approachable enlarged lymph node that does not always correspond to the one with worst echographic aspect. We present 16 cases of patients with laterocervical adenopathy with inconclusive or non-adequate results at fine needle aspiration cytology addressed to open biopsy. Those patients underwent US-guided preoperative injection of a charcoal suspension inside the lymph node to excise to mark it, and then excisional biopsy was performed. Sixteen marked lesions (100 %) were detected intraoperatively and dissected. The injected charcoal was detected intraoperatively in all cases. In 14 patients (87, 5 %) it was inside the lesion; in two cases (12, 5 %), the charcoal suspension was found in the tissues above the lesion. The procedure was well tolerated in all cases. No major procedure-related complications were encountered. US-guided charcoal tattooing is a new, safe, well-tolerated, and easy-to-perform technique for the marking of US suspicious laterocervical lymph nodes. This preliminary study shows a high technical success rate (76 %) and high percentage of intraoperative detection of marked lesions (100 %) with a low rate of complications.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - M A Cova
- Department of Radiology, University of Trieste, Trieste, Italy
| | - F Zanconati
- Clinical Unit of Pathological Anatomy and Histology, Department of Medical Science, University of Trieste, Trieste, Italy
| | - E Makuc
- Department of Radiology, University of Trieste, Trieste, Italy
| | - D Bonazza
- Clinical Unit of Pathological Anatomy and Histology, Department of Medical Science, University of Trieste, Trieste, Italy
| | - M Tofanelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - R Di Lenarda
- Division of Oral Medicine and Pathology, University of Trieste, Trieste, Italy
| | - N Gardenal
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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16
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Rajkovaca Z, Gajanin R, Pavkovic I, Kovacevic P, Kovacevic T. A CASE OF RIEDEL'S THYROIDITIS. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:339-343. [PMID: 31149111 DOI: 10.4183/aeb.2016.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Riedel thyroiditis is a rare, chronic inflammatory disease of the thyroid, characterized by a dense fibrosis that replaces normal thyroid parenchyma. In literature descriptions of individual cases of Riedel thyroiditis can be found. Case report We present an euthyroid patient with multinodular goiter who was diagnosed with Riedel thyroiditis using pathology. Imaging diagnostic methods (Ultrasonography, X-ray computed tomography, Magnetic resonance imaging, Radionuclide imaging) or various tests of thyroid function cannot confirm the diagnosis of Riedel thyroiditis. Conclusion Only level of IgG4 may be helpful for the diagnosis of Riedel thyroiditis, while pathology is used for its definitive confirmation.
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Affiliation(s)
- Z Rajkovaca
- University Hospital Clinical Center Banja Luka - Department of Nuclear Medicine and Thyroid Gland Disease, Banja Luka, Bosnia and Herzegovina
| | - R Gajanin
- University Hospital Clinical Center Banja Luka - Institute of Pathology, Banja Luka, Bosnia and Herzegovina
| | - I Pavkovic
- University Hospital Clinical Center Banja Luka - Department of Nuclear Medicine and Thyroid Gland Disease, Banja Luka, Bosnia and Herzegovina
| | - P Kovacevic
- University Hospital Clinical Center Banja Luka - Department of Intensive Care Medicine, Banja Luka, Bosnia and Herzegovina
| | - T Kovacevic
- University Hospital Clinical Center Banja Luka - Department of Medical Supplies and Pharmacy KC, Banja Luka, Bosnia and Herzegovina
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Fernandes VT, De Santis RJ, Enepekides DJ, Higgins KM. Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study. J Otolaryngol Head Neck Surg 2015; 44:42. [PMID: 26510834 PMCID: PMC4625451 DOI: 10.1186/s40463-015-0099-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice. Methods UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test. Results In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ2 = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0 %. Conclusions Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon’s office.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
| | - Robert J De Santis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
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18
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Mohammed Nur M, Murphy M. Adequacy and accuracy of salivary gland fine needle aspiration cytology. Ir J Med Sci 2015; 185:711-716. [DOI: 10.1007/s11845-015-1352-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/30/2015] [Indexed: 10/23/2022]
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Fernandes VT, Magarey MJR, Kamdar DP, Freeman JL. Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center. Head Neck 2015; 38 Suppl 1:E1281-4. [PMID: 26316053 DOI: 10.1002/hed.24212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/12/2015] [Accepted: 07/11/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates. METHODS Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy. RESULTS One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001). CONCLUSION Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Dev P Kamdar
- Hofstra North Shore - LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Jeremy L Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
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20
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Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls. The Journal of Laryngology & Otology 2015; 129:682-7. [DOI: 10.1017/s0022215115000092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study aimed to examine the performance of head and neck cytology at Nottingham University Hospitals between 2009 and 2010.Methods:Cases were extracted from the Winpath pathology reporting system and correlations were investigated between results and the histological and clinical outcomes. Specimen adequacy and the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the cytology tests were calculated.Results:In all, 19.7 per cent of aspirates were judged to be inadequate. The absolute and relative sensitivities of head and neck cytology were 87.0 per cent and 89.0 per cent, respectively, and the absolute and relative specificities were 99.0 per cent and 97.0 per cent, respectively. The positive predictive values were 99.0 per cent and 96.0 per cent and the negative predictive values were 92.0 per cent and 92.0 per cent for a diagnostic accuracy of 94.5 per cent and 93.0 per cent. The performance was consistent with previous reports and superior to that of a recent UK series. The high rate of inadequate samples is, however, a concern.Conclusion:Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.
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21
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Howlett DC, Skelton E, Moody AB. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section. Br J Oral Maxillofac Surg 2015; 53:580-3. [PMID: 25886878 DOI: 10.1016/j.bjoms.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022]
Abstract
The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic.
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Affiliation(s)
- D C Howlett
- Eastbourne District General Hospital, United Kingdom
| | - E Skelton
- Eastbourne District General Hospital, United Kingdom.
| | - A B Moody
- Eastbourne District General Hospital, United Kingdom
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22
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Sharma SD, Kumar G, Horsburgh A, Huq M, Alkilani R, Chawda S, Kaddour H. Do Immediate Cytology and Specialist Radiologists Improve the Adequacy of Ultrasound-Guided Fine-Needle Aspiration Cytology? Otolaryngol Head Neck Surg 2014; 152:292-6. [DOI: 10.1177/0194599814561204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess whether a dedicated “1-stop” neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC. Study Design Retrospective review. Setting District General Hospital in the United Kingdom. Subjects and Methods Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125). Results There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005). Conclusion Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non–cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.
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Affiliation(s)
- Sunil Dutt Sharma
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Gaurav Kumar
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Avril Horsburgh
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Mahmuda Huq
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Raed Alkilani
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Sanjiv Chawda
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Hesham Kaddour
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
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23
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Henrys CE, Grigg R. Use of fine-needle aspiration cytology in the diagnosis of parotid neoplasms. ANZ J Surg 2014; 85:838-42. [DOI: 10.1111/ans.12939] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Courtenay E. Henrys
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Roger Grigg
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Yang TL, Chen CN. Optimizing Clinical Utility of the Ultrasound-guided Core Biopsy for Head and Neck Tumor. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schmidt RL, Jedrzkiewicz JD, Allred RJ, Matsuoka S, Witt BL. Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis. Head Neck 2014; 36:1654-61. [PMID: 24114985 DOI: 10.1002/hed.23495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias. METHODS We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias. RESULTS We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies. CONCLUSION Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.
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Affiliation(s)
- Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah
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Baloch Z, Bubendorf L, Bedrossian CWM. There is more than meet the eyes in head and neck cytopathology. Diagn Cytopathol 2014; 42:1-4. [PMID: 24376170 DOI: 10.1002/dc.23089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Breeze J, Poller DN, Gibson D, Tilley EA, Cooke L, Soar E, Repanos C. Rapid on-site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology. Cytopathology 2013; 25:316-21. [PMID: 24138590 DOI: 10.1111/cyt.12106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Immediate rapid on-site assessment (ROSA) of fine needle aspiration cytology (FNAC) specimens by biomedical scientists (BMS), the UK equivalent of cytotechnologists, or by pathologists may improve specimen quality and cellular adequacy rates for lymph node, head and neck and thyroid FNAC. The aim of this study was to evaluate the effect of introducing ROSA by BMS in an outpatient clinic setting. METHODS The adequacy rate and sensitivity of histological diagnosis for lymph node, thyroid and salivary gland FNAC samples were determined before and after the introduction of BMS ROSA. The additional financial costs and time required to perform this service were also estimated. RESULTS Thirty-one patients underwent ultrasound (US)-guided FNAC with ROSA and 151 without. ROSA reduced the number of FNAC insufficient in quality for diagnosis from 43% to 19% (P = 0.0194). The estimated additional cost for pathology per patient for ROSA was between £52.05 and £70.74, equivalent to €65.40/US $83.90 and €88.89/US $114.0, respectively, an increase of between 28% and 49% from the original cost. ROSA necessitated an additional 6 minutes clinic time per patient, reducing the number of patients that could be seen in an average clinic from 13 to 10 as well as requiring increased laboratory time for FNAC slide assessment. CONCLUSION ROSA by suitably trained biomedical scientists and with appropriate consultant pathologist support can improve the quality of FNAC sampling for head and neck lesions. Although ROSA resulted in both additional financial and time costs, these are more than likely to be offset by a reduction in patients returning to clinic for repeat FNAC or undergoing unnecessary surgery.
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Affiliation(s)
- J Breeze
- Department of Ear Nose and Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Neck lump clinics: is on-site assessment of fine needle aspirate diagnostic adequacy cost-effective? The Journal of Laryngology & Otology 2013; 127:1122-6. [PMID: 24131944 DOI: 10.1017/s0022215113002272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy). METHOD The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment. RESULTS Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit. CONCLUSION In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.
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Akhavan-Moghadam J, Afaaghi M, Maleki AR, Saburi A. Fine needle aspiration: an atraumatic method to diagnose head and neck masses. Trauma Mon 2013; 18:117-21. [PMID: 24350168 PMCID: PMC3864395 DOI: 10.5812/traumamon.10541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 02/18/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
Background Patients presenting with a mass require tissue biopsy for histological diagnosis and treatment. Fine needle aspiration (FNA) is offered as an atraumatic, well tolerated, and inexpensive method for obtaining a biopsy from these lesions. Objectives In this study we evaluated the accuracy of FNA as an atraumatic method among patients with nonthyroidal masses for diagnosis of neoplastic masses compared to open surgery. Patients and Methods In a cross-sectional study, 65 patients with a head and neck masses (nonthyroidal) referred to us from 2004 to 2009. Those who had both FNA and open biopsy (the gold standard) were assessed for specificity, sensitivity, positive and negative predictive values of FNA in diagnoses. Results Sixty-five cases with both definite diagnoses of open biopsy and FNA were assessed. The mean (± standard deviation) age of patients was 39.96 ± 19.69 years (range 10 to 82 years). Twenty-five (40.8%) subjects were categorized as malignant neoplasms, 16 (19.4%) as benign neoplasms, and 24 (39.8%) as non-neoplastic lesions. The sensitivity, specificity, positive and also negative predictive values of FNA in the diagnosis of neoplastic masses were 95%, 85%, 92.68%, and 91.66% respectively, and the diagnostic accuracy was 92.3%. Conclusions It seems that FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses.
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Affiliation(s)
- Jamal Akhavan-Moghadam
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahdi Afaaghi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ali Reza Maleki
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Amin Saburi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
- Corresponding author: Amin Saburi, Health Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Av., Vanak Sq., Tehran, IR Iran. Tel./Fax: +98-2188600067, E-mail:
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Cutting cancer waiting times: streamlining cervical lymph node biopsy. The Journal of Laryngology & Otology 2013; 127:1007-11. [PMID: 24074011 DOI: 10.1017/s0022215113002004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with enlarged lymph nodes present to a number of different specialties and diagnosis is often made following a biopsy. OBJECTIVE This study aimed to establish department waiting times for cervical lymph node biopsy, and compare these to the cancer services guidelines. METHODS A retrospective audit was carried out to record patient waiting times (defined as the number of days from referral to biopsy) between May and December 2010. A proforma for referral was introduced. In addition, appointments for biopsies were arranged by a co-ordinator. A prospective re-audit was carried out from March to September 2011. RESULTS The first audit showed that national guidelines were not met; there was a median waiting time of 74 days (interquartile range, 47-113). Re-audit demonstrated a significant reduction in waiting times using the proforma; the median waiting time had decreased to 18 days (interquartile range, 9-22). CONCLUSION A proforma for lymph node biopsy and a designated co-ordinator streamlined the service, significantly reducing waiting times. Together, these can aid referral for meeting guidelines and improve patient care.
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Choudhury N, Hassen Y, Siddiqui J, Falzon A, Ghufoor K. A multidisciplinary audit of head and neck referrals: considerations for patients' timelines and outcomes. Eur Arch Otorhinolaryngol 2013; 270:3121-6. [PMID: 23536138 DOI: 10.1007/s00405-013-2453-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
Abstract
The Rapid Diagnostic Clinic (RDC) was introduced to comply with NICE recommendations for improving head and neck cancer services (National Institute of Clinical Excellence 2004 Improving outcomes in head and neck cancer: the manual. NICE, London). It provides multi-modality specialist assessment for new referrals, with on-site sonography and cytology. We have critically appraised the efficacy of our RDC, with respect to its impact on patients' timelines and outcomes. A retrospective audit of new referrals to the head and neck clinic during a 6-month period was conducted (pre-RDC period); areas in delay in patients reaching a definitive outcome were identified. Following implementation of the RDC, a second cycle, prospective audit was performed and its impact on timelines for patients' journey and outcomes determined. One hundred and ninety-seven patients were seen during the pre-RDC period. The average time from referral to being seen was 11 days for 2-week wait (2WW) referrals and 34 days for other sources. During the RDC period, 299 patients were seen in total. The average waiting time was reduced to 9 days for 2WW referrals and 23 days for other referrals. During the RDC period, over one-third of patients utilised the provision of ultrasound ± FNAC, and consequently, the majority reached a definitive outcome (discharged or scheduled for surgery) following their first consultation. This was a significant improvement compared to the pre-RDC period, where the main outcome was referral for an investigation, with consequently longer waiting time for surgery. We report the first study to consider the effect of a 'one-stop' clinic on patients' journey timelines and outcomes. Our study has shown that the RDC provides an efficient and effective system, which facilitates the patients' pathway to a definitive management plan.
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Wu EH, Chen YL, Wu YM, Huang YT, Wong HF, Ng SH. CT-guided core needle biopsy of deep suprahyoid head and neck lesions. Korean J Radiol 2013; 14:299-306. [PMID: 23482651 PMCID: PMC3590344 DOI: 10.3348/kjr.2013.14.2.299] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 05/16/2012] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the efficacy of computer tomography (CT)-guided core needle biopsy (CNB) in the diagnosis of deep suprahyoid lesions in patients with treated head and neck cancers. Materials and Methods Between December, 2003 and May, 2011, 28 CT-guided CNBs were performed in 28 patients with deep suprahyoid head and neck lesions. All patients had undergone treatment for head and neck cancers. Subzygomatic, paramaxillary, and retromandibular approaches were used. The surgical results, response to treatment, and clinical follow-up were used as the diagnostic reference standards. Results All biopsies yielded adequate specimens for definitive histological diagnoses. A specimen from a right parapharyngeal lesion showed atypia, which was deemed a false negative diagnosis. Diagnostic accuracy was 27/28 (96.4%). Two minor complications were encountered: a local hematoma and transient facial palsy. Between the 18 or 20 gauge biopsy needles, there was no statistical difference in the diagnostic results. Conclusion CT-guided core needle biopsy, with infrequent and minor complications, is an accurate and efficient method for the histological diagnosis of deep suprahyoid lesions in post-treated head and neck cancer patients. This procedure can preclude an unnecessary surgical intervention, especially in patients with head and neck cancers.
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Affiliation(s)
- En-Haw Wu
- Department of Medical Imaging and Internvetion, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Al Hamarneh O, Liew L, Shortridge RJ. Diagnostic yield of a one-stop neck lump clinic. Eur Arch Otorhinolaryngol 2012; 270:1711-4. [DOI: 10.1007/s00405-012-2197-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
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Herd M, Woods M, Anand R, Habib A, Brennan P. Lymphoma presenting in the neck: current concepts in diagnosis. Br J Oral Maxillofac Surg 2012; 50:309-13. [DOI: 10.1016/j.bjoms.2011.03.263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/31/2011] [Indexed: 12/13/2022]
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Mistry SG, Mani N, Murthy P. Investigating the value of fine needle aspiration cytology in thyroid cancer. J Cytol 2011; 28:185-90. [PMID: 22090693 PMCID: PMC3214464 DOI: 10.4103/0970-9371.86345] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Current guidance recommends the use of fine needle aspiration cytology (FNAC) as an essential investigation in patients presenting with a thyroid lump. Current literature suggests that the sensitivity of FNAC in thyroid nodules ranges between 80-90%. However, only very few studies have looked specifically at the sensitivity of FNAC in solely thyroid cancer patients. Aims: The aim of our study was to investigate the value of FNAC as a first-line investigation in patients with thyroid cancer. We aimed specifically to assess the sensitivity of FNAC within this group. Materials and Methods: Patients diagnosed with thyroid cancer between 2000-08 were identified from a local histopathology database. Sixty-seven case notes were retrieved, retrospectively reviewed and analyzed. Analysis included results of FNAC, ultrasound scanning and final histopathological diagnosis. Results: Analysis of the 56 patients who underwent FNAC revealed that a cytological grading of thy3 or greater was only given to 31 cases (55.3%). Conclusion: In this study, FNAC findings of thy3 or greater were reported only in 55.3% of proven thyroid cancer cases. This study highlights the greater diagnostic difficulties of thyroid cancer compared to other thyroid nodules. Our findings suggest that clinicians must interpret the results of this initial investigation with caution and consider the routine use of ultrasound scanning to help guide FNAC.
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Affiliation(s)
- Sandeep G Mistry
- Department of Otolaryngology, Royal Albert Edward Infirmary, Wigan, UK
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Hafez NH, Tahoun NS. Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy. J Egypt Natl Canc Inst 2011; 23:105-14. [PMID: 22776815 DOI: 10.1016/j.jnci.2011.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this work is to evaluate the reliability and diagnostic accuracy of fine needle aspiration cytology (FNAC) of cervical lymph nodes with an emphasis on discordant cases between the cytology and the histopathology. PATIENTS AND METHODS This retrospective study was conducted on 157 selected patients with cervical lymphadenopathy that had undergone FNAC. Cervical nodal enlargement was the first clinical manifestation of the patients in all cases. Hypocelluar slides were excluded from the current study. The cytopathological diagnoses were compared with the histopathological results of the same excised nodes. For all discordant cases, special attention was focused on the cytomorphological features. Diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and discordance rate were calculated. RESULTS The cytological diagnoses were found to be benign in 48 cases (30.6%) and malignant in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2% (129/157), while the overall discordance rate was 17.8% (28/157). The diagnostic accuracy of reactive lymphoid hyperplasia, chronic necrotizing lymphadenitis, chronic granulomatous lymphadenitis, metastatic carcinoma, Hodgkin lymphoma, and Non Hodgkin lymphoma was 85%, 83.3%, 70%, 100%, 77.8%, and 75%, respectively. CONCLUSION The overall diagnostic accuracy of FNAC of cervical lymph nodes was 82.2% while the overall discordance rate was 17.8%. The evaluation of FNA in patients with no previously diagnosed malignancy should be interpreted by an experienced cytopathologist in the context of clinical, radiological, and laboratory finding and if any of these findings is suspicious, further investigation is justified to overcome the limitations and pitfalls of the cytomorphological features when applied alone.
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Affiliation(s)
- Nesreen H Hafez
- Department of Pathology, Cytopathology Unit, National Cancer Institute (NCI), Cairo University, Egypt.
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Schmidt RL, Hall BJ, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle biopsy for salivary gland lesions. Am J Clin Pathol 2011; 136:516-26. [PMID: 21917673 DOI: 10.1309/ajcp5ltq4rvoqait] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Core needle biopsy (CNB) of salivary gland lesions is a relatively new technique that may offer benefits for diagnosis of the lesions. We conducted a systematic literature review to identify studies published between January 1, 1985, and March 15, 2011. Summary estimates of sensitivity and specificity were obtained by using a summary receiver-operating characteristic (SROC) curve. Study quality was assessed by using the QUADAS survey. We identified 5 studies (277 cases) for inclusion. The area under the SROC for CNB was 1.00 (95% confidence interval [CI], 0.99-1.00). Based on histologically verified cases, the sensitivity of CNB is 0.92 (95% CI, 0.77-0.98) and the specificity is 1.00 (95% CI, 0.76-1.00). We conclude that CNB has high accuracy and a low (1.2%) inadequacy rate. CNB is more accurate than fine-needle aspiration, at least in some settings, but the best selection of which test to use for an individual patient and setting remains to be defined.
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Affiliation(s)
| | - Brian J. Hall
- Department of Pathology, University of Utah, Salt Lake City
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Yom SS, Garden AS, Staerkel GA, Ginsberg LE, Morrison WH, Sturgis EM, Rosenthal DI, Myers JN, Edeiken-Monroe BS. Sonographic examination of the neck after definitive radiotherapy for node-positive oropharyngeal cancer. AJNR Am J Neuroradiol 2011; 32:1532-8. [PMID: 21757532 DOI: 10.3174/ajnr.a2545] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiographic determination of viable disease in cervical adenopathy following RT for head and neck cancer can be challenging. The purpose of this study was to evaluate the utility of US, with or without FNA, in regard to the postradiotherapy effects on documented metastatic adenopathy in patients with oropharyngeal cancer. MATERIALS AND METHODS This study included 133 patients with node-positive oropharyngeal cancer who were irradiated from 1998 to 2004. Sonographic evaluation was performed within 6 months of completion of radiation. Posttreatment US results were compared with pretreatment CT images and were recorded as the following: progression, suspicious, indeterminate, posttreatment change, or regression (positive) versus nonsuspicious or benign (negative). FNAC was classified as nondiagnostic, negative, indeterminate, or positive. Results of US and US-guided FNAC were correlated with findings at neck dissection and disease outcome. RESULTS Of 203 sonographic examinations, 90% were technically feasible and yielded a nonequivocal imaging diagnosis. Of 87 US-guided FNAs, 71% yielded a nonequivocal tissue diagnosis. The PPV and NPV of initial posttreatment US were 11% and 97%. Sensitivity and specificity were 92% and 28%. The PPV and NPV of US-guided FNA were 33% and 95%, and the sensitivity and specificity were 75% and 74%. On serial sonographic surveillance, of 33 patients with nonsuspicious findings, only 1 (3%) had neck recurrence. Of 22 patients with questionable findings on CT and negative findings on US, none had a neck recurrence. CONCLUSIONS In experienced hands, serial US is an inexpensive noninvasive reassuring follow-up strategy after definitive head and neck RT, even when CT findings are equivocal.
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Affiliation(s)
- S S Yom
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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Woolgar JA, Ferlito A, Devaney KO, Rinaldo A, Barnes L. How trustworthy is a diagnosis in head and neck surgical pathology? A consideration of diagnostic discrepancies (errors). Eur Arch Otorhinolaryngol 2011; 268:643-51. [PMID: 21340559 DOI: 10.1007/s00405-011-1526-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 02/02/2011] [Indexed: 12/17/2022]
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Wilkins BS. Pitfalls in lymphoma pathology: avoiding errors in diagnosis of lymphoid tissues. J Clin Pathol 2011; 64:466-76. [PMID: 21325143 DOI: 10.1136/jcp.2010.080846] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The complexity involved in the histological interpretation of lymph nodes and other lymphoid tissue specimens suspected of harbouring lymphoma is underappreciated. As with other histology specimens, the quality of sections and background information are crucial but so, increasingly, is the appropriate use of immunocytochemistry and a variety of molecular analyses. Within the UK National Health Service, progressive regional centralisation is ongoing, to ensure access to specialist expertise and a full range of testing beyond traditional stains. This is to be welcomed but there remains a need to maintain skills in smaller district hospitals, to ensure lymphoma recognition in unexpected circumstances, to permit clinically useful interim diagnoses when needed urgently and to sustain training in haematopathology among junior pathologists. In this review a range of potential pitfalls in lymphoid tissue pathology is outlined, arising at all stages from specimen preparation to reporting. Knowledge of such pitfalls, some of which are common while others are rare but of vital clinical importance, should help increase confidence in lymphoma diagnosis among histopathologists.
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Affiliation(s)
- Bridget S Wilkins
- Histopathology Department, Second Floor, North Wing, St Thomas' Hospital and King's College, London SE1 7EH, UK.
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Saha S, Woodhouse NR, Gok G, Ramesar K, Moody A, Howlett DC. Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience. Eur J Radiol 2010; 80:792-5. [PMID: 21093189 DOI: 10.1016/j.ejrad.2010.10.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/12/2010] [Accepted: 10/20/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared. MATERIALS AND METHODS All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results. RESULTS A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively. CONCLUSIONS USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.
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Affiliation(s)
- Shouvik Saha
- Department of Radiology, Eastbourne District General Hospital, United Kingdom.
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Kovacević DO, Fabijanić I. Sonographic diagnosis of parotid gland lesions: correlation with the results of sonographically guided fine-needle aspiration biopsy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:294-298. [PMID: 20544864 DOI: 10.1002/jcu.20704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim was to assess the value of ultrasound (US) in differentiating benign from malignant parotid gland lesions. METHODS During a 3-year period, US-guided fine-needle aspiration biopsy was performed on 89 parotid lesions with a size > or = 5 mm in 68 patients. In 80 (90%) lesions, specimens were adequate for cytologic analysis. We recorded the seven following US parameters: size, number, echogenicity, echotexture, margins' clarity, distal acoustic enhancement, and regional lymph node enlargement. RESULTS Fine-needle aspiration biopsy revealed 18 (22%) malignant tumors, 30 (38%) benign tumors, and 32 (40%) nonneoplastic lesions. The mean size of the malignant tumors was 25 +/- 17 mm versus 27 +/- 17 mm for benign tumors versus 21 +/- 12 mm for nonneoplastic lesions (p > 0.05). Among 33 solitary tumors, 9 were malignant tumors and 24 were benign tumors. The majority of the parotid lesions were hypoechoic. The US feature that was most often associated with a benign lesion was distal acoustic enhancement. The US features that suggested malignancy were a heterogeneous echotexture, indistinct margins, and regional lymph node enlargement. CONCLUSION US can aid in the differentiation of parotid gland tumors, although benign and malignant parotid tumors often have a similar sonographic appearance.
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Affiliation(s)
- Dragica Obad Kovacević
- Department of Diagnostic and Intervention Radiology, University Hospital "Merkur", University School of Medicine, Zajceva 19,10 000 Zagreb, Croatia
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Tan WJH, Sanghvi K, Liau KH, Low CH. An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n5p359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: The aim of this study was to conduct an audit of the sensitivity and specificity of ultrasound, fine needle aspiration cytology (FNAC) and frozen section in the evaluation of thyroid malignancies in our practice. Materials and Methods: The medical records of all the patients who underwent thyroid surgery in a tertiary institution’s General Surgery Department between January 2005 and December 2007 were retrospectively reviewed using a standardised data collection template. Results of the ultrasounds, FNACs and frozen sections were compared with the final histological diagnosis. Results: A total of 112 patients underwent thyroid surgery in the 3-year study period. Thyroid malignancy constituted 34 (30%) of all patients who underwent thyroid surgery. The most popular diagnostic tools used were ultrasound (81%), FNAC (69%) and frozen section (59%). The sensitivity of ultrasound, FNAC and frozen section were 41.4%, 86.4% and 68.8%, respectively. FNAC was shown to be a superior diagnostic test in detecting malignancy compared to ultrasound. FNAC was able to pick up 53% of thyroid cancers missed by ultrasound. Frozen section was able to pick up 33% of thyroid cancers that were missed by both ultrasound and FNAC. Conclusion: FNAC is the most reliable tool in detecting malignancies and ought to form the mainstay for investigation of thyroid nodules. The utilisation of ultrasonographic features in the evaluation of thyroid nodules might not necessary improve the detection rate of thyroid malignancy. Frozen section helps to improve the detection ate of thyroid malignancy but further studies into its cost-effectiveness ought to be performed.
Key words: Investigations, Thyroid lesions
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How good are we at fine needle aspiration cytology? The Journal of Laryngology & Otology 2010; 124:765-6. [DOI: 10.1017/s0022215109992635] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology.Design:Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals.Main outcome measures:Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound.Results:Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance.Conclusion:Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.
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Diagnosis and treatment of a neck node swelling suspicious for a malignancy: an algorithmic approach. Int J Surg Oncol 2010; 2010:581540. [PMID: 22312490 PMCID: PMC3265261 DOI: 10.1155/2010/581540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/27/2010] [Indexed: 12/03/2022] Open
Abstract
Aim. To present an up-to-date algorithm incorporating recent advances regarding its diagnosis and treatment. Method. A Medline/Pubmed search was performed to identify relevant studies published in English from 1990 until 2008. Only clinical studies were identified and were used as basis for the diagnostic algorithm. Results. The eligible literature provided only observational evidence. The vast majority of neck nodes from occult primaries (>90%) represent SCC with a high incidence among middle aged man. Smoking and alcohol abuse are important risk factors. Asiatic and North African patients with neck node metastases are at risk of harbouring an occult nasopharyngeal carcinoma. The remainder are adenocarcinoma, undifferentiated carcinoma, melanoma, thyroid carcinoma and Merkel cell carcinoma. Fine needle aspiration cytology (FNAC) reaches sensitivity and specificity percentages of 81% and 100%, respectively and plays an important role as the second diagnostic step after routine ENT mirror and/or endoscopic examination. FDG-PET/CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. Conclusion. Although reports on the diagnostic process offer mainly descriptive studies, current information seems sufficient to formulate a diagnostic algorithm to contribute to a more systematic diagnostic approach preventing unnecessary steps.
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Kocjan G, Chandra A, Cross P, Denton K, Giles T, Herbert A, Smith P, Remedios D, Wilson P. BSCC Code of Practice--fine needle aspiration cytology. Cytopathology 2009; 20:283-96. [PMID: 19754835 DOI: 10.1111/j.1365-2303.2009.00709.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.
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Affiliation(s)
- G Kocjan
- Department of Histopathology, University College Hospital, London, UK
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Geldenhuys L, Naugler CT. Impact of a reporting template on thyroid fine needle aspiration cytology reporting and cytohistologic concordance. J Cytol 2009; 26:105-8. [PMID: 21938167 PMCID: PMC3168010 DOI: 10.4103/0970-9371.59396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Reporting templates are increasingly common in all fields of pathology. In this paper, we present an assessment of the impact of a thyroid fine needle aspiration cytology (FNAC) template on diagnostic classification and cytohistologic concordance. MATERIALS AND METHODS A thyroid FNAC reporting template was developed and introduced at a university teaching hospital. We examined FNAC reports for a five-month period before introduction of the template and compared these to the five month period after the template introduction. We recorded diagnostic categorization as well as cytohistologic correlation. RESULTS A total of 168 cases were identified in the five month period prior to the introduction of the reporting template and 172 cases in the five month period after the introduction of the reporting template. The template appeared to improve the diagnostic precision of benign conditions without altering the proportion of cases classified as unsatisfactory, benign or abnormal. There was no significant difference in the rate of cytohistologic concordance before and after the template introduction. CONCLUSIONS The introduction of a reporting template for thyroid FNAC improved diagnostic precision of benign conditions and did not alter the general diagnostic classification or cytohistologic concordance.
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Affiliation(s)
- Laurette Geldenhuys
- Dalhousie University and Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, 5788 University Avenue, Halifax, Nova Scotia, Canada B3H 1V8, Canada
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Pfeiffer J, Kayser G, Ridder GJ. Sonography-assisted cutting needle biopsy in the head and neck for the diagnosis of lymphoma: Can it replace lymph node extirpation? Laryngoscope 2009; 119:689-95. [DOI: 10.1002/lary.20110] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Anderson CE, Duvall E, Wallace WA. A single ThinPrep®slide may not be representative in all head and neck fine needle aspirate specimens. Cytopathology 2009; 20:87-90. [DOI: 10.1111/j.1365-2303.2008.00635.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kocjan G, Ramsay A, Beale T, O’Flynn P. Head and neck cancer in the UK: what is expected of cytopathology? Cytopathology 2009; 20:69-77. [DOI: 10.1111/j.1365-2303.2009.00647.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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