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Bagıs M, Can N, Sut N, Tastekin E, Erdogan EG, Bulbul BY, Sezer YA, Kula O, Demirtas EM, Usta I. A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More. Endocr Pathol 2024; 35:51-76. [PMID: 38280141 PMCID: PMC10944398 DOI: 10.1007/s12022-024-09797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/29/2024]
Abstract
Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS "nuclear" and AUS "other" is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely "high-risk group" than the group including other subcategories, namely "low-risk group" (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories.
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Affiliation(s)
- Merve Bagıs
- Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Nuray Can
- Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey.
| | - Necdet Sut
- Department of Biostatistics, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Ebru Tastekin
- Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Ezgi Genc Erdogan
- Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Buket Yilmaz Bulbul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Yavuz Atakan Sezer
- Department of General Surgery, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Osman Kula
- Department of Radiology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Elif Mercan Demirtas
- Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey
| | - Inci Usta
- Department of Pathology, Adiyaman University Training and Research Hospital, 02040, Adiyaman, Turkey
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Meena R, Nambirajan A, Mohan A, Malik PS, Jain D. Retrospective application of WHO reporting system for lung cytopathology with assessment of risk of malignancy. J Am Soc Cytopathol 2024:S2213-2945(24)00013-9. [PMID: 38514360 DOI: 10.1016/j.jasc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/28/2024] [Accepted: 02/10/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The recently introduced World Health Organization (WHO) Reporting System for Lung Cytopathology presents 5 diagnostic categories with corresponding risk of malignancy (ROM) and management protocols. This study uses the system to categorize our institutional respiratory tract cytology specimens, evaluating ROM and diagnostic accuracy for each category. MATERIALS AND METHODS In a retrospective analysis (May 2020 to August 2021), the following respiratory cytology specimens were classified based on the WHO categories: bronchoalveolar lavage (BAL), bronchial wash/bronchial brushings (BB/BW), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), fine-needle aspiration cytology (FNAC), sputum, biopsy imprint (BI), and endotracheal wash. Exclusions comprised pleural effusions and EBUS-TBNA from mediastinal and hilar lymph nodes. Correlation of cytologic and histopathologic diagnoses was performed to assess ROM collectively and individually. RESULTS A total of 1518 respiratory samples (BAL [968], BW/BB [380], EBUS-TBNA [42], FNAC [32], sputum [80], BI [11] and endotracheal wash [5]) of 1410 patients were screened, of which 522 cases (34.3%) had histopathologic correlation. One hundred forty-one cases (9.3%) were Insufficient/Inadequate/Non-Diagnostic (ND), 1221 (80.4%) were Benign (B), 3 (0.2%) were Atypical (A), 32 (2.1%) were Suspicious for malignancy (SM) and 121 (8.0%) were Malignant (M). The estimated ROM for each category was 49.2% for ND, 13.3% for B, 66.6% for A, 81.5% for SM and 92.7% for M. FNAC and EBUS-TBNA exhibited the highest sensitivity (100%) compared with BW/BB (66.3%). Specificity ranged from 96.8% to 100% across the samples, while diagnostic accuracy varied from 58.8% to 100%. CONCLUSIONS Application of the WHO reporting system enhances standardized terminology, aiding clinicians in informed decision-making and improving patient care through accurate risk assessment of malignancy.
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Affiliation(s)
- Rachana Meena
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Critical Care Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr B.R.A Institute Rotary Cancer Hospital, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
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McConnell RJ, Kamysh O, O’Kane PL, Greenebaum E, Rozhko AV, Yauseyenka VV, Minenko VF, Drozdovitch V, Yarets Y, Kukhta T, Mabuchi K, Little MP, Cahoon EK, Zablotska LB. Radiation Dose Does Not Affect the Predictive Value of Thyroid Biopsy for Diagnosing Papillary Thyroid Cancer in a Belarusian Cohort Exposed to Chernobyl Fallout. Acta Cytol 2024; 68:34-44. [PMID: 38246154 PMCID: PMC10987278 DOI: 10.1159/000536387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The Chernobyl nuclear accident exposed residents of contaminated territories to substantial quantities of radioiodines and was followed by an increase in thyroid cancer, primarily papillary thyroid cancer (PTC), among exposed children and adolescents. Although thyroid biopsy is an essential component of screening programs following accidental exposure to radioiodines, it is unknown whether the predictive value of biopsy is affected by different levels of environmental exposure. METHODS A cohort of 11,732 Belarusians aged ≤18 years at the time of the Chernobyl accident with individual thyroid radiation dose estimates was screened at least once 11-22 years later. Paired cytologic conclusions and histopathologic diagnoses were possible for 258 thyroid nodules from 238 cohort members. Cytologic conclusions were divided into five reporting categories, with all follicular lesion aspirates combined into a single indeterminate category. Standard performance indicators, risk of malignancy (ROM), and odds ratios for a correct cytologic conclusion were calculated, both overall and according to quintile of thyroid radiation dose. RESULTS The arithmetic mean thyroid dose estimate for the study group was 1.73 Gy (range: 0.00-23.64 Gy). The final histopathologic diagnosis was cancer for 136 of 258 biopsies (52.7%; 135 papillary and 1 follicular). The overall ROM was 96.7% for cytologies definite for PTC, 83.7% for suspicious for PTC, 33.0% for indeterminate, 8.1% for benign, and 31.0% for non-diagnostic. The ROM showed little change according to level of radiation exposure. Overall, there was no association between thyroid radiation dose and the odds ratio for a correct cytologic conclusion (p = 0.24). When analyzed according to dose quintile, the odds ratio for a correct conclusion increased two-fold at 0.10-0.29 Gy compared to a dose of 0.00-0.09 Gy and decreased at doses of 0.3-24 Gy (p value for linear trend = 0.99). CONCLUSIONS At radiation doses received by a cohort of young Belarusians exposed to radioiodines by the Chernobyl accident, the predictive value of thyroid biopsy for diagnosing PTC was not significantly affected by level of radiation exposure.
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Affiliation(s)
- Robert J. McConnell
- The Thyroid Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Olga Kamysh
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Patrick L. O’Kane
- Department of Radiology, Jefferson Health-Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Ellen Greenebaum
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander V. Rozhko
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | | | - Victor F. Minenko
- Institute for Nuclear Problems, Belarusian State University, Minsk, Belarus
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Yuliya Yarets
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Tatiana Kukhta
- United Institute of Informatics Problems, Minsk, Belarus
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth K. Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Guzmán-Arocho YD, VanderLaan PA, Nishino M. Binary subclassification scheme (AUS-Nuclear versus AUS-Other) adequately risk-stratifies thyroid fine needle aspiration specimens classified as Atypia of Undetermined Significance. J Am Soc Cytopathol 2024; 13:23-32. [PMID: 37957061 DOI: 10.1016/j.jasc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology previously described 4 subclasses of atypia within the Atypia of Undetermined Significance (AUS) category: nuclear (AUS-Nuc), architectural (AUS-A), oncocytic (AUS-Onc), and atypia not otherwise specified (AUS-NOS). Accumulating evidence supports a binary AUS subclassification scheme based primarily on the presence of nuclear atypia only. The purpose of this study is to compare the risk stratification of binary versus 4-tier AUS subclassification systems among AUS nodules with molecular and/or histologic follow-up. MATERIALS AND METHODS Thyroid aspirates classified as AUS and tested using Afirma (Veracyte, Inc.) between 6/2013 and 7/2021 were included. For resected nodules, histological classification was considered as the final outcome. For unresected nodules, benign Afirma results were considered low-risk outcomes, similar to histologically benign nodules. Suspicious or nondiagnostic Afirma results were considered indeterminate outcomes. The prevalence of outcomes warranting surgery (noninvasive follicular thyroid neoplasm with papillary-like nuclear features [NIFTP] or cancer) was calculated for each AUS subclass. RESULTS A total of 559 AUS nodules with Afirma testing were identified. Excluding nodules with indeterminate molecular outcomes, NIFTP/cancer prevalence for AUS-Nuc was 21% (57/266), which was higher than that for AUS-A (6%, 11/188), AUS-Onc (8%, 4/53), and AUS-NOS (0%, 0/9). A binary AUS subclassification scheme based on nuclear atypia showed a significant difference in NIFTP/cancer prevalence (21% versus 6%, P < 0.0001). CONCLUSIONS Binary reporting of AUS subclasses based on nuclear atypia distinguishes cases with a higher risk of NIFTP/cancer. There is a low but non-negligible prevalence of NIFTP/cancer in cases without nuclear atypia.
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Affiliation(s)
- Yaileen D Guzmán-Arocho
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Jiragawasan C, Himakhun W. The risk of malignancy in the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category subgroups: a Thai institute experience. J Am Soc Cytopathol 2024; 13:16-22. [PMID: 37903698 DOI: 10.1016/j.jasc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/28/2023] [Accepted: 09/15/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION This study investigated the rate of reporting and the risk of malignancy (ROM) for atypia of undetermined significance (AUS) subgroups in a Thai population. AUS, which is category III of the Bethesda System for Reporting Thyroid Cytopathology, is a problematic diagnosis for thyroid nodule management because the risks of malignancy are diverse. MATERIALS AND METHODS Patients who underwent thyroid fine needle aspirations between January 2015 and December 2019 were included in this retrospective study. Gender, age, and nodule features were described, and all slides were re-evaluated and categorized into 2 subgroups: AUS-Nuclear (including cytology atypia and cytologic and architectural atypia) and AUS-Other (including architectural atypia, oncocytic atypia, and atypia not otherwise specified). The lower and upper limits of ROM were calculated for each subgroup. RESULTS Of total, 258 out of 2995 fine needle aspirations (8.6%) were diagnosed as AUS. The patients were predominantly female (88.9%), with a mean age of 54.1 years. The average nodule size was 2.5 cm. Of the 258 AUS patients, 81 (38.9%) had histological correlations. The ROM for the AUS category was 9.1% to 23.5%. The ROM of the AUS-Nuclear and AUS-Other were 11.1% to 27.3% and 2.2% to 6.7%, respectively. Features of pseudonuclear inclusions had the highest ROM (33.3%-42.9%), followed by pale chromatin (28.57%-47.06%). CONCLUSIONS Less than ten percent of our interpretations were AUS, which is acceptable in our practice. Cytological atypia harbored the highest ROM. Studies of associations between cytology and histology may aid in improving diagnostic criteria for this population.
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Affiliation(s)
| | - Wanwisa Himakhun
- Department of Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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Ahuja S, Aziz Khan A, Ahuja R, Ahuja P, Zaheer S. Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Sydney System for Reporting Lymph Node Fine-Needle Aspiration Biopsy in Diagnosing Malignancy. Acta Cytol 2023; 68:13-25. [PMID: 38096796 DOI: 10.1159/000535797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The aim of the study was to perform the first meta-analysis for assessment of the pooled risk of malignancy of each category of the Sydney system for reporting of lymph nodal aspirates along with the evaluation of diagnostic accuracy. METHODS PubMed/MEDLINE and Embase were searched with the following keywords: "(Lymph node) AND (fine needle aspiration biopsy) OR (International system OR Sydney system)" in the timeframe 2020 to August 4, 2023. The selected articles were assessed for the risk of bias by the QUADAS-2 tool. The meta-analysis for sensitivity (SN) and specificity for each cut-off, that is, "atypical considered positive," "suspicious of malignancy considered positive," and "malignant considered positive" for the lesions, was carried out after excluding the inadequate samples in each study. To assess the diagnostic accuracy, summary receiver operating characteristic curves were constructed, and the diagnostic odds ratio was pooled in both scenarios. RESULTS Nine studies, all of which were retrospective cross-sectional studies, were evaluated with a total of 13,205 cases. The SN and specificity for the "atypical and higher risk categories" considered positive for malignancy were 97% (95% CI, 95-99%) and 96% (95% CI, 91-98%), respectively. The SN and specificity for the "suspicious of malignancy and higher risk categories" considered positive for malignancy were 91% (95% CI, 85-95%) and 99% (95% CI, 97-100%), respectively. The SN and specificity for the "malignant" considered positive for malignancy were 75% (95% CI, 65-84%) and 100% (95% CI, 99-100%), respectively. The pooled area under the curve was 99-100% for each of the cut-offs. CONCLUSION This meta-analysis highlights the accuracy of the Sydney system in reporting lymph node aspirates. It exhibits the significance of the "suspicious" and "malignant" categories in diagnosing malignancy and of the "benign" category in excluding malignancy.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
| | - Adil Aziz Khan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rhea Ahuja
- Departments of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Pragun Ahuja
- MBBS student, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Sachan R, Gupta A, Awasthi PN, Singh P, Anand N, Chandra S, Gaur G, Husain N, Sachan KD. Application of international system for reporting serous fluid cytology (ISRSFC) in effusion samples-a prospective study in an oncology setting. J Am Soc Cytopathol 2023; 12:351-361. [PMID: 37244848 DOI: 10.1016/j.jasc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Serous fluid cytology is a cost-effective procedure that can help in the diagnosis, staging, and origin of the malignancy. Recently introduced International System for Reporting Serous Fluid Cytology (ISRSFC) standardizes the reporting of serous fluid cytology in the 5 categories: Category 1: Nondiagnostic (ND), Category 2: negative for malignancy (NFM), Category 3: atypia of undetermined significance (AUS), Category 4: suspicious for malignancy (SFM), and Category 5: malignant (MAL). Here, we present our experience adopting the ISRSFC. MATERIALS AND METHODS We implemented ISRSFC in December of 2019 at our institute and included a cohort of 555 prospective effusion samples. The pertinent surgical pathology, radiology, and clinical follow-up were also extracted to assess the risk of malignancy (ROM) and performance parameters. RESULTS The assessment of interobserver reliability indicated substantial concordance (κ = 0.717) between the 2 investigators for serous fluid categorization. A total of 555 effusion samples were classified as follows: ND, 14 (2.5%); NFM, 394 (71%); AUS, 12 (2.2%); SFM, 13 (2.3%); and MAL, 122 (22%). The ROM for the ND, NFM, AUS, SFM, and MAL categories was 57.1%, 9.9%, 66.7%, 66.7%, and 97.2%, respectively, in peritoneal effusions and 57.1%, 7.1%, 66.7%, 100%, 100%, respectively, in pleural effusions. The ROM for NFM and MAL was 0% and 100%, respectively, in pericardial effusion. CONCLUSIONS Application of the proposed ISRSFC can help in achieving uniformity and reproducibility in diagnoses and also help in risk stratification in cytology. ISRSFC was successfully adopted by our cytology laboratory and clinicians, with overall diagnostic performance similar to previous studies.
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Affiliation(s)
- Ruchita Sachan
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Punit Namrata Awasthi
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradyumn Singh
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat Chandra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gauri Gaur
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumar Dheerendra Sachan
- Department of Radiation Oncology, Shrimant Rajmata Vijayaraje Scindia Medical College, Shivpuri, Madhya Pradesh, India
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Xia Q, Li F, Min R, Sun S, Han YX, Feng ZZ, Li N. Malignancy risk factors and prognostic variables of pancreatic mucinous cystic neoplasms in Chinese patients. World J Gastroenterol 2023; 29:3119-3132. [PMID: 37346158 PMCID: PMC10280801 DOI: 10.3748/wjg.v29.i20.3119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes.
AIM To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC).
METHODS All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC.
RESULTS Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes.
CONCLUSION The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.
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MESH Headings
- Humans
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- East Asian People
- Neoplasms, Cystic, Mucinous, and Serous/epidemiology
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Prognosis
- Receptors, Progesterone
- Retrospective Studies
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Affiliation(s)
- Qing Xia
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Fan Li
- Department of Pathology, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Rui Min
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Shuai Sun
- Department of Pathology, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Yue-Xin Han
- School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Zhen-Zhong Feng
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Nan Li
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Krishnan V, Victor AR, Bose S, Bakkar R. Lymphoid cell rich fine-needle aspirations of the salivary gland: What is the risk of malignancy? Cytojournal 2023; 20:11. [PMID: 37292122 PMCID: PMC10246398 DOI: 10.25259/cytojournal_4_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/21/2022] [Indexed: 06/10/2023] Open
Abstract
Objectives Lymphoid cell rich fine-needle aspirations (FNAs) of the salivary glands pose a diagnostic dilemma, with a wide range of differential diagnoses that include several benign and malignant entities. There is limited literature regarding the entities that are commonly encountered in this situation. Our goal was to characterize the surgical outcome in these cases and to evaluate the risk of malignancy. Material and Methods This is a retrospective study at a tertiary care institution. Our database was queried over a 10-year period. FNAs yielding a prominent population of well-visualized lymphoid cells were included in the study. Only cases with surgical follow-up were evaluated. FNAs with epithelial cells, diagnostic features of any entity (such as granulomas or chondromyxoid stroma), history of metastatic malignancy, or scant cellularity were excluded from the study. Lymphoid cells were classified as atypical according to morphologic findings (monomorphism, irregular nuclear contours, and abnormal chromatin patterns). Statistical analysis was performed. Results Of the 224 lymphoid cell rich FNAs identified, 29 (28%) had surgical follow-up in our data records. Twenty-two were from the parotid and seven from the submandibular gland. Ten cases (35%) were non-neoplastic (benign lymphoepithelial cyst [n = 4], reactive lymph node [n = 5] and chronic sialadenitis [n = 1]). Benign epithelial neoplasms including pleomorphic adenoma (n = 2) and Warthin's tumor (n = 1) were identified in 10% of the cases. One case with non-atypical lymphocytes proved to be a mucoepidermoid carcinoma (n = 1). Lymphomas were detected in 52% (n = 15). Of note, none of these patients had a history of lymphoid malignancy. 8/15 were low-grade and 7/15 were high-grade lymphoma. Most of these cases (11/15) had atypical lymphocytes on FNA. Ancillary studies were available in a few cases and supportive of the diagnosis of lymphoma, including cell block and immunohistochemistry (n = 7, 47%), flow cytometry (n = 3, 27%), and clonality polymerase chain reaction (PCR) (n = 1; 7%). Most of these were performed in cases with atypical lymphocytes. In cases with non-atypical lymphocytes, five cases were malignant on surgical excision (5/17). Morphology on FNA had a specificity of 92% for malignancy and sensitivity of 69%. The positive predictive value on FNA of atypical lymphocytes for malignancy was 92%. Conclusion Lymphoid cell rich FNAs carry a 52% incidence rate lymphoma in our small study population. Specificity of FNA for malignancy is high (92%) and lymphocyte atypia is a strong predictor of malignancy. Ancillary studies may be of added value in FNAs with non-atypical lymphoid cells. FNA has a valuable role in triaging lymphoid lesions of the salivary glands.
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Affiliation(s)
- Vimal Krishnan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Aaron R. Victor
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Shikha Bose
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Rania Bakkar
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
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Ratzon F, Feliciano DL, Katabi N, Xu B, Lin O, Wei XJ. Salivary gland fine-needle aspiration biopsy: quality assurance results from a tertiary cancer center. J Am Soc Cytopathol 2023; 12:206-215. [PMID: 36792408 PMCID: PMC10563449 DOI: 10.1016/j.jasc.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Fine-needle aspiration biopsy (FNAB) plays a critical role in the management of patients with salivary gland lesions. A specific diagnosis can be difficult due to the wide range of lesions with overlapping morphologic features, potentially leading to interpretation errors. We analyzed the cytologic-histologic discrepancies identified in the quality assurance program of a major cancer center in cases of salivary gland FNAB and performed a root cause analysis. MATERIALS AND METHODS Salivary gland FNAB specimens performed during a 12-year period at a major tertiary cancer center were reviewed. The inclusion criteria for this study included FNAB cases of salivary glands with subsequent histologic or flow cytometry follow up. The cytologic diagnoses for these cases were recategorized according to the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) based on the original reports. The risk of neoplasm and malignancy based on the cases with subsequent resection or flow cytometry and the most common causes of discrepancy were analyzed. RESULTS The risk of neoplasm ranged from 41% to 99% and the risk of malignancy ranged from 22% to 99% among the different MSRSGC categories. Lymphoid and myoepithelial rich lesions were the most common miscategorized lesions using the MSRSGC. Reactive changes due to inflammation were associated with overcalls. The most common malignancy in the atypical category was mucoepidermoid carcinomas. CONCLUSIONS Myoepithelial and lymphoid rich lesions arising in the salivary gland are associated with a higher risk of misclassification. The use of category IVB in the MSRSGC is appropriate for lesions with abundant myoepithelial cells. Reactive atypia seen in sialadenitis was the most common feature associated with overcall.
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Affiliation(s)
- Fanni Ratzon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Xiao-Jun Wei
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Rana C, Nigam N, Agarwal S, Mishra P, Singh A, Bychkov A. Cytological evaluation of thyroid nodules in children and young adults: a multi-institutional experience. Endocrine 2023; 80:580-588. [PMID: 36604406 DOI: 10.1007/s12020-022-03297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The utility of the Bethesda system for reporting thyroid cytopathology is debatable in determining the risk of malignancy in pediatric patients. Moreover, the upper age limit for defining the pediatric group has varied across different studies. The aim of this study is to compare the risk of malignancy (ROM) and risk of neoplasia (RON) across different Bethesda categories between the pediatric, young adult, and adult patients. METHODS This is a retrospective multi-institutional study performed in three Indian hospitals. ROM was calculated and compared across Bethesda categories in adult (>18 years) and pediatric age groups (≤18 years), with a subgroup analysis in young adults (19-21 years). RESULTS Thyroid nodules from a total of 5958 patients were subjected to fine needle aspiration. Of these 199 were pediatric (3.3%) and follow-up histology was available in 2276. The ROM and RON rates, including overall ROM/RON, were significantly higher in pediatric age group as compared to adults. Overall ROM of suspicious for malignancy and malignant categories was higher in children as compared to adults. The overall surgical resection rates were also higher in pediatric patients (45.2% vs. 35.7%; p < 0.01). The similar trend of increased ROM, RON and resection rates was seen among young adults as compared to adult age group. CONCLUSION Thyroid nodules presenting in children are more likely to be malignant than those in adults. Importantly, the young adult group behaved in a similar manner with regard to surgical resection rates, ROM and RON to pediatric.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Akanksha Singh
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
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Rajeswaran PK, Srinivasan V, Mahesh SSV, Ashok AU. A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience. Acta Cytol 2022; 67:70-79. [PMID: 36476509 DOI: 10.1159/000527398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The International Academy of Cytology and the American Society of Cytopathology recently proposed the International System for Reporting Serous Fluid Cytology (ISRSFC) to standardize serous fluid cytopathology reporting and guide further clinical management. The current study aimed to assess the feasibility of utilizing ISRSFC reporting categories for serous fluids, estimate the risk of malignancy (ROM) of each category, and scrutinize if the management protocols followed in our institution are as per the ISRFSFC recommendations. METHODS All pleural, peritoneal, and pericardial effusions submitted for evaluation at our institute between January 2021 and December 2021 were retrieved. All these cases were reviewed and re-categorized into one of the five categories proposed by the ISRSFC: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL), and ROM was calculated for each category. RESULTS The present study examined 596 serous effusions, of which 229 were pleural effusions, 358 were peritoneal effusions, and the remaining nine were pericardial effusions. Among 596 cases, 395 cases had a radiological or histological follow-up. The serous effusion samples were re-categorized as 61 (10.2%) ND, 449 (75.3%) NFM, 47 (7.8%) AUS, 17 (2.9%) SFM, and 22 (3.8%) MAL, and ROM for each above category were 10%, 4.4%, 19%, 83.3%, and 100%, respectively. CONCLUSION Categorizing serous effusion cytology samples per the ISRSFC diagnostic categories reduces reporting variability. The ISRSFC provides a standardized format to predict the ROM and thus improves the quality of clinical care.
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Affiliation(s)
| | | | | | - Arsha Usha Ashok
- Department of Pathology, PSG Institute of Medical Sciences, Coimbatore, India
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Trimboli P, Ferrarazzo G, Cappelli C, Piccardo A, Castellana M, Barizzi J. Thyroid Nodules with Indeterminate FNAC According to the Italian Classification System: Prevalence, Rate of Operation, and Impact on Risk of Malignancy. An Updated Systematic Review and Meta-analysis. Endocr Pathol 2022; 33:457-471. [PMID: 36044162 PMCID: PMC9712406 DOI: 10.1007/s12022-022-09729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
A thyroid nodule classified as indeterminate on fine-needle aspiration cytology (FNAC), hereafter referred to as an indeterminate thyroid nodule (ITN), represents a clinical dilemma. The Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) divides ITNs into low- and high-risk categories (i.e., TIR3A and TIR3B, respectively) to better manage patients. This study aimed to achieve high-evidence estimates of the prevalence, rate of operation, and risk of malignancy of ITNs, including TIR3A and TIR3B ITNs. This systematic review was conducted according to MOOSE to retrieve all original studies citing ICCRTC. The last search was performed in February 2022. The risk of bias of the included studies was assessed. Separate proportion meta-analyses were performed with a random-effect model using OpenMeta[Analyst]. The online search processed 271 studies, and 33 were finally considered. First, the cancer prevalence among ITNs was 32.4%. Second, the cancer prevalence among TIR3As was 12.4%, with heterogeneity (I2 90%) explained by a linear correlation between sample size and cancer rate (p = 0.009). Third, the cancer prevalence among TIR3Bs was 44.4%, with heterogeneity (I2 75%) explained by the inverse correlation between sample size and cancer rate (p = 0.031). Fourth, the prevalence of ITNs, TIR3A, and TIR3B among FNACs was 29.6%, 12.6%, and 12.9%, respectively, with sample size and TIR3B prevalence being inversely correlated (p = 0.04). Fifth, the operation rates of ITNs, TIR3A, and TIR3B were 54.3%, 48.3%, and 75.2%, respectively, and the sample size and TIR3A operation rate were inversely correlated (p = 0.010). These data strongly support the division of ITNs into low- and high-risk subcategories. Importantly for clinical practice, the cancer rate among ITNs is significantly influenced by the study sample size.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio Di Endocrinologia E Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
- Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland.
| | | | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina Ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Arnoldo Piccardo
- Struttura Complessa Di Medicina Nucleare, E.O. Ospedali Galliera, Genoa, Italy
| | - Marco Castellana
- Ambulatorio Di Endocrinologia E Diabetologia, Poliambulatorio Di Monopoli, Azienda Sanitaria Locale Bari, Monopoli, Italy
| | - Jessica Barizzi
- Servizio Di Citopatologia, Istituto Cantonale Di Patologia, Locarno, Switzerland
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O'Connor D, Fabre A, Gibbons D. Application of a Standardized Terminology and Nomenclature for Respiratory Cytology: Experience from a Large Tertiary Respiratory Cancer Centre. Acta Cytol 2022; 67:46-54. [PMID: 36446316 DOI: 10.1159/000527435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION In 2020, the World Health Organization-International Agency for Research on Cancer/International Academy of Cytology (WHO-IARC IAC) joint project was commenced to develop standardized nomenclature and diagnostic criteria in cytopathology internationally. Our institution has been coding all respiratory cytological specimens in a similar fashion for over 10 years. Our aim was to analyse the effectiveness of our respiratory cytology coding system by calculating the estimated risk of malignancy (ROM) and rates of each diagnostic category. METHODS Over a 2 year period, all endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), bronchial brushing, bronchial washing, bronchial lavage, and sputum specimens reported at our institution were analysed. For each specimen, the diagnostic code, the relevant indication for each diagnostic procedure, the diagnosis, and the presence or absence of a positive corresponding biopsy were recorded. RESULTS In total, 1,432 respiratory cytological specimens from 945 patients over a 2-year period were analysed. 467 specimens were confirmed to be associated with a malignant process. The overall ROM for respiratory cytology specimens was 37.7% for nondiagnostic, 18.1% for benign, 46.7% for atypical, 85.7% for suspicious for malignancy, and 91.9% for malignant. For each diagnostic procedure, the ROM increased from the benign to malignant categories. DISCUSSION/CONCLUSION Our ROM rates for overall respiratory cytology specimens and for EBUS-TBNA, bronchial brushing, and bronchial washing specimens separately are concordant with other major international studies. With the WHO-IARC IAC joint project in progress and an international respiratory cytology coding system being developed, our study has the potential to add value by providing indicative ROM rates, which can be used to inform the development of this new classification system. Our rates of diagnostic accuracy are in keeping with international standards, which support the accuracy of our data.
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Affiliation(s)
- Diarmuid O'Connor
- Histopathology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- Histopathology Department, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - David Gibbons
- Histopathology Department, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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Nikas IP, Vey JA, Proctor T, AlRawashdeh MM, Ishak A, Ko HM, Ryu HS. The Use of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy. Am J Clin Pathol 2022; 159:138-145. [PMID: 36370120 PMCID: PMC9891409 DOI: 10.1093/ajcp/aqac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To perform the first meta-analysis regarding the pooled risk of malignancy (ROM) of each category of the Yokohama system for reporting breast fine-needle aspiration, as well as assess the latter's diagnostic accuracy using this new system. METHODS Two databases were searched, followed by data extraction, study quality assessment, and statistical analysis. RESULTS The "Insufficient," "Benign," "Atypical," "Suspicious," and "Malignant" Yokohama system categories were associated with a pooled ROM of 17% (95% CI, 10%-28%), 1% (95% CI, 1%-3%), 20% (95% CI, 17%-23%), 86% (95% CI, 79%-92%), and 100% (95% CI, 99%-100%), respectively. When both "Suspicious" and "Malignant" interpretations were regarded as cytologically positive, sensitivity (SN) was 91% (95% CI, 87.6%-93.5%) and false-positive rate (FPR) was 2.33% (95% CI, 1.30-4.14%). A summary receiver operating characteristic curve was constructed and the pooled area under the curve was 97.3%, while the pooled diagnostic odds ratio was 564 (95% CI, 264-1,206), indicating a high level of diagnostic accuracy. When only "Malignant" interpretations were regarded as cytologically positive, the pooled FPR was lower (0.75%; 95% CI, .39%-1.42%) but at the expense of SN (76.61%; 95% CI, 70.05%-82.10%). CONCLUSIONS Despite Yokohama's system early success, more data would be needed to unravel the system's value in clinical practice.
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Affiliation(s)
| | - Johannes A Vey
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | | | - Angela Ishak
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Hyang Mi Ko
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Han Suk Ryu
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea,Department of Pathology, Seoul National University Hospital, Seoul, Korea
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Gocun PU, Simsek B, Ekinci O, Ekmen N, Arhan M, Karakan T, Ibis M, Cindoruk M. Risk of Malignancy Using the Diagnostic Categories Proposed by the World Health Organization International System for Reporting Pancreaticobiliary Cytopathology. Acta Cytol 2022; 66:475-485. [PMID: 35732161 PMCID: PMC9808633 DOI: 10.1159/000525276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The World Health Organization (WHO) proposed an updated reporting system for pancreaticobiliary cytology, which moves low-grade malignancies to "positive for malignancy" group and serous cystadenoma to "negative for malignancy" group. The WHO system also created two new categories, namely, pancreatic neoplasia-low grade (PaN-Low) and pancreatic neoplasia-high grade (PaN-High), which includes neoplastic mucinous cysts and stratifies them according to their cytologic atypia. The risk of malignancy (ROM) of the new categories of the WHO system needs to be defined. METHODS Cytologic slides of all patients, who underwent endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy at our institution from January 2010 to December 2021 and had a histopathological or clinical follow-up of at least 6 months, were reviewed and reclassified under the Papanicolaou Society of Cytopathology (PSC) and WHO reporting systems. The absolute ROM was calculated for each category of both reporting systems. RESULTS A total of 420 EUS-FNA samples from 410 patients were reviewed and reclassified. The absolute ROM for the proposed WHO system was 35% for "nondiagnostic," 1.0% for "negative for malignancy," 69.0% for "atypical," 11% for "PaN-Low," 100% for "PaN-High," 91% for "suspicious for malignancy," and 100% for "malignant." Comparatively, the absolute ROM under the PSC reporting system was 34% for "nondiagnostic," 1.0% for negative (for malignancy), 50.0% for "atypical," 0.0% for "neoplastic: benign," 16% for "neoplastic: other," 88% for "suspicious for malignancy," and 100% for "positive or malignant." CONCLUSION The proposed WHO international reporting system has advantages regarding risk stratification improvement and case management.
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Affiliation(s)
- Pınar Uyar Gocun
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey,*Pinar Uyar Gocun,
| | - Berkay Simsek
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozgur Ekinci
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nergis Ekmen
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Arhan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tarkan Karakan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Ibis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Cindoruk
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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Jiang D, Chen ZX, Ma FX, Gong YY, Pu T, Chen JM, Liu XQ, Zhao YJ, Xie K, Hou H, Wang C, Geng XP, Liu FB. Online calculator for predicting the risk of malignancy in patients with pancreatic cystic neoplasms: A multicenter, retrospective study. World J Gastroenterol 2022; 28:5469-5482. [PMID: 36312834 PMCID: PMC9611704 DOI: 10.3748/wjg.v28.i37.5469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Efficient and practical methods for predicting the risk of malignancy in patients with pancreatic cystic neoplasms (PCNs) are lacking.
AIM To establish a nomogram-based online calculator for predicting the risk of malignancy in patients with PCNs.
METHODS In this study, the clinicopathological data of target patients in three medical centers were analyzed. The independent sample t-test, Mann–Whitney U test or chi-squared test were used as appropriate for statistical analysis. After univariable and multivariable logistic regression analysis, five independent factors were screened and incorporated to develop a calculator for predicting the risk of malignancy. Finally, the concordance index (C-index), calibration, area under the curve, decision curve analysis and clinical impact curves were used to evaluate the performance of the calculator.
RESULTS Enhanced mural nodules [odds ratio (OR): 4.314; 95% confidence interval (CI): 1.618–11.503, P = 0.003], tumor diameter ≥ 40 mm (OR: 3.514; 95%CI: 1.138–10.849, P = 0.029), main pancreatic duct dilatation (OR: 3.267; 95%CI: 1.230–8.678, P = 0.018), preoperative neutrophil-to-lymphocyte ratio ≥ 2.288 (OR: 2.702; 95%CI: 1.008–7.244, P = 0.048], and preoperative serum CA19-9 concentration ≥ 34 U/mL (OR: 3.267; 95%CI: 1.274–13.007, P = 0.018) were independent risk factors for a high risk of malignancy in patients with PCNs. In the training cohort, the nomogram achieved a C-index of 0.824 for predicting the risk of malignancy. The predictive ability of the model was then validated in an external cohort (C-index: 0.893). Compared with the risk factors identified in the relevant guidelines, the current model showed better predictive performance and clinical utility.
CONCLUSION The calculator demonstrates optimal predictive performance for identifying the risk of malignancy, potentially yielding a personalized method for patient selection and decision-making in clinical practice.
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Affiliation(s)
- Dong Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Fu-Xiao Ma
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Yu-Yong Gong
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Tian Pu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Jiang-Ming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Xue-Qian Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Yi-Jun Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Kun Xie
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Cheng Wang
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Xiao-Ping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Fu-Bao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
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Trimboli P, Ferrarazzo G, Piccardo A, Lucchini B, Durante C. Operation rate and cancer prevalence among thyroid nodules with FNAC report of suspicious for malignancy (TIR4) or malignant (TIR5) according to Italian classification system: a systematic review and meta-analysis. Endocrine 2022; 78:24-31. [PMID: 35986840 PMCID: PMC9474526 DOI: 10.1007/s12020-022-03165-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the Italian system for reporting thyroid cytology (ICCRTC), nodules suspicious for (TIR4) and consistent with (TIR5) malignancy are thought being 5% and 4-8% of all biopsies and having risk of malignancy of 60-80% and >95%, respectively. However, no evidence-based data exist about these figures. The present systematic review aimed at achieving solid estimates about TIR4 and TIR5 also considering potential influencing factors. METHODS The review was conducted according to MOOSE. Databases of Google Scholar and Cochrane were searched. No language restriction was used. The last search was performed on February 26th 2022. Quality assessment was performed. Proportion meta-analyses were performed using random-effect model. Statistical analyses were performed using OpenMeta [Analyst]. RESULTS The online search retrieved 271 articles and 16 were finally included for quantitative analysis. The risk of bias was generally low. The pooled cancer prevalence in TIR4 was 92.5% (95%CI 89.4-95.6%) with unexplained moderate heterogeneity. The pooled cancer rate among TIR5 was 99.7% (95%CI 99.3-100%) without heterogeneity. The resection rate in TIR4 and TIR5 showed heterogeneity, being the latter explained when using their prevalence among biopsies: the higher the prevalence, the higher the operation rate. The pooled risk difference between TIR5 and TIR4 was significant (OR 11.153). CONCLUSIONS These figures can form the basis for the next updated version of ICCRTC. Any institution using ICCRTC should revise its series of TIR4/TIR5 to calculate the cancer rate, and, importantly, consider the modifiers of the risk of malignancy. A cross check among institutions is advised.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | | | - Arnoldo Piccardo
- Struttura Complessa di Medicina Nucleare, E.O. Ospedali Galliera, Genoa, Italy
| | - Barbara Lucchini
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
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Bentestuen M, Gossili F, Almasi CE, Zacho HD. Prevalence and significance of incidental findings on 68 Ga-DOTA-conjugated somatostatin receptor-targeting peptide PET/CT: a systematic review of the literature. Cancer Imaging 2022; 22:44. [PMID: 36057635 PMCID: PMC9441055 DOI: 10.1186/s40644-022-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Aim We aimed to evaluate the prevalence of incidental 68 Ga-DOTA-conjugated somatostatin receptor-targeting peptide PET/CT (SSTR PET/CT) findings, their clinical significance in the need for follow-up, and their risk of malignancy. Materials and methods Studies reporting incidental SSTR PET/CT findings were systematically searched in PubMed, Cochrane, Embase and Web of Science literature published prior to 1st of May 2020. Studies were filtered by two independent readers for eligibility based on title and abstract, and subsequently on full text. The main exclusion criteria were: 1) pathological findings that matched scan indication, 2) known organ specific disease and/or incidental findings confirmed on other scan modality prior to SSTR PET/CT, 3) lack of diagnosis and/or follow up, and 4) results published in proceedings or conference abstracts. Results Twenty-one studies, comprising a total of 2906 subjects, were eligible for the analysis. Studies included were retrospective cohort studies on incidental SSTR PET/CT findings in a specific organ (n = 2888, 7/21) or case reports (n = 18, 14/21). A total of 133 subjects had incidental SSTR PET/CT findings. Incidental findings were predominantly seen in the thyroid gland (n = 65), spine (n = 30), brain (n = 26) and breast (n = 6). Seventeen of 133 (13%) incidental findings were malignant on final diagnosis. Incidental breast findings were associated with the highest risk of malignancy (67%). In the thyroid, incidental SSTR uptake was caused by malignancy in 8%, all presenting as focal uptake. The lowest risk was seen in the spine with a malignancy rate of 3% in patients with incidental SSTR uptake and benign cases were interpreted as vertebral hemangiomas on CT. Incidental SSTR PET/CT findings in other locations were of malignant etiology in two out of six cases (33%) and should be evaluated individually. Conclusion The most incidental SSTR PET/CT findings were found in the thyroid gland, spine, and brain. The risk of malignancy was greatest in incidental SSTR PET/CT findings in the breast, cranially, and thyroid gland. The results of the present study can prove useful in the interpretation of atypical findings on SSTR PET/CT and in the counseling of clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00484-0.
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Affiliation(s)
- Morten Bentestuen
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Farid Gossili
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Charlotte Elberling Almasi
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Helle Damgaard Zacho
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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20
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Zhu YL, Ren WH, Wang Q, Jin HZ, Guo YY, Lin DM. A retrospective analysis of serous effusions based on the newly proposed international system for reporting serous fluid cytopathology: a report of 3633 cases in an oncological center. Diagn Pathol 2022; 17:56. [PMID: 35780135 PMCID: PMC9250735 DOI: 10.1186/s13000-022-01241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The International System for Reporting Serous Fluid Cytopathology (TIS) was recently proposed. We retrospectively applied TIS recommendations for reporting the cytological diagnosis of serous effusions and reported our experience. Methods All the serous effusions from January 2018 to September 2021 were retrieved from the database. Recategorization was performed using the TIS classification, the risk of malignancy (ROM) was calculated for each TIS category. In addition, on the basis of the original TIS classification, we further subdivided the TIS category IV (suspicious for malignancy, SFM) into 2 groups (IVa and IVb) according to cytological characteristics (quality and quantity) to explore the necessity of SFM subclassification. The performance evaluation was carried out using different samples (pleural, peritoneal and pericardial effusions) and preparation methods (conventional smears, liquid-based preparations and cell blocks). Results A total of 3633 cases were studied: 17 (0.5%) were diagnosed as ‘nondiagnostic’ (I, ND), 1100 (30.3%) as ‘negative for malignancy’ (II, NFM), 101 (2.8%) as ‘atypia of undetermined significance’ (III, AUS), 677 (18.6%) as ‘suspicious for malignancy’ (IV, SFM), and 1738 (47.8%) as ‘malignant’ (V, MAL). The ROMs for the categories were 38.5%, 28.6%, 52.1%, 99.4% and 100%, respectively. The ROM for SFM was significantly higher than that for AUS (P < 0.001), while the difference between the ROMs for IVa and IVb was insignificant. The sensitivity, negative predictive value (NPV) and diagnostic accuracy of liquid-based preparations were all superior to those of conventional smears and cell blocks in detecting abnormalities. Using the three preparation methods simultaneously had the highest sensitivity, NPV and diagnostic accuracy. Conclusion Serous effusion cytology has a high specificity and positive predictive value (PPV), and TIS is a user-friendly reporting system. Liquid-based preparations could improve the sensitivity of diagnosis, and it is best to use three different preparation methods simultaneously for serous effusion cytologic examination.
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Affiliation(s)
- Yan-Li Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Wen-Hao Ren
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Qian Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Hai-Zhu Jin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yi-Yi Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Dong-Mei Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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21
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Bharti S, Nalwa A, Elhence PA, Rao M, Bharti JN, Khera S, Vedant D, Vishwajeet V, Goel A. Risk Stratification of Pleural Fluid Cytology Based on the International System for Reporting Serous Fluid Cytology in a Tertiary Care Centre. Acta Cytol 2022; 66:449-456. [PMID: 35413720 DOI: 10.1159/000524144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The International Academy of Cytology and the American Society of Cytopathology proposed the international system for reporting serous fluid cytology (TISRSFC) in 2019 to form uniform reporting terminologies for fluid cytology. This system defines a spectrum of diagnostic categories to be used in daily clinical practice. Fluid cytology is a widely accepted, cost-effective, minimally invasive earliest diagnostic method for the investigation that aids management decisions. The present study aims to reclassify pleural fluid cytology and calculate the risk of malignancy (ROM) for each diagnostic category. MATERIAL AND METHODS It is a retrospective 2 years observational study comprising 690 pleural fluid specimens. Retrospective reviews were performed, and cases were reclassified into five categories as per TISRSFC. Immunohistochemistry was applied whenever needed. Cytological diagnosis was correlated with respective histopathology and/or clinical and/or radiological diagnosis. ROM was calculated for all diagnostic categories. RESULTS In the present study of 690 cases, 7.97% were non-diagnostic (ND), 84.1% cases were negative for malignancy (NFM), 0.87% were atypia of undetermined significance (AUS), 1.16% were suspicious for malignancy (SFM), and 5.94% were malignant (MAL). Cell blocks were prepared in 33 (4.8%) cases and immunohistochemistry was applied in 7 cases. The commonest site for pleural fluid metastasis was the lungs, accounting for 4.64% (32/690) cases. Further, ROM was calculated for all diagnostic categories as follows: (1) ND: 30.9%, (2) NFM: 12.9%, (3) AUS: 100%, (4) SFM: 100%, and (5) MAL: 90.2%. CONCLUSION Cytological examination of pleural fluids is an accurate, prompt, and affordable technique. This standardized ISRSFC reporting system will maintain uniformity and reproducibility in reporting, leading to improved clinical decision-making of pleural fluids.
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Affiliation(s)
- Sushma Bharti
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Aasma Nalwa
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Poonam Abhay Elhence
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Meenakshi Rao
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sudeep Khera
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Vedant
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vikarn Vishwajeet
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Akhil Goel
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
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22
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Yoshizawa A, Hiroshima K, Takenaka A, Haba R, Kawahara K, Minami Y, Kakinuma H, Shibuki Y, Miyake S, Kajio K, Kiyonaga K, Nagatomo M, Nishimura S, Mano M, Matsubayashi J, Motoi N, Nagao T, Nakatsuka SI, Yoshida T, Satoh Y. Cytology Reporting System for Lung Cancer from the Japan Lung Cancer Society and the Japanese Society of Clinical Cytology: An Extensive Study Containing More Benign Lesions. Acta Cytol 2021; 66:124-133. [PMID: 34872081 DOI: 10.1159/000520426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Japan Lung Cancer Society (JLCS) and the Japanese Society of Clinical Cytology (JSCC) have proposed a new four-tiered cytology reporting system for lung carcinoma (JLCS-JSCC system). Prior to the proposal, the Papanicolaou Society of Cytopathology (PSC) had proposed a revised reporting system (PSC system), which comprises the "neoplastic, benign neoplasm, and low-grade carcinoma" category (N-B-LG category), in addition to the 4 categories of the JLCS-JSCC system. This study aimed to evaluate the interobserver agreement of the JLCS-JSCC system with an additional dataset with more benign lesions in comparison with the PSC system. METHODS We analyzed 167 cytological samples, which included 17 benign lesions, obtained from the respiratory system. Seven observers classified these cases into each category by reviewing one Papanicolaou-stained slide per case according to the JLCS-JSCC system and PSC system. RESULTS The interobserver agreement was moderate in the JLCS-JSCC (k = 0.499) and PSC (k = 0.485) systems. Of the 167 samples, 17 samples were benign lesions: 7 pulmonary hamartomas, 5 sclerosing pneumocytomas, 2 squamous papillomas, one solitary fibrous tumor, one meningioma, and one lymphocytic proliferation. There were diverse sample types as follows: 11 touch smears, 3 brushing smears, 2 aspirations, and one sputum sample. Fourteen samples (82.3%) were categorized into "negative" or "atypical" by more than half of the observers in the JLCS-JSCC system. Conversely, 3 samples were categorized as "suspicious" or "malignant" by more than half of the observers in the JLCS-JSCC system. On the other hand, 11 samples (64.7%) were categorized into the N-B-LG category by more than half of the observers in the PSC system. CONCLUSIONS The concordance rate in the JLCS-JSCC system was slightly higher than that in the PSC system; however, the interobserver agreement was moderate in both the JLCS-JSCC and PSC systems. These results indicate that both the JLCS-JSCC and PSC systems are clinically useful. Therefore, both systems are expected to have clinical applications. It may be important to integrate the 2 systems and construct a universal system that can be used more widely in clinical practice.
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Affiliation(s)
- Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
- Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan
- Sodegaura Satsukidai Hospital, Sodegaura, Japan
| | - Akemi Takenaka
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kagawa, Japan
| | | | - Yuko Minami
- Department of Diagnostic Pathology, National Hospital Organization Ibarakihigashi National Hospital, the Center of Chest Diseases and Severe Motor & Intellectual Disabilities, Ibaraki, Japan
| | - Hirokuni Kakinuma
- Department of Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yasuo Shibuki
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Miyake
- Department of Diagnostic Pathology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kenta Kajio
- Department of Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Kana Kiyonaga
- Department of Diagnostic Pathology, Kagawa University Hospital, Kagawa, Japan
| | - Moe Nagatomo
- Department of Central Laboratory, Osaka Toneyama Medical Center, Osaka, Japan
| | - Sanako Nishimura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Noriko Motoi
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Tsutomu Yoshida
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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23
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González Vásquez CM, Muñoz Durán JA, Isaza Zapata S, González Londoño JF, García Gómez V. Concordance of the ACR TI-RADS. Radiologia (Engl Ed) 2021; 63:469-475. [PMID: 34801179 DOI: 10.1016/j.rxeng.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS The ACR TI-RADS classification system is reproducible.
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Affiliation(s)
| | - J A Muñoz Durán
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | - S Isaza Zapata
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | | | - V García Gómez
- Radiólogo, Hospital Pablo Tobón Uribe, Antioquia, Colombia
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24
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Alhashem MH, Alabidi A, Aly MG. The Bethesda System for Reporting Thyroid Cytopathology: A Retrospective Review of its Diagnostic Utility at Johns Hopkins Aramco Healthcare, Saudi Arabia. Am J Otolaryngol 2021; 42:103088. [PMID: 34090018 DOI: 10.1016/j.amjoto.2021.103088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Fine needle aspiration (FNA) is the gold standard for assessment of thyroid nodules, with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) used to predict the malignancy risk of these nodules. Our aim was to evaluate the diagnostic utility of the TBSRTC for a Saudi population, by comparing the malignancy risk based on histopathology to FNA-based diagnosis of each of the TBSRTC categories and to previously published malignancy risk in other population. MATERIALS AND METHODS This was a retrospective study of the data of 241 patients who underwent FNA assessment of thyroid nodules and surgical resection with histopathology at John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, between January 2016 and December 2019. RESULTS The malignancy risk for each of the TBSRTC categories was as follows: non-diagnostic, 25%, benign; 5.74%; atypia of undetermined significance, 37%; suspicious for follicular neoplasm, 38%; suspicious for malignancy, 100%; and malignant, 95%. Our finding were comparable to previously published malignancy risks, except for a higher rate of malignancy in the benign category at 18% compared to 0-3%. CONCLUSION Our findings validate the diagnostic reproducibility of the TBSRTC for a Saudi population, with the risk of malignancy confirmed by histopathological assessment being consistent with those previously reported for other populations.
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Scola WH, Linhares SM, Handelsman RS, Picado O, Khan ZF, Farrá JC, Lew JI. Molecular Testing Has Limited Utility in the Surgical Evaluation of Bethesda III Thyroid Nodules. J Surg Res 2021; 268:209-213. [PMID: 34358733 DOI: 10.1016/j.jss.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology has 6 diagnostic categories, each with an implied cancer risk of malignancy (ROM). Bethesda III, defined as atypia or follicular lesions of undetermined significance (AUS/FLUS) on fine needle aspiration (FNA), has an indeterminate ROM. This study investigates the utility of Afirma Gene Expression Classifier (GEC) and Thyroid Sequencing (ThyroSeq) molecular testing to predict malignancy in AUS/FLUS thyroid nodules. METHODS A retrospective review of prospectively collected data of 1457 patients with index thyroid nodules who underwent FNA and thyroidectomy at a single academic institution was performed. Use of GEC or ThyroSeq for AUS/FLUS thyroid nodules was examined. GEC testing was reported benign or suspicious for malignancy whereas ThyroSeq testing was reported on a spectrum of low, intermediate or high ROM. Descriptive statistics were utilized to compare the ROM among AUS/FLUS thyroid nodules. RESULTS Of 1457 patients with FNA thyroid cytology, 359 (25%) corresponded to AUS/FLUS results. There were 132 (37%) patients with GEC testing and 88 (24%) had ThyroSeq testing. ROM without GEC or ThyroSeq testing was 49%, whereas ROM with suspicious GEC was 55%. ROM with positive ThyroSeq was 73%. Among ThyroSeq patients, 43 had intermediate-risk mutations with 60% malignancy, and 23 had high-risk mutations with 96% malignancy (P < 0.01). CONCLUSION Surgical patients with AUS/FLUS thyroid nodules have a high ROM. High-risk ThyroSeq testing may have some utility in predicting malignancy, but GEC and intermediate-risk TGC results have limited value. Surgeons should carefully consider the utility of molecular tests to determine surgical resection.
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Affiliation(s)
- William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL.
| | - Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Rachel S Handelsman
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Omar Picado
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Zahra F Khan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Josefina C Farrá
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
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Ngo HTT, Nguyen TPX, Vu TH, Jung CK, Hassell L, Kakudo K, Vuong HG. Impact of Molecular Testing on the Management of Indeterminate Thyroid Nodules Among Western and Asian Countries: a Systematic Review and Meta-analysis. Endocr Pathol 2021; 32:269-279. [PMID: 32767256 DOI: 10.1007/s12022-020-09643-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 01/14/2023]
Abstract
Molecular testing has a potential to improve the management of patients with indeterminate thyroid nodules considered for surgery. This study examined the influence of molecular tests on the treatment of indeterminate nodules, particularly the differences between Western and Asian countries. Electronic databases including PubMed and Web of Science were searched for relevant articles from 2010 to March 2019. We computed meta-analysis of proportion and their 95% confidence intervals (CIs) utilizing the random-effect model. We used independent samples t test to compare the resection rate (RR), rate of malignancy (ROM), rate of preoperative molecular testing (RMT), and rate of positive test (RP) between subgroups. We included a total of 34 studies with 7976 indeterminate nodules. The multigene panel testing methods were exclusively used in the USA. Compared with the non-molecular era, molecular testing was associated with a significantly increased ROM (47.9% versus 32.1%; p = 0.001). The ROM of indeterminate nodules in Asian institutes was significantly higher than that in Western countries (75.3% versus 36.6%; p < 0.001, respectively). Institutes employing single-gene tests achieved a higher ROM (59.8% versus 37.9%; p = 0.013). Molecular testing is a promising method to tailor the clinical management for indeterminate thyroid FNA. Certain differences in routine thyroid cytopathology practice among the West and the East are still present. The combination of molecular testing and active surveillance enhances the accuracy of case selection for surgery in Asian countries.
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Affiliation(s)
- Hanh Thi Tuyet Ngo
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700-000, Vietnam
| | | | - Trang Huyen Vu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, 700-000, Vietnam
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Lewis Hassell
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Wake-cho 4-5-1, Izumi City, 594-0073, Japan
| | - Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Vuong HG, Suzuki A, Na HY, Tuyen PV, Khuy DM, Nguyen HC, Jitpasutham T, Abelardo A, Amano T, Park SY, Jung CK, Hirokawa M, Katoh R, Kakudo K, Bychkov A. Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population. Am J Clin Pathol 2021; 155:680-689. [PMID: 33269383 DOI: 10.1093/ajcp/aqaa182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. METHODS Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. RESULTS Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. CONCLUSIONS Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Pham Van Tuyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Doan Minh Khuy
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hiep Canh Nguyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Tikamporn Jitpasutham
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Agustina Abelardo
- Department of Pathology, College of Medicine University of Philippines Manila, Manila, Philippines
- Department of Laboratories, Philippine General Hospital Medical Center, Manila, Phillipines
| | | | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | | | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Tokyo, Japan
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Osaka, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Pinhas S, Tessler I, Bizer LP, Khalilia K, Warman M, Adi M, Halperin D, Cohen O. Validating the 'CUT score' risk stratification tool for indeterminate thyroid nodules using the Bethesda system for reporting thyroid cytopathology. Eur Arch Otorhinolaryngol 2021; 279:383-390. [PMID: 33844064 DOI: 10.1007/s00405-021-06783-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Managing intermediate thyroid nodules remains challenging. The CUT score is an Italian metanalysis-based cytologic (SIAPEC-IAP) scoring system, designed to assist clinicians. However, it was never evaluated against the Bethesda system for reporting thyroid cytopathology (BSRTC). This study aims to validate its utility for BSRTC III and IV nodules in a non-Italian population. METHODS We collected all BSRTC III and IV thyroid nodules with a documented final pathology between 2010 and 2020. We calculated the C + U components of the CUT score using retrospective clinical (C) data collection and reevaluation of preoperative sonography (U) examination. The cytology (T) component which originally referred to the five-tiered SIAPEC-IAP cytologic classification was replaced by the corresponding BSRTC categories. Optimal test performances were calculated using receiver operating characteristic (ROC) curve analysis. Data were analyzed twice with considering of NIFTP as benign and as malignant. RESULTS After exclusions, 62 nodules from 61 patients were included (50% BSRTC III, 50% BSRTC IV). Malignant nodules demonstrated a significantly higher C + U score compared with benign in both categories. The C + U cutoff value for BSRTC III was 5.25 (sensitivity and specificity of 69.23% and 66.67%, respectively, AUC = 0.72, p-value = 0.016), and 5.75 for BSRTC IV (sensitivity and specificity of 85.7% and 76.5%, respectively, AUC = 0.84, p-value < 0.001). CONCLUSION Our study suggests that the CUT score is applicable for both BSRTC III and IV nodules, and highlights the need for internal validations, since the cutoffs found were higher than previously reported.
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Affiliation(s)
- Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Idit Tessler
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel. .,Hadassah Medical School, Hebrew University, Jerusalem, Israel.
| | - Luba Pasherstnik Bizer
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Khaled Khalilia
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Meital Adi
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Massa F, Caraci P, Sapino A, De Rosa G, Volante M, Papotti M. Outcome and diagnostic reproducibility of the thyroid cytology "indeterminate categories" SIAPEC/SIE 2014 in a consecutive series of 302 cases. J Endocrinol Invest 2021; 44:803-809. [PMID: 32797379 PMCID: PMC7946669 DOI: 10.1007/s40618-020-01377-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/28/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The clinical impact of the SIAPEC/SIE 2014 classification for thyroid cytology has been addressed in few studies that evaluated the malignancy rate and the relative prevalence of each category. No study analyzed its intra-observer and inter-observer reproducibility, so far. METHODS We retrospectively collected all "indeterminate" lesions diagnosed before (2011-2014) and after (2015-2018) the application of the SIAPEC/SIE 2014 classification at our Institution. Their relative malignancy risks were calculated based on available histological diagnoses. Cytological and clinical features of TIR3A were compared with the surgical outcome. Finally, a large set of samples was re-evaluated in blind of the original cytological and histological diagnoses by two pathologists, independently. RESULTS The prevalence of "indeterminate" diagnoses increased in years 2015-2018 (302/1482, 21% with 14% of TIR3A and 7% TIR3B categories) compared to years 2011-2014 (261/1680, 16%). Surgery was performed in 27% TIR3A and in 97% TIR3B cases. Malignancy rates were 40% for TIR3B and 17% for TIR3A, but were greatly influenced by the adoption of the WHO 2017 re-classification of encapsulated follicular-patterned lesions (decreasing to 28% and 6%, respectively). No criteria except for tumor size were associated to malignancy in TIR3A category. Intra-observer agreement of the experienced pathologist was 122/141 (86%), whereas inter-observer agreement between the expert and in-training pathologist was 95/141 (67%). CONCLUSIONS In this real-life experience, the sub-classification of TIR3A and TIR3B slightly increased the overall prevalence of "indeterminate" diagnoses. Malignancy rates were higher than estimated for both TIR3A and TIR3B categories. Agreement among observers highly depended on pathologist's training.
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Affiliation(s)
- F Massa
- Department of Oncology, University of Turin and Pathology Unit, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - P Caraci
- Internal Medicine Unit, San Luigi Hospital, Orbassano, Turin, Italy
| | - A Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - G De Rosa
- Pathology Unit, Mauriziano Hospital, Turin, Italy
| | - M Volante
- Department of Oncology, University of Turin and Pathology Unit, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - M Papotti
- Department of Oncology, University of Turin, and Pathology Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy
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Madgar O, Avior G, Shochat I, Joshua BZ, Baraf L, Avidor Y, Avi Khafif, Assadi N, Alon EE. Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study. Eur J Surg Oncol 2021; 47:1370-1375. [PMID: 33745793 DOI: 10.1016/j.ejso.2021.03.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology was developed in 2007 to facilitate an accurate, reproducible communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists and to serve as a guide for treatment. Based on large patient series, the system details the risk of malignancy for each category as well as a suggested management for each FNA result. Though this system has been widely adopted, there are only few studies to determine whether results are applicable for Israel. METHODS A multicenter, retrospective analysis of medical charts of all patients who underwent thyroid surgery between January 1st, 2012 and December 31st, 2016 in four medical centers in Israel was performed. Data was analyzed for the overall risk of malignancy for the Bethesda system groups as well as comparison between the different laboratories performing the test. RESULTS Records of 810 thyroidectomies in which preoperative cytological reports and final pathology were available and reviewed. The malignancy rates according to the Bethesda groups' I-VI for our cohort were: 27.8%, 17.6%, 41.4%, 41.4%, 86.9%, and 98.1% respectively. Similar results were seen when results were analyzed according to the different laboratories performing the tests. CONCLUSIONS Post-surgical review of all Bethesda groups had higher malignancy rates than those reported in the original report. These results indicate a difference in the malignancy rates for the different Bethesda system groups in Israel compared to those reported. Physicians are encouraged to use data validated for their own country or patients' community in addition to published values.
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Affiliation(s)
- Ory Madgar
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Galit Avior
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Isaac Shochat
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel. Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Baraf
- Endocrinology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Avidor
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Khafif
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Niddal Assadi
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Archondakis S, Roma M, Kaladelfou E. Two-Year Experience of the Implementation of the Milan for Reporting Salivary Gland Cytopathology at a Private Medical Laboratory. Head Neck Pathol 2021; 15:780-786. [PMID: 33459992 PMCID: PMC8384965 DOI: 10.1007/s12105-020-01278-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
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Guo Y, Jiang T, Ouyang L, Li X, He W, Zhang Z, Shen H, You Z, Yang G, Lai H. A novel diagnostic nomogram based on serological and ultrasound findings for preoperative prediction of malignancy in patients with ovarian masses. Gynecol Oncol 2020; 160:704-712. [PMID: 33357959 DOI: 10.1016/j.ygyno.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop a novel diagnostic nomogram model to predict malignancy in patients with ovarian masses. METHODS In total, 1277 patients with ovarian masses were retrospectively analyzed. Receiver operating characteristic (ROC) analysis was performed to identify valuable predictive factors. Univariate and multivariate logistic regression analyses were used to identify risk factors for ovarian cancer. Subsequently, a predictive nomogram model was developed. The performance of the nomogram model was assessed by its calibration and discrimination in a validation cohort. Decision curve analysis (DCA) was applied to assess the clinical net benefit of the model. RESULTS Overall, 496 patients (38.8%) had ovarian cancer. Eighteen parameters were significantly different between the malignant and benign groups. Five parameters were identified as being most optimal for predicting malignancy, including age, carbohydrate antigen 125, fibrinogen-to-albumin ratio, monocyte-to-lymphocyte ratio, and ultrasound result. These parameters were incorporated to establish a nomogram model, and this model exhibited an area under the ROC curve (AUC) of 0.937 (95% confidence interval [CI], 0.920-0.954). The model was also well calibrated in the validation cohort and showed an AUC of 0.925 (95%CI, 0.896-0.953) at the cut-off point of 0.298. DCA confirmed that the nomogram model achieved the best clinical utility with almost the entire range of threshold probabilities. The model has demonstrated superior efficacy in predicting malignancy compared to currently available models, including the risk of ovarian malignancy algorithm, copenhagen index, and the risk of malignancy index. More importantly, the nomogram established here showed potential value in identification of early-stage ovarian cancer. CONCLUSION The cost-effective and easily accessible nomogram model exhibited favorable accuracy for preoperative prediction of malignancy in patients with ovarian masses, even at early stages.
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Affiliation(s)
- Yunyun Guo
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Tengjia Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, PR China
| | - Linglong Ouyang
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Xiaohui Li
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Weipeng He
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Zuwei Zhang
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Hongwei Shen
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Zeshan You
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China
| | - Guofen Yang
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China.
| | - Huiling Lai
- Department of Gynecology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510060, Guangdong, PR China.
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Hirata Y, Higuchi K, Tamashiro K, Koja K, Yasutomi Y, Matsuzaki A, Yoshimi N. Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution. Acta Cytol 2020; 65:123-131. [PMID: 33113539 DOI: 10.1159/000510990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. STUDY DESIGN A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. RESULTS RON, ROM, and O-ROM rates were as follows - non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. CONCLUSIONS The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.
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Affiliation(s)
- Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Okinawa, Japan,
| | - Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Koichi Tamashiro
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Keisuke Koja
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yuiko Yasutomi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Akiko Matsuzaki
- Department of Diagnostic Pathology, Urasoe General Hospital, Okinawa, Japan
| | - Naoki Yoshimi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
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Jha S, Mitra S, Purkait S, Adhya AK. The Milan System for Reporting Salivary Gland Cytopathology: Assessment of Cytohistological Concordance and Risk of Malignancy. Acta Cytol 2020; 65:27-39. [PMID: 33045705 DOI: 10.1159/000510720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/31/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was proposed by the American Society of Cytopathology and the International Academy of Cytology to bring uniformity in the reporting system and the treatment protocol. A wide range of risk of malignancy for each category has been reported by various authors by applying the system. AIM We intend to study the cytohistological concordance and the ROM for each of the diagnostic categories of the Milan system. MATERIALS AND METHODS The study included 292 cases of fine-needle aspiration cytology (FNAC) of salivary gland lesions over a period of 3 years. The diagnosis of these cases was reclassified into the 6 categories of the Milan system. The cytohistological concordance and ROM for each category of the Milan system were calculated based on the clinical and histopathological follow-up. RESULTS The patients' age ranged from 3 to 81 years with the mean of 42.65 ± 16.3 years. The cases included 189 (64.7%) parotid, 82 (28.1%) submandibular, and 21 (7.2%) cases of minor salivary gland swellings. Follow-up histopathological diagnosis for 102 cases was available. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated to be 64.28, 97.01, 90, 86.67, and 87.37%, respectively. After reclassification, the number of cases in each category was as follows: category I: 31 (10.62%), category II: 80 (27.4%), category III: 2 (0.68%), category IVA: 143 (48.97%), category IVB: 1 (0.34%), category V: 13 (4.45%), and category VI: 22 (7.53%). The calculated ROM was as follows: category I: 42.86%, category II: 26.67%, category III: 100% category IVA: 10.17%, category IVB: 0%, category V: 71.42%, category VI: 100%. CONCLUSION FNAC is an excellent procedure to differentiate benign from malignant tumors, and MSRSGC is a useful system for risk assessment and deciding the further treatment protocol. Our findings also suggest that in addition to the surgical follow-up, inclusion of the clinical and radiological follow-up may be a better strategy for calculation of ROM, especially for categories I and II.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suvradeep Mitra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suvendu Purkait
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Amit Kumar Adhya
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India,
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Pastorello RG, Barkan GA, Saieg M. Experience on the use of The Paris System for Reporting Urinary Cytopathology: review of the published literature. J Am Soc Cytopathol 2020; 10:79-87. [PMID: 33160893 DOI: 10.1016/j.jasc.2020.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was first published in 2016 with clear objectives to standardize cytologic diagnostic criteria and provide uniform reporting, in order to improve patient stratification and associated clinical management. The aim of this paper is to evaluate the performance of TPS and review the literature published since TPS was introduced. MATERIALS AND METHODS Original articles focusing on the utilization and performance of TPS in urinary cytology specimens were identified using PubMed for publications from January 2016 to July 2020, using the keywords "Paris System", "urine cytology", and "urinary cytology". RESULTS Twenty-three relevant articles in the literature regarding the use of TPS were included in the review from a total of 30,802 urine cytology specimens, of which 21,485 (69.8%) had available diagnoses. Distribution of cases among categories ranged from 50.5% to 95.3% for negative for high-grade urothelial carcinoma (NHGUC), 1.2% to 23% for atypical urothelial cells (AUC), 0.2% to 6.6% for suspicious for high-grade urothelial carcinomas (SHGUC), and 2.2% to 14.1% for high-grade urothelial carcinomas (HGUC). The calculated risk of high-grade malignancy (ROHM) ranged from 8.7% to 36.8% for NHGUC, 12.3% to 60.9%% for AUC, 33.3% to 100% for SHGUC, and 58.8% to 100% for HGUC. Mean ROHM weighted by sample size was calculated at 15.7% (±7.8%), 38.5% (±14.3%), 76.2% (±17.2%), and 88.8% (±12.7%) for NHGUC, AUC, SHGUC, and HGUC, respectively. Reported sensitivity of TPS ranged from 40% to 84.7%, specificity from 73% to 100%, PPV from 62.3% to 100%, and NPV from 46% to 90%. CONCLUSIONS The application of TPS in the selected series has improved the screening and surveillance potential of urine cytology, while reducing high rates of indeterminate diagnoses, improving sensitivity and providing proper risk stratification for patients.
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Affiliation(s)
- Ricardo G Pastorello
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Healthcare System, Maywood, Illinois; Department of Urology, Loyola University Healthcare System, Maywood, Illinois
| | - Mauro Saieg
- Department of Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Pathology, Santa Casa Medical School, São Paulo, Brazil.
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Gilani SM, Adeniran AJ, Cai G. Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytologic Evaluation of Intraductal Papillary Mucinous Neoplasm and Mucinous Cystic Neoplasms of Pancreas. Am J Clin Pathol 2020; 154:559-570. [PMID: 32589187 DOI: 10.1093/ajcp/aqaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To evaluate the role of endoscopic ultrasound-guided fine needle aspiration cytology in identifying mucinous cystic lesions (MCLs) in histologically proven cases of intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN) and risk of malignancy associated with each cytologic category based on the Papanicolaou Society of Cytopathology (PSC) guidelines. METHODS All resected cases with histologic diagnosis of IPMN or MCN at our institution from January 1, 2004, to August 31, 2019, with associated cytology were included. Available cytology slides of nondiagnostic (ND), negative/benign (BN), and atypical cytology (AC) cases were reviewed and reclassified based on the PSC guidelines. RESULTS A total of 120 cases were identified, including 57 IPMNs with low-grade or moderate dysplasia (LGD/MD) and high-grade dysplasia (HGD), 34 MCNs with LGD/MD or HGD, and 29 IPMNs with invasive malignancy. After cytology slide review and reclassification, we observed that ND and BN cases were paucicellular and lacked ancillary testing (carcinoembryonic antigen levels or KRAS mutation analysis). The risk-of-malignancy rates were 33% for ND, 11% for BN, 28.5% for AC, 17% for MCL, and 100% for suspicious/positive cytologic diagnosis. CONCLUSIONS A multidisciplinary approach including combined use of cytology and ancillary testing is helpful in establishing a diagnosis of MCL and identifying associated malignancy.
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Affiliation(s)
- Syed M Gilani
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | | | - Guoping Cai
- Department of Pathology, Yale School of Medicine, New Haven, CT
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Guo HQ, Zhao H, Cao J, Zhao LL, Sun Y, Wang C, Zhang ZH. [Implementation of the Bethesda system for reporting the thyroid cytopathology: study on 5 729 cases from a cancer center]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 55:258-62. [PMID: 32268696 DOI: 10.3760/cma.j.issn.1673-0860.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the data of the Bethesda system for reporting thyroid cytopathology applied in a comprehensive cancer center and to evaluate the diagnostic ability of fine needle aspiration (FNA). Methods: We retrospectively reviewed the medical records of 5 729 cases applying this reporting system at Cancer Hospital, Chinese Academy of Medical Sciences. The series were from 5 011 patients including 1 174 men and 3 837 women, and their median age was 45 years (range, 7-88 years). FNA results were correlated with final histological diagnosis after surgery and the accuracy of FNA diagnosis and the malignancy rates for each of categories were also analyzed. Results: Among 5 729 thyroid aspirates, aside from 456 (8.0%) cases with nondiagnostic or unsatisfactory (ND/UNS) outcomes, 1 055 (18.4%) cases were benign, 409 (7.1%) cases showed atypical of undetermined significance or follicular lesions with undetermined significance (AUS/FLUS), 80 (1.4%) cases were follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 982 (17.1%) cases were suspicious for malignancy (SUS), and 2 747 cases were malignant (47.9%). Of 5 729 cases, 3 239 had received thyroidectomies after FNA, 95.99% of them were proven histologically to be malignant, with following malignancy rates in individual FNA categories: ND/UNS 75.00%; benign 40.91%; AUS/FLUS 77.67%; FN/SFN 41.67%; SUS 96.86%; and malignant 99.96%. FNA predicted malignancy with sensitivity, specificity, accuracy, positive predictive value and negative predictive values of 98.8%, 60.5%, 97.7%, 98.9% and 59.1%, respectively. Conclusions: The data of the Bethesda reporting system indicates high proportion of malignant diagnosis and high risk of malignancy at all FNA diagnostic categories. FNA offers high diagnostic accuracy and positive predictive value for the diagnosis of thyroid diseases.
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Park JH, Cha YJ, Seo JY, Lim JY, Hong SW. A retrospective cytohistological correlation of fine-needle aspiration cytology with classification by the Milan System for Reporting Salivary Gland Cytopathology. J Pathol Transl Med 2020; 54:419-425. [PMID: 32631037 PMCID: PMC7483028 DOI: 10.4132/jptm.2020.06.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Before publication of the new classification system named the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in 2018, there was no standard classification for salivary gland lesions obtained by fine-needle aspiration (FNA). We therefore aimed to evaluate the diagnostic utility of this system by retrospectively reviewing FNA samples using the MSRSGC and to determine their risk of developing into neoplasms and becoming malignant. Methods Retrospective slide review and classification of salivary gland FNAs obtained over a 6-year period (2013–2018) at a single center were performed by two pathologists. The risks of neoplasm and malignancy for each category also were calculated. Results This study surveyed 374 FNAs (371 patients) performed over a six-year period and selected 148 cases that included documented surgical follow-up (39.6%). Among the surgically treated cases, the distributions of FNA categories were as follows: non-diagnostic (ND; 16.9%), non-neoplastic (NN; 2.7%), atypia of undetermined significance (AUS; 3.4%), benign (BN; 54.7%), salivary gland neoplasm of uncertain malignant potential (SUMP; 10.1%), suspicious for malignancy (SM; 6.8%), and malignant (M; 5.4%). The risk of malignancy (ROM) was 24.0% for ND, 0% for NN, 40.0% for AUS, 2.5% for BN, 46.7% for SUMP, 100% for SM, and 87.5% for M. The overall diagnostic accuracy was 95.9% (142/148 cases). Conclusions The newly proposed MSRSGC appears to be a reliable system for classification of salivary gland lesions according to the associated ROM.
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Affiliation(s)
- Ji Hyun Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Yeong Seo
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Mazzola F, Tomasoni M, Mocellin D, Dalè M, Iandelli A, Carobbio A, Marchi F, Filauro M, Petruzzi G, Massa B, Facchetti M, Battocchio S, Marandino F, Lombardi D, Pichi B, Pellini R, Nicolai P, Peretti G. A multicenter validation of the revised version of the Milan system for reporting salivary gland cytology (MSRSGC). Oral Oncol 2020; 109:104867. [PMID: 32593953 DOI: 10.1016/j.oraloncology.2020.104867] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is a basic step in the diagnosis of salivary gland tumors that have a wide variety of histological types. The recent Milan system for reporting salivary gland cytopathology (MSRSGC) can correlate the risk of malignancy with precise cytological features. A revised version was recently proposed to improve the surgical relevance and facilitate uniform management. MATERIAL AND METHODS A multicenter study retrospectively used the original and revised MSRSGC criteria to classify a series of patients who received surgery after FNAC. RESULTS We enrolled 503 patients from three tertiary centers. The risk of malignancy for the MSRSGC resulted 19.5% in cat. I, 14.3% in cat. II, 17.6% in cat. III, 3.6% in cat. IVa, 24.6% in cat. IVb, 66.7% in cat. V, and 96.8% in cat. VI. The results from the revised MSRSGC were consistent with the original values. CONCLUSION The MSRSGC is a promising classification system. In our opinion, the revised version of the MSRSGC supplements FNAC with some crucial clinical information and can better identify the appropriate treatment in each category.
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Affiliation(s)
- F Mazzola
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy; Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
| | - M Tomasoni
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - D Mocellin
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - M Dalè
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - A Iandelli
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - A Carobbio
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - F Marchi
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - M Filauro
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genoa, Via Leon Battista Alberti, 2, 16132, Genoa, Italy
| | - G Petruzzi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - B Massa
- Cyto-Histopathological Unit and Pathology Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - M Facchetti
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - S Battocchio
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - F Marandino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - D Lombardi
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - B Pichi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - R Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - P Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Via Giustiniani, 2 - 35128 Padua, Italy
| | - G Peretti
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
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González Vásquez CM, Muñoz Durán JA, Isaza Zapata S, González Londoño JF, García Gómez V. Concordance of the ACR TI-RADS. Radiologia (Engl Ed) 2020; 63:S0033-8338(20)30071-0. [PMID: 32522374 DOI: 10.1016/j.rx.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS The ACR TI-RADS classification system is reproducible.
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Affiliation(s)
| | - J A Muñoz Durán
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | - S Isaza Zapata
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | | | - V García Gómez
- Radiólogo, Hospital Pablo Tobón Uribe, Antioquia, Colombia
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Al-Sharafi BA, AlSanabani JA, Alboany IM, Shamsher AM. Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic. Thyroid Res 2020; 13:8. [PMID: 32518593 PMCID: PMC7275581 DOI: 10.1186/s13044-020-00082-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background The prevalence of thyroid cancer is increasing worldwide. No previous data are available on the prevalence of thyroid cancer in Yemen. We performed this study to determine the prevalence of thyroid cancer among patients with thyroid nodules in Yemen. Methods A retrospective chart review was performed for 550 patients with thyroid nodules who underwent fine needle aspiration and/or thyroid surgery at a private endocrine clinic and at an endocrine clinic in a tertiary hospital in Yemen over a 3 -year period from October 2016–2019. The prevalence of thyroid cancer; the sonographic findings, Bethesda classification, age, sex, thyroid stimulating hormone (TSH) levels of the patients; and the nodule size and number were reviewed. Results A total of 550 charts were reviewed [501 females (91.1%) and 49 males (8.9%)]. The thyroid cancer prevalence among the patients was 13.8% (CI = 10.9–16.7), and the mean age of the patients was 38.5 years (SD = 12.2). The TSH level and the rate of cancer were significantly related (P = 0.01), but no significant difference in the prevalence of thyroid cancer was found between females (13.4%) and males (18.4%) (P = 0.334). When correlating the rate of cancer with the ultrasound guided fine needle aspiration (UG-FNA) result, those with Bethesda system category III and IV, V and VI had malignancy rates of 20.8, 27.2, 52.4 and 69.2%, respectively. Thyroid nodules highly suspicious for malignancy on ultrasound had a 70% cancer diagnosis rate. The most common thyroid cancer was papillary cancer (71%), followed by follicular cancer (23.7%). Among those undergoing surgery, 44.2% had thyroid cancer, and 5.2% had a premalignant diagnosis. Conclusion Thyroid cancer has a higher prevalence in Yemen than in other middle eastern countries. Our study also reports a higher rate of follicular thyroid cancer than that in other published data, which has to be confirmed by further studies. The malignancy and premalignant diagnosis rate was ~ 50% in our patients who underwent surgery. Many centers in Yemen still do not perform FNA before thyroid surgery. It is important that other centers in the country start emphasizing the need for FNA before surgery. This will decrease the number of unnecessary surgeries and associated complications.
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Affiliation(s)
| | | | - Ibraheem M Alboany
- Department of Radiology, University of Science and Technology, Sana'a, Yemen
| | - Amani M Shamsher
- Department of Pathology, University of Science and Technology Hospital, Sana'a, Yemen
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Ohori NP, Landau MS, Manroa P, Schoedel KE, Seethala RR. Molecular-derived estimation of risk of malignancy for indeterminate thyroid cytology diagnoses. J Am Soc Cytopathol 2020; 9:213-220. [PMID: 32336670 DOI: 10.1016/j.jasc.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/31/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION One of the key features of the Bethesda System for Reporting Thyroid Cytopathology is the risk of malignancy (ROM), which guides management for each diagnostic category. However, calculation of the ROM can be challenging for indeterminate diagnoses because only a portion of cases will be resected for cytologic-histologic correlation (CHC) analyses. In the present study, we used the probability of cancer information from ThyroSeq, version 3, reports to calculate the molecular-derived (MD) ROM for indeterminate categories. MATERIALS AND METHODS Cytology cases with indeterminate BSRTC diagnoses and adequate molecular test results were retrieved from our cytopathology laboratory for a 12-month period. The probability of cancer information from the ThyroSeq, version 3, molecular reports were tabulated, and the mean ROM was calculated for each diagnostic category. The MDROM included noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) as a "malignant" outcome because it is considered a surgical disease. RESULTS A total of 361 cases had adequate material for molecular testing. The diagnostic distribution was as follows: atypia of undetermined significance/follicular lesion of undetermined significance, 271 cases (75.1%), follicular neoplasm/suspicious for a follicular neoplasm, 59 cases (16.3%), and Hürthle cell type/suspicious for a follicular neoplasm, Hürthle cell type, 31 cases (8.6%). The corresponding estimated MDROMs were 14.9%, 32.6%, and 34.4%. A comparison with the CHC data was performed, and the 95% confidence intervals of the MDROMs overlapped well with the 2 endpoint CHC values. CONCLUSIONS Calculation of the MDROMs provides a new method to approximate the ROMs of indeterminate diagnoses and has the advantage of potentially evaluating all cases, not just those resected. Furthermore, for those using the same platform, interinstitutional comparisons will be possible.
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Affiliation(s)
- N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania.
| | - Michael S Landau
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Pooja Manroa
- Division of Endocrinology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Karen E Schoedel
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
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Hiroshima K, Yoshizawa A, Takenaka A, Haba R, Kawahara K, Minami Y, Kakinuma H, Shibuki Y, Miyake S, Kajio K, Miyamoto K, Nagatomo M, Nishimura S, Mano M, Matsubayashi J, Motoi N, Nagao T, Nakatsuka SI, Yoshida T, Satoh Y. Cytology Reporting System for Lung Cancer from the Japan Lung Cancer Society and Japanese Society of Clinical Cytology: An Interobserver Reproducibility Study and Risk of Malignancy Evaluation on Cytology Specimens. Acta Cytol 2020; 64:452-462. [PMID: 32222718 DOI: 10.1159/000506431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The classification of lung carcinoma is based on small biopsies and/or cytology in 80% of patients with non-small cell carcinoma. However, there is no widely accepted classification system for respiratory cytology. The Japan Lung Cancer Society (JLCS) and Japanese Society of Clinical Cytology (JSCC) have proposed a new four-tiered cytology reporting system for lung carcinoma with the following categories: (1) "negative for malignancy," (2) "atypical cells," (3) "suspicious for malignancy," and (4) "malignancy." OBJECTIVE The aim of this work was to perform an interobserver reproducibility study to confirm the utility of the four-tiered reporting system on respiratory cytological samples. METHODS We analyzed 90 cytological samples obtained with bronchoscopy. Seven observers classified these cases into each category by reviewing one Papanicolaou-stained slide per case according to the three-, four-, and five-tiered reporting systems. RESULTS The interobserver agreement was fair in the three- (κ = 0.50), four- (κ = 0.45), and five-tiered (κ = 0.45) reporting systems. However, the four-tiered reporting system provided more precise information than the three-tiered reporting system in patient management. The risk of malignancy in the four-tiered reporting system was also stratified well: 19.3% for "negative for malignancy," 45.6% for "atypical cells," 74.7% for "suspicious for malignancy," and 88.1% for "malignancy." CONCLUSIONS The reporting system proposed by the JLCS and JSCC was designed to enhance the communication between clinicians and pathologists and among different institutions. It is simple and applicable to cytological diagnosis of any respiratory diseases. We propose establishing an international classification for respiratory cytology, harmonizing the reporting systems proposed by different countries.
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Affiliation(s)
- Kenzo Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan,
- Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan,
- Sodegaura Satsukidai Hospital, Sodegaura, Japan,
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akemi Takenaka
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kagawa, Japan
| | | | - Yuko Minami
- Department of Diagnostic Pathology, National Organization Hospital Ibarakihigashi National Hospital, The Center of Chest Diseases and Severe Motor and Intellectual Disabilities, Ibaraki, Japan
| | - Hirokuni Kakinuma
- Department of Pathology, Kitasato University Hospital, Sagamihara, Japan
| | - Yasuo Shibuki
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Miyake
- Department of Diagnostic Pathology Division, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kenta Kajio
- Department of Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Kana Miyamoto
- Department of Diagnostic Pathology, Kagawa University Hospital, Kagawa, Japan
| | - Moe Nagatomo
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Sanako Nishimura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Noriko Motoi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Tsutomu Yoshida
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Na HY, Woo JW, Moon JH, Choi JY, Jeong WJ, Kim YK, Choe JY, Park SY. Preoperative Diagnostic Categories of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in Thyroid Core Needle Biopsy and Its Impact on Risk of Malignancy. Endocr Pathol 2019; 30:329-339. [PMID: 31605276 DOI: 10.1007/s12022-019-09590-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study was designed to evaluate the preoperative diagnostic categories of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) using thyroid core needle biopsy (CNB) and to analyze its impact on the risk of malignancy (ROM). A total of 2687 consecutive thyroid CNBs were reviewed retrospectively and classified into six diagnostic categories using a standardized reporting system similar to the Bethesda System for Reporting Thyroid Cytopathology. Diagnostic categories of CNBs were compared with the final surgical diagnoses, and the ROM in each category was calculated both before and after excluding NIFTP from malignancy. Of 946 surgically resected cases, 683 were diagnosed as papillary thyroid carcinoma (PTC), and 32 (4.7% of PTC) were reclassified as NIFTP. The CNB diagnostic categories of NIFTP were as follows: follicular neoplasm in 20 (62.5%; 14, with nuclear atypia), indeterminate lesion in 11 (34.4%), and suspicious for malignancy in one (3.1%). When combined, NIFTP and encapsulated follicular variant of PTC (EFVPTC) were more often categorized as follicular neoplasm compared with other PTC variants including infiltrative FVPTC. Exclusion of NIFTP from malignant diagnosis led to a significant decrease in the ROM in follicular neoplasm with nuclear atypia category. Thus, thyroid CNB enables to differentiate NIFTP/EFVPTC from other PTCs, providing a useful guide for optimal treatment in patients with these tumors.
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Affiliation(s)
- Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Ji Won Woo
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Ji-Young Choe
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Republic of Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
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Gan Q, Edeiken BS, Chen MM, Grubbs EG, Busaidy NL, Zafereo M, Perrier ND, Gule-Monroe MD, Krishnamurthy S. Utility of subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance category in ultrasound-guided thyroid fine-needle aspiration in a large referral cancer center. J Am Soc Cytopathol 2019; 8:309-316. [PMID: 31526696 DOI: 10.1016/j.jasc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Subclassification of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is encouraged in the Bethesda System. In our practice, we subclassified AUS/FLUS into 3 subcategories: atypical follicular cells of undetermined significance (ACUS) for cases with cytologic atypia; follicular lesion (FL) for cellular cases with follicular cells with-minimal or no atypia, arranged in a macro- and micro-follicular pattern with scant colloid; and indeterminate follicular lesion, favor benign (IFL-FB) for cases with few clusters of follicular cells without atypia associated with minimal or no colloid. The objective of our study was to evaluate the prevalence, clinical management, and risk of malignancy for each subcategory. MATERIALS AND METHODS We retrospectively identified ultrasound-guided fine-needle aspiration (US-FNA) of thyroid cases that were subcategorized as ACUS, IFL-FB, and FL at our-institution during 2014-2016. The results of US-FNA were correlated with clinical outcome in the subsequent 2 years including repeat US-FNA, thyroid surgery, and clinical/imaging follow-up. RESULTS Of 3207 thyroid US-FNA cases, 718 (22.4%) cases were included in the study. Of these 718 cases, 104 (14.5%) were subcategorized as ACUS, 166 (23.1%) as FL, and 448 (62.4%) as IFL-FB. The surgery rate was 39.4% (41 of 104) for ACUS, 13.6% (61 of 448) for IFL-FB, and 27.1% (45 of 166) for FL. The risk of malignancy (ROM) was 25% (26 of 104) for ACUS, and 2.9% (13 of 448) for IFL-FB, 6.0% (10 of 166) for FL. The surgery rate and ROM was significantly higher for ACUS in comparison to IFL-FB (P < 0.05) and FL (P < 0.05). CONCLUSIONS Subclassification of AUS/FLUS into 3 groups based on cytopathologic findings alone not only improved the triage of patients for subsequent clinical management but also effectively stratified the risk of malignancy.
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Affiliation(s)
- Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth S Edeiken
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa M Chen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth G Grubbs
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Zafereo
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy D Perrier
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria D Gule-Monroe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Sauter JL, Lehrke H, Zhang X, Al Badri OT, Rodriguez-Gutierrez R, Delivanis DA, Singh Ospina N, Donegan D, Hamidi O, Iñiguez-Ariza N, Sharma A, Kittah NEN, Tamhane SU, Hurtado Andrade MD, Kotwal A, Jenkins SM, Spears G, Rivera M, Dean DS, Henry MR. Assessment of The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2019; 152:502-511. [PMID: 31305880 DOI: 10.1093/ajcp/aqz076] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA). METHODS Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated. RESULTS Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM). CONCLUSIONS Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.
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Affiliation(s)
- Jennifer L Sauter
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi Lehrke
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Xiaotun Zhang
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | | | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- KER-Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Naykky Singh Ospina
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Division of Endocrinology, University of Florida, Gainesville
| | - Diane Donegan
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Oksana Hamidi
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, TX
| | - Nicole Iñiguez-Ariza
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anu Sharma
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | | | - Anupam Kotwal
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Grant Spears
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Michael Rivera
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Diana S Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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Miller JA, An D, Shafique K, Song S, Rao RA, Viswanathan K, Eykman E, Wiles A, Ali SZ, Field A, Fadda G, Barkan GA, Layfield LJ, Rossi ED, Powers CN, Siddiqui MT, Kholova I, Baloch Z, Maleki Z. Mucoepidermoid carcinoma, acinic cell carcinoma, and adenoid cystic carcinoma on fine-needle aspiration biopsy and The Milan System: an international multi-institutional study. J Am Soc Cytopathol 2019; 8:270-277. [PMID: 31104944 DOI: 10.1016/j.jasc.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND We evaluated the diagnostic accuracy (DA), risk of neoplasm (RON), and risk of malignancy (ROM) for the commonly encountered malignant salivary gland tumors mucoepidermoid carcinoma (MECa), acinic cell carcinoma (ACCa), and adenoid cystic carcinoma (ADCa) applying The Milan System for Reporting Salivary Gland Cytology (MSRSGC). MATERIALS AND METHODS The cytology archives from 2007 to 2017 of 9 academic institutions were searched for salivary gland FNAs for the following key words mentioned either in the principal and/or differential diagnosis: MEC, ACCa, and ADCa. The original cytology diagnosis was retrospectively classified according to the MSRSGC. Patient demographics, biopsy site, and available surgical follow-up were recorded. The final analysis included only cases with surgical follow-up. RESULTS A total of 212 salivary gland FNAs were included. Based on retrospective reclassification according to MSRSGC, 97 of 212 (46%) FNA cases carried a diagnosis of malignancy specific for either MECa, ACCa, or ADCa. In the remaining 115 cases, 24 of 212 (11%) were reclassified as suspicious for malignancy (SM) and 91 of 212 (43%) as salivary gland neoplasm of uncertain malignant potential (SUMP). The DA for MECa, ACCa, and ADCa was 78.7%, 75% and 89%, respectively. The RON was 100% for all 3 tumors and the ROM was 93.6% for MECa, 96.8% for ACCa, and 94.4% for ADCa. CONCLUSIONS The DA of 78.7% for MECa, 75% for ACCa, and 89% for ADCa is reasonable in FNA specimens. Although the management of definitive cases of malignancy remains unchanged, the MSRSGC provides a ROM for SM and SUMP categories, which can improve patient management.
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Affiliation(s)
- James A Miller
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel An
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Khurram Shafique
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rema A Rao
- Department of Pathology, New York Presbyterian, Weill Cornell Medicine, Pathology and Laboratory Medicine, New York, New York
| | - Kartik Viswanathan
- Department of Pathology, New York Presbyterian, Weill Cornell Medicine, Pathology and Laboratory Medicine, New York, New York
| | - Elizabeth Eykman
- Department of Pathology, St. Vincent Hospital, Sydney, Australia
| | - Austin Wiles
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Syed Z Ali
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Andrew Field
- Department of Pathology, St. Vincent Hospital, Sydney, Australia
| | - Guido Fadda
- Department of Pathology, Catholic University of Sacred Heart, Fondazione Policlinico Univeristario A, Rome, Italy
| | - Guliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Lester J Layfield
- Department of Pathology, University of Missouri School of Medicine, Columbia, Missouri
| | - Esther D Rossi
- Department of Pathology, Catholic University of Sacred Heart, Fondazione Policlinico Univeristario A, Rome, Italy
| | - Celeste N Powers
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Momin T Siddiqui
- Department of Pathology, New York Presbyterian, Weill Cornell Medicine, Pathology and Laboratory Medicine, New York, New York
| | - Ivana Kholova
- Department of Pathology, Fimlab Laboratories and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Zubair Baloch
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
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Chung SR, Baek JH, Lee JH, Lee YM, Sung TY, Chung KW, Hong SJ, Jeon MJ, Kim TY, Shong YK, Kim WB, Kim WG, Song DE. Risk of Malignancy According to the Sub-classification of Atypia of Undetermined Significance and Suspicious Follicular Neoplasm Categories in Thyroid Core Needle Biopsies. Endocr Pathol 2019; 30:146-154. [PMID: 31044350 DOI: 10.1007/s12022-019-9577-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The objective of this study was to evaluate the risk of malignancy (ROM) associated with atypia of undetermined significance (AUS) and suspicious follicular neoplasm (SFN) core needle biopsy (CNB) categories after further sub-classification. Data from 2267 thyroid nodules evaluated by ultrasound-guided CNB, from January to December 2015, were retrospectively reviewed. AUS nodules (n = 556) were sub-classified as follows: (1) architectural atypia (AUS-A; n = 369, 66.4%), (2) cytologic atypia (AUS-C; n = 35, 6.3%), (3) cytologic/architectural atypia (AUS-C/A; n = 85, 15.3%), or (4) oncocytic atypia (AUS-O; n = 67, 12.1%). SFN nodules (n = 172) were sub-classified as follows: (1) architectural atypia only (SFN-A; n = 110, 64%), (2) cytologic/architectural atypia (SFN-C/A; n = 24, 14%), or (3) oncocytic atypia (SFN-O; n = 38, 22%). Diagnostic surgery was performed in 162 (30.2%) AUS cases and 105 (61%) SFN cases. The ROM of each sub-category was evaluated. The overall ROM was 15.3-52.5% in AUS nodules and 35.5-58.1% in SFN nodules. The ROM was higher in the AUS-C (22.9-88.9%) and AUS-C/A (32.9-90.3%) groups than AUS-A (11.9-40%) and AUS-O (7.5-41.7%). In the SFN category, ROM in the SFN-C/A group was also higher than SFN-A or SFN-O (37.5-75%, 40-57.9%, and 21.1-47.1%, respectively). Our study shows that the ROM was higher in AUS or SFN sub-categories with cytologic atypia than those without cytologic atypia. Because of the heterogeneous nature of AUS and SFN categories, sub-classification may be a more effective approach for risk stratification, allowing optimal management of patients with thyroid nodules.
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Affiliation(s)
- Sae Rom Chung
- Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jung Hwan Baek
- Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jeong Hyun Lee
- Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Yu-Mi Lee
- Departments of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Tae-Yon Sung
- Departments of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Ki-Wook Chung
- Departments of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Suck Joon Hong
- Departments of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Min Ji Jeon
- Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Tae Yong Kim
- Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Young Kee Shong
- Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Won Bae Kim
- Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Won Gu Kim
- Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Dong Eun Song
- Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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49
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Trimboli P, Crescenzi A, Castellana M, Giorgino F, Giovanella L, Bongiovanni M. Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis. Endocrine 2019; 63:430-438. [PMID: 30519908 DOI: 10.1007/s12020-018-1825-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules. METHODS A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated. RESULTS The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias. CONCLUSIONS The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Anna Crescenzi
- Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy
| | - Marco Castellana
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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50
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Reuters KB, Mamone MC, Ikejiri ES, Camacho CP, Nakabashi CC, Janovsky CC, Yang JH, Andreoni DM, Padovani R, Maciel RM, Vanderlei FA, Biscolla RP. Bethesda Classification and Cytohistological Correlation of Thyroid Nodules in a Brazilian Thyroid Disease Center. Eur Thyroid J 2018; 7:133-138. [PMID: 30023345 PMCID: PMC6047492 DOI: 10.1159/000488104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Bethesda System has been used to classify thyroid cytology in 6 categories besides presenting malignancy rates and respective approaches. Reference centers have validated its use by comparing its proposed malignancy rates with those in in their populations. However, to the best of our knowledge, there has been no corresponding study in Brazil. OBJECTIVES To evaluate the performance of the Bethesda classification in a Brazilian thyroid reference center and correlate the results with cytohistological reports in patients referred to surgery. METHODS Data records from 980 fine-needle aspiration (FNA) results were retrospectively analyzed, and, in patients who underwent surgery, the results were correlated with the cytohistological findings. RESULTS 980 FNAs and 585 patients were evaluated. The incidence of each cytological category was: 11% nondiagnostic (ND), 59.6% benign, 7.1% (atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 8.5% follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 5.1% suspicious for malignancy (SM), and 8.3% malignant. The surgery rate was 41.8% (245/585). The malignancy rate in each category was: 6% benign, 12% AUS/FLUS, 20.8% FN/SFN, 72.5% SM, and 97.3% malignant. For ND nodules, the malignancy rate was 25.7% (66.6% multifocal and papillary microcarcinomas), a higher rate than in the literature. In this category, surgery was performed in multinodular goiters presenting with another nodule > 3.0 cm and/or with an FN/SFN, SM, or malignant cytological result. CONCLUSION The Bethesda System can be applied to the Brazilian population, since the frequency and malignancy rates of each category were similar to those described by its classification. It is noteworthy that a higher risk of malignancy was observed in the ND cytological category.
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Affiliation(s)
- Kassia B. Reuters
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria C.O.C. Mamone
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elsa S. Ikejiri
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cleber P. Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia C.D. Nakabashi
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina C.P.S. Janovsky
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ji H. Yang
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Danielle M. Andreoni
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosalia Padovani
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Santa Casa de São Paulo, São Paulo, Brazil
| | - Rui M.B. Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Felipe A.B. Vanderlei
- Head and Neck Division, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosa P.M. Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
- *Rosa Paula Mello Biscolla, MD, PhD, or Rui M.B. Maciel, MD, PhD, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, 11th floor, São Paulo, SP 04039-032 (Brazil), E-Mail or
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