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Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.

BACKGROUND Both squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) are common malignant tumors in the neck. However, seldom has SCC of the thyroid been diagnosed. Further, cytological features of SCC and PTC have rarely been reported. The significance of fine-needle aspiration cytology (FNAC) in the diagnosis of neck masses has been established. Herein, we present an exceedingly rare case of an intrathyroidal SCC diagnosed using FNAC, along with its cytological features. CASE SUMMARY A 66-year-old man presented with a left-sided neck mass. Ultrasound examination showed an ill-defined nodule. The appearance was hypoechoic with a few hyperechoic spots. FNAC of the left thyroid nodule was performed. A cellular smear was obtained, and it showed a large number of neoplastic cells with rich cytoplasm and poor cell adhesion. Tumor cell nuclei showed coarse nuclear chromatin and a few enlarged prominent nucleoli. An increased nuclear/cytoplasm ratio was observed. Thus, malignancy was diagnosed without a confirmed tumor type. Percutaneous tumor biopsy was performed to make a definite diagnosis. The tumor cells showed typical squamous cell characteristics. CONCLUSION Head and neck SCC and PTC have different cytologies. Measures are needed to ensure accurate diagnosis using FNAC.

Ultrasound-guided, lymph node, fine-needle aspiration cytology is important in diagnosing axillary lymph node metastasis in breast cancer. However, poor needle visibility can render the procedure difficult. We describe a case in which state-of-the-art enhancement techniques using matrix linear probes can provide better needle visibility and improve the certainty and efficiency of the examination.

In recent years, there has been an increasing move towards the use of standardized reporting systems in the field of cytopathology. Their implementation aims to provide a universal language of cytology reporting, fostering better communication and understanding between pathologists and clinicians. Such standardized systems can help reduce reporting variability, provide frameworks for clinical audit and research, and guide clinical management strategies, ultimately improving patient care. This article summarises the salient and practical points set out in some of the more recently developed international reporting systems, namely The International System for Reporting Serous Fluid Cytopathology, The Milan System for Reporting Salivary Gland Cytopathology, and The Paris System for Reporting Urinary Cytology. A subsequent subsection discusses the international reporting systems available for thyroid fine-needle aspiration cytology specimens, with particular focus on the UK Royal College of Pathologists guidance.

Context.— Mediastinal tumors/lesions are frequently encountered in daily cytopathology practice. These lesions are accessible through endoscopic/endobronchial ultrasound-guided or computed tomography–guided fine-needle aspiration cytology and represent a wide range of primary and metastatic tumors. This often poses diagnostic challenges because of the complexity of the mediastinal anatomic structures. Tumors metastatic to mediastinal lymph nodes represent the most common mediastinal lesions and must be differentiated from primary lesions. Objective.— To provide an updated review on the fine-needle aspiration cytology of mediastinal tumors/lesions, with an emphasis on diagnostic challenges. This review encompasses thymic epithelial neoplasms, mediastinal lymphoproliferative disorders, germ cell tumors, neuroendocrine tumors, soft tissue tumors, and metastatic tumors. Differential diagnoses; useful ancillary studies, including targeted immunohistochemical panels; and diagnostic pitfalls are discussed. Data Sources.— Data were gathered from a PubMed search of peer-reviewed literature on mediastinal tumors. Data were also collected from the authors' own practices. Conclusions.— Fine-needle aspiration cytology plays a vital role in evaluation of mediastinal lesions. Being familiar with the clinical and cytomorphologic features of these lesions, appropriately triaging the diagnostic material for ancillary testing, and correlating with radiologic findings are important in arriving at correct diagnoses and guiding management.

Objective Recently, several scientific societies designed ultrasound (US) risk stratification systems (RSS) to guide the workup of thyroid nodules and decide which nodules should undergo fine-needle aspiration cytology (FNAC). However, these systems have been developed against papillary thyroid carcinoma, and scanty data on their role in identifying medullary thyroid carcinoma (MTC) are available. The aims of this study are to describe the US features of MTC and evaluate the performance of RSS in identifying MTC. Methods Data of 152 consecutive patients with MTC was evaluated. The results of the pre-operative neck US of all patients were collected. Ultrasound features of each MTC were evaluated and classified according to the five main RSS available. Results Median MTC dimension was 1.3 cm. Most of the nodules showed solid composition, hypoechoic pattern, and regular margins. About half of them showed the presence of calcifications, but only a subgroup had microcalcifications. A minority of the nodules showed a 'taller than wide' shape. Only 7.9% of all MTC showed the simultaneous presence of at least four US features suggestive of malignancy. Ultrasonographic high-risk of malignancy of the MTC included in the five RSS, varied from 45.4 to 47.4%, and performing FNAC was suggested in only 48.7 to 63.8% of all MTC. Conclusions In this series, neither single nor the association of US features are specific for MTC. The five main RSS correctly identify less than 50% of MTC and do not suggest performing FNAC in about half of them with potentially missed or delayed diagnosis.

Tuberculous lymphadenitis (TBLN) is the most common form of extrapulmonary tuberculosis. However, the optimal diagnosis using Fine-Needle Aspiration Cytology (FNAC) or excisional biopsy is uncertain. This research aims to improve the diagnostic of TBLN with FNAC and immunocytochemistry (ICC) compared to the response to antituberculosis therapy. The cross-sectional study involved 43 patients with the criteria for TBLN diagnosis based on the appropriate clinical history of tuberculosis and indicative cytological results. Immunocytochemical examination employed rabbit-polyclonal to Mycobacterium tuberculosis (MTB) antibody (AB905). The MTB expression was found in 35 out of 43 cases (81%) that appropriate cytological features of the tuberculosis process. Meanwhile, eight out of 43 cases (19%) did not express MTB. Diagnostic tests for lesions with a positive cytologic appearance of TBLN and ICC were compared to the response to anti-tuberculosis therapy, revealing the sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 75%, 95.2%, and 17%, respectively. Besides, Fisher's exact tests utilized to identify the relationship between two variables; p 0.05 was considered significant. This research found immunocytochemical study was a sensitive and specific tool for improving the diagnostic of TBLN.

Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions. The proper diagnosis, differentiation, and staging of these cystic lesions are considered a crucial issue in planning further management. There are great challenges for their diagnostic models. In our time, new emerging methods for this diagnosis have been discovered. Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needle-based confocal laser endomicroscopy, through the needle microforceps biopsy, and single-operator cholangioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions. Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.

Objectives: The objectives of the study were (1) to study the fine-needle aspiration cytology (FNAC) features of skin lesions of leprosy, (2) to determine the agreement between FNAC and histopathology to classify leprosy into different groups of the spectrum, and (3) to determine the sensitivity and specificity of FNAC to classify leprosy into different groups of the spectrum against the gold standard of histopathology. Materials and Methods: All newly diagnosed cases of leprosy who attended the outpatient department of dermatology and venereology of a tertiary referral center during the 16 months study period were included in this cross-sectional study. Based on FNAC and histopathology, patients were classified into different groups of the spectrum. Agreement between FNAC and histopathology to classify leprosy was determined by Kappa statistics. Sensitivity and specificity of FNAC to classify leprosy were determined against the gold standard of histopathology. Results: All the 47 study participants had histopathology features of leprosy. FNAC could obtain adequate aspirate in 30 patients (63.8%), who were considered for further analysis. There was moderate agreement (76.6%) between classification of leprosy by FNAC and histopathology on Kappa statistics (Kappa value 0.766). FNAC showed 80–100% sensitivity and 84–100% specificity to classify leprosy against the gold standard of histopathology. Limitation: Small sample size. Conclusion: When adequate aspirate is obtained, FNAC could serve as a useful tool in classification of leprosy.

Bone Marrow Aspiration (BMA) is a procedure that is often used to evaluate patients with haematological disorders including haematological malignancies (HMs) which account for about 6.5% of all cancers worldwide. There is paucity of data on the prevalence and pattern of HMs from BMA cytology in Nigeria. We carried out a retrospective review to determine the prevalence and distribution of HMs among adult patients who had BMA cytology at Benue State University Teaching Hospital (BSUTH) from June 2012 to July 2019. A total of 158 BMA reports extracted from the marrow and clinic medical records were reviewed. Out of 158 adult BMA cytology reports, HMs accounted for 78(49.4%) of all haematological disorders. There was no significant gender difference. The Male 38(48.7%) to Female 40(51.3%) ratio (M:F) was 1:1.1. Their ages ranged from 16 to 85 years with the median age of 54.0 years. Out of the 78 HMs, Lymphoid neoplasms were the most prevalent 47(60.3%), the leukaemias were higher 53/78(67.9%) compared to the non-leukaemic neoplasms. Of the 53 leukaemias, those of chronic lymphoid types were more 24/53(45.3%), followed by the chronic myeloid 15/53(28.3%). Chronic lymphocytic leukaemia (CLL) was the predominant leukaemia 24/53(45.3%) as well as the most prevalent HM 24/78(30.8%), followed by chronic myeloid leukaemia (CML) 19.2%(15/78). Others were myelodysplastic syndrome (MDS) 11.5%(9/78), acute lymphoblastic leukaemia (ALL) 10.3% (8/78), multiple myeloma (MM) 10.3%(8/78), acute myeloblastic leukaemia (AML) 7.7%(6/78), non-Hodgkin's lymphoma (NHL) 6.4%(5/78), Small lymphocytic lymphoma (SLL) 2.6%(2/78) and Hodgkin's lymphoma (HL) 1.3%(1/78). In conclusion, we established high prevalence of HMs among patients who had BMA cytology evaluation at BSUTH with the preponderance of lymphoid malignancies. We advocate for inclusion of HMs in the National Health Insurance Scheme (NHIS) for full implementation and to prioritise provision of modern diagnostic equipment and treatment options for quality and optimal management of leukaemias in the center.

Objective To summarize the diagnosis and treatment outcomes of basal cell adenocarcinoma (BCAC) of the parotid gland, a rare low-grade malignancy, at a single institution, and to investigate the treatment approach for this rare malignancy. Methods We conducted a retrospective analysis of 9 patients with BCAC during 20 years from September 1999 to December 2019. Forty-five patients with basal cell adenoma (BCA), who were treated during the same time period, were used for comparison. The clinical characteristics of BCAC, diagnostic imaging, the usefulness of fine-needle aspiration cytology (FNAC) and frozen section biopsy (FSB), histological assessment of malignancy, and treatment outcomes were investigated. Results There were no marked differences in sex, age, tumor diameter, or tumor location between BCAC and BCA cases. Among the 9 patients with BCAC, one patient was noted with pain/tenderness, and two patients were observed with adhesion to the surrounding tissues. Only one patient was diagnosed as malignant based on MRI/US. FNAC for BCAC was suspicious for malignancy in 6 of the 9 cases, which included one patient with the correct grade of malignancy, one patient with malignancy only, and 4 patients suspicious for malignancy. FSB was suspicious for malignancy in 8 of the 9 cases. Malignancy grade was determined based on infiltration to the surrounding tissues and expression of Ki-67, p53, and bcl-2. One patient with infiltration to the surrounding tissue was diagnosed as intermediate-grade malignancy, while the remaining 8 patients were diagnosed as low-grade malignancy. The BCAC cases included 7 patients with T2 and 2 patients with T1. Conservative resection was performed for all patients, and all cases are surviving cancer-free. Conclusion The malignancy of BCAC can be suspected before surgery based on symptoms/signs, diagnostic imaging, and FNAC. FSB enables the diagnosis of not only malignancy but also the grade of malignancy, which may help determine the appropriate surgical resection. Although all 9 patients with BCAC are surviving free from cancer, a long-term follow-up is warranted.

Purpose We aimed to evaluate the feasibility, accuracy, and safety of Programmed Death-1/ Programmed Death-Ligand 1 (PD-1/ PD-L1) expression quantification in cytology cell-block samples obtained through transthoracic CT-guided fine-needle aspiration cytology (FNAC) from the interventional radiologist's perspective. Methods We performed a consecutive unselected series of 361 CT-guided biopsies of pulmonary nodules and masses which came to our observation from June 2017 to October 2018. For each case, exhaustive clinical, morphologic, molecular and tomographic data were available. All the material obtained was fixed in formalin to obtain a cell-block for the pathologist, who performed immunohistochemical analysis to detect PD-L1 expression levels on each sample. Results Of all the analyzed samples, 93.6% (338/361) were defined to be diagnostic, including neoplastic (72%, 260/361) and non-neoplastic lesions (21.6%, 78/361); only 6.4% (23/361) of them resulted in nondiagnostic specimens. Non-small cell lung cancer (NSCLC) accounted for 73.8% of neoplastic lesions (192/260): most of them were adenocarcinoma (83%, 160/192), followed by squamous carcinoma (14%, 27/192) and poorly differentiated carcinoma (3%, 5/192). In 96% of NSCLC (184/192), the diagnosis was reached either in the absence of complications or with early minor complications. PD-L1 expression was evaluated in all 192 NSCLC cytology specimens: 180 immunostainings were found to be adequate for PD-L1 testing. In 76% of cases, PD-L1 expression level was lower than 50%. Conclusion The findings of our study indicate that PD-L1 quantification using a cell-block approach on CT-guided FNAC is a feasible and safe technique and should be taken into account alongside with core biopsy approach, especially in case of advanced disease and/or fragile and older patients.

Plasmablastic lymphoma (PBL) is a rare subtype of non-Hodgkin’s lymphoma that is associated with acquired immunodeficiency syndrome (AIDS), characterized by its association with Epstein-Barr virus (EBV), aggressive nature, and plasmacytic/plasmablastic differentiation. PBL remains a therapeutic and diagnostic challenge. Diagnosis of PBL by fine-needle aspiration cytology (FNAC) is reported infrequently. We herein describe the cytodiagnosis of a rare case of HIV-negative PBL in a 58-year-old man without EBV infection presented by parotid swelling. The current case study highlights the cytomorphologic features that may help to distinguish PBL from other mimics. However, although the cytomorphologic features may suggest PBL, a definitive diagnosis requires additional studies including tissue biopsy and immunohistochemistry, in addition to biochemical investigations and radiological workup to establish the diagnosis and exclude similar conditions. In conclusion, FNAC is a very useful, simple, rapid and reliable procedure for diagnosis of the lymphoma. FNAC provided the earliest clue to diagnosis of PBL, which was later confirmed by tissue biopsy.

Ten stage I/II breast cancer patients with one or two suspicious lymph nodes (LNs) detected on ultrasonography underwent sentinel LN biopsy (SLNB) after the introduction of Twirl® breast markers into each suspicious LN revealed that each Twirl®-marked LN was SLN and was likely the first SLN. Three patients had less than three SLN metastases and were candidates for sparing completion axillary lymph node dissection (cALND). Indeed, of them, one underwent breast-conserving surgery without cALND and the other two underwent total mastectomy with cALND. These results suggest that, as all suspicious LNs are SLNs, patients can be treated with SLNB alone if they fulfill the ACOSOG Z-0011 criteria, despite suspicious LNs yielding positive results on preoperative fine-needle aspiration cytology.

Background: Endobronchial ultrasound (EBUS)-guided fine-needle aspiration cytology (FNAC) is recommended for diagnosing bronchial neoplasms and evaluating mediastinal lymph nodes. However, it may not be possible to subtype or definitely categorize many bronchial neoplasms on FNAC smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from FNAC material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to EBUS guided FNAC smears. Material and Methods: One hundred and eighty-five cases of EBUS guided FNAC having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to FNAC smears alone for the above parameters were calculated. Results: Cell blocks provided additional information in 31 out of 185 cases. Cell blocks were necessary for subtyping 24/59 malignant tumors, definite categorization into benign and malignant in 10/140 adequate samples, and increasing adequacy in 6/185 total samples. A total of 45 samples were inadequate in spite of adding information from cell blocks to smears. Conclusion: Cell blocks added clinically significant information to EBUS guided FNAC and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated.

Background: Fine needle aspiration cytology (FNAC) is rapid, inexpensive, and easy technique to establish the diagnosis of scalp lesions. The use of ancillary techniques such as immunocytochemistry (ICC), immunohistochemistry (IHC), and flow cytometry on aspiration material aids in accurate diagnosis which is additionally beneficial for management and prognosis. Aims: The objective of this prospective case series was to evaluate the utility of ancillary techniques in the accurate cyto-diagnosis of malignant scalp lesions. Materials and Methods: This study was a prospective case series that included 64 cases of scalp lesions in which FNAC had been performed for diagnosis. The lesions were categorized as Non-diagnostic/Inadequate, Inflammatory, Benign and Malignant. In all the cases that were categorized as malignant additional material was collected for ancillary testing that included ICC, cell block preparation followed by IHC and flow cytometry. Results: Non-diagnostic/inadequate aspirates were 17.19% (n = 11/64), 25% (n = 16/64) aspirates were inflammatory, 35.93% (n = 23/64) aspirates were benign and 21.87% (n = 14/64) aspirates were categorized as malignant. With the aid of ancillary techniques, 57.14% malignant scalp aspirates were accurately categorized as epithelial origin. Lesions of bone and soft tissue constituted 28.57% (n = 4/14) of cases and lesions of hematolymphoid origin constituted 14.29% (n = 2/14) of all cases. Conclusion: This is a novel study where accurate categorization of malignant scalp tumors has been done with the use of ancillary techniques. This is useful as it may help in defining the tumor type, may aid in patient management. The material obtained can also be triaged for molecular testing.

BACKGROUND Fine needle aspiration cytology (FNAC) is commonly used as a safe and minimally invasive diagnostic test in benign salivary gland lesions. Nevertheless, the capacity of aspiration cytology in diagnosing benign lesions in the salivary gland is still disputed because accurate tumour typing is dependent on the quality and yield of the aspirate, as well as the competence of the cytopathologist. We aim to assess the precision of fine needle aspirate in the pre-operative diagnosis of benign salivary gland lesions and compare it with the histopathological findings. METHODS This is a longitudinal study conducted among 45 patients with preoperative cytological diagnosis of benign salivary gland lesions, who were followed-up till surgery with subsequent histopathological examination in Government Medical College, Thrissur, from 1 st January 2013 to 30th June 2015. RESULTS Among the benign neoplasms, 29 out of 30 cases of pleomorphic adenoma were confirmed on histopathology and one was basal cell adenoma. Out of nine cases of Warthin’s tumour, only seven were confirmed by histopathology. Of the remaining two, one was found to be salivary duct carcinoma showing the typical comedo necrosis and the other was found to be low grade mucoepidermoid carcinoma. So, these two cases were found to be false negative. The statistical analysis showed an overall diagnostic accuracy of 95.5 % for benign salivary gland lesions. CONCLUSIONS FNAC is a minimally invasive technique useful in salivary gland lesions. In nonneoplastic lesions surgery can be avoided and in neoplasms appropriate surgery can be planned. An accurate cytological diagnosis is often possible but may sometimes require the expertise of the cytopathology and use of ancillary techniques KEYWORDS Salivary Gland, Fine Needle Aspiration Cytology, Benign Tumours, Pleomorphic Adenoma, Warthin’s Tumour, Mucoepidermoid Carcinoma, Salivary Duct Carcinoma

Background: Early detection of pancreatic adenocarcinomas is essential for improving survival. In this regard, endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) has established itself as the method of choice for its ability to target lesions smaller than those which could be targeted by the traditional imaging methods like transabdominal ultrasound. Identifying these tumors correctly on FNA may be challenging because pancreatic adenocarcinomas may show a wide range of morphological features and the presence of contaminants from the gastrointestinal tract may show up as potential pitfalls. This study presents detailed cytomorphological analyses of 59 cases reported as pancreatic adenocarcinomas on smears and cell blocks. The clinical and histopathology follow-up data wherever available have also been presented. Materials and Methods: EUS-FNAC smears and cell blocks from cases reported as pancreatic adenocarcinomas were retrospectively evaluated with individual assessments of a range of features related to cellularity, cellular arrangement, cytoplasmic qualities, and nuclear features. Aspirates from peripancreatic lymph nodes, histopathology sections, and clinical records were reviewed wherever available. Results: Nonneoplastic cells like pancreatic ductal cells and acinar cells, duodenal, and gastric epithelia were detected along with neoplastic cells showing a wide range of variations in different cytomorphological characters. Often, a mixture of features was noted in the same case. Cell block preparations served as useful adjuncts since they made it possible to render unequivocal diagnoses of malignancies in cases where smears were hypocellular. Conclusion: The study creates a useful knowledge base of cytomorphological features of pancreatic adenocarcinomas.

Introduction: There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. Materials and Methods: From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as “soft,” “hard,” or “hard with grittiness.” The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. Results: There was a significant correlation between puncture feeling and postoperative pathology (p < 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (p < 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size >1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (p < 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. Conclusion: Puncture feeling is of great value during US-FNAC. “Hard” and “hard with grittiness” were indicators for malignancy, while “soft” indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.

Marine-Lenhart Syndrome is a rare entity, described as Graves' disease with coexisting functioning thyroid nodules. It is often diagnosed on thyroid scintigraphy as a cold nodule with surrounding extranodular hyperactivity initially and postradioiodine ablation, they regain function on the follow-up thyroid scintigraphy due to endogenous thyroid-stimulating hormone (TSH) stimulation. We retrospectively reviewed all thyroid scintigraphy database performed between January 2018 and March 2020 in our institute. We searched patients with Graves' disease with the following criteria to suggest Marine-Lenhart Syndrome: (a) initial thyroid scintigraphy showing features of Graves' disease with coexistent poorly functioning nodules (b) There is normalization of uptake within the nodule on thyroid scan after radioiodine ablation suggestive of endogenous TSH stimulation (this also indirectly proves nodules are TSH dependent), (c) nodule(s) is/are benign on fine-needle aspiration cytology. Four patients (1.46%) were confirmed as Marine-Lenhart Syndrome as per the criteria. Three patients were female, and one was male. The eye signs were present in two of four patients. Two patients had two hypofunctioning nodules, whereas the remaining two had a single nodule and required re-ablation with radioiodine. Marine-Lenhart Syndrome requires special attention as these patients are relatively radioiodine resistant, require higher activity for iodine-131; however, it is curable with radioiodine treatment.

Rapid on-site evaluation of fine-needle aspiration cytology is time-consuming and requires specialized cytopathology staff. Mobile Rose® is a newly developed device for rapid on-site evaluation of fine-needle aspiration cytology. This study aimed to investigate the potential role of Mobile Rose® in reducing delayed repeated aspiration of the thyroid. A total of 120 cytological samples were collected and observed using Mobile Rose® after fine-needle aspiration cytology between September and October 2020, with immediate assessment of minimal or no cell clusters after conventional smear preparation. After qualifying and scoring, needle washout materials were prepared using the BD CytoRichTM method and correlated with cytology results. The average turn-around time of Mobile Rose® was found to be 1.5 minutes. Sensitivity, specificity, positive predictive value, and negative predictive value were 94.4%, 100%, 100%, and 57.1%, respectively. False-negative results were attributed to small aggregates of cells that were difficult to distinguish from the background and artifacts. Mobile Rose® may represent an important innovation for rapid on-site evaluation that is fast, has high diagnostic performance, does not require the presence of specialized cytology staff, and can reduce delayed repeated aspiration of the thyroid gland. However, further minor improvements and confirmation are required.

Ocular metastasis is considered a rare phenomenon. Metastatic spread of tumors in the eyeball is usually discovered only when it affects the visual acuity. In women, breast tumors are to known metastasize in and around the eyeball. Cervical carcinomas are rarely known to metastasize in the eyeball. We present here a rare case of ocular metastasis, diagnosed on fine-needle aspiration cytology, in a known case of squamous cell carcinoma of the cervix.

Nontuberculous mycobacterial lymphadenitis often presents a diagnostic challenge. This study aimed to evaluate the role of fine-needle aspiration cytology in the diagnosis of nontuberculous mycobacterial lymphadenitis in children. We conducted a retrospective review of fine-needle aspiration cytology performed in patients 17 year-old with subacute lymphadenitis from 2003 to 2016 in a tertiary hospital in Spain. Confirmed nontuberculous mycobacterial lymphadenitis (isolation of nontuberculous mycobacterial in culture from fine-needle aspiration cytology or biopsy samples) and probable nontuberculous mycobacterial lymphadenitis ("granulomatous inflammation" in cytopathologic examinations from fine-needle aspiration cytology or biopsy and clinical-epidemiological history compatible with nontuberculous mycobacterial) were selected. Forty-one patients with nontuberculous mycobacterial lymphadenitis were included: 14 confirmed and 27 probable. Fine-needle aspiration cytology was done in all of them. For 34 patients with excised lymphadenopathy, cytopathology from fine-needle aspiration cytology was concordant with biopsy in 100% cases. Culture results were available from 78.0% (32/41) of patients with fine-needle aspiration cytology and from 85.3% (29/34) with excisional biopsy. Among 22 patients with microbiological results from fine-needle aspiration cytology and biopsy, fine-needle aspiration cytology allowed advanced results in concordance with biopsy or with positive isolation not found in biopsy in 90.1% (20/22) of patients. Sensitivity of nontuberculous mycobacterial cultures obtained by fine-needle aspiration cytology compared to biopsy was 45.5% vs. 36.4% (p = 0.07). Two patients with previous skin alterations presented fistulas after fine-needle aspiration cytology (4.9%); no other complications were described.Conclusion: Fine-needle aspiration cytology provides quick cytopathologic information and is an accurate and safe technique for the diagnosis of nontuberculous mycobacterial lymphadenitis, especially in cases with challenging work-up. What is Known: • Nontuberculous mycobacterial (NTM) infection is an important cause of subacute lymphadenitis in children. • Fine-needle aspiration cytology (FNAC) is an available technique for the diagnosis of lymphadenitis of unknown etiology. What is New: • FNAC is an accurate and safe technique for the diagnosis of NTM lymphadenitis in children. • FNAC can provide reliable samples for cytopathological studies and even a better sensitivity for microbiological culture than excisional biopsy in the study of suspected NTM lymphadenitis.

Objectives : To evaluate the accuracy and e cacy of ne-needle aspiration cytology (FNAC) in diagnosing thyroid nodules, correlating it with the histopathological findings. Methods : A retrospective evaluation of 314 patients was undertaken at a tertiary referral center of King Abdullah Medical City (KAMC), Makkah, Kingdom of Saudi Arabia, between 2010-2019. Patients who presented with thyroid swellings underwent ultrasonography and FNAC. If indicated, surgery was performed. The FNAC findings were compared to the final histopathological reports. Results : Th e findings for FNAC from our data set of 314 patients showed a sensitivity value of 79.8%, specificity of 82.1%, accuracy of 74.8%, positive predictive value of 74.8%, and negative predictive value of 85.9%. Conclusion : Our study showed that FNAC has high sensitivity and speci city in the initial evaluation of patients with thyroid nodules. When guided by ultrasonography, the accuracy can be markedly improved. Molecular markers once widely available can improve the diagnostic power of FNAC to be no less than the histopathologic evaluation of thyroid tissue. Saudi Med J 2020; Vol. 41 (10): 1098-1103 doi: 10.15537/smj.2020.10.25417 How to cite this article: Ahmed S. Bahaj, Haddad H. Alka, Bashair N. Melebari, Anwar N. Melebari, Suhail I. Sayed, Syeddah S. Mujtaba, Sherif K. Abdelmonim, Saeed A. Alghamdi, Fares E. Alghamdi, Omar A. Abu Suliman, Mohammad A. Alessa, Firas R. Abi Sheffah, Anas H. Al-Tammas, Rajab A. Al-Zahrani, Osama A. Marglani, John C. Heaphy, Osama A. Bawazir, Ameen Z. Alherabi. Role of fine-needle aspiration cytology in evaluating thyroid nodules. A retrospective study from a tertiary care center of Western region, Saudi Arabia. Saudi Med J 2020; Vol. 41 (10): 1098-1103. doi: 10.15537/smj.2020.10.25417

Fine-needle aspiration cytology (FNAC) of the thyroid is a widely accepted method for aiding the diagnosis of thyroid nodules. In Myanmar, it has been done since the early 1990s, and mainly performed by surgeons and otorhinolaryngologists. The interpretation of cytology is solely made by pathologists. Although some of the experts particularly those from specialist hospitals use the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), many still prefer the British five-tier cytopathology report. Available local publications addressing the accuracy of FNAC and cytologic-histologic correlations were queried. Ten studies performed in 1991–2018 on 540 thyroid nodules were included. Cytologic-histologic correlations showed a range of sensitivity from 64.29% to 100%, specificity from 93% to 100%, and diagnostic accuracy from 94% to 100%. The adoption of TBSRTC by pathologists is still slow and should be encouraged via seminars and training programs. Further multihospital-based large cohort studies with uniform design and adequate follow-up are needed to better promote and assess utility of thyroid FNAC in Myanmar.

The term pemphigus is collectively used to describe a group of immunobullous disorders characterized by intraepidermal cleft and circulating antibodies against intercellular adhesion molecules. Pemphigus vegetans was first described as a variant of pemphigus vulgaris by Neumann in 1876. We report a case of 36-year-old female who presented with swelling of scalp, which was diagnosed as pemphigus by fine-needle aspiration cytology.

Background: The nature of parotid tumors often remains unknown preoperatively and final histopathology may reveal unexpected malignancy. Still, the use of fine-needle aspiration cytology (FNAC) and imaging varies in the management of these tumors. Methods: We evaluated the preoperative examinations and management of all 195 parotid gland tumors diagnosed within our catchment area of 1.6 million people during 2015. Results: Altogether 171 (88%) tumors were classified as true salivary gland neoplasms. FNAC showed no false malignant findings, but it was false benign in 5 (2.6%) cases. Preoperative MRI was utilized in 48 patients (25%). Twenty (10%) malignancies included 16 salivary gland carcinomas. Pleomorphic adenomas accounted for 52% of all adenomas. For 24 (40%) Warthin tumors, surgery was omitted. Conclusion: The proportion of malignancies was lower than generally presented. Our proposed guidelines include ultrasound-guided FNAC with certain limitations. MRI is warranted in selected cases, but seems unnecessary routinely.

Pancreatic neuroendocrine tumors (PanNETs) are rare neoplasms that include even rarer variants that may pose different diagnostic problems, especially in fine needle aspiration cytology (FNAC). We describe the diagnostic clues of the amyloid-rich variant of PanNETs in endoscopic ultrasound (EUS)-guided fine needle aspiration cytology (EUS-FNAC). Three cases of PanNETs with an amyloid-rich stromal component were retrieved and retrospectively reviewed. For every case, the pancreatic lesion was investigated by a EUS-FNAC procedure. The final diagnosis was supported by immunocytochemistry and Congo red staining. All cases had similar EUS-FNAC features: neoplastic cells were entrapped in an eosinophilic, homogeneous dense and amorphous matrix. The neuroendocrine nature was confirmed by immunoexpression of synaptophysin and chromogranin A, while the amorphous stroma was characterized as amyloid based on positive Congo red staining. Regarding the hormonal profile, no insulin or proinsulin reactivity was observed, but all cases were diffusely positive for amylin. The diagnosis of uncommon variants of PanNETs, such as the amyloid-rich, is challenging especially in EUS-FNAC procedures because of a unique and misleading morphology, potentially mimicking fibrotic conditions and amyloid deposition within systemic amyloidosis. In cytology specimens, the presence of amorphous material requires amyloid deposition to be considered in the differential diagnosis of pancreatic neoplasms with neuroendocrine phenotype.

Introduction Guided fine-needle aspiration cytology is a popular investigative procedure in diagnosing pulmonary lesions. The Papanicolaou Society of Cytopathology (PSC) has already outlined a categorical system for reporting respiratory cytology. Though each category has a known malignancy risk, their inter observer reproducibility have not been well documented. This study was directed towards establishing the reproducibility of this categorical system in diagnosing pulmonary lesions. Method One hundred and one consecutive cytology specimens obtained by CT-guided FNA from lung lesions were independently reviewed by 3 experienced cytopathologists, who allotted each case to 1 of 6 PSC categories. Statistical analysis for percent overall agreement was done using Fleiss' Kappa. Result Percent overall agreement was 71.29% and free marginal kappa was 0.66. On combining categories "suspicious" and "malignant" percent overall agreement was 79.54% and free marginal kappa was 0.74. Conclusion There was substantial agreement among the observers as regards reproducibility of categories which can improve if we combine certain categories, especially "suspicious" and "malignant."

Focal thyroid incidentaloma (TI) occurs in a 2% of 18F-FDG PET/CT and about one-third of TIs is cancer. Due to the lack of evidence on the optimal management of TI, current guidelines suggest performing fine-needle aspiration cytology (FNA). The study aim was to evaluate the reliability of ACR-TIRADS, EU-TIRADS, and K-TIRADS in indicating FNA in TIs. We retrospectively reviewed 18F-FDG PET/CT TIs recorded during the period 2016–2019. Enrolled were TIs with histologic outcome and autonomous nodules. Cases with uncertain matching between 18F-FDG PET/CT, US/scintiscan and histology were excluded. Eighty TIs at 18F-FDG PET/CT (median size 17 mm, median SUVmax 7.85) were included; a 26.2% was cancer. The percentage of nodules classified as high risk according to ACR-TIRADS, EU-TIRADS, and K-TIRADS was 20%, 30%, and 29.8%, respectively. The cancer prevalence in high-risk class was 56.2%, 66.7%, and 65.2% in ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively. ACR-TIRADS had the lowest number of cases with FNA indication (48%) and the K-TIRADS, the highest one (75%). Evaluating the reliability of the three systems in indicating FNA, we found a 100% sensitivity and NPV for EU-TIRADS and K-TIRADS; while all the three systems showed poor specificity and PPV. All TIRADSs were reliable to stratify the risk of cancer in focal TI. Comparing their reliability in indicating FNA, we found a good performance of EU-TIRADS and K-TIRADS. Considering the high cancer percentage expected in this setting of patients, those TIRADS with higher propensity to indicate FNA should be preferred.

Fine-needle aspiration cytology is a minimally invasive diagnostic strategy. However, collected specimens have to undergo a series of complex preparation steps, thus limiting the use of fine-needle...

Background: Scandinavian countries were the first to use fine needle aspiration cytology (FNAC) as a diagnostic tool in the 1930. Fine needle aspiration cytology is a diagnostic approach, which helps the clinicians in diagnosis of the various lesions. Most common sites which can be targeted include breast lumps, lymph nodes, thyroid masses and other palpable swellings. The most common lesion encountered is thyroid nodule. In current cross sectional study we tried to find frequency of different thyroid lesions by fine needle aspiration cytology in different rural areas of Sindh. Methodology and Results: 158 samples were recruited from the Vital Laboratory Larkana with different pathological midline neck (thyroid) swelling during 2014 and 2015 by non-probability consecutive sampling. 125 (79.1%) were females and 33 (20.9%) were males with a ratio of 4:1. Majority of case were of 20-39 years of age (52.5%). Most of the cases were diagnosed with nodular goiter (88.6%) followed by colloid goiter (4.4%). In present study we failed to find any association of diagnosis with gender (p =0.211) and age (p =0.553). Conclusion: So in this study we concluded that large number of thyroid lesions present with nodular goiter at the age of 20-39 years. The frequency is increased for these lesions due to different risk factors.

Rhabdomyosarcomas (RMS) are the most common childhood soft-tissue tumors. Case reports of RMS presenting at multiple cutaneous sites simultaneously are extremely rare and most of these have been reported as of embryonal type which is the most common RMS in childhood. We present here a rare case of a 2-year-old child who presented to us with multiple cutaneous swellings that had grown over the past 6 months. Fine-needle aspiration cytology was performed from all the swellings and diagnosis of small round blue cell tumor was made. Biopsy from one of these swellings showed features of alveolar RMS (ARMS) (solid variant) that was confirmed on immunohistochemistry. ARMS are associated with a poorer prognosis compared to other RMS with higher rates of dissemination and mortality even after an initially good response to chemotherapy; hence, it becomes important to be aware of their unusual histological variants and accurately diagnose them.

Introduction: The diagnosis of parotid tuberculosis requires a high degree of clinical suspicion, so as to avoid unnecessary surgery, and fine-needle aspiration cytology is an easy and reliable investigation for the same. Salivary glands are suitable for unguided fine needle aspiration cytology (FNAC) because of their superficial location. Methods: The present study involved a total of 42 cases of salivary gland swellings in which fine needle aspiration cytology was performed in the department of pathology of our hospital from December 2011 to August 2019. Results: The prevalence of granulomatous inflammation among salivary gland swellings was 38.1 % (n=16). Anti-tubercular treatment was given in 5 patients, all of whom showed improvement after anti-tubercular treatment. Therefore, 5 out of the total of 16 cases were a case of tuberculous parotitis (31.2 %). Conclusion: Although tuberculous parotitis is a rare entity, it should be always kept in mind as a differential during the evaluation of solitary parotid mass lesion. Fine needle aspiration cytology of all mass lesions of salivary glands must be done before doing excision of salivary gland so as to avoid unnecessary surgery.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a newly-described, rare, malignant tumour. Few patients present with MASC of the parotid gland, so the exact characteristics, outcomes of treatment, and prognosis are unknown. The aim of this study was to analyse the clinical features and outcomes of treatment of MASC of the parotid gland in patients being treated at a single hospital. Five patients with histopathologically-confirmed MASC of the parotid gland between January 2015 and August 2018 were retrospectively enrolled. In all cases preoperative fine-needle aspiration cytology had failed to provide an accurate diagnosis. All patients underwent a macroscopically complete oncological resection. Two patients had postoperative radiotherapy (RT). On immunohistochemical examination all tumours stained for S-100 and mammaglobin but not for DOG1. There were no regional recurrences or distant metastases in any of the patients at their last follow-up. We obtained good results for patients with MASC of the parotid gland with surgical treatment and postoperative RT.

BACKGROUND: The study was conducted in BRAC-administered areas of the Bangladesh National Tuberculosis (TB) Programme (42 of 64 districts). According to the 2013–2017 financial support scheme, direct costs due to TB diagnosis were reimbursed among economically disadvantaged people with presumptive smear-negative pulmonary (PTB) and extrapulmonary TB (EPTB).OBJECTIVE: To describe the implementation of the scheme and associated changes in case notification.DESIGN: This was a descriptive study involving programme data.RESULTS: Between 2013 and 2017, persons reimbursed reduced from 125 680 to 88 763, and the case detection ratio increased from 18% to 24%. The number of patients with presumptive EPTB who were reimbursed decreased from 5024 to 3484. More than 95% were reimbursed for chest radiograph, fine-needle aspiration cytology and biopsy. However, large numbers of ancillary investigations were also reimbursed. During 2013–2017, the observed national quarterly new smear-negative PTB case notification rates (CNRs) were significantly higher than the forecasted CNRs (based on CNR trends during 2008–2012). New EPTB and all form TB CNRs increased but not significantly.CONCLUSION: Implementation of the financial support scheme was accompanied by a significant improvement in new, smear-negative PTB notification. The absence of a comparison arm was a key limitation, but comparison was not possible as the scheme was implemented in all districts.

Introduction and Objective: Fine needle a spiration cytology has importance in the diagnosis of breast lesions in several clinical and hospital settings. A study was done to assess the role of fine needle aspiration cytology (FNAC) in breast lumps and diagnostic significance of cytological features in FNA for diagnosis of benign or malignant condition of breast lesions. Materials and Methods: The study comprised of breast cytology reports and slides recorded over a period from January 2018 to December 2018. Results: A total of 250 breast cytology reports were made over the period. Out of the 250 cases, 140(56%) were benign, 30(12%) cases were suspicious probably benign, 30(12%) cases were suspicious of malignany and 50(20%) were malignant. Conclusion: Fine-needle aspiration cytology is widely used in the diagnosis of breast cancer because it is an excellent, safe, and cost-effective diagnostic procedure. Keywords: Breast, Fine needle aspiration cytology, Benign breast lesions, Carcinoma.

Background: Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis. Patients and Methods: Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared. Results: Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p

Schwannomas are relatively rare neoplasm and even rarer in the pediatric age group. The nerve sheath tumors originating from the nerves of the neck are extremely rare. We report a 4-year-old girl presenting with a history of an asymptomatic neck swelling for 6 months. The child was meticulously evaluated with imaging and fine-needle aspiration cytology. Complete surgical excision was done, and the histopathological examination confirmed the diagnosis. The child was completely recovered without any morbidity. Here, we present this case of schwannoma as it is rarely seen in the pediatric age group where the child was recovered completely. Hence, there is a possibility for complete cure and without complications of schwannoma in the neck of a child after complete excision of the tumor.

Aims and Objectives: The aim of this work was to study the application of Modified Millipore technique (MMT) as a liquid-based tool to have multiple monolayer cellular smears for the routine cytology and Immunocytochemistry. Materials and Methods: In this study, we included 32 effusion fluid samples and 30 fine-needle aspiration cytology (FNAC) samples. From each of the samples, at first routine conventional smear was prepared. The residual samples were processed by MMT to make multiple smear preparation. Both the conventional and MMT of the monolayer cells were evaluated. The various cytomorphological features including the cellularity, background information, nuclear morphology, and cytoplasmic preservation were compared in these two techniques. Result: There were a total of 15 cases of fluid samples and 27 cases of FNAC. Statistical analysis of Mann–Whitney U test showed that the monolayer preparation by MMT and liquid-based cytology of fluid and FNAC smears are of same quality (P > 0.01). Conclusion: Monolayer preparation by MMT is cheap and effective. This technique can be used in routine laboratory for multiple monolayer cell preparations.

Background: International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant). Aims and Objectives: The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom–Richardson grading. Materials and Methods: All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India. Results: A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases. Conclusion: Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.

Amyloidosis is a well-recognized entity, that can present as a systemic disease, or, uncommonly, as a localized mass. We report here, a rare presentation of amyloidosis presenting as a supraclavicular swelling, diagnosed on fine-needle aspiration cytology. Subsequent bone marrow examination led to the diagnosis of multiple myeloma. This case highlights the need to be aware of cytological characteristics of amyloidosis, which can have unusual presentation posing a diagnostic dilemma.

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It can occur both in the pelvic and extra pelvic regions. Abdominal scar endometriosis is a rare type of extra pelvic endometriosis that occurs after surgery involving the uterus. In the post-cesarean section, the development of scar endometriosis is a rare event and the diagnosis of scar endometriosis is usually confirmed after surgical excision and histopathological examination. We present a case of an abdominal lump in a 26-year-old female with a myriad of clinical differential diagnoses, which was rendered a confirmed diagnosis of scar endometriosis with the help of fine-needle aspiration cytology and cell block aided with immunohistochemistry.

Background: Splenic fine needle aspiration cytology (FNAC) has been used as a diagnostic method since the turn of last century, with the first report being in 1916. It has the reputation of being dangerous & difficult to assess, but these prejudicial ideas are fundamentally wrong. FNAC remains the easy, cheap, safe and first mainstay diagnostic investigation. Objective: The objective of the present study was to evaluate and determining the diagnostic role of aspiration cytology in splenic lesions. Methods: Fine needle aspiration cytology (FNAC) of the spleen was performed in 34 cases in our retrospective analysis, with 28 cases aspirated under ultrasonological guidance and 6 cases aspirated blindly. There were 23 male and 11 female patients, ranging in age from 2 to 69 years, with 8 paediatric patients. All essential precautions and tests, including a coagulation profile, were carried out prior to the procedure. Results: Five of the 34 FNAC cases had bloody aspirates, while the other two had normal splenic aspirates. In 27 of the cases, a definitive diagnosis was possible. The most patients (8 cases) in the non-neoplastic group had extramedullary hematopoiesis, followed by 4 cases of tuberculosis, 3 cases each of kala azar and storage disease, and 2 cases with granulomas. We had two cases of non-Hodgkins lymphoma, one case of Hodgkin lymphoma, two cases of hairy cell leukaemia, and one case of histiocytosis in the neoplastic group. When aspiration was performed blindly or with ultrasound guidance, no significant differences in cellularity were observed. In our research, no procedural problems were discovered. Conclusion: As a result, when carried out with extreme caution, as a primary inquiry, FNAC spleen is a safe, low-cost, quick, and highly diagnostic treatment.

Ultrasonography (US) is the primary diagnostic tool for thyroid nodules, while the accuracy is operator-dependent. It is widely used not only by radiologists but also by physicians with different levels of experience. The aim of this study was to investigate whether US with computer-aided diagnosis (CAD) has assisting roles to physicians in the diagnosis of thyroid nodules. 451 thyroid nodules evaluated by fine-needle aspiration cytology following surgery were included. 300 (66.5%) of them were diagnosed as malignancy. Physicians with US experience less than 1 year (inexperienced, n = 10), or more than 5 years (experienced, n = 3) reviewed the US images of thyroid nodules with or without CAD assistance. The diagnostic performance of CAD was comparable to that of the experienced group, and better than those of the inexperienced group. The AUC of the CAD for conventional PTC was higher than that for FTC and follicular variant PTC (0.925 vs. 0.499), independent of tumor size. CAD assistance significantly improved diagnostic performance in the inexperienced group, but not in the experienced groups. In conclusion, the CAD system showed good performance in the diagnosis of conventional PTC. CAD assistance improved the diagnostic performance of less experienced physicians in US, especially in diagnosis of conventional PTC.

Introduction: This study was attempted to investigate the prevalence of BRAF gene mutation (V600E) in aspiration cytology of patients with suspected papillary thyroid carcinoma (PTC). Materials and methods: Seventy six Patients suspected of having PTC who referred for fine needle aspiration (FNA) biopsy were included in this cross-sectional study. Ultrasound-guided FNA was taken from the thyroid masses and samples were sent for cytologic evaluation. Simultaneously, the samples were sent to a genetic laboratory to check the status of BRAFV600E mutation. Patients with FNA positive for PTC were assigned in one group and those with FNA negative for PTC were assigned in other group. Cytological and molecular results were compared with those of histopathology and sonography. Results: The results showed that the prevalence of the BRAF gene (V600E) mutation in our study was 21.1% (16 out of 76 patients). In addition the results showed a significant relation between gene mutation and pathologic findings so that the highest gene mutation was significantly detected in patients with FNA positive for PTC (p.value=0.001). Also, our results showed a significant relation between gene mutation and some sonographic findings (calcification, p.value=0.004) and no significant relation in the other sonographic findings (hypo echoic changes, p.value=1.12 and regular changes, p.value=0.194). Conclusion: According to the results of the present study, BRAF mutation (V600E) can be an effective indicator for definitive diagnosis and primary treatment of PTC in suspected cases.