The Utility of Fine-Needle Aspiration in the Diagnosis and Management of Follicular Thyroid Neoplasms:One Institution’s 10-Year Experience

Background: Classical teaching dictates that follicular adenoma (FA) can be distinguished from follicular carcinoma (FC) based on histologic features only. We retrospectively reviewed our institution’s 10-year experience in the use of fine-needle aspiration (FNA) to diagnose follicular thyroid neoplasms. Methods: Patients who had FNA of a thyroid neoplasm from 2000 to 2010 were reviewed. Diagnoses of FA, FC, or follicular neoplasm-not otherwise specified (NOS) were included. Cytopathological results were correlated with surgical pathology. Results: Of 138 patients, 65% underwent surgery. FNA diagnosis for FA had a sensitivity of 50% and specificity of 71%. 25% of patients with an FNA diagnosis of FA were found to have cancer after surgical specimen examination. FNA diagnosis for FC had a sensitivity of 60% and specificity of 94%. Conclusions: FNA has a low sensitivity for diagnosing FA. Surgical pathology remains the gold standard for differentiating follicular carcinoma from adenoma.

The effect of treatment package time in head and neck cancer patients treated with adjuvant radiotherapy and concurrent systemic therapy

Objectives:In patients with head and neck carcinoma,“treatment package time”(TPT)was proven to impact outcomes in cases receiving adjuvant radiotherapy alone.Its impact in patients receiving radiotherapy with concurrent systemic therapy has not been studied previously.The TPT influence on survival endpoints for patients treated with surgery followed by radiation and concurrent systemic therapy was analyzed.Methods:Institutional database to identify head and neck carcinoma cases treated with definitive surgery followed by concomitant chemo(bio)radiotherapy(CRT)was used.TPT was the number of days elapsed between surgery and the last day of radiation.%FINDCUT SAS macro tool was used to search for the cutoff TPT that was associated with significant survival benefit.Kaplan-Meier curves,log-rank tests as well as univariate and multivariate analyses were used to assess overall survival(OS)and recurrence free survival(RFS).Results:One hundred and three cases with a median follow up of 37 months were included in the study.Oropharyngeal tumors were 43%,oral cavity 40%and laryngeal 17%of cases.Concurrent systemic therapy included platinum and cetuximab in 72%and 28%,respectively.Optimal TPT was found to be<100 days with significantly better OS(P=0.002)and RFS(P=0.043)compared to TPT≥100 days.On multivariate analysis;TPT<100 days,extracapsular nodal extension,high-risk score,iymphovascular space and perineural invasion were independent predictors for worse OS(P<0.05).T4,extracapsular nodal extension and high-risk score were all significantly detrimental to RFS(P<0.05).Conclusions:Addition of concomitant systemic therapy to adjuvant radiotherapy did not compensate for longer TPT in head and neck squamous cell carcinoma.Multidisciplinary coordinated care must be provided to ensure the early start of CRT with minimal treatment breaks.