Fine-needle aspiration cytology of an intrathyroidal nodule diagnosed as squamous cell carcinoma: A case report

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.

Value of thyroglobulin combined with ultrasound-guided fine-needle aspiration cytology for diagnosis of lymph node metastasis of thyroid carcinoma

BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.

Combined use of fine needle aspiration cytology and full field digital mammography in preoperative assessment of breast masses

Objective: To evaluate the accuracy of these two methods and focus on the analysis and management of the false-negative cases. Methods: Results of full field digital mammography (FFDM) and fine needle aspiration cytology (FNAC) were obtained and analyzed from a consecutive of 102 women with palpable breast masses, results were correlated with the histopathological findings. Results: Of the 102 cases, malignancy was confirmed in 43 cases (42.16%) by final pathological examination, the sensitivity and specificity of cancer detection with FNA cytology was 90.7% (39/43) and 89.8% (53/59), re- spectively, the whole accuracy was 90.2% (92/102), with a positive predictive value of 86.7% (39/45) and a negative predictive value of 93.0% (53/57). FFDM gave a sensitivity of 88.4% (38/43), specificity of 83.1% (49/59), and whole accuracy 85.3% (87/102), the positive predictive value and negative predictive value was 79.2% (38/48) and 90.7% (49/54), respectively. All the FNAC-negative cancer cases were suggestive of malignancy by FFDM findings, however, the benign cases which present as equivocal finding by FNA cytology, could not be ruled out the presence of malignancy. Conclusion: FNAC and FFDM both are accurate, effective and economical diagnostic modalities, combined use of these two methods can reduced the misdiag- nosis rate of breast masses.

Recurrent medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation:A case report

BACKGROUND Treatment for neck lymph node metastases after adequate initial surgery in medullary thyroid carcinoma(MTC)has been controversial.Ultrasound(US)-guided radiofrequency ablation(RFA)has been widely used in recurrent welldifferentiated thyroid carcinoma.Here,we report for the first time the use of RFA in a patient with recurrent MTC.CASE SUMMARY We report the case of a 56-year-old woman with cervical lymph node metastases of MTC.Four years previously,she had undergone a total thyroidectomy and neck lymph node dissection.A neck US revealed many enlarged nodes during the follow-up period.Moreover,the serum calcitonin jumped to 198.17 pg/mL,which strongly indicated the recurrence of MTC.Subsequently,two metastatic lymph nodes were confirmed by US-guided fine-needle aspiration-cytology and fineneedle aspiration-calcitonin,and then the patient was treated with RFA.Four months later,the neck US and a contrast-enhanced US showed obvious shrinkage in the ablation zones,and the serum calcitonin dropped to 11.80 pg/mL.CONCLUSION This case suggests that RFA may be an effective and safe treatment for local recurrent MTC.

Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance?A case report

BACKGROUND In clinical work,85%-90%of malignant thyroid diseases are papillary thyroid cancer(PTC);thus,clinicians neglect other types of thyroid cancer,such as medullary thyroid carcinoma(MTC).CASE SUMMARY We report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL.There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology,but the presence of PTC and MTC was confirmed by postoperative paraffin pathology.The patient underwent total thyroidectomy and bilateral central lymph node dissection.Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.CONCLUSION The issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC.In the absence of central lymph node metastasis,it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.

Solitary thyroid gland metastasis from rectal cancer:A case report and review of the literature

BACKGROUND Metastatic carcinoma of the thyroid gland is a rare encounter in clinical practice, but autopsy series showed that it is not so rare. Thyroid metastasis from colorectal cancer(CRC) is rare and has a poor prognosis. We herein report a rare case of solitary thyroid metastasis from rectal cancer combined with needle tract implantation after fine-needle aspiration(FNA) of the thyroid nodule and review the relevant literature.CASE SUMMARY A 54-year-old woman with a history of TNM stage Ⅲ CRC presented a 1.3 cm × 1.0 cm mass in the left thyroid gland. FNA and histological examination of the left thyroid lobe surgical specimen confirmed the diagnosis of isolated metastatic adenocarcinoma from the rectum. Needle tract implantation was observed in the neck 11 mo after the FNA examination. The 2.5-cm seeding lesion was successfully removed by surgery, and the patient recovered well. The literature relevant to this clinical condition, the diagnostic workup, spread pathway, and surgical management of these rare lesions is reviewed.CONCLUSION For a patient with a thyroid mass and a history of CRC, metastatic thyroid carcinoma should be considered even if the patient has no evidence of other organ metastasis from CRC. FNA cytological examination of the thyroid mass is useful in the differential diagnosis between primary thyroid disease and metastatic thyroid carcinoma. Thyroid lobectomy of the gland containing the metastatic tumor is suggested in patients with metastatic carcinoma of the thyroid.

腋窝前哨淋巴结活检在原发性乳腺癌患者中的应用价值

目的探讨前哨淋巴结活检在临床检查腋窝淋巴结阳性的原发性乳腺癌患者中的应用价值。方法回顾性分析255例临床检查腋窝淋巴结阳性的原发性乳腺癌患者的临床资料,对比临床查体、超声影像学检查、超声影像异常的淋巴结穿刺病理学检查对于腋窝淋巴结状态判断的可靠性。结果 255例乳腺癌患者中,199例(78.0%)经病理学检查证实存在腋窝淋巴结转移。245例(96.1%)在超声检查时发现异常淋巴结;通过超声结合影像异常淋巴结穿刺病理学检查确诊腋窝淋巴结转移172例,占所有腋窝淋巴结转移患者的86.4%。125例临床查体c N1的患者中,18例(14.8%)穿刺病理学检查及前哨淋巴结活检均未见癌转移。结论对于临床检查腋窝淋巴结阳性的原发性乳腺癌患者,特别是穿刺未获得阳性结果者,应行前哨淋巴结活检,以避免不必要的腋窝淋巴结清扫。

乳癌术前细针针吸细胞学替代术中切除活检的指征探讨

为探讨乳癌术前细针针吸细胞学选择性替代术中切除活检的可能性，对１９９５年９月～１９９６年５月间住院手术治疗的１１８例“乳房肿块”病人均行了术前临床触诊及细针针吸细胞学检查。结果显示：１１８例病人病理证实为乳癌者６９例。细针针吸细胞学检查诊断乳癌灵敏度为９５．７％，阳性预测值为９７．１％。当触诊与细针针吸均阳性时，其联合诊断乳癌的灵敏度仅为４７．８％，但联合阳性预测值却达到１００％。提示：对于住院接受手术的乳腺肿块病人，如果术前触诊能基本肯定为乳癌，则应行细针针吸细胞学检查；若针吸涂片查到癌细胞。

全视野数字化乳腺摄像与细针穿刺细胞学检查对乳腺肿块的诊断意义

目的评估细针穿刺活检与数字化乳腺摄像在乳腺肿块定性诊断中的准确性。方法102例乳腺肿块患者(年龄17～76岁,中位年龄50岁)均进行细针穿刺活检与数字化乳腺摄像检查,且所有患者均入院手术获得病理诊断,所得结果与最终的病理学诊断结果进行对照分析。结果102例患者中,最终病理确诊为乳腺癌者43例(42.2%),细针穿刺活检对乳腺癌检测的敏感性为90.7%(39/43),特异性为89.8%(53/59),总准确率为90.2%(92/102)。数字化乳腺摄像检查对乳腺癌的敏感性也是88.4%(38/43),而特异性是83.1%(49/59),总的准确率是85.3%(87/102)。细针穿刺活检假阴性的乳腺癌可通过数字化乳腺摄像检查得到正确诊断。结论细针穿刺活检与数字化乳腺摄像都是诊断乳腺疾病的准确有效方法,两者联合应用能够降低乳腺肿块的误诊率。

细针穿刺细胞学诊断乳腺浸润性小叶癌的形态学分析及意义探讨

目的:观察8例浸润性小叶癌的形态特点,并与组织切片对照,就其能否进行正确的组织学分类,提出诊断的参考指标及意义。方法:收集乳腺细针穿刺细胞学涂片926例,其中289例乳腺癌(包括可疑癌)病例中浸润性小叶癌8例,观察其形态特点,并用图像分析系统行细胞形态分析。结果:乳腺浸润性小叶癌发生率占乳腺癌的2.8%(8/289),细胞病理上有其特殊形态特点,其它临床特征与一般乳腺癌无显著差异(P>0.05)。结论:细针穿刺细胞学对于多数浸润性小叶癌可以做出分型诊断,但有时形态鉴别较困难,加之其常与浸润性导管癌混合存在,因此明确分型宜慎重。

乳腺细针针吸细胞学检查在基层医院应用的可行性分析

目的分析基层医院乳腺细针针吸细胞学(fine needle aspiration cytology,FNAC)诊断的准确性,评价该检查方法在基层医院应用的可行性。方法回顾北京市怀柔区中医医院有组织病理学结果的145例乳腺肿物细针针吸病例,将细胞学结果与组织学结果对照分析。结果 145例乳腺针吸病例中乳腺癌27例,纤维腺瘤45例,乳腺腺病40例,其他良性病变33例。针吸细胞学诊断乳腺癌的敏感性为92.6%,特异性为100%,准确性为98.6%。结论FNAC检查操作简便,诊断准确性高,可以作为基层医院乳腺肿物的常规检查项目。

钼靶CR摄影与高频超声及针吸细胞学联合诊断小乳腺癌的价值

目的:探讨钼靶CR摄影、高频超声、针吸细胞学联合诊断小乳腺癌的准确率、灵敏度、特异度。方法:对87例乳腺小肿块患者进行钼靶CR摄影、高频超声及针吸细胞学检查,与术后病理结果进行对比,分析研究三种方法联合应用的准确率、灵敏度、特异度。结果:三种检查方法联合应用,灵敏度、特异度及准确率均较独自诊断有所提高,分别为98.1%、100%、98.8%。结论:对乳腺小肿块患者进行了术前三种方法的联合检查是诊断早期小乳腺癌的有效的方法。

乳腺癌针吸细胞性激素受体的检测及其意义

目的：探讨ER、PR在乳腺癌针吸细胞涂片上的检测及其临床意义。方法：应用免疫组化技术对78例乳腺癌病人进行针吸细胞涂片性激素受体的检测，检测结果与石蜡切片检测结果相对照。结果：两种方法，ER全部阳性者为54例，PR全部阳性者为47例。针吸细胞涂片结果显示：ER、PR的阳性例数分别为58例、50例，石蜡切片结果显示：ER、PR的阳性倒数分别为57例、48例。结论：乳腺癌针吸细胞ER、PR的检测是成功的，可为术前进行预治疗的病人及失去手术机会的晚期癌病人提供内分泌治疗的依据。

乳腺穿刺细胞学诊断报告方式的探讨——1999年761例次乳腺穿刺细胞学诊断分析

目的评价细胞学报告方式对临床的指导价值。方法本文对我院1999年乳腺肿块穿刺细胞学761例次的报告方式进行分析。结果发现我们使用的5组分类法,采取文字描述的报告方式,能恰当反映穿刺的质量、细胞学涂片所见、细胞学诊断与对临床的建议。260例有细胞-组织病理学对照的病例中,乳腺癌细胞诊断的敏感性为79.5%。①类报告(涂片见癌细胞)病例的术中冰冻切片率仅为10.5%,大大低于其它报告类型的病例组,恶性预测值为100%,无假阳性报告。良性病例组细胞学诊断的特异性为100%,良性预测值94.7%。结论乳腺FNA用于可扪及肿块的诊断,应严格掌握阳性诊断标准,尽量避免假阳性的发生。认为确有必要将一些难以确定性质的增生性病变归为一类,与可疑癌的报告同属提示临床有必要作进一步检查的类型。诊断报告也有必要对穿刺涂片质量进行评价,对取材不满意的涂片应予说明。

针吸细胞学检查诊断乳腺癌(附40例报告)

目的： 了解针吸细胞学检查（ Ａｓｐｉｒａｔｉｏｎ Ｃｙｔｏｌｏｇｉｃ Ｅｘａｍｉｎａｔｉｏｎ ， Ａ Ｃ Ｅ） 诊断乳腺癌的临床意义。方法： 对４０ 例女性乳腺癌病人进行术前 Ａ Ｃ Ｅ。结果： 全组 Ａ Ｃ Ｅ 阳性３６ 例， 阳性率９０ ％ 。结论： 通过 Ａ Ｃ Ｅ 的诊断依据， 临床意义， 影响诊断的因素，提高诊断准确率的方法及其安全性进行讨论， 认为 Ａ Ｃ Ｅ 是诊断乳腺癌的一种简单准确而又安全可靠的方法。

BRAF^(V600E) vs. TIRADS in predicting papillary thyroid cancers in Bethesda system Ⅰ, Ⅲ, and Ⅴ nodules

Objective: Bethesda System for Reporting Thyroid Cytopathology(BSRTC) categories Ⅰ, Ⅲ, and Ⅴaccount for a significant proportion of fine needle aspiration cytology(FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAF^(V600E) mutation and the Thyroid Imaging Reporting and Data System(TIRADS) classification in differentiating papillary thyroid cancers(PTCs) from benign lesions among BSRTC I, III, and V nodules.Methods: A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAF^(V600E) mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination.Results: In the BSRTC I category, BRAF^(V600E) showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAF^(V600E) were similar to those of TIRADS. In comparison to BRAF^(V600E) alone, the combination of the two methods significantly improved sensitivity(BSRTC Ⅰ:93.6% vs. 67.7%, P < 0.01; BSRTC Ⅲ: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC Ⅰ nodules(93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules(93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules(96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001).Conclusions: BRAF^(V600E) exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC Ⅰ nodules, while the two methods showed similar diagnostic value in BSRTC Ⅲ/Ⅴ nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC Ⅰ, Ⅲ, and Ⅴ nodules.

乳腺癌针吸细胞学激素受体的测定及临床意义研究

目的探讨乳腺癌针吸细胞学激素受体检测的临床意义。方法应用单克隆抗体免疫组化法对42例乳腺癌患者的针吸细胞学涂片与组织切片检查结果对照。结果针吸细胞学涂片与其石蜡切片雌激素受体(ER)、孕激素受体(PR)检测的总符合率为83.3%、80.95%,二者差异无统计学意义。结论乳腺癌针吸细胞涂片检测激素受体结果与组织切片同样可靠。这种方法简便易行,安全性好,对不适合手术的患者的治疗方案选择具有重要的意义。

针吸细胞学对乳腺黏液癌的诊断价值

目的探讨乳腺黏液癌的针吸细胞形态学特点和鉴别诊断。方法结合临床及组织病理学资料,回顾性分析2017—2019年本院收治的针吸细胞学诊断的5例乳腺黏液癌患者的细胞学资料,结合相关文献总结乳腺黏液癌的细胞形态学诊断特征。结果以病理学结果为金标准,5例乳腺黏液癌针吸细胞学诊断结果全部与组织病理学结果一致,准确率为100%。5例乳腺黏液癌针吸物均为半透明胶冻样黏稠物,镜下形态学特点:癌细胞体积轻微增大、轻度异型,呈乳头状或三维立体球团样紧密排列,背景可见大量粘液样物质,可形成黏液湖,癌细胞团如同小岛漂浮在黏液湖中。结论乳腺黏液癌是一种少见但具有独特针吸细胞形态学特征的肿瘤,FNAC诊断准确率高,可以作为乳腺黏液癌术前诊断的一种常规检查方法。

TI-RADS、UE、CEUS及FNAC在预测甲状腺乳头状癌颈部淋巴结转移中的意义

目的探讨甲状腺影像报告与数据系统(TI-RADS)、超声弹性成像(UE)、超声造影(CEUS)及细针穿刺细胞学检查(FNAC)在预测甲状腺乳头状癌(PTC)颈部淋巴结转移中的意义。方法选取我院接受手术治疗的甲状腺乳头状癌患者153例,根据术后颈部淋巴结是否转移将其分为转移组(n=83)和未转移组(n=70)。所有患者在术前均进行TI-RADS、UE、CEUS、FNAC检查。比较TI-RADS、UE、CEUS、FNAC在预测甲状腺乳头状癌颈部淋巴结转移的效能,并采用单因素和多因素Logistic回归法分析各参数对甲状腺乳头状癌颈部淋巴结转移的预测价值。结果与单独应用TI-RADS、UE、CEUS、FNAC相比,联合应用后预测颈部淋巴结转移的敏感度、特异度和准确率显著升高(P<0.05);经单因素和多因素分析发现,PSV、RI、淋巴结内囊性变、包膜被累及程度、弹性评分、内部增强均匀及FNA-Tg是甲状腺乳头状癌患者发生颈部淋巴结转移的独立危险因素(P<0.05)。根据Logistic多因素分析结果建立预测模型,发现其有较高的检验效能。结论TI-RADS、UE、CEUS、FNAC联合应用在预测甲状腺乳头状癌颈部淋巴结转移的价值较高。

細針吸取細胞學診斷乳腺導管病變的細胞學指標

目的探討形態學上診斷乳腺細針吸取細胞學(FNAC)導管病變的最有效和聯合細胞學指標,從而建立有效的乳腺導管病變的細針吸取細胞學診斷模式。方法收集本院6年内的400例有隨訪活檢結果的乳腺FNAC病例,作回顧性病例分析。按手術組織學結果分為導管上皮非增生性乳腺病變(104例),導管上皮增生性乳腺病變(163例)和癌(133例)3組。回顧性分析塗片的60個細胞學指標,對各指標的評估根據其程度或量採用半定量分級評估。以手術組織學結果為金標準對病變分類,指標分析採用Logistic多重回歸模型(統計軟件SPSS)和分類樹模型(統計軟件SAS)統計學分析,研究各指標對診斷導管病變的意義。結果1.400例良、惡性病變組,上皮細胞團中摻雜肌上皮細胞(P<0.05)、上皮細胞排列成大的細胞團(P<0.05)、上皮細胞排列成小的細胞團(P<0.05)、細胞漿内空泡(P<0.05)和細胞套細胞(P<0.1)為統計學上有意義的鑒別診斷指標。最重要的鑒別指標為上皮細胞團中有無摻雜有肌上皮細胞。考慮良性病變的診斷指標為上皮細胞團中摻雜有肌上皮細胞,聯合大量的上皮細胞排列成大的細胞團,94.4%為良性病變,中等至大量的上皮細胞排列成小的細胞團,傾向為增生性病變;考慮癌的診斷指標為上皮細胞團中無摻雜肌上皮細胞,上皮細胞排列成小的細胞團,細胞漿内空泡和細胞套細胞。上皮細胞團中無摻雜肌上皮細胞時,癌佔81.3%。2.267例良性的導管上皮非增生性和增生性病變組,上皮細胞團中見不規則的細胞間腔隙(P=0.001)、上皮細胞團成鬆散排列(P<0.05)和細胞核深染(P<0.1)為診斷增生性病變的有意義指標。兩結構指標在塗片中出現的量越多,越提示為增生性病變,單一出現上皮細胞團中見不規則的細胞間腔隙,增生性病變佔70.1%,當其為中等至大量時,增生性病變佔82.7%,同時伴上皮細胞團成鬆散排列,均為中等至大量時,診斷增生性病變的陽性預測價值為87.5%。3.35例伴不典型細胞學改變的FNAC病例,活檢結果26例為增生性病變,多為導管上皮增生的纖維腺瘤,極少數為不典型增生或癌。結論乳腺細針吸取細胞學對乳腺病變的診斷,結構指標較細胞指標更重要,聯合指標和對其量的評估,更可有效地診斷良、惡性病變,良性病變中非增生性和增生性病變;對伴不典型細胞學改變的病例,應避免誤診為癌,但需作活檢明確診斷。