Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid pseudopapillary tumor of the pancreas: A case report and literature review

We describe the clinical, imaging and cytopathological features of solid pseudopapillary tumor of the pancreas (SPTP) diagnosed by endoscopic ultrasound- guided (EUS-guided) fine-needle aspiration (FNA). A 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic abdominal pain for 2 mo and a short history of hypertension in the endocrinology clinic. Clinical laboratory examinations revealed polycystic ovary syndrome, splenomegaly and low serum amylase and carcinoembryonic antigen (CEA) levels. Computed tomography (CT) analysis revealed a mass of the pancreatic tail with solid and cystic consistency. EUS confirmed the mass, both in body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct (major diameter 3.7 mm). The patient underwent EUS-FNA. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform malignant cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores and nuclear overlapping. Naked capillaries were also seen. The nuclei of malignant cells were round or oval, eccentric with fine granular chromatin, small nucleoli and nuclear grooves in some of them. The malignant cells were periodic acid Schiff (PAS)-Alcian blue (+) and immunocytochemically they were vimentin (+), CA 19.9 (+), synaptophysin (+), chromogranin (-), neuro-specific enolase (-), a1- antitrypsin and a1-antichymotrypsin focal positive. Cytologic findings were strongly suggestive of SPTP. Biopsy confirmed the above cytologic diagnosis. EUS- guided FNA diagnosis of SPTP is accurate. EUS findings,cytomorphologic features and immunostains of cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma and papillary mucinous carcinoma.

Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas:diagnostic efficacy of cell-block immunocyto-chemistry

BACKGROUND： Endoscopic ultrasound-guided fine-needle aspiration cytology was demonstrated to be a useful tool for the diagnosis and staging of pancreaticobiliary neoplastic le- sions. Nonetheless, the diagnostic value of this procedure may be limited by low cellularity of the specimen, contamination of intestinal cells and unfeasibility of ancillary immunocy- tochemical procedures. The present study was to evaluate its usefulness in the diagnosis of neoplastic lesions.

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.

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.

Slow-pull and different conventional suction techniques in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid lesions using 22-gauge needles

AIM To evaluate the cytological diagnostic capacity and sample quality of the slow-pull technique and compare them with different suction techniques.METHODS From July 2010 to December 2015, 102 patients with pancreatic solid lesions who underwent endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) with 22-gauge needles were retrospectively evaluated. EUS-FNA diagnosis was based on a cytological examination, and final diagnosis was based on a comprehensive standard of cytological diagnosis, surgical pathology and clinical or imaging follow-up. Cytological specimens were characterized for cellularity and blood contamination. The cytological diagnostic capacity and sample quality of the slow-pull technique and suction techniques with 5-m L/10-m L/20-m L syringes were analyzed.RESULTS Of all of the EUS-FNA procedures, the slow-pull technique and suction techniques with 5-m L/10-m L/20-m L syringes were used in 31, 19, 34 and 18 procedures, respectively. There were significant differences between these four suction techniques in terms of cytological diagnostic accuracy(90.3% vs 63.2% vs 58.8% vs 55.6%, P = 0.019), sensitivity(88.2% vs 41.7% vs 40.0% vs 36.4%, P = 0.009) and blood contamination(score ≥ 2 for 29.0% vs 52.6% vs 70.6% vs 72.2%, P = 0.003). The accuracy and sensitivity of the slow-pull technique were significantly higher than those of the suction techniques using 5-m L(P = 0.03, P = 0.014), 10-m L(P = 0.005; P = 0.006) and 20-mL syringes(P = 0.01, P = 0.01). Blood contamination was significantly lower in the slow-pull technique than in the suction techniques with 10-m L(P = 0.001) and 20-mL syringes(P = 0.007).CONCLUSION The slow-pull technique may increase the cytological diagnostic accuracy and sensitivity with slight blood contamination during EUS-FNA when using 22-gauge needles for solid pancreatic masses.

Endoscopic ultrasound-guided fine-needle aspiration biopsy-Recent topics and technical tips

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.

The diagnostic evaluation of fine needle aspiration cytology of thyroid and its clinical application

Objective:The aim of the study was to investigate the diagnostic value of fine needle aspiration cytology (FNAC) and its clinical application.Methods:From April 2009 to February 2011,thyroid FNAC were performed in a total of 186 patients with thyroid nodule or mass in our hospital and 78 of those 186 patients subsequently underwent thyroidectomy.The FNAC findings were compared with the results of the corresponding histological diagnosis.Results:The results of thyroid FNAC for 186 patients showed that,(1) 166 cases of benign lesions,the detection rate was 89.24% (166/186),including 96 cases of nodular colloid goiter (51.61%),28 cases of simple colloid goiter (15.05%),38 cases of Hashimoto's thyroiditis (HT) (20.43%) and 4 cases of thyroid adenoma (2.15%);(2) 4 cases of suspicious malignant lesion,the detection rate was 2.15% (4/186);(3) 16 cases of malignant tumor,the detection rate was 8.60% (16/186).Seventy eight patients including malignant (16),suspicious malignant (4),HT (20) and nodular colloid goiters (38) cases diagnosed by FNAC were performed operation with thyroidectomy and the postoperative histopathologic results showed that there were 2 cases HT combined thyroid papillary carcinoma in HT 20 cases by FNAC,15 cases of thyroid papillary carcinoma and 1 case of follicular carcinoma in 16 cases of malignant tumor by FNAC and 4 case of thyroid papillary carcinoma in 4 cases of suspicious malignant by FNAC.Conclusion:Thyroid FNAC is a valuable and reliable method for the diagnosis of the thyroid nodules or mass or even most diffuse thyroid diseases.Diagnosis of HT and thyroid papillary carcinoma can be made by thyroid FNAC.There was larger hint value for nodular colloid goiter and simple colloid goiter according to thyroid FNAC.

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.

Fine needle aspiration cytology of Wilms' tumor:a case report

Wilms' tumor is extremely rare.In this article,we reported one case diagnosed by fine needle aspiration cytology(FNAC) and pathology.A three and a half-year-old boy was admitted to hospital with abdominal pain for two days.CT scan showed a large mass in the region of the left kidney of the boy.FNAC was performed on the mass,and the cytologic specimen showed malignant cells suggestive of a Wilms' tumor.Histologic examination of the operative specimen after the left nephrectomy also revealed Wilms' tumor.

Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy of smear cytology(SC)and liquid-based cytology(LBC)for pancreatic lesions yielded mixed results.AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODS A comprehensive search of PubMed,Embase,and Cochrane was undertaken through July 18,2020.The primary endpoint was diagnostic accuracy(sensitivity and specificity).Secondary outcomes included sample adequacy and post procedure complications.In addition,factors affecting diagnostic efficacy were discussed.RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria.Pooled rates of sensitivity for SC and LBC were 78%(67%-87%)vs 75%(67%-81%),respectively.In any case,both SC and LBC exhibited a high specificity close to 100%.Inadequate samples more often appeared in LBC compared with SC.However,the LBC samples exhibited a better visual field than SC.Very few post procedure complications were observed.CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions(particularly solid lesions),SC with Rapid On-Site Evaluation represents a superior diagnostic technique.If Rapid On-Site Evaluation is unavailable,LBC may replace smears.The diagnostic accuracy of LBC depends on different LBC techniques.

甲状腺癌诊断中FNAC假阴性结果影响因素的分析

目的探讨容易导致细针穿刺细胞学(FNAC)假阴性结果的危险因素并评估FNAC在甲状腺癌诊断上的价值。方法回顾性分析2014年10月-2015年10月间,对甲状腺结节患者行FNAC,并于吉大一院甲状腺外科住院行手术治疗的612例患者资料。所有患者术前均行超声、实验室检查等常规检查,术中均行冰冻切片病理,术后行石蜡病理检查。对其中27例FNAC假阴性和36例FNAC真阴性两组患者的结节大小(≤0.5cm或者>0.5cm)、合并桥本氏甲状腺炎、多病灶、超声提示钙化、合并甲亢、TSH、FT3、FT4以及心率值行对比分析。结果两组比较结节大小、多病灶、合并桥本以及超声提示钙化,P值<0.05,有统计学差异。而合并甲亢、术前TSH、FT3、FT4以及心率,P值>0.05,无统计学差异。结论 (1)结节直径≤0.5cm、多病灶、合并桥本以及超声提示钙化,容易导致FNAC假阴性结果。(2)结节直径>0.5cm以及合并甲亢不会增加FNAC假阴性几率且假阴性结果与患者心率以及术前的TSH、FT3、FT4值无关。

Value of contrast-enhanced ultrasound combined with percutaneous ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions

Background:Contrast-enhanced ultrasound(CEUS)can detect lesions hidden in inflammatory regions and find necrosis or areas of severe fibrosis within the lesion.This retrospective study aimed to compare the diagnostic accuracy of solid pancreatic lesions using percutaneous ultrasound(US)-guided fine-needle aspiration(FNA)with or without CEUS assessment.Methods:Clinical,imaging,and pathologic data of 181 patients from January 2014 to December 2018 in Pecking Union Medical College Hospital,with solid pancreatic masses who underwent percutaneous US-FNA and ThinPrep cytologic test were retrospectively evaluated.Patients were divided into CEUS and US groups according to whether CEUS was performed before the biopsy.According to FNA cytology diagnoses,we combined non-diagnostic,neoplastic,and negative cases into a negative category.The positive category included malignant,suspicious,and atypical cases.The final diagnosis was confirmed by pathology or clinical and radiological follow-up for at least 12 months.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of US-FNA were evaluated between the two groups.Results:This study enrolled 107 male and 74 female patients(average age:60 years).There were 58 cases in the US group and 123 cases in the CEUS group.No statistically significant differences in age,gender,or lesion size were found between the two groups.The diagnostic accuracy of the CEUS group was 95.1%(117/123),which was higher than the 86.2%(50/58)observed in the US group(P=0.036).The sensitivity,specificity,PPV,and NPV of the CEUS group were increased by 7.5%,16.7%,3.4%,and 18.8%,respectively,compared with the US group.However,the differences of the two groups were not statistically significant.Conclusions:Compared with the conventional US,the use of CEUS could improve the biopsy accuracy and avoid the need for a repeat biopsy,especially for some complicated FNA cases.

细针穿刺细胞学检查以及BRAF、RAS基因突变筛查对甲状腺癌的诊断价值分析

目的:评估甲状腺细针穿刺细胞学检查(FNAC)以及BRAF、RAS基因突变筛查对甲状腺癌的诊断价值。方法:回顾性分析2022年1月至2022年12月,在本院门诊或住院行FNAC的甲状腺结节患者共计597例,其中25例因标本不满意予以剔除,282例患者进行了BRAF/RAS基因检测,227例进行了手术治疗。以术后病理结果为金标准,分析FNAC、BRAF、RAS,以及联合检测诊断甲状腺癌的敏感性、特异性和诊断准确率。结果:分析FNAC诊断为非典型病变、且术后病理为甲状腺恶性肿瘤的患者,BRAF/RAS基因的阳性率为42.9%,其中超声TI-RADS分类4B以上的亚组,BRAF的阳性率69.2%,但差异无统计学意义(P=0.116)。单独应用FNAC对甲状腺癌的敏感性为82.8%、特异性为100.0%,联合BRAF基因检测,其敏感性可提高到89.3%、特异性为96.6%,诊断的准确率由82.8%提升到85.9%。结论:在甲状腺结节患者中,通过超声TI-RADS分类筛查出高危患者(尤其是4B及以上的),联合FNAC和BRAF基因检测,可提高甲状腺癌的诊断率。

超声造影与细针穿刺细胞学活检对甲状腺微小癌的诊断价值

目的:探究超声造影(CEUS)与细针穿刺细胞学(FNAC)活检对甲状腺微小癌(TMC)的诊断价值。方法:选取经医院病理证实的124例TMC患者(184个甲状腺结节),所有患者均经日立图腾CEUS与FNAC活检,以甲状腺细胞病理学(Bethesda System)分级>Ⅳ级和CEUS不均匀低增强作为甲状腺恶性结节的诊断标准,评估CEUS、FNAC及二者联合对MTC的诊断价值。结果:124例TMC患者的184个甲状腺结节经CEUS检查恶性结节102个,良性结节82个;FNAC活检恶性结节112个,良性结节72个;与病理结果的一致性均为一般(Kappa=0.478,Kappa=0.620;P<0.05)。CEUS检查显示,良性结节的边界清晰、形态规则,无细小钙化且血流不丰富,增强模式为高增强,且均显著高于恶性结节,差异均有统计学意义(x^(2)=30.183,x^(2)=41.743,x^(2)=55.174,x^(2)=12.672,x^(2)=-10.505;P<0.05)。采用受试者工作特征(ROC)曲线分析显示,CEUS、FNAC及二者联合诊断TMC的ROC曲线下面积(AUC)分别为0.770、0.835和0.885;CEUS诊断TMC的灵敏度、特异度分别为71.88%和82.14%,FNAC诊断TMC的灵敏度、特异度分别为81.25%和85.71%,联合检查诊断TMC的灵敏度、特异度分别为85.94%和91.07%。结论:CEUS及FNAC对TMC均具有一定的诊断价值,且两者联合检测可提高其早期诊断的价值。

细针穿吸细胞学检查在腮腺区肿块诊断中的价值

目的评价细针穿吸细胞学检查(FNAC)在腮腺区肿块诊断中的应用价值。方法应用细针穿吸方法,对121例腮腺区肿块患者进行细胞学检查,其中男性62例,女性59例;年龄5～95岁,平均年龄57.88岁。将细胞学检查结果与术后组织病理和随访资料进行比较研究。结果FNAC的定性诊断准确率为92.56%(112/121),诊断准确率为89.26%。肿瘤的敏感性为91.25%,特异性为100%;7例患者为假阴性,假阴性率为8.75%;良、恶性病变的敏感性为70.97%,特异性为100%;9例患者为假阴性,假阴性率为29.03%,无假阳性患者。无临床并发症。结论FNAC在腮腺区肿块的诊断中有重要作用,是一种经济、快速、安全、并发症少见和诊断准确率高的细胞学诊断手段。

甲状腺乳头状癌中针吸穿刺细胞学的诊断及漏诊原因分析

目的探讨针吸穿刺细胞学(fine needle aspiration cytology,FNAC)对甲状腺乳头状癌的诊断价值。方法收集新疆医科大学第一附属医院206例术后诊断甲状腺乳头状癌、术前行甲状腺针吸穿刺细胞学检查的患者相关资料,其中76例制备细胞蜡块。对涂片中细胞的排列结构、细胞核的特点以及背景特点进行观察;细胞蜡块行HE染色和免疫组织化学标记。结果 206例针吸穿刺的甲状腺结节患者中,189例诊断为甲状腺乳头状癌,17例漏诊,0例误诊。诊断的准确率为91.75%,漏诊率为8.25%,误诊率为0%。结论 FNAC对甲状腺乳头状癌具有重要的术前诊断价值,可作为临床确诊的首选检查方式,对临床的进一步治疗具有指导性意义。甲状腺结节的大小、部位、距体表的距离及伴发的基础疾病作为漏诊因素,需要细胞学医师提高警惕。

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。

385例乳腺肿物穿刺的临床细胞学与组织学对比分析

目的:探讨乳腺肿块细针吸取细胞学检查在临床中的应用价值。方法:分析385例乳腺肿块针吸细胞学诊断,并与术后病理组织学诊断结果相对比。结果:385例针吸细胞学检查与组织学诊断比较,总准确率为95.5%,无假阳性报告。结论:细针吸取细胞学检查在乳腺肿块良恶性病变的鉴别中具有较高的诊断价值。

细针吸取细胞学检查在临床病理诊断中的应用

目的探讨细针吸取细胞学检查在体表以及经体表可触及肿物的诊断价值。方法对158例行细针吸取细胞学检查患者的结果与组织学诊断结果进行对照。结果 68例恶性肿瘤的敏感性为(63/68)92.6%,90例良性病变的特异性为(85/90)94.4%,148例获得正确诊断,10例病变虽未明确诊断,但均未因诊断意见不一致造成过度治疗或治疗不当。总的正确率为93.7%,无一例假阳性病例。结论细针吸取细胞学检查对于体表或经体表可触及肿物的临床病理诊断具有重要作用,是具有较高应用价值的病理检查诊断手段。

超声引导下细针与粗针穿刺在腮腺肿瘤诊断中的对比研究

腮腺属于涎腺,腮腺肿物是临床常见病之一。腮腺细针穿吸活检（fine-needle aspiration cytology FNAC）早已被广泛应用于临床。而随着介入性超声的发展,彩超引导下粗针穿刺活检（Ultrasound-guided core biopsy,USCB）逐步被应用于头颈部肿物的活检。