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The cytological diagnosis of metastases to the brest from extramammary malignancies; a cytomorphologic study with emphasis on ancillary techniques
IAP 2014 ABSTRACTS
with 6 main diagnostic categories and their subcategories. The system is widely accepted in USA and some of the European countries where its pathological and clinical utility has been acknowledged in follow up studies. No such study however is available from our part of the world. Objective: The present study was designed to determine the diagnostic accuracy of Bethesda System of reporting the fine needle aspiration cytology of thyroid. Material and methods: This descriptive cross-sectional study was conducted in FNAC clinic of department of pathology, Allama Iqbal Medical College, Lahore, and Surgical units of Jinnah Hospital, Lahore, Pakistan. Data was collected from January 2012 to December 2013. A total of 130 patients with thyroid swelling were included who underwent thyroid surgery following FNAC of thyroid. FNA was reported according to Bethesda system. The histopathological examination of thyroidectomy specimen acted as the gold standard for evaluating the diagnostic accuracy of FNAC results. Results: Of 130 FNACs, 7 (5.4%) cases were diagnosed as category I - non-diagnostic or unsatisfactory, 91 (70%) were diagnosed as category II - benign, 7 (5.4%) were diagnosed as category III - atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 8 (6.2%) as category IV - suspicious for follicular neoplasm, 4 (3.1%) as category V - suspicious for malignancy and 13 (10%) cases as category VI - malignant. Cytohistological correlation revealed a sensitivity of 86.4%, specificity of 85%, positive predictive value of 96.9%, negative predictive value of 53.1%, and diagnostic accuracy of 86.1% for FNAC of thyroid reported with Bethesda system. Conclusion: FNAC thyroid reported by Bethesda system is a highly sensitive and specific method for differentiating benign from malignant thyroid nodules.
Cytopathology: Poster#089 THE CYTOLOGICAL DIAGNOSIS OF METASTASES TO THE BREST FROM EXTRAMAMMARY MALIGNANCIES; A CYTOMORPHOLOGIC STUDY WITH EMPHASIS ON ANCILLARY TECHNIQUES Henryk Adam Domanski and Anna Maria Domanski Department of Pathology, Ska˚ne University Hospital, Lund, Sweden Metastatic neoplasm to the breast is a rare and heterogeneous event which can mimic primary breast carcinoma or benign neoplasm. Distinguishing metastasis from primary breast carcinoma is very important because of the difference in treatment options. This study aimed to investigate the diagnostic utility of fine-needle aspiration biopsy (FNAB) in differentiating breast metastases from primary breast neoplasm. FNAB of 50 metastases to the breast were evaluated for the following: cytomorphology, influence of clinical history and adjunctive methods on the final diagnosis. Reliable cytological criteria of malignancy were found in all 50 smears. These criteria, correlated with clinical data or complemented by ancillary techniques in selected cases, allowed correct diagnosis in 48 patients. Of the remaining two cases, wrongly diagnosed as primary carcinoma, one patient presented with a breast mass and the other had a history of intestinal carcinoid. FNAB plays an important role in the separation of metastatic neoplasm in the breast from primary breast carcinoma.
S69
Recognition of unusual cytomorphologic patterns, awareness of patient history and, in selected cases, ancillary techniques, are necessary in rendering a correct diagnosis of breast metastasis in FNAB smears.
Cytopathology: Poster#090 THE TRIAGE OF ASC-US/LSIL CYTOLOGY BY HPV DNA TESTING AND GENOTYPING IN NORTHERN THAILAND Surapan Khunamornpong1, Jongkolnee Settakorn1, Kornkanok Sukpan1, Jatupol Srisomboon2, Prapaporn Suprasert2 and Sumalee Siriaunkgul1 1Department of Pathology, and 2Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To assess the benefit of high-risk human papillomavirus (hrHPV) DNA testing and genotyping in the histologic detection of high-grade squamous intraepithelial lesion or worse (HSILþ) in women with low-grade abnormal cytologies [atypical squamous cells of undetermined significance (ASC-US) and lowgrade squamous intraepithelial lesion (LSIL)]. Methods: A prospective study on samples from women with ASC-US/LSIL cytology who were referred for colposcopy between October 2010 and October 2012. Hybrid capture 2 (HC2) was used for hrHPV DNA testing. HPV genotyping was performed by the linear array assay. Cervical tissue histology was obtained by biopsy or LEEP in all patients. Results: Of 101 women with ASC-US/LSIL cytology, 45 (44.6%) were HC2-positive and 56 (55.4%) were HC2-negative. Compared with the HC2-negative group, the HC2-positive group had significantly higher rates of histologic HSILþ (24.4% vs 0%, p < 0.001) and LSIL (55.6% vs 32.1%, p ¼ 0.026). HC2-positive patients with either of 4 HPV genotypes (16/18/52/58) had a significantly higher rate of histologic HSILþ than those without (40.7% vs 0%, p ¼ 0.003). Conclusions: In northern Thailand, hrHPV DNA testing is useful in the triage of women with ASC-US/LSIL cytology. Genotyping for HPV16/18/52/58 has an additional value in the selection of the women who require immediate colposcopy.
Cytopathology: Poster#091 THYROGLOBULIN MEASUREMENTS IN FINE-NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODES FOR THE DETECTION OF METASTATIC DIFFERENTIATED THYROID CARCINOMA Elwira Bakuła-Zalewska1, Emilia Musiał2, Elzbieta StachlewskaNasfeter2 and Marek Dedecjus2 1Department of Pathology, and 2Department of Oncological Endocrinology and Nucelar Medicine, The Maria SklodowskaCurie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland Ultrasound-guided fine needle aspiration biopsy (US-FNAB) is a routinely used technique in the examination of suspicious lymph nodes in patients treated for differentiated thyroid carcinoma (DTC). The measurement of thyroglobulin levels in needle washout fluids (FNAB-Tg) has been reported to increase the diagnostic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
with 6 main diagnostic categories and their subcategories. The system is widely accepted in USA and some of the European countries where its pathological and clinical utility has been acknowledged in follow up studies. No such study however is available from our part of the world. Objective: The present study was designed to determine the diagnostic accuracy of Bethesda System of reporting the fine needle aspiration cytology of thyroid. Material and methods: This descriptive cross-sectional study was conducted in FNAC clinic of department of pathology, Allama Iqbal Medical College, Lahore, and Surgical units of Jinnah Hospital, Lahore, Pakistan. Data was collected from January 2012 to December 2013. A total of 130 patients with thyroid swelling were included who underwent thyroid surgery following FNAC of thyroid. FNA was reported according to Bethesda system. The histopathological examination of thyroidectomy specimen acted as the gold standard for evaluating the diagnostic accuracy of FNAC results. Results: Of 130 FNACs, 7 (5.4%) cases were diagnosed as category I - non-diagnostic or unsatisfactory, 91 (70%) were diagnosed as category II - benign, 7 (5.4%) were diagnosed as category III - atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 8 (6.2%) as category IV - suspicious for follicular neoplasm, 4 (3.1%) as category V - suspicious for malignancy and 13 (10%) cases as category VI - malignant. Cytohistological correlation revealed a sensitivity of 86.4%, specificity of 85%, positive predictive value of 96.9%, negative predictive value of 53.1%, and diagnostic accuracy of 86.1% for FNAC of thyroid reported with Bethesda system. Conclusion: FNAC thyroid reported by Bethesda system is a highly sensitive and specific method for differentiating benign from malignant thyroid nodules.
Cytopathology: Poster#089 THE CYTOLOGICAL DIAGNOSIS OF METASTASES TO THE BREST FROM EXTRAMAMMARY MALIGNANCIES; A CYTOMORPHOLOGIC STUDY WITH EMPHASIS ON ANCILLARY TECHNIQUES Henryk Adam Domanski and Anna Maria Domanski Department of Pathology, Ska˚ne University Hospital, Lund, Sweden Metastatic neoplasm to the breast is a rare and heterogeneous event which can mimic primary breast carcinoma or benign neoplasm. Distinguishing metastasis from primary breast carcinoma is very important because of the difference in treatment options. This study aimed to investigate the diagnostic utility of fine-needle aspiration biopsy (FNAB) in differentiating breast metastases from primary breast neoplasm. FNAB of 50 metastases to the breast were evaluated for the following: cytomorphology, influence of clinical history and adjunctive methods on the final diagnosis. Reliable cytological criteria of malignancy were found in all 50 smears. These criteria, correlated with clinical data or complemented by ancillary techniques in selected cases, allowed correct diagnosis in 48 patients. Of the remaining two cases, wrongly diagnosed as primary carcinoma, one patient presented with a breast mass and the other had a history of intestinal carcinoid. FNAB plays an important role in the separation of metastatic neoplasm in the breast from primary breast carcinoma.
S69
Recognition of unusual cytomorphologic patterns, awareness of patient history and, in selected cases, ancillary techniques, are necessary in rendering a correct diagnosis of breast metastasis in FNAB smears.
Cytopathology: Poster#090 THE TRIAGE OF ASC-US/LSIL CYTOLOGY BY HPV DNA TESTING AND GENOTYPING IN NORTHERN THAILAND Surapan Khunamornpong1, Jongkolnee Settakorn1, Kornkanok Sukpan1, Jatupol Srisomboon2, Prapaporn Suprasert2 and Sumalee Siriaunkgul1 1Department of Pathology, and 2Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To assess the benefit of high-risk human papillomavirus (hrHPV) DNA testing and genotyping in the histologic detection of high-grade squamous intraepithelial lesion or worse (HSILþ) in women with low-grade abnormal cytologies [atypical squamous cells of undetermined significance (ASC-US) and lowgrade squamous intraepithelial lesion (LSIL)]. Methods: A prospective study on samples from women with ASC-US/LSIL cytology who were referred for colposcopy between October 2010 and October 2012. Hybrid capture 2 (HC2) was used for hrHPV DNA testing. HPV genotyping was performed by the linear array assay. Cervical tissue histology was obtained by biopsy or LEEP in all patients. Results: Of 101 women with ASC-US/LSIL cytology, 45 (44.6%) were HC2-positive and 56 (55.4%) were HC2-negative. Compared with the HC2-negative group, the HC2-positive group had significantly higher rates of histologic HSILþ (24.4% vs 0%, p < 0.001) and LSIL (55.6% vs 32.1%, p ¼ 0.026). HC2-positive patients with either of 4 HPV genotypes (16/18/52/58) had a significantly higher rate of histologic HSILþ than those without (40.7% vs 0%, p ¼ 0.003). Conclusions: In northern Thailand, hrHPV DNA testing is useful in the triage of women with ASC-US/LSIL cytology. Genotyping for HPV16/18/52/58 has an additional value in the selection of the women who require immediate colposcopy.
Cytopathology: Poster#091 THYROGLOBULIN MEASUREMENTS IN FINE-NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODES FOR THE DETECTION OF METASTATIC DIFFERENTIATED THYROID CARCINOMA Elwira Bakuła-Zalewska1, Emilia Musiał2, Elzbieta StachlewskaNasfeter2 and Marek Dedecjus2 1Department of Pathology, and 2Department of Oncological Endocrinology and Nucelar Medicine, The Maria SklodowskaCurie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland Ultrasound-guided fine needle aspiration biopsy (US-FNAB) is a routinely used technique in the examination of suspicious lymph nodes in patients treated for differentiated thyroid carcinoma (DTC). The measurement of thyroglobulin levels in needle washout fluids (FNAB-Tg) has been reported to increase the diagnostic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.