Search Results (274)

Background: Axillary lymph node (ALN) fine-needle aspirations (FNAs) can guide the next steps in the management of patients with invasive breast carcinoma (BC). The objective is to evaluate the diagnostic performance of ALN FNA in the detection of metastatic breast carcinoma. Methods: We evaluated ALN FNAs from 2020 to 2024 to determine the risk of malignancy (ROM) of different cytologic diagnostic categories using a general WHO cytology reporting system framework (insufficient, benign, atypical, suspicious, and malignant). Results: A total of 290 axillary lymph node FNAs from patients with newly diagnosed invasive breast carcinoma were identified, of which 226 (78%) had histologic and/or adequate clinical follow-up. Cytologic diagnoses included six (2.1%) non-diagnostic, 99 (34.1%) benign, two (0.7%) atypical, seven (2.4%) suspicious for malignancy, and 176 (60.7%) malignant cases. The risk of malignancy (ROM) was 50.0% for non-diagnostic, 17.0% for benign, 100% for atypical, 85.7% for suspicious, and 99.2% for malignant diagnoses. Most false-negative benign cases were attributed to sampling limitations rather than interpretive error, with five cases showing only a single sentinel lymph node metastasis measuring <5 mm. Indeterminate diagnoses were most commonly associated with scant cellularity, acellular cell blocks, obscuring blood or fibrin, and equivocal immunohistochemistry. Excluding cases without histologic follow-up, ALN FNA demonstrated a sensitivity of 86.5%, specificity of 97.4%, positive predictive value of 98.5%, negative predictive value of 79.2%, and overall accuracy of 90.3% for the detection of metastatic breast carcinoma (OR = 243.2, Fisher’s exact test, p < 0.0001). Conclusion: ALN FNA is a highly reliable method for confirming axillary lymph node metastasis in invasive breast carcinoma when malignant cells are identified, with a ROM of 99% for the malignant category. The suspicious category was also strongly associated with malignancy (ROM 86%). However, the 17% ROM observed in the benign category indicates that a negative FNA does not reliably exclude metastatic disease, and surgical nodal staging may still be warranted in clinically or radiologically suspicious cases. These findings support the clinical applicability of the WHO System for Reporting Lymph Node Cytopathology and provide breast carcinoma-specific ROM estimates for this clinical setting. Full article

Background: Management of Bethesda III–IV thyroid nodules remains challenging because of diagnostic uncertainty and variable malignancy risk. This study evaluated the diagnostic performance of fine-needle aspiration biopsy (FNAB) and ultrasonographic (USG) features separately and in combination. Methods: This retrospective cohort study included 1800 patients with Bethesda III–IV thyroid nodules who underwent thyroidectomy between 2017 and 2025. FNAB results and USG features, including hypoechogenicity, microcalcifications, and irregular margins, were analyzed. Logistic regression and ROC curve analyses were performed to determine predictors of malignancy and diagnostic performance. Results: The overall malignancy rate was 25%. Malignancy rates were 19.1% in Bethesda III and 37.4% in Bethesda IV nodules (p < 0.001). In multivariable analysis, Bethesda IV category, microcalcifications, irregular margins and hypoechogenicity were independent predictors of malignancy (all p < 0.001). FNAB and USG alone showed limited discrimination (AUC 0.60 and 0.61, respectively), whereas the combined model demonstrated significantly improved performance (AUC 0.78). The combined model achieved 82.4% sensitivity, 70.1% specificity and 92.1% negative predictive value. Conclusions: USG features provide significant additional diagnostic value beyond cytology in Bethesda III–IV thyroid nodules. Combining USG findings with FNAB improves risk stratification and may support clinical decision-making in indeterminate thyroid nodules. Full article

An 8-year-old, 3.3 kg spayed female Korean Shorthair cat presented with chronic vomiting, waxing and waning hyporexia, and weight loss. Ultrasonography revealed a 1.5 × 1.6 cm ileocecocolic junction (ICCJ) mass and multiple colonic nodules. Fine-needle aspiration biopsy yielded predominantly oval cells with loosely cohesive clustering, and an intestinal neuroendocrine tumor (NET) was favored. Segmental resection of the distal ileum, ICCJ, and proximal colon with stapled side-to-side ileocolic anastomosis was performed. Histopathology also favored NET because the lesion consisted of relatively monomorphic round-to-polygonal cells with eosinophilic to chromophobic granular cytoplasm. Neoplastic cells showed strong CD20 immunoreactivity and nuclear PAX5 labeling but lacked CD3 immunoreactivity, with CD3-positive lymphocytes mainly peripheral to the neoplastic population. Labeling for chromogranin A, synaptophysin, and NSE was absent. These findings led to reclassification as B-cell lymphoma with NET-like morphology, most consistent with an intermediate-cell type. Postoperatively, vomiting improved and resolved after cyclophosphamide, doxorubicin, vincristine, and prednisolone-based chemotherapy was initiated. At approximately 6 months after surgery, body weight remained stable, no postoperative complications were identified, and no discrete recurrent mass was detected. This case demonstrates that feline enteric B-cell lymphoma may rarely exhibit NET-like morphology and be misclassified on cytology and routine histopathology without immunophenotypic confirmation. Full article

Background/Objectives: Salivary gland tumors account for 2.0–6.5% of all head and neck neoplasms, approximately 70% of which are located in the parotid gland. Preoperative determination of tumor histology is a crucial step in the diagnostic and therapeutic pathway because it guides the choice of surgical technique, affecting the achievement of adequate resection margins and preservation of the facial nerve. Fine-needle aspiration (FNA) cytology is the most commonly used cytologic method. However the complex and heterogenous histologic architecture of salivary gland tumors is associated with a significant proportion of false results. Dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI) is a valuable complementary diagnostic tool that enables noninvasive analysis based on perfusion assessment and tissue characterization. The aim of this study is to evaluate the utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of salivary gland tumors and to compare its diagnostic performance with fine-needle aspiration (FNA). Methods: We present a study of 25 patients who underwent DCE-MRI, FNA and postoperative histopathologic examination. Results: Among the 25 patients included, DCE-MRI results were concordant with the postoperative histopathologic diagnosis in 76% of cases, whereas only 36% of positive FNA results correlated with the histopathologic diagnosis. Conclusions: DCE-MRI demonstrates greater correlation with postoperative histopathologic diagnosis compared with FNA. Advantages of DCE-MRI include its noninvasive nature and the ability to image the entire region of interest. Key benefits of FNA are its wide availability and low cost. Selecting the most appropriate preoperative diagnostic modality can positively influence subsequent diagnostic and therapeutic management. Full article

Background: The increasing use of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in patients with breast cancer has led to a growing number of incidentally detected thyroid lesions. Thyroid incidentaloma refers to a focal area of increased metabolic activity within the thyroid gland. Up to 35% of focal thyroid incidentalomas are malignant. Early detection of thyroid carcinoma may allow less invasive surgical management and reduce the need for more extensive treatment associated with advanced disease, including total thyroidectomy, neck dissection, and radioactive iodine therapy. The objective of this study was to estimate the prevalence of focal thyroid incidentaloma and incidental thyroid carcinoma detected on PET/CT scans performed in breast cancer patients at a single tertiary medical center serving a highly ethnically diverse population. Methods: Medical records and PET/CT scans were retrospectively reviewed at a single medical center. Data collected included the presence of thyroid incidentaloma, maximum standardized uptake value (SUVmax), thyroid cytology, primary malignancy type, breast cancer status, ethnicity, and age. A total of 1233 patients with cancer who underwent PET/CT imaging and received treatment at ZIV Medical Center between August 2018 and December 2024 were included. Forty-two patients with primary thyroid carcinoma or head and neck carcinoma were excluded. Patients were categorized into breast cancer and non-breast cancer groups and compared regarding the prevalence of thyroid incidentaloma, referral rates for further evaluation by head and neck specialists, and the rate of incidental thyroid carcinoma. Results: Among 330 patients with breast cancer, 16 (4.8%) had a focal incidental thyroid finding, compared with 24 (2.8%) of 861 patients with non-breast malignancies who underwent PET/CT imaging. Among the 16 breast cancer patients with thyroid incidentaloma, thyroid carcinoma was subsequently confirmed in 4 patients (25%) who underwent further evaluation. The proportion of patients with confirmed thyroid carcinoma among those with incidentalomas was 1.2% (4/330) in the breast cancer group compared with 0.46% (4/861) in the non-breast cancer group. Approximately half of the patients in both groups were referred for further thyroid evaluation. Among breast cancer patients, non-significant trends toward higher referral rates were observed in patients with non-advanced disease, higher SUVs, and Jewish ethnicity. Nearly all patients evaluated by head and neck specialists underwent fine-needle aspiration (FNA). The mean SUV among patients diagnosed with papillary thyroid carcinoma (PTC) on FNA (n = 8; breast and non-breast cancer combined) was 15.2 (IQR: 7.3–17.0), compared with 5.2 (IQR: 5.0–6.0) among patients with benign cytology (n = 5; p = 0.011). Conclusions: Thyroid incidentalomas identified on PET/CT scans in breast cancer patients were relatively common in this cohort, and a proportion of evaluated lesions were subsequently diagnosed as thyroid carcinoma. Referral and diagnostic follow-up rates were variable, with approximately half of patients referred for further evaluation and only one-third attending a head and neck clinic. Given the retrospective design, limited number of biopsy-confirmed cases, and potential verification bias, these findings should be interpreted with caution. Nevertheless, they highlight the importance of clinical awareness and support individualized assessment of PET/CT-detected thyroid incidentalomas rather than broad management recommendations. Full article

Background/Objectives: A taller-than-wide shape is considered a suspicious ultrasound feature in the assessment of thyroid nodules. Although previous studies indicate an association with malignancy, its predictive value may vary depending on the population, methodology and measurement criteria. This study aimed to evaluate the diagnostic significance of the TTW feature and selected nodule dimensions in predicting malignancy risk. Methods: A retrospective observational study was conducted including 367 patients with thyroid nodules referred for fine-needle aspiration biopsy. Nodule height, width and the height-to-width ratio were assessed and compared with cytological outcomes according to the Bethesda classification. Spearman rank correlation and logistic regression analyses were performed, and the predictive value of the TTW ratio was evaluated using receiver operating characteristic analysis. Results: A statistically significant but weak positive correlation was observed between Bethesda category and both nodule height and the product of height and width (p < 0.05; r < 0.3). No significant association was found between the TTW ratio and lesions requiring further clinical evaluation and potential surgical management (OR = 1.03; p = 0.931). The area under the ROC curve for the TTW ratio was 0.497, indicating limited discriminatory performance between benign and potentially malignant lesions. Conclusions: In this cohort, the TTW feature showed limited predictive value in assessing malignancy risk. It should not be used as a standalone criterion for biopsy or surgery, but interpreted as part of a comprehensive ultrasound-based risk assessment together with cytological findings. Further studies in larger populations and with standardized ultrasound measurement protocols are warranted. Full article

Canine appendicular osteosarcoma (OSA) is typically managed by limb amputation. However, this approach may be suboptimal in dogs with concurrent osteoarthrosis (OA). Limb-sparing surgery using three-dimensional (3D)-printed patient-specific implants (PSIs) may be an alternative, although evidence on implant durability and revision strategies remains limited, in particular for proximal humeral reconstructions. This report describes a 9-year-old, overweight dog referred for a 4-week history of persistent left forelimb lameness. Computed tomography (CT) confirmed a lesion affecting the proximal humerus and severe bilateral hip OA. Fine-needle aspiration cytology supported a presumptive diagnosis of OSA. Limb-sparing surgery with 3D-printed PSIs was chosen instead of amputation due to overweight status and OA. Patient-specific guides (PSGs) and endoprosthesis (PSE) were designed based on preoperative CT. Histopathology of the resected tumour confirmed OSA with complete surgical margins. Postoperative functional recovery was favorable, with progressive return to weight-bearing and mild residual lameness up to 8 months. At 9 months, implant failure occurred due to fracture at the distal humeral fixation region. Revision surgery was performed using a novel 3D-printed modular PSE integrating the retained proximal component, allowing restoration of limb function for an additional 6 months. The dog was euthanized at 15 months due to pulmonary metastases. Post-mortem macroscopic and histological visual semi-quantitative assessment of peri-implant tissue suggested advanced osseointegration, with no local recurrence or infection. This report suggests that PSI-based limb-sparing reconstruction may be feasible in proximal humeral OSA and highlights mechanical fatigue as a key limitation. The modular revision approach suggests the potential of additive manufacturing for salvage strategies after implant failure. Full article

Non-Hodgkin lymphomas (NHL) are lymphoproliferative neoplasms with a heterogenous genetic landscape that require multiple assays to be characterized. Cytological samples are frequently utilized in the diagnosis of NHL. An RNA-based assay was utilized to detect translocations and identify mutations in fine-needle aspiration cytology (FNAC) samples of NHL. Fragmentation index and RNA concentration were evaluated in 54 FNAC and eight corresponding histological samples of NHL to establish first the material adequacy before sequencing. To sequence FusionPlex Lymphoma (ArcherDX, Boulder, USA), an anchored multiplex polymerase chain reaction-based RNA targeting 125 genes was used. The sequencing data processing was entirely carried out on the ArcherDX online platform. Mutations were detected in 21 of 62 samples (34%), and in 41 of 62 samples (66%), no genomic alterations were found. The FusionPlex assay detected five BCL6 translocations (three IGH-BCL6 and two EIF4A2-BCL6), six IGH-BCL2 translocations, two IGH-CCND1 translocations, two TP53 point mutations, two MYD88 mutation and four uncommon translocations (two EIF4E3-FOXP1, one TBL1XR1-TP63, one LOC105370537-FUT8). In eight out of eight cases, there was NGS (Next Generation Sequencing) results concordance between corresponding cytological and histological samples (100% concordance). FNAC samples of NHL are suitable for molecular assessment by NGS and FusionPlex Lymphoma assay is an effective method for this purpose. NGS allows the detection of mutations and the identification of translocations on cytological samples also with scanty diagnostic material. Full article

Background/Objectives: Although ultrasound-guided fine-needle aspiration biopsy with suction (FNA-S) is preferred for evaluating thyroid nodules, the capillary technique (FNA-C) is also used. However, the diagnostic performance of both techniques remains unclear. Our objective was to compare the diagnostic performance of FNA-S versus FNA-C for thyroid nodules. Methods: This retrospective, observational, exploratory, single-center pilot evaluation study was conducted at a tertiary hospital from January 2023 to June 2024. A total of 157 ultrasound-guided FNA biopsies were prospectively analyzed, comprising 71 FNA-S and 86 FNA-C procedures. Clinical, ultrasound, and cytological parameters were evaluated to compare the rates of non-diagnostic samples (Bethesda I) and the necessity for repeat punctures. Bivariate analyses and multivariate logistic regression were conducted. Results: Both techniques exhibited comparable rates of non-diagnostic samples (28.17% for FNA-S and 27.91% for FNA-C; p = 0.220) and repetition rates (38.03% for FNA-S and 43.02% for FNA-C; p = 0.637). The only factors significantly associated with sample adequacy, regardless of techniques employed, were the location and composition of the nodule. Conclusions: Ultrasound-guided FNA-S and FNA-C yield similar diagnostic performance for biopsy of thyroid nodules. The choice may depend on operator preference and nodule characteristics. Full article

Background/Objectives: Fine-needle aspiration biopsy (FNAB) is the primary diagnostic procedure for the evaluation of thyroid nodules. Although considered safe and minimally invasive, its immediate systemic biochemical effects, particularly those related to oxidative stress and mechanical tissue injury, remain insufficiently characterized. This study aimed to evaluate the acute systemic impact of FNAB on oxidative stress parameters and to determine whether these changes correlate with cytological malignancy risk. Methods: A total of 208 patients undergoing ultrasound-guided FNAB for a solitary thyroid nodule were prospectively included. Venous blood samples were collected in the supine position immediately before and within 1 min after the procedure. Thiol–disulfide homeostasis parameters were measured using an automated spectrophotometric method, and ischemia-modified albumin (IMA) levels were analyzed concurrently. Pre- and post-procedural values were compared using the Wilcoxon signed-rank test. Associations between oxidative stress markers and Bethesda cytological categories were assessed using Spearman’s correlation analysis. Results: Native thiol and IMA levels demonstrated statistically significant changes following FNAB, whereas total thiol, disulfide levels, and derived thiol–disulfide ratios remained unchanged. The reduction in IMA levels was predominantly observed in lower-risk cytological categories. No significant correlations were identified between oxidative stress parameters and Bethesda-based malignancy risk. Conclusions: FNAB induces only minor and transient alterations in selected systemic oxidative stress markers, which are clinically inconsequential. The observed changes in native thiol and IMA levels appear to reflect short-term procedural effects rather than malignancy-associated redox alterations. These findings support the systemic safety of FNAB and emphasize the need for careful temporal standardization when interpreting circulating oxidative biomarkers in thyroid nodule research. Full article

Apocrine sweat gland adenocarcinoma is an uncommon feline adnexal neoplasm, and lower-lip involvement is rarely documented. A 14-year-old spayed female Siamese cat was evaluated for a firm 1.3 cm right lower-lip mass at a documented hemorrhagic lesion site. Approximately 1 year earlier, the lesion was fluctuant and superficially erosive to ulcerative; fine-needle aspiration yielded bloody fluid with cytologically nondiagnostic material. The lesion reportedly subsided after empirical treatment, but reassessment, tissue diagnosis, and objective confirmation of resolution were not performed. Cytology of the later same-site mass supported malignant epithelial neoplasia. Contrast-enhanced computed tomography (CT) identified a 12.5 × 13.2 × 16.6 mm rim-enhancing mass without mandibular invasion or distant metastasis; the ipsilateral mandibular lymph node was mildly thickened. Histopathology supported a diagnosis of lower-lip apocrine sweat gland adenocarcinoma with lymphovascular tumor emboli, lymphatic invasion, and nodal metastasis. The diagnosis was supported by superficial dermal/subcutaneous location, adjacent adnexal structures, skeletal-muscle separation from nearby minor salivary glands, epithelial immunoreactivity, periodic acid-chiff (PAS) and Alcian blue findings without distinct intratumoral mucin/mucopolysaccharide-rich material. The cat died without necropsy on postoperative day 87. This case supports tissue-based diagnosis and regional lymph node assessment for suspicious feline lower-lip glandular epithelial lesions. Full article

Background: Accurate preoperative risk stratification of intraductal papillary mucinous neoplasms (IPMNs) remains a major challenge in pancreatic surgery. Cytology obtained through endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) demonstrates high specificity but limited sensitivity, whereas molecular analysis of cyst fluid—particularly KRAS and GNAS mutations—has emerged as a promising complementary diagnostic tool. Methods: We conducted a narrative review combined with a retrospective single-center observational study of patients evaluated for suspected IPMN between 2018 and 2025 who underwent EUS-FNA with cytology and KRAS/GNAS testing followed by surgical resection. Histology was used as the reference standard. Given the limited number of resected cases (n = 25), results should be interpreted with caution. Results: A total of 105 patients were included, of whom 70 underwent EUS-FNA and 25 surgical resection. Final histology showed low-grade dysplasia in 12 cases (48%) and high-grade dysplasia in 13 cases (52%), with no invasive carcinoma detected, limiting the evaluation of diagnostic performance for invasive disease. Cytology demonstrated a sensitivity of 38.5% and specificity of 75% for advanced neoplasia. Molecular testing achieved 100% sensitivity but low specificity. A combined diagnostic strategy increased sensitivity to 92.3% compared with 38.5% for cytology alone, although with reduced specificity. Conclusions: A multimodal diagnostic approach integrating morphology, cytology, and molecular testing improves risk stratification of IPMNs and may supports surgical decision-making within multidisciplinary pancreatic teams, particularly in indeterminate cases, although its impact should be interpreted in the context of limited sample size. Full article

Lymphatic malformations (LMs) are rare congenital low-flow vascular anomalies that frequently involve the head and neck and may be managed with surgery, laser therapy, sclerotherapy, or multimodal approaches depending on lesion type, size, depth, and relationship with adjacent structures. Ultrasound-guided sclerotherapy with doxycycline is an established treatment option for macrocystic lesions, whereas the practical role of high-frequency superficial ultrasound as a technical adjunct has been less specifically discussed. We report the case of a 32-year-old man presenting with a painless left submandibular swelling of approximately two years’ duration. Magnetic resonance imaging showed a well-encapsulated cystic lesion measuring 56 × 35 mm in the left submandibular region, extending into the internal paralaryngeal space and causing mild compression of the laryngeal wall. Previous fine-needle aspiration cytology had not conclusively established the lymphatic nature of the lesion; therefore, an incisional biopsy was performed and confirmed a macrocystic LM. The patient underwent day-surgery intralesional doxycycline sclerotherapy under real-time high-frequency ultrasound guidance using an 18 MHz hockey-stick transducer. After aspiration of the main cystic compartment through a 25-gauge needle, 100 mg of doxycycline diluted to 10 mg/mL in normal saline was slowly injected under continuous visualization. The procedure was well tolerated under topical local anesthesia, without pain, complications, or adverse effects. A partial clinical reduction was observed after the first session; the treatment was repeated after three months, resulting in apparent complete clinical resolution at one-year follow-up; no post-treatment imaging was available to confirm radiological resolution. This case highlights the potential technical value of high-frequency superficial ultrasonography, particularly for needle positioning, improved delineation of superficial locules, and real-time monitoring of sclerosant distribution. Full article

Objective: Preoperative prediction of incidental papillary thyroid microcarcinoma (PTMC) in patients undergoing surgery for multinodular goiter (MNG) is a clinically significant challenge. This study aimed to evaluate the association of preoperative radiological (TI-RADS), cytological (Bethesda), and systemic inflammatory markers (neutrophil/lymphocyte ratio [NLR] and systemic immune-inflammation index [SII]) with incidental PTMC. Methods: This retrospective study included patients who underwent total thyroidectomy due to multinodular goiter. Preoperative ultrasonography findings (TI-RADS), fine needle aspiration biopsy results (Bethesda), and inflammatory markers (NLR and SII) were analyzed. Patients were grouped according to the presence of PTMC based on postoperative pathology results. Independent associations with PTMC were evaluated using multivariable binary logistic regression analysis with TI-RADS and Bethesda classifications entered as categorical variables. Results: A total of 283 patients who underwent total thyroidectomy for multinodular goiter were included in the study. The mean age was 52.75 ± 11.39 years, and 78.1% of the patients were female. Postoperative histopathological examination revealed incidental papillary thyroid microcarcinoma (PTMC) in 67 patients (23.6%). PTMC was detected in 67 patients (23.6%). In multivariable binary logistic regression analysis, high-risk TI-RADS categories (TR4–5 vs. TR1–3) and Bethesda III–IV categories (vs. Bethesda I–II) were independently associated with PTMC, whereas NLR and SII were not independently significant. Conclusions: High-risk TI-RADS and Bethesda categories were independently associated with incidental PTMC in patients with multinodular goiter, whereas inflammatory markers including NLR and SII were not independent predictors. Radiological and cytological evaluation appear to remain the primary components of preoperative assessment in incidental PTMC. Full article

In recent years, thyroid nodule diagnosis and classification have been updated by two major developments: the fifth edition of the World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors classification 2022), which includes thyroid neoplasms, and the third edition of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) (2023). Importantly, these classification systems converge in terminology, improving clinicopathologic correlation between fine-needle aspiration cytology (FNAC) and surgical pathology and supporting more consistent risk-based management. In parallel, molecular testing has assumed a growing role, particularly for indeterminate FNA categories, as reflected in contemporary practice recommendations. Moreover, the 2025 American Thyroid Association guidelines recalibrate postoperative risk stratification in differentiated thyroid cancer by reasserting histopathology as the cornerstone of clinical decision-making. In this review, we summarize key updates in thyroid FNAC reporting, histopathologic classification, and the practical application of molecular pathology for the evaluation and management of thyroid nodules. Full article