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The Asian Thyroid Working Group, from 2017 to 2023
Kennichi Kakudo, Chan Kwon Jung, Zhiyan Liu, Mitsuyoshi Hirokawa, Andrey Bychkov, Huy Gia Vuong, Somboon Keelawat, Radhika Srinivasan, Jen-Fan Hang, Chiung-Ru Lai
J Pathol Transl Med. 2023;57(6):289-304.   Published online November 14, 2023
DOI: https://doi.org/10.4132/jptm.2023.10.04
  • 8,718 View
  • 304 Download
  • 12 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, “First do not harm patients,” and an oriental filial piety “Do not harm one’s own body because it is a precious gift from parents,” which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.

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  • Performance of Two‐Tiered Subclassification of Atypia of Undetermined Significance in Thyroid Fine‐Needle Aspiration Without Routine Molecular Testing
    Pocholo D. Santos, Chiung‐Ru Lai, Jen‐Fan Hang
    Diagnostic Cytopathology.2026; 54(2): 78.     CrossRef
  • Risk of Infertility in Reproductive-Age Patients With Thyroid Cancer Receiving or Not Receiving 131I Treatment
    Chun-Yi Lin, Cheng-Li Lin, Chia-Hung Kao
    Clinical Nuclear Medicine.2025; 50(3): 201.     CrossRef
  • Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Thyroid Cancer
    Sang Yi Moon, Minkook Son, Jung-Hwan Cho, Hye In Kim, Ji Min Han, Ji Cheol Bae, Sunghwan Suh
    Thyroid®.2025; 35(1): 79.     CrossRef
  • Letter: “High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis” by Fung et al
    Kennichi Kakudo, Andrey Bychkov, Jen-Fan Hang, Mitsuyoshi Hirokawa, Somboon Keelawat, Zhiyan Liu, Radhika Srinivasan, Chan Kwon Jung
    Thyroid®.2025; 35(5): 595.     CrossRef
  • Thyroid Nodules with Nuclear Atypia of Undetermined Significance (AUS-Nuclear) Hold a Two-Times-Higher Risk of Malignancy than AUS-Other Nodules Regardless of EU-TIRADS Class of the Nodule or Borderline Tumor Interpretation
    Dorota Słowińska-Klencka, Bożena Popowicz, Joanna Duda-Szymańska, Mariusz Klencki
    Cancers.2025; 17(8): 1365.     CrossRef
  • Response to Kakudo et al.: “High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis”
    Man Him Matrix Fung, Ching Tang, Gin Wai Kwok, Tin Ho Chan, Yan Luk, David Tak Wai Lui, Carlos King Ho Wong, Brian Hung Hin Lang
    Thyroid®.2025; 35(5): 597.     CrossRef
  • Molecular Testing Could Drive Smarter Decision-Marking for Indeterminate Thyroid Nodule if the Price was Right
    Sarah C. Brennan, Matti L. Gild, Venessa Tsang
    Clinical Thyroidology®.2025; 37(5): 165.     CrossRef
  • Welcoming the new, revisiting the old: a brief glance at cytopathology reporting systems for lung, pancreas, and thyroid
    Rita Luis, Balamurugan Thirunavukkarasu, Deepali Jain, Sule Canberk
    Journal of Pathology and Translational Medicine.2024; 58(4): 165.     CrossRef
  • Are we ready to bridge classification systems? A comprehensive review of different reporting systems in thyroid cytology
    Esther Diana Rossi, Liron Pantanowitz
    Cytopathology.2024; 35(6): 674.     CrossRef
  • Aggressive Types of Malignant Thyroid Neoplasms
    Maria Boudina, Eleana Zisimopoulou, Persefoni Xirou, Alexandra Chrisoulidou
    Journal of Clinical Medicine.2024; 13(20): 6119.     CrossRef
  • Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia
    Hee Young Na, Miyoko Higuchi, Shinya Satoh, Kaori Kameyama, Chan Kwon Jung, Su-Jin Shin, Shipra Agarwal, Jen-Fan Hang, Yun Zhu, Zhiyan Liu, Andrey Bychkov, Kennichi Kakudo, So Yeon Park
    Journal of Pathology and Translational Medicine.2024; 58(6): 331.     CrossRef
Article image
A stepwise approach to fine needle aspiration cytology of lymph nodes
Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee
J Pathol Transl Med. 2023;57(4):196-207.   Published online July 11, 2023
DOI: https://doi.org/10.4132/jptm.2023.06.12
  • 46,452 View
  • 2,308 Download
  • 11 Web of Science
  • 13 Crossref
AbstractAbstract PDFSupplementary Material
The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

Citations

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  • Development and Validation of Explainable Artificial Intelligence System for Automatic Diagnosis of Cervical Lymphadenopathy From Ultrasound Images
    Ming Xu, Yubiao Yue, Zhenzhang Li, Yinhong Li, Guoying Li, Haihua Liang, Di Liu, Xiaohong Xu, Mohamadreza (Mohammad) Khosravi
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  • Application of the Sydney system for classification and reporting lymph node cytopathology: a retrospective analysis at a tertiary centre
    Ashok Teja Kummari, Pramod Kumar Pamu, Krishna Kiran Ganna, Param Jyothi, Sadashivudu
    International Journal of Research in Medical Sciences.2025;[Epub]     CrossRef
  • Diagnostic approach to FNA biopsy of cystic lesions of the head and neck
    Stefen Andrianus, Olivia Leung, Zubair Baloch
    Cancer Cytopathology.2025;[Epub]     CrossRef
  • Applicability of Fine-Needle Aspiration Biopsy of Lymph Nodes Using WHO Reporting System: Comparison between Pediatric and Adult Brazilian Populations
    Leonardo Fávaro Ficoto, Deolino João Camilo Júnior, Gustavo Resende Nora, Vitor Bonetti Valente, Daniel Galera Bernabé, José Cândido Caldeira Xavier-Júnior
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    O. V. Pankova, S. V. Vtorushin, M. V. Klimova, D. S. Pismenny, M. O. Ochirov, L. A. Kolomiets, V. M. Perelmuter
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  • From smear to diagnosis: the impact of ancillary techniques in lymph node fine-needle cytology
    Elisabetta Maffei, Giuseppe Di Motta, Angela D’Ardia, Riccardo Ruotolo, Valentina Giudice, Alessandro Caputo, Pio Zeppa
    Journal of the American Society of Cytopathology.2025;[Epub]     CrossRef
  • Immunocytochemical markers, molecular testing and digital cytopathology for aspiration cytology of metastatic breast carcinoma
    Joshua J. X. Li, Gary M. Tse
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  • Response to comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”
    Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee
    Journal of Pathology and Translational Medicine.2024; 58(1): 43.     CrossRef
  • Comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”
    Elisabetta Maffei, Valeria Ciliberti, Pio Zeppa, Alessandro Caputo
    Journal of Pathology and Translational Medicine.2024; 58(1): 40.     CrossRef
  • The Incidence of Thyroid Cancer in Bethesda III Thyroid Nodules: A Retrospective Analysis at a Single Endocrine Surgery Center
    Iyad Hassan, Lina Hassan, Nahed Balalaa, Mohamad Askar, Hussa Alshehhi, Mohamad Almarzooqi
    Diagnostics.2024; 14(10): 1026.     CrossRef
  • Efficiency of Fine-Needle Aspiration (FNA) in Relation to Tru-Cut Biopsy of Lateral Neck Swellings
    Mohammed S Al Olaimat, Fahad S Al Qooz, Zaid R Alzoubi, Elham M Alsharaiah, Ali S Al Murdif, Mohammad O Alanazi
    Cureus.2024;[Epub]     CrossRef
  • Pitfalls in the Cytological Diagnosis of Nodal Hodgkin Lymphoma
    Uma Handa, Rasheeda Mohamedali, Rajpal Singh Punia, Simrandeep Singh, Ranjeev Bhagat, Phiza Aggarwal, Manveen Kaur
    Diagnostic Cytopathology.2024; 52(12): 715.     CrossRef
  • Rapid 3D imaging at cellular resolution for digital cytopathology with a multi-camera array scanner (MCAS)
    Kanghyun Kim, Amey Chaware, Clare B. Cook, Shiqi Xu, Monica Abdelmalak, Colin Cooke, Kevin C. Zhou, Mark Harfouche, Paul Reamey, Veton Saliu, Jed Doman, Clay Dugo, Gregor Horstmeyer, Richard Davis, Ian Taylor-Cho, Wen-Chi Foo, Lucas Kreiss, Xiaoyin Sara J
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Article image
Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions
Haeryoung Kim, Kee-Taek Jang
J Pathol Transl Med. 2020;54(5):367-377.   Published online August 31, 2020
DOI: https://doi.org/10.4132/jptm.2020.07.21
  • 8,910 View
  • 222 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) cytology/biopsy specimens is one of the most challenging tasks in cytology and surgical pathology practice, as the procedure often yields minimal amounts of diagnostic material and contains contaminants, such as blood cells and normal intestinal mucosa. EUS-FNA cytology/biopsy will nevertheless become a more popular procedure for evaluation of various pancreatic lesions because they are difficult to approach with conventional endoscopic procedures. Pathologists should understand the structural differences and limitations of EUS-FNA that make pathologic diagnosis difficult. Ancillary tests are available for differential diagnosis of EUS-FNA for various pancreatic lesions. Immunostains are the most commonly used ancillary tests, and pathologists should able to choose the necessary panel for differential diagnosis. Pathologists should review clinical history and radiologic and/or EUS findings before selecting an immunostain panel and making a pathologic diagnosis. In addition, one’s threshold of malignancy should be adjusted according to the appropriate clinical setting to avoid under-evaluation of pathologic diagnoses. Clinico-pathologic correlation is essential in pathologic evaluation of EUS-FNA for pancreatic lesions. Pathologists can reduce errors by correlating clinical and radiologic findings when evaluating EUS-FNA. Some molecular tests can be applied in differential diagnosis of pancreatic neoplastic and cystic lesions. Molecular data should be used as supportive evidence of a specific disease entity, rather than direct evidence, and should be correlated with clinico-pathologic findings to avoid errors in pathologic diagnosis.

Citations

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  • Diagnostic Performance of EUS‐FNA for Pancreatic Lesions at Tertiary Centers in Iran Without Rapid On‐Site Evaluation
    Maryam Bazmandegan, Gholam Reza Sivandzadeh, Kamran Bagheri Lankarani, Zahra Beyzaei, Bita Geramizadeh
    Cytopathology.2025;[Epub]     CrossRef
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    Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
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    Bokyung Ahn, Jin Kying Jung, HaeSung Jung, Yeon-Mi Ryu, Yeon Wook Kim, Tae Jun Song, Do Hyun Park, Dae wook Hwang, HyungJun Cho, Sang-Yeob Kim, Seung-Mo Hong
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  • Comparison of Endoscopic Ultrasound-Guided Fine Needle Aspiration with 19-Gauge and 22-Gauge Needles for Solid Pancreatic Lesions
    Changjuan Li, Jianwei Mi, Fulai Gao, Xinying Zhu, Miao Su, Xiaoli Xie, Dongqiang Zhao
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Original Article
Cytological Features That Differentiate Follicular Neoplasm from Mimicking Lesions
Kanghee Han, Hwa-Jeong Ha, Joon Seog Kong, Jung-Soon Kim, Jae Kyung Myung, Jae Soo Koh, Sunhoo Park, Myung-Soon Shin, Woo-Tack Song, Hye Sil Seol, Seung-Sook Lee
J Pathol Transl Med. 2018;52(2):110-120.   Published online January 29, 2018
DOI: https://doi.org/10.4132/jptm.2018.01.17
  • 16,587 View
  • 226 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
It is difficult to correctly diagnose follicular neoplasms (FNs) on fine-needle aspiration cytology (FNAC) because it shares many cytological features with other mimicking lesions. The aim of this study was to identify the cytological features that differentiate FNs from mimicking lesions.
Methods
We included the cytological slides from 116 cases of thyroid FN diagnosed on FNAC, and included their subsequent histological diagnoses. We evaluated the cytological architectural pattern and nuclear features of the lesions according to their histological groups.
Results
The final histological diagnoses of the 116 cases varied, and included 51 FNs (44%), 47 papillary thyroid carcinomas (40%) including follicular variant, and seventeen cellular nodular hyperplasias (15%). Regardless of the final histological diagnosis, microfollicular pattern was observed in most cases. On the other hand, trabecular pattern was identified in 34% of FNs, but not in any other lesions. Additionally, elongated nuclei and ground glass chromatin were found in only some papillary thyroid carcinomas.
Conclusions
This study shows that the trabecular pattern is a representative cytological feature of FNs that can be used to distinguish FNs from mimicking lesions. In addition, nuclear shape and chromatin pattern can be used to further confirm the diagnosis of FNs from mimicking lesions through FNAC.

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  • АКТУАЛЬНІ ТЕНДЕНЦІЇ ДІАГНОСТИКИ ТА ЛІКУВАННЯ ФОЛІКУЛЯРНИХ НЕОПЛАЗІЙ ЩИТОПОДІБНОЇ ЗАЛОЗИ
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    Heeseung Sohn, Kennichi Kakudo, Chan Kwon Jung
    Cytopathology.2024; 35(3): 383.     CrossRef
  • Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia
    Hee Young Na, Miyoko Higuchi, Shinya Satoh, Kaori Kameyama, Chan Kwon Jung, Su-Jin Shin, Shipra Agarwal, Jen-Fan Hang, Yun Zhu, Zhiyan Liu, Andrey Bychkov, Kennichi Kakudo, So Yeon Park
    Journal of Pathology and Translational Medicine.2024; 58(6): 331.     CrossRef
  • Using Deep Convolutional Neural Networks for Enhanced Ultrasonographic Image Diagnosis of Differentiated Thyroid Cancer
    Wai-Kin Chan, Jui-Hung Sun, Miaw-Jene Liou, Yan-Rong Li, Wei-Yu Chou, Feng-Hsuan Liu, Szu-Tah Chen, Syu-Jyun Peng
    Biomedicines.2021; 9(12): 1771.     CrossRef
  • The Role of Fine Needle Aspiration Biopsy with Bethesda System in the Evaluation of Thyroid Nodules
    Gizem AKKAŞ AKGÜN, Figen ASLAN
    Anadolu Kliniği Tıp Bilimleri Dergisi.2021; 26(1): 23.     CrossRef
  • Comprehensive DNA Methylation Profiling Identifies Novel Diagnostic Biomarkers for Thyroid Cancer
    Jong-Lyul Park, Sora Jeon, Eun-Hye Seo, Dong Hyuck Bae, Young Mun Jeong, Yourha Kim, Ja Seong Bae, Seon-Kyu Kim, Chan Kwon Jung, Yong Sung Kim
    Thyroid.2020; 30(2): 192.     CrossRef
  • Preoperative diagnostic categories of fine needle aspiration cytology for histologically proven thyroid follicular adenoma and carcinoma, and Hurthle cell adenoma and carcinoma: Analysis of cause of under- or misdiagnoses
    Hee Young Na, Jae Hoon Moon, June Young Choi, Hyeong Won Yu, Woo-Jin Jeong, Yeo Koon Kim, Ji-Young Choe, So Yeon Park, Paula Soares
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Reviews
History and Practice of Thyroid Fine-Needle Aspiration in China, Based on Retrospective Study of the Practice in Shandong University Qilu Hospital
Zhiyan Liu, Dongge Liu, Bowen Ma, Xiaofang Zhang, Peng Su, Li Chen, Qingdong Zeng
J Pathol Transl Med. 2017;51(6):528-532.   Published online October 19, 2017
DOI: https://doi.org/10.4132/jptm.2017.09.12
  • 10,073 View
  • 103 Download
  • 15 Web of Science
  • 12 Crossref
AbstractAbstract PDF
Cytology in China developed from nothing and underwent a long journey from gynecologic cytology to that of all organs, laying a solid foundation for new developments in the 21st century. Thyroid fine-needle aspiration (FNA) was primarily developed in an endocrinology department and then in the clinical laboratory department or pathology department in the 1970–80s. Wrights staining is popular in endocrine and clinical laboratory departments, while hematoxylin and eosin staining is common in pathology. Liquid based cytology is not common in thyroid FNA cytology, while BRAFV600E mutation analysis has been the most popular molecular test. The history and practice of thyroid FNA practice in China were reviewed based on retrospective study of the practice in Qilu Hospital of Shandong University.

Citations

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  • High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis
    Man Him Matrix Fung, Ching Tang, Gin Wai Kwok, Tin Ho Chan, Yan Luk, David Tak Wai Lui, Carlos King Ho Wong, Brian Hung Hin Lang
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  • The Asian Thyroid Working Group, from 2017 to 2023
    Kennichi Kakudo, Chan Kwon Jung, Zhiyan Liu, Mitsuyoshi Hirokawa, Andrey Bychkov, Huy Gia Vuong, Somboon Keelawat, Radhika Srinivasan, Jen-Fan Hang, Chiung-Ru Lai
    Journal of Pathology and Translational Medicine.2023; 57(6): 289.     CrossRef
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Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital
Shinya Satoh, Hiroyuki Yamashita, Kennichi Kakudo
J Pathol Transl Med. 2017;51(6):548-554.   Published online October 11, 2017
DOI: https://doi.org/10.4132/jptm.2017.09.29
  • 12,565 View
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  • 26 Web of Science
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AbstractAbstract PDF
In Japan, fine-needle aspiration (FNA) cytology is the most important diagnostic modality for triaging patients with thyroid nodules. A clinician (endocrinologist, endocrine surgeon, or head and neck surgeon) generally performs FNA cytology at the outpatient clinic, and ultrasound (US)-guided FNA is widespread because US is extremely common and most clinicians are familiar with it. Although almost all FNA thyroid samples are examined by certified cytopathologists and pathologists, some clinicians assess cytological specimens themselves. In Japan, there are two clinical guidelines regarding the management of thyroid nodules. One is the General Rules for the Description of Thyroid Cancer (GRDTC) published by the Japanese Society of Thyroid Surgery (JSTS) in 2005, and the other is the national reporting system for thyroid FNA cytology published by the Japan Thyroid Association in 2013 (Japanese system). Although the Bethesda System for Reporting Thyroid Cytopathology (Bethesda system) is rarely used in Japan, both the GRDTC and Japanese system tried to incorporate the Bethesda system so that the cytological diagnoses would be compatible with each other. The essential point of the Japanese system is stratification of follicular neoplasm (FN) into three subgroups based on cytological features in order to reduce unnecessary diagnostic thyroidectomy, and this system has been successful in stratifying the risk of malignancy in FN patients at several high-volume thyroid surgery centers. In Japan, the measurement of thyroglobulin and/or calcitonin in FNA needle washings is often used as an adjunct for diagnosis of possible cervical lymph node metastasis when FNA cytology is performed.

Citations

Citations to this article as recorded by  
  • High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis
    Man Him Matrix Fung, Ching Tang, Gin Wai Kwok, Tin Ho Chan, Yan Luk, David Tak Wai Lui, Carlos King Ho Wong, Brian Hung Hin Lang
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    Mitsuyoshi Hirokawa, Ayana Suzuki
    Journal of Pathology and Translational Medicine.2025; 59(4): 214.     CrossRef
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    Byeong-Joo Noh, Won Jun Kim, Jin Yub Kim, Ha Young Kim, Jong Cheol Lee, Myoung Sook Shim, Yong Jin Song, Kwang Hyun Yoon, In-Hye Jung, Hyo Sang Lee, Wooyul Paik, Dong Gyu Na
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  • Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia
    Hee Young Na, Miyoko Higuchi, Shinya Satoh, Kaori Kameyama, Chan Kwon Jung, Su-Jin Shin, Shipra Agarwal, Jen-Fan Hang, Yun Zhu, Zhiyan Liu, Andrey Bychkov, Kennichi Kakudo, So Yeon Park
    Journal of Pathology and Translational Medicine.2024; 58(6): 331.     CrossRef
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    Mitsuyoshi Hirokawa, Manon Auger, Chan Kwon Jung, Fabiano Mesquita Callegari
    Cancer Cytopathology.2023; 131(7): 415.     CrossRef
  • The Asian Thyroid Working Group, from 2017 to 2023
    Kennichi Kakudo, Chan Kwon Jung, Zhiyan Liu, Mitsuyoshi Hirokawa, Andrey Bychkov, Huy Gia Vuong, Somboon Keelawat, Radhika Srinivasan, Jen-Fan Hang, Chiung-Ru Lai
    Journal of Pathology and Translational Medicine.2023; 57(6): 289.     CrossRef
  • Criteria for follow‐up of thyroid nodules diagnosed as follicular neoplasm without molecular testing – The experience of a high‐volume thyroid centre in Japan
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  • The Use of Fine-Needle Aspiration (FNA) Cytology in Patients with Thyroid Nodules in Asia: A Brief Overview of Studies from the Working Group of Asian Thyroid FNA Cytology
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Thyroid Fine-Needle Aspiration Cytology Practice in Korea
Yoon Jin Cha, Ju Yeon Pyo, SoonWon Hong, Jae Yeon Seok, Kyung-Ju Kim, Jee-Young Han, Jeong Mo Bae, Hyeong Ju Kwon, Yeejeong Kim, Kyueng-Whan Min, Soonae Oak, Sunhee Chang
J Pathol Transl Med. 2017;51(6):521-527.   Published online October 11, 2017
DOI: https://doi.org/10.4132/jptm.2017.09.26
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AbstractAbstract PDF
We reviewed the current status of thyroid fine-needle aspiration cytology (FNAC) in Korea. Thyroid aspiration biopsy was first introduced in Korea in 1977. Currently, radiologists aspirate the thyroid nodule under the guidance of ultrasonography, and cytologic interpretation is only legally approved when a cytopathologist makes the diagnosis. In 2008, eight thyroid-related societies came together to form the Korean Thyroid Association. The Korean Society for Cytopathology and the endocrine pathology study group of the Korean Society for Pathologists have been updating the cytologic diagnostic guidelines. The Bethesda System for Reporting Thyroid Cytopathology was first introduced in 2009, and has been used by up to 94% of institutions by 2016. The average diagnosis rates are as follows for each category: I (12.4%), II (57.9%), III (10.4%), IV (2.9%), V (3.7%), and VI (12.7%). The malignancy rates in surgical cases are as follows for each category: I (28.7%), II (27.8%), III (50.6%), IV (52.3%), V (90.7%), and VI (100.0%). Liquid-based cytology has been used since 2010, and it was utilized by 68% of institutions in 2016. The categorization of thyroid lesions into “atypia of undetermined significance” or “follicular lesion of undetermined significance” is necessary to draw consensus in our society. Immunocytochemistry for galectin-3 and BRAF is used. Additionally, a molecular test for BRAF in thyroid FNACs is actively used. Core biopsies were performed in only 44% of institutions. Even the institutions that perform core biopsies only perform them for less than 3% of all FNACs. However, only 5% of institutions performed core biopsies up to three times more than FNAC.

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    Daniel Javier Velez Bohorquez, Nohora Bibiana Varon Arce, Sandra Milena Tellez Olaya, Sebastian Camilo Mora Garcia, Anggi Margarita Velez Bohorquez, Mabel Elena Bohorquez Lozano
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    Hyunseo Cha, Ju Yeon Pyo, Soon Won Hong
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Original Articles
Article image
Image-Guided Fine Needle Cytology with Aspiration Versus Non-Aspiration in Retroperitoneal Masses: Is Aspiration Necessary?
Rajiv Kumar Misra, Shaila Mitra, Rishav Kumar Jain, Shilpa Vahikar, Archana Bundela, Purak Misra
J Pathol Transl Med. 2015;49(2):129-135.   Published online March 12, 2015
DOI: https://doi.org/10.4132/jptm.2015.01.28
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AbstractAbstract PDF
Background
Although using fine needle cytology with aspiration (FNC-A) for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA) for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Methods: Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. Results: By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%). The diagnostic accuracy of other sites by FNC-A varied from 75.0%–81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%–72.8%. Conclusions: Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

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  • A comparison of cytologic quality in fine‐needle specimens obtained with and without aspiration from superficial lymph nodes in the dog
    V. Karakitsou, M. M. Christopher, E. Meletis, P. Kostoulas, D. Pardali, C. K. Koutinas, M. E. Mylonakis
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Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Pancreatic Lesions
Hae Woon Baek, Min Jee Park, Ye-Young Rhee, Kyoung Bun Lee, Min A Kim, In Ae Park
J Pathol Transl Med. 2015;49(1):52-60.   Published online January 15, 2015
DOI: https://doi.org/10.4132/jptm.2014.10.26
  • 12,774 View
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  • 33 Crossref
AbstractAbstract PDF
Background
Endoscopic ultrasound–guided fine needle aspiration cytology (EUS-FNAC) is currently the most commonly used procedure for obtaining cytologic specimens of the pancreas. It is accurate, minimally invasive, safe and cost-effective. However, there is discrepancy between cytological and surgical diagnoses. This study was aimed at evaluating the diagnostic accuracy of EUS-FNAC of the pancreas. Methods: We performed a retrospective review of 191 cases of pancreatic lesions initially diagnosed by EUS-FNAC with subsequent histological diagnosis between 2010 and 2012 in the Department of Pathology, Seoul National University Hospital. Cytologic and surgical diagnoses were categorized into five groups: negative, benign, atypical, malignant, and insufficient for diagnosis. Subsequently, 167 cases with satisfactory yield in both surgical and cytology specimens were statistically analyzed to determine correlations with diagnosis. Results: In comparison to surgical diagnoses, cytologic diagnoses were true-positive in 103 cases (61.7%), true-negative in 28 cases (16.8%), false-positive in 9 cases (5.4%), and false-negative in 27 cases (16.1%). The diagnostic accuracy was 78.4%, sensitivity was 79.2%, and specificity was 75.7%. The positive predictive value was 92.0%, and negative predictive value was 50.9%. Conclusions: EUS-FNAC has high accuracy, sensitivity, specificity and positive predictive value. Overcoming the limitations of EUS-FNAC will make it a useful and reliable diagnostic tool for accurate evaluation of pancreatic lesions.

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Brief Case Reports
Digital Papillary Carcinoma
Sharon Lim, Inju Cho, Mi Ja Lee
Korean J Pathol. 2014;48(6):438-441.   Published online December 31, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.438
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PDF

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Indolent CD56-Positive Clonal T-Cell Lymphoproliferative Disease of the Stomach Mimicking Lymphomatoid Gastropathy
Mineui Hong, Won Seog Kim, Young Hyeh Ko
Korean J Pathol. 2014;48(6):430-433.   Published online December 31, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.430
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Myoepithelial Carcinoma of Soft Tissue: A Case Report and Review of the Literature
Chang Hwan Choi, Young Chae Chu, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim
Korean J Pathol. 2014;48(6):413-417.   Published online December 31, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.413
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Pulmonary Hodgkin Lymphoma in a Patient with Crohn’s Disease
Jae-Young Park, Juhie Lee
Korean J Pathol. 2014;48(5):387-389.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.387
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One Case of a BRCA1 Germ Line Mutation Ovarian Carcinoma Patient Based on Abnormal Immunohistochemistry Finding
Hyun Joo Kim, Jung Min Park, Hyoun Wook Lee, Eun Hee Lee, Min Kyu Kim
Korean J Pathol. 2014;48(5):379-381.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.379
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Cytokeratin-Positive Gastrointestinal Stromal Tumor of Biphasic Morphology: A Case Report
Sung Sun Kim, Yoo Duk Choi, Jae Hyuk Lee, Chan Choi
Korean J Pathol. 2014;48(5):375-378.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.375
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Cystic Brunner’s Gland Hamartoma in the Gastric Body: A Case Report
Dong Hae Chung, Na Rae Kim, Hyun Yee Cho, Yoon Jae Kim
Korean J Pathol. 2014;48(5):371-374.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.371
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  • An Unusual Gastric Polyp: Brunneroma
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Case Study
Nodular Fasciitis of the Parotid Gland, Masquerading as Pleomorphic Adenoma
Chung Su Hwang, Chang Hun Lee, Ahrong Kim, Nari Shin, Won Young Park, Min Gyoung Park, Do Youn Park
Korean J Pathol. 2014;48(5):366-370.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.366
  • 8,949 View
  • 56 Download
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AbstractAbstract PDF
It is difficult to distinguish nodular fasciitis (NF) from other neoplasm of the parotid gland, especially pleomorphic adenoma (PA) by fine needle aspiration cytology. A 39-year-old female noticed a mass in the parotid region. The aspirate material showed cohesive parts composed of the cells that had oval or spindle-shaped nuclei and relatively abundant cytoplasm and some cells with plasmacytoid features. The background substance was fibromyxoid. PA was diagnosed based on the cytologic findings. Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings. NF in the parotid region is rare and may be misdiagnosed as other benign or malignant tumors of the parotid gland. The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA. In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.

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Original Articles
Preparation of Compact Agarose Cell Blocks from the Residues of Liquid-Based Cytology Samples
Suk Jin Choi, Yeon Il Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu
Korean J Pathol. 2014;48(5):351-360.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.351
  • 17,476 View
  • 363 Download
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AbstractAbstract PDF
Background: Inevitable loss of diagnostic material should be minimized during cell block preparation. We introduce a modified agarose cell block technique that enables the synthesis of compact cell blocks by using the entirety of a cell pellet without the loss of diagnostic material during cell block preparations. The feasibility of this technique is illustrated by high-throughput immunocytochemistry using high-density cell block microarray (CMA). Methods: The cell pellets of Sure- Path residues were pre-embedded in ultra-low gelling temperature agarose gel and re-embedded in standard agarose gel. They were fixed, processed, and embedded in paraffin using the same method as tissue sample processing. The resulting agarose cell blocks were trimmed and represented on a CMA for high-throughput analysis using immunocytochemical staining. Results: The SurePath residues were effectively and entirely incorporated into compact agarose cell buttons and embedded in paraffin. Sections of the agarose cell blocks revealed cellularities that correlated well with corresponding SurePath smears and had immunocytochemical features that were sufficient for diagnosis of difficult cases. Conclusions: This agarose-based compact cell block technique enables preparation of high-quality cell blocks by using up the residual SurePath samples without loss of diagnostic material during cell block preparation.

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    Jin Su Kim, Chan Hee Park, Eunyoung Kim, Hee Seung Lee, Jinyoung Lee, Jeehoon Kim, Eun Hee Kam, Sanghee Nam, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Sangwoo Kim, Galam Leem, Seungmin Bang
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    Chia-Ing Jan, Wan-Chen Tsai, Horng-Jyh Harn, Woei-Cherng Shyu, Ming-Chao Liu, Hsin-Man Lu, Shao-Chih Chiu, Der-Yang Cho
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Histologic Disorderliness in the Arrangement of Tumor Cells as an Objective Measure of Tumor Differentiation
Sungwook Suh, Gyeongsin Park, Young Sub Lee, Yosep Chong, Youn Soo Lee, Yeong Jin Choi
Korean J Pathol. 2014;48(5):339-345.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.339
  • 7,496 View
  • 66 Download
AbstractAbstract PDF
Background: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. Methods: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. Results: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. Conclusions: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.
Review & Perspective
Cytotechnologists and On-Site Evaluation of Adequacy
Jennifer A. Collins, Anna Novak, Syed Z. Ali, Matthew T. Olson
Korean J Pathol. 2013;47(5):405-410.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.405
  • 12,653 View
  • 83 Download
  • 26 Crossref
AbstractAbstract PDF

While fine needle aspiration (FNA) is certainly not a new biopsy technique, recent developments in advanced imaging techniques, molecular testing, and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Concurrently, the demand for on-site evaluation of adequacy (OSEA) has also increased, outstripping the capacity of available cytopathologists at some institutions. Among the several alternatives to cytopathologist-performed OSEA, cytotechnologist-attended OSEA stands out because it preserves the representation of the pathology service at the time of the procedure. Herein, we review the current literature about OSEA and the necessity of cytotechnologists to expand access of this useful pathology service to a broader patient population. We also examine how cytotechnologists are likely to fit into the emerging practice of telecytology.

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    Radu Dudas, Christopher VandenBussche, Alex Baras, Syed Z. Ali, Matthew T. Olson
    Journal of the American Society of Cytopathology.2014; 3(1): 49.     CrossRef
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    Brian T. Collins
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    Lisa M. Rooper, Syed Z. Ali, Matthew T. Olson
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  • Cytotechnologist-attended on-site evaluation of adequacy for fine-needle aspiration of bone and soft tissue neoplasms
    Matthew T. Olson, Anna Novak, Thiraphon Boonyaarunnate, Hinna Shahid, John Kirby, Syed Z. Ali
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  • Accuracy of Cytotechnologist Evaluation of Specimen Adequacy and Screening Interpretation of Malignancy in Fine-Needle Aspiration of the Liver
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  • Cytotechnologist Performance for Screening Microfollicular Atypia in Indeterminate Thyroid Fine-Needle Aspirates
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Original Articles
Aspiration Cytopathology of Peripancreatic Space: A Clinicoradiologic and Cytopathologic Analyses of 42 Cases
Justin Bishop, Wei Zhang, Olga B. Ioffe, Syed Z. Ali
Korean J Pathol. 2013;47(3):258-264.   Published online June 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.258
  • 9,563 View
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AbstractAbstract PDF
Background

The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature.

Methods

A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed.

Results

Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy.

Conclusions

FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.

Fine Needle Aspiration Cytology of Thyroid Follicular Neoplasm: Cytohistologic Correlation and Accuracy
Changyoung Yoo, Hyun Joo Choi, Soyoung Im, Ji Han Jung, Kiouk Min, Chang Suk Kang, Young-Jin Suh
Korean J Pathol. 2013;47(1):61-66.   Published online February 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.1.61
  • 12,909 View
  • 86 Download
  • 19 Crossref
AbstractAbstract PDF
Background

This study evaluated the accuracy of fine needle aspiration cytology (FNAC) in cases of follicular neoplasm (FN) on the basis of histologic diagnosis, and reviewed the cytologic findings of FN according to the FNAC.

Methods

Among the 66 cases diagnosed with thyroid FN by FNAC during the 7-year period from 2003 to 2009, 36 cases that had undergone thyroid surgery were available for review. Cytologic diagnosis was compared with the histologic diagnosis of each case.

Results

Among the 36 cases with a cytologic diagnosis of thyroid FN, histologic diagnosis was as follows: 20 follicular adenomas (55.6%), 3 Hurthle cell adenomas (8.3%), 2 follicular carcinomas (5.6%), 8 nodular goiters (22.2%), 2 papillary carcinomas (5.6%), and 1 Hashimoto's thyroiditis (2.8%), resulting in a diagnostic accuracy of FNAC for thyroid FN of 69.5%.

Conclusions

This study shows that FNAC for thyroid FN is a useful primary screening method because when FN is diagnosed by FNAC, the rate of FN histologic diagnosis is relatively high, however, adequate sampling and experience is a prerequisite for this procedure.

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Case Report
Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology Diagnosis of Solid Pseudopapillary Neoplasm: Three Case Reports with Review of Literature
Joon Seon Song, Chong Woo Yoo, Youngmee Kwon, Eun Kyung Hong
Korean J Pathol. 2012;46(4):399-406.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.399
  • 10,085 View
  • 62 Download
  • 15 Crossref
AbstractAbstract PDF

Solid pseudopapillary neoplasm of the pancreas (SPN) is relatively rare and it occurs almost exclusively in women. We recently experienced three cases of SPN diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). These three cases were two male and one female patient whose age was 29, 37, and 44 years old. Radiological diagnosis was pancreatic endocrine tumor (PEN) showing solid with a heterogenous echogenicity. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores. In conclusion, a single diagnosis of SPN based on clinical and radiological findings would be risky because there is a possibility of it being misdiagnosed as PEN or other malignancies. An EUS-FNA is therefore essential for establishing the diagnosis. In addition, the pathologists should recognize the characteristic cytologic findings with immunoprofiles of SPN to prevent misdiagnosis of SPN.

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Original Articles
Fine Needle Aspiration Cytology of hepatocellular Carcinoma: A Study on 247 Cases.
Kwang Gil Lee, Jong Tae Lee, Soo Im Choi, Chan II Park
J Pathol Transl Med. 1990;1(1):1-17.
  • 41,916 View
  • 91 Download
AbstractAbstract PDF
Hepatocellular carcinoma(HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration(FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesion-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block material, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level(over 400 I. U.). All aspiration smears were stained by the Papainicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endothelial lining, multinucleated giant cells, eosinophilc, globules bile and Mallory body. Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern(80.3%). The irregular(12.6%), the acinar(5.5%), and the dispersed patterns(1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells : the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows : intranuclear cytoplasmic inclusion in 86.8% ; endothelial lining in 56.1% ; bile in 19.8% ; and giant cells in 60.1%. Clear cells were often present in 11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern. hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.
Cytopathologic Diagnosis of Pulmonary Diseases by Transthoracic Fine Needle Aspiration Biopsy.
In Ae Park, Eui Keun Ham
J Pathol Transl Med. 1990;1(1):27-35.
  • 1,897 View
  • 21 Download
AbstractAbstract PDF
The authors report series of 360 cases of transthoracic fine-needle aspiration cytology(TFNA) from Oct, 1982, through Aug. 1986 at the Seoul National University Hospital. A diagnosis of neoplastic lesion was established in 50.3% of the cases. A non-neoplastic diagnosis was made in 38.5%, nondiagnostic one in 6.5% and inadequate one in 4.7% of the total. Statistical findings on cytological diagnoses were as follows. Specificity was 100% ; sensitivity, 92%; predictive value for positive, 1.0 ; predicitive value for negative, 0.9 : concordance rate, 84.2% ; diagnostic accuracy in non-neoplastic lesion, 65.4%, and typing accuracy in malignant tumor, 0.77.
Fine Needle Aspiration Cytology of the Mediastinal Lesions.
In Ae Park, Eui Keun Ham
J Pathol Transl Med. 1990;1(1):43-50.
  • 1,912 View
  • 15 Download
AbstractAbstract PDF
The authors report 16 cases of mediastinal fine-needle aspiration cytology from Jan. 1985 to Mar. 1988 at the Seoul National University Hospital. Among them, diagnostic materal were obtained in fifteen cases, establishing the diagnosis of 7 thymomas, 2 germinomas, 2 neurogenic tumosr, 1 lymphoma, and 3 meastatic carcinomas. The 9 cytologic diagnoses could be confirmed by histologic examination in 8 patients and by another cytologic method in one patient, allowing concordance rate of 77%.
Fine Needle Aspiration Biopsy Cytology of Breast Tumors.
In Sook Kim, Jung Dal Lee
J Pathol Transl Med. 1990;1(1):51-59.
  • 1,974 View
  • 17 Download
AbstractAbstract PDF
Fine needle aspiration biopsy cytology (FNA) for diagnosis of a variety of breast tumors has been proven to be a simple, sate, and cost saving diagnostic methodology with high accuracy. Cytologic specimens from 1,029 fine needle aspirations of the breast during last 3-year period were reviewed and subsequent biopsies from 107 breast lesions were reevaluated for cytohistological correlation. FNA had a sensitivity of 81.6% and a specificity of 98.3%. One out of 107 cases biopsied revealed a false positive result (0.9%) and the case was due to misinterpretation of apocrine metaplastic cells in necrotic background as malignant cells. A false negative rate was 8.4% (9 of 107 cases biopsied). Six of 9 false negative cases were resulted from insufficient aspirates for diagnosis, and remaining three of 9 false negative cases revealed extensive necrosis with no or scanty viable cells on smears. The results indicate that for reducing false positive and false negative rates of FNA, an experienced cytopathologist and a proficient aspirator are of great importance.
Diagnostic Features of Fine Needle Aspiration Cytology of Pleomorphic Adenoma, Adenoid Cystic Carcinoma, and Mucoepidermoid Carcinoma of Salivary Gland.
Eun Sook Nam, Won Bo Jo, Jung Ho Han, Insun Kim
J Pathol Transl Med. 1990;1(1):60-67.
  • 6,748 View
  • 299 Download
AbstractAbstract PDF
The evaluate the diagnostic findings of salivary gland tumors, we reexamined aspiration cytology smears of 7 cases of pleomorphic adenoma, 3 cases of adenoid cystic carcinoma, and 3 cases of mucoepidermoid carcinoma, performed during April 1986 to March 1990, which were comfurmed by surgical excision and histologic diagnosis. The results obtained are summarized as follows : 1. All cases of pleomorphic adenoma showed branching cellular clusters of epithelial and myoepithelial cells. Acellular elements including myxomatous and chondroid components were observed. There were no cellular pleomorphism and nucleoli. Keratinizing squamous epithelial cells and keratin pearls were noted. 2. The smears of adenoid cystic carcinoma showed cell balls or cell cords containing a central hyaline core. Nuclear atypism and the nucleoli were frequently observed. There were no keratinizing squamous epithelial cells. 3. The smears of mucoepidermoid carcinoma showed mainly sheets or clusters of intermediate cells and some mucin-producing cells. Some nuclear pleomorphism was observed. Mucinous material and many inflammatory cells were present in the background.
Fine Needle Aspiration Cytology in the Diagnosis of Tuberculosis.
Dong Wha Lee, So Young Jin, Eun Suk Koh, Chung Ja Kwak
J Pathol Transl Med. 1990;1(1):68-73.
  • 2,233 View
  • 41 Download
AbstractAbstract PDF
A total 48 cases of tuberculous lesion in the lymph nodes(43 cases), lung (3 cases) and soft tissue(2 cases), was subjected to fine needle aspiration cytology(FNAC). The age of the patients ranged from 19 to 77 year-old(average 33.6 years in age) and the male to female ratio was 1:4. Thirty-four cases (70.8%) demonstrated distinct granulomatous reaction with or without caseastion necrosis, nine cases(18.8%) showed no granulomas, but large amount of necrotic debris with numerous polymorphonuclear cells and histiocytes, and five cases (10.4%) revealed acellular material only. The overall AFB positivity in smears was 62.5%. In areas associated with granulomatous reaction and necrosis, AFB positivity was 55.8%, while it was 80.0% in cases with acellular necrotic material. There were 2 cases of parasitic infestation which could not be easily differentiated from tuberculosis based on aspiration smears only.
Fine Needle Aspiration Cytology of Solid and papillary Neoplasm of the Pancreas: Report of a Case.
Mee Yon Cho, Kwang Gil Lee, Kyi Beom Lee, Hyeun Joo Jeong, Woo Hee Jung
J Pathol Transl Med. 1990;1(1):85-92.
  • 1,849 View
  • 21 Download
AbstractAbstract PDF
We present the cytologic features of a case of solid and papillary neoplasm of the pancreas. Cytologically, the tumor was composed of a monotonous population of polygonal cells containing ecentrically located round nuclei with one or two distinct small nucleoli and a finely stippled chromatin pattern. The tumor cells were similar to those of the islet cell tumor and showed isolated loosety aggregated and solid sheedts or large cell clumps. The large cell clumps revealed a branching papillary structure containing fibrovascular central core, which is characteristic histologic feature of solid and papillary neoplasm of the pancreas. The case was confirmed by tissue examination including histochemical immunohistochemical and electron microscopical studies. Utrastructurally, the tumor cells contanined a few membrane-bound electron dense granules.
Case Report
Fine Needle Aspiration Cytologic Findings of Angiosarcoma: Report of Two Cases.
Jin Xian Ji, Young Chae Chu, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim, Kyu Ho Kim, Ju Young Song
Korean J Pathol. 2011;45(2):217-222.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.217
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  • 36 Download
  • 2 Crossref
AbstractAbstract PDF
Angiosarcoma is a rare malignant vascular neoplasm which can arise in any part of the body. Specific recognition of this neoplasm in cytological specimens is difficult in the absence of an ancillary method. Herein, we present the cytologic findings of two cases of angiosarcomas diagnosed on fine needle aspiration cytology. One case is a recurred angiosarcoma in the left chest wall and the other case is a lymphedema-associated angiosarcoma in the left lower leg. The cytologic findings of both cases are similar. Cytologic features that identified this neoplasm as an angiosarcoma included arborizing microtissue fragments, irregular anastomosing vascular spaces lined by atypical cells, microacini, intracytoplasmic lumen, and intracellular red blood cells, marked cell discohesiveness, spindle to ovoid, irregular, hyperchromatic nuclei, and elongated cytoplasmic processes with indistinct borders. This report emphasizes that when aspiration smears show vasoformative features in a bloody background, angiosarcoma should be included in the differential diagnosis.

Citations

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  • A Case Series and Literature Review of Angiosarcoma With Malignant Effusion—A Challenging Cytologic Diagnosis With Dire Prognostic Implications
    Jamie C. Y. Lam, Iris Y. H. Liu, Joanna K. M. Ng, Joshua J. X. Li
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Review Article
Liquid-Based Cytology in Fine-Needle Aspirates of the Thyroid and Breast.
Ji Young Kim
Korean J Pathol. 2009;43(2):99-106.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.99
  • 4,800 View
  • 41 Download
  • 5 Crossref
AbstractAbstract PDF
Liquid-based cytology (LBC) is becoming more widely used in analyzing the fine-needle aspirates (FNAs) from various organs, including the thyroid and breast. Compared to the conventional smear, LBC can achieve more consistent cellularity and evenly distributed mono-layered cell preparations and it can diminish the obscuring background, thus lower the rate of 'unsatisfactory' specimens. The cytomorphological details are better preserved with LBC, and it also provides the opportunity to perform ancillary tests such as immunocytochemical or molecular studies. It requires less time and manpower for screening, too. Yet there are drawbacks for the liquid-based technique. The cell clusters tend to be more fragmented and they often lose their typical structural characteristics that may have helped in making a diagnosis. Some useful background material such as colloid and mucin is diminished. However, LBC still retains many of the cytological features of a conventional smear and possesses unique characteristics as well. Here, some of the typical cytological findings of the liquid-based technique for FNA of the thyroid and breast are reviewed. Experience and awareness of the cytomorphological characteristics of liquid-based technique in non-gynecological aspirates is crucial for correct interpretation.

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  • Fine needle aspiration of spindle cell ductal carcinoma in situ of the breast: A case report and the use of ancillary tests for the differential diagnosis of metaplastic carcinoma
    Yosep Chong, Young Sub Lee, Tae-Jung Kim, Woo-Chan Park, Chang Suk Kang, Eun Jung Lee
    CytoJournal.2017; 14: 23.     CrossRef
  • Comparison of EASYPREP® and SurePath® in thyroid fine‐needle aspiration
    Yosep Chong, Ki Hyun Baek, Jee Young Kim, Tae‐Jung Kim, Eun Jung Lee, Chang Suk Kang
    Diagnostic Cytopathology.2016; 44(4): 283.     CrossRef
  • Liquid‐based cytology improves preoperative diagnostic accuracy of the tall cell variant of papillary thyroid carcinoma
    Sung Hak Lee, Chan Kwon Jung, Ja Seong Bae, So Lyung Jung, Yeong Jin Choi, Chang Suk Kang
    Diagnostic Cytopathology.2014; 42(1): 11.     CrossRef
  • CellprepPlus® Liquid-based Smear in Sono-guided Thyroid Fine Needle Aspiration: A Comparison of Conventional Method and CellprepPlus® Liquid-based Cytology
    Ji Hae Koo, Seung Young Lee, Ho-chang Lee, Jin-Woo Park, Sung Soo Koong, Tae Keun Oh, Hyun Jeong Jeon, Eun-Joong Kim, Ok-Jun Lee
    The Korean Journal of Pathology.2011; 45(2): 182.     CrossRef
  • Clinical Usefulness of SurePath™ Liquid-based Cytology in Thyroid Fine Needle Aspiration: Comparison with the Conventional Smear in Diagnostic Efficacy and Applicability ofBRAFMutation Test
    Wook Youn Kim, Sang Hwa Lee, Young Sin Ko, So Dug Lim, Wan Seop Kim, Hye Seung Han, Hye Sil Seol, Seo Young Oh, Won-Jin Moon, Tae Sook Hwang
    The Korean Journal of Pathology.2011; 45(2): 188.     CrossRef
Case Report
Fine Needle Aspiration Cytology of Kuttner Tumor of the Submandibular Gland: A Case Report.
Dong Hoon Kim, Jin Hee Sohn, Seoung Wan Chae, Min Kyung Kim, Kyungbun Lee, Seong Hee Kang, Young Hye Cho, Sang Hyuk Lee
Korean J Pathol. 2009;43(2):195-198.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.195
  • 4,362 View
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AbstractAbstract PDF
Kuttner tumor is a relatively uncommon benign tumor-like lesion of the salivary gland that clinically mimics neoplasm because of its presentation as a hard mass. It is also known as chronic sclerosing sialadenitis or cirrhosis of the submandibular gland. We present here the aspiration cytological findings of a case of Kuttner tumor in a 58-year old woman. The aspiration specimen of this lesion showed numerous lymphoid cells that were similar to lymph node aspirates, with several scattered benign ductal cells and eosinophilic fibrous tissue. The lymphoid cells were composed of mature bland lymphocytes and follicular center cells. Any acinar cells were not identified. The excised mass was ill-demarcated, hard and fibrotic, and it histologically exhibited an intense lymphocytic infiltration with irregular lymphoid follicle formation, dense periductal and stromal sclerosis, and loss of acini. No evidence of neoplasm or sialolithiasis was discovered, and this led to the diagnosis of Kuttner tumor.
Original Article
Cytohistologic Correlation of Phyllodes Tumors of the Breast: A Study on 17 Cases.
Young Ha Oh, Moon Hyang Park
Korean J Pathol. 2009;43(1):68-74.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.68
  • 3,586 View
  • 31 Download
AbstractAbstract PDF
Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast, and these tumors are subdivided into benign, borderline, and malignant tumors. The criteria for their histologic diagnosis have been relatively well-described. However, the cytologic diagnosis presents more difficulties and only a few cytologic studies concerned with their subclassification have been published. The objective of the current study is to describe the cytologic features of benign, borderline and malignant PTs in an attempt to distinguish one from the others. Cytohistologic correlation for 11 benign, 3 borderline and 3 malignant PTs was performed. For all these cases, the preoperative fine needle aspiration (FNA) findings were available for review. The features we examined were a necrotic background, cellularity, stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis. The overall diagnostic accuracy of FNA for the PT grading was 88.2% (15/17). Two benign PTs were cytologically misinterpreted as "atypical epithelial and stromal cells" and "highly suspicious for ductal carcinoma". Nevertheless, the cytologic diagnosis and the grading of PTs on FNA were relatively reliable. Semiquantitative analysis for the cellular stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis might be helpful for subclassifing PTs on FNA. In the case of encountering a markedly necrotic background, special concern about degenerative change such as infarction is needed.
Case Reports
Fine Needle Aspiration Cytology of Metastatic Prostatic Adenocarcinoma, Pseudohyperplastic Variant.
Youngmee Kwon, Won Seo Park, Geon Kook Lee, Eun Kyung Hong
J Pathol Transl Med. 2008;19(2):183-187.
DOI: https://doi.org/10.3338/kjc.2008.19.2.183
  • 2,656 View
  • 19 Download
AbstractAbstract PDF
Pseudohyperplastic prostatic adenocarcinoma is a rare histologic variant of prostatic adenocarcinoma that resembles benign nodular hyperplasia. Immunohistochemistry can verify the absence of basal cells, but it is frequently admixed with conventional adenocarcinoma. Because fine needle aspiration cytology is rarely performed in primary prostatic adenocarcinoma, the cytology of the pseudohyperplastic variant has not been described. We experienced a case of metastatic pseudohyperplastic adenocarcinoma in a pulmonary nodule of 75-year-old man. The cytologic smear was mostly composed of large, flat sheets with elongated branching papillae in a clean background. The sheets showed a well-defined honeycomb appearance of tall columnar, regularly arranged monotonous cells with little cytologic atypia. In subsequent prostatic biopsy, pseudohyperplastic variants were identified together with conventional adenocarcinoma of Gleason's grade 3 and 4. The cytologic features of pulmonary nodules were identical to those of pseudohyperplastic components of prostatic adenocarcinoma.
Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of a Gastrointestinal Stromal Tumor of the Stomach: A Case Report.
Lucia Kim, Hyung Gil Kim, Young Chae Chu, In Suh Park, Suk Jin Choi, Jee Young Han, Sun Hee Kim, Don Haeng Lee, Joon Mee Kim
J Pathol Transl Med. 2008;19(2):178-182.
DOI: https://doi.org/10.3338/kjc.2008.19.2.178
  • 2,674 View
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AbstractAbstract PDF
We report here a case of a gastrointestinal stromal tumor (GIST) in the stomach that was diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA). A 67 year old male patient underwent regular check-ups for five years due to the presence of a submucosal tumor that was found in the fundus of the stomach incidentally. EUS-FNA was performed to evaluate the tumor, which had increased in size from 1cm to 2.8cm. A cytologic smear revealed cohesive sheets or clusters of spindle cells with elongated nuclei. Immunohistochemical staining revealed a strong positive reaction for c-kit and CD34, without any reaction for smooth muscle actin and Ki-67. Therefore, a diagnosis of GIST was made.
Original Articles
Cytologic Features of Folliculars Adenoma and Follicular Carcinoma of the Thyroid: A Study on the Likelihood of Cytologic Diagnosis by Fine Needle Aspiration Cytology.
Hee Dae Park, Woon Sun Park, Sun Hee Kim, Seock Hyun Choi, Young Hye Cho, Sung Hee Kang, Kyung Bun Lee, Dong Hoon Kim, Seoung Wan Chae, Jin Hee Shon
J Pathol Transl Med. 2008;19(2):152-159.
DOI: https://doi.org/10.3338/kjc.2008.19.2.152
  • 12,573 View
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  • 2 Crossref
AbstractAbstract PDF
Fine-needle aspiration cytology (FNAC) cannot differentiate follicular adenoma from follicular carcinoma since this distinction can only be based on the presence of capsular or vascular invasion, and this cannot be detected on a cytologic smear. The goal of this study was to define the diagnostic cytologic findings of follicular neoplasm and the possibility of diagnosing follicular neoplasm by performing FNAC. The cases of histologically diagnosed follicular adenoma and follicular carcinoma on the thyroidectomy specimens were retrieved. Among them, the cases with preoperative FNAC that was done within 3 months of the operation were finally selected. Then we reviewed the FNAC and histologic slides of 19 cases: 9 follicular adenomas and 10 follicular carcinomas. Our results suggest that for cases of follicular neoplasm, the aspirates show high or abundant cellularity, frequent follicle formation and occasional cellular atypism of the follicular cells. However, the atypism is more pronounced and more frequently noticed in the cases of follicular carcinoma, which reveals more higher anisocytosis (7/10, 70%), nuclear pleomorphism (9/10, 90%), coarse clumping of chromatin (8/10, 80%) and cellular overlapping (8/10, 80%).

Citations

Citations to this article as recorded by  
  • Practical and challenging issue in thyroid cytopathology
    Qianqian Zhang, Belen Padial Urtueta, Elisabetta Merenda, Gabriele Rotondaro, Noemi Morelli, Alessia Piermattei, Patrizia Straccia, Federica Cianfrini, Angela Feraco, Alessia Granitto, Antonino Mule, Esther Diana Rossi
    Human Pathology.2025; : 106019.     CrossRef
  • Fine Needle Aspiration Cytology of Thyroid Follicular Neoplasm: Cytohistologic Correlation and Accuracy
    Changyoung Yoo, Hyun Joo Choi, Soyoung Im, Ji Han Jung, Kiouk Min, Chang Suk Kang, Young-Jin Suh
    Korean Journal of Pathology.2013; 47(1): 61.     CrossRef
Correlation and Accuracy Between Fine Needle Aspiration Cytology of Thyroid Lesions and Histopathologic Diagnosis: Analysis of 322 Histopathologically Confirmed Cases.
Jaseung Koo, Woo Hee Jung, Seokwoo Yang, SoonWon Hong
J Pathol Transl Med. 2008;19(2):144-151.
DOI: https://doi.org/10.3338/kjc.2008.19.2.144
  • 2,997 View
  • 19 Download
  • 1 Crossref
AbstractAbstract PDF
Fine needle aspiration (FNA) cytology is the decisive test in the preoperative diagnostics of thyroid nodules. Here we share our institutional experience about thyroid aspiration and give suggestions for suspicious cytology results. Three hundred twenty-two cases in 270 patients (mean age 47.4 years, 243 women and 27 men) who underwent thyroidectomy were reviewed. Among the 322 cases, the FNA diagnosis of "positive for malignancy" was 87 cases (27.0%), "suggestive of malignancy" 30 cases (9.3%), "suspicious for malignancy" 61 cases (18.9%), "negative for malignancy" 102 cases (31.7%), and "unsatisfactory smear" 42 cases (13.0%). Eighty seven cases (100%) out of "positive for malignancy", 29 cases (96.7%) out of "suggestive of malignancy", and 39 cases (64.0%) out of "suspicious for malignancy" were papillary carcinoma (148 cases, 95.5%), or follicular carcinoma (2 cases, 1.3%), or metastatic carcinoma (1 case, 0.6%). Seventeen patients who had only negative or unsatisfactory cytology underwent thyroidectomy and nine cases (52.9%) were papillary carcinoma. We suggest that: the cytology diagnosis of "suggestive of malignancy" could be regarded as "positive for malignancy", the cytology diagnosis of "suspicious of malignancy" should be carefully correlated with clinico-radiologic manifestation, and even a negative or unsatisfactory smear should be carefully followed up.

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  • Fine Needle Aspiration Cytology of Thyroid Follicular Neoplasm: Cytohistologic Correlation and Accuracy
    Changyoung Yoo, Hyun Joo Choi, Soyoung Im, Ji Han Jung, Kiouk Min, Chang Suk Kang, Young-Jin Suh
    Korean Journal of Pathology.2013; 47(1): 61.     CrossRef
Case Report
Touch Imprint and Fine Needle Aspiration Cytology of Giant Cell Tumor of Tendon Sheath: A Case Report.
Jong Im Lee
J Pathol Transl Med. 2008;19(1):57-64.
DOI: https://doi.org/10.3338/kjc.2008.19.1.57
  • 3,465 View
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AbstractAbstract PDF
Giant cell tumor of the tendon sheath (GCTTS) is a slowly growing, benign soft tissue tumor. The tumors occur predominantly on the hands and feet. Although the clinical and histopathologic features are well-defined, only a few reports have described the cytologic appearance of this entity. A 26-year-old woman presented with a gradually developing circumscribed soft tissue mass near the proximal phalanx of her left little finger for one year. Imprint and fine needle aspiration (FNA) smears were obtained from the excisional biopsy specimen. The imprint smears were composed of predominantly singly dispersed bland mononuclear cells and several giant cells. The mononuclear cells were polygonal to round, and they showed a histiocyte-like appearance. Osteoclast-type multinucleated giant cells of various sizes were randomly scattered throughout the smears, and these cells contained 3 to 50 nuclei. Nuclear atypia and pleomorphism were absent in both the single and giant cells. Loose aggregates of hemosiderin-laden macrophages and binuclear stromal cells were also seen. The cytologic features of the FNA smears were similar with those of the imprint. Additionally, the FNA smears contained several clumps of densely collagenous stromal tissue that were seldom noted in previously reported cytologic material. The cytologic features were well-correlated with the concurrent histologic findings and the diagnosis of GCTTS was made. When the clinical and radiologic datas are integrated, the diagnosis of GCTTS can be strongly suggested, based on the pre-operative cytologic specimen.
Original Articles
Cytologic Findings of Fine Needle Aspiration Biopsy of 23 Schwannomas.
Sunhee Chang, Mee Joo, Hanseong Kim
J Pathol Transl Med. 2008;19(1):41-46.
DOI: https://doi.org/10.3338/kjc.2008.19.1.41
  • 3,491 View
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  • 1 Crossref
AbstractAbstract PDF
In an attempt to better define the cytologic characteristics of schwannomas, we have reviewed aspirates and corresponding histologic sections from 23 schwannomas. Of this number, the original cytologic diagnoses were: schwannoma in 14 cases (61%), benign soft tissue tumor in 2 cases (9%), and insufficient specimen in 7 cases (30%). The cytologic findings common to all cases of schwannoma included fragments of tightly cohesive fascicles with variable cellularity and corresponding Antoni type A area. The Antoni type B area, consisting of scattered spindle cells and some histiocytes and lymphocytes against a myxoid background, was seen in 14 cases. Fibrillary stroma was seen in 12 cases. The tumor cells had spindle- or oval-shaped nuclei, with pointed ends and indistinct cell borders. Nuclear palisading was seen in 10 cases, and distinctive Verocay bodies were seen in 5 cases. In ancient schwannomas, there were no Verocay bodies. Most schwannomas have distinct cytomorphologic features that allow correct diagnosis. The major problem with fine needle aspiration cytology of these tumors is the high frequency of poor cellularity, particularly in lesions with cystic degeneration. Of 7 cases with insufficient specimen, 4 showed marked cystic changes and 1 showed marked hyaline changes on histologic sections. In conclusion, we believe that if cytopathologist reminds the situation such as cystic degeneration or hyaline degeneration, the correct diagnosis of the schwannoma will be easily made.

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  • Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer
    Ji-Sun Kim, Chang-Young Yoo, Rae-Hyung Kim, Jung-Hae Cho
    Journal of Korean Thyroid Association.2014; 7(1): 102.     CrossRef
Manual Liquid-Based Cytology (Liqui-PREPtrade mark) in Breast Fine Needle Aspiration Cytology: Comparison with the Conventional Smears.
Ji Yun Jeong, Jeong Shik Kim, Young Su Kim, Hye Jung Kim, Ji Young Park
J Pathol Transl Med. 2008;19(1):34-40.
DOI: https://doi.org/10.3338/kjc.2008.19.1.34
  • 3,975 View
  • 40 Download
  • 2 Crossref
AbstractAbstract PDF
Fine needle aspiration (FNA) cytology of the breast is a useful method for diagnosing breast lesions. Yet making the definite diagnosis with performing FNA is limited by some problems, such as the low cellularity, the poor preservation and the obscuring background. Recent studies have found that liquid-based cytology solves such problems, but it is an expensive method and it is limited by the loss of the background information. The purpose of this study is to compare the Liqui-PREP(TM), a new manual liquid-based method of cytology, and the conventional smears for analyzing breast FNA cytology materials. A total of 31 randomized FNA specimens of breast were studied. In each case, both the conventional smears and the Liqui-PREP(TM) method were performed, and the smears were evaluated for cellularity, cellular preservation, the background, the cytologic features and the architectural arrangement. The cellularity and architectural arrangement were equal for both preparations. The Liqui-PREP(TM) specimens showed better cellular preservation, loss of the obscuring background, no overlapping of cells and a smaller area to screen compared with the conventional smears. Moreover, it has the potential advantages of being able to use the remaining specimens for immunohistochemical study and ploidy analysis, and it can reduce the costs for preparation compared with the other liquid-based methods of cytology. But some background information is lost in the Liqui-PREP(TM) specimens, the same as the other liquid-based methods of cytology. In conclusion, the Liqui-PREP(TM) and conventional smears showed good correlation, but they have their respective advantages and disadvantages. These results suggest that Liqui-PREP(TM) can contribute to making the accurate diagnosis with performing breast FNA cytology when it is used along with other methods.

Citations

Citations to this article as recorded by  
  • Liquid-Based Cytology in Fine-Needle Aspirates of the Thyroid and Breast
    Ji-Young Kim
    The Korean Journal of Pathology.2009; 43(2): 99.     CrossRef
  • Comparison of Liqui-PREP™ and Conventional Preparations in Thyroid Fine Needle Aspiration
    Eun Su Park, Eun Yoon Cho, In Gu Do, Soon Jae Kim, Jung Hee Shin, Boo Kyung Han, Young Lyun Oh
    The Korean Journal of Pathology.2009; 43(6): 550.     CrossRef
Case Reports
Fine Needle Aspiration Cytology of the Sclerosing Hemangioma of the Lung: A Report of Five Cases.
Ji Young Kim, Yong Hee Lee, Kwang Gil Lee
J Pathol Transl Med. 1998;9(2):193-200.
  • 1,794 View
  • 14 Download
AbstractAbstract PDF
Sclerosing hemangioma is a rare, benign neoplasm of the lung, usually presented as a solitary pulmonary nodule in an otherwise asymptomatic middle-aged woman. Cytologically it shows papillary, sheet, and cyst-like arrangements representing three main histologic patterns of papillary, solid, and angiomatous ones, respectively. Herein, we report the fine needle aspiration cytology of 5 cases of sclerosing hemangioma of the lung. The most characteristic finding is cyst-like spaces intimately related to the papillary or solid cell nests. The tumor cells are relatively monotonous, round to oval, small to medium in size. They have small amount of eosinophilic cytoplasm. The nuclei are uniform, round and have small but conspicuous nucleoli. The tumor cells in one of the presenting cases are large with abundant cytoplasm and show moderate nuclear pleomorphism. The nuclear chromatin, however, is fine and even without exception, even in the case showing nuclear pleomorphism. Major differential diagnoses based on the cytologic findings are well-differentiated papillary adenocarcinoma, bronchioloalveolar carcinoma, and carcinoid tumor.
Fine Needle Aspiration Cytology of Invasive Ductal Carcinoma with Osteoclast-like Giant cells: A Case Report .
Eun Ha Jung, Hye Rim Park, Jin Hee Sohn
J Pathol Transl Med. 1998;9(2):221-226.
  • 2,657 View
  • 40 Download
AbstractAbstract PDF
Malignant tumors of the breast with stromal multinucleated giant cells are rare entity of uncertain clinical significance. There have been few reports on the fine needle aspiration cytologic(FNAC) findings about these rare tumors. We report a FNAC case of invasive mammary carcinoma with osteoclast-like giant cells not only for its rare occurrence but in particular for its distinctive cytologic picture on aspirated material. The patient was a 40-year-old woman who presented with a right breast mass for one month. Mammography showed a well-demarcated rounded mass density without calcification. The aspirates of FNAC were highly cellular and two main cell types were seen; malignant epithelial cells and osteoclast-like multinucleated giant cells. The carcinoma cells occurred singly or arranged in loose clusters with ill-defined cytoplasm, oval nuclei, coarse chromatin and small but distinct nucleoli. The multinucleated giant cells showed variable number of nuclei with prominent nucleoli and abundant dense oxyphilic cytoplasm. The immunocytochemical studies suggested that osteoclast-like giant cells were not of epithelial origin, but rather of histiocytic origin.
Fine Needle Aspiration Cytology of Clear Cell Sarcoma: A Case Report.
Sung Chul Lim, You Kyung Chung, Dong Chool Kim, Yoon Kyung Lee, Eun Taik Shin
J Pathol Transl Med. 1998;9(2):233-233.
  • 2,017 View
  • 34 Download
AbstractAbstract PDF
Clear cell sarcoma(CCS) is an uncommon soft tissue sarcoma that occurs in tendons and aponeuroses, usually of the lower extremities and is believed to be of neural crest origin that have a capability to produce melanin. These tumors commonly metastasize and have a very poor prognosis. The fine needle aspiration cytologic finding of CCS is not well documented. We recently experienced a case of CCS. The patient was a 54-year-old male with painful swelling of the right inguinal area. Fine needle aspiration cytology revealed polygonal or fusiform tumor cells with clear or granular cytoplasm and vesicular nuclei containing one or two nucleoli. Im munohistochemical staining for S-100 protein and HMB-45 revealed strong positivity, and variable developing stages of premelanosomes were observed by electron microscopy in the excised specimen.
Fine Needle Aspiration Cytology of Lipoblastoma: A Report of Two Cases.
So Yeong Oh, Myoung Ja Chung, Woo Sung Moon, Myoung Jae Kang, Dong Geun Lee
J Pathol Transl Med. 1998;9(2):241-244.
  • 1,865 View
  • 20 Download
AbstractAbstract PDF
Lipoblastoma is a rare benign neoplasm occurring exclusively in children below the age of three years. It affects chiefly the upper and lower extremities, and less commonly head and neck area, trunk, mediastinum, mesentery, and retroperito neum. We present two cases of lipoblastoma occurring in the mediastinum of a 21-month-old boy and in the back of a 15-month-old boy. The characteristic features of Fine needle aspiration cytology smears were the presence of immature fat cells in the form of spindle-shaped cells, stellate cells and vacuolated lipoblasts along with lipocytes against a myxomatous background. Two tumors were histologically confirmed to be lipoblastomas. Lipoblastoma can be cytologically diagnosed by considering the cytologic findings and the age of the patient.
Original Articles
Transthoracic Fine Needle Aspiration Cytology of the Lung .
Min Suk Kim, In Ae Park, Sun Hoo Park, Sung Shin Park, Hwal Wong Kim, Kyung Chul Moon, Young Ah Kim, Hye Seung Lee, Ki Wha Park, Jeong wook Seo, Hyun Soon Lee, Eui Keun Ham
J Pathol Transl Med. 1999;10(1):13-19.
  • 2,033 View
  • 14 Download
AbstractAbstract PDF
The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.
A Cytomorphologic Study of Benign and Malignant Papillary Neoplasms of the Breast.
Ho Jung Lee, Gyungyub Gong, Bohng Hee Kim, Sei Hyun Ahn, Jeong Mi Park, Jooryung Huh, Shin Kwang Khang, Jae Y Ro
J Pathol Transl Med. 1999;10(1):27-34.
  • 2,167 View
  • 12 Download
AbstractAbstract PDF
Benign and malignant papillary neoplasms of the breast may be difficult to distinguish in both cytologic and histologic preparations. To define the cytologic features of benign and malignant papillary lesions, we retrospectively reviewed 18 cases of fine needle aspirates from histologically confirmed cases of papilloma or papillary carcinoma of the breast. This study included 3 intraductal papillary carci nomas, 3 invasive papillary carcinomas, and 12 intraductal papillomas. All cases were evaluated for presence or absence of papillary fragments, bloody background, apocrine metaplasia, macrophages, and degree of cellularity, atypia, and single isolated columnar epithelial cells. Papillary fragments were present in all cases. The background of the smear was bloody in all 6 carcinomas, but in only 7 out of 12 papillomas. Markedly increased cellularity was present in 4 carcinomas(67%) and 7 papillomas(58%). Single cells were present in 5 carcinomas(83%) and 8 papil lomas(67%). The majority of papillomas and papillary carcinomas had mild to moderate atypia, and severe atypia was noted in one case of intraductal papillary carcinoma and one case of invasive papillary carcinoma. Apocrine metaplasia was absent in all cases of papillary carcinomas, but present in 8 papillomas(67%). Macrophages were noted in 4 carcinomas and were present in all cases of papillomas. The constellation of severe atypia, bloody background, absence of apocrine metaplasia and/or macrophages were features to favor carcinoma. Malignant lesions tended to show higher cellularity and more single isolated cells. The cytologic features mentioned above would be helpful to distinguish benign from malignant papillary lesions of the breast. However, because of overlapping of cytologic features, surgical excision should be warranted in all cases of papillary lesions of the breast to further characterize the tumor.
Diagnostic Usefulness and Limitation of Fine Needle Aspiration Cytology of Lymph Node: Analysis of 176 Cases Confirmed by Biopsy .
Hee Sung Kim, Dae Soo Kim, Young Lyun Oh, Young Hyeh Ko, Howe J Ree
J Pathol Transl Med. 1999;10(1):35-42.
  • 3,387 View
  • 53 Download
AbstractAbstract PDF
The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.
Fine Needle Aspiration Cytology of Thyroid Nodules: Assessment of diagnostic accuracy and evaluation of each cytologic diagnosis .
In Ae Park, Eui Keun Ham
J Pathol Transl Med. 1999;10(1):43-53.
  • 1,875 View
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AbstractAbstract PDF
We retrospectively reviewed the results of 1,850 fine needle aspiration cytology (FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases(30.4%) and 13 cases(4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity for the detection of neoplasm(malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases(7.0%), and 19 false-negative cases(8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100% in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in "suspicious malignancy" and 26.7% in "atypical lesion".
Fine Needle Aspiration Cytologic Features of Schwannomas .
Sun Young Kim, Hae Joo Nam, Jung Hee Kim, Young Rok Cho, Yu Na Kang, Sang Sook Lee
J Pathol Transl Med. 1999;10(1):55-60.
  • 5,937 View
  • 238 Download
AbstractAbstract PDF
Schwannoma is a benign encapsulated nerve sheath tumor and is histologically characterized by a mixture of Antoni type A and B tissue. A preoperative diagnosis of schwannoma by fine needle aspiration cytology or by any other means is important to preserve clinically important nerves. Therefore, it is necessary to make a specific cytological diagnosis of nerve sheath tumor. However, there are a few reports regarding cytological features of schwannoma in Korea. We experienced seven cases of solitary schwannoma and here we report their characteristic cytological features with a review of literatures. The characteristic features of schwannoma on cytology were the presence of both Antoni type A and B tissue. The cytologic findings common to all cases of schwannoma generally corresponded to the histologic findings of Antoni type A tissue, consisting of fragments of tightly cohesive fascicles with variable cellularity. Dense fibrillary substances were found, along with palisading nuclei and Verocay bodies. Individual tumor cells consisted of cohesive cells having spindle or oval nuclei, with pointed ends and indistinct cell borders. Variation in nuclear size and shape was also present. The Antoni type B consisted of scattered wavy or short spindle cells and some histiocytes and lymphocytes in the abundant myxoid background with formation of microcysts. Immunohistochemistry for S-100 protein revealed a uniformly strong positive reaction and was helpful to make more accurate diagnosis of schwannoma.
J Pathol Transl Med : Journal of Pathology and Translational Medicine
© The Korean Society of Pathologists and the Korean Society for Cytopathology.
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