Fine-needle Aspiration Biopsy of Pilomatrixoma (Cytological Features of Six Cases Histologically Approved).

Background and Objective: Pilomatrixoma is a rare, benign, slow-growing tumor of the hair matrix. Excisional biopsy is often the preferred method of diagnosis for cutaneous masses including pilomatrixoma. However, fine-needle aspiration is also performed on these lesions. There are very few reports on the cytologic features of pilomatrixoma in fine-needle aspiration. In this study, we aimed to evaluate the clinical and cytological features of six cases of pilomatrixoma, which were confirmed histopathologically. Materials and Methods: The study includes six cases of pilomatrixoma, which were diagnosed by two cytopathologists in 2019 and 2022. A detailed cytological analysis was done by a semiquantitative method. Cellularity, basaloid cells, squamous cells, giant cells, shadow cells, naked nuclei, calcium deposits, inflammation, and debris were semiquantified from 0 to 3+. Results: The ages of patients ranged from 8 to 63 years old. The male-to-female ratio was 2:1. All cases occurred in the head and neck area. The cytological diagnosis was pilomatrixoma in five cases and epidermoid/dermoid cyst in one case. The surgical excision was performed in all patients. The diagnosis of pilomatrixoma was confirmed histologically in all cases. Conclusion: Fine-needle aspiration biopsy (FNAB) of pilomatrixoma can be a diagnostic challenge. There are very few reports on the cytologic features of pilomatrixoma in FNAB smears. The presence of ghost cells and basaloid cells should suggest the possibility of pilomatrixoma. The presence of giant cells, fibrillary matrix, calcium deposits, squamous cells, naked nuclei, inflammation, and debris are cytological findings supporting the diagnosis.

The European Thyroid Imaging and Reporting Data System as a Remedy for the Overdiagnosis and Overtreatment of Thyroid Cancer: Results from the EUROCRINE Surgical Registry.

BACKGROUND: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. METHOD: We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low-moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. RESULTS: We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low-moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low-moderate risk, 21% high risk, and only 0.7% minimal risk. CONCLUSION: The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study.

Objective: This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. Methodology: One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. Results: The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. Conclusion: The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

Changes in thyroid cytology reporting in the 3rd edition of the Bethesda system.

Reporting fine-needle aspiration of thyroid nodules in the Bethesda classification is a practice widely used internationally and by us. The revised third edition of the Bethesda System of Reporting Thyroid Cytopathology brings changes in terminology, content, and new chapters. In terms of terminology, an obvious change is the removal of the two-word names of three categories while maintaining the six diagnostic categories of the previous versions - new: BI - non-diag- nostic, BIII - atypia of undetermined significance, BIV - follicular neoplasia. In the detailed description of the findings within the individual categories, the ter- minological changes adopted by the fifth edition of the WHO classification of thyroid neoplasia are respected - in particular, the recommended name follicular thyroid nodular disease for the most frequently represented category BII - benign. In the evaluation itself, the diagnostic specifications accepted by the current WHO classification of histopathological findings are reflected in the individual categories - if they are applicable at the cytological level. Targeted attention will need to be paid to high grade features. The revised version brings new chapters dedicated to molecular testing and evaluation of the paediatric population.

Papillary thyroid carcinoma in an 8-year-old Ethiopian child: A case report with literature review.

Thyroid nodular disease can present in different forms, such as a solitary nodule, multinodular goiter, nodular goiter caused by autoimmune goiter, and nonpalpable thyroid nodules. Among children, thyroid cancer is the most common type of endocrine cancer. Pediatric thyroid cancer is usually detected as a neck mass without any symptoms, leading to variable stages of progression when diagnosed. Papillary thyroid carcinoma is the most common type of thyroid cancer in children with thyroid nodules. We are presenting a case of an 8-year-old male child who was referred to Jimma Medical Center after he developed swelling on the right side of his neck. On examination, multiple, matted 8 × 6 cm, firm to hard, non-tender right lateral neck masses were found, which moved with swallowing. Thyroid function tests were normal. An ultrasound diagnosis of thyroid carcinoma and a cytologic diagnosis of suspicion for papillary thyroid carcinoma (Bethesda V) was made, and an excisional biopsy was advised. A total thyroidectomy was done. A histopathology diagnosis of Papillary thyroid carcinoma (Classic variant) was made. This is an unusual case of Papillary thyroid carcinoma in an Ethiopian child, with plenty of examples previously recorded in the literature but no such report of its occurrence in our setup to our knowledge. When children under 10 have cervical masses, thyroid cancer should be considered. The evaluation of a palpable thyroid mass typically begins with a blood test to check thyroid function, along with ultrasound and fine-needle aspiration biopsy. Currently, fine-needle aspiration biopsy is the most reliable way to diagnose malignancy and determine the appropriate surgical approach. In most cases, treatment will involve a total thyroidectomy. Lymph node dissection is necessary only if lymph node disease is detected during preoperative evaluation.

The Diagnosis of Esophageal Tuberculosis through an Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy.

A 54-year-old woman presented with an elevated esophageal lesion. Computed tomography (CT) and magnetic resonance imaging revealed a mass in the pancreatic head. Endoscopic ultrasound (EUS) showed a well-defined, round, hypoechoic mass, which was considered lymph node enlargement. An EUS-guided fine-needle aspiration biopsy (FNAB) was performed on the esophagus and the mass above the pancreatic head. The pathologically confirmed epithelial cells and multinucleated giant cells were positive for T-SPOT. Clinically, tuberculous lymphadenitis and esophageal tuberculosis were suspected, with successful treatment with anti-tuberculosis therapy resulting in a good response. Our findings suggest that an EUS-FNAB is useful for diagnosing esophageal tuberculosis.

Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations.

BACKGROUND: Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. MATERIALS AND METHODS: Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA-PTH assay) and/or GATA3/PTH/chromogranin-A immunostainings. RESULTS: Sixty-four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA-PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA-PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three-dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid-like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. CONCLUSIONS: High cellularity scattered naked nuclei, cribriform and three-dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA-PTH assay and/or GATA3, PTH, and chromogranin-A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions.

[SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Interest and place of thyroid cytology]. / Consensus SFE-AFCE-SFMN 2022 sur la prise en charge des nodules thyroïdiens : intérêt et place de la cytologie thyroïdienne.

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a symptom that is a frequent reason for consultation in endocrinology. Thyroid nodules are very common and mostly benign. Thyroid ultrasound and thyroid fine-needle aspiration biopsy (FNAB) are the reference tests for the analysis of these nodules. The aim of this article is to describe for the cytopathologist the key points of the SFE-AFCE-SFMN 2022 consensus involving thyroid cytology: the indications for thyroid FNAB, the technique and analysis, and the management (treatment, follow-up) following this cytological screening examination, a key element in the management of the thyroid nodule.

Diagnostic accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A single-center cross-sectional study / Journal of the ASEAN Federation of Endocrine Societies

Objective@#This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center.@*Methodology@#One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results.@*Results@#The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%.@*Conclusion@#The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

Pitfalls in soft tissue cytopathology.

Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.

Value of repeated US-guided fine-needle aspiration (US-FNAB) in the follow-up of benign thyroid nodules: a real-life study based on the MoCyThy (Modena's Cytology of the Thyroid) DATABASE with a revision of the literature.

PURPOSE: The utility of repeating ultrasound-guided fine-needle aspiration (US-FNAB) in the follow-up of benign (THY2) thyroid nodules is still debated. The aim of this study was to retrospectively investigate the diagnostic value of re-biopsy of thyroid nodules following an initially benign result. METHODS: We retrospectively analyzed US-FNABs performed at the Unit of Endocrinology of Modena from 2006 to 2009. The firstly benign cytological result was compared with the cytological results of subsequent US-FNABs (2nd and/or 3rd) executed on the same nodule. RESULTS: Among 10449 US-FNABs, 6270 (60%) received a THY2 cytological categorization. Of them, 278 (4.43%) underwent a subsequent US-FNAB: 86.7% maintained the same cytology, 32 (11.5%) changed to THY3 (indeterminate) and 5 (1.8%) to THY4 (suspicious of malignancy). Among the 24 nodules addressed to surgery, 9 (37%) were histologically malignant, with an overall miss rate of 3.2%. Male patients had higher risk of discordant results at subsequent US-FNAB (p = 0.005, OR:3.59, 95%CI:1.453-7.769) while dimensional increase above 5 mm was predictive of concordant benign cytology (p = 0.036, OR:0.249, 95%CI:0.068-0.915). Age, suspicious US characteristics, and distance between US-FNABs resulted not predictive. CONCLUSIONS: Re-biopsy of benign nodules confirmed the benign nature in most cases. In case of discordant cytology, relocation in indeterminate category was the most common. The histological diagnosis of cancer occurred in one quarter of nodules surgically removed, with a low overall clinically significant miss rate. Thus, a small percentage of false negatives exists; males and subjects with US suspicious nodules should be carefully followed-up, considering case by case re-biopsy possibility.

Thyroid nodule core needle biopsy - current approach.

Fine needle aspiration biopsy (FNAB) guided by ultrasonography is routinely used to identify thyroid nodules prior to surgery. Although FNAB has great diagnostic accuracy and safety, it is limited by its relatively low diagnostic accuracy in follicular lesions, such as non-diagnostic or atypia of unclear significance (AUS)/follicular lesion of uncertain significance (FLUS). Additional diagnostic tests are required to overcome these challenges in evaluating thyroid nodules. Thyroid nodules can now be diagnosed with spring-activated single- or double-action needles following the introduction of core needle biopsy (CNB). CNB has the ability to address the limitations of FNAB by obtaining a sizeable tissue sample with more details on the histological structure supporting the capsule and fewer non-diagnostic effects brought on by the absence of follicular cells. Compared to repeated FNAB, CNB has been demonstrated to produce fewer ambiguous results, such as non-diagnostic or AUS/FLUS results. The Korean Endocrine Pathology Thyroid CNB Working Group issued its first set of guidelines for "Pathology Reporting of Thyroid Core Needle Biopsy" in 2015. In 2017, the Korean Society of Thyroid Radiology (KSThR) published "Core Needle Biopsy of Thyroid: 2016 Consensus Statement and Recommendations from the Korean Society of Thyroid Radiology". The main objectives of thyroid CNB are to detect individuals with thyroid illness who require surgery and to obtain a significant number of thyroid lesions with low morbidity.

GYRB - POLYMERASE CHAIN REACTION AND HISTOPATHOLOGIC CHARACTERISTIC FIGURE POTENTIAL FOR DETERMINING DIAGNOSIS OF TUBERCULOUS LYMPHADENITIS.

Background: TB lymphadenitis is still a problem that needs serious treatment. In Indonesia, it was reported that 53% of TB cases were extrapulmonary tuberculosis, with the most cases being Lymphadenitis TB, 11.6%. In children, 43% of extrapulmonary tuberculosis cases are TB lymphadenitis. Diagnosis is quite difficult; a method of determining the diagnosis and appropriate comprehensive treatment is required in managing TB Lymphadenitis. Materials and Methods: In this study, 15 fine needle aspiration biopsy aspirate samples were subjected to molecular examination using the gyrB-polymerase chain reaction method and histopathological observations using the smear method with hematoxylin-eosin staining. Observation of preparations using a microscope with a magnification of 200x. Results: The histopathological characteristics of the fine needle aspiration biopsy aspirate showed positive results in 4 out of 15 samples, with epithelioid cells arranged in a characteristic granuloma structure, necrotic debris was visible, and cells joined together to form multinucleated giant cells as an inflammatory response to Mycobacterium tuberculosis complex infection. In this study, 6 out of 15 (40%) were detected to be positive in the diagnosis based on molecular detection using a specific target gene gyrB - polymerase chain reaction . Conclusion: Characteristic features on histopathological examination associated with gyrB - positive polymerase chain reaction on lymphadenitis fine needle aspiration biopsy aspirate samples can be used as a determinant diagnosis of tuberculous lymphadenitis.

Do large thyroid nodules (≥4 cm) without suspicious cytology need surgery?

Background: Fine-needle aspiration biopsy (FNAB) is a good diagnostic tool for thyroid nodules; however, its high false-negative rate for giant nodules remains controversial. Many clinicians recommend surgical resection for nodules >4 cm owing to an increased risk of malignancy and an increased false-negative rate. This study aimed to examine the feasibility of this approach and investigate the incidence of malignancy in thyroid nodules >4 cm without suspicious cytology based on medical records in our center. Methods: This was a retrospective analysis of 453 patients that underwent preoperative FNAB for nodules measuring >4 cm between January 2017 and August 2022 at Severance Hospital, Seoul. Results: Among the 453 patients, 140 nodules were benign and 119 were indeterminate. Among 259 patients, the final pathology results were divided into benign (149) and cancerous (110) groups, and the prevalence of malignancy was 38.9% in the benign group and 55.5% in the indeterminate group. Among the malignancies, follicular carcinoma and follicular variants of papillary carcinoma were observed in 83% of the cytologically benign group and 62.8% of the indeterminate group. Conclusion: Preoperative FNAB had high false-negative rates and low diagnostic accuracy in patients with thyroid nodules >4 cm without suspicious cytologic features; therefore, diagnostic surgery may be considered a treatment option.

Cut-off Value for Thyroglobulin Washout Concentration in the Detection of Cervical Lymph Node Metastases in Patients after Thyroidectomy Due to Differentiated Thyroid Cancer.

The aim of this study was to establish the cut-off value for the thyroglobulin (Tg) concentration in washout fluid from fine needle aspiration biopsy (FNA-Tg) in the detection of cervical lymph node metastases of differentiated thyroid cancer (DTC). We evaluated the validity and clinical utility of fine needle aspiration biopsy cytology (FNAB-C), FNA-Tg, and the combined method in detecting DTC recurrences. The study included 82 patients after the total thyroidectomy and elective and, in some cases, also selective cervical lymphadenectomy. The majority of patients also underwent subsequent 131I ablative therapy. The patients presented with 1-6 enlarged and/or ultrasonographically suspicious cervical lymph nodes. One to four aspirates of each lymph node were taken, with a total of 297 samples. An FNA-Tg of 4.34 ng/mL was established as the cut-off value for detecting cervical lymph node DTC metastases for the IRMA Brahms DYNO test, Tg-S. FNAB-C is highly specific (91-99%) but not sensitive enough (53-69%) to be used as a standalone method in the detection of cervical lymph node metastases. FNA-Tg is more sensitive (91%), but caution should be taken when selecting patients for surgery with an FNA-Tg higher than the established cut-off value but lower than the serum Tg concentration. To select patients for lymphadenectomy, we recommend using the combined method (FNAB-C and FNA-Tg) with a sensitivity of 96% and specificity of up to 97%. More than one sample should be taken with each fine needle aspiration biopsy (FNAB) to obtain a representative set of samples.

Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

Diagnostic Accuracy of Lymph Nodes Fine Needle Aspiration Biopsy Based on The Sydney System for Reporting Lymph Node Cytology.

OBJECTIVE: To evaluate the diagnostic accuracy and malignancy risk of The Sydney System Reporting for Lymph Nodes Cytology. MATERIAL AND METHODS: This study utilized secondary data from 156 cases to conduct a retrospective analysis of a diagnostic test method. During 2019-2021, data were collected at Dr. Wahidin Sudirohusodo's Anatomical Pathology Laboratory in Makassar, Indonesia. The cytology slides of each case were split into five diagnostic groups using the Sydney method, which were then compared with the results of the histopathological diagnosis. RESULTS: There were six cases in the L1 category, thirty-two cases in the L2 category, thirteen patients in the L3 category, seventeen cases in the L4 category, and ninety-one cases in the L5 class. The malignant probability (MP) is computed for each diagnostic classification. L1 MP value is 66.7%, L2 MP value is 15.6%, L3 MP value is 76.9%, L4 MP value is 94.0%, and L5 MP value is 98.9%. The diagnostic value of the FNAB examination is as follows: 89.9% sensitivity, 92.9% specificity, 98.2% positive predictive value, 68.4% negative predictive value, and 90.47% diagnostic accuracy. CONCLUSION: The FNAB examination provides high sensitivity, specificity, and accuracy in diagnosing lymph node tumors. Using a classification based on the Sydney system promotes communication between laboratories and clinicians.
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