Chhavi Gupta

Introduction: Lymphocytic thyroiditis is the second most common thyroid lesion diagnosed on FNAC after goitre. Clinical features, thyroid antibody titres, thyroid hormonal profile, and ultrasonography also aid in its diagnosis besides FNAC. The present study was carried out to evaluate thyroid fine needle aspirates for cytological features of lymphocytic thyroiditis; to grade lymphocytic thyroiditis cases based on predefined cytological criteria and to correlate cytological grades with thyroid hormonal status. Materials and Methods: It was a three year retrospective study conducted in the Department of Pathology, Government Medical College, Jammu. Lymphocytic thyroiditis cases reported as per Bethesda system were further graded based on predefined cytological criteria as per Bhatia et al. Cytological grades were correlated with thyroid hormonal status wherever available. Results: A total of 162 cases of lymphocytic thyroiditis were reported as per Bethesda system in our study. On further grading, majority cases were of grade II thyroiditis (104, 64.2%) followed by grade I (48, 29.6%) and grade III (10, 6.2%). Of the 78 cases with available thyroid hormonal profile, maximum patients were hypothyroid (42; 53.85%) followed by euthyroid (21; 26.92%) and hyperthyroid (15; 19.23%). There was no statistically significant association of grades with hormonal status with P value > 0.05. Conclusion: FNAC remains the "gold standard" investigation for diagnosis of Lymphocytic thyroiditis. However, the cytological grades show no statistically significant correlation with thyroid hormonal status in our study. Keywords: Lymphocytic thyroiditis, Cytological grading, Thyroid hormonal status.

Introduction: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a six category scheme for reporting thyroid Fine Needle Aspirates (FNAs) and represents a major step towards a uniform reporting system for thyroid FNAs, enabling better understanding of thyroid cytopathology report by referring clinicians and providing rational management guidelines. The present study was carried out to analyse cytological features of thyroid FNAs and categorise them by The Bethesda System for Reporting Thyroid Cytopathology; and to assess interobserver variability between two independent reporting pathologists using the Bethesda system. Materials and Methods: The study was conducted over three years from Nov. 2015 to Oct. 2018 in the Department of Pathology, Government Medical College, Jammu. The thyroid FNAs were categorized according to the Bethesda system by two independent pathologists in a double blinded fashion. Interobserver variability was assessed by calculating percentage of agreement, disagreement and statistically using Cohen’s kappa. Results: A total of 610 cases were categorized as Nondiagnostic-51 cases (8.36%), 50 cases (8.20%); Benign-524 cases (85.90%), 510 cases (83.61%); Atypia of Undetermined Significance-2 cases (0.33%), 12 cases(1.97%); Follicular Neoplasm-15 cases (2.46%), 16 cases (2.62%); Suspicious for Malignancy- 1 case (0.16%), 6 cases (0.98%); Malignant-17 cases (2.79%), 16 cases (2.62%) by two pathologists respectively. The two pathologists agreed in 548 cases (89.84%) and disagreed in 62 cases (10.16%) with Cohen’s kappa=0.628 (62.8%). Agreement was highest in Benign category-95.68%, followed by Malignant-87.5%, Follicular Neoplasm -75%, Nondiagnostic-68%. No agreement was seen in Atypia of Undetermined Significance and Suspicious for Malignancy categories. Conclusion: The present study thus encourages the use of The Bethesda System for Reporting Thyroid Cytopathology as a standardized reporting system with relative ease of reproducibility for effective communication among pathologists and clinicians with regard to thyroid Fine Needle Aspiration Cytology reporting and management. Keywords: Bethesda system, Thyroid fine needle aspiration, Cytology, Interobserver variability.

Introduction: Fine Needle Aspiration Cytology (FNAC) is the first line diagnostic procedure for evaluating thyroid lesions. The present study was carried out to assess the diagnostic utility of thyroid FNAC using The Bethesda System for Reporting Thyroid Cytopathology. Materials and Methods: It was a one year prospective study conducted in the Department of Pathology, Government Medical College, Jammu and included all patients presenting with thyroid swelling referred to this department. The thyroid fine needle aspirates from these patients were classified into six categories according to The Bethesda System for Reporting Thyroid Cytopathology. The Risk of Malignancy was calculated for each Bethesda category by follow-up histopathology. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were also calculated using histopathology diagnosis as gold standard. Results: Thyroid fine needle aspirates from a total of 300 patients were classified according to Bethesda system as Nondiagnostic (ND)- 17cases(5.67%), Benign- 264cases(88%), Atypia of Undetermined Significance (AUS)- 1case(0.33%), Follicular Neoplasm(FN)-6cases(2%), Suspicious for malignancy(SFM)- 0case( 0%) and Malignant- 12cases(4%). The Risk of Malignancy was Nondiagnostic- 50%, Benign-0%, AUS-0%, FN-50%, Suspicious for malignancy-not possible, Malignant-100%. Sensitivity, Specificity, PPV and NPV were 100%, 100%, 100%, 100% (FN excluded); 80%, 100%, 100%, 96% (FN included as benign); and 100%, 95.83%, 83.33%, 100% (FN included as malignant). Conclusion: The present study concludes Bethesda system to be an effective reporting system for thyroid cytology, FNAC to be a sensitive and specific test for evaluation of thyroid lesions and FNAC using Bethesda guidelines is useful in risk assessment of thyroid nodules thereby guiding appropriate management. Keywords:Thyroid fine needle aspiration cytology, Bethesda system, Risk of malignancy, Sensitivity, Specificity.

Background: Lymphadenopathy is a sign of underlying infection, primary or metastatic malignancy. Fine-needle aspiration is a simple and reliable tool for its initial investigation. Objectives: To analyse the cytomorphological features of malignant lymph node lesions and to determine the frequency of different lymph node malignancies. Materials and Methods: It was an observational, retrospective study conducted in the cytology section of Department of Pathology, Govt. Medical College, Jammu. It included lymph node aspirates that were reported as malignant. May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) stained smears were examined under light microscope and the cytological features were studied. Results: A total of 97 malignant lymph node aspirates were included in this study. Metastatic malignancy accounted for maximum number of cases (78, 80.4%) followed by lymphoma (19, 19.6%). Squamous cell carcinoma was the most common metastatic malignancy and also the most frequently diagnosed malignant lesion in our study (42, 43.3%). Cervical lymph nodes were the most commonly aspirated lymph nodes. Conclusion: FNAC of lymph nodes is a simple and valuable tool in the diagnosis of lymph node malignancies.   Keywords: Lymph node, FNAC, Malignant

Background: A wide range of inflammatory as well as neoplastic lesions can present as cutaneous and subcutaneous swellings all over the body. FNAC (Fine Needle Aspiration Cytology) is considered to be the first reliable technique for diagnosing them. Aims and Objectives: To assess the cytological spectrum of lesions presenting as skin and subcutaneous swellings. Materials and Methods: It was an observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. FNAC was performed on patients presenting with palpable skin and subcutaneous swellings. May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) stained smears were examined under light microscope. The cytological features were studied and diagnosis was made. Results: The present study had 290 patients which included 169 (58%) males and 121 (42%) females. On FNA examination, 111 (38.3%) were non-neoplastic and 179 (61.7%) were neoplastic. Epidermal inclusion cyst was the most common non- neoplastic lesion. Among neoplastic lesions, 166 cases (57.2%) were benign and 13 cases (4.5%) were malignant. Lipoma was the most common benign neoplastic lesion and was also overall the commonest lesion in our study. Metastatic carcinoma cases were maximum among malignant lesions. Conclusion: Fine Needle Aspiration Cytology is a rapid, reliable technique for initial assessment of cutaneous and subcutaneous swellings and thereby guiding further management.   Keywords: Cytology, Cutaneous, Subcutaneous