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Diagnostic accuracy of thyroid cytology reporting between a general and a specialist histopathology department, over a five year period Submit Manuscript | http://medcraveonline.com Abbreviations: FNA, fine-needle aspiration; ID, initial diagnosis; SOD, second opinion diagnosis; RCPath, Royal College of Pathologists; MDT, multi-disciplinary team; DGH, district general hospital; BTA, British Thyroid Association. AbstractBackground: According to the current Royal College of Pathologists (RCPath) guidelines, thyroid cytology cases classified as Thy4/Thy5 are expected to be reviewed by a cyto-histopathologist core member of the thyroid multi-disciplinary team (MDT) meeting. We reviewed the usefulness of such practice in a district general hospital (DGH) in the UK.Methods: Over a five year period, all thyroid fine needle aspirations (FNA) referred from a DGH to a specialist centre with subsequent histology were reviewed. The frequency and degree of discordant thyroid FNA diagnoses between in-house initial diagnosis (ID) and the specialist's second opinion diagnosis (SOD) were analysed, alongside cyto-histological correlations. Results:A total of 164 cases were reviewed, with 35% showing diagnostic disagreement between the ID and the SOD. Overall, the SOD was better supported by the subsequent histology, with an improved diagnostic accuracy rate (82% vs 73%), sensitivity (80% vs 73%) and specificity (83% vs 74%). Conclusion:This study demonstrates interpretation of thyroid cytology is dependent on the experience of the cyto-histopathologist. Due to the limitations of FNA cytology, the nature of thyroid lesions can be challenging to interpret. A specialist review is considered safe practice to prevent errors and subsequent adverse outcomes in patient management.Citation: Palial K, Roskell D, Wathuge G. Diagnostic accuracy of thyroid cytology reporting between a general and a specialist histopathology department, over a five year period.Diagnostic accuracy of thyroid cytology reporting between a general and a specialist histopathology department, over a five year period Copyright:©2018 Palial et al. 101Citation: Palial K, Roskell D, Wathuge G. Diagnostic accuracy of thyroid cytology reporting between a general and a specialist histopathology department, over a five year period.Diagnostic accuracy of thyroid cytology reporting between a general and a specialist histopathology department, over a five year period Copyright:

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A 53-year-old man was referred to Dermatology with a 12-week history of painful bilateral fungating lesions arising from the great toenail beds (a). He was undergoing treatment for metastatic renal cell carcinoma (RCC) with tyrosine kinase inhibitor sunitinib. A skin biopsy (b) of the right great toe demonstrated a dermal infiltration of atypical spindled epithelioid cells positive for pancytokeratin (c) and CD10 (d), in keeping with metastatic RCC. Metastatic deposits were confirmed in the subsequent bilateral hallux amputations. RCC commonly metastasizes to the lymph nodes, lung, bone, liver and brain. 1 This is the first report of symmetrical hallux acrometastases. 2 We wish to highlight this rare metastatic phenomenon which may present to the Dermatology clinic in the first instance. References 1 Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med 1996; 335:865-75. 2 Mavrogenis AF, Mimidis G, Kokkalis ZT et al. Acrometastases. Eur J Orthop Surg Traumatol 2014; 24:279-83.Funding sources: no external funding.Conflicts of interest: none to declare.