BackgroundPathological diagnosis based on core needle biopsy (CNB) should be different from a resected specimen because it is difficult to apply the histological criteria established for resected specimens to CNB due to sampling limitations. A pathological classification for thyroid nodule on CNB was first proposed by the Korean Group in 2015. The objective of this study was to test the reliability and clinical value of this proposal.MethodsAccording to the Korean proposal, the CNB diagnoses were categorized into unsatisfactory, benign, indeterminate, follicular neoplasm, suspicious for malignancy and malignant. A comparative study between the diagnoses of CNB and resected specimens was performed.ResultsThe consistency was moderate (κ = 0.448). Combined indeterminate, suspicious for malignancy and malignant into a single group collectively referred to as “malignant” with the remaining merged into “others”, CNB demonstrated a 95.93% sensitivity, 97.30% specificity, 62.07% accuracy, 99.81% positive predictive value (PPV) and 62.07% negative predictive value (NPV) for preoperative malignancy evaluation.ConclusionsThe Korean proposal for pathological classification of thyroid nodules on CNB is objective, operable and highly valuable.
Core needle biopsy (CNB) is now more frequently used for the preoperative diagnosis of thyroid nodules. Based on morphology alone, 5–20% of CNB samples cannot be determined as malignant or benign. Compared to fine-needle biopsy (FNB), samples collected by CNB are more accessible for various tests. Therefore, studying biomarkers’ application in distinguishing uncertain CNB samples of thyroid nodules is a practical need. Patients of thyroid nodules with both CNB and matched resected specimens were reviewed. Cases classified as indeterminate lesions, follicular neoplasms, and suspicious for malignancy were retrieved. All CNB samples were stained by immunohistochemistry (IHC) using antibodies against CK19, galectin-3, HBME-1, and CD56 and detected by next-generation sequencing (NGS) using an OncoAim® thyroid cancer multigene assay kit (Singlera Genomics) that detected 26 genes. Taking the resected specimens’ classification as the gold standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of a single biomarker, and various combinations for discriminating malignancy from benignity were calculated. The sensitivity, specificity, PPV, NPV, and accuracy for preoperative malignancy evaluation were as follows. In the cohort of non-follicular-neoplasm-lesions (non-FN-lesion), they were 95.16%, 53.85%, 90.77%, 70.00%, and 88.00% for CK19; 95.16%, 38.46%, 88.06%, 62.50%, and 85.33% for galectin-3; 77.42%, 76.92%, 94.12%, 41.67%, and 58.00% for HBME-1; 66.13%, 100.00%, 100.00%, 38.24%, and 72.00% for CD56; 90.32%, 92.31%, 98.25%, 66.67%, and 90.67% for NGS; and 88.71%, 92.30%, 98.21%, 63.16%, and 89.33% for integrated IHC. In the cohort of follicular neoplasms (FN), they were 30.43%, 77.77%, 77.77%, 30.43%, and 43.75% for CK19; 73.91%, 66.67%, 85.00%, 50.00%, and 71.88% for galectin-3; 26.09%, 88.89%, 85.71%, 32.00%, and 43.75% for HBME-1; 26.09%, 100.00%, 100.00%, 34.62%, and 46.88% for CD56; 52.17%, 88.89%, 92.31%, 42.11%, and 62.50% for NGS; 82.61%, 66.67%, 86.36%, 60.00%, and 78.13% for integrated IHC; and 100%, 66.67%, 88.46%, 100%, and 90.63% for integrated IHC-NGS. The application of biomarkers in distinguishing uncertain CNB samples of thyroid nodules is available and capable. CD56 negative or NGS positive suggests malignancy strongly for both FN and non-FN-lesion, which may be used as a “rule in” tool. The negative predictive value of the integrated IHC and the integrated IHC-NGS implies a high possibility to be benign for non-FN-lesion and FN separately, which can work as a “rule out” tool. Considering the balance of specificity and sensitivity, NGS is the best for non-FN-lesion and the integrated IHC-NGS is the best for FN.
In the initiation and evolution of human cancers, circular RNAs (circRNAs) act as crucial regulators.
Warthin tumor (WT)-like mucoepidermoid carcinoma (WT MEC) resembles the histologic pattern of WT, and pathologists unaware of this possibility may misdiagnose it as squamous and mucoepithelial WT or WT malignant transfer into MEC (MEC ex WT). Here, we report a case of a 41-year-old Chinese woman with a solitary mass in the left parotid gland. In this case, microscopic observation revealed prominent lymph node stroma and multiple cystic structures similar to those seen in WT. It lacked the two layers of oncocytic epithelial tissue characteristic of WT. Considering the histological findings, we diagnosed this case as WT MEC. This case provides pathological and clinical features to differentiate from MEC ex-WT and WT with squamous and mucous epithelium. In conclusion, further observations and case reports will clearly define this tumor.
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