Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017;125:767-75. © 2017 American Cancer Society.

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BACKGROUND Fine‐needle aspiration cytology (FNAC) is one of the most commonly used techniques for evaluating lymphadenopathy. Recently, the Sydney system was proposed for assessing the performance, classification, and reporting of lymph node (LN) cytopathology. The present study was conducted to assess the risk of malignancy associated with each of the diagnostic categories of the proposed Sydney system. METHODS This was a 2‐year retrospective study of LN‐FNAs; cytologic diagnoses were categorized by the proposed Sydney system. Cytological diagnoses were correlated with the corresponding histopathological diagnoses to assess diagnostic accuracy and risk of malignancy for each diagnostic category. RESULTS Of 23,335 FNAs during the study period, 6983 (30%) were performed on LNs. Of these, 289 (4.1%) cases were reported as nondiagnostic/inadequate (L1); 3397 (48.6%) were reported as benign (L2); 33(0.5%) as atypical cells of undetermined significance (L3), 96 (1.4%) as suspicious for malignancy (L4) and 3168 (45.4%) as malignant (L5). Subsequent histopathology was available for 618 (8.8%) cases. On cytohistopathologic correlation, 552 (89.3%) were concordant and 66 (10.7%) discordant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LN‐FNA were 79.9%, 98.7%, 98.4%, 83.1%, and 89.3%, respectively. The risk of malignancy was 27.5% for the nondiagnostic category, 11.5% for the benign, 66.7% for the atypical, 88% for the suspicious, and 99.6% for the malignant categories. CONCLUSIONS FNAC has high diagnostic accuracy for the diagnosis of various LN pathologies. Application of the proposed Sydney system can help in achieving uniformity and reproducibility in cytologic diagnoses and also help in risk‐stratification on cytology.

In this study, we evaluated the usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumours. We have also assessed the various pitfalls of FNAC of soft tissue tumours. This was a retrospective study and here we analysed only 82 histopathology proven cases of FNAC of soft tissue tumours diagnosed in a five and half year period. On histopathological examination, 55 of these cases were malignant and 27 were benign. There was a total of 15 recurrences and histopathology was available prior to FNAC in only eight of these cases. Therefore, excluding these eight cases, malignant tumours were primarily diagnosed by FNAC in 47 cases. The sensitivity, specificity and positive predictive value of FNAC in diagnosis of soft tissue tumours were 91.5%, 92.5% and 95.5%, respectively. Only 22 of 47 cases (46.8%) were correctly categorized. There were two false-positive and four false-negative cases. One case each of fibromatosis and schwannoma were reported as sarcoma. False-negative cases were fibrosarcoma (1), malignant nerve sheath tumour (2) and haemangiopericytoma (1). FNAC was very useful in distinguishing benign from malignant soft tissue tumours. However, it was not so effective in exact categorization of tumours.

There are many significant morphological alterations of a nucleus of cancer cell that are detectable by light microscopy on routine staining. These changes are often associated with deranged cellular functions of cancer cell. It is difficult to understand the exact relationship between nuclear morphology and alteration of nuclear structural organization in cancer. Herein, the salient visual and subvisual morphological changes of cancer nuclei and their possible etiology and significance have been reviewed.

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Aneuploidy is frequently noted in malignant tumours. There is much controversy about its cause and effect in relation to malignant tumours. Failure of the spindle checkpoint caused by mutation of the responsible genes may be one of the important factors for the development of aneuploidy. Telomere dysfunction may also be a possible source of failure of cytokinesis resulting in aneuploidy. Evidence such as tumour specific aneuploidy, presence of aneuploidy in various preneoplastic conditions, increased frequency of genetic instability in aneuploid cell lines compared with diploid cells, and mutation of mitotic checkpoint genes suggests that aneuploidy possibly plays an active role in carcinogenesis. In this brief review, the various aspects of aneuploidy with special emphasis on its mechanism of development and impact on progression of cancer are discussed.

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