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This document provides information about fine needle aspiration cytology (FNAC) of the thyroid. It discusses that FNAC is a simple, quick, and inexpensive technique used to distinguish between benign and malignant thyroid lesions. FNAC has high sensitivity and specificity and is the investigation of choice for evaluating thyroid nodules. The document outlines the equipment, technique, indications, contraindications, complications, limitations of FNAC, and the Bethesda system for classifying thyroid cytopathology results and recommended clinical management.
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Bethesda system for reporting thyroid cytology
The document discusses the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which provides a standardized classification system for thyroid fine needle aspiration (FNA) results. The BSRTC aims to improve communication between clinicians by establishing uniform diagnostic terminology. It categorizes FNA results as non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy, or malignant. The document outlines the criteria for each category and risk of malignancy. It notes recent enhancements in the 2017 version of BSRTC, including recalculated risk of malignancy and the
The bethesda system for reporting thyroid cytopathology
The Bethesda System for Reporting Thyroid Cytopathology document outlines the standardized categories for reporting thyroid fine needle aspiration biopsy results. The categories include: Nondiagnostic/Unsatisfactory, Benign, Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance, Follicular Neoplasm/Suspicious for Follicular Neoplasm, Suspicious for Malignancy, and Malignant. Each category has specific criteria for cellularity, architecture, and nuclear features to provide consistent terminology for thyroid FNA interpretation and patient management.
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Gross of thyroid gland
This document discusses the gross examination and sampling of thyroid specimens. It describes:
1. The normal anatomy of the thyroid gland and types of thyroid surgery including lobectomy, subtotal thyroidectomy, and total thyroidectomy.
2. The steps for gross examination including orientation, measurement, inspection of posterior aspect, palpation, slicing, and sequential layout of slices.
3. Features to note for diffuse versus isolated lesions and guidelines for sampling different types of thyroid specimens, including solitary nodules and multinodular glands.
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Bethesda system for reporting thyroid cytology
The document discusses the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which provides a standardized classification system for thyroid fine needle aspiration (FNA) results. The BSRTC aims to improve communication between clinicians by establishing uniform diagnostic terminology. It categorizes FNA results as non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy, or malignant. The document outlines the criteria for each category and risk of malignancy. It notes recent enhancements in the 2017 version of BSRTC, including recalculated risk of malignancy and the
The bethesda system for reporting thyroid cytopathology
The Bethesda System for Reporting Thyroid Cytopathology document outlines the standardized categories for reporting thyroid fine needle aspiration biopsy results. The categories include: Nondiagnostic/Unsatisfactory, Benign, Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance, Follicular Neoplasm/Suspicious for Follicular Neoplasm, Suspicious for Malignancy, and Malignant. Each category has specific criteria for cellularity, architecture, and nuclear features to provide consistent terminology for thyroid FNA interpretation and patient management.
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2. Transudates and exudates are distinguished based on characteristics like protein content and cell differentials. Infection, inflammation, and malignancy can be identified by analyzing changes in fluid characteristics.
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This document discusses the gross examination and sampling of thyroid specimens. It describes:
1. The normal anatomy of the thyroid gland and types of thyroid surgery including lobectomy, subtotal thyroidectomy, and total thyroidectomy.
2. The steps for gross examination including orientation, measurement, inspection of posterior aspect, palpation, slicing, and sequential layout of slices.
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- What constitutes normal cervical cells and abnormalities that may be detected, following the Bethesda system for reporting cervical cytology.
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Derived through ultrafilteration and secretion through choroid plexus, produced at the rate of 500 ml/day.
Provides physical support, collects wastes, circulates nutrients and lubricates the CNS.
Normal CSF volumes:
In Adults: 90 - 150 ml
In Neonates: 10 - 60 ml
Total CSF volume is replaced every 5-7 hours.
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Opening pressure – 90-180 mm H2O
Approximately 15-20 cc fluid collected
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- Preparing direct smears, cytospins, cell blocks and liquid-based preparations from the aspirated material.
- The Bethesda system for reporting thyroid cytopathology which includes 6 diagnostic categories and their associated cancer risks to guide clinical management.
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- Guidelines for patient preparation, specimen collection using an Ayres spatula and cytobrush, sample preparation including fixation and staining.
- Criteria for evaluating specimen adequacy, including what constitutes an adequate, satisfactory but limited, and unsatisfactory smear.
- What constitutes normal cervical cells and abnormalities that may be detected, following the Bethesda system for reporting cervical cytology.
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Derived through ultrafilteration and secretion through choroid plexus, produced at the rate of 500 ml/day.
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- Preparing direct smears, cytospins, cell blocks and liquid-based preparations from the aspirated material.
- The Bethesda system for reporting thyroid cytopathology which includes 6 diagnostic categories and their associated cancer risks to guide clinical management.
- Key cytologic features that help diagnose common thyroid lesions and cancers.
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2) Grossing techniques for mandibulectomy specimens are outlined, including orientation, identification of resection margins, separation of soft tissue from bone, and sectioning of lymph nodes. India ink is used to demarcate resection margins.
3) Histological sectioning of the specimen includes sections of the tumor, resection margins, lymph nodes, and bone if invaded. Standardized documentation of findings is emphasized for accurate pathological diagnosis and staging.
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Rhinosinusitis is primarily managed medically with antibiotics and nasal steroids. Surgery is reserved for cases that fail maximal medical therapy. The goals of treatment are to reduce symptoms, prevent recurrence and complications. For chronic rhinosinusitis, intranasal corticosteroids are the mainstay of treatment, targeting intrinsic mucosal inflammation. Surgery establishes drainage pathways and restores sinus ventilation and clearance when medical therapy is insufficient.
Adrenal Gland and its Disorders with surgical management.
The document discusses adrenal gland tumours including adrenal cortical tumours, phaeochromocytoma, neuroblastoma, and Cushing's syndrome. Key points are:
1) Adrenal cortical tumours can be functioning or non-functioning adenomas. Incidentalomas are adrenal tumours found incidentally on imaging and require hormone evaluation.
2) Phaeochromocytomas arise from chromaffin cells and secrete catecholamines. They present with severe headaches and symptoms of sympathetic overactivity.
3) Neuroblastoma is the most common abdominal tumour in children that arises from adrenal medulla. It has different risk groups and stages that determine prognosis and treatment.
4
Imaging of the thyroid
1. The document discusses imaging modalities used for evaluating the thyroid gland including ultrasound, CT, MRI, nuclear scintigraphy, and recent developments.
2. Common thyroid pathologies like diffuse thyroid disease, thyroid nodules, and thyroid cancer are discussed in terms of their imaging appearance and evaluation.
3. Guidelines for evaluation and management of thyroid nodules based on sonographic features, biopsy results, and risk of malignancy are presented.
ROSE CASE MOULD BRACHY FOR UVULA
1. The patient presented with a 1.5 x 1.5 cm cancerous growth on their uvula. A biopsy confirmed it was a moderately differentiated squamous cell carcinoma.
2. A mould was prepared using alginate impression material and dental stone to create an intraoral prosthesis for brachytherapy treatment planning and delivery.
3. Brachytherapy treatment was planned using CT imaging and catheter reconstruction to deliver 60Gy in 13/14 fractions twice daily to adequately cover the clinical target volume while sparing nearby organs at risk.
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This document provides information about exfoliative cytology and fine needle aspiration cytology (FNAC). It discusses how exfoliative cytology involves studying cells that are shed from body surfaces and explains the basic procedure. FNAC is described as using a thin needle to aspirate cells from lumps or masses and make smears for microscopic examination. The document outlines the equipment, steps, applications and advantages of both techniques, noting they are minimally invasive ways to study cells for diagnostic purposes like detecting cancer.
PG OGSSI revision course.pptx
The document discusses various gynecological instruments including speculums, dilators, forceps and cannulas. It explains their uses in obstetrics and gynecology for examining patients, performing procedures like dilation and curettage, and managing conditions like postpartum hemorrhage. Key instruments mentioned are Sims speculum, Simpson sound, Matthew Duncan dilator, Mayo scissors, sponge holding forceps, and Green Armytage forceps. Conditions where only dilation is needed and contraindications for procedures are also summarized.
Thyroid swelling and its management
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
ca endometrium.pptx
The document discusses the anatomy and histology of the endometrium, the lining of the uterus. It then covers endometrial cancer, including risk factors, common presentations, workup involving endometrial biopsy and imaging, and staging. Treatment is discussed for each stage, with surgery being primary treatment and adjuvant therapy depending on grade, myometrial invasion, and other pathological factors. Sentinel lymph node biopsy and recent advances are also mentioned.
Approach to solitary pulmonary nodule
This document outlines the approach to evaluating a solitary pulmonary nodule (SPN). It defines an SPN as a rounded opacity less than 3cm surrounded by lung tissue. About 40% of SPNs are malignant. The workup includes reviewing prior imaging, CT scan, PET scan, and biopsy if needed. Features like size, margins, calcification, cavitation, and growth rate provide clues about malignancy, but biopsy is often necessary for a definitive diagnosis. The goal is to accurately differentiate benign from malignant lesions to guide treatment.
Breast Ductography.pptx
1. Breast Ductography:Evaluation and Surgical Planning
2.INTRODUCTION: Breast ductography, sometimes referred to as galactography, is an imaging modality used to assess lesions resulting in discharge from the breasts. It offers helpful information for surgical approach and planning and aids in accurately finding the lump within breast tissue.
3. ANATOMY
4. Indications:If a single duct has a discharge, breast ductography is recommended.
Contraindications: When there are two or more discharging ducts, breast ductography is not recommended since the cause is either physiological or systemic.
5. Surgery: It helps locate the mass within breast tissue and provides useful information for surgical planning.
Excision of lesions: Surgery for breast ductography involves excising the majority of lesions found in ducts, such as intraductal papillomas.
Ultrasound-Guided Percutaneous Biopsy: For smaller lesions, ultrasound-guided percutaneous biopsy can be used.
Duct Excision with Dye: The duct is excised after it is filled with dye.
6. Procedure : A blunt-tipped sialogram needle is used in breast ductography procedure to perform the ductogram.
Once the aberrant duct has been located and cannulated, 1-2 mL of contrast agent is administered.
Images taken from standard mammography are obtained.
7. The tip of the cannula is inserted into the duct opening once the duct causing the discharge has been located.
The cannula is then carefully straightened. The cannula typically falls in the duct to the hub in patients. There is no force applied. Cannulation shouldn't cause any pain for the patient.
8. Before injecting contrast, watch the tubing for a short while after cannulation.
Since the duct is cannulated and the tubing is now part of a closed system, it is occasionally possible to view the contents of the duct refluxing into the tubing. This indicates that the duct producing the discharge has been cannulated if it is observed.
9. When contrast is injected into the cannula, duct contents occasionally form a droplet (arrow) around the cannula if they do not reflux into the tubing. Duct contents are displaced by the contrast. Observing this verifies that the duct causing the discharge has been cannulated.
10. Following the injection of 0.2 to 0.4 mL of contrast, the cannula is secured to the nipple with two pieces of paper tape. Leaving the cannula in situ allows for additional contrast injections when duct evaluation is required. Additionally, the cannula lessens the quantity of contrast that compression forces out of the duct.
11. Intraductal Abnormalities
Filling defects. Fusiform or tubular dilatation of ducts
Abrupt ductal cut off.
Causes of Abnormalities
The intraductal abnormalities observed on mammography can have both pathological and artifactual causes.
12. Complications: Duct Perforation, Pain or Burning Sensation, Infection.
13. It matters more how a patient perceives the discharge than what kind of discharge it is.
Sinonasal Tumours - Okoye
This document provides an outline on sinonasal tumours. It discusses the relevant anatomy, epidemiology, classification, clinical features, investigations, staging, treatment and complications of sinonasal tumours. It notes that sinonasal tumours comprise a diverse group of benign and malignant neoplasms that often present non-specifically, leading to delays in diagnosis and management. The document outlines the different tumour types, their characteristics, staging systems used and multidisciplinary treatment approaches involving surgery, radiotherapy and chemotherapy. Early detection and management is emphasized for improving patient outcomes.
solitarythyroidnodule-1904200227 by professor Dr Ahmed Al Abbasi52 [Autosaved...
- Solitary thyroid nodules are more common in women than men and occur in about 4-19% of the population depending on the method of detection. Fine-needle aspiration cytology (FNAC) is the most important diagnostic tool for evaluating thyroid nodules and can differentiate between benign and malignant nodules with over 90% accuracy. Ultrasonography is also useful for evaluating nodule characteristics that may indicate malignancy such as hypoechogenicity, microcalcifications, and irregular shapes. A combination of FNAC, ultrasound, and sometimes thyroid scans can accurately evaluate thyroid nodules in most cases.
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原版制作(Newcastle毕业证书)纽卡斯尔大学毕业证在读证明一模一样
学校原件一模一样【微信：741003700 】《(Newcastle毕业证书)纽卡斯尔大学毕业证》【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
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一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
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◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
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Improving the viability of probiotics by encapsulation methods for developmen...
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The popularity of functional foods among scientists and common people has been increasing day by day. Awareness and modernization make the consumer think better regarding food and nutrition. Now a day’s individual knows very well about the relation between food consumption and disease prevalence. Humans have a diversity of microbes in the gut that together form the gut microflora. Probiotics are the health-promoting live microbial cells improve host health through gut and brain connection and fighting against harmful bacteria. Bifidobacterium and Lactobacillus are the two bacterial genera which are considered to be probiotic. These good bacteria are facing challenges of viability. There are so many factors such as sensitivity to heat, pH, acidity, osmotic effect, mechanical shear, chemical components, freezing and storage time as well which affects the viability of probiotics in the dairy food matrix as well as in the gut. Multiple efforts have been done in the past and ongoing in present for these beneficial microbial population stability until their destination in the gut. One of a useful technique known as microencapsulation makes the probiotic effective in the diversified conditions and maintain these microbe’s community to the optimum level for achieving targeted benefits. Dairy products are found to be an ideal vehicle for probiotic incorporation. It has been seen that the encapsulated microbial cells show higher viability than the free cells in different processing and storage conditions as well as against bile salts in the gut. They make the food functional when incorporated, without affecting the product sensory characteristics.
原版制作(Manitoba毕业证书)曼尼托巴大学毕业证学位证一模一样
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本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
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Results of geophysics and pneumatic injection pilot tests during 2003 – 2007 yielded significant positive results for injection delivery design and contaminant mass treatment, resulting in permanent shut-down of an existing groundwater Pump & Treat system.
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In 2022, the first commercial application of MetaArray™ was performed at the site. MetaArray™ utilizes statistical analysis, such as principal component analysis and multivariate analysis to provide evidence that reductive dechlorination is active or even that it is slowing. This creates actionable data allowing users to save money by making important site management decisions earlier.
The results of the MetaArray™ analysis’ support vector machine (SVM) identified groundwater monitoring wells with a 80% confidence that were characterized as either Limited for Reductive Decholorination or had a High Reductive Reduction Dechlorination potential. The results of MetaArray™ will be used to further optimize the site’s post remediation monitoring program for monitored natural attenuation.
Microbial characterisation and identification, and potability of River Kuywa ...
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Water contamination is one of the major causes of water borne diseases worldwide. In Kenya, approximately 43% of people lack access to potable water due to human contamination. River Kuywa water is currently experiencing contamination due to human activities. Its water is widely used for domestic, agricultural, industrial and recreational purposes. This study aimed at characterizing bacteria and fungi in river Kuywa water. Water samples were randomly collected from four sites of the river: site A (Matisi), site B (Ngwelo), site C (Nzoia water pump) and site D (Chalicha), during the dry season (January-March 2018) and wet season (April-July 2018) and were transported to Maseno University Microbiology and plant pathology laboratory for analysis. The characterization and identification of bacteria and fungi were carried out using standard microbiological techniques. Nine bacterial genera and three fungi were identified from Kuywa river water. Clostridium spp., Staphylococcus spp., Enterobacter spp., Streptococcus spp., E. coli, Klebsiella spp., Shigella spp., Proteus spp. and Salmonella spp. Fungi were Fusarium oxysporum, Aspergillus flavus complex and Penicillium species. Wet season recorded highest bacterial and fungal counts (6.61-7.66 and 3.83-6.75cfu/ml) respectively. The results indicated that the river Kuywa water is polluted and therefore unsafe for human consumption before treatment. It is therefore recommended that the communities to ensure that they boil water especially for drinking.
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Water polluted by dyestuffs compounds is a global threat to health and the environment; accordingly, we prepared a green novel sorbent chemical and Physical system from an algae, chitosan and chitosan nanoparticle and impregnated with algae with chitosan nanocomposite for the sorption of Malachite green dye from water. The algae with chitosan nanocomposite by a simple method and used as a recyclable and effective adsorbent for the removal of malachite green dye from aqueous solutions. Algae, chitosan, chitosan nanoparticle and algae with chitosan nanocomposite were characterized using different physicochemical methods. The functional groups and chemical compounds found in algae, chitosan, chitosan algae, chitosan nanoparticle, and chitosan nanoparticle with algae were identified using FTIR, SEM, and TGADTA/DTG techniques. The optimal adsorption conditions, different dosages, pH and Temperature the amount of algae with chitosan nanocomposite were determined. At optimized conditions and the batch equilibrium studies more than 99% of the dye was removed. The adsorption process data matched well kinetics showed that the reaction order for dye varied with pseudo-first order and pseudo-second order. Furthermore, the maximum adsorption capacity of the algae with chitosan nanocomposite toward malachite green dye reached as high as 15.5mg/g, respectively. Finally, multiple times reusing of algae with chitosan nanocomposite and removing dye from a real wastewater has made it a promising and attractive option for further practical applications.
在线办理(lboro毕业证书)拉夫堡大学毕业证学历证书一模一样
学校原件一模一样【微信：741003700 】《(lboro毕业证书)拉夫堡大学毕业证学历证书》【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
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Epcon is One of the World's leading Manufacturing Companies.
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Fnac thyroid
- 1. FNAC THYROID
- 2. INTRODUCTION • Fine Needle Aspiration Cytology(FNAC) is a technique whereby cells are obtained from a lesion using a thin bore needle and smears are made for cytopathological diagnosis. • This technique is based on the fact that tumor cells are less cohesive and are easily aspirated. • It is a simple,quick and inexpensive method and is usually performed as an outpatient procedure. • Used in the diagnosis of thyroid nodules,breast lumps,liver disease,subcutaneous soft tissue mass,oral and salivary gland lesions.
- 3. FNAC THYROID • FNAC is the investigation of choice for thyroid Nodules. • As FNAC distinguishes between benign and malignant lesions quite effectively,its use has markedly decreased the number of unnecessary thyroid surgeries. • USG guidance increases the accuracy of FNAC • Sensitivity: 93.4% ; specificity: 74.9%
- 4. EQUIPMENTS • NEEDLE: 22-23 gauge needle; 1.5 inch length • SYRINGE: 20 ml • GLASS SLIDES • FIXATIVES: 95% ethanol • STAINS: Papanicolaou stain, hematoxylin&eosin stain,Romanowsky stain • MICROSCOPE
- 5. TECHNIQUE • After sterilizing the skin over the palpable mass, 23 gauge needle is introduced through the skin into the mass. • Having confirmed the position of the needle within the mass,negative pressure should be created within the syringe by pulling the plunger. • The needle should be moved back and froth through the mass in different rotational directions • Suction should be maintained throughout the process. By this method,the needle can cut loose many small pieces of tissue that can be aspirated • To and fro strokes should be repeated 6-8 times.
- 6. • After the aspirations ,all suction should be released before removing the needle from the mass by allowing the syringe plunger to return gently to its resting position. • The needle is then withdrawn gently from the mass and a firm pressure should be applied over the site to limit hematoma formation
- 9. INDICATIONS OF FNA IN THYROID LESIONS 1. Evaluation of solitary thyroid nodules (to distinguish benign from malignant) 2. Evaluation of diffuse thyroid lesions (to distinguish inflammatory/autoimmune lesions from nodular goiter) 3. Confirmation and categorisation of clinically obvious thyroid malignancy 4. For prognosis
- 11. COMPLICATIONS • Minor hematoma • Rarely, puncture of the trachea, carotid artery or jugular vein
- 12. LIMITATIONS • Cannot differentiate between follicular adenoma and carcinoma • Needling may convert hot nodule to a cold nodule and vice versa therefore all non- invasive investigations should be done before FNA • False positive results: Hashimoto’s Graves’s Toxic nodules
- 13. BETHESDA SYSTEM 1.NON-DIAGNOSTIC OR UNSATISFACTORY: • Cyst fluid only • Virtually acellular specimen 2.BENIGN • Consistent with benign follicular nodule- adematoid nodule,colloid nodule • Consistent with lymphocytic (hashimoto’s) thyroiditis • Consistent with granulomatous (subacute) thyroiditis
- 14. 3. ATYPIA OF UNDETERMINED SIGNIFICANCE 4.FOLLICULAR NEOPLASM OR SUSPICIOUS FOR FOLLICULAR NEOPLASM 5.SUSPICIOUS FOR MALIGNANCY
- 15. 6.MALIGNANT • Papillary thyroid carcinoma. • Medullary thyroid carcinoma. • Undifferentiated (anaplastic) carcinoma • Squamous cell carcinoma • Metastatic carcinoma • Non-Hodgkins lymphoma
- 16. COLLOID NODULE
- 23. • FNAC cannot differentiate between follicular adenoma and carcinoma as it depends upon capsular and angioinversion • Options in follicular ca: Frozen section biopsy
- 26. BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY DIAGNOSTIC CATEGORIES RECOMMENDED MANAGEMENTS RISK OF MALIGNANCY Nondiagnostic or unsatisfactory Repeat FNA with USG guidance - Benign Clinical followup & repeat FNA if the lesion increases in size 0-3% Atypia of undetermined significance or Follicular lesion of undetermined significance Repeat FNA 5-15% Follicular neoplasm or suspicious for a follicular neoplasm surgical lobectomy 15-30% Suspicious for malignancy Near total thyroidectomy 60-75% Malignant Total thyroidectomy 97-99%
- 27. THANK YOU