Is There a Role for On-Site Evaluation of Thyroid Fine Needle Aspiration to Reduce the Nondiagnostic Rate?

The use of immediate on-site evaluation of fine-needle aspiration biopsy (FNAB) specimens can determine the adequacy of specimens and provides a specific preliminary diagnosis. In this prospective study, we evaluated the impact of on-site assessment of thyroid FNAB performed under ultrasound guidance. Totally, 204 (170 female, 34 male) patients (102 on site, 102 control group) were included. The patients were randomized on site and regular cytologic examination groups. Quick May-Grünwald Giemsa stain was used for on-site examination and FNA was continued until adequate aspirate for optimal cytological examination. Two (2.0 %) of the 102 patients evaluated with on-site examination had a nondiagnostic result. However, 16 (15.7 %) of the 102 patients examined by regular cytologic examination method, had nondiagnostic result. The difference between these two groups was statistically significant (p?<?0.0001). The major cause of a nondiagnostic thyroid FNAB specimen is the failure to aspirate a sufficient number of cells necessary for diagnosis cystic lesions. Immediate on-site evaluation can significantly decrease the nondiagnostic rate of thyroid FNAB specimens.     

Tubular Cell Emboli in the Glomerulus–A Needle Biopsy Artifact

In a needle biopsy specimen of the kidney, epithelial cells were found within the capillaries of a single glomerulus. These proved to be proximal tubular epithelial cells with their typical nuclei, mitochondria, lysosomes, junctional complexes, and brush border. Similar cells were also found in Bowman's space.

This is an artifact of the needle biopsy in which tubular cells or cell fragments had been detached from the tubule by the needle and then pushed through the cut end of an arteriole into the giomerular capillaries and to Bowman's space.     

Cytomorphological Analysis of Thyroid Nodules Diagnosed as Follicular Variant of Papillary Thyroid Carcinoma: a Fine Needle Aspiration Study of Diagnostic Clues in 42 Cases and the Impact of Using Bethesda System in Reporting—an Institutional Experience

Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary thyroid carcinoma (PTC) after classical PTC (cPTC). Follicular thyroid lesions such as follicular adenomas/carcinomas, FVPTC, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) pose some diagnostic challenges for FNAC. In this study, we aimed to explore whether FNAC can demonstrate diagnostic clues by re-evaluating cytology slides from histopathologically diagnosed FVPTC cases. A total of 42 patients were enrolled in this study: patients were diagnosed with FVPTC via surgical resection between 2006 and 2016, and all patients were subjected to preoperative FNAC, which was conducted at either a private center or at the teaching hospital of Kocaeli University and reported by the same cytopathologist (NP). Clinical and cytomorphological characteristics were reviewed by both authors .Most cases (76.2%) are diagnosed either Bethesda IV or V. The majority of cases had a high cellularity (38/42; 90.5%), and the most frequent observations were monolayer and large syncytial groups of cells (95.2%). While microfollicular structures were observed in 30 (71.4%) cases, nuclear crowding and large naked nuclei were observed in all cases. Nuclear grooves were sparsely detected in 23 (54.8%) cases, and nuclear pseudoinclusions were detected in only six (14.3%) cases. Because thyrocytes often have a mixed architecture in FVPTC, despite a distinct follicular morphology, we believe that nuclear overcrowding, enlargement, and hyperchromasia in cases presenting with increased cellularity are notable clues for the cytodiagnosis of FVPTC. We believe that the primary aim of FNAC in such cases is to give preoperative diagnosis as either category IV or V. Nuclear crowding, monolayered clusters with large syncytial formations, nuclear enlargement, and hyperchromasia are notable cytomorphologic clues for the diagnosis of FVPTC on FNAC.     

Initial Report of the Results of Percutaneous Laser Ablation of Benign Cold Thyroid Nodules: Evaluation of Histopathological Changes After 2 Years

Percutaneous laser ablation (PLA) is a new method to be used for reducing the volume of symptomatic cold benign thyroid nodules. We aimed to introduce the long-term histopathological effects of PLA procedure in thyroid nodules. A 42-year-old male patient with 18.7-mL nodule volume was transferred a total of 720 J of energy with 3-W power. A 50-year-old female patient with 14.1-mL volume nodule was transferred a total of 3,300 J with 5-W power. A 61-year-old female patient with 49.7-mL volume nodule was transferred a total of 4,200 J with 5-W power. The thyroidectomy materials were examined histopathologically 2 years later. In histopathologic examination, it was observed that the periphery of ablated area was organized with hyalinized connective tissue and the center was organized with necrosis and carbon particles. Concurrently, in the center, we detected calcifications and colloid and foreign-body giant cells against colloid in one patient. We did not encounter any pathologic findings in the tissue adjacent to ablated area. In the cold benign thyroid nodules taken out by thyroidectomy 2 years after PLA procedure, necrosis and hyalinization were detected histopathologically. PLA procedure in cold benign thyroid nodules seems to be safe according to long-term histopathological findings.     

Oxidative stress. Should it be measured in the diabetic patient?

Oxidative stress has been defined as a loss of counterbalance between free radical or reactive oxygen species production and the antioxidant systems, with negative effects on carbohydrates, lipids, and proteins. It is also involved in the progression of different chronic diseases and apoptosis. Diabetes mellitus is associated to a high oxidative stress level through different biochemical pathways, i.e. protein glycosylation, glucose auto-oxidation, and the polyol pathway, mainly induced by hyperglycemia. Oxidative stress could also be involved in the pathogenesis of atherosclerotic lesions and other chronic diabetic complications. Measurement of oxidative stress could be useful to investigate its role in the initiation and development processes of chronic diabetic complications and also to evaluate preventive actions, including antioxidative therapy. Different attempts have been made to obtain a practical, accurate, specific, and sensitive method to evaluate oxidative stress in clinical practice. However, this ideal method is not currently available to date and the usefulness of the current methods needs to be confirmed in daily practice. We suggest quantifying oxidated and reduced glutation (GSSG/GSH) and the thiobarbituric reactive substances (TBARS) with currently alternatives. Currently available alternative methods while we await better options.     

Should epitope-based HLA compatibility be used in the kidney allocation system?

The new kidney allocation system (KAS) still applies donor-recipient HLA compatibility mostly at the antigen level and although some four-digit alleles have been included. This system is used to record unacceptable mismatches for sensitized transplant candidates with serum HLA antibodies. Since the reactivities of such antibodies are specifically associated with epitopes rather than HLA antigens, a more scientifically accurate assessment of mismatch acceptability could be based on epitopes. HLA class I and class II epitope specificity analyses can now be readily performed with serum antibody assays with single allele panels. This report describes an epitope-based HLA compatibility system for KAS and involves recipient and donor HLA typing at the four-digit allele level. It focuses on sensitized patients who have serum antibodies specific for HLA epitopes that can be entered as unacceptable mismatches in the transplant candidate database. Newly developed software programs could readily identify compatible HLA types.     

Should the instructions issued to the subject in traditional static posturography be standardised?

The postural ability of a subject is usually evaluated through the observation of the centre of pressure parameters obtained through posturography. These parameters are known to be sensitive to various factors and standards have consequently been proposed for data acquisition and analysis. A factor usually not taken into due consideration but likely to influence the postural exam is the kind of standing posture (e.g. natural or immobile) a subject is instructed to maintain. This study aimed at investigating whether instructions issued in a traditional static posturographic test influence its outcome and hence should be considered in the standardisation of the posturography protocols. Two groups of young healthy subjects were each issued one of two common instructions, "stand quietly" or "stand as still as possible", by means of projected instructions. Differences between the two groups were investigated for commonly calculated centre of pressure parameters. All these parameters, but the mean frequency, were significantly different, with variations in the range between 8% (mean velocity) and 71% (confidence circle area). These results suggest that instructions given to the subjects strongly influence the outcome of posturography and should, hence, be standardised.     

Should Cochrane reviews be performed during the development of new concepts?

Cochrane reviews are internationally recognized as the highest standard in evidence-based health care. A Cochrane analysis conducts systematic reviews of primary research in human health care, and the analysis includes a comprehensive search of all potentially relevant studies and the use of explicit, reproducible criteria in the selection of studies for review. Thus, Cochrane reviews, undoubtedly provide many useful clinical guidelines. In this opinion paper, however, it is questioned at what level of clinical development of a new strategy a Cochrane review should be conducted in order not to draw premature conclusions that may not be sustained later on. Previous examples of this are debated together with the most recent Cochrane review regarding GnRH agonist triggering of final oocyte maturation, in which debatable conclusions are drawn from early studies, when the concept was still under development. We question the current policy of meta-analysis and recommend that in the future, the meta-analysts should await the results of a sufficient number of well-performed studies with an established new regime before an analysis is performed in order to avoid too early and possibly biased conclusions.