Ezzat, N. E., E. S. Abusinna, N. E. S. R. E. E. N. H. HAFEZ, and N. H. Alieldin, "Inter-observer reproducibility of the Royal College system for reporting thyroid cytology: Experience of the Egyptian National Cancer Institu", Journal of Egyptian National Cancer Institute, vol. 30, issue 1, pp. 85-91, 2018. royal_college.pdf
Ezzat, N. E. - S., and N. S. Tahoun, "The role of arginase-1 and glypican-3 in differentiating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration cytology", Egyptian Journal of Pathology:, vol. 33, issue 2, pp. 157–164, 2013. lbhth_lkhms.pdf
Ezzat, N. E. - S., N. S. Tahoun, and Y. M. Ismail, "The role of S100P and IMP3 in the cytologic diagnosis of pancreatic adenocarcinoma", Journal of the Egyptian National Cancer Institute, vol. 28, issue 1, pp. 229–234, 2016. pancreas_3.pdf
Ezzat, N. E. - S., and N. S. Tahoun, "The role of Napsin-A and Desmocollin-3 in classifying poorly differentiating non-small cell lung carcinoma", Journal of the Egyptian National Cancer Institute, vol. 28, issue 1, pp. 13-22, 2016. lung_napsin.pdf
Ezzat, N., E. AbuSinna, and G. Sheref, "Role of thyroid transcription factor-1 and P63 immunocytochemistry in cytologic typing of non-small cell lung carcinomas", Journal of the Egyptian National Cancer Institute, vol. 25, pp. 209–218, 2013. lbhth_lrb.pdf
Noha, E., and N. Hafez, "The validity of immunocytochemical expression of cyclin D1in fine needle aspiration cytology of breast carcinoma", Journal of Egyptian National Cancer Institute, vol. 24, issue 3, pp. 145-150, 2012. Abstract

Purpose: The aim of this work is to study the utility of cyclin D1 expression, a cell cycle regulatory protein, on fine needle aspiration cytology (FNAC) samples in patients with breast carcinoma using immunostaining technique.
Patient and methods: This is a study done on 70 patients with primary breast carcinoma, presented to Cytology Unit, Pathology Department, National Cancer Institute, Cairo University. They were underwent preoperative FNAC and diagnosed as breast carcinoma.( ) The cytologic and tissue section slides were subjected to cyclin D1 immunocytochemical staining. Only the nuclear immunoreactivity for cyclin D1 was considered specific. The rate of concordance, and discordance, and kappa value were calculated. Correlation between cytologic expression of cyclin D1 and different clinicopathologic parameters was evaluated.
Results: Cyclin D1expression was observed in 53/70 cases (75.7%) in cytologic smears. In histologic sections of the corresponding cases, cyclin D1was detected in 48/70 cases (68.6%). The concordance rate of cyclin D1 expression in the FNA and histologic sections was 87.1% while the discordance rate was 12.9%. Kappa showed a value of 0.65. A statistically significant correlation was found between cyclin D1 expression and hormonal status as well as nuclear grade.
Conclusion: Cyclin D1 can be performed successfully on cytologic samples as it showed a high concordance rate and agreement with histologic results. The marker showed a significant correlation with hormone receptor status and nuclear grade.

E.A.Sinna, and N. Ezzat, "Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions", Journal of Egyptian National Cancer Institute, vol. 24, issue 2, pp. 63-70, 2012. Abstract

Purpose: Evaluation of the accuracy of FNAC in the preoperative diagnosis of different thyroid lesions.
Patients and methods: This is a retrospective study of 296 diagnosed cases of thyroid nodules referred to cytology unit, pathology department, NCI, who underwent preoperative cytologic diagnosis. The results were categorized into: insufficient for diagnosis, benign, atypical follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling according to the recent Bethesda classification. The final histologic diagnosis and/ or follow up ultrasonography assessment for non-neoplastic lesions were considered the gold standard.
Results: The study included 296 cases presented with thyroid nodules who underwent preoperative diagnostic thyroid FNAC. Male to female ratio was 5.2:1, and the median age was 44 years. 98 cases (33.1%) were diagnosed as benign, 40 cases (13.5%) as follicular lesion of undetermined significance, 49 cases (16.5%) as follicular neoplasm, 30 cases (10.1%) as suspicious for malignancy, 58 cases (19.5%) as malignant, and 21 cases (7.1%) as unsatisfactory. Nodular hyperplasia represented the majority of benign cases (89.8%), while papillary carcinoma was the most frequent malignant lesion (72.4%). Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 92.8, specificity of 94.2%, positive predictive value of 94.9%, negative predictive value of 91.8%, false positive rate of 7.2%, false negative rate of 5.8%, and a total accuracy of 93.6%.
Conclusion: FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings.

N.S.Tahoun, and N. Ezzat, "Diagnostic accuracy and pitfalls of preoperative fine needle aspiration cytology in salivary gland lesions ", Journal of Egyptian National Cancer Institute, vol. 20, issue 4, pp. 358-368, 2008. Abstract

Purpose: The diagnostic efficacy of fine needle aspiration cytology (FNAC) was evaluated to assess its value in accurate preoperative diagnosis of salivary gland lesions and to compare it to that of histopathologic diagnosis with discussion of the possible diagnostic pitfalls.
Patients and methods: This is a retrospective study of 82 patients presented at NCI, Cairo University with salivary gland lesion which underwent preoperative FNAC diagnosis with subsequent excision and histopathologic assessment. Cytology results were classified as negative, positive, inconclusive for cancer, and inadequate. The definitive histopathologic report according to WHO Histological typing was the gold standard diagnosis against which FNAC was compared.
Results: Our study included 82 patients underwent preoperative FNAC of major salivary glands with subsequent surgical excision. Male to female ratio was 1.4: 1. The mean age was 49 years. Parotid gland was involved in (68.3%), submandibular in (28%), and submental gland in (3.7%). Forty cases (48.8%) were cytologically diagnosed as benign lesions, 26 (31.7%) were malignant, and 10 (12.2%) were inconclusive. Cytological findings were nondiagnostic in 6 (7.3%). The most common benign cytologic diagnosis was pleomorphic adenoma, 16 out of 40 cases (40%), while the most common malignant tumor was carcinoma, 22 out of 26 cases (84.6%). Cytologic diagnoses were compared with histopathologic one and were true-negative in 37 (92.5%), true-positive in 33 (91.6%), false-negative in 3 (8.3%) and false-positive in 3 (7.5%) cases regarding detection of malignant tumors. The rates of agreement of histopathologic type for benign and malignant tumors were 89.2%, and 91%, respectively.

Conclusion: FNAC is a valuable diagnostic tool in preoperative assessment of salivary gland masses as preoperative recognition of malignant tumors may help to prepare both the surgeon and patient for an appropriate surgical procedure. Multidirectional aspiration is preferred to avoid selective sampling. Re-aspiration of solid portion after cyst fluid aspiration is necessary to decrease the rate of inadequacy. Attention to subtle morphologic changes, pitfalls, and limitations may aid in arriving at the right diagnosis. Lastly but not least correlation of cytologic diagnoses with clinical and radiological data (triple approach) is the golden rule for management of salivary gland lesion before any radical surgery.

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