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• W2609600263 abstract "Original ArticlesAspiration Biopsy of Thyroid Nodules: A Review of Experience at King Faisal Specialist Hospital Muhammad Ashraf Ali, MD, FRCP(C), FCAP Mohammed Akhtar, and MD, FCAP Nicholas WoodhouseFRCP Muhammad Ashraf Ali Chief Division of Surgical Pathology-Cytology, Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author , Mohammed Akhtar Director of Electron Microscopy, Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author , and Nicholas Woodhouse Head, Division of Endocrinology & Metabolism, Department of Medicine, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1986https://doi.org/10.5144/0256-4947.1986.163SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutABSTRACTABSTRACTA series of 137 aspiration biopsies of thyroid nodules were reviewed. In 110 biopsies adequate material was obtained and the diagnosis rendered included papillary carcinoma 31; follicular neoplasms 11; medullary carcinoma 2; anaplastic carcinoma 12; Hurthle cell tumor 1; undifferentiated carcinoma 1; malignant lymphoma 6; indeterminate 6, nodular goiter 30, thryoiditis 8, and tuberculosis 2. Histologic examination of excisional biopsies in 49 of these cases revealed a good correlation with cytologic diagnosis in cases of papillary carcinoma, anaplastic carcinoma, and nodular goiter. Only two of five medullary carcinomas were correctly diagnosed initially but all were confirmed by staining for calcitonin. In the indeterminate group, histologic examination in five cases revealed one papillary carcinoma, one medullary carcinoma, and three cases of nodular goiter. The morphologic spectrum of aspiration cytology in the various thyroid lesions is briefly described.INTRODUCTIONA thyroid nodule can be due to a variety of underlying pathologic conditions, including inflammation, hyperplasia, degeneration and a benign or a malignant neoplasm. Of these, only malignant neoplasms require surgical exploration or excision while the remaining conditions can be managed effectively with a more conservative therapeutic approach.It has been estimated that approximately 2.5 to 5% of the thyroid nodules harbor a malignant neoplasm.1,2 Clinical distinction between the benign and malignant thyroid nodules is not always possible. Surgical exploration followed by histologic examination of these nodules could identify the malignant neoplasms but would result in a large number of surgical procedures on patients with benign conditions. Several additional diagnostic modalities including thyroid function tests, scintiscanning, ultrasonography and response to thyroid stimulating hormone have been used over the years in order to enhance our ability to discriminate between these two groups, but the results are far from satisfactory.2,3 More recently fine-needle aspiration biopsy (FNAB) has been used in the diagnosis of these lesions and the experiences from centers all over the world seem to indicate that this technique is extremely useful in identifying malignant thyroid nodules.1–11The purpose of this study is to review our experience with aspiration biopsy of thyroid lesions at King Faisal Specialist Hospital and to describe the morphologic spectrum of various benign and malignant conditions encountered in these biopsies.MATERIALS AND METHODSA total of 137 FNABs were performed on thyroid masses at King Faisal Specialist Hospital between August 1977 and September 1985. Records of these cases from the files of the department of pathology were reviewed and those cases in which histologic material from these nodules was subsequently available, were identified.Pathology reports as well as aspiration smears and all available histologic sections from these cases were reviewed. Aspiration smears from those cases in which histologic correlation was available were selected for detailed study with regards to the presence of a variety of cytomorphologic parameters such as cell arrangement, intranuclear cytoplasmic inclusions, inflammatory cells, macrophages, giant cells, oncocytes, colloid, and amyloid.The technique for aspiration biopsy has been described elsewhere.8 Smears were air dried and stained by Diff-Quik stain. Additional smears when available were stained by Papanicolaou and hematoxylin and eosin stain.RESULTSIn 27 of the 137 cases the aspirated material was judged as insufficient for proper evaluation and accordingly no diagnosis was rendered. In the remaining 110 cases, the cellular yield in the aspiration smears was sufficient for diagnosis. In this group the diagnoses rendered were as follows: papillary carcinoma 31, follicular neoplasm 11, medullary carcinoma 2, anaplastic carcinoma 12, Hurthle cell tumor 1, undifferentiated carcinoma 1, malignant lymphoma 6, indeterminate 6, nodular goiter 30, thyroiditis 8, and tuberculosis 2. Among these 110 patients, 85 were females and 25 were males. Their ages ranged from 9 to 84 years.Aspiration biopsies as well as tissue sections with a mixed follicular and papillary pattern were classified as papillary carcinoma. In case of pure follicular lesions in aspiration biopsies, no attempt was made to distinguish between follicular adenoma and carcinoma. Similarly, Hurthle cell lesions were called Hurthle cell tumors and no morphologic distinction between benign and malignant tumors was attempted. In the indeterminate group a definitive diagnosis of a malignant tumor could not be made. However, because of the presence of atypical features, an excisional biopsy for histologic examination was suggested.The correlation between the FNAB interpretation and histologic diagnosis could be made in 49 of the 110 cases. The results are given in Table 1. There were three false positive diagnoses, all of which were in the indeterminate group. In these cases, a biopsy was recommended based on a abundant cellular yield and nuclear atypia but, the excisional biopsy revealed changes indicative of nodular goiter. Medullary carcinoma was diagnosed correctly in two cases. In one case it was diagnosed as undifferentiated carcinoma, another as indeterminate while the fifth was erroneously interpreted as follicular neoplasm. One false negative aspiration biopsy was also encountered. In this case FNAB diagnosis was nodular goiter which was confirmed by excisional biopsy which also revealed a focus of occult sclerosing papillary carcinoma. The FNAB diagnoses in all other patients were confirmed by histologic examination of the excisional biopsies.Table 1. FNAB diagnosis in 110 cases with histiocytic correlations in 49 casesTable 1. FNAB diagnosis in 110 cases with histiocytic correlations in 49 casesMorphologic Spectrum of FNAB SmearsThe morphologic descriptions in this section are based exclusively on the observations made on smears stained by Diff-Quick stain which in our experience has proven to be most useful for interpretation of thyroid aspiration biopsies. The smears were examined for a large variety of morphologic parameters.Papillary carcinoma (20 cases).In papillary carcinoma large numbers of epithelial cells were present usually mixed with variable numbers of hemosiderin-containing macrophages and benign giant cells. The tumor cells were arranged in monolayers of various sizes. Nuclear pleomorphism was slight to moderate. The size of the nuclei however was larger than that of nuclei in normal thyroid epithelium. Careful evaluation of the arrangement of these cells revealed several patterns, i.e., solid sheets, large papillary structures, small papillary structures and complex papillary structures. In the solid sheets the cells did not show any specific orientation (Figure 1). In the large papillary structures the cell clusters were usually composed of large numbers of cells. At the periphery, the cells were somewhat larger and their nuclei were arranged toward the basal part with cytoplasm extending outwards. Towards the center the cells appeared smaller and denser due to compression (Figure 2). The small papillary structures usually contained 15-20 cells arranged in a small cluster (Figures 3 and 4). Compression of the cells near the center was usually absent. Occasionally, the cells forming the small papillary structures showed varying degrees of oncocytic change. The complex papillary structures were composed of tissue fragments in which several papillary processes as well as their fibrous cores were observed (Figure 5). Psammoma bodies were seen in two cases. The colloid when present was in the form of irregular streaks (chewing-gum colloid).Figure 1. Photomicrograph of an aspiration smear from a papillary carcinoma showing a monolayer of cells arranged as a solid sheet. (Diff-Quik stain ×100)Download FigureFigure 2. Another cell cluster from papillary carcinoma arranged as a large papillary structure. Cells near the center of the cluster are compressed and appear denser than those at the periphery. Some of the cells show intranuclear cytoplasmic inclusions. (Diff-Quik stain X100)Download FigureFigure 3. Photomicrograph showing a small papillary structure. One of the cells contains an intranuclear cytoplasmic inclusion. (Diff-Quik stain ×100)Download FigureFigure 4. Aspiration smear from papillary carcinoma featuring large number of hemosiderin-containing macrophages. A small papillary structure is also present. (Diff-Quik stain × 120)Download FigureFigure 5. Photomicrograph featuring a complex papillary structure. (Diff-Quik stain ×100)Download FigureFollicular neoplasm (4 cases).These lesions were characterized by the presence of abundant cellular material in the aspirate. These cells were arranged in solid sheets or in the form of follicles (Figures 6 and 7). The amount of colloid was variable and was often seen as small dense round masses in the center of the follicles. The inflammatory cells and macrophages were lacking. Oncocytic change was not seen. Nuclear atypia was usually present and was marked in less differentiated carcinomas. Rare intranuclear cytoplasmic inclusions were noted in one case.Figure 6. Photomicrograph of aspiration smear from a follicular neoplasm. Large numbers of cells are present some of which are arranged as follicles. A small amount of colloid is noted near the center of the photomicrograph. (Diff-Quik stain ×100)Download FigureFigure 7. Another smear from a follicular neoplasm. Several follicles, some containing colloid, are recognizable (Diff-Quik stain ×100)Download FigureAnaplastic carcinoma (5 cases).The tumor cells were large and irregular or spindle-shaped (Figure 8). The nuclei were large, markedly hyper-chromatic and occasionally multiple. In one case osteoclast-like multinucleated giant cells were present in larger numbers (Figure 9). This is a rare variant of anaplastic carcinoma of the thyroid.12,13Figure 8. Photomicrograph of an aspiration smear from anaplastic carcinoma, showing clusters of spindle shaped cells with large hyperchromatic nuclei. (Diff-Quik stain ×120)Download FigureFigure 9. Smear from another anaplastic carcinoma with prominent osteoclast-like giant cells. (Diff-Quik stain ×120)Download FigureMedullary carcinoma (5 cases).The tumor cells were small and polygonal arranged in sheets or small clusters (Figure 10). In one case, the cells were spindle-shaped. Amyloid was noted in two of five cases. Immunoperoxidase staining for calcitonin, performed in the smears in all five cases, revealed strong positivity of most of the tumor cells thus confirming the diagnosis (Figure 1). In one case occasional intranuclear cytoplasmic inclusions were seen.Figure 10. Photomicrograph of an aspiration smear from medullary carcinoma. Two clusters of closely packed slightly elongated cells with dark staining nuclei. (Diff-Quik stain X130)Download FigureHurthle cell neoplasm (2 cases).The tumor cells were present in large numbers and were arranged in large sheets with occasional papillary structures. The cytoplasm of the cells was abundant and was slightly granular (Figure 12). Nuclei were round with varying degrees of nuclear pleomorphism. Inflammatory cells, giant cells and hemosiderin-containing macrophages were usually not seen.Figure 11. A cluster of cells from medullary carcinoma stained for calcitonin using immuno-peroxidase technique. (x100)Download FigureFigure 12. Photomicrograph of a cluster of cells from a Hurthle cell neoplasm. The tumor cells have abundant cytoplasm with relatively small nuclei. (Diff-Quik stain ×130)Download FigureMalignant lymphoma (4 cases).Aspiration smears in all cases were almost entirely composed of lymphoma cells (Figure 13). Variable numbers of macrophages were scattered amongst the tumor cells. Epithelial cells were usually lacking except for one case in which several sheets of benign epithelial cells were present.Figure 13. Photomicrograph of aspiration smear from undifferentiated lymphoma Burkitt's type. The cells are uniform with a high nuclear-cytoplasmic ratio. The cytoplasm shows several lipid vacuoles. (Diff-Quik stain ×130)Download FigureNodular goiter (6 cases).The cellular yield in the aspirated material was usually moderate and the cells were arranged in sheets or follicles. The colloid was seen as pale, light, staining material spread out in the smears. Most of the cases also revealed the presence of large numbers of hemosiderin-containing macrophages and occasional benign multinucleated giant cells (Figure 14). Oncocytic change was not seen. Nuclear atypia was present in some cases. Intranuclear cytoplasmic inclusions were not noted.Figure 14. Aspiration smear from a nodular goiter showing small clusters of uniform cells with occasional histiocytes. (Diff-Quik stain ×100)Download FigureThyroiditis (one case).The smear revealed large numbers of mature lymphocytes mixed with variable numbers of benign epithelial cells (Figure 15).Figure 15. Aspiration smear from a lymphocytic thyroiditis. There are large numbers of mature lymphocytes with scattered epithelial cells. (Diff-Quik stain ×100)Download FigureTuberculosis (one case).The smears revealed extensive necrotic debris with variable numbers of polymorphonuclear cells. Several epithelioid cells as well as foamy macrophages with rare giant cells were also seen (Figure 16).Figure 16. Aspiration smear from tuberculosis thyroiditis featuring extensive necrotic debris with scattered polymorphonuclear cells and epithelioid cells. (Diff-Quik stain X100)Download FigureDISCUSSIONOur findings in this study are consonant with those from several other studies published in recent years in which the usefulness of FNAB in the diagnosis and management of thyroid nodules has been affirmed.1–11 This technique is rapid, simple, relatively painless and generally free of any significant complications. The technique can be performed in a doctor’s office and outpatient clinic and results can be obtained within minutes. The material obtained by aspiration biopsies can also be used for special techniques such as electron microscopy and immuno-histochemical studies.14,15,16In our series one major limitation of the technique is the relatively high rate of technically unsuccessful biopsies. Of the 137 biopsies performed, 27 (20%) yielded scanty cellular material which was insufficient for proper evaluation. The reported rate of technical failure in aspiration biopsies has varied from as low as 3% to as high as 28%.4,5 The rate of technical failure is primarily related to the experience and skill of the person performing the biopsy, although other factors such as location and size of the lesions can also influence the success rate.In our setting, the biopsies have been performed over the last eight years by a large number of pathologists with varying degrees of experience and levels of technical skill. It is hoped that with increasing experience and greater use of special imaging techniques such as ultrasonography, the number of technical failures will be reduced to the minimum.Another factor limiting the usefulness of FNAB in the diagnosis of thyroid nodules is the rate of false negative biopsies. These are biopsies in which the aspirated material is adequate in amount but has either been misinterpreted as a benign condition or it is not representative of the pathology within the nodules. The incidence of false negative aspiration biopsy of thyroid nodules reported in the literature varies from 2.6% to 31.4%.8,15 In our series only one false negative biopsy was encountered. In this case a diagnosis of nodular goiter was made on the basis of FNAB. Subsequent excisional biopsy, however, revealed nodular goiter with a focus of occult sclerosing papillary carcinoma. This relatively low incidence of false negative results in our series, however, is misleading because an overwhelming majority of our patients with a FNAB diagnosis of a benign condition were not followed by surgical excision. It is therefore impossible to determine the real rate of false negative results in our material.It is now generally recognized that the FNAB diagnosis of lesions such as papillary carcinoma, anaplastic carcinoma, nodular goiter and thyroiditis is relatively easy.8 Our experience is also similar. Thus, 19 of 20 papillary carcinomas, 5 of 5 anaplastic carcinomas, 3 of 3 nodular goiters, and one thyroiditis diagnosed on FNAB were confirmed by histologic examination of subsequent excisional biopsies (Table 1).The diagnosis of medullary carcinoma, once its cytomorphologic features are fully understood, can also be made reliably on the basis of FNAB. In our material three out of five cases of medullary carcinoma were misdiagnosed. However, these cases were encountered during the early part of the study when we were not familiar with the FNAB appearance of this lesion. The last two cases, were diagnosed correctly. The experience of other observers is also similar.14,15Fine-needle aspiration biopsy diagnosis of medullary carcinoma can be further confirmed by performing immunoperoxidase staining for calcitonin on the aspiration material. Smears on all five of our cases were positive for calcitonin and all three cases in which electron microscopy was performed revealed characteristic neurosecretory granules.The diagnosis of follicular carcinoma and its distinction from follicular adenoma on the basis of FNAB continues to be difficult. This is because the distinction between an adenoma and a carcinoma usually depends upon the demonstration of capsular and vascular invasion.18 These are features which can only be demonstrated in histologic sections. Most of the observers realizing the difficulty in making a distinction between these two entities suggest that both these lesions should be categorized on the basis of FNAB as follicular neoplasms and that the final distinction should be deferred until a histologic examination is performed.5,8,19 This however, will inevitably result in large numbers of patients with a benign follicular lesion undergoing a surgical procedure.More recently some observers have attempted to distinguish between the benign and malignant follicular lesions on the basis of FNAB smears using cytologic criteria.11 The results from this study are encouraging but additional studies are needed to confirm these findings. The number of follicular lesions in our material is too small to draw any firm conclusions regarding this point. In three of our cases, there was sufficient nuclear atypia to warrant a diagnosis of carcinoma on the basis of cytologic examination. However, in our practice we rarely attempt to distinguish between an adenoma and carcinoma on the basis of FNAB. We believe that all lesions diagnosed by FNAB as follicular neoplasms should have at least hemithyroidectomy.Another area in which FNAB diagnosis is usually imprecise is the distinction between benign and malignant Hurthle cell tumors.19 The difficulty arises from the fact that there are no reliable criteria for distinction between the benign and malignant Hurthle cell tumors even on histologic grounds.20 Many authors believe that the behavior of these tumors is highly unpredictable and that correlation between the morphologic features of malignancy such as nuclear atypia and mitotic activity and the malignant potential of these tumors is poor. These tumors are therefore designated as Hurthle cell tumors and all are considered potentially malignant.21,22 A recent study however, indicates that this may not necessarily be true. In a series of 84 Hurthle cell lesions, Gosain and Clark demonstrated that histologic examination is quite effective in distinguishing between the benign and malignant Hurthle cell tumors.23 These findings however remain to be confirmed. It is hoped that as this issue is resolved at the histologic level, the FNAB diagnosis of Hurthle cell tumors will become more precise.The diagnosis of tuberculosis by FNAB has not received much attention and consequently there is little information available in the literature regarding the cytologic parameters which are helpful in establishing such a diagnosis. In a recent study from our laboratory, it was shown that tuberculosis can be diagnosed effectively with aspiration biopsy. Two patterns were seen: one consisted of extensive necrotic debris with scattering of polymorphonuclear cells, epithelioid cells and foamy histiocytes. This corresponded to the caseating granulomas seen in histologic sections. The second pattern revealed aggregates of epithelioid cells with occasional multinucleated giant cells in the absence of significant necrotic debris. This corresponded to the noncaseating epithelioid granulomas in histologic sections.24In summary, this paper reviews our experience at King Faisal Specialist Hospital with regard to the FNAB diagnosis of thyroid nodules. Our findings are in agreement with a large number of recent studies which indicate the usefulness of this technique in the diagnosis of thyroid lesions. In addition, light microscopic appearance of aspiration smears from thyroid lesions is described in order to further elucidate the cytomorphology of the various pathologic processes present within these nodules. This, we hope, will be helpful to those who are interested in the FNAB diagnosis of thyroid lesions.ARTICLE REFERENCES:1. Stavric GD, Karanfilski BT, Kalamaras AK, et al.. Early diagnosis and detection of clinically non-suspected thyroid neoplasia by cytologic method: A critical review of 1536 aspiration biopsies . Cancer. 1980; 45(2):340–4. Google Scholar2. Ashcraft MW, Van Herle AJ. Management of thyroid nodules. II: Scanning techniques thyroid suppressive therapy and fine-needle aspiration . Head Neck Surg. 1981; 3(4):297–322. Google Scholar3. Walfish PG, Hazani E, Strawbridge HTG, et al. Combined ultrasound and needle aspiration cytology in assessment and management of hypofunctioning thyroid nodules . Ann Intern Med. 1977; 87(3):270–4. Google Scholar4. Gershengorn MC, McClung MR, Chu EW, et al.. Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules . Ann Intern Med. 1977; 87(3):265–9. Google Scholar5. Prinz RA, O'Morchoe PJ, Barbato AL, et al.. Fine needle aspiration biopsy of thyroid nodules . Ann Surg. 1983; 198(1):70–3. Google Scholar6. Blum M. The diagnosis of the thyroid nodule using aspiration biopsy and cytology [editorial] . Arch Intern Med. 1984; 144(6): 1140–2. Google Scholar7. Ramacciotti CE, Pretorius HT, Chu E, et al. Diagnostic accuracy and use of aspiration biopsy in the management of thyroid nodules . Arch Intern Med. 1984; 144(6):1169–73. Google Scholar8. Lowhagen T, Granberg PO, Lundell G, et al.. Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant . Surg Clin N Am. 1979; 59(1):3–18. Google Scholar9. Chu EW, Hanson TA, Goldman JM, Robbins J. Study of cells in fine-needle aspirations of the thyroid glands . Acta Cytol (Baltimore). 1979; 23(4):308–14. Google Scholar10. Miller JM, Hamburger JI, Kini SR. The needle biopsy diagnosis of papillary thyroid carcinoma . Cancer. 1981; 48(4):989–93. Google Scholar11. Miller JM, Kini SR, Hamburger JI. The diagnosis of malignant follicular neoplasms of the thyroid by needle biopsy . Cancer. 1985; 55(12):2812–7. Google Scholar12. Willems JS, Lowhagen T, Palombini L. The cytology of a giant-cell, osteoclastoma-like malignant thyroid neoplasm: a case report . Acta Cytol. 1979; 23(3):214–6. Google Scholar13. Esmaili JH, Hafez GR, Warner TF. Anaplastic carcinoma of the thyroid with osteoclast-like giant cells . Cancer. 1983; 52(11):2122–8. Google Scholar14. Geddie WR, Bedard YC, Strawbridge HTG. Medullary carcinoma of the thyroid in fine-needle aspiration biopsies . Am J Clin Path. 1984; 82(5):552–8. Google Scholar15. Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathologic features of medullary carcinoma of the thyroid . Arch Pathol Lab Med. 1984; 108(2):156–9. Google Scholar16. Akhtar M, Ali MA, Owen EW. Application of electron microscopy in the interpretation of fine-needle aspiration biopsies . Cancer. 1981; 48(11):2458–63. Google Scholar17. Radetic M, Kralj Z, Padovan I. Reliability of aspiration biopsy in thyroid nodes: study of 2190 operated patients . Tumori. 1984; 70(3):271–6. Google Scholar18. Evans HL. Follicular neoplasms of the thyroid. A study of 44 cases followed for a minimum of 10 years, with emphasis on differential diagnosis . Cancer. 1984; 54(3):535–40. Google Scholar19. Gharib H, Goellner JR, Zinsmeister AR, et al. Fine-needle aspiration biopsy of the thyroid. The problem of suspicious cytologic findings . Ann Intern Med. 1984; 101(1):25–8. Google Scholar20. Rosai J, Carcangiu ML. Pathology of thyroid tumors: some recent and old questions . Human Pathol. 1984; 15(11):1008–12. Google Scholar21. Thompson NW, Dunn EL, Batsakis JG, et al. Hurthle cell lesions of the thyroid glands . Surg Gynecol Obstet. 1974; 139(4):555–60. Google Scholar22. Gundry SR, Burney RE, Thompson NW, Lloyd R. Total thyroidectomy for Hurthle cell neoplasms of the thyroid . Arch Surg. 1983; 118(5):529–32. Google Scholar23. Gosain AK, Clark OH. Hurthle cell neoplasms. Malignant potential . Arch Surg. 1984; 119(5):515–9. Google Scholar24. Bailey TM, Akhtar M, Ali MA. Fine-needle aspiration biopsy in the diagnosis of tuberculosis . Acta Cytologica. 1985; 29(5):732–6. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byKhan K, Shakira S, Hashmi I and Awad A (2019) Fine Needle Aspiration Biopsies (FNAB) in the Preoperative Diagnosis of Thyroid Nodules, Annals of Saudi Medicine , 12:6, (584-585), Online publication date: 1-Nov-1992.Beecham J, Alibutud M and Burke M (2019) Fine-Needle Aspiration Biopsy for the Routine Screening of Saudi Patients with Thyroid Nodules, Annals of Saudi Medicine , 8:4, (252-256), Online publication date: 1-Jul-1988. Volume 6, Issue 3July 1986 Metrics History Accepted4 February 1986Published online1 July 1986 KeywordsBiopsyThyroid gland-pathologyneedleACKNOWLEDGEMENTThe authors would like to thank Ms. Sherrell Bradford for her help in collecting the cytology material for review.InformationCopyright © 1986, Annals of Saudi MedicinePDF download" @default.
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