Kamal Khurana

State University of New York Upstate Medical University, Syracuse, NY, United States

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Publications (3)7.57 Total impact

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    ABSTRACT: Objective In this study we discuss the diagnostic accuracy and unsatisfactory rate of onsite evaluation of ultrasound guided fine needle aspiration (USGFNA) of thyroid nodules using telecytopathology and compare it to that of a control group without telecytopathology.Methods This was a retrospective analysis of USGFNA of thyroid nodules over a 9 month period with and without telecytopathology. There was no randomization for selection of the groups with and without telepathologist. A single provider performed all the procedures. Real time images of Diff Quik stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via the internet by a cytotechnologist to a pathologist who communicated the preliminary diagnosis and sample adequacy. The unsatisfactory specimen rate was compared between a group whose images were transmitted (n=45) vs. another group without onsite adequacy assessment (non-transmitted) (n=47).Results A total of 92 nodules in 67 patients were aspirated with ultrasound guidance. The unsatisfactory sample rate in the transmitted group was 13% (6/45) and that of the non-transmitted group was 23% (11/47). In the transmitted group, the cytology specimens of 3 patients that were initially deemed inadequate by the pathologist were considered adequate after 2 additional passes. In the transmitted group preliminary diagnosis concurred with the final diagnosis in 96% of cases. Four passes were made in the non-transmitted group vs. 2 passes in the transmitted group.Conclusions Immediate assessment of USGFNA via telecytopathology assures adequacy of the cytology sample and may reduce number of passes per nodule. Preliminary onsite telecytopathology diagnosis was highly accurate when compared to final diagnosis.
    Endocrine Practice 09/2012; · 2.49 Impact Factor
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    ABSTRACT: The reported incidence of thyroid nodules in children and adolescents is estimated to be between 1% and 2%. However, this incidence may be increasing because diagnostic radiological procedures are detecting incidental thyroid nodules in children. The objective of this study was to assess the diagnostic accuracy, sensitivity, and specificity of ultrasound-guided fine-needle aspiration (US-FNA) of thyroid nodules in children and adolescents. Forty-two children (mean age, 14.75 years) underwent US-FNA of 52 thyroid nodules. The specificity, sensitivity, diagnostic accuracy, and unsatisfactory rates were compared to other similar studies. Six patients had a cytological diagnosis of papillary thyroid cancer, which was confirmed at surgery. There were no false-negative specimens, and cytological diagnostic accuracy was 93.7%. The inadequate rate was only 1.9%. US-FNA of thyroid nodules in children and adolescents is highly accurate in experienced hands and is associated with a very low inadequate rate.
    Thyroid: official journal of the American Thyroid Association 06/2009; 19(7):703-5. · 2.60 Impact Factor
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    ABSTRACT: To investigate the role of thyroid ultrasonography in our outpatient endocrine practice. We compared the efficacy of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules with that of palpation-guided aspiration (P-FNAB) and determined the malignancy rates of palpable and nonpalpable nodules. All patients referred for assessment of thyroid nodular disease from October 1997 through August 2001 were included in the study. Fine-needle aspirations were performed by palpation guidance until October 1999, after which US-FNAB was exclusively performed. All thyroid examinations, ultrasound imaging, and aspiration biopsies were performed by the same endocrinologist in an office-based setting. Histopathologic and cytologic diagnoses were compared for patients who underwent thyroidectomy. A total of 376 nodules in 276 patients were aspirated during a 47-month period. P-FNAB was used on 157 nodules, and US-FNAB was performed on 219 nodules (both procedures were done on 21 nodules). For palpable thyroid nodules that were resected, the cytologic diagnostic accuracy rate was 60.9% and 80% for P-FNAB and US-FNAB, respectively. With use of ultrasound guidance, the sensitivity, positive predictive value, and negative predictive value increased significantly. In addition, the inadequate specimen rate decreased from 11.2% in the P-FNAB group to 7.1% in the US-FNAB group. Among the nodules that were not palpable, the malignancy rate was similar to that for the palpable thyroid nodules (5.1% versus 6.8%). US-FNAB improved the cytologic diagnostic accuracy, sensitivity, and positive predictive value and reduced the false-negative rate in comparison with P-FNAB. The malignancy rate for nonpalpable thyroid nodules was similar to that for palpable nodules.
    Endocrine Practice 11/2006; 12(6):609-14. · 2.49 Impact Factor