Bone tumour diagnosis in resource poor settings: the role of fine needle aspiration cytology

Abstract

Background: Bone tumours are rare with limited diagnostic options in resource- poor settings. Open biopsies have several complications hence the need for an alternative, cheaper, effective diagnostic method. Aim: To compare fine needle aspiration cytology (FNAC) in the diagnosis of bone tumours with histology of open surgical biopsy and to ascertain whether FNAC can be substituted for open surgical biopsy. Methodology: This prospective study was carried out at the National Orthopaedic Hospital, Lagos between August 2005 and July 2006. We compared the diagnostic accuracy of bone tumour specimens obtained by FNAC with the follow -up open surgical biopsy. We determined whether FNAC could be used to delineate bone tumours into benign, malignant,or metastatic tumours. Results: 22 patients were studied, age range 11-57 years. FNAC had sensitivity of 100%, false positive of 16.7%(1), and overall diagnostic accuracy of 95.2% which was higher for conclusive smears. FNAC was non- diagnostic in one case but diagnostic accuracy for giant cell tumours and osteosarcomas was 100%. The average time interval for FNAC result was 5.1 days + SD 2 days (1-9 days) compared to 25.4 + 20.5 SD (9-91 days) for the histology surgical biopsy (P. value 0.001). No significant complications were noted with FNAC. Conclusion: Where clinicoradiological evaluations have provided a focused differential, FNAC can confidently be used in the diagnosis of bone tumours and is a cheaper and quicker alternative to open surgical biopsy with little or no significant complication in resource poor settings. Keywords: Fine needle aspiration cytology, open biopsy, histopathology