Real time ultrasound guided fine needle aspiration cytology of intra-abdominal and intra-pelvic masses- synergistic approach of radiologist and cytopathologist for better cellular yield

Abstract

Real time ultrasound guided fine needle aspiration cytology (FNAC) of non-palpable, intra-abdominal and intra-pelvic masses are easily performed and reported rapidly. Needle tip can be visualized and manipulated on real time aspirations. It increases the sensitivity due to high diagnostic yield from target areas. The present study is a retrospective study of 161cases, where real time ultrasound guided FNAC of intra-abdominal and intra-pelvic masses were done from 1 July 2018 to 31 December 2019 in a tertiary cancer center. Aspirations from ovary and other pelvic masses-18 gauge, liver/gall bladder-22- 23 gauge and kidney-23 gauge spinal needles were taken respectively. Total 161 cases of intra-abdominal lesions- ovary- 73 cases, liver-45 cases, kidney-27 cases, gall bladder-07 cases, colon (caecum+descending colon)-03 cases and pelvis mass- 03cases, pancreas- 02 cases and retroperitoneal lymph node-01 case were retrieved and studied. Ultrasound guided aspirates were conclusive for reporting in 145 cases, inconclusive for reporting in 10 cases and acellular/ haemorrhagic in 06 cases. There was high sensitivity and specificity of 90.9% and 100% respectively. Real time image guided FNAC is the method of choice for intra-abdominal masses with better cell yield and minimal complication. It permits precise localization and targeting of lesions safely. The localization is good in most of the masses but, it’s challenging in few locations. Complication like needle track seedling, discussed in many studies, was not seen in the present study.Image guided FNAC is very rewarding in diagnosis of intra-abdominal masses. USG guided FNAC is easy, causes minimal radiation, rapid reporting, less complication and needle tip can be easily visualized and manipulated in any direction, thus aids in faster planning if the treatment.