Diagnosis Of Intra-abdominal Lesions Research Articles

Usefulness of Image Guided Fine Needle Aspiration Cytology in the Assessment of Intra-abdominal Lesions

Introduction: The appropriate diagnosis of intra-abdominal lesions is difficult and often requires histopathological confirmation. Image guided Fine Needle Aspiration Cytology (FNAC) is a simple, readily available, safe, inexpensive, time saving, rapid procedure which prevent unnecessary surgical interventions. Aim: The study was conducted to determine the diagnostic efficacy of image guided FNAC in the assessment of intra- abdominal lesions and to determine age and sex distribution. Materials and Methods: This cross-sectional study was conducted in Department of Pathology SN Medical College Agra (from September 2019 to September 2021. Two hundred and seven patients who were detected to have abdominal lesions by Ultrasonography (USG) or Computed Tomography (CT), image guided Fine Needle Aspiration (FNA) was performed under all aseptic condition. The sample was spread onto slides, air-dried and stained with Giemsa and was fixed in 95% ethanol and stained with Papanicolaou’s stain. The cyto-histopathological association was done wherever possible, the overall accuracy, sensitivity, specificity, the Negative Predictive Value (NPV) and Positive Predictive Value (PPV) was calculated. Results: Out of 207 patients, 110 were males and 97 were females with male to female ratio of 1.13:1. Out of 207 cases, the aspirate was satisfactory in 201 (97%) cases. Unsatisfactory aspirate was obtained in 06 (3.0%) of cases. Among 207 cases, most common lesions were malignant 170(82.1%) cases, followed by inflammatory 31 (14.9%) cases and unsatisfactory 06 (3.0%) cases. Most common age group for malignant lesions was 59-68 years with 45 (26.4%) cases followed by 49-58 years with 41 (24.1%) cases. The majority of aspirates were from liver 78 cases (38.2%), followed by 47 cases (22.71%) from gall bladder and 44 cases (21.30%) from the lymph nodes. The sensitivity was 92.3% while specificity was 100%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 91.4%, respectively. The diagnostic accuracy of image guided FNAC was 95.8%. Conclusion: FNA of abdominal lesions guided by ultrasound is a quick, low-cost, safe, highly accurate, and minimally invasive approach for getting a tissue diagnosis in solid localised lesions of the abdomen.

Cytomorphological study of intraabdominal lesions by FNAC

Fine Needle Aspiration Cytology (FNAC) is a simple, safe, low-cost and rapid procedure for diagnostic purpose which makes surgical intervention and exploratory laparotomy unnecessary. The deep seated organs like gall bladder, spleen, pancreas, retroperitoneum and ovary are sampled safely and routinely aspirated using the fine needle under radiological guidance. To assess the utility of FNAC in the diagnosis of intraabdominal lesions, to study the cytomorphological features and to determine the reliability of ultrasonography guided FNAC in distinguishing neoplastic from non-neoplastic intraabdominal mass lesions. The study included 48 intra-abdominal lesions which were detected clinically or radiologically. USG guided FNA was done whenever indicated. The smears were stained with Haematoxylin and eosin (H and E), May Grunwald Giemsa (MGG) and Papanicolaou’s stains. Among 48 cases, 45 cases were usg-guided, 2 cases were blind and one case was intraoperative. The diagnostic yield of usg-guided FNAC was 84.4%.Majority of aspirations were done in the age group of 51-60 years with male:female ratio of 1:1.53. Most common organ subjected to FNA was Liver followed by ovary. Majority of the lesions were found to be malignant. The most common lesion encountered in the whole study was metastastatic carcinoma. Fine needle aspiration cytology is a repeatable and rapid diagnostic procedure that has application in the evaluation of deep seated abdominal mass lesions. With the help of radiological guidance, diagnostic accuracy of FNAC of deep seated lesions dramatically increases.

Key Role of Image Guided Fine Needle Aspiration Cytology in Diagnosing Intra-Abdominal Lesions

Background: Masses in the abdominal cavity are often deep, non-palpable and palpable at times which can be inflammatory, benign or malignant. With increased sophistication of radiologic imaging techniques these deep seated lesions are detected more frequently and confirmed tissue diagnosis is essential for both planning of treatment and staging in case of malignant lesions. Image guided aspiration is an effective way to obtain diagnostic material and avoid diagnostic laparotomy. This study was conducted to categorize various intra-abdominal lesions according to their site of involvement, study their cytomorphological features, and classify them as benign, malignant and inflammatory and assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. Methods: This cross sectional study approved was done on image guided fine needle aspiration cytology smears of intra-abdominal masses. Age, sex and site details were retrieved from the archives. Hematoxylin and Eosin stained smears were reviewed by the Cytopathologist and diagnosis was arrived at after correlating with clinical and radiological data. Core biopsy or excision biopsy of the available cases were also reviewed and checked for correlation. Result: A total of 120 cases were studied with age ranging from 18-81years, 30% of patients were in the 61-70 years age group, followed by 27% cases in 51-60 years age group and 20% cases in 41-50 years age group. The male to female ratio was 1.03:1. 62.5% of cases were from hepatobiliary region, followed by 17.5% cases from pancreatic masses and 11 cases (9.16%) from ovarian masses. 80% cases were malignant, 10% were inflammatory cases, 9.2% cases were inconclusive and 1 (0.8) benign lesion. Among the malignant lesions primary malignancies (Hepatocellular carcinomas and Adenocarcinomas) were more common than secondary deposits. This study showed 88.9% sensitivity, 83.3% specificity and 87.5% of diagnostic accuracy. Conclusion: Image guided aspiration of intra-abdominal lesion is a simple, economical, less complicated and less time consuming procedure that differentiates between malignant and non malignant conditions with high accuracy and can be used as pre-operative diagnostic procedure for planning further management of patient.

Endoscopic ultrasound guided fine needle aspiration in the diagnosis of intra-abdominal lesions

Background: Endoscopic ultrasound guided fine-needle aspiration cytology (EUS-FNA) in the diagnosis of intra-abdominal lesion is a safe and accurate procedure which is practiced in various parts of the world.12 However, this technique is very new in Bangladesh. To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the diagnosis of abdominal lesions.
 Methods: EUS-FNA was carried out on a total of ­48 cases during the study period. The lesions were categorized according to the site of FNA. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated.
 Results: Out of 48 cases, 10 cases (20.8%) were reported as inconclusive while a definite diagnosis was given in 38 cases (79.21%). The mean patient age was 47.68 years. There were 28 (58.33%) males and 20 (41.67%) females. The most common site biopsied was pancreas followed by abdominal lymph node. The average number of passes made was two.
 Conclusion: Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of intra-abdominal lesion is a useful procedure in the evaluation of deep seated lesions of gastrointestinal tract (GIT) and abdominal cavity.
 Bangladesh Med Res Counc Bull 2019; 45: 41-46

Role of radiological-guided FNAC in intra-abdominal lesions

Introduction: Diagnosis of intra-abdominal lesions is mysterious many a times, especially deep-seated lesions. Confirmed diagnosis is essential for proper management. FNAC with radiological assistance helps to approach the lesion and obtain diagnostic material.Aims and Objective:1. To study the utility of radiological-guided FNAC in intra-abdominal lesions.2. To distribute the lesions according to anatomical site and categorization of these lesions as non-neoplastic/inflammatory, benign and malignant based on cytomorphological features.Material and Methods: A total of 82 intra-abdominal and pelvic lesions detected clinically or radiologically from January 2015 to December 2017 were included in the study. CT or USG guided FNAC was performed. H&E and Leishman stained slides were retrieved from archives of pathology department. Histopathological follow up was done, wherever available.Results: The mean age was 52.5years, with male to female ratio being 2.03:1. The diagnostic yield in CT-guided FNAC was 96.8% and USG guided FNAC was 94.2%. Out of 82 cases, 4 were unsatisfactory, 12 were non-neoplastic, 8 were benign, and 57 were malignant lesions. Liver was the most common organ followed by retroperitoneum and kidney. Hepatocellular carcinoma was the most common malignant lesion.Conclusion: Radiological-guided FNAC is simple, relatively quick and safe method in diagnosing intra-abdominal lesions and can be used as a preliminary procedure in management of intra-abdominal lesions.

Role of radiological-assisted cytology in intra-abdominal lesions: A 3 years' experience in a tertiary care center.

Background:Fine needle aspiration (FNA) with assistance of radiological tools such as ultrasonography (USG) and computed tomography (CT) is an effective and safe technique for diagnosing intra-abdominal neoplastic and nonneoplastic lesions.Aims and Objectives:(1) To assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. (2) To categorize various intra-abdominal lesions according to their site of occurrence and study their cytomorphological features.Materials and Methods:A cross-sectional study was conducted in the Department of Pathology between January 2012 and January 2015. A total of 174 cases with intra-abdominal lesions were included in the study.Results:In our study, diagnostic yield was 84.5%. The mean age was found to be 52 years with M: F ratio 1.1:1. We found that 92 (52.87%) cases were in hepatobiliary region, 33 (18.96%) in adnexa, 13 (7.47%) in pancreatic-ampullary region, 14 (8.04%) in unknown abdominal lumps, 8 (4.6%) in lymph nodes, 6 (3.4%) in renal, 5 (2.87%) in retroperitoneum, 2 (1.1%) in omental nodules, and 1 (0.5%) in splenic mass. Of total 174 cases, 106 (61%) cases were malignant, 10 (5.7%) benign, 16 (9.1%) inflammatory, 27 (15.5%) inadequate, and 15 (8.7%) suspicious for malignancy.Conclusion:Ultrasound and CT-guided FNA cytology had a significant role in diagnosis of palpable and nonpalpable intra-abdominal lesions. Being a relatively quick and safe method, it also avoids invasive diagnostic procedures.