Fine-needle Aspiration Biopsy Diagnosis Research Articles

Compte-rendu de la quarante-sixième réunion de l’American Society for Therapeutic Radiology and Oncology (ASTRO). Atlanta, 3–7 octobre 2004

Major salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.We retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.The number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).FNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.

Fine-needle aspiration biopsy of salivary gland lesions in a selected patient population.

To report the role of selective use of preoperative fine-needle aspiration biopsy (FNAB) in patients with major salivary gland lesions at a tertiary care cancer center. Retrospective review of FNAB results compared with final histologic diagnosis as the criterion standard. An academic tertiary care cancer center. A consecutive series of 258 patients who underwent FNAB of major salivary gland lesions between 1996 and 2000, of whom 169 had surgical resection. Predictive value, sensitivity, specificity, and accuracy. FNAB was performed in 169 (37%) of 463 salivary gland lesions undergoing surgical procedures. A total of 126 lesions were in the parotid gland and 44 in the submandibular gland. Seventy-nine lesions (46%) were malignant. There were 150 FNAB specimens (89%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesion had positive and negative predictive values of 84% and 77%, respectively. Ten of 20 false-negative FNAB results were low-grade lymphoma on final histologic assessment. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 83% and 88%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 47% of cases. Fifteen (47%) of 32 lymphocyte-predominant FNAB specimens were lymphoma on final histologic assessment. Ten (20%) of 49 patients with history of a solid, non-head and neck malignancy had evidence of distant metastasis to the salivary gland by histologic and/or cytopathologic assessment. An FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of final histologic diagnosis. The predictive value of a negative FNAB finding is low, and should not supersede clinical suspicion. Cytologic findings of a lymphocyte-predominant lesion should prompt further workup to rule out lymphoma.

The value of fine-needle aspiration biopsy in salivary gland tumors

The aim of the study was to evaluate the utility of fine-needle aspiration biopsy (FNAB) in the salivary gland pathologies and to assess its capacity to provide accurate diagnosis and decide whether surgery is needed.A retrospective study: From April 1995 through November 2000, fine-needle aspiration biopsies (FNAB) were performed on 63 patients with salivary gland tumors; 4 of FNABs were inadequate. Of the remaining 59 FNAB diagnoses, 47 were checked histologically.Regarding the capacity to disseminate between malignant and benign tumors and non-neoplastic tumors, FNAB correctly diagnosed 39 lesions (39 true negative and 4 true positive and failed in one case). Our experience demonstrates the sensitivity rate of 80%, specificity of 92.86%, the positive predictive value of 57.14%, negative predictive value of 97.50% and the accuracy rate of 91.49%. The concurrence between cytologic diagnosis and subsequent histologic diagnosis was 82.98%. Patients of 17.02% were inconcurrent.FNAB is still valuable in the rapid diagnosis, staging, treatment and follow-up of patients with salivary gland masses.

Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules.

The purpose of the present study was to determine the role of repeat fine-needle aspiration biopsy (FNAB) in the evaluation of thyroid nodules initially classified as "nondiagnostic" due to limited cellularity or as "indeterminate for neoplasm." We reviewed a cohort of 431 patients (352 females, 79 males; average age 50 yr); 237 patients were classified as "nondiagnostic" due to limited cellularity and 194 as "indeterminate for neoplasm" over a 3-yr period (1999-2002). Repeat FNAB under ultrasound guidance was performed in 226 patients (226/431, 52%); surgical pathology results were available in 101 patients. Repeat FNAB diagnoses were: benign 70 (31%), follicular/Hürthle cell neoplasm 62 (27%), suspicious for papillary carcinoma 25 (12%), malignant 17 (7%), and nondiagnostic 52 (23%) cases. Surgical follow-up was available in 101 (45%) patients; malignancy was identified in 50 (49%) patients. The malignancy rate was 51% and 48% in cases in which initial FNAB was nondiagnostic and indeterminate for neoplasm, respectively. There were no false-positives and all malignant cases undergoing surgery were found to be malignant. This study demonstrates that repeat FNAB is warranted in patients with thyroid nodules diagnosed on initial FNAB as nondiagnostic and indeterminate for neoplasm since it can yield a definitive diagnosis in the majority of cases with an overall malignancy rate of 49%.

Punção aspirativa por agulha fina em tumores cervicais

Introdução: Inúmeras são as patologias que podem se apresentar inicialmente como uma lesão em região cervical, o que torna o seu diagnóstico nem sempre simples. A punção aspirativa por agulha fina (PAAF) é um método simples, seguro e eficaz no sentido de auxiliar o diagnóstico de tumorações cervicais. Objetivo: Avaliar o desempenho diagnóstico da PAAF em lesões cervicais realizadas no Serviço de Otorrinolaringologia (SORL) do Hospital de Clínicas de Porto Alegre (HCPA). Forma de estudo: retrospectivo, clínico, não randomizado. Material e método: Foi realizado um estudo retrospectivo dos pacientes que foram submetidos a PAAF no SORL do HCPA entre julho de 1998 e dezembro de 1999. Foram excluídos pacientes¹submetidos à PAAF de tireóide² com dados incompletos³ que perderam acompanhamento4 que não tinham diagnóstico definitivo da lesão. Os resultados das PAAF foram comparados com o diagnóstico definitivo, sendo este estabelecido por exame anatomopatológico (grupo I) ou por evolução clínica e/ou outros exames (grupo II). Resultados: Dos 70 pacientes incluídos no estudo, 7% apresentaram punções insatisfatórias e, dentre os materiais satisfatórios, houve 88,6% de acerto diagnóstico. No grupo I encontramos 8% de punções insatisfatórios e 88,2% de acerto diagnóstico. Já no grupo II os mesmos dados foram, respectivamente, 6% e 87,1%. O índice total de acerto, incluindo as punções insatisfatórias chegou a 81,5%. Discussão: Os resultados encontrados corroboram os altos índices de acerto diagnóstico das PAAF descritos na literatura, confirmando ser este um método de grande auxílio no diagnóstico de tumorações cervicais. Assim, nos sentimos encorajados a seguir utilizando de forma rotineira tal técnica.

Fine-needle aspiration biopsy in diagnosis of follicular lymphoma: cytomorphologic and immunohistochemical analysis.

Follicular lymphoma is a relatively uncommon type of non-Hodgkin's lymphoma (NHL) thought to derive from follicular center cells. There are limitations to fine-needle aspiration in the diagnosis of follicular NHL, and very few studies are available on it. We describe here the cytomorphologic features of eight biopsy-proven cases of follicular NHLs and five biopsy-proven cases of intermediate-grade NHLs. Five cases of reactive lymphoid hyperplasia (RLH) diagnosed on cytology were also studied cytomorphologically. Image morphometry was done in follicular and intermediate-grade NHLs, immunocytochemistry was done in follicular and intermediate-grade NHLs, and immunocytochemistry for bcl-2 expression was studied in five cases of follicular NHLs. The aspirate smears of follicular NHL showed the presence of higher grades, many to abundant (++ to +++) monomorphic lymphoid aggregates, with an increased number of mast cells. Lymphohistiocytic tangles and tingeable body macrophages were not observed in any of the cases. Cytomorphologically, all the cases of intermediate-grade NHL showed a predominantly monomorphic population of lymphoid cells with absent or few grades (+) of lymphoid aggregates. Image morphometric data analysis of each cell parameter for follicular and intermediate-grade NHLs were found to be statistically insignificant (P > 0.05) and hence of little help in diagnosis of follicular vs. low-grade NHLs. Immunocytochemistry for bcl-2 expression in follicular NHL showed variable results, ranging from 0-90% (expressed as bcl-2 index). Certain characteristic cytomorphological features such as the presence of monomorphic lymphoid cell aggregates and an increased number of mast cells are soft indicators for the diagnosis of follicular NHL on aspiration smears. Immunocytochemistry for bcl-2 expression may be of help in cases with clinical and cytological suspicion of lymphoma. Image morphometry has a small role in this regard.

Fine-needle aspiration biopsy diagnosis of "invasive" temporomandibular joint pigmented villonodular synovitis.

The clinical and aspiration cytologic details of a case of temporomandibular joint pigmented villonodular synovitis are presented and correlated with imaging, surgical, histopathologic, and clinical follow-up findings; the origin of such lesions is discussed. The lesion originally presented in a 36-year-old, otherwise healthy, white man as a unilateral mass involving the temporal fossa and temporomandibular joint region. The tumor's extent was defined by magnetic resonance imaging and computed tomographic scan; there was destruction of the temporomandibular joint and erosion of the temporal cranial bones by a lesion whose maximum dimensions were estimated by imaging to be 2.75 x 3.25 cm. The lesion was initially sampled and classified by computed tomography-guided fine-needle aspiration biopsy. Following complete resection, the original diagnosis was confirmed with both hematoxylin-eosin-stained paraffin sections and immunohistochemical staining. The patient remains free of disease 7 years postoperatively.

Fibroadenomas with atypia: causes of under- and overdiagnosis by aspiration biopsy.

Fibroadenoma (FA) is a common benign breast lesion frequently sampled by fine-needle aspiration biopsy (FNAB). Although the cytologic diagnosis is straightforward in most cases, cellular discohesion and atypia in FAs may lead to falsely atypical or positive FNAB diagnoses. Conversely, some adenocarcinomas mimic a fibroadenomatous pattern on FNAB, resulting in a false-negative diagnosis. We reviewed the cytologic and histologic findings in 25 cases with a preoperative FNAB diagnosis of FA, wherein excision was recommended based on atypia. Our aim was to analyze the spectrum of changes causing under- or overdiagnosis in such cases. The smears were assessed for cellularity, cellular discohesion, presence of dissociated intact cells and nucleoli, nuclear pleomorphism, oval bare nuclei, and stromal fragments. The histologic findings were correlated with FNAB features. At excision, 88% of FAs classified as atypical on FNAB were benign (FA with ductal hyperplasia and lactational change, myxoid FA, and other fibroepithelial lesions). Differentiating myxoid FA from colloid carcinoma was difficult due to the abundance of extracellular mucin in which the dissociated epithelial cells were floating. Two (8%) cases were carcinomas on excision; the reasons for underdiagnosis in one case reflected sampling, and in the other, interpretative error. There was one (4%) benign phyllodes tumor which lacked stromal fragments and single stromal cells on FNAB smears. The lesion was called atypical, based on the epithelial discohesion on the smears. We conclude that the majority of FAs with atypia on FNAB are benign lesions. Considering the grave consequences of a false-positive cytologic diagnosis, we recommend a conservative approach in interpreting FNAB smears which overall display a fibroadenomatous pattern.

Fine-needle aspiration biopsy diagnosis of gastrointestinal stromal tumors using morphology, immunocytochemistry, and mutational analysis of c-kit.

Differentiating gastrointestinal stromal tumors (GISTs) from other intramural mesenchymal tumors of the GI tract on fine-needle aspiration biopsies (FNABs) is difficult. Recent studies have shown that GISTs are immunophenotypically and genetically distinct. GISTs exhibit consistent immunohistochemical expression of CD-117 (KIT) and often express activating mutations of this protooncogene. The aim of the current study was to employ immunocytochemistry and mutational analysis of the c-kit gene to aid in the diagnosis of GISTs on FNAB. Five endoscopic ultrasound-guided FNABs of gastrointestinal spindle cell neoplasms performed at the Veterans Affairs Medical Center (VAMC) in Portland, Oregon, from 1998-1999 were reviewed. A panel of immunocytochemical stains was performed on each cellblock including CD-117 (KIT), smooth muscle actin (SMA), desmin, S-100, and CD34. Genomic DNA (gDNA) was extracted, and amplification of exons 9, 11, 13 and 17 of c-kit was performed by polymerase chain reaction (PCR) on CD-117 (KIT) and CD34 positive cases. Direct sequencing of amplicons identified the mutations. Five patients were diagnosed with GISTs based on morphology and immunocytochemical positivity for CD-117 and CD34. PCR analysis of c-kit exon 11 revealed three cases with novel-sized PCR bands in addition to the expected wild-type-sized PCR product. Amplicons from these cases contained an in-frame deletion mutation. One of the two cases with wild-type-;sized exon 11 amplicons was found to be heterozygous for a point mutation producing an amino acid substitution (W557R). No mutations in exon 9, 11, 13, or 17 of c-kit were found in the remaining case. Ancillary techniques such as immunocytochemistry and c-kit gene mutational analysis may aid in the diagnosis of GISTs on FNABs.

Fine Needle Aspiration Cytology in Lymphadenopathy of HIV-Positive Cases

To evaluate the role of fine needle aspiration biopsy (FNAB) material in 25 HIV-positive cases with lymphadenopathy. We selected 25 cases for the present study who were enzyme-linked immunosorbent assay positive for HIV (HIV-1). FNAB was performed as a routine, outdoor procedure with informed consent of the patient. For each case, along with routine May-Grünwald-Giemsa and hematoxylin and eosin staining, Ziehl-Neelsen staining for acid-fast bacilli and periodic acid-Schiff staining for fungi were performed wherever necessary. A total of 28 sites were aspirated from 25 HIV patients. All these patients were heterosexual, and none had a history of drug abuse. FNAB was performed under ultrasound guidance in all four cases of a retroperitoneal group of lymph nodes. The most common FNAB diagnosis was reactive lymphoid hyperplasia (10), followed by tuberculosis (8). There were three cases diagnosed as fungal infection (two, Cryptococcus; one, histoplasmosis). FNAB of a case of lymph node was suggestive of tuberculosis. There was one case each diagnosed as non-Hodgkin's lymphoma and squamous cell carcinoma (metastatic). One case of a small axillary lymph node did not yield representative material. FNAB is a relatively inexpensive initial investigative technique in the diagnosis and management of HIV-positive patients. It can obviate the need for surgical excision and enable immediate treatment of specific infections.

Fine-Needle Aspiration Biopsy in the Diagnosis and Classification of Primary and Recurrent Lymphoma: A Retrospective Analysis of the Utility of Cytomorphology and Flow Cytometry

We retrospectively reviewed our experience with the fine-needle aspiration biopsy (FNAB) diagnosis of primary and recurrent lymphoma to assess the ability of cytomorphology with and without ancillary flow cytometry (FCM) analysis to diagnose and subclassify these tumors according to the Revised European-American Lymphoma/World Health Organization classifications. We reviewed 139 consecutive FNABS of 84 primary and 55 recurrent lymphomas. FCM was successful in 105 (75%) cases. The overall results, including cases without FCM, included 93/139 (67%) true positive, 7 (5%) false negative, and 39 indeterminate (27 [19%] suspicious and 12 [9%] atypical) diagnoses of lymphoma. In cases with FCM, there were 80/105 (77%) true positive, no false negative, and 25 indeterminate diagnoses (15 [14%] suspicious and 10 [9%] atypical). The overall results of the 84 primary lymphomas were 55 (67%) true positive, 5 (5%) false negative, and 24 indeterminate (14[16%] suspicious and 10 [12%] atypical) diagnoses for lymphoma. Of the 68 primary lymphomas analyzed with FCM, 50 [74%] were true positives, and 28 were indeterminate (11 [16%] suspicious and 7 [10%] atypical). There were no false negatives. Diagnostic accuracy varied among lymphoma subtypes. Subclassification of the positive cases were initially conclusive in only 55/93 cases (59%). However, a retrospective review of the morphologic together with FCM data in 15 of the 23 unclassified cases improved the overall subclassification of positive cases to 77%. Subclassification was best in small lymphocytic lymphoma/chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, Burkitt's lymphoma, mantle cell lymphoma, and plasmacytoma (all 100%). Subclassification was poor in marginal-zone lymphoma (33%), and initially as well in diffuse large B-cell lymphoma (62%), but it improved on review (95%), as did subclassification of follicular lymphoma (77 to 100% on review). Hodgkin's disease was recognized as malignant in only 44% of the cases (7/16) and was classified as such based on morphology alone.This review of our early efforts to diagnose and subclassify lymphoma with FNAB and FCM indicates that although a diagnosis and proper subclassification of lymphoma can be made with certainty in the majority of cases, recurrent or primary, it requires close coordination of cytomorphology and immunophenotyping data, which often comes with close cooperation of cytopathologists and hematopathologists. A mere cytological diagnosis of positive for lymphoma is no longer acceptable if FNAB is to become an independent diagnostic tool for lymphoma.

Accuracy of fine-needle aspiration of thyroid.

Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.-Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982-1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.

Fine-needle aspiration biopsy of bronchioloalveolar carcinoma

The purpose of the current study was to determine the accuracy of the cytologic diagnosis of bronchioloalveolar carcinoma (BAC) by fine-needle aspiration biopsy (FNAB). During a 4-year period (1994-1998), 1664 lung FNABs were performed. Forty-nine patients with BAC diagnosed by FNAB and/or surgical biopsy formed the basis of this study. Twenty-four patients diagnosed with BAC by FNAB had histologic confirmation. Surgical pathology revealed BAC in 15 patients with a cytologic diagnosis of large cell carcinoma (LCA) or adenocarcinoma (ACA). Nine patients diagnosed with BAC by FNAB were found to have ACA histologically. One unsatisfactory aspirate was diagnosed as BAC by surgical pathology. Review of 15 FNAB specimens with a diagnosis of LCA or ACA revealed cytologic features typical of BAC. In six aspirates, additional features such as pronounced nuclear crowding and overlapping, variation in nuclear size, and increased number of pleomorphic cells interfered with the FNAB diagnosis of BAC. Nine FNABs with a diagnosis of BAC were found histologically to have ACA with a focal BAC growth pattern. One unsatisfactory FNAB aspirate diagnosed as BAC histologically was due to sampling error. A diagnosis of BAC by FNAB is possible using conventional cytologic criteria. Some BACs show pronounced nuclear crowding and overlapping, variation in nuclear size, and an increased number of pleomorphic cells cytologically, which may interfere with an FNAB diagnosis of BAC. FNABs from ACA cases with a focal BAC pattern remain a diagnostic dilemma due to the nature of the lesion. In addition, sampling error by FNAB can be a diagnostic pitfall. Cancer (Cancer Cytopathol)

Fine Needle Aspiration Biopsy of Azoospermic Testes

To evaluate the possibility of replacing histologic biopsy of azoospermic testes by fine needle aspiration (FNA) for diagnostic and management purposes. Twenty-seven patients were examined under general anesthesia, and 53 testes were biopsied by FNA. Fifty-four testes were biopsied for histologic examination. Histology and cytology of each testis were compared to assess the discrepancy or concordance between the diagnoses. Twenty-seven testes showed complete concordance of cytology and histology, and 13 testes showed a mild degree of discrepancy. A severe degree of discrepancy was seen in 13 testes. In the majority of discrepant cases, FNA biopsy diagnosis was more sensitive in detecting evidence of full or advanced maturation. In one case of discrepancy, the histologic finding was Sertoli cells only, and cytology revealed focal full maturation. In vitro fertilization using sperm from this case was successful. FNA biopsy of testes in azoospermia is a fast, reliable and minimally traumatic method. The prospects for utilizing FNA biopsy material in assisted and microassisted fertilization are promising.

The role of fine-needle aspiration biopsy in the primary diagnosis of mesenchymal lesions: a community hospital-based experience.

The objective of this study was to determine the utility of fine-needle aspiration biopsy (FNAB) in the primary diagnosis of mesenchymal lesions. A total of 162 cases with a diagnosis of benign or malignant mesenchymal lesion (excluding lipoma) on FNAB were retrieved from the cytopathology archives for the years 1990-1997. Patients selected for inclusion in this study underwent FNAB as the primary diagnostic modality without a previous tissue diagnosis and had a subsequent surgical procedure for definitive histologic correlation. Seventy-two patients were selected on the basis of the above criteria. Cytologic diagnoses were categorized as benign, malignant, or suspicious for malignancy. Among the 72 cases selected, 42 (58%) benign, 18 (25%) malignant, and 12 (16%) suspicious diagnoses were rendered. Of the patients with benign FNAB diagnoses, 39 of 42 (93%) had a benign lesion on histologic follow-up, and 3 of 42 (7%) had a malignancy. Of the patients with malignant FNAB diagnoses, 17 of 18 (94%) had a malignant lesion and 1 of 17 (6%) proved to be benign. In the subset of suspicious lesions, subsequent histology was benign in 5 of 12 (42%) and malignant in 7 of 12 (58%). Based on our study, FNAB has excellent accuracy (88%), sensitivity (89%), and specificity (87%) for classifying a mesenchymal tumor as benign or malignant. FNAB can be a rapid and effective tool for the primary categorization of mesenchymal lesions and provide reliable information to the clinician for triage of patients.

Fine-needle aspiration cytopathology in diagnosis and classification of malignant lymphoma: accurate and reliable?

Diagnosis of malignant lymphoma by fine-needle aspiration biopsy (FNAB) remains a topic of skepticism and controversy. Because of the limitations of pure morphology, subclassfication of non-Hodgkin malignant lymphoma (NHML) by FNAB often requires ancillary studies which impose a challenge not typically required of other FNAB diagnoses. Despite the dubiousness expressed by many, the evidence shows that a large percentage of NHML cases can be recognized and correctly classified using FNAB. Diagnostic accuracy is dependent on several factors including the type of NHML. The emergent WHO classification of lymphomas is one that appears to more readily accommodate the cytologic methods for NHML diagnosis.

Aspiration cytopathology of malignant lymphoma

The cytopathologic diagnosis of malignant lymphoma using fine-needle aspiration biopsy (FNAB) is challenging but possible using the Revised European–American Classification of Lymphoid Neoplasms and ancillary diagnostic techniques. Cytopathologists need to familiarize themselves with the cytomorphology, immunophenotype, genotype, and clinical features of this classification system and thoughtfully apply these ancillary techniques to the FNAB diagnosis of malignant lymphoma.. See also pages 325-45

Fine-needle aspiration biopsy of intraosseous jaw lesions

Purpose: This study assessed diagnostic accuracy, determined reasons for error, and evaluated modifications to improve the reliability of fine-needle aspiration biopsy (FNAB) of primary jaw lesions. Patients and Methods: This was a retrospective review of 32 FNABs of intraosseous jaw lesions performed at the Massachusetts General and Children's Hospital between 1993 and 1998. A consistent, standardized technique was used, and each case was evaluated for 1) adequacy of cells to allow diagnosis, 2) presence of malignant cells, and 3) correlation between FNAB diagnosis and the final histopathology. Results: Material obtained by FNAB was adequate for evaluation in 30 of 32 cases. No complications were reported. Malignant cells were found in 5 of 30 cases. FNAB diagnosis was confirmed by histopathology in all 5 of these specimens (100% accuracy). The FNAB diagnosis of benign lesions was confirmed in 17 of 25 cases (68%). The most common benign lesions were odontogenic cysts, ameloblastomas, and fibro-osseous and giant cell lesions. Incorrect diagnosis was related to lack of architectural context of the FNAB material, sampling of a nonrepresentative part of a large lesion, and inadequate quantity or quality of the aspirate. Conclusions: FNAB is a useful technique to distinguish between malignant and benign intraosseous jaw lesions. Its simplicity, suitability as an outpatient procedure, rapidity of interpretation, and minimal morbidity potentially make it the diagnostic tool of choice in the hospital setting.

Fine-needle aspiration biopsy diagnosis of small round cell tumors of childhood: A comprehensive approach.

Fine-needle aspiration biopsy findings in small round cell malignant tumors of children are briefly reviewed. All of these tumors usually have characteristic cytomorphology which, when recognized, may lead to a definitive diagnosis. However, when these tumors are undifferentiated, morphologic criteria may not be sufficient for arriving at a correct diagnosis. A variety of ancillary studies including electron microscopy, immunohistochemistry and DNA ploidy, cytogenetics, and fluorescent in situ hybridization may provide valuable additional information for precise characterization of these neoplasms. Some of the ancillary studies may also be used for assigning these cases to prognostically significant subgroups. This information may also help in defining the most suitable chemotherapeutic regimens for these tumors. Since most of these special studies require only a small amount of cellular material, fine-needle aspiration biopsy is ideally suited for obtaining samples for these procedures. It is hoped that as cytogenetic and molecular techniques become available in many diagnostic laboratories, a comprehensive evaluation of aspiration biopsies from round cell malignant tumors, encompassing a precise pathologic diagnosis, determination of prognosis, and prediction of response to therapy, will be possible in a majority of cases. Diagn. Cytopathol. 1999;21:81-91.

Diagnostic Reliability of Combined Approach of Physical Examination, Mammography and Fine Needle Aspiration Biopsy in Patients with Breast Cancer

Breast cancer is a common malignancy in females. For that reason the disease has to be suspected when one encounters a solid mass in the breast. Until recently in order to find out the actual nature of the lump both excisional biopsy and histopathologic examination were thought to be essential. Nowadays fine-needle aspiration biopsy (FNAB) is performed to evaluate the solid mass in the breast and by using this technique individual characteristics of each cell can lead to diagnosis. But it is reported that erroneous diagnosis is more common with FNAB than with excisional biopsy and histopathologic examination. Despite the recent advances in diagnostic techniques physical examination is still the first step in breast cancer diagnosis and it is the most widely used method. Mammography and FNAB should follow. However the accuracy rate of mammography alone is especially low for the evaluation of small masses. Therefore FNAB has become of use as an important adjunctive diagnostic procedure and it is used along with physical and mammographic examinations. Some authors report that the rate of correct diagnosis rises sometimes up to 100% when these three methods are applied together. The aim of the present study is to detect the diagnostic reliability of a combined approach with physical examination mammography and FNAB in patients with breast cancer. (excerpt)