Fine-needle Aspiration Biopsy Of Nodules Research Articles

Current approach to detecting neck recurrences in patients with differentiated thyroid cancer: role of neck lymph node fine-needle aspiration biopsy

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Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen

We evaluated the efficacy of abdominal ultrasound (US) and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in acquired immunodeficiency syndrome (AIDS). Twelve AIDS patients (nine male, three female; age range, 22-43 years) with DM underwent abdominal US within 2 days after admission with 3.5- to 5-MHz convex probes and a 7.5-MHz linear probe. All patients underwent FNAB of one or two enlarged abdominal lymph nodes. Eight patients underwent FNAB of the spleen. The aspirated specimens were stained with acid fast for quick examination and cultured for isolation of mycobacteria. Abdominal US showed enlarged, hypoechoic, round or oval, abdominal lymph nodes (diameter, 10-35 mm; mean, 18 mm) in all patients; splenomegaly (spleen diameter, 14-22 cm; mean, 16.8 mm) in all patients; numerous splenic abscesses (diameter, 3-20 mm) in nine patients; hepatomegaly (right hepatic lobe thickness, 14.5-17 cm) in all patients; small intestinal wall thickening in five patients (maximum bowel wall thickness, 7-15 mm); mild to moderate ascites in six patients; pleural effusion in four patients; bilateral enlargement of the kidneys with hyperechogenicity of the cortex in three patients; and a retroperitoneal tubercular abscess in one patient. No complication occurred after FNAB of lymph nodes and spleens. Fast-acid stain of spleen and/or lymph node FNAB specimens allowed early diagnosis of mycobacteriosis in 12 of 12 cases (100%). Cultures of lymph node aspirates grew mycobacteria in six of 12 patients (50%). Spleen aspirates grew mycobacteria in nine of nine patients (100%). Blood cultures were positive in four of 12 patients (33%). Mycobacterium tuberculosis was diagnosed in six patients and M. avium in five. Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymph node FNAB indicated the specific diagnosis in 100% of patients.

Usefulness of Light Microscopy in Lymph Node Fine Needle Aspiration Biopsy

To evaluate light microscopic examination of lymph node fine needle aspiration biopsy (FNAB) in order to determine the indications for ancillary procedures and biopsy. Reports and smears from 693 consecutive lymph node FNABs were reviewed. Fifty-five cases were excluded because of inadequacy of the material, and another 26 were excluded because follow-up information was not available. Cytologically, 220 cases were diagnosed as positive for malignancy and 392 as negative. Global sensitivity was 94.1% and specificity 96.9%. Sensitivity was higher for nonlymphoid neoplasms (98.2%) than for lymphoproliferative disorders (82.8%). Lymph node FNAB is a cost-effective procedure, and with adequate cytologic examination and follow-up, a large number of biopsies and time-consuming ancillary techniques can be avoided.

Diagnosing Kikuchi Disease on Fine Needle Aspiration Biopsy

To study the accuracy of fine needle aspiration (FNA) diagnosis of Kikuchi lymphadenitis (KL). Retrospective review of all cases of FNA biopsy of lymph nodes in which KL was diagnosed or suggested. False positive cases were studied. Cases of KL diagnosed by histopathology were examined for the false negative rate of FNA diagnosis. Forty-four cases of KL diagnosed or suggested by FNA were found. Five of eight cases were confirmed on lymph node excision. The false positive rate was 37.5%. One case was nonspecific reactive changes. Two cases were proven to be tuberculous lymphadenitis by culture. Eight cases of KL diagnosed by lymph node excisional biopsy had prior FNA. Four were diagnosed as or suspected to be KL. The false negative rate was 50%. The overall accuracy of FNA diagnosis of KL was 56.25%. Detailed study offalse positive cases and knowledge of other conditions suggested that overreliance on certain cytologic features and the morphologic erlap between KL and tuberculous lymphadenitis could have been the reasons for the inaccuracies.

Usefulness of Ultrasonography in the Management of Nodular Thyroid Disease

Fine-needle aspiration biopsy is the standard diagnostic test for evaluating possible malignancy in a thyroid nodule. To evaluate the role of routine ultrasonography in the management of nodular thyroid disease. Retrospective chart review. Multidisciplinary thyroid nodule clinic (endocrinology and radiology). Patients with suspected nodular thyroid disease or suspected recurrent thyroid cancer referred between October 1995 and March 1997. All patients had thyroid ultrasonography and ultrasonography-guided fine-needle aspiration biopsy of nodules at least 1 cm in maximum diameter. Medical records, ultrasonography findings, cytology reports, and histologic reports were reviewed. Ultrasonography findings were compared with the referring physician's findings on physical examination. 223 patients were seen in the clinic. A total of 209 fine-needle aspiration biopsies were performed on 156 patients. Among 50 of 114 patients referred for a solitary nodule, ultrasonography detected additional nonpalpable nodules at least 1 cm in diameter in 27 and determined that no nodules required aspiration in 23. Of 59 patients referred for a diffuse goiter or a multinodular gland, ultrasonography detected discrete nodules at least 1 cm in diameter that required aspiration in 39 and determined that aspiration was unnecessary in 20. Ultrasonography altered the clinical management for 63% of the patients (109 of 173) referred to the thyroid nodule clinic after abnormal results on thyroid physical examination.

Correlation of the ratio of CD4+/CD8+ cells in lymph node fine needle aspiration biopsies with HIV clinical status. A preliminary study.

To test the hypothesis that lymph node (LN) fine needle aspiration biopsy (FNAB) may provide reliable measures of human immunodeficiency virus (HIV) disease status. HIV+ participants in this study had persistent generalized lymphadenopathy without clinical evidence of lymphoma or nodal infections due to organisms other than HIV. Seven males and five females ranging in age from 23 to 55 and at HIV Centers for Disease Control (CDC) stages A2-C3 were enrolled in this study. From each participant, LN and blood samples were submitted for cytologic examination and flow cytometric analysis of lymphocyte subsets. Flow cytometry measures included T, B, CD4+, CD8+ and natural killer (NK) cells. The percentages of T, B and NK cells in LN and blood samples were different and reflected the expected distribution of these cell types in the respective tissues. The percentages of CD4+ and CD8+ cells in blood and LN were different, but this variation was not statistically significant. In contrast, the ratio of CD4+/CD8+ cells in LN and blood was different and statistically significant (P < .001) for patients in CDC categories A2-B2 but not different for categories B3-C3. More important, there was a significant (r = .76) correlation between the ratio of CD4+/CD8+ cells in LN with CDC stage. FNAB, in combination with flow cytometry, may prove to be an important tool in HIV clinical staging. However, further assessment, including clinical follow-up and participation of additional patients, is necessary and currently under way.

Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes.

The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has made fine-needle aspiration biopsy (FNAB) under direct endosonographic guidance possible. Because the imaging and instrumentation planes overlap, the operator can visualize a biopsy needle lengthwise as it enters the sector-shaped sound field. We performed EUS-guided FNAB of lymph nodes in seven patients who met the following criteria: (1) Lymph node size over > 1 cm; (2) no endoscopic or endosonographic evidence for tumor involvement of bowel wall interposed between the lymph node and the transducer; and (3) absence of coagulopathy or thrombocytopenia. A positive tissue yield was obtained in six patients, of whom five had malignant cells identified on cytology. The patient with an inadequate yield had a dry aspirate, possibly related to prior irradiation treatment for esophageal carcinoma. No procedure-related complications were observed. We conclude that EUS-guided FNAB of lymph nodes is technically feasible, provides a high diagnostic yield, and appears to be safe. Further studies to determine the sensitivity and specificity of this novel procedure are warranted.

Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy.

The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biopsy of nodes with a small axis of 5 mm or greater was performed. Supraclavicular metastases were detected on CT scans in 11 of 13 patients (85%) and on US scans in 14 of 16 patients (88%) but were palpable in only three of the 16 patients (19%). The predictive value of a supraclavicular node indicating metastases was .74 at US and .85 at CT. Metastases were diagnosed in 10 of 46 patients with squamous cell carcinoma (22%) and five of 50 patients (10%) with adenocarcinoma. Nodes with metastases had a round configuration, with a statistically significant greater short-axis to long-axis ratio than that of benign nodes (0.89 vs 0.54; P = .05). In four of 16 patients (25%) with supraclavicular metastases proved with cytologic examination, neither CT nor US of the mediastinum and abdomen showed enlarged nodes.

Experience with modified chiba needle in staging of genitourinary tumors

The features of a new needle used in the percutaneous pelvic node fine-needle aspiration biopsy in 56 patients with urologic neoplasms are described. The side openings on either side of the needle walls and the bevel angle lowered to 15 degrees provide excellent penetration and aspiration ability. Representative specimens were obtained from all patients, and the accuracy of aspiration biopsy results in determining true stage of disease was 94.64 per cent. These data provided sufficient evidence of the efficiency of our needle to recommend it for use in TNM classifications of urologic tumors.