Nondiagnostic Samples Research Articles

Ultrasound-Guided Percutaneous Fine-Needle Aspiration of 545 Focal Pancreatic Lesions

The purpose of this study was to assess the accuracy and short-term complication rate of ultrasound-guided fine-needle aspiration cytologic sampling of focal pancreatic lesions. We reviewed 545 consecutive ultrasound-guided fine-needle aspiration cytologic sampling procedures for focal pancreatic lesions from January 2004 through June 2008. The procedures were performed with a 20- or 21-gauge needle. The onsite cytopathologist evaluated the appropriateness of the sample and made a diagnosis. We reviewed the final diagnosis and the radiologic and medical records of all patients for onset of complications during or within 7 days of the procedure. The study sample included 262 women and 283 men (mean age, 62 years; range, 25-86 years). The head or uncinate process of the pancreas was the location of 63.0% of the lesions, and 35.2% of the lesions were located in the body or tail of the pancreas. The site of 10 lesions (1.8%) was not specified. Sampling was diagnostic in 509 of the 545 cases (93.4%). Excluding the 36 nondiagnostic samples, ultrasound-guided fine-needle aspiration cytologic sampling had 99.4% sensitivity, 100% specificity, and 99.4% accuracy. In 537 of the 545 cases (98.5%), the procedure was uneventful. In two cases, abdominal fluid was found after the procedure that was not present before the procedure. Six patients experienced postprocedural pain without abnormal findings at subsequent imaging. No major complications occurred. Ultrasound-guided cytologic sampling is safe and accurate for the diagnosis and planning of management of focal pancreatic lesions. With a cytologist on site, the rate of acquisition of samples adequate for diagnosis is high, reducing the need for patient recall.

CT-guided percutaneous core biopsy of deep face and skull-base lesions

To evaluate the diagnostic accuracy of deep face and skull-base computed tomography (CT)-guided core biopsy. Seventeen patients underwent CT-guided percutaneous core biopsies of deep face and skull-base lesions. One biopsy was repeated due to a non-diagnostic sample so 18 biopsy procedures were evaluated. The 17 lesions were centred within the central skull base (n=2), parapharyngeal (n=3), retropharyngeal spaces (n=4), masticator (n=3), pterygopalatine fossa (n=1), and deep lobe of parotid (n=4). Subzygomatic (n=7), retromaxillary (n=9), suprazygomatic (n=1), and transparotid (n=1) needle approaches were used. The diagnostic accuracy was either assessed by a positive histological result from the operative specimen or based on treatment response and clinical follow-up. No immediate or delayed procedural complications were encountered. A histological diagnosis was obtained in 16 of the 18 biopsies (89% diagnostic yield). The pathological diagnosis was confirmed by surgical excision (5/18 biopsies) and by predicted treatment response or clinical follow-up (10/18 biopsies). Diagnosis could not be confirmed for three of the 18 biopsies. The diagnostic accuracy of core biopsy was 13 of 15 (87%) for all samples. CT-guided percutaneous deep face core biopsy is a safe technique with good diagnostic accuracy, allowing diagnosis of benign disease and classification of malignant disease.

Non-thyroid neck lumps: appraisal of the role of fine needle aspiration cytology

To compare the non-diagnostic rate of fine needle aspiration cytology (FNAC) of non-thyroid neck lumps performed under ultrasound (US) guidance against non-guided FNAC (performed in outpatient clinic). Final histology results were compared with cytological diagnosis. We performed a retrospective study of 625 patients identified as having undergone FNAC of non-thyroid neck lumps from the pathology/radiology databases over a 3 year period. A total of 396 patients underwent non-ultrasound guided FNAC (12 excluded). 34% of patients had a non-diagnostic sample. A total number of 229 patients underwent ultrasound guided FNAC with a non-diagnostic rate of 12%. The Chi-squared test showed a significant difference (P < 0.001). FNAC results were compared with definitive histology in 238 patients. Sensitivity was 92% and specificity was 90%. US-guided FNAC resulted in a lower non-diagnostic rate. FNAC was highly sensitive for diagnosis of malignant lumps but less good at confirming a lump to be benign.

Value of rapid assessment cytology in the surgical management of head and neck tumors in a Nigerian mission hospital

Fine-needle aspiration (FNA) or touch preparation with rapid assessment is a valuable diagnostic tool with a reported accuracy of diagnosis similar to intraoperative frozen section consultation. The Nigeria Christian Hospital partners with health care professionals from the United States to provide surgical care for rural residents of Aba, Nigeria. Frozen section diagnosis is impractical in this setting because of very limited resources. Therefore, intraoperative rapid assessment FNA or touch preparation to guide surgical management was performed on all mass lesions, and the results were evaluated. FNA was performed just before surgery using a 22-gauge needle attached to a 10-mL syringe and/or an intraoperative touch preparation was performed on biopsies of lesions that failed to yield cellular aspirates. Smears were prepared and stained with hematoxylin and eosin, and an immediate diagnosis was rendered. Tissue samples from the same resected/biopsied cases were fixed in 10% formalin and later transported to Vanderbilt University Medical Center Department of Pathology for processing. Cytologic and histologic correlations were then performed. More than 100 patients underwent surgery for head and/or neck masses during the 2-week periods between November 2002 and November 2003. Of these patients, 98 had either preoperative FNA and/or intraoperative touch preparation performed. Twenty-seven patients were male and 71 were female; the ages ranged from 2 months to 70 years. Sites sampled included the following: thyroid (n = 40); facial/jaw area (n = 19); parotid/submandibular gland (n = 13); scalp/skull region (n = 7); cervical lymph nodes (n = 5); neck (n = 5); other (n = 4); supraclavicular lymph nodes (n = 3); and oral cavity (n = 2). On cytologic analysis, there were 79 benign diagnoses, 17 malignant diagnoses, and 2 nondiagnostic samples. A benign versus malignant cytologic diagnosis was accurate in 97 of 98 cases. In conclusion, rapid assessment cytology was invaluable in the surgical treatment of many of the patients.

Fine needle aspiration cytology of thyroid nodules at Kenyatta National Hospital, Nairobi

To determine the pattern of thyroidal nodules diagnosed by (FNA) cytology. A cross-sectional study. Kenyatta National Hospital (KNH)--a University of Nairobi affiliated hospital. Forty two patients seen at FNA clinic at KNH between June and August 2001. The female to male ratio was 7:1, with the majority in the age group 31-50 years. Overall 88.1% patients had benign FNA cytologic diagnostic results, 2.4% had a malignant, and a suspicious result respectively and 7.1% were non-diagnostic. Cytological results were as follows, nodular goiter comprised 83.3%, non-diagnostic samples 7.1%, papillary carcinoma 2.4%, atypia 2.4%, thyroglossal cyst 2.4%, and thyroiditis 2.4%. The findings are comparable in terms of sex, age and FNA cytologic diagnostic results to other studies. FNA cytology offered clinicians the possibility of early diagnosis of benign (>70%) and malignant (<5%) lesions. The test was an out-patient procedure, safe, time saving, cost effective and helped determine the course of therapy in the management of patients with thyroid nodules.

Diagnostic Accuracy of CT-Guided Core Biopsy of Ground-Glass Opacity Pulmonary Lesions

The purpose of our study was to evaluate the accuracy of CT-guided percutaneous core biopsy of ground-glass opacity (GGO) pulmonary lesions. The study included 50 patients (24 men, 26 women; age range, 43-78 years) who had a GGO pulmonary lesion and underwent CT-guided core biopsy. Diagnostic accuracy was compared between two groups according to lesion size (< 2 cm vs > or = 2 cm) and GGO component (> 90% vs 50-90%). Each case was reviewed for complications, including pneumothorax, thoracostomy tube insertion, and hemoptysis. Malignancy was finally diagnosed in 33 patients, including three who underwent repeated biopsies, with 33 true-positive and three false-negative findings for an overall sensitivity of 92% (33/36). A benign lesion was finally diagnosed in 10 patients with one false-positive result, for a specificity of 90%. Two benign lesions without confirmative diagnosis because of loss of follow-up and five nondiagnostic samples were excluded from the calculations of sensitivity, specificity, and diagnostic accuracy. The overall diagnostic accuracy was 91%, with a positive predictive value of 97% and a negative predictive value of 75%. Sensitivity and accuracy were not significantly different between the two groups of lesion size and GGO components (p = 0.0491). Ten (18%) patients had pneumothorax, with one (2%) requiring placement of a thoracostomy tube. Mild hemoptysis occurred in seven (13%) patients. CT-guided core biopsy of GGO lesions can yield high diagnostic accuracy and acceptable complication rates approaching those of solid lesions.

Ultrasound‐guided core‐needle biopsy in the diagnosis of head and neck masses: Indications, technique, and results

Unclear cervicofacial masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine-needle aspiration cytology includes a high rate of nondiagnostic samples. A retrospective analysis on 181 core-needle biopsies in 88 patients was performed to determine the diagnostic efficacy of ultrasound-guided core-needle biopsies in the head and neck. We experienced 100% success in obtaining high-quality histopathologic specimens. The target tissue was correctly sampled in 80 of 88 patients. In these patients the sensitivity, specificity, and accuracy rate of core-needle biopsies in differentiating benign from malignant cervicofacial lesions was 98.1%, 100%, and 98.8%, respectively. Ultrasound-guided core-needle biopsies can be recommended as a safe and reliable technique in the diagnosis of cervicofacial masses with a high diagnostic yield. It obtains tissue samples of high quality and represents a sufficient alternative to open biopsy even in the diagnosis of lymphoma.

Endoscopic Ultrasound Features of Gastrointestinal Stromal Cell Tumors Can Be Predictive of Our Ability to Obtain Diagnostic Cytology Via EUS-Guided Fine Needle Aspiration

Background: Endoscopic ultrasound (EUS) is frequently used to evaluate suspected subepithelial tumors seen on endoscopy. EUS guided fine needle aspiration (FNA) has been well documented to aid in diagnosis by providing cytologic material. One limitation of EUS-FNA is the frequency of non-diagnostic samples as a result of low cellularity of specimens. The purpose of this study was to determine if EUS features of GISTs are associated with ability to obtain diagnostic cytology via EUS-FNA. We hypothesized that the biologic behavior of a GIST was more predictive of positive cytologic specimens as compared to accessibility of the GIST by EUS. Methods: In a retrospective study, all patients at Massachusetts General Hospital with histologically confirmed c-kit positive GIST who underwent EUS-FNA between 1997-2006 were included. Diagnostic cytology via FNA was defined as a spindled or epithelioid population of cells on smear. EUS images were reviewed by a blinded endosonographer, and evaluated for mass size, shape, location, wall layer, heterogeneity, echogenicity, cystic spaces, lobulation, ulceration, and central umbilication. Needle gauge, # of passes, and presence of a cytologist during the EUS-FNA were also recorded. Results: 27 patients met inclusion criteria; 20 with diagnostic cytology (Group A), and 7 with non-diagnostic cytology (Group B). Table 1 summarizes the main findings. The size, shape, and location of the GIST were predictive of a diagnostic cytology specimen. A trend toward non-diagnostic specimens was seen with higher risk histology, absence of a cytologist, and ulceration, but these were not statistically significant. There was no significant difference between the two groups for the presence of heterogeneity, cystic spaces, echogenicity, lobulation, central umbilication, needle gauge, or # needle passes. Findings: 1) Gastric location other than antrum, smaller size, and round shape are associated with an EUS directed diagnostic cytology specimen. 2) Location in the antrum or duodenum, larger size, and irregular shape are associated with non-diagnostic specimens. 3) The histologic grade of GIST is not predictive of a diagnostic cytology specimen. Conclusion: Accessibility of GISTs is a more important determinant of diagnostic cytology than biologic behavior. Table 1Results Group A (Diagnostic cytology) n Group B (Non-diagnostic cytology n p-value Location in duodenum/antrum 2 (10%) 20 5 (71%) 7 0.005 Size (mm) 36.4 ± 18 20 75.7 ± 49 7 0.005 Irregular shape 1 (5%) 19 3 (60%) 5 0.016 Histology findings of high/intermediate risk 8 (28%) 20 4 (57%) 7 0.66 Presence of cytologist 5 (45%) 11 1 (25%) 4 0.662 Ulceration 5 (26%) 19 3 (50%) 6 0.344 Open table in a new tab

Role of Endoscopic Ultrasound in the Diagnosis of Intraductal Papillary Mucinous Neoplasms: Correlation With Surgical Histopathology

Intraductal papillary mucinous neoplasms (IPMNs) are precancerous tumors characterized by dilation of the main pancreatic duct, its side branches, or both. The purpose of this study was to evaluate the role of endoscopic ultrasound (EUS) in differentiating benign and malignant IPMNs. We identified all patients between July 1996-November 2005 who underwent preoperative EUS for IPMNs. Malignancy was defined as the presence of invasive carcinoma; all other neoplasms were considered benign. The results of EUS and EUS-guided fine-needle aspiration (EUS-FNA) were compared with corresponding histopathology. Seventy-four patients (38 male; mean age, 65 years) with 21 (28%) malignant and 53 (72%) benign IPMNs were identified. Sixty-five (88%) underwent EUS-FNA. Compared with benign tumors, patients with malignant IPMNs were more likely to be older (P = .011), present with jaundice (P = .03) or weight loss (P = .03), and have EUS features of a dilated main pancreatic duct (P = .0001), solid lesion (P = .0001), pancreatic ductal filling defects (P = .03), or thickened septa within any cyst (P = .02). The sensitivity, specificity, and accuracy of EUS-FNA for the diagnosis of malignancy were 75% (95% confidence interval [CI], 53%-89%), 91% (95% CI, 79%-97%), and 86% (95% CI, 76%-93%), respectively. Cyst or pancreatic duct fluid carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 did not differ between groups. Older age, jaundice and weight loss, and EUS features of a solid lesion, dilated main pancreatic duct, ductal filling defects, and thickened septa are predictive of malignancy in patients with IPMNs. EUS-FNA cytology is helpful, but cyst fluid CEA and CA 19-9 are of limited value to differentiate malignant from benign IPMNs.

Correlation between cytology & thyroid function test

Thyroid dysfunction can be evaluated by measuring serum thyroid stimulating hormone (TSH), total tri-iodothyronine (T3) and total thyroxine (T4) which will establish euthyroidism, hyperthyroidism and hypothyroidism. Fine needle aspiration (FNA) is the diagnostic test of choice in determining whether a nodule is benign or malignant. To correlate hormonal levels to FNA cytologic findings. A cross-sectional study. Kenyatta National Hospital (KNH). Forty two patients had their thyroid profiles done and the results were correlated with FNA diagnosis. Majority of patients had nodular goiter (83.3%), of which 47.6% had euthyroidism, 16.7% had biochemical euthyroidism, 11.9% had hyperthyroidism, 4.8% had sub-clinical hyperthyroidism and 2.4% had sub-clinical hypothyroidism. Three patients (7.1%) with FNA diagnosis of non-diagnostic sample had euthyroidism while 2.4% each with papillary carcinoma, thyroglossal cyst, and atypia, had a hormonal profile of euthyroidism. There was no significant statistical difference (p > 0.05) of the mean levels of T4 (0.406), T3 (0.311), and TSH (0.90), between and within the various groups of FNA cytological diagnoses. The study showed that there was no correlation between T4, T3, and TSH measurements and FNA cytological diagnoses.

Diagnosis of Renal Lymphoma by Percutaneous Image Guided Biopsy: Experience With 11 Cases

We reviewed an institutional experience with image guided percutaneous biopsy of focal renal masses that yielded a diagnosis of lymphoma. We retrospectively reviewed the hospital records of patients undergoing percutaneous renal biopsy between September 1997 and February 2005. A total of 407 image guided focal renal lesion biopsies were identified. A diagnosis of lymphoma was made in 11 patients (3%). Biopsies were performed under computerized tomography guidance in 9 cases (82%) and under ultrasound guidance in 2 (18%). Core biopsies were performed in 11 cases, while fine needle aspiration was done in 10 (91%). Fine needle aspirations underwent cytological analysis in 10 cases and flow cytometry analysis in 9. The final combined pathological diagnoses were B-cell lymphoma in 10 cases and lymphomatoid granulomatosis in 1. Analysis of core biopsies yielded a diagnosis of B-cell lymphoma in 10 cases (91%) and lymphomatoid granulomatosis in 1. Analysis of fine needle aspirations yielded a diagnosis of B-cell lymphoma in 3 cases (30%), lymphoma in 4 (40%), suspicion of lymphoma in 1 (10%), atypical cells in 1 (10%) and a nondiagnostic sample in 1 (10%). Flow cytometry concurred with cytology in the diagnosis of B-cell lymphoma in 2 cases, allowed the identification of lymphoma subtype, which was not made on cytology, in 4, was insufficient in 2 and identified no abnormality in 1. No patients underwent surgery or an ablative procedure. Core biopsy has a higher diagnostic yield than fine needle aspiration for diagnosing renal lymphoma. Flow cytometry analysis adds additional diagnostic information to cytological examination of fine needle aspiration samples. Accurate diagnosis of lymphoma in these cases allowed proper treatment without unnecessary surgery or other procedures.

A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis

The primary objective was to quantify and compare the accuracy and failure rates of directional vacuum assisted biopsy (DVAB) and core needle biopsy (CNB) when used under stereotactic (ST) guidance to biopsy suspicious breast lesions identified with screening mammography. We performed a systematic review of the literature published from January 1996 to July 2004, reporting all-comers populations in Western-style health care systems (i.e., North America, Europe, Australia or New Zealand), referred after screening mammography for breast biopsy using DVAB or CNB under ST guidance. Meta-analyses were conducted for DVAB and CNB, using open surgical biopsy and/or long-term clinical and/or mammogram follow-up as the diagnostic reference standard. The main outcomes of interest were those of greatest clinical relevance, i.e., miss rates and underestimation rates for malignancy. Also, technical failure rate and non-diagnostic rate were assessed for each biopsy method. Thirty-five studies qualified for the review. There were 12 studies with a DVAB group (n=5,119 patients), and 25 studies with a CNB group (n=6,236). There were no studies including both a DVAB and a CNB group, thus precluding any direct, within-study comparisons of accuracy. Overall agreement rate between DVAB and the reference standard was 97.3%, and between CNB and the reference standard, 93.5%. The frequency of technical failures with CNB was slightly higher than DVAB (5.7 vs. 1.5%), as was the frequency of non-diagnostic samples (2.1 vs. 0%). Of the non-diagnostic CNB samples, 23% were subsequently found to be malignant on reference standard. In multivariate analyses using four covariates (procedure type, geographic location, reference standard, and patient position), there were no significant predictors of agreement rates, but some variables were significant predictors of miss rates. For benign to malignant upgrades, study location was a significant predictor, with more upgrades in non-NA locations. For atypia to malignant upgrades, the type of procedure was a significant predictor, with more underestimations in CNB studies. The best available evidence suggests that, in screening populations referred for minimally invasive breast biopsy biopsy requiring ST guidance, DVAB may provide lower miss and underestimation rates for clinically relevant diagnoses than does CNB.

Diagnostic Value of Transbronchial Needle Aspiration by Wang 22-Gauge Cytology Needle in Intrathoracic Lymphadenopathy

The aim of this study was to investigate the diagnostic value of transbronchial needle aspiration (TBNA) performed with a Wang 22-gauge cytology needle in patients with mediastinal and/or hilar adenopathy. Cross-sectional study. Tertiary care training hospital. TBNA procedures were performed using a flexible bronchoscope and a 22-gauge Wang needle in 60 consecutive patients (36 women and 24 men; mean age, 39 +/- 16 years [+/- SD]) who had mediastinal or hilar adenopathy identified on CT of the chest. Adequate lymph node sampling was obtained from 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 60 patients (75%). TBNA was the only tool of diagnosis in 30 of the 60 patients (50%). Diagnoses included tuberculosis (n = 21), sarcoidosis (n = 21), carcinoma (n = 15), and lymphoma (n = 3). Adequate material was obtained from 20 of 21 patients with tuberculosis. The diagnosis made by TBNA was tuberculosis in 13 of 20 cases (65%). In 12 patients, diagnosis of tuberculosis was made cytologically; for the remaining 1 patient, mycobacterial culture was used. TBNA was the only diagnostic tool utilized in 8 of 20 patients with tuberculosis (40%). Diagnostic material was obtained from 16 of 21 patients with sarcoidosis (76%). In sarcoidosis, TBNA provided the only diagnostic specimen in 13 of 21 patients (62%). In all 15 patients with carcinoma (100%), diagnostic materials were obtained. Adequate but nondiagnostic samples were obtained from two patients with lymphoma, and one patient had lymphoma successfully diagnosed with TBNA. No complications were seen except minimal bleeding. TBNA performed with a Wang 22-gauge cytology needle is an effective and safe way of obtaining cytologic specimens from intrathoracic lymph nodes and can rapidly provide diagnosis, both in malignant and benign mediastinal diseases. Hopefully, this technique will reduce further need for more invasive surgical procedures.

The c-myc x E2F-1/p21 Interactive Gene Expression Index Augments Cytomorphologic Diagnosis of Lung Cancer in Fine-Needle Aspirate Specimens

Morphological analysis of cytologic samples obtained by fine-needle aspirate (FNA) or bronchoscopy is an important method for diagnosing bronchogenic carcinoma. However, this approach has only about 65 to 80% diagnostic sensitivity. Based on previous studies, the c-myc x E2F-1/p21WAF1/CIP1 (p21 hereafter) gene expression index is highly sensitive and specific for distinguishing normal from malignant bronchial epithelial tissues. In an effort to improve sensitivity of diagnosing lung cancer in cytologic specimens, we used Standardized Reverse Transcriptase Polymerase Chain Reaction (StaRT-PCR) to measure the c-myc x E2F-1/p21 index in cDNA samples from 14 normal lung samples (6 normal lung parenchyma and 8 normal bronchial epithelial cell [NBEC] biopsies), and 16 FNA biopsies from 14 suspected tumors. Based on cytomorphologic criteria, 11 of the 14 suspected tumors were diagnosed as bronchogenic carcinoma and three specimens were non-diagnostic. Subsequent biopsy samples confirmed that the three non-diagnostic samples were derived from lung carcinomas. The index value for each bronchogenic carcinoma was above a cut-off value of 7000 and the index value of all but one normal sample was below 7000. Thus the c-myc x E2F-1/p21 index may augment cytomorphologic diagnosis of bronchogenic carcinoma biopsy samples, particularly those considered non-diagnostic by cytomorphologic criteria.

Sample collection and preparation in cytology: increasing diagnostic yield

Cytology is a valuable diagnostic tool for examining many types of lesions. The diagnostic yield of cytology is dependent on optimal sample collection and smear preparation. This article outlines the basic techniques for collection of samples via fine-needle biopsy, imprints, scrapings, and swabs. Tips are given on how to avoid some of the most common problems that lead to nondiagnostic samples.

FINE-NEEDLE ASPIRATION BIOPSY OF THE THYROID

The routine use of thyroid FNAB caused profound changes in the management of thyroid nodules. FNAB allows a prompt identification and treatment of thyroid malignancies and avoids unnecessary surgery in patients with benign lesions, improving quality of life in patients with thyroid nodules. Furthermore, FNAB provides guidance for the type of surgery and reduces costs of care. On average, standard FNAB is nondiagnostic in 25% to 40% of cases, which include inadequate specimens and indeterminate (suspicious) diagnoses. In addition, a small percentage of false-negative diagnoses occur, which are unavoidable and raise concern of a late diagnosis of cancer. To minimize the limitations of FNAB, every center should reach and maintain a high standard of expertise in all of the steps of smear preparation and interpretation. Alternative modes of sampling or sample preparation may result in a reduction of nondiagnostic samples and better accuracy. Every center should set up clinical guidelines tailored to their own FNAB results and including the evaluation of clinical data. More work is needed to increase the accuracy of FNAB in suspicious cases. Toward this goal a variety of molecular markers have been evaluated; although none of them are ideal, some are promising. More studies need to be carried out in larger series to further evaluate the accuracy of these markers in identifying specific cancer histotypes within the group of suspicious lesions. It is hoped that, in the near future, the routine use of a combination of these markers will cost-effectively improve the diagnosis of malignant nodules classified as suspicious on traditional cytology. Statistical methods such as bayesian analysis or neural networks can be advantageously used to integrate different relevant information derived from family and personal history, clinical data, cytologic results, and evaluation of molecular markers.

Extravisceral masses in the peritoneal cavity: sonographically guided biopsies in 52 patients.

Our objective was to determine the effectiveness of sonographically guided biopsies of extravisceral masses (masses outside the solid organs) in the peritoneal cavity. We retrospectively reviewed the results of sonographically guided biopsies of extravisceral masses found in the peritoneal cavity of 52 patients (age range, 25-90 years old; mean age, 52 years) from June 1990 to December 1996. Fifty-one patients underwent biopsy through the abdominal wall, and one patient underwent transvaginal biopsy. Sonographic guidance was obtained using 3.5- to 7.0-MHz vector probes. The size, depth, and sonographic characteristics of the mass and the type of biopsy (aspirate versus core) were determined for all lesions. Pathology reports and clinical courses were reviewed. Placement of the biopsy needle within the lesion was successful in all patients. The mean depth from skin surface to lesion was significantly less (p < .0001) when shown by sonography (2.4 cm) than when shown by CT (3.8 cm). Biopsy results were true-positive for malignancy in 37 patients (no false-positives), true-negative for benign masses in 10 patients, and false-negative for malignancy in three patients (sensitivity, 93%; specificity, 100%; accuracy, 94%). Nondiagnostic samples were obtained in two patients (4%). Treatment was based on diagnostic biopsy results in 43 patients (86%). Sonography is an effective alternative to CT in guiding biopsy of extravisceral masses in the peritoneal cavity.

Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies.

A retrospective study of 97 patients undergoing 101 image-guided adrenal biopsies (IGABs) was performed to analyze the effects of specific pathologic results on test characteristics. Three categories of pathologic results (benign adrenal tissue, malignant tissue, and nondiagnostic) were compared with outcomes. Diagnostic samples were obtained in 86% of cases. Among 72 patients with proved outcomes, IGAB had an accuracy of 96%, a sensitivity of 93%, and a negative predictive value of 91% (92% in patients with bronchogenic carcinoma). In this subset of patients, 33 had biopsy specimens that contained benign adrenal tissue. In these 33 patients, three masses (each smaller than 3 cm) proved malignant. In the 14 patients with nondiagnostic samples, two masses proved malignant. Obtaining benign adrenal tissue was highly predictive of benignity, even in the setting of lung cancer. The authors conclude that IGAB is an accurate procedure in both oncologic and nononcologic patients. However, when the biopsy specimen does not contain benign adrenal tissue or malignant cells, repeat percutaneous biopsy or surgery should be considered.

Resolution of Indeterminate HIV-1 Test Data Using the Department of Defense HIV-1 Testing Program

The Department of Defense HIV-1 Test Program was designed to provide timely, accurate, and cost-effective HIV-1 testing services for military personnel. This program incorporated a comprehensive quality assurance and quality improvement program in conjunction with large-scale commercial contracts. Definitive diagnostic data were provided for all sera, and nondiagnostic data were resolved as either reactive or nonreactive using the described guidelines and test system. The program used Food and Drug Administration (FDA)-approved HIV-1 ELISA and Western blot methodologies in conjunction with CBre3 recombinant protein and radioimmunoprecipitation (RIPA) assays. The program has evaluated over 4.7 million serum samples. The ELISA repeat reactive rate was approximately 0.6%, and when Western blot and CBre3 tests were performed with the specified criteria, nondiagnostic Western blot data were reduced from 10% to 1%. The remaining nondiagnostic serum samples were analyzed with the third confirmatory procedure, RIPA, which successfully resolved all but 19 samples (0.0004%). These remaining samples were eventually resolved when additional serum samples were retested as previously described. The overall HIV-1 prevalence was determined to be 0.33/1,000, and the program at an average test cost of $4.55 successfully identified over 2,500 infected individuals. This testing program, which required the analysis of two separate specimens, had a false-positive rate estimated at 1 in 1,000,000.

Inferences based on nondiagnostic information

Nondiagnostic samples of evidence were presented sequentially in an inference task. These were samples which logically should not have influenced inference responses, e.g., by Bayes theorem. Experiment I, however, demonstrated that three different types of nondiagnostic samples (neutral, irrelevant, and null) consistently resulted in less extreme inference judgments. Experiment II indicated that the size of this “nondiagnostic effect” depended on serial location and was less with aggregate than sequential samples. Moreover, the effect was shown not to be a response artifact due to a central regression tendency. Several theoretical accounts were considered, such as representativeness and expectancy. But, the most plausible was that inference judgments are based on an averaging combination rule. Finally, some practical implications of this nondiagnosticity finding were discussed.