Percutaneous Fine Needle Aspiration Cytology Research Articles

Hyalinizing Granuloma: An Unusual Case of a Pulmonary Mass

We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT). He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.

PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy

PET/CT, used as a guiding tool, can improve the accuracy of percutaneous fine needle aspiration cytology (FNAC)/biopsy due to its ability to incorporate both physiological and anatomical information.

Focal splenic lesions as a cause of extramedullary hematopoiesis in a case of thalassemia

Focal splenic lesions are rather uncommon in radiology practice although pathologists encounter them more frequently. The etiology of focal splenic lesions can be diverse, with infarcts, abscesses, granulomata, metastases and lymphomatous deposits being the relatively commoner ones. Extramedullary hematopoiesis as the cause of radiologically detectable focal splenic lesion is extremely uncommon and extensive literature search has revealed only 11 proven cases being reported earlier. We report a case of thalassemia intermedia with focal splenic lesions on sonography which on percutaneous fine needle aspiration cytology (FNAC) was proved to be foci of extramedullary hematopoiesis. To our best of knowledge this is the only case report of splenic extramedullary hematopoiesis in a case of thalassemia which was detected on ultrasound examination.

Computed Tomography Guided Percutaneous Transthoracic Fine Needle Aspiration Cytology in Chest Masses

A retrospective, hospital based descriptive study was done to know the pathological spectrum of thoracic lesions and to correlate the radiological findings with cytological findings obtained from computed tomography guided percutaneous transthoracic fine needle aspiration of chest mass. The clinical, radiological and cytological data of 100 patients were studied who underwent CT guided FNAC from May, 2004 to May, 2007. Diagnostic accuracy of FNAC is 82%. Cytological examination showed that 51 cases were malignant and 31 cases were benign. Provisional diagnosis based on radiological findings were 50 and 32 cases of malignant and benign lesions respectively. Sensitivity and specificity, positive and negative predictive value of radiological findings in this study was 88%, 84%, 90% and 81% respectively. Post procedure complication were (a) pneumothorax in two cases and both the cases had to be hospitalized for active management (b) minimal perilesional hemorrhage and hemoptysis in three cases and (c) chest pain in six cases. CT guided FNAC is a simple and safe procedure with high diagnostic accuracy in the evaluation of focal chest lesions. Pneumothorax, perilesional hemorrhage, hemoptysis and chest pain are the usually encountered complications. Very few cases of complication require active management.

Quantitative Analysis of NPTX2 Hypermethylation Is a Promising Molecular Diagnostic Marker for Pancreatic Cancer

Percutaneous fine-needle aspiration cytology or biopsy has been used for pathological confirmation in pancreatic cancer. Sometimes, it is difficult to approach the mass because of surrounding major vessels, and there is a risk of seeding. Although endoscopic retrograde cholangiopancreatography (ERCP)-guided pancreatic duct brush cytology is less invasive, its reliability is very low. Recently, aberrantly methylated genes were reported in pancreatic cancer tissue. This study was to develop a novel molecular diagnostic approach based on epigenetic characteristics. We enrolled pathologically proven 33 pancreatic cancer patients and 22 benign pancreaticobiliary disease patients. The ERCP-guided pancreatic duct brush cytology samples were obtained. Genomic DNA was extracted, and NPTX2 CpG island hypermethylation was examined quantitatively by real-time polymerase chain reaction amplification after chemical modification. Pancreatic cancer cytology samples had statistically significant higher levels of NPTX2 methylation compared with benign diseases, and the optimal cutoff value of NPTX2 methylation was 1.2%. The sensitivity was 87%, and specificity was 80%, whereas pathological examination by ERCP-guided pancreatic duct brush cytology had a sensitivity of 38%. The quantitative analysis of NPTX2 hypermethylation may play a role in making highly sensitive and less invasive diagnosis of pancreatic cancer. Therefore, NPTX2 hypermethylation could be a promising molecular diagnostic marker.

Diagnostic value of cytology for biliary stricture.

Over the past 20 years, bile aspiration at endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography has been developed for cytological diagnosis of biliary tract stricture. This safe and specific test has allowed a diagnosis to be reached before or without operation in about one-third of malignancies of the pancreas or biliary tree. The recent development of biliary brush cytology has produced better results. An endobiliary biopsy forceps is now available that may allow safe sampling of lesions causing extrinsic compression of the biliary tract. An endobiliary aspiration cytology needle has been produced that may permit non-ulcerating lesions to be diagnosed. A safe alternative to endobiliary methods is percutaneous fine-needle aspiration cytology; this yields a diagnosis in about half of patients presenting with obstructive jaundice and an imaged mass lesion.

Percutaneous fine-needle aspiration cytology in the diagnosis and management of liver tumours.

The aim of the study was to investigate the value of percutaneous fine-needle aspiration cytology (FNAC) in the diagnosis and management of liver tumours. FNAC followed by histopathological examination was carried out in 216 patients with suspected liver tumours. The final diagnosis was primary liver cancer in 106, colorectal metastases in 51, non-colorectal metastases in 46, benign tumour in nine and no tumour in four patients. Cytology resulted in correct classification of the lesion as benign or malignant in 87 per cent of patients, correct discrimination between primary and secondary malignancy in half of the patients, and a correct diagnosis of tumour type in one-third of patients. The tumour was erroneously classified as benign or malignant in 22 patients (11 per cent) and four patients (2 per cent) respectively. When FNAC showed malignancy, the predictive value was 98 per cent, whereas the predictive value was 27 per cent when it did not. FNAC guided investigations and treatment in one-quarter of patients. Implantation metastases were recorded in seven patients (3 per cent), including five (10 per cent) of 51 patients with colorectal liver metastases, and caused major local problems and death in four patients. FNAC was valuable in about a quarter of patients with liver tumour. The risks of implantation metastases and a false-negative finding do not justify its use in candidates for curative therapy of liver tumours.

The value of percutaneous fine needle aspiration cytology under ultrasound guidance in the diagnosis of pancreatic masses

Between September 1996 and May 1999 twenty six pa-tients with a pancreatic mass were studied. In 24 patients (92.3%) the masses could be detected by ultrasound but were not detectable in the other two cases. In the 24 pa-tients percutaneous FN AC under u/s guidance produced only one complication. The accuracy of this test in diagnosing pancreatic ma-lignant tumours was 90.4%. Laparotomy was not neces-sary in three cases with advanced pancreatic carcinoma (11.5%) and the material aspirated was not suitable for di-agnosis in three cases. No benign lesions were found and so it was not possible to estimate the reliability of FN AC in their diagnosis.

Percutaneous fine needle aspiration cytology with CT fluoroscopy can increase diagnostic rates in patients with small sized pulmonary nodules undiagnosed by bronchoscopy

Percutaneous fine needle aspiration cytology with CT fluoroscopy can increase diagnostic rates in patients with small sized pulmonary nodules undiagnosed by bronchoscopy

Assessment of percutaneous fine needle aspiration cytology as a technique to provide diagnostic and prognostic information in neuroblastoma

The International Neuroblastoma Staging System (INSS) criteria for diagnosis requires an unequivocal pathological diagnosis and favours the identification of prognostic markers in the samples. Surgical biopsies of the primary tumour and bone marrow (BM) sampling in metastatic disease constitute the major sources of tumour material for the laboratory. We analysed the possibility of percutaneous fine needle aspiration cytology (FNAC) constituting an alternative procedure to the conventional technique of sampling of the primary tumour in children with advanced neuroblastoma. From July 1987 through July 1998, 64 consecutive children suspected of having advanced neuroblastoma and referred to our institution underwent percutaneous FNAC of deeply located tumours. FNAC was performed using 22-gauge needles under ultrasound guidance, before any chemotherapy and within the first days following admission. No complication occurred after FNAC. The median number of the extracted tumour cells was 2.3×10 6 (range: 0–40.6×10 6). Cytology analysis was possible in 59/64 cases (92%) and immunocytochemistry in 56/64 (88%) allowing confirmation of the diagnosis. N-Myc analysis was available in 46/64 (72%). In addition, the presence of a partial deletion of chromosome 1p (del 1p) was assessed, since 1992, in 24/47 cases (51%), where enough cells were available. FNAC of deeply located advanced neuroblastoma is safe and information is available in a few hours after admission. The provided material is reliable for confirmation of diagnosis and analysis of biological prognostic markers in the majority of cases. More invasive tumour sampling procedures are required only in selected cases.

Enteroclysis-guided fine-needle aspiration cytology of focal small-bowel lesions.

To study the role of enteroclysis-guided percutaneous fine-needle aspiration cytology (FNAC) of focal small-bowel lesions. Twenty patients with non-palpable circumscribed small-bowel lesions found on enteroclysis underwent FNAC after confirmation of needle position under fluoroscopy. Positive diagnosis was obtained in 18 (90%) of the patients. Thirteen patients with positive FNAC and one with inconclusive cytology underwent surgery. In all, the cytological diagnosis was confirmed by histopathology. No complications were seen. Enteroclysis-guided FNAC of focal small-bowel lesions is a safe and accurate diagnostic method.

Koch's or Crohn's: the debate continues

In response to the comments made by Green et al (IJCP 1997; 51(7): 480), the discussion in my article in the June issue of this journal was restricted to the diagnostic dilemma between tuberculosis and Crohn's disease. Green et al are absolutely right to point out that tuberculosis is a great mimic; it should, in fact, be considered in the differential diagnosis of patients not only with ileocaecal disease but with any unexplained, undiagnosed and unresolved abdominal problem. Statistically speaking, most patients – at least, in the UK – with a clinical picture and radiology that are compatible with Crohn's disease will have Crohn's disease, but some of them, and not necessarily only those who are obviously immunosuppressed or who are first generation immigrants, may have tuberculosis. This small minority of patients with tuberculosis, when put on steroids with a presumptive diagnosis of Crohn's disease, will have a flare-up of the disease which may be fatal. As for the lymph nodes, while most calcified lymph nodes are tuberculous, not many patients with abdominal tuberculosis have calcified lymph nodes. To obtain the best results, various diagnostic investigations should be used judiciously, depending upon the type of suspected abdominal lesion, e.g. image-guided percutaneous fine needle aspiration cytology (FNAC) for abdominal masses, paracentesis and laparoscopic biopsy for ascitic peritoneal tuberculosis, and colonoscopic biopsy for colonic and ileocaecal lesions. Various techniques, such as multiple biopsies, biopsy-on-biopsy and endoscopic FNAC, have been described to increase the diagnostic yield of colonoscopy. While in some desperate situations it may be justified to give the patient a trial of empirical therapy when there is a high index of suspicion, it is usually preferable to make every effort to arrive at the diagnosis before treatment is started. That is exactly what the article attempted to do when the dilemma is between Koch's and Crohn's.

Role of fine-needle aspiration cytology in the preoperative evaluation of smooth muscle tumors.

A preliminary study was undertaken to assess the feasibility and the diagnostic role of fine-needle aspiration cytology (FNAC) in the preoperative evaluation of eight uterine smooth muscle tumors manifesting as single large masses with signs of growth. Percutaneous FNAC was performed under echographic control with a 22-gauge needle and the material was stained according to conventional techniques. Histology of surgically resected specimens was available for final diagnosis and comparative analysis in all the cases, including five leiomyomas (LM), one smooth muscle tumor of uncertain malignant potential (TUMP), and two low-grade leiomyosarcomas (LMS). Cellularity, as indicated by the density (crowding) of nuclei reflecting the amount of cytoplasmic volume, and the cohesiveness of the tissue fragments in the smears appeared to be the most important diagnostic parameters in the distinction between LM and LMS. LM usually showed few scattered poorly cellular fragments of highly cohesive tapering cells without nuclear crowding and with abundant cytoplasm. LMS usually showed a large number of single cells and fragments of loosely arranged tapering cells with nuclear enlargement and crowding and ill-defined scanty cytoplasm. Borderline forms such as TUMP were hardly distinguishable from LMS and LM. FNAC appears to be a feasible preoperative procedure in uterine smooth muscle tumors and may play a diagnostic role, especially in distinguishing frankly benign from overtly malignant forms.

Immediate assessment of fine needle aspiration cytology of lung.

To assess the value of immediate assessment of cytology in percutaneous fine needle aspiration (FNA) cytology of lung. FNA specimens from 75 consecutive patients with suspected pulmonary neoplasms were subjected to immediate cytology assessment. Direct smears were prepared in the radiology department and stained using the Diff Quik method. The cellular content was assessed and, if possible, a provisional diagnosis offered. A second FNA was requested if the initial aspirate seemed of doubtful adequacy. The diagnostic accuracy was examined by review of clinical and radiological data in all patients, and by correlation with other histological or cytological material in 25 patients. Complications of the procedure were identified during the clinical review. Two of 75 specimens were inadequate for diagnosis. Satisfactory diagnostic material was obtained in 51 patients on a single aspirate and following a second FNA in 22 patients. Of the 73 satisfactory aspirates, 58 were malignant, one highly suspicious of malignancy and 14 reported as negative for malignancy. All malignant diagnoses were confirmed on clinical or pathological review. FNA accurately distinguished primary small cell and large cell carcinomas in those patients with pathological follow up. There were two false negative reports, one due to sampling error and the other due to misinterpretation of aspirate material. The diagnostic specificity was 100% and sensitivity 96.6%. Complications were recorded in seven (9.3%) patients, five of whom developed pneumothorax; a chest drain was required in one patient. Percutaneous FNA cytology provides safe and accurate diagnosis in the investigation of pulmonary lesions. Immediate cytology assessment ensures that aspirate material is handled optimally, and those patients requiring further sampling or ancillary investigation identified rapidly. The number of unsatisfactory and false negative lung FNA are therefore reduced. The complication rate is minimised by decreasing the number of pleural punctures.

High sensitivity of pancreatic percutaneous fineneedle aspiration cytology (FNAC) under pancreatographic guidance

High sensitivity of pancreatic percutaneous fineneedle aspiration cytology (FNAC) under pancreatographic guidance

Transthoracic (percutaneous) fine needle aspiration cytology diagnosis of pulmonary tuberculosis

Objective: The present study was carried out to assess the utility of transthoracic (percutaneous) fine needle aspiration (FNA) cytology in the diagnosis of pulmonary tuberculosis. Design: During a period of 6 years (1985-90), 202 ultrasound and computerized tomography (CT)-guided transthoracic FNA of pulmonary lesions were performed. Review of smears available in 190 cases revealed 38 (20%) cases of pulmonary tuberculosis. Age of the patients ranged from 11 months-75 years with a median of 40 years. The common clinical diagnoses were malignancy (14 cases), tuberculosis (8 cases) and pneumonitis (7 cases). The sites of FNA were lungs in 36 cases and pleural based lesions in 2 cases. Results: Epithelioid granuloma without necrosis (type 1 reaction) were observed in 4 (10.5%) cases. Epithelioid granuloma with necrosis (type 2 reaction) and necrosis without epithelioid granuloma (type 3 reaction) were seen in 17 (44.7%) cases each. The overall rate of AFB positivity was 45.8%. The rate of acid-fast bacilli (AFB) positivity in type 1, 2 and 3 reactions were 0%, 38.5% and 60.0% respectively. Conclusion: This study shows that transthoracic (percutaneous) FNA is a useful means for diagnosis of pulmonary tuberculosis, especially when the clinical and/or radiological features are non-specific or point towards malignancy rather than tuberculosis.

Diagnosis of renal cell carcinoma: value of fine-needle aspiration cytology in patients with metastases or contraindications to nephrectomy.

A retrospective study of imaging-directed percutaneous fine-needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspiration biopsy in establishing the diagnosis of renal cell carcinoma and avoiding nephrectomy in patients with a renal mass and disseminated metastases or with a renal mass and relative contraindications to nephrectomy. Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biopsies at our institution. We examined the medical records, pathology reports, imaging studies, and follow-up information of the 23 patients who had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminary diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients). Cytopathologic findings were true-positive in 12 patients, true-negative in eight, false-negative in three, and false-positive in none. The sensitivity was 80%, the specificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, and all died within 1 year. Of the 13 patients with relative contraindications to surgery, seven were treated without surgery. The cytologic diagnosis was renal cell carcinoma in two of the seven, and these two patients have since died. Cytopathology was negative for renal cell carcinoma in five of the seven, and subsequent imaging studies in these patients have shown no renal mass enlargement or metastases 2-3 years after biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining six patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications. Percutaneous renal aspiration biopsy cytology is accurate, safe, and useful in establishing the diagnosis of renal cell carcinoma in patients with disseminated metastases or relative contraindications to surgery.

Immunocytochemical analysis of receptors for estrogen and progesterone in fine needle aspirates from anal epidermoid carcinoma

Fifteen patients with anal epidermoid carcinoma were examined with percutaneous or transanorectal fine needle aspiration (FNA) cytology. Aspirates from all patients allowed cytologic verification of the diagnosis. Estrogen receptor (ER) and progesterone receptor (PgR) were analyzed using an immunohistochemical technique well adapted for steroid receptor analysis in hormone-dependent carcinomas. Neither ER nor PgR could be detected in any of the aspirates. This finding is somewhat unexpected since there is a strong female predominance in this tumor type. However, our findings do not negate that sex steroid hormones may indirectly play a role in the tumorigenesis of anal epidermoid carcinoma.

Percutaneous Fine Needle Aspiration Cytology and Biopsy in the Diagnosis and Classification of Lymphoma: Clinical Evaluation.

In some patients with suspected de novo or recurrent lymphoma, the absence of a palpable mass or peripheral lymph node enlargement can be a diagnostic challenge. We report our experience of fine needle aspiration (FNA) and biopsy in the management of 47 consecutive patients investigated in our institution over a period of 4 years. Lymphoma was suspected in 32 cases, and recurrent disease in 15 cases. Cytology was performed in all patients and biopsy in 16 patients, when a safe approach was possible. The specimens were obtained with computed tomography guidance and were diagnostic by cytology in 85% of cases: 28 patients had a newly diagnosed lymphoma and 3 had recurrent disease; residual fibrosis was diagnosed in 2 cases. Five patients with a previously diagnosed lymphoma had a new neoplasm: lung carcinoma: 3, renal adenocarcinoma: 1, metastatic lymph nodes: 1. One patient had non-neoplastic intercurrent disease (pulmonary nocardiosis). In 7 patients, no conclusive tissue was obtained (acellular: 1, blood: 3, necrosis: 3). In one case of suspected recurrent disease, a false-positive result was obtained. Cytology always allowed distinction between non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), with attempts to subclassify NHL according to the International Working Formulation. In 12 patients, immunochemical studies could be performed for immunologic subclassification of lymphoma on the basis of cytology (n = 6) and biopsy (n = 6). Our results show that percutaneous fine needle aspiration cytology is a reliable method for the diagnosis and classification of lymphoma, and immunologic studies can be performed on cytology alone if biopsy is unsafe.

Audit of fine needle aspiration cytology of 120 renal lesions

Solid renal masses in 120 patients were assessed by percutaneous fine needle aspiration cytology, performed under radiographic guidance. Follow-up was obtained in all but seven cases. Diagnostic sensitivity for 83 tumours in the series was 91.6%, while two false positive reports resulted in a specificity of 93.8%. Positive and negative predictive values were 97.4% and 81.1% respectively. One advantage of the procedure was the ability to cell type neoplasms accurately, which enabled administration of pre-operative chemotherapy in childhood tumours, and selection of appropriate surgical procedures in adults. The technique offered a non-surgical means of confirming primary renal tumours in patients presenting initially with distant metastases, and documenting renal secondaries in cases with malignancy at other sites. The diagnosis of benign or inflammatory lesions permitted institution of definitive therapy.