Positive Diagnosis Of Malignancy Research Articles

Brush Cytology Performance for the Assessment of Biliopancreatic Strictures

Introduction: Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. Methods: Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. Results: One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04–22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70–43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). Conclusion: Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.

Diagnostic potency of EUS-guided FNA for the evaluation of pancreatic mass lesions.

Background and Objectives:Diagnosis of pancreatic lesions remains a clinical challenge. This study aimed to evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic mass lesions.Patients and Methods:Clinical data, laboratory tests, and cytopathological and imaging reports were collected from 185 pancreatic EUS cases performed from March 2010 to January 2014. The final diagnosis was based on surgical findings, EUS-FNA or computed tomography (CT)-guided biopsy.Results:A total of 100 pancreatic FNAs were obtained by EUS. Most positive diagnoses of malignancy were pancreatic adenocarcinomas (n = 61). The site of pancreatic adenocarcinoma was the head in 50 (82.0%), body in seven (11.5%), and tail in four (6.5%). The sensitivity, specificity, and positive and negative predictive values of EUS-FNA for diagnosing adenocarcinoma were 80.3%, 92.3%, 94.2%, and 75.0%, respectively.Discussion:We concluded that EUS-FNA of pancreatic lesion accurately diagnoses pancreatic adenocarcinoma and should be considered for the standard management of pancreatic adenocarcinoma.

Unusual presentation of a case of fallopian tube carcinoma

Background: Primary fallopian tube carcinoma (PFTC) accounts only for <1% of all female genital cancers. The diagnosis of PFTC is rarely considered preoperatively and is usually first appreciated at the time of operation or by a pathologist. Case Presentation: Here we are presenting a case report of 45 years old lady with fallopian tube carcinoma, who presented to us with features of advanced ovarian malignancy. FNAC from tumor showed epithelial malignancy and she received neo-adjuvant chemotherapy followed by staging laparotomy and interval debulking surgery. She developed a non-healing ulcer at FNAC site which was excised during laparotomy. On laparotomy, 200cc ascitic fluid was drained. Uterus, right ovary and tube appeared normal. Left side tube showed growth of 3cm x 2cm. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy was done. Histopathological examination revealed left side poorly differentiated primary fallopian tube carcinoma. Uterus and right tube with ovary were free of tumor. She was advised to get 3 cycle of chemotherapy postoperatively. Conclusion: In our patient, FNAC gave a positive diagnosis of malignancy and we were able to operate her malignancy properly following chemotherapy.

Endoscopic Ultrasound-Guided Fine Needle Aspiration in Hollow Viscus Cancer

Accurate cancer staging is essential in patients with hollow viscus malignancy to decide therapeutic modalities. Endoscopic ultrasound (EUS) is considered as the best modality for local staging of hollow viscus cancer. EUS-guided fine needle aspiration (FNA) is a minimally invasive and effective sampling method. EUS-FNA should be applied when positive diagnosis of malignancy can possibly change the choice of therapeutic options. EUS in conjunction with EUS-FNA can optimize stage-directed therapy which is helpful in selecting minimally invasive treatment option including endoscopic treatment and avoiding unnecessary surgery in advanced cases.

PWE-009 Per oral cholangioscopy: systematic evaluation in clinical practice

<h3>Introduction</h3> A new technological approach to per oral cholangioscopy (POC) has led to a re-examination of this technique for diagnosis and therapy of hepatobiliary disease. We present a single centre experience from a tertiary regional hepatobiliary unit. <h3>Methods</h3> Prospective analysis of indications and technical success including direct visualisation, tissue acquirement and analysis and therapeutic success. Analysis of contribution of POC to clinical decision making. <h3>Result</h3> Since June 08 to date 36 ERCPs have been undertaken with POC. The indications were indeterminate strictures 28/36 (78%), filling defect 4/36 (11%), POC directed electro-hydraulic lithotripsy (EHL) 4/36 (11%). In one case the bile duct could not be intubated with the cholangioscope. Good views were obtained in 34 of 36 cases (94%). Biopsies were attempted in 16 patients, all of whom had focal mucosal change. Biopsy was not attempted if the mucosa appeared completely normal. In 15 of the 16 cases biopsy was successful in obtaining useful tissue for assessment. 12/15 biopsies were judged to be accurate on basis of either a positive diagnosis of malignancy or a non-malignant result in patients who subsequently had a benign clinical course. Three of the four cases of filling defect were shown to be stones and one a carcinoma. EHL lead to complete stone clearance in three of four cases. The addition of POC appeared to critically influence clinical decision making in 21 of 32 cases (65%). There no significant complications related to the POC procedure that could be identified. <h3>Conclusion</h3> POC is currently being re-evaluated in the management of complex hepatobiliary disease. It appears to be safe and add significantly to the information used to manage patients with indeterminate strictures and filling defects. It is undoubtedly useful for the management of complex stone disease. We initially restricted our use of POC to the most challenging patients whom had previously undergone multiple ERCP9s. We intend to evaluate POC further as a primary ERCP technique in patients with proximal biliary strictures.

False positive diagnosis of malignancy in a case of cryptogenic organising pneumonia presenting as a pulmonary mass with mediastinal nodes detected on fluorodeoxyglucose-positron emission tomography: a case report

IntroductionWe report the case of a patient with positive findings on a lung emission tomography/computed tomography (PET/CT) scan, with possible contra lateral mediastinal involvement, which strongly suggested an inoperable lung carcinoma. The lung mass proved to be a cryptogenic organising pneumonia. While the latter has previously been shown to be PET/CT positive, mediastinal involvement simulating malignant spread has not been previously reported.Case presentationA 50-year-old Caucasian woman presented with a history of unproductive cough and was found to have a mass in the right upper lobe as shown on chest X-ray and a computed tomography scan. A subsequent PET/CT scan showed strong uptake in the right upper lobe (maximum standard uptake values (SUVmax) 9.6) with increased uptake in the adjacent mediastinum and contralateral mediastinal nodes. Surgical resection and mediastinoscopy revealed cryptogenic organising pneumonia, with enlarged reactive mediastinal lymph nodes.ConclusionThe case illustrates the limits of PET/CT scanning as a diagnostic tool, and emphasizes the importance of obtaining histological confirmation of malignant diseases whenever possible.

Endosonografisch gestützte Biopsie: diagnostischer Ertrag, Fallstricke, Qualitätssicherung

The differential diagnosis of tumorous lesions in the pancreas, liver, adrenal gland or lymph nodes is ambiguous. Specific tissue diagnoses are essential for treatment decisions. Endoscopic ultrasound-guided biopsy has proven to be a reliable and effective modality in obtaining samples for cytological or histological examinations either primarily or in cases in which other biopsy techniques have failed. The reproducibility of cytopathological diagnoses among pathologists with special experience in assessing material obtained by endoscopic ultrasound-guided biopsies is very high. False positive diagnoses of malignancy in endoscopic ultrasound-guided biopsy are rare; false negative diagnoses appear in a variable frequency depending on target tissue, technical factors, and expertise of the endosonographer and cytopathologist. There are numerous challenges and pitfalls in the differential diagnostic classification of benign and malignant lesions. These problems are related to the characteristics of samples obtained by endoscopic ultrasound-guided biopsy, as well as to the multiple diagnoses with similar or overlapping cytological or histological characteristics. This review discusses the performance of endoscopic ultrasound-guided biopsy in establishing specific tissue diagnoses, possible pitfalls as well as opportunities to minimise differential diagnostic errors.

Molecular diagnostic testing as an adjunct to morphologic evaluation of pancreatic ductal system brushings: Potential augmentation for diagnostic sensitivity

Malignancies arising from the pancreatic and biliary ductal systems present the gastroenterologist and pathologist with diagnostic challenges. Tumors of the pancreatic and/or biliary ductal system may present as either duct strictures or mass lesions. When lesions present as strictures without associated demonstrable masses, brushing cytology may represent the only reasonable diagnostic technique aside from open biopsy. Diagnostic sensitivities for brushing cytology have ranged from 18 to 90%. Positive diagnoses of malignancy are of great clinical value but a negative result is of relatively little clinical aid when the radiographic or clinical findings are suspicious for a malignancy.A variety of techniques have been used in an attempt to improve diagnostic sensitivity for brushing cytology. These have included immunohistochemistry and various molecular diagnostic techniques. Using the high resolution melting curve technique, we performed mutational analysis on 20 bile duct brushing specimens for mutations in p53, K-ras, BRAF, and EGFR genes. Eleven specimens had corresponding surgical specimens, which were similarly analyzed. Our series included twelve adenocarcinomas, one islet cell tumor, one case of dysplasia, and six benign cases. K-ras mutations were found in cytology specimens of 3 out of 12 malignancies. No EGFR or B-raf mutations were detected and only a single p53 mutation in an adenocarcinoma was detected in the corresponding cytology specimen. No mutations were detected in benign lesions or in the dysplasia. Only 8% of specimens from adenocarcinomas had p53 mutations and only 33% of cases had K-ras mutations. Mutational analysis did not appear to improve the cytologic detection of adenocarcinoma by bile duct brushings.

EUS-SOS

Purpose: Bronchoscopy with transbronchial FNA, mediastinoscopy, CT guided bx and laparoscopy are accepted techniques for tissue sampling of intrathoracic and intra-abdominal masses. We report our experience with EUS FNA/Trucut bx (EUS FNA/TCB) as a rescue procedure in patients (pts.) who previously failed or were refused by other bx techniques. Aim: To evaluate the accuracy of EUS FNA in pts with malignant disease and a previously failed bx procedure. Methods: Retrospective analysis of EUS FNA/TCB results in all pts. referred for pancreatic or mediastinal bx from 10/03 to 4/05. Pts. who failed or were refused by other bx modalities and had a final diagnosis of malignancy were included. A positive diagnosis of malignancy by EUS FNA/TCB was considered true positive. All procedures were performed only with linear array EUS by a single endosonographer. No on-site cytopathology was done. FNA was performed in all pts. and TCB was added at the discretion of the endosonographer. Results: A total of 160 pts. were referred for pancreatic or mediastinal bx for solid masses. Thirty-nine pts. (24%) met the inclusion criteria. The mean age was 67 years (18 F and 21 M). There were 26 pancreatic masses and 13 mediastinal masses. In the mediastinal group, 11 failed bronchoscopy with transbronchial FNA, one failed mediastinoscopy, and one was turned down for CT guided bx. In the pancreatic group, sixteen failed CT guided bx, six failed laparoscopy, three were turned down for CT guided bx and one failed prior EUS FNA/TCB. The sensitivity of EUS FNA/TCB for detecting malignancy in 39 pts. was 85%. In the mediastinal and pancreatic subgroups sensitivities were: 100% and 77% respectively. The mean number of FNA passes was 6 (range 3–10), Trucut was used in 19 pts., mean number of passes of 2.4 (range 2–5). All six pts. with pancreatic cancer missed by EUS FNA did not undergo additional EUS TCB due to technical reasons (uncinate process lesions). Four of the six pts. with pancreatic cancer missed by EUS FNA, had at least two prior failed biopsies by CT FNA. Conclusions: In pts. who have failed other bx procedures, EUS FNA/TCB should still be considered an accurate and safe modality to detect malignancy. Addition of TCB to FNA appears safe and should be considered in the absence of on-site cytopathology review.

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)

Transthoracic fine-needle aspiration biopsy cytology of pulmonary neoplasms.

The experience with 212 transthoracic fine-needle aspiration biopsy cytology specimens of mass lesions of the lung at a small Canadian hospital is reviewed. The technique showed a sensitivity of 78.0%, a specificity of 85.7%, a positive predictive value of 98.5%, and a negative predictive value of 25.0% when the cytological diagnoses were compared with the final clinicopathological diagnoses listed in the patients' charts. There was only one false positive diagnosis of malignancy. Diagnoses based on cytology of the aspirates were compared with histological diagnoses in 127 cases and the accuracy of typing of the major groups of carcinoma was assessed. Distinction between small-cell carcinoma and non-small-cell carcinoma was usually accurate and fairly good correlation was achieved for all major types of carcinoma. The results for typing of the neoplasm are not as good as those from larger centres in the world. The technique is considered to be useful even in the setting of a small hospital.

Möglichkeiten und Grenzen der perkutanen Nadelbiopsie in der histologischen Klassifikation von malignen Tumoren

180 sonographically guided percutaneous biopsies in a variety of anatomic regions (abdomen, 110; thorax, 33; neck, 28; breast, 4; extremity, 5) were retrospectively reviewed to evaluate the percentage of correct histologic diagnoses of malignant tumours. A positive diagnosis of malignancy was established in 101 (96%) of 107 malignant tumours. A correct histologic classification was achieved in 79 (73%) of 108 malignant tumours by means of cytologic and histologic examination of the tissue acquired. Correct histologic classification of malignant tumours depends on several factors including a) needle diameter, b) location of the tumour, c) clinical constellation and, most important d) the complexion of the tumour histology. The percentage of correct histological diagnoses varied between carcinomas (79%), Hodgkin lymphomas (100%), non-Hodgkin lymphomas (45%), sarcomas (50%) and carcinoid tumours (0%). Histological classification of malignant tumours by means of percutaneous biopsy can be improved by multiple biopsies of different portions of the tumour and by using larger cutting needles.

Ultrasonography and Computed Tomography in Diffuse Liver Disease with Cholestasis

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.

ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN THE MANAGEMENT OF THORACIC LESIONS

Fine needle aspiration cytology was performed on 121 occasions in 100 patients with various thoracic lesions. The investigation was performed chiefly with the help of straight and lateral chest skiagrams regardless of the size or depth of the lesion. The cellular yield was 87.6%. Positive diagnosis of malignancy could be made in 50 cases. The histopathological correlation in malignant cases was 80%. Non-malignant cytology including neoplastic and inflammatory pathology was also found useful in patient management. This report highlights the versatile role of this procedure in arriving at a diagnosis and planning the treatment for malignant as well as non-malignant thoracic diseases.

Fibreoptic bronchoscopy: An assessment of immediate cytological diagnosis using methylene blue stain

A method of examining cytological material during fibreoptic bronchoscopy using a methylene blue (MB) stain was assessed in 164 consecutive fibreoptic bronchoscopies where cytology specimens were taken. The MB method provided an immediate positive diagnosis in 86% of bronchoscopically visible tumours. Subsequent histology provided a positive diagnosis in 69%, conventional brush cytology in 81% and trap cytology in 77%. The MB method produced no false positive diagnosis of malignancy and the tumour cell type identified by MB stain agreed with the histological cell type in 72% of cases. This technique is considered to be sufficiently specific to provide a method of controlling the quality of specimens taken at bronchoscopy, for further analysis in the laboratory.

Percutaneous needle aspiration of hilar and mediastinal masses.

Needle aspiration biopsy of hilar and mediastinal masses was attempted in 100 patients and completed in 91. There were no major complications. In the group with completed biopsies, there were 83 patients with malignant neoplasms; a positive diagnosis of malignancy was established in 80 (96%). Two of the three false-negative results occurred in patients with Hodgkin disease. In all 8 patients with benign masses, the biopsy results were correct. Five of the nine incomplete biopsies occurred in patients with aortic aneurysms that simulated lung or mediastinal masses. In the other 4 patients, the needle biopsy was not completed for technical reasons. Needle biopsy can be performed in practically all areas of the mediastinum, does not require general anesthesia or hospitalization, and is well tolerated by the patient. In this series, the use of mediastinal needle biopsy made it possible to avoid surgery and mediastinoscopy in 72 patients with unresectable malignant neoplasms and 5 patients with innocuous benign mediastinal masses. Needle biopsy may be the preferred initial procedure to obtain a tissue diagnosis in patients with mediastinal masses.

Progress in the cytological diagnosis of gastric lymphoma.A report of 32 cases

Thirty-two cases of gastric lymphoma have been examined cytologically in our laboratory. In one series (1953-1972), a technique combining washings and abrasion under fluoroscopic control was used. A positive diagnosis of malignancy was made in 7 of 17 cases. In a recent series (1972-1976), 15 cases of gastric lymphoma have been studied by direct abrasion during endoscopy. Malignant cells were identified in 13 cases and a correct diagnosis of lymphoma was made in 11 cases. Biopsy was positive for malignancy in 12 cases and lymphoma was specifically diagnosed in 9 instances. Combining cytology and biopsy, a diagnosis of cancer was made in 14 of 15 cases. Endoscopic cytology appears to be far superior to blind abrasion and washings techniques in the diagnosis of lymphoma of the stomach.