Role Of Fine Needle Aspiration Cytology Research Articles

Fine‐needle aspiration biopsy of metastatic soft‐tissue sarcomas to lymph nodes

This paper highlights the role of fine-needle aspiration cytology (FNAC) in 15 cases of metastatic soft-tissue sarcomas involving lymph nodes. Histopathology reports of the primary tumor were available in all cases. Histological diagnoses correlated well with the cytology reports. The most common type of sarcoma to involve the lymph node was embryonal rhabdomyosarcoma (6 cases), followed by synovial sarcoma (2 cases), leiomyosarcoma (2 cases), malignant fibrous histiocytoma (2 cases), fibrosarcoma (1 case), malignant peripheral nerve sheath tumor (1 case), and rhabdomyosarcoma (1 case). FNAC was thus helpful in the early diagnosis, proper staging, and management. Importantly, it obviated a lymph node biopsy in the majority of cases.

The Role of Fine-Needle Aspiration Cytology and Frozen Section in the Operative Management of Thyroid Nodule

The Role of Fine-Needle Aspiration Cytology and Frozen Section in the Operative Management of Thyroid Nodule

The role of fine-needle aspiration cytology in children with persistent or suspicious lymphadenopathy

The aim of this study was (1) To determine the value of fine-needle aspiration cytology (FNAC) in children with persistent or suspicious peripheral lymphadenopathy and (2) to analyze whether a history of previous malignancy influenced the accuracy of FNAC. A retrospective study in an Academic Children's Hospital of 73 FNACs of peripheral lymph nodes in 64 patients (35 boys and 29 girls; median age, 9 years; range, 15 months to 20 years) was performed between 1992 and 1997. Eleven patients were excluded because aspirated material appeared inadequate. Outcome was compared with results of subsequent surgical biopsies, clinical follow-up, or both. Patients were divided into group A "de novo" lymphadenopathy (n = 39) and group B lymphadenopathy and a history of previous malignancy (n = 23). Group A: FNAC showed a benign diagnosis in 25 cases, a malignancy in 13, and was inconclusive in 1. Outcome was false-negative in 2 and false-positive in 1. Sensitivity and specificity were 86% and 96%, respectively. FNAC helped avoid additional surgical procedures in 27 cases (61%). However, if FNAC showed malignant lymphoma, open biopsy was inevitable (8 of 13) to establish proper classification. Group B: FNAC showed a benign diagnosis in 10 cases and a malignancy in 13. Outcome was false-negative in 1, and false-positive in 1. Sensitivity and specificity were 92% and 90%, respectively. FNAC helped avoid additional surgical diagnostic procedures in 25 cases (86%). (1) Fine-needle aspiration cytology is a rapid, simple and accurate diagnostic procedure to differentiate between benign and malignant peripheral lymphadenopathy in children. FNAC can avoid open biopsy in at least 60% of cases. (2) A history of previous malignant disease does not influence the accuracy of the test.

Expanding role of fine-needle aspiration cytology in thyroid diagnosis and management.

In non-iodine-deficient areas, 4% to 7% of the population are reported to have thyroid abnormalities. Prophylactic operations of these nodules in the thyroid are not indicated and not cost-effective, as at least four of five nodules are colloid goiter and only a few are malignant. The need for a reliable preoperative diagnosis is great, and fine-needle aspiration (FNA) is now considered the first choice during workup for thyroid nodules. The steps in the FNA procedure are clinical examination and localization of the target lesion, aspiration, preparation of smears, and collecting material for ancillary microscopy techniques. All these steps must be exercised to allow optimal use of FNA. It can also be combined with various other methods, such as immunohistochemistry of thyroglobulin and calcitonin, analysis of nuclear DNA, DNA preparation for molecular biology analyses, and magnetic resonance spectra. The accuracy of the clinical routine in our unit was evaluated by studying the 5-year outcomes of almost 4000 FNAs of the thyroid. The results were good, with only a few false-negative and false-positive results; but the problem of differentiating follicular adenoma from follicular carcinoma remains a significant problem. It is now well established that FNA biopsy and cytology is the best modality available for the workup of thyroid nodules and is widely utilized in endocrine surgical centers worldwide.

Diagnosis of lymphoma by fine-needle aspiration cytology using the revised European-American classification of lymphoid neoplasms.

Recent changes in the classification of non-Hodgkin lymphoma (NHL) emphasize the diagnostic importance of cytomorphology, immunophenotyping, and molecular findings in addition to histology. These changes have allowed for a greater role of fine-needle aspiration cytology (FNA) in the diagnosis of NHL. A review of the English language literature regarding the use of FNA in the cytodiagnosis of lymphoma was performed. The revised European-American classification of lymphoid neoplasms (REAL) was reviewed in the context of its adaptability to the cytologic diagnosis of lymphoid neoplasms. FNA is being used more frequently in the diagnosis, staging, and follow-up of lymphoma whenever supportive studies are readily available. Cytomorphologic, immunophenotypic, and molecular criteria as well as pitfalls in the diagnosis of lymphoma by FNA have been delineated. Information was compiled into tables to facilitate correlation of criteria with the proposed REAL system. Many cases of NHL can be diagnosed and subclassified by FNA when there is adequate immunophenotypic information. Cancer (Cancer Cytopathol)

The role of fine-needle aspiration cytology in the evaluation of metastatic clear cell tumors.

Clear cell tumors (CCTs) occur as primary neoplasms in a number of anatomic sites. Due to their overlapping morphologic features, these tumors can be challenging for the cytologist, particularly when they present as metastatic lesions. Forty-nine fine-needle aspirations (FNA) of metastatic CCTs from 46 patients (age range, 29-87 years; mean, 64 years) were reviewed retrospectively. In addition to the routine smears and cell block preparations, ancillary studies were performed in selected cases. Clinical and/or histologic follow-up was obtained for all patients. The sites of the 49 FNAs were the lung (12 cases), lymph nodes (9 cases), liver (7 cases), bone (7 cases), soft tissue (4 cases), pelvis (2 cases), adrenal gland (2 cases), pancreas (1 case), thyroid (2 cases), peritoneum (2 cases), and vagina (1 case). Twenty-seven patients had a previous history of a CCT and the FNA material in these cases was consistent with a metastasis. The primary anatomic sites in these cases were the kidney (20 cases), ovary (2 cases), salivary gland (1 case), and cervix (1 case). On light microscopy, these tumors had a similar appearance and often were indistinguishable. Nineteen patients did not have a prior history of malignancy; 12 of these patients had a concurrent renal mass and the diagnosis of metastatic renal cell carcinoma was made. The anatomic site of origin of seven of the ten remaining tumors (kidney [2 cases], lung [2 cases], ovary [1 case], germ cell [1 case], and endometrium [1 case]) was established through immunocytochemical studies of cytologic material and clinical follow-up. FNA plays an important role in the diagnosis of metastatic CCT. Cytologic examination, ancillary studies, and clinical information can establish the anatomic site of origin in the majority (95%) of cases, precluding the necessity of obtaining additional tissue. Cancer (Cancer Cytopathol)

Improving cytological diagnosis and surgical management of parotid adenolymphoma.

The role of fine-needle aspiration cytology (FNAC) in the diagnosis and management of discrete parotid swellings remains controversial. Controlled enucleation can be appropriate with accurate preoperative diagnosis. This study (1985-1995) reviewed the role of FNAC in the diagnosis and surgical management of adenolymphoma. Review of cytological smears by two observers concentrated on the features of infarction and squamoid metaplasia. Sensitivity, interobserver and intraobserver variation were evaluated statistically in a two-run 'blinded' analysis of 80 cytological slides from a variety of lesions. Of 222 epithelial neoplasms of the parotid, 33 were adenolymphomas. FNAC was performed before operation in 32, producing 34 slides, and a correct cytological diagnosis was made in 21 patients. Retrospective review of the 34 slides, to examine specific features of squamoid metaplasia and infarction, improved diagnostic accuracy. The reliability and reproducibility of cytodiagnosis was confirmed by analysis of interobserver and intraobserver agreement. The sensitivity was high (0.76-0.88). Controlled enucleation was performed in 12 patients and superficial parotidectomy in 11. There were no tumour recurrences. Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.

Metastasis of unknown origin: the role of fine-needle aspiration cytology.

Metastasis of unknown origin (MUO) manifests either as a tumor deposit in an organ, often cervical lymphadenopathy, or as a multiorgan carcinomatosis. As a diagnostic and therapeutic challenge, the definition of its cell type and possibly its origin is imperative, although a limited diagnostic investigation is usually recommended. At Hines VA Hospital from 1986 to 1994, there were 116 cases with admitting clinical diagnosis of MUO, evaluated by fine-needle aspiration cytology (FNAC). The ages of patients ranged from 29 to 82 years (mean 56 years). All were male; Caucasians predominated. The FNAC examination with Diff-Quik and Papanicolaou smears were complemented with special and immunostains in 48 cases (41%) and electron microscopy in 93 cases (80%). The FNAC involved lymph nodes in 57 cases (49%), liver in 27 cases (23%), skin in 22 cases (19%), bone in six cases (5%), lung in three cases (3%), and pleura in one case (1%). The neoplasm was generally cell typed, and there were 60 adenocarcinomas/poorly differentiated carcinomas, 26 small-cell carcinomas (SCC), 23 squamous-cell carcinomas (SQCC), and six undifferentiated large-cell carcinomas. The primary source was defined in 30 cases (26%), consisting of lung in 11 cases, prostate in nine, kidney in four, colon in four, pleura in one, and peritoneum in one. Clinical correlation also supported a lung origin for the SCC, while the majority of the SQCC in upper and middle cervical lymph nodes were considered head-and-neck tumors. Our results affirm that FNAC is a viable and simple procedure in MUO investigations.

The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience.

A review of the literature was undertaken to determine the use by UK surgeons of fine-needle aspiration cytology (FNAC) and frozen section histology in management of differentiated thyroid carcinoma. The extent of FNAC use was highly variable, but commoner amongst more specialised surgeons who performed more than 25 thyroid operations per year. Such surgeons generally perform ipsilateral total lobectomy and isthmectomy for solitary thyroid nodule and use FNAC to assist in planning surgical strategy for differentiated thyroid cancer mainly by determining the likely extent of contralateral lobe resection and nodal dissection required. The use of frozen section histology to aid this decision intra-operatively is largely unreported in the UK literature.

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.

Fine-needle aspiration cytodiagnosis of recurrent carcinoma of the breast in operative scars.

Recurrence of carcinoma in scars following surgical treatment of breast carcinoma is a frequent problem. An early diagnosis of recurrent lesions is essential to enable timely management. In this study, the role of fine-needle aspiration cytology (FNAC) in the diagnosis of scar lesions was evaluated in 156 women seen over a period of 12 1/2 yr. Ninety-eight of these on FNAC showed features of a recurrent carcinoma, and in six samples, the FNAC showed suspicious features. In all the six suspicious cases, a subsequent biopsy confirmed a recurrent breast carcinoma. The remaining 52 cases on repeated FNAC were diagnosed as benign, and this was confirmed on a subsequent biopsy. The sensitivity, specificity, and predictive value for cytologic findings were 94.2, 100, and 100%, respectively. It was concluded that FNAC clearly has a role as a first line of investigation for distinguishing between recurrent malignant and benign lesions in scars in women which have been surgically treated for a breast carcinoma.

The role of percutaneous renal biopsy in clinical nephrology.

Percutaneous renal biopsy provides the cornerstone for our understanding of the diseases of the kidney. Recent advances in biopsy techniques, such as the use of real-time ultrasonography and the biopsy gun, have made this procedure easier, increased the yield of diagnostically adequate tissue, and may result in a lower complication rate as well. Despite these improvements, the role of biopsy in the treatment of individual patients remains controversial. Even in diseases such as nephrotic syndrome and systemic lupus erythematosus, where biopsy findings have been used to categorize outcome events, it is unclear whether the biopsy provides more accurate information than can be obtained from less invasive procedures or from empiric therapy. Renal biopsy, however, does remain the best method for evaluation of renal dysfunction in renal allograft recipients. The role of fine-needle aspiration cytology in the management of transplant rejection remains to be established.

Role of fine needle aspiration-cytology in the management of lymphoma

Fine needle aspiration (FNA) is a recognised technique in the diagnosis and management of malignancy. Its application has been used less in the management of non-Hodgkin's malignant lymphomas (NHML) than other malignancies. The reasons for this are difficulty in distinguishing benign hyperplasias from malignant lymphomas, inability to use Rappaport Classification on smears, associated fibrosis causing poor cell yield and less experience due to the less frequent occurrence of lymphoma compared to epithelial malignancy. Using FNA sufficient numbers of cells can be obtained to perform tumour markers, T and B lymphocyte markers and Electron Microscopy studies. During a two year period 72 Fine Needle Aspirates were performed on patients with a previous diagnosis of malignant lymphoma or clinical findings suggesting malignant lymphoma. 26(36%) were benign 9(12%) suspicious and 37(51%) malignant and 8 unsatisfactory. One benign case was diagnosed as aspergillus. 13(18%) of the cytologically benign cases and 8(10%) unsatisfactory were histologically diagnosed as malignant. The false negative rate was 29%. There was no false positive diagnosis. Cytological diagnoses on the 37 malignant cases were 20 large cell lymphoma, 6 mixed large and small cleaved cell lymphoma, 6 myeloma, 6 lymphoma cell type not classifiable and 1 small cell lymphoma. The results indicate Fine Needle Aspiration is a reliable diagnostic technique in the management of malignant lymphoma, it is safe, decreases time for diagnosis and cost effective.

The Treatment of Thyroid Cancer: The Role of Fine-Needle Aspiration Cytology

A series of 960 fine-needle aspiration biopsies of thyroid lesions are reported. The primary indication is the presence of a solitary thyroid mass. Aspiration biopsy is accomplished using a 23-gauge needle and a commercially available syringe pistol equipped with a 20.0-mL syringe. Sensitivity for the presence of a thyroid neoplasm, specificity for the absence of a thyroid neoplasm, predictive value of a positive diagnosis for a thyroid neoplasm, and diagnostic efficiency are all over 90% in this series. Eight percent of the aspirates were unsatisfactory. Use of fine-needle aspiration biopsy for the diagnosis of thyroid conditions reduces thyroid surgery significantly for nonneoplastic disease. It is cost-effective and essentially free of complications.

Cytologic results of fine-needle aspiration biopsies of the central nervous system

The cytologic results of 34 fine-needle aspiration (FNA) biopsies of the central nervous system (CNS) are reported. There were 31 intraoperative biopsies performed at the time of craniotomy. All the cases were diagnosed using direct smear preparations stained with Papanicolaou and Diff-Quik (Harleco, NJ) stains. The sensitivity of the procedure was 90.7%, specificity 100%, positive predictive value 100%, and efficiency of the test of 91%. There were no false-positive diagnoses and three false-negative diagnoses. This study attests to the diagnostic accuracy of FNA cytologic examination of the central nervous system. Statistical analysis of the few previous FNA biopsy series of the CNS are presented. Review of the indications, advantages and complications of CNS needle biopsy are discussed. This report supports the role of fine-needle aspiration cytology in the evaluation of CNS lesions. With recent developments in radiologic imaging, especially ultrasound and computed tomography (CT) using stereotactic guidance, specimens can be obtained for cytologic diagnosis using thinner needles. Excellent diagnostic accuracy can be obtained, as pathologists gain greater familiarity with interpreting FNA biopsy material. Other advantages of FNA biopsy of the central nervous system include the low morbidity and mortality of the procedure and the ability to perform the biopsy through a burr hole under local anesthesia and thereby decrease hospitalization time and cost.

Surgery of the Salivary Glands,

This is a compact textbook totaling less than 150 pages divided into six chapters. Much effort must have gone into achieving this publication in such a condensed manner. In the preface, the author claims that this book is the product of a lifelong professional interest in the subject. The title is somewhat misleading as an attempt has been made to compile and summarize all of the information available on salivary gland abnormalities, rather than just their surgical treatment. For example, the author's preferred technique for parotidectomy is discussed in the first chapter, as well as an update of structure, function and biochemistry of salivary gland secretion, and anatomy of the different salivary glands. Succeeding chapters deal with the diagnostic workup, including roentgenographic investigation, and the role of fine-needle aspiration cytology. Other chapters deal with inflammatory disorders, noninflammatory disorders, nonneoplastic disorders, and benign and malignant neoplasms. Surgical techniques for special situations,

Fine needle cytology of thyroid.

Fine needle aspiration cytology (FNAC) of thyroid nodules is a useful diagnostic technique. The cases of 107 patients with pathological changes in the thyroid are reviewed. Nine carcinomata were found--seven of which showed abnormal cytology. There was one false negative but no false positive result. The role of FNAC in pre-operative evaluation of thyroid nodules is discussed.

Role of Needle Biopsy in Thyroid Nodules

The role of fine-needle aspiration cytology of thyroid nodules is analyzed in 116 cases. Forty-six percent of the patients with "cold" solid nodules were operated on with a 1% known false-negative and a 5% false-positive result. Ninety-four percent of the aspirations provided adequate cytologic material for evaluation. A new approach to the assessment and management of the thyroid nodule with fine-needle aspiration is proposed as the initial step in the evaluation.

The role of fine-needle aspiration cytology in the management of thyroid disease

Fine-needle aspiration cytology of the thyroid gland is a low-cost office procedure which even in children does not require regional anaesthesia. The method is safe, without appreciable complications or side effects. Since the needling is readily accepted by patients, it can be repeated when necessary. A morphological diagnosis is then rapidly obtainable, and time-consuming and expensive investigations are bypassed. In the hands of experienced cytopathologists, fine-needle biopsy is a reliable means of selecting patients for surgery, thereby reducing the frequency of operations for benign lesions. The cytological report enables the clinician to recognize the conditions which will benefit from non-surgical management, for example colloid goitre, thyroiditis and lymphoma, and also to plan surgical strategy in papillary, medullary and anaplastic giant cell neoplasms. In follicular neoplasms, aspiration biopsy cytology does not permit reliable distinction between adenoma and carcinoma. With combined consideration of aspiration biopsy cytology and scintiscans, however, it is possible to distinguish non-neoplastic from neoplastic follicular proliferation. In cases where cytological study does not give a specific or conclusive diagnosis, broad disease categories such as inflammatory or neoplastic states can be recognized. Even for these patients, therefore, the method can serve as a guide in the further management. In post-therapy follow-up of thyroid neoplasms, aspiration biopsy cytology permits rapid detection of recurrence.