Routine Fine Needle Aspiration Cytology Research Articles

Multicoloured flow cytometry to detect metastatic carcinoma in lymph node by epithelial cell adhesion molecule.

The metastatic carcinoma in the lymph node may be missed in routine fine needle aspiration cytology (FNAC). There are limited studies on the role of epithelial cell adhesion molecule (EpCAM) in detecting metastatic carcinoma in the FNAC of lymph nodes by flow cytometry (FCM). To evaluate the role of EpCAM in flow cytometry detecting metastatic carcinoma in the fine needle aspiration cytology (FNAC) of the lymph node. In this prospective study, successive 42 cases of lymph nodes were subjected to FNAC followed by flow cytometry to detect the EpCAM positive cell population. The sample was used for cytology and FCM (CD45, CD14, and EpCAM antibodies tagged with fluorochromes). The percentage of EpCAM positive cell population in each case was calculated and compared in the metastatic carcinomas and reactive lymphoid hyperplasia (RLH) cases. There were 29 cases of metastatic carcinoma and 13 non-neoplastic cases (12 RLH and one granulomatous inflammation). The average percentages of EpCAM in metastatic carcinoma and reactive lymphoid cells were 11.37 and 1.24, respectively. The independent sample t-test showed a significant difference (0.001) in the percentage of EpCAM in the two groups. The cut of value of 3% EpCAM in FCM showed 97% sensitivity and 92% specificity to detect metastatic carcinoma in FNAC of the lymph node. The percentage of EpCAM in FCM may be helpful in detecting metastatic carcinoma in the lymph node. The FCM is a rapid and quantitative test with high sensitivity and specificity.

Negative images of mycobacteria revisited in rapid on-site evaluation

Rapid on-site evaluation (ROSE) with routine fine-needle aspiration cytology (FNAC) is a simple, economical, highly accurate tool in the diagnosis of tuberculous lesions. The sample collected can be used for ancillary studies, i.e., Ziehl–Neelsen stain, Cartridge-based nuclei acid amplification testing (CB-NAAT) and bacterial culture for confirmation of the tubercular species. We report a case of a 31-year-old male who presented with left supraclavicular lymphadenopathy. ROSE with FNAC helped in the diagnosis of the patient. FNAC is a rapid minimally invasive method for the early detection of tubercular lesions and helps in proper treatment.

Utility of rapid brillant cresyl blue stained wet mount preparation in routine fine needle aspiration cytology

Fine Needle Aspiration Cytology is the preliminary investigation employed for superficial and deep swelling in the body. It provides early information regarding the lesions before performing biopsy and aid in the treatment plan of the patient. However sample inadequacy from representative lesion may render patients to repeat aspirations and may also cause delay in reports. There is an ever increasing demand for rapid diagnosis in cytology. The present study was conducted to assess the utility of brilliant cresyl blue as a rapid stain in fine needle aspiration cytology. To assess the utility of rapid Brilliant cresyl blue (BCB) stained wet mount preparation in routine fine needle aspiration cytology. The study was carried out in the Cytology laboratory, Govt. Medical College Thiruvananthapuram and PG Pathology Lab, Department of MLT, Govt. Medical College Thiruvananthapuram for a period of six months. A total of 50 cases referred to cytology laboratory for FNAC were included in this study. A wet mount preparation with Brilliant cresyl was prepared immediately after aspiration and examined for cellular adequacy and cytomorphology, which was then compared with the routine Papanicolau stained smear . In situations for rapid diagnosis, and to assess the cellular adequacy of a lesion Brilliant cresyl blue staining method is very helpful. Most of the cases diagnosed as malignant on Brilliant cresyl blue staining correlate with the Pap stain. All the cases diagnosed as benign on rapid brilliant cresyl blue stain were also diagnosed as benign with Pap stain. The result clearly indicate that the brilliant cresyl blue stained wet mount preparation can be used as a rapid supplementary diagnostic procedure in FNAC at least for urgent reporting and sample adequacy assessment.

FNAC of Breast Lesions with Special Reference to IAC Standardized Reporting and Comparative Study of Cytohistological Grading of Breast Carcinoma.

Background:International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant).Aims and Objectives:The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom–Richardson grading.Materials and Methods:All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India.Results:A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases.Conclusion:Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.

A randomized trial comparing health-related quality-of-life and utility measures between routine fine-needle aspiration cytology (FNAC) and surveillance alone in patients with thyroid incidentaloma measuring 1-2 cm.

To present the impact of treatment on health-related quality-of-life (HRQOL) and health utility measures from the randomized controlled trial (ClinicalTrials.gov Identifier: NCT02398721) that investigated the FNAC versus watchful surveillance in patients with incidental benign thyroid nodules. Health utility and HRQOL were evaluated using the EQ-5D 5-level (EQ-5D-5L), 6-item Short-Form Health Survey (SF-6D), and generic 12-item Short-Form Health Survey (SF-12v2) at baseline, 3-month, 6-month, and 12-month assessments. A repeated measure analysis of variance evaluated differences in HRQOL scores between treatment groups over time. Multiple imputations were used to impute missing data at each time point. HRQOL data completion rates were 99.7% at baseline, 92.7% at 3-month, 93.9% at 6-month, 92.7% at 12-month, and 88.6% at 18-month follow-up after baseline. There were significant mean differences in SF-6D, EQ-5D-5L, and SF-12v2 over time except the domain of vitality and mental health of SF-12v2. Mean change of SF-12v2 scores and utility scores from baseline between groups did not exceed minimal important difference. No significant treatment group by time interactions were found in all HRQOL and utility scores except in the vitality domain and PCS of SF-12v2 (p value = 0.033; 0.024). When compared with watchful surveillance, FNAC intervention was associated with better vitality and physical-related HRQOL scores but did not provide better preservation of utility score improvement over the 18-month period. These findings support the routine FNAC approach for nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0 cm.

Usefulness of core needle biopsy for the diagnosis of thyroid Burkitt\u2019s lymphoma: a case report and review of the literature

BackgroundThyroid lymphomas are an exceptional finding in patients with thyroid nodules. Burkitt’s lymphoma is one of the rarest and most aggressive forms of thyroid lymphomas, and its prognosis depends on the earliness of medical treatment. Given the rarity of this disease, making a prompt diagnosis can be challenging. For instance, fine-needle aspiration (FNA) cytology, which is the first-line diagnostic test that is performed in patients with thyroid nodules, is often not diagnostic in cases of thyroid lymphomas, with subsequent delay of the start of therapy.Case presentationHere we report the case of a 52-year-old woman presenting with a rapidly enlarging thyroid mass. Thyroid ultrasonography demonstrated a solid hypoechoic nodule. FNA cytology was only suggestive of a lymphoproliferative disorder and did not provide a definitive diagnosis. It is core needle biopsy (CNB) that helped us to overcome the limitations of routine FNA cytology, showing the presence of thyroid Burkitt’s lymphoma. Subsequent staging demonstrated bone marrow involvement. The early start of an intensive multi-agent chemotherapy resulted in complete disease remission. At 60 months after the diagnosis, the patient is alive and has not had any recurrence.ConclusionsClinicians should be aware that thyroid Burkitt’s lymphoma is an aggressive disease that needs to be treated with multi-agent chemotherapy as soon as possible. To diagnose it promptly, they should consider to order/perform a CNB in any patient with a rapidly enlarging thyroid mass that is suspicious for lymphoma.

Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology

Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology

Fine Needle Aspiration Cytology (FNAC) of Neoplasms in Dogs and Cats, with Emphasis on Differential Diagnosis - A Retrospective Study

Fine needle aspiration cytology (FNA) is a fast, noninvasive method, widely used by clinical laboratories to diagnose neoplasms before the surgical intervention. FNA can be used for obtaining a tissue diagnosis of subcutaneous and other tumors and also for body cavity effusions. This study proposes an evaluation of the types of neoplasms and malignancy criteria found in cytological samples obtained from dogs and cats. The study was conducted at the Faculty of Veterinary Medicine of Iasi between 2012 and 2014 on 23 dogs and 15 cats. Patients diagnosed with masses and body cavity effusions by the pathologists from Internal Medicine and Radiology Clinic were referred to further assessment. Routine FNAC was performed by the attending pathologist. The cytological samples were obtained by fine needle aspiration in order to establish the cellular origin of the neoplasms. Of 67 samples of fine needle aspiration, 38 (56,7 %) specimens were diagnosed as neoplasms, 23 (60,5 %) being obtained from dogs and 15 (39,5 %) from cats. Based on cytological malignancy criteria were diagnosed with certainty a number of 18 (47.4%) neoplasms represented by: adenocarcinoma - 4 cases (three cases with pulmonary origin and one with mammary origin), cutaneous mastocytoma - 3 cases, osteosarcoma - 3 cases, lymphoma and lymphosarcoma - 2 cases, liposarcoma - 1 case, hemangiosarcoma - 2 cases, leukemia - 2 cases and hemophagocytic histiocytic sarcoma in one case. For the rest of the samples the cell type was not established, being recommended further histopathological examination in order to provide a certain diagnosis. The results of this study confirmed FNAC as a reliable and useful diagnostic procedure for neoplastic masses. Even though FNAC has a limited value in determining the cellular origin of tumoral masses or malignant effusions, it often provides a definitive diagnosis or can narrow the list of differentials.

Incidental Diagnosis of Filariasis in Superficial Location by FNAC: A Retrospective Study of 10 Years.

Filariasis, transmitted by the bite of various species of mosquito, is a common disease of tropical belt of the world. In South East Asia, including India, it is a major public health problem. The parasite is primarily confined to Lymphatic channel or lymph nodes where it can remain viable for more than two decades. The most common presentation of the disease is asymptomatic/ subclinical microfilaremia, Hydrocele, acute adeno-lymphangitis (ADL) and chronic lymphatic disease. However, the disease may rarely present as superficial swellings at unusual sites. Incidental findings of microfilaria on fine needle aspiration cytology in these situations, helps in prompt recognition of the disease. The aim of this retrospective study was to assess the incidental diagnosis of Filariasis on fine needle aspiration cytology (FNAC), done for swellings in superficial locations over last ten years at our institute. This retrospective study was conducted over a period of 10 years from April 2003 to March 2013 on the cases where FNAC was carried out on swellings in superficial locations of the body. Twenty cases of filariasis were diagnosed on routine FNAC material obtained from various superficial sites. Their data was retrieved and analyzed. Among the 20 cases diagnosed as filariasis on FNAC, six cases involved lymph nodes, six involved testiculo-scrotal region, three cases of thyroid swelling, soft tissue swelling in three cases and breast lump in two cases. On FNA smears, microfilariae were seen in all 20 cases, eggs in three cases, adult female worm in two cases and adult male worm in one case. Adherence of inflammatory cells and macrophages to microfilariae was noticed in 4 cases. Eosinophilia was present in seven cases. Microfilaremia was present in only three cases. Causative agent was Wuchereria bancrofti in all cases. Although not so common, filariasis should be considered as one of the differential diagnosis of a superficial swelling particularly if clear fluid is obtained on FNAC. Careful screening of smears plays a significant role in recognition of the disease even in asymptomatic patients.

Immunocytochemistry: It′s role in diagnosis of undifferentiated neoplasms by fine needle aspiration cytology

Background:Fine needle aspiration cytology (FNAC) is a rapid, cheap and reliable method for diagnosing any accessible lesion. However, there remains a group of malignant undifferentiated neoplasms, which can only be categorized with the help of immunocytochemistry (ICC). The categorization is important due to their vast difference in treatment and prognosis.Aim:To evaluate the effectiveness of ICC in categorizing the undifferentiated neoplasms diagnosed on routine FNAC smears.Materials and Methods:Thirty six cases of undifferentiated neoplasms were selected from a group of total 78 cytology cases of undifferentiated tumors from different sites like head and neck, lymph node, soft tissue etc. These were then subjected to a panel of ICC markers based on the clinical and cytomorphological features.Results:Of these, 21 were simple, ten were computerized tomography guided and five were ultrasound guided FNACs respectively. All the 78 cases were confirmed by histopathological examination and immunohistochemistry. Of the 36 cytological cases, final diagnosis correlated in 30 cases histologically. The six cases were incorrect either due to inadequate material on the smears (three cases) or false positive staining (three cases).Conclusions:Our study found that ICC is a sensitive and specific method for early and definitive diagnosis of undifferentiated neoplasms. However, selection of antibodies must be judicious to make it cost effective.

Microfilaria in cytological smears at rare sites coexisting with unusual pathology: A series of seven cases

Filariasis is a major public health problem in India and microfilaria is sometimes seen during routine fine needle aspiration cytology (FNAC) smears, but it is very rare to find microfilaria coexistent with neoplastic lesions. Here we report a series of seven cases in which microfilaria is associated with neoplastic lesions. Out of these seven cases one is benign and six are malignant. Also we first time report the microfilaria coexistent with parotid pleomorphic adenoma, undifferentiated carcinoma thyroid and gall bladder carcinoma.

Kikuchi-Fujimoto disease in fine needle aspiration smears: A clinico-cytologic study of 18 pediatric cases and correlation with 68 adult patients

Kikuchi-Fujimoto disease (KFD) is a self-limiting disorder which usually affects young women. There are only a few studies on pediatric KFD patients and their fine-needle aspiration (FNA) cytodiagnosis. We report a series of pediatric KFD patients diagnosed by FNA cytology and compare them with adults. By routine FNA cytology and through retrospective review smears initially diagnosed as reactive hyperplasia of lymph node during the years 2004-2009, 18 pediatric and 68 adult KFD cases were detected. The clinico-cytologic features of these two groups were compared. The age of the pediatric patients ranged from 6 to 18 years with a median of 13.5 years and adult cases were aged 19 to 54 years with a median of 30 years. Only 1 pediatric case (5.6%) and 20 (29.4%) adult cases were initially diagnosed as KFD (P = 0.0604). Arab:non-Arab ratios were 4.3:1 among the pediatric patients and 1:1.5 for the adults (P = 0.0043). FNA smears were highly cellular in 4 (22.2%) pediatric cases and 37 (54.4%) adult cases (P = 0.0180). More than 5% Kikuchi histiocytes was present in 8 (44.4%) pediatric and 49 (72.1%) adult cases (P = 0.0474). No significant difference was observed in male: female ratio, frequency of head & neck lymphadenopathy, time (season) of presentation, and presence of neutrophils and capillary networks, etc. Besides observation and interpretation errors, a significant difference between the two groups in respect of some clinico-cytomorphological features could have influenced the routine cytodiagnosis leading to lower pickup rate of pediatric KFD cases as compared to adults.

Breast ductal lavage (DL) and P16 immunocytochemistry.

1587 Background: The low sensitivity in detecting high-grade atypical cells makes cytologic evaluation of DL specimens a low-yield tool for assessing risk or identifying intraepithelial neoplasia. Following the uterine cervix carcinogenesis model, the hypotheses on some viral role and the loss of p16 function as a pivotal trigger for cell to progress to malignancy, we tested the overexpression of p16 by immunostaining in order to test the possibility of improving cytology sensitivity in DL by means of p16 immunocytochemistry. Methods: 102 DLs and 8 random periareolar fine needle aspiration cytology (FNAC) performed on volunteer women at increased risk for breast cancer (history or presence of controlateral breast cancer or BRCA1/2 mutation carriers or >10% of risk of mutation according to the BRCAPRO model) were retrieved from our institutional files and submitted for p16 immunostain. The morphological diagnosis were: C2 in 77 DLs and in all random FNAC, C3 in 22 DLs and C4 in 7 DLs. Ten cases of routine FNAC positive (C5) for tumor cells were tested too. Results: 5 DLs resulted inadequate for p16 staining, 81 (83.5%) negative, 11 (11.3%) ambiguous, 5 (5.2%) positive (morphologically diagnosed as C2). 6 random FNAC resulted negative for p16 staining, 1 ambiguous and 1 positive (morphologically diagnosed as C2). 8 routine FNAC tumor cells stained for p16 while 2 resulted negative. No relationship was found with DLs of the 26 BRCA mutation carriers. Conclusions: In a different way from what happens for Pap test, p16 does not seem to significantly improve the sensitivity of DL cytology in our series.

Tubulolobular carcinoma of the breast with grooved and cerebriform nuclei: Failure to identify this specific subtype in a case during routine fine needle aspiration cytology and histopathological diagnosis

Tubulolobular carcinoma (TLC) is a rare tumor of the breast in which histologic features of both tubular and lobular carcinoma are combined. We report a case of TLC, in which the specific subtype was missed at routine cytologic and histopathological examination. A 69-year-old woman presented with a right breast lump. Imaging studies indicated a malignant lesion in right upper quadrant. Routine fine needle aspiration (FNA) cytology diagnosis was a duct cell carcinoma (small cell type). In a setting of cystic thyroid lesions, presence of excessive nuclear grooves, and rare intranuclear cytoplasmic inclusion, metastatic papillary thyroid carcinoma was also considered. However, both these possibilities were not supported by immunocytochemical findings (estrogen receptor+, thyroglobulin-, and chromogranin-). The histopathology diagnosis was invasive duct cell carcinoma. Review of FNA smears and paraffin sections led to the diagnosis of TLC, which was supported by positive immunohistochemical stainings for markers like e-cadherin and β-catein.

Fine needle aspiration of a neck lump: a mercurial mystery

We describe an interesting case of mercury within a lymph node, which we found during routine fine needle aspiration cytology of a neck lump. We know of no similar reports and look for any suggestions from our readers as to the cause of such a finding.

Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology

Abstract Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection. In these cases, the number of inflammatory cells within the graft can decline, stabilize or increase with time. In this study, we sought to determine whether the analysis of the expression of ICAM-I, HLA-DR and IL-2R along with borderline FNAC results increases the specificity to diagnose rejection. Of 117 FNAC samples taken from 24 patients after renal transplantation, 85 (72 %) were considered suitable for cytological analysis. Of these patients, 9 (37 %) did not suffer an acute cellular rejection (ACR) episode and 15 (63 %) had at least one ACR episode. ICAM-1 and IL-2R were studied using an immune-peroxidase technique. The ICAM-1 results are expressed as the percentage of tubular cells in the aspirate stained with this marker and the IL-2R results are expressed as the absolute number of positively stained lymphocytes in the whole cytopreparation. With a total corrected increment (TCI) of > 3 there was a sharp increase in the specificity index for rejection that reached almost 100 % at a TCI of ≤ 4. Sensitivity for rejection at this level was only 20 %. Between a TCI of 2.5 and 2.9 the sensitivity increased to 75 %, with specificity for rejection around 75 %. There was an upregulation of ICAM-1 and IL-2R when FNAC diagnosed rejection but with a large overlap of the results when compared either to normal graft or acute tubular neurosis. The mean TCI during the week preceding the rejection episode was 2.5 and the TCI reached a mean value of ≤ 3 only during rejection. The peak ICAM-1 and IL-2R expression occurred during the week preceding the clinically evident rejection episode. The expression of ICAM-1 by ≥ 70 % of the tubular cells increased the specificity for rejection of a TCI of ≥ 2.5 to 100 %. In the same way, the specificity for rejection increased up to 90 % when eight to ten IL-2R-positive lymphocytes were seen along with a TCI of ≥ 2.5. There was no further increase in specificity after that. A specificity index of 100 % for rejection could be obtained for moderate levels of both ICAM-1 (70% or more tubular cells) and IL-2R (eight or more lymphocytes). ICAM-1 expression in 70 % or more tubular cells and/or IL-2R expression in eight or more lymphocytes was found in 58 % of the FNAC aspirates with a TCI between 2.5 and 2.9. In conclusion, the expression of IL-2R in lymphoid cells and ICAM-1 in tubular cells was upregulated during rejection episodes and the upregulation preceded both the clinical and the routine FNAC diagnosis of rejection by 1 week. The ddition of these markers to the FNAC increased substantially the specificity of the FNAC to diagnose rejection.

Accuracy of Fine Needle Aspiration Cytology and Frozen Section Histopathology for Lesions of the Major Salivary Glands

Identifying malignancy either preoperatively or intraoperatively can have a significant impact on the management of salivary gland tumours. We review our experience with fine needle aspiration cytology (FNAC) and frozen section (FS) for salivary gland lesions. We analyse the accuracy of both modalities and their influence on management. Retrospective review of 114 patients who underwent salivary gland surgery, 91 with intraoperative FS and 68 with preoperative FNAC. Both sets of results were compared against each other and the final histopathological diagnosis. The accuracy of FS was 92.3%, with a sensitivity and specificity of 62.5% and 100%. Histologic concordance was 92.4% for benign lesions, and 100% for malignant tumours. The accuracy of FNAC was 89.7%, with a sensitivity and specificity of 100%. The non-diagnostic rate was 10.3%. Histologic concordance for FNAC was inferior to that for FS, with only 64.2% of benign lesions and 50% of malignant tumours correctly identified. FNAC did not alter the management of benign disease even when a correct diagnosis was obtained. Our results suggest that FNAC and FS are complementary in usefulness for malignant tumours. However, FNAC does not influence the management of benign lesions and routine FNAC for every patient may not be cost-effective.

Comparison between DNA Image Analysis and Cytology in the Assessment of Spermatogenesis

Objective: The aim of the study is to evaluate the DNA image analysis of smears in assessing spermatogenesis and to compare it to routine fine-needle aspiration cytology (FNAC). Methods: A total of 33 testicular needle aspirates from azoospermic infertile patients were blindly studied by 2 different cytologists separately; one studied the FNAC and the other evaluated the DNA contents. DNA image analysis was done on Feulgen-stained cytology smears. The generated DNA histogram was compared to cytology results. Results: Twenty-three (69.7%) testes showed complete agreement between the image analysis and cytology mainly in the presence of sperms, while 10 (30.3%) testes showed discrepancy between the DNA image analysis and cytology, mainly in the syndrome with Sertoli cells only and spermatogenic arrest. Conclusions: DNA image analysis of testicular aspirates is an objective and reliable method in assessing spermatogenesis, while cytology is a relatively subjective method and observer dependent. The discrepancy may be explained by cytologist inter- and intra-observer variability in evaluating spermatogenesis in the FNAC specimens.

Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology.

Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection. In these cases, the number of inflammatory cells within the graft can decline, stabilize or increase with time. In this study, we sought to determine whether the analysis of the expression of ICAM-I, HLA-DR and IL-2R along with borderline FNAC results increases the specificity to diagnose rejection. Of 117 FNAC samples taken from 24 patients after renal transplantation, 85 (72%) were considered suitable for cytological analysis. Of these patients, 9 (37%) did not suffer an acute cellular rejection (ACR) episode and 15 (63%) had at least one ACR episode. ICAM-1 and IL-2R were studied using an immune-peroxidase technique. The ICAM-1 results are expressed as the percentage of tubular cells in the aspirate stained with this marker and the IL-2R results are expressed as the absolute number of positively stained lymphocytes in the whole cytopreparation. With a total corrected increment (TCI) of > 3 there was a sharp increase in the specificity index for rejection that reached almost 100% at a TCI of > or = 4. Sensitivity for rejection at this level was only 20%. Between a TCI of 2.5 and 2.9 the sensitivity increased to 75%, with specificity for rejection around 75%. There was an upregulation of ICAM-1 and IL-2R when FNAC diagnosed rejection but with a large overlap of the results when compared either to normal graft or acute tubular neurosis. The mean TCI during the week preceding the rejection episode was 2.5 and the TCI reached a mean value of > or = 3 only during rejection. The peak ICAM-1 and IL-2R expression occurred during the week preceding the clinically evident rejection episode. The expression of ICAM-1 by > or = 70% of the tubular cells increased the specificity for rejection of a TCI of > or = 2.5 to 100%. In the same way, the specificity for rejection increased up to 90% when eight to ten IL-2R-positive lymphocytes were seen along with a TCI of > or = 2.5. There was no further increase in specificity after that. A specificity index of 100% for rejection could be obtained for moderate levels of both ICAM-1 (70% or more tubular cells) and IL-2R (eight or more lymphocytes). ICAM-1 expression in 70% or more tubular cells and/or IL-2R expression in eight or more lymphocytes was found in 58% of the FNAC aspirates with a TCI between 2.5 and 2.9. In conclusion, the expression of IL-2R in lymphoid cells and ICAM-1 in tubular cells was upregulated during rejection episodes and the upregulation preceded both the clinical and the routine FNAC diagnosis of rejection by 1 week. The ddition of these markers to the FNAC increased substantially the specificity of the FNAC to diagnose rejection.

Non-palpable lesions of the breast detected by mammography — Review of 1182 consecutive histologically confirmed cases

We report on 1182 consecutive histologically confirmed non-palpable breast lesions detected by mammography (infiltrating carcinoma 427, in situ carcinoma 121, benign 634). The proportion of cancer cases varied according to age (< 50 years = 33%; 50-59 years = 46%; > 59 years = 63%), mammographic pattern (regular opacities = 8%, parenchymal distortions = 20%, isolated calcifications = 42%, irregular opacities = 62%, stellate opacities = 73%), and calendar period (1970-1985 = 29%, 1986-1989 = 56%; 1990-1992 = 69%). A sharp decrease of the benign/malignant biopsy ratio was evident after routine fine-needle aspiration cytology (sonography-guided or stereotaxic) was introduced in 1986. The independent significant association of cancer frequency to age, calendar period and mammographic pattern was confirmed by multivariate analysis. A significant trend over time in favour of conservative surgery was also observed for cancer cases (1970-1979 = 6%, 1980-1985 = 41%, 1986-1992 = 83%). Among invasive cancers, node involvement was observed in 11.5% of cases, being associated with tumour size (pT1a = 0%, pT1b = 7%, pT1c = 13%, pT2a = 33%). Five-, ten- and fifteen-year overall survivals of invasive cancers were 98.1, 95.7 and 87.3%, respectively.