Utility Of Fine Needle Aspiration Research Articles

The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions.

Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.

Clinical diagnostic utility of ultrasound-guided fine needle aspiration biopsy in parotid masses.

Fine needle aspiration (FNA) is a common diagnostic tool used in the initial evaluation of parotid masses. In the literature, variable diagnostic accuracy of FNA is reported. Therefore, when considering clinical management of these patients, the utility of FNA is unclear. The aim of this study was to determine the capability of ultrasound-guided FNA to differentiate between benign and malignant neoplasms. Further, the way in which FNA results affect clinical decision-making was assessed. Retrospective data were collected for all patients who underwent parotidectomy at a large Canadian tertiary care center between 2011 and 2016. Patient demographics, preoperative imaging reports, preoperative FNA results, and final pathological diagnosis were analyzed. Of the 199 patients who underwent parotidectomy, 184 had preoperative ultrasound-guided FNA. There were a total of 13 non-diagnostic FNAs. In diagnosing malignancy, FNA had a sensitivity and specificity of 71.4% and 98.7%, respectively. The positive predictive value (PPV) was 83.3%. The negative predictive value was 97.5%. Of the non-diagnostic FNAs, 2 out of 13 (15.4%) were deemed malignant neoplasms on final pathology. FNA is a useful adjunct in the work-up of parotid masses, but it should be used with caution. Due to limited sensitivity, it should not be relied upon as the sole determinant of a surgeon's management plan.

Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience.

Although the diagnostic utility of lymph node fine-needle aspiration (FNA) is well established in the evaluation of metastatic malignancy, its value in the diagnosis of lymphoma is more controversial; yet, there is a growing trend among practitioners towards less-invasive procedures such as FNA and core needle biopsy (CNB). The guidelines recently published by the American Society for Clinical Pathology/College of American Pathology (CAP) regarding the workup of lymphoma include recommendations on the value and limitations of FNA. We reviewed 1237 image-guided lymph node aspirates from 695 procedures (410 nodes from 360 ultrasound [US]-guided cases, 799 from 309 endobronchial ultrasound [EBUS], 25 from 23 endoscopic ultrasound [EUS], and 3 from 3 computed tomography [CT]). The majority (40 of 46, 87%) of lymph nodes suspected of lymphomatous involvement were aspirated under ultrasound. Core needle biopsy [CNB] was obtained for 41 (89%) lymph nodes, including all 40 US specimens. Flow cytometry (FC) was performed on 37 (80%) aspirates; aspirates without FC were from patients who had a history of Hodgkin lymphoma, or showed granulomata or non-hematologic malignancy onsite. Thirty-one (67%) lymph nodes were sent for review by hematopathology. Forty-two (91%) lymph node FNA/CNB yielded actionable diagnoses. Seventeen of 241(7%) cases aspirated for other indications (14 US, 3 EBUS) were involved by a lymphoproliferative process. All were reviewed by hematopathology. All 14 US cases had FC and CNB. Our institutional approach towards lymph node cytopathology for lymphoma workup appears to be in accordance with the new CAP guidelines, and demonstrates a potential triage and workflow model for lymph node FNA specimens that allows for accurate diagnosis in cases where lymphoma is a consideration.

Deep Lobe Parotid Tumors: A Systematic Review and Meta-analysis.

We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics. PubMed/Medline, Embase, Web of Sciences, and Cochrane Library databases were queried for relevant literature. Studies were individually assessed by 2 independent reviewers. Risk of bias was assessed with the Cochrane bias tool, GRADE criteria, and MINORS criteria. Results were reported according to the PRISMA guidelines. Statistical analysis was performed by comparing rates of malignancy between deep and superficial lobe tumors. In total, 8 studies including 379 deep lobe parotid tumors met inclusion criteria. Mean age at diagnosis was 44.9 years. Computed tomography scan was the most common imaging modality. Preoperative diagnostic fine-needle aspiration was utilized in 39.4% of patients and demonstrated high sensitivity for malignant disease. The most common approach was subtotal parotidectomy with facial nerve preservation (58.9%). The rate of malignancy was 26.6%, which was significantly higher than that of the superficial lobe tumors in this study (risk ratio, 1.25; 95% CI, 1.01-1.56). The rate of temporary postoperative facial nerve weakness between deep and superficial lobe tumors was 32.5% and 11.7%, respectively. Deep lobe parotid tumors had a 26.6% rate of malignancy. On meta-analysis, deep lobe tumors appeared to have higher rates of malignancy than superficial lobe tumors. Surgical excision of deep lobe tumors showed increased rates of temporary facial nerve paresis as compared with superficial lobe tumors. Computed tomography scan was the most common imaging modality. There were limited data regarding the utility of fine-needle aspiration.

Diagnostic utility of fine needle aspiration cytology in pediatric thyroid nodules based on Bethesda Classification.

The Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of thecategories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category. We retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined. A total of 171 patients were included with 203cytological samples. Average age at initial FNA was 14.7 years (range 6.9-18.6 years). The numbers of nodules reported for Bethesda categories I-VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8,4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014. The risk of malignancy for thyroid nodules inthis pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.

Application of the Milan System for Reporting Pediatric Salivary Gland Cytopathology: Analysis of histologic follow-up, risk of malignancy, and diagnostic accuracy.

The diagnosis and management of salivary gland tumors in pediatric patients can be challenging. The utility of fine-needle aspiration (FNA) cytopathology and the performance of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in this age group have not been systematically assessed. The paucity of data has contributed to the controversial role of FNA cytopathology in the presurgical management of these patients. The authors retrospectively analyzed 104 pediatric salivary gland FNAs (2000-2020). A correlation with the available histopathologic follow-up (n = 54) was performed. The distribution percentages, the risk of neoplasm (RON), and the risk of malignancy (ROM) were assessed for each category of the MSRSGC. The overall sensitivity, specificity, negative predictive value, and positive predictive value of pediatric salivary gland FNAs were 80%, 97%, and 92%, respectively. The RON values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories were 60%, 11%, 100%, 100%, 100%, 100%, and 100%, respectively, whereas the ROM values were 0%, 11%, 100%, 6%, 67%, 100%, and 100%, respectively. The percentage of nonneoplastic FNAs was greater in comparison with the adult population (52% vs 8%). All neoplasms in patients aged 0 to 10 years were malignant, whereas benign neoplasms occurred only in patients aged ≥11 years; this supported an inverse correlation between age and malignancy rate in salivary gland neoplasms. FNA cytopathology demonstrates excellent diagnostic performance in differentiating malignant and benign pediatric salivary gland lesions. The MSRSGC is a valuable tool for standardization of the reporting and preoperative risk stratification of these lesions.

The utility of fine-needle aspiration: how FNA has affected our musculoskeletal oncology practice

Fine-needle aspiration (FNA) has been a widely accepted practice in the diagnosis of head and neck, thyroid, lung, pancreas, and many other visceral sites. This has not been the case with the diagnosis of primary bone and soft tissue lesions. FNA has been an important part of our orthopaedic oncology practice for 18 years. Our ability to efficiently and effectively care for patients dramatically improved when FNA became an option for obtaining a tissue diagnosis. We discuss the advantages and disadvantages of a pathologist-driven FNA service in orthopaedic oncology.

Controversies in the Workup and Surgical Management of Parotid Neoplasms.

Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary approach to evaluation and surgical management of parotid tumors. PubMed and Web of Science Databases. Searches of the PubMed and Web of Science databases were performed on subjects related to the diagnosis and surgical management of parotid neoplasms. Particular emphasis was placed on the following areas: evaluation of parotid tumors, including imaging workup and the utility of fine-needle aspiration; extent of surgery of the primary lesion, including the extent of parotidectomy as well as oncologic management of the facial nerve; the extent of surgery of involved and at-risk cervical lymphatics; and parotid bed reconstruction. Articles published from 2014 to the present were prioritized, supplementing with information from prior studies in areas where data are lacking. A summary of the literature in these areas is outlined to provide an evidence-based approach to evaluation and management of parotid neoplasms. While data are available to help guide many aspects of workup and management of parotid neoplasms, further research is needed to refine protocols for this heterogeneous group of diseases.

Utility of Fine Needle Aspiration in Diagnosis of Intraoral Minor Salivary Gland Tumors.

Objective:To evaluate the utility of intraoral fine-needle aspiration cytology (FNAC) in diagnosis of minor salivary gland neoplasms (MSGN) with application of Milan system of reporting salivary gland cytopathology; keeping histopathology as gold standard and to detail the cytological findings of MSGNs.Method:Retrospective study between Jan 2008 and June 2017 (appro × 10 years) on the cytology of the minor salivary gland tumor along with the histopathological correlation. The relevant clinical data was collected from the medical record.Result:Sixty-four cases of MSGNs were included in the study. The histodiagnosis of the 41 were available. Twenty-one cases were diagnosed as malignant, while rest 20 cases were reported as benign. The most common tumor diagnosed was pleomorphic adenoma (PA) (50% cases), followed by mucoepidermoid carcinoma (14%) and adenoid cystic carcinoma (12.5%). The most common site of MSGT was found to be hard palate (44%), followed by soft palate (23%), floor of the mouth (12%), lip (11%), buccal mucosa (5%), and tongue (5%) with no gender predilection. Sensitivity of FNAC for detection of malignancy was 81% while specificity 95%. For malignancies, positive predictive value for malignancies was 17/18 (94.4%) and negative predictive value was 19/23 (82.3%). According to Milan system out of 21 cases in category IV B, 4 cases were found malignant (Category VI), while 1/18 case in category VI turned out to be nonneoplastic lesion (Category II).Conclusion:FNAC is imperative in early diagnosis and subsequent management of MSGNs

Diagnosing Kikuchi's disease on fine needle aspiration biopsy

To investigate the diagnostic utility of fine needle aspiration (FNA) smear, cell block (CB), flow cytometry (FC) and tuberculosis polymerase chain reaction (Tb-PCR) analysis for Kikuchi's disease (KD). A total of 173 FNA biopsy samples were collected using a Youyi aspirator. KD was diagnosed by FNA smear, with or without, CB, FC and Tb-PCR. Out of 173 patients, 131 (75.7%) were female and 126 (72.8%) aged 21-40years. Of these, 171 patients (98.8%) presented with painful enlarged cervical lymph nodes. All cytological samples identified intracellular apoptotic debris embedded in the cytoplasm of crescentic and phagocytic macrophages. In 24 cell-blocks (CBs), clusters of CD123 positive plasmacytoid monocytes were observed in KD. FC and CBs showed non-specific lymphoid hyperplasia in nine cases with suspicious lymphoma. Tb-PCR was negative in five cases with suspicion of tuberculosis. In summary, FNA biopsy is a fast, reliable, and relatively inexpensive diagnosis tool for KD. CB preparation is an important adjunct method for the diagnosis of KD.

Thyroid cytopathology: updates and molecular testing.

SummaryThe utility of fine needle aspiration (FNA) is well described in the context of evaluating thyroid lesions. Among the various international systems of classification of thyroid cytology, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has also provided a sound framework to standardize the reporting of FNA cytology results. New molecular evidence and clinical studies demonstrated the need for revision of the nomenclature resulting in introduction of new categories, such as the noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP). Indeterminate thyroid cytology results pose a challenge for further management and the continued development of molecular markers may aid in the management of indeterminate thyroid lesions.

Utility of Fine Needle Aspiration for Diagnosis of Plasmacytoma

Plasmacytomas are rare extramedullary plasma cell neoplasms that present in bone and/or soft tissue. Diagnosis can require a variety of laboratory approaches such as serum protein electrophoresis, bone marrow biopsy, Bence Jones protein assays, and imaging. However, few case reports describe using fine needle aspiration for diagnosis. We present a case of a plasmacytoma diagnosis in a 55-year-old patient, who initially presented to the emergency room with symptoms of chest pain. Imaging revealed right apical and medial lung mass extending just posterior to the trachea with invasion and destruction of the anterolateral T3 vertebral body. Multiple smaller hypodensities were also present in thoracic vertebral bodies, ribs, and sternum. Biopsies were performed on the mediastinal mass. Fine needle aspiration revealed groups of mature and immature plasma cells at various stages of maturation. Flow cytometry demonstrated a kappa light chain-restricted plasma cell population. Paraffin immunoperoxidase studies showed that the neoplastic cells bore monotypic kappa light chains. The patient’s presentation emphasizes the utility of fine needle aspiration, in conjunction with other ancillary studies, for diagnosing plasmacytomas. J Med Cases. 2019;10(2):37-40 doi: https://doi.org/10.14740/jmc3223

Utility of Fine Needle Aspiration for Diagnosis of Plasmacytoma

Utility of Fine Needle Aspiration for Diagnosis of Plasmacytoma

Utility of Fine-Needle Aspiration in the Diagnosis of Liver lesions: An Institutional Experience

Utility of Fine-Needle Aspiration in the Diagnosis of Liver lesions: An Institutional Experience

Neurolymphomatosis in Primary Cutaneous CD4+ Pleomorphic Small/Medium-sized T-cell Lymphoma Mimicking Hansen's Disease.

Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setting of a known or an unknown hematological malignancy. It typically presents as painful or painless peripheral mononeuropathy, mononeuritis multiplex, polyneuropathy, polyradiculopathy, or cranial neuropathy. A 32-year-old male presented with a hyperpigmented hypoesthetic plaque over the anterolateral aspect of the right leg with thickening of the right common peroneal nerve and foot drop clinically diagnosed as Hansen's disease. Biopsy taken from skin showed infiltrates of pleomorphic small and medium sized lymphocytes in the dermis and subcutis. On immunohistochemistry, the cells were positive for CD3, CD4 and negative for CD8, CD20, and CD30. Ultrasonography-guided fine-needle aspiration of the thickened nerve showed infiltrates of atypical lymphoid cells. Based on these findings, a diagnosis of NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma was made. The disease responded to systemic chemotherapy and localized radiotherapy with no evidence of relapse during 3 years follow-up. NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma presenting with manifestations redolent of Hansen's disease is not described in available literature. This case also demonstrates the utility of fine needle aspiration of nerve, a minimally invasive procedure in the diagnosis of NL.

Warthin's Tumor Masquerading as Metastatic Tumor in Patients with Prior History of Malignancy: Utility of Fine Needle Aspiration (FNA) Cytology

Warthin's Tumor Masquerading as Metastatic Tumor in Patients with Prior History of Malignancy: Utility of Fine Needle Aspiration (FNA) Cytology

Fine Needle Aspiration Cytology of Breast Lumps-A correlation with histopathology diagnosis

FNAC of breast lump is an important mode of diagnosis and forms a part of triple assessment. A retrospective study was undertaken at a tertiary hospital to know the feasibility and utility of fine needle aspiration of breast aspirates by comparing the diagnosis of malignancy with its histology. Of the 321 cases selected for the study, 93 cases were detected positive for malignancy. On reviewing, one case of false positivity and 5 cases of false negativity were detected. The sensitivity and specificity of FNAC for detecting malignancy was 98.27% and 99.49% respectively. Thus, we conclude that FNAC is a very important preliminary diagnostic test in palpable breast lumps and the results show a high degree of correlation with the final histopathology report.

The utility of fine needle aspiration in the management of thyroid nodules

Nodular goitre is a common clinical problem. The last decades have seen a rise in the prevalence of differentiated thyroid cancer (DTC), mostly because of the increasing use of diagnostic tools such as ultrasound. Frequently, newly-diagnosed DTC cases are papillary microcarcinomas (≤1 cm). We reviewed the literature of the last five years in order to evaluate the most appropriate management of thyroid nodules. This included recording the clinical and family history, clinical examination, thyroid and neck ultrasound, hormonal investigation as well as ultrasound guided fine-needle-aspiration (FNA). The therapeutic decisions are mostly based on the cytological findings obtained by FNA combined with the ultrasound findings. Various classifications have been suggested for FNA cytological diagnosis, with the Bethesda System for reporting Thyroid Cytopathology being the most widely used. This system includes six diagnostic categories, each of which includes an estimated cancer risk and recommendation for appropriate clinical management. For indeterminate lesions in FNA specimens, new management algorithms have been proposed. The decision for surgery is based on the risk for malignancy as evaluated by FNA cytological findings.

The underestimated risk of cancer in patients with multinodular goiters after a benign fine needle aspiration.

Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3%. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical. To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy. Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012. Incidence of thyroid cancer on surgical pathology. Of the 134 patients included in the study, 31 (23.1%) were found to have thyroid cancer on final pathology. Twenty-one (15.7%) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5%) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95% CI 1.35-76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95% CI 1.2-30) were independently associated with non-micropapillary thyroid cancer. The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.

Diagnostic utility of fine needle aspiration for assessment of cutaneous malignancies in the plastic surgery clinic

Diagnostic utility of fine needle aspiration for assessment of cutaneous malignancies in the plastic surgery clinic