Fine needle aspiration of the abnormal prostate: a cytohistological correlation

Cytological diagnosis by fine needle aspiration of the prostate was compared to histological diagnosis by either perineal needle biopsy or transurethral prostatic resection in 110 patients suspected to have prostatic cancer by rectal examination. Of the 94 prostatic aspirations that could be given a definite cytological diagnosis there was histological correlation in 85 (90.4 per cent). The false negative rate was 2.7 per cent for fine needle aspiration and 5.3 per cent for perineal needle biopsy. Inadequate cytological samples occurred mainly at the beginning of the study. There was a 69 per cent correlation in 36 cases in which cytological grading was compared to histological grading. Our results indicate that fine needle aspiration is an easily performed, diagnostically reliable outpatient procedure with minimal complications that also can be used for grading purposes.     

Does transurethral resection of the prostate promote metastatic disease?

Previously published data have suggested that transurethral resection of the prostate might promote the subsequent appearance of metastatic disease. To confirm or deny these observations 145 patients underwent radical prostatectomy, after having had the disease diagnosed either by transurethral resection of the prostate or transrectal needle biopsy. Of the 145 patients 6 were excluded from analysis since they had had transurethral resection of the prostate and transrectal needle biopsy. In 33 patients the disease was diagnosed by transurethral resection of the prostate only and in 106 it was diagnosed by transrectal needle biopsy only. The relative distribution of Gleason grade and the positive versus negative margins among the 2 populations were similar. Using time to first evidence of distant disease as the endpoint of the study no difference in failure rates could be detected between the 2 populations. It is concluded that transurethral resection of the prostate does not enhance the appearance of metastatic disease.     

Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours

BACKGROUND: The accurate diagnosis of musculoskeletal tumours is important for successful treatment. Image guided biopsy is gaining increasing acceptance for obtaining tissue for diagnosis. The aim of the present study is to assess the accuracy of computed tomography (CT)-guided core needle biopsy of musculoskeletal tumours. METHODS: This is a retrospective study on a series of 127 patients with a musculoskeletal tumour. The biopsies were performed over a 4-year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to distinguish between a benign and malignant tumour. RESULTS: Computed tomography guided core needle biopsy in the present series has an overall accuracy of 80.3%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81.4% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 98.9% and the PPV of benign tumour 90.2%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n = 12), osteosarcoma (n = 11) and giant cell tumour (n = 11). There were no reported complications arising from the biopsy. CONCLUSION: Computed tomography guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours. It should be performed in a specialized institution with a multidisciplinary musculoskeletal tumour team.     

How reliable is cancer diagnosis with needle biopsy of the prostate?

Aim of the study was to investigate the reproducibility and the reliability of the morphological diagnosis, of different morphological parameters and representativity of needle biopsy material compared with transurethral resection material. 416 needle biopsies of carcinomas of the prostate were studied by 5 pathologists. 130 biopsies were evaluated twice by the same investigators and 325 at least by one other investigator. In 65 cases, tissue obtained by transurethral resection was evaluated by the same investigator who had seen the biopsy. The diagnosis of carcinoma of the prostate was highly reproducible, only in 2% of the cases the original diagnosis was not confirmed; 5 out of 27 systematically evaluated parameters proved to be very reliable and reproducible, i.e. histological tumor classification, cribriform glands, invasion of perineural spaces, nucleoles, nuclear polymorphism, 8 parameters were sufficiently reproducible and 14 were unreliable among which cytologic differentiation was one. The diagnostic reproducibility between biopsy material and transurethral resection material was only 48.8%. This very low figure can be explained by the marked histologic heterogeneity of the tumors of which only 13% were classified as uniform carcinomas. The conclusions of the investigation are: 1. The diagnosis carcinoma is highly reliable and reproducible in needle biopsies. 2. Needle biopsy tissue is not representative for the entire tumor. 3. Grading of prostate carcinoma is highly subjective and therefore no sound basis for therapy and prognosis in the individual patient.     

Incidental carcinoma of the prostate: significance of staging transurethral resection

We compared the results of staging by a second circumferential transurethral resection and/or transperineal needle biopsy in 42 patients with stage A prostatic adenocarcinoma on initial transurethral resection (defined as tumor of low grade, Gleason sum 2 to 4, and low volume, less than 5 per cent of the specimen or less than 3 foci). Transurethral resection only was done in 16 patients, transperineal needle biopsy only in 2 and both procedures in 24. In the 24 patients who underwent both procedures residual carcinoma was identified by transurethral resection in 6 and confirmed by transperineal needle biopsy in only 1. Thirty-two patients (76 per cent) had no residual carcinoma. Of the 10 patients (24 per cent) with residual carcinoma 5 underwent radical prostatectomy with pelvic lymphadenectomy, 1 had interstitial irradiation with pelvic lymphadenectomy and 1 had pelvic lymphadenectomy only. No lymphatic metastases were detected; persistent carcinoma confined to the prostate was noted in all 5 patients who had undergone radical prostatectomy and 3 of these tumors were upstaged because of higher grade and/or volume. We conclude that residual carcinoma cannot be assessed accurately with transperineal needle biopsy, whereas transurethral resection staging enabled us to define a substantial number of our patients (24 per cent) with persistent disease. Importantly, upstaging by either low volume/high grade or high volume carcinoma was identified in 3 patients at the time of radical prostatectomy. However, the true stage and prognosis of those patients with persistent low volume and low grade prostatic carcinoma remain to be determined.     

Fallibility of transthoracic needle biopsy of anterior mediastinal masses.

Percutaneous transthoracic core needle biopsy has been advocated as a highly accurate technique for the diagnosis of anterior mediastinal masses. A patient is described with a large anterior mediastinal mass in whom the diagnosis of mediastinal carcinoid tumour was made by transthoracic core needle biopsy. At definitive surgical resection the tumour proved to be a B cell lymphoma. This case illustrates one of the important limitations of needle biopsy with its potential for sampling error.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.     

Needle Track Seeding of Primary and Secondary Liver Carcinoma After Percutaneous Liver Biopsy

Seeding of tumour in the needle track following percutaneous needle biopsy of liver neoplasms is rarely reported. We describe two such cases following the needle biopsy of an hepatocellular carcinoma and secondary colorectal carcinoma respectively. The risk of needle track recurrence of liver tumours should not be regarded as insignificant. The diagnosis of liver neoplasms may be achieved by non-invasive modalities, and their needle biopsy should be reserved for cases not amenable to surgical resection.     

Role of ureteroscopic biopsy in the management of upper urinary tract malignancy

BACKGROUND: The aim of the study presented here was to examine the accuracy of ureteroscopic biopsy in the diagnosis of upper urinary tract transitional cell carcinoma (TCC) and whether nephron-sparing management (holmium YAG laser, transurethral resection or partial ureterectomy) is possible or not based on pathological diagnosis. METHODS: Forty consecutive patients underwent ureteroscopic biopsy with the use of 3-Fr cold cup forceps. Pathological diagnosis of the biopsy sample and grade or stage of surgically resected tumors were compared. In patients with grade 1 or 2 TCC diagnosed by ureteroscopic biopsy, the disease-free and survival rates determined whether nephron-sparing management was performed or not. RESULTS: There were no major complications associated with ureteroscopic biopsy. The pathological grading of the biopsy specimen was almost the same as that of the surgically resected specimen. Eighty five percent of grade 2 or 3 TCC showed muscle invasive disease. There were no significant differences in the disease-free and survival rates between the nephroureterectomy and the nephron-sparing management groups, except for grade 3 or pT3 tumors. CONCLUSION: Ureteroscopic biopsy is safe and accurate if sufficient tissue sample is obtained. Ureteroscopic biopsy should be performed in patients who require nephron-sparing management. Nephroureterectomy can be avoided if the tumor is confirmed as low-grade.     

Primary squamous cell carcinoma of the prostate: a case report

The patient was a 72-year-old man who visited our hospital with a chief complaint of pollakisuria. Digital rectal examination suggested prostatic carcinoma, but prostate specific antigen level was within normal limits. Transperineal needle biopsy was performed and histology was squamous cell carcinoma. Because of the urinary retention, transurethral resection of the prostate was performed and histological examination revealed squamous cell carcinoma. In spite of radiotherapy and chemotherapy with cis-platinum, the progression of cancer continued. The patient died about 13 months after the diagnosis.     

经直肠超声引导穿刺活检诊断早期前列腺癌漏诊原因的分析

目的:分析经直肠超声(TRUS)引导下穿刺活检诊断前列腺癌的漏诊原因,减少漏诊率,提高诊断率。方法:80例疑似前列腺癌的良性前列腺增生(BPH)患者行TRUS引导下穿刺活检,结果均为阴性,均行前列腺电切术(TURP),术后标本行病理检查。结果:25例术后病理报告为前列腺癌,漏诊率31.25%(25/80)。其中10例行经会阴前列腺癌根治术、8例行手术去势、7例行药物去势。结论:TRUS引导穿刺活检诊断前列腺癌存在一定的漏诊,多次或多点穿刺活检可以减少漏诊率。     

Management of 155 patients with benign liver tumours.

BACKGROUND: Benign hepatic tumours continue to represent a diagnostic and therapeutic challenge. This study evaluates the indications and results of resection compared with observation in patients with benign hepatic tumours. METHODS: Patients with a primary diagnosis of benign liver tumour were identified from a prospective database and evaluated retrospectively. RESULTS: From January 1992 to June 1999, 155 patients with benign hepatic tumours were evaluated. The diagnoses included haemangioma (n = 97), focal nodular hyperplasia (FNH) (n = 42), hepatic adenoma (n = 12) and cystadenoma (n = 4). Sixty-eight patients (44 per cent) underwent resection because of symptoms (n = 36), inability to exclude a malignancy (n = 31) or enlargement on serial imaging (n = 11). The operative morbidity and mortality rates were 21 per cent and zero respectively. Thirty patients had a preoperative percutaneous needle biopsy, 19 of which were either incorrect or indeterminate. Overall, 39 of 42 patients with symptoms attributed to the tumour were asymptomatic after resection and 18 of 21 patients with symptoms considered unrelated to the tumour were asymptomatic after a period of observation and/or treatment of unrelated conditions (median follow-up 16 months). CONCLUSION: When indicated, resection of benign liver tumours can be performed safely. Symptomatic patients with a small FNH or haemangioma can be observed because their symptoms are unlikely to be related to the liver tumour. Percutaneous needle biopsy rarely changes management.     

A case of primary transitional cell carcinoma of the prostate]

We report a rare case of primary transitional cell carcinoma of the prostate. A 66-year-old man was referred to our hospital with the chief complaints of pollakisuria and residual urine sensation on January 21, 1998. Under a preoperative diagnosis of benign prostatic hyperplasia, transurethral resection of the prostate was performed. Histopathological examination revealed grade 3 transitional cell carcinoma. Then the transrectal needle biopsy of the prostate and random biopsy of the urinary bladder were performed. Since no metastatic tumors or tumor cells were detected in either the prostate or urinary bladder or any other organs, this patient was diagnosed with primary transitional cell carcinoma of the prostate. Three courses of adjuvant chemotherapy (M-VAC) were performed, and tumor recurrence was not recognized 9 months after the operation. This is the 35th case of primary transitional cell carcinoma of the prostate in the Japanese literature.     

The significance of atypia in fine needle aspiration cytology of the prostate

Of 411 fine needle aspirates of the prostate 208 could be matched with conventional pathological material. Cytological diagnosis had a complete sensitivity of 94 per cent, specificity 99 per cent and efficiency 74 per cent. Corresponding figures for 36 patients who underwent total prostatectomy were complete sensitivity 100 per cent, specificity 100 per cent and efficiency 78 per cent. Atypical cytology results not amounting to frank malignancy were the main reasons for reduced efficiency and, therefore, analysis of the significance of atypia was performed. In 50 aspirates from 43 patients atypia of varying degree was noted but the degree of atypia did not allow for a diagnosis of malignancy. Subsequent diagnosis of carcinoma was made by cutting needle biopsy or transurethral resection in 7 of 14 specimens (50 per cent) of severe, 3 of 9 (33 per cent) moderate, 3 of 7 (43 per cent) mild and 3 of 16 (19 per cent) reactive atypia. Thus, specific cytological diagnoses have a high degree of accuracy but atypia and attempts to categorize it did not predict accurately the final diagnosis. Pathological conditions that may account for atypia in fine needle aspiration cytology are reviewed.     

Durability and cost-effectiveness of transurethral needle ablation of the prostate as an alternative to transurethral resection of the prostate when alpha-adrenergic antagonist therapy fails

PURPOSE: We analyzed the adverse event profile, long-term efficacy and cost-effectiveness of transurethral needle ablation of the prostate for lower urinary tract symptoms associated with benign prostatic hyperplasia as an alternative to transurethral resection of the prostate in men with symptoms uncontrolled by medical therapy. MATERIALS AND METHODS: A total of 71 men on a waiting list for transurethral resection of the prostate after failed medical therapy underwent transurethral needle ablation of the prostate. Symptom scores, uroflowmetry and residual urine were measured before and up to 10 years following treatment. Transrectal ultrasound and pressure flow studies were performed before, and 3 and 12 months following treatment, respectively. Treatment failure was defined as lower urinary tract symptoms progression requiring further therapy or associated with deteriorating quality of life assessment. RESULTS: Apart from transient postoperative urinary retention, no significant treatment emergent adverse events due to transurethral needle ablation of the prostate were observed. Treatment failure occurred in 58 men (83%) at a median of 20 months. A total of 36 men (51%) underwent invasive treatment (transurethral resection of the prostate 33, bladder neck incision 2, microwave thermal ablation 1), 2 men (3%) were deemed unfit for anesthesia and now practice clean intermittent self-catheterization, 14 men (20%) reported improvement following resumption of treatment with an alpha-adrenergic antagonist after transurethral needle ablation of the prostate and 6 men (9%) have experienced deterioration in lower urinary tract symptoms with reduction in quality of life assessment (International Prostate Symptom Score 3 or greater) but have declined further intervention. There were 12 men (17%) who remained symptom-free up to 10 years after transurethral needle ablation of the prostate. The estimated additional cost of treatment for lower urinary tract symptoms per man treated with transurethral needle ablation of the prostate during the 10-year followup was $1,377. CONCLUSIONS: Despite documented safety and lack of morbidity, the high re-treatment rate associated with transurethral needle ablation of the prostate renders it relatively expensive when viewed as a long-term alternative to transurethral resection of the prostate for the management of lower urinary tract symptoms associated with benign prostatic hyperplasia in men in whom medical therapy failed. Of men failing alpha-blockade therapy 20% will benefit from a combination of transurethral needle ablation of the prostate and alpha-blockade.     

Transurethral resection of bladder tumour (TURBT)

The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.     

Angiomyolipoma of the liver

Hepatic angiomyolipoma is a rare tumour of the liver. Its behaviour is benign and this paper reports the first case described in Australia. A review of the literature suggests that the use of ultrasonography, computerized tomography and angiography should enable pre-operative diagnosis to be made with relative certainty, yet the difficulties with histological diagnosis, particularly on needle biopsy, may necessitate resection.     

Carcinoma in situ of the urinary bladder--definition and status of treatment

Carcinoma in situ is a noninvasive intraepithelial disease without papillary growth. Anaplasia and a disarranged growth form of the epithelium are histopathological characteristics. Carcinoma in situ can appear as a secondary disease combined with a papillary tumour or after transurethral resection of a papillary tumour. On the other hand, primary carcinoma in situ is also known to appear without a papillary tumour. Symptoms of cystitis are often seen. Sometimes, however, the disease does not cause any symptoms. Urinary cytology is the most important noninvasive investigation, followed by biopsy of the bladder epithelium. Treatments commonly applied at present are intravesical immunotherapy with BCG and intravesical chemotherapy. Photodynamic laser therapy is presently being investigated. Carcinoma in situ is very significant as a prognostic factor. The progression rate is up to 83%, and progression signifies development of a poorly differentiated invasive bladder cancer. The treatment of choice for inefficiently treated carcinoma in situ is cystectomy. The urinary diversion selected in men depends on the histopathological findings in the prostatic urethra; an ileum neobladder, the standard diversion in men, cannot be performed if carcinoma in situ has been found in the prostatic urethra.     

A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer

Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.     

膀胱移行细胞癌伴发前列腺腺癌五例

为了提高膀胱移行细胞癌伴发前列腺癌的诊断水平，对１９８６年至今收治经病理证实的５例膀胱移行细胞癌伴发前列腺腺癌患者，与膀胱肿瘤浸润前列腺及前列腺癌浸润膀胱两种疾病相比较。术前明确诊断需要注意：（１）前列腺直肠指诊必不可少；（２）术前前列腺穿刺活检可防止漏诊，尤其对可疑前列腺癌者更有必要；（３）膀胱镜检查、活检，前列腺特异性抗原检测具有一定意义。明确诊断对指导治疗及判断预后具有重要意义。