Stereotactic fine needle biopsy of the breast.

The experience of the use of the TRC-Mammotest machine for stereotactic fine needle biopsy (SFNB) of the breast in Perth is presented. During the period 20 October 1988 to 10 January 1990, 404 SFNB were performed on 389 women with impalpable, mammographically detected lesions of the breast. Surgical biopsy was performed in 73 cases, of which 38 were malignant, giving a benign to malignant ratio in less than 1:1. The sensitivity for detecting cancer was 95%, with a positive predictive value of 100%. Using a combination of the mammographic and cytologic rating for the likelihood of cancer, all the cancers were detected and no cancers have developed in those considered mammographically and cytologically benign. The importance of a combined assessment of mammography and cytology in the management of patients with mammographically detected abnormalities is stressed.     

Intraoperative pancreatic fine needle aspiration biopsy. Results in 166 patients

Intraoperative fine needle aspiration biopsy (NAB) of undiagnosed pancreatic masses was studied in 166 patients over a 17-year period. The cytologic diagnoses were correlated with histologic specimens, autopsy results, or clinical follow-up (benign disease was documented if the patient was alive without malignancy at least 2 years after laparotomy). Aspirates were interpreted as benign, suspicious, malignant, or unsatisfactory. Malignant disease was the final diagnosis in 109 patients; the cytology was concordant in 101 and was interpreted as suspicious in four. Four patients with benign cytology later proved to have malignant disease--a false-negative rate of 2.5 per cent. A total of 57 patients had benign disease; 51 of these had benign cytology. The remaining patients had "unsatisfactory" cytology reports. A 93 per cent sensitivity, 100 per cent specificity, and 0 per cent complication rate are reported. There were no false-positive cytology reports. Complications are rare and represent case reports, thus, additional sampling is at minimal risk. Intraoperative pancreatic NAB is a safe, easy, more accurate biopsy technique than historical wedge or core needle biopsies. It is the biopsy method of choice for pancreatic masses found at laparotomy.     

Sample size in fine needle aspiration biopsy

The weights of biopsy specimens from bovine liver taken for fine needle aspiration cytology (FNAC) by three groups of physicians, were compared. The groups differed from each other in their extent or degree of experience in FNAC. When the physicians used their normal technique, the mean sample weight increased significantly with experience, from 4.6 mg in the least experienced group to 17.2 mg in the group with the longest experience. Thirty-six per cent of the samples taken by the group with the least experience were in the weight class 0-2 mg, whereas no such samples were encountered for the other groups. When all the physicians were advised to use the same, standard technique there were no statistically significant differences in mean sample weight between the groups or in the proportion of samples in class 0-2 mg. Sample weights correlated significantly (P less than 0.001) with cell counts. This study shows that differences in the technique of FNAC are responsible for differences in sample weights and cell counts, including the number of the acellular samples obtained. This could explain in some part the wide variation in the reported accuracy rates of FNAC.     

Peroperative fine needle aspiration biopsy of lung tumors

The feasibility and reliability of peroperative fine needle aspiration biopsy of lung tumors were studied in a series of 54 patients. The postoperative histologic examination confirmed that 47 of the lesions were malignant. The cytologic examination also showed malignancy in 45 of these cases. The accuracy of fine needle cytology thus was 96%. In the two false negative reports the classification was Papanicolaou grades II and III. The cytologic classification of the histologically benign lesions was only grades I or II. Thus there were no false positive cytologic results. No complications arose from the needle biopsies. Peroperative fine needle aspiration biopsy at thoracotomy is rapid, simple and safe, and has a high degree of accuracy. It is diagnostically useful in cases without preoperative confirmation of suspected lung tumor if excisional biopsy is judged to be hazardous or unlikely to yield a definite diagnosis. The method permits the surgeon to assess the extent of a malignancy and can specify the cell type of the tumor.     

Accuracy and cost-effectiveness of fine needle aspiration biopsy

Two hundred eighty-six fine needle aspiration biopsies were reviewed. The sensitivity for the diagnosis of malignancy was 90 percent for lymph node specimens, 93 percent for skin and soft tissue masses, and 74 percent for breast cancer. The overall accuracy of the technique was 82 percent for breast lesions, and 90 to 92 percent for soft tissue and lymph node lesions. Traditional open biopsy in an outpatient setting for these tumors is twice as costly as fine needle aspiration biopsy. Further refinement in the use of the cytocentrifuge and immunohistochemical techniques will result in fewer inadequate fine needle aspiration specimens and an increase in the diagnostic information available with this technique. Fine needle aspiration is recommended as the first biopsy technique of choice for localized solid tumors.     

Transtracheal aspiration and fine needle aspiration biopsy for the diagnosis of pulmonary infection in heart transplant patients

A total of 129 transtracheal aspirations or fine needle aspirations, or both, were performed in 65 heart and heart-lung transplant patients to identify the causative pathogen in suspected pulmonary infection. Transtracheal aspiration was performed in 82 instances, fine needle aspiration in 47, and both procedures in 23. Both transtracheal and fine needle aspiration were highly specific, 96% and 100%, respectively. Sensitivity for transtracheal aspiration was lower than for fine needle aspiration, 70% and 89%, respectively. The lower sensitivity of transtracheal aspiration is attributed to its performance in all patients with suspected infection regardless of chest radiographic findings. Fine needle aspiration was performed when identifiable lesions could be used as a "target." Overall accuracy of transtracheal aspiration was 78% compared to 91% for fine needle aspiration both alone and combined with transtracheal aspiration. More invasive procedures such as bronchoalveolar lavage and open lung biopsy were required in only three patients (2%). Transtracheal aspiration resulted in one minor complication (1%). The commonest complication of fine needle aspiration was pneumothorax (21%). There were no deaths associated with either procedure. We conclude that in heart and heart-lung transplant patients with suspected pulmonary infection, transtracheal aspiration and fine needle aspiration are safe and accurate methods to identify the causative organism. More invasive techniques may be required in a small minority of patients.     

Value of flow cytometry with fine needle aspiration biopsy in patients with head and neck lymphoma

Lymphomas frequently present in the head and neck clinically as painless adenopathy or as a swelling of an extranodal site, such as salivary gland or Waldeyer's ring. Most non-Hodgkin's lymphomas are B-cell neoplasms with distinctive clonal proteins that can be readily detected using flow cytometric analysis. In our experience, flow cytometric analysis has been a useful, convenient adjunct in the diagnosis of head and neck non-Hodgkin's lymphomas by fine needle aspiration biopsy.     

Ultrasonically guided fine needle aspiration biopsy of renal masses

A consecutive series of 301 ultrasonically guided fine needle aspiration biopsies of renal masses was reviewed. The retrieval rate was 95 per cent and a correct cytological diagnosis was established in 82 per cent of the cases. There were 14 false positive aspirates, for a predictive value of a malignant aspirate of only 93 per cent. All false positive results were misinterpreted as relatively well differentiated adenocarcinoma. We conclude that renal fine needle aspiration biopsy may add information but the risk of a false positive finding must always be considered.     

Transbronchial fine needle aspiration.

In a pilot study, 21 patients underwent transbronchial fine needle aspiration (TBFNA) using a 45 cm-22 gauge needle guided by means of a semi-rigid metal sleeve, which was introduced through a standard rigid bronchoscope. A total of 33 aspirations were performed from main carina (15), paratracheal (five), and lobar carinal (13) foci. Six aspirations yielded malignant cellular samples, 22 aspirations presented only normal cells, and in five no adequate cellular sample was obtained. Fifteen patients underwent surgical exploration (mediastinoscopy with or without thoracotomy). Four of the cytologically malignant cases were explored and in three the aspiration site was confirmed histologically. In the remaining patients where the site of aspiration was explored, no tumour was demonstrated in the cytologically negative or cytologically inadequate cases. There were no complications from TBFNA. We suggest that TBFNA is useful in determining mediastinal malignant involvement rapidly and with lesser invasion than with current techniques.     

超声引导下细针穿刺抽吸活检对甲状腺床病灶的应用价值

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对甲状腺癌术后甲状腺床新生病灶的临床应用价值。方法回顾性分析于我院接受US-FNAB的63例次甲状腺癌患者术后新生甲状腺床病灶,分别评估病灶大小及超声引导下细针穿刺细胞学结果,并与手术病理结果及临床随访结果进行对照分析。结果 63例次患者的69个病灶中,细胞学结果满意60个,诊断为恶性38个,可疑恶性4个,良性18个;细胞学结果不满意9个。与最终临床诊断结果对照,USFNAB诊断甲状腺床病灶的敏感度为97.62%(41/42)、特异度为94.44%(17/18)、阳性预测值为97.62%(41/42)、阴性预测值为94.44%(17/18)、准确率为96.67%(58/60)。结论 US-FNAB对甲状腺癌术后甲状腺床新生病灶具有较高的诊断价值。     

Nonimage-guided fine needle aspiration biopsy of palpable axillary lymph nodes in breast cancer patients

We report the utility of office-based, nonimaged guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients. We examine the sensitivity and specificity of this procedure, and examine factors associated with a positive fine needle aspiration biopsy result. Although the utility of ultrasound-guided fine needle aspiration biopsy (FNA) of axillary lymph nodes is well established, there is little data on nonimage guided office-based FNA of palpable axillary lymphadenopathy. We investigated the sensitivity and specificity of nonimage-guided FNA of axillary lymphadenopathy in patients presenting with breast cancer, and report factors associated with a positive FNA result. Retrospective study of 94 patients who underwent office-based FNA of palpable axillary lymph nodes between 2004 and 2008 was conducted. Cytology results were compared with pathology after axillary sentinel node or lymph node dissection. Nonimage-guided axillary FNA was 86% sensitive and 100% specific. On univariate analysis, patients with positive FNA cytology had larger breast tumors (p = 0.007), more pathologic positive lymph nodes (p < 0.0001), and were more likely to present with a palpable breast mass (p = 0.006) or with radiographic lymphadenopathy (p = 0.002). FNA-positive patients had an increased presence of lymphovascular invasion (p = 0.001), higher stage of disease (p < 0.001), higher N stage (p < 0.0001), and higher rate of HER2/neu expression (p = 0.008). On multivariate analysis, radiographic lymphadenopathy (p = 0.03) and number of positive lymph nodes (p = 0.04) were associated with a positive FNA result. Nonimage-guided FNA of palpable axillary lymphadenopathy in breast cancer patients is an inexpensive, sensitive, and specific test. Prompt determination of lymph node positivity benefits select patients, permitting avoidance of axillary ultrasound, sentinel lymph node biopsy, or delay in receiving neoadjuvant therapy. This results in time and cost savings for the health care system, and expedites definitive management.     

Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy

Two patients are described who developed pneumothoraces more than 24 hours after computed tomography (CT) guided percutaneous fine needle aspiration lung biopsies. The pneumothoraces required treatment in both cases. Such delayed pneumothorax after lung biopsy is extremely unusual. Patients should be warned of the possible occurrence of this complication and instructed to seek medical help if they develop chest pain or breathlessness.