Fine-Needle Aspiration Biopsy: A Reproducibility Study and a Correlation With the Tru-Cut Biopsy in the Evaluation of Renal Allotransplants

Forty patients receiving a living related donor kidney transplantin the last 12 months were subjected to evaluation by Fine NeedleAspiration Biopsies (FNABs) and Tru-cut biopsies. The reproducibilityof the transplant aspiration cytology was tested by comparing90 double FNABs (FNAB₁ and FNAB₂) Furthermore, the accuracyof FNABs was assessed by comparison with 30 kidney transplantTru-cut biopsies obtained simultaneously. Statistical analysis showed no significant difference (P>0.1)between FNAB₁ and FNAB₂ and both correlated positively withthe Tru-cut biopsies. All the 25 acute rejection episodes documentedby Tru-cut biopsies were positive in the simultaneously obtainedFNABs. FNABs failed to diagnose histologically documented chronicrejection, humoral rejection, and a case of disseminated intravascularcoagulation. In one case with deteriorating graft function,Tru-cut biopsy showed normal histology, yet transplant aspirationcytology showed cyclosporin nephrotoxicity. Sensitivity of transplantaspiration cytology was found to be 90.9% and specificity was100%. We have concluded that FNAB when performed frequently, especiallyif double aspirates are obtained, is safe, sensitive and highlyspecific for diagnosis of renal transplant rejection. Humoraland chronic rejections are major limitations.     

Ultrasonography and Fine-Needle Aspiration Cytology Can Spare Breast Cancer Patients Unnecessary Sentinel Lymph Node Biopsy

Background Some 30% to 40% of the breast cancer patients scheduled for sentinel node biopsy have axillary metastasis. Pilot studies suggest that ultrasonography is useful in the preoperative detection of such nodes. The aims of this study were to evaluate the sensitivity of preoperative ultrasonography and fine-needle aspiration cytology for detecting axillary metastases and to assess how often sentinel node biopsy could be avoided. Methods Between October 1999 and December 2003, 726 patients with clinically negative lymph nodes were eligible for sentinel node biopsy. A total of 732 axillae were examined. Preoperative ultrasonography with subsequent fine-needle aspiration cytology in case of suspicious lymph nodes was performed in all patients. The sentinel node procedure was omitted in patients with tumor-positive axillary lymph nodes in lieu of axillary lymph node dissection. Results Ultrasound and fine-needle aspiration cytology established axillary metastases in 58 (8%) of the 726 patients. These 58 were 21% of the total of 271 patients who were proven to have axillary metastasis in the end. Of the patients with ultrasonographically suspicious lymph nodes and negative cytology, 31% had tumor-positive sentinel nodes. Patients with preoperatively established metastases by ultrasonography and fine-needle aspiration cytology had more tumor-positive lymph nodes (P < .001) than patients with metastases established later on. Conclusions The sensitivity of ultrasonography and fine-needle aspiration cytology is 21%, and unnecessary sentinel node biopsy is avoided in 8% of the patients. This approach improves the selection of patients eligible for sentinel node biopsy.     

Large-Gauge Core Needle Biopsy of the Breast

Abstract: Large-gauge core needle biopsy (LGCNB) of the breast is gaining acceptance as a viable alternative to surgical excision. The procedure can be performed efficiently using ultrasound or stereotactic guidance. We report our experience with 137 LGCNB performed over a 40-month period. One hundred thirty-seven lesions in 125 patients were subjected to LGCNB. Fifty-nine procedures were performed using stereotactic guidance and 78 using ultrasound guidance. Stereotactic procedures utilized a prone table and ultrasound procedures used a freehand technique. All biopsies were performed with a 14-gauge core needle attached to an automated biopsy device. There were 53 malignant and 84 benign diagnoses in this group of 137 LGCNB. Surgical correlation is available in 46 of the 53 malignant cases. There were no false positives, though one lesion was missed at the initial surgical excision but retrieved at reexcision. Of the 84 benign cases, there has been surgical (n = 10) or mammographic follow-up (n = 32) in 42. The mean duration of mammographic follow-up is 13 months (range: 5–36 months). There was one false negative LGCNB. The sensitivity, specificity, positive predictive value, and negative predictive value in this series are 98%, 100%, 100% and 96%, respectively. LGCNB has a high degree of accuracy and is well accepted by patients. There are some persistent difficulties with the technique, such as ensuring compliance with follow-up recommendations among patients with benign results and excluding invasive carcinoma.?     

The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy

World Journal of Surgery - The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30&nbsp;years, this has evolved from...     

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

Background Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy. Methods This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy. Results Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively. Conclusions FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.     

Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature

Purpose For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase. Methods One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard. Results It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging. Conclusion This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.     

Imaging-Guided Core Needle Biopsy of the Breast: Study of Psychological Outcomes

The objective of this study was to evaluate and document pain and psychological distress related to imaging-guided core needle biopsy (CNB) of the breast. This prospective study of 52 consecutive patients undergoing CNB of the breast assessed anxiety, pain, acute stress disorder, and activities of daily living both preprocedure and at 24 hours, 5 days, and 30 days postprocedure. Survey instruments included the State-Trait Anxiety Inventory (STAI), a visual analog pain scale, the SF-36 Physical Functioning Scale, and DSM IV criteria for acute stress disorder. Preprocedure the mean scores for self-reported levels of state and trait anxiety were 47.11 (SD = 13.53) and 37.71 (SD = 11.24), respectively. At 24 hours postprocedure, the mean score for self-reported state anxiety was 38.74 (SD = 17.77), a significant reduction from the preprocedure level reported by patients (p < 0.005). Further reductions in state anxiety levels were reported at 5 and 30 days postprocedure. The mean scores for state anxiety fell within the normal range at 30 days postprocedure (mean 32.75, SD = 10.97). However, at 5 days post-CNB, patients with confirmed malignancies reported significantly more anxiety than patients without malignancies (p = 0.002). This difference was not present at 30 days post-CNB (p = 0.17). Patients reported average pain scores of 2.0 (on a scale of 0-10) during the biopsy. This decreased to 1.3 at 24 hours, 0.3 at 5 days, and 0.2 at 30 days. Reported symptoms of acute stress related to the procedure significantly increased over the period between the 5-day interview and the 30-day interview. One (2%) patient reported avoidance of thoughts about CNB 5 days postprocedure and 5 (12%) patients reported this at 30 days postprocedure (p < 0.05). Patients undergoing CNB reported significant levels of state anxiety which were greatest at the time of biopsy. A significant decrease was observed at 24 hours postprocedure, despite the fact that biopsy results were not available to the patients. Self-reported levels of anxiety for the group, regardless of biopsy results, fell within the normal range by 30 days. Further research and interventions are recommended to address the management of anxiety for patients undergoing CNB.     

Fine Needle Aspiration Biopsy of Bone Lesions: Clinical Value

The clinical value of cytological aspiration biopsy in 85 patients with lytic bone lesions was studied. In 71 cases cytology was of diagnostic value, but in 14 cases it was inconclusive or misleading. The method is considered a simple primary diagnostic procedure especially in lytic bone lesions of uncertain nature.     

乳腺X线摄影、局部数字化处理与立体核心活检对乳腺癌诊断的意义（附122例分析）

目的：评估立体核检在乳腺癌诊断中的意义。方法：1999年3月15日－2000年3月15日,我院外科门诊应用意大利Giotto乳腺诊断系统行高清晰乳腺X线摄影（HI－TECH mammography,HT-M)1888例,对其中符合：（1）临床Meng及乳腺肿块,性质不明：（2）X线片发现肿块;（3）X线片上有多形性、集簇性微小钙化灶;（4）双侧摄片出现局限不对称、高密度区或结构畸形等适应证者,进行数字化局部处理（digital spot image,DSI)与Bard 16G针立体核心活检（stereotactic core needle biopsy,SCNB)122例,占HT－M总数的6．46％。结果：诊断为乳腺癌（包括2例原位导管癌,1例早期导管浸润癌）59例,全部手术证实：良性病变（包括乳腺增生、纤维腺瘤、导管乳头状瘤、囊腺瘤等）63例,其中23例为手术证实,40例随诊中未发现癌变。在乳腺癌中,SCNB真阳性率为89．83％（53／59）,假阴性率为10．17％（6／59）;乳腺良性病变中SCNB无一例假阳性,故SCNB对乳腺良恶性病变的敏感性和特异性分别为89．83％和100％,全部122例SCNB者均无并发症发生。结论：为保证该项诊断技术的准确性,我们的初步经验是：（1）必须有一套包括高清晰成像、快速准确定位和活检的高质量;（2）由一个有高中级外科医师、外科护师（技师）与病理医师组成的专业小组,参与门诊临床检查→HT－M、DIS、SCNB→病理检查→手术→随1 全过程,不断提高操作的娴熟性、准确性,并在综合分析的基础上作出诊断;（3）自动弹射式Bard 16G针适用于大多数病人,但对X线片上的微小病灶采用负压切削式Mammotome针,能将SCNB正确率提高到95％－100％,想念通过克服传统旧观念,将HT－M、DIS与SCNB广泛用于医院门诊与高危人群的普查,能大大改善我国乳腺癌病人治疗的生存率与生活质量。     

Stereotactic Percutaneous Breast Biopsy: A Comparative Analysis Between Surgeon and Radiologist

▪  Abstract: The purpose of this study was to analyze the use of stereotactic percutaneous breast biopsy in the treatment of nonpalpable breast abnormalities. In addition, we set out to compare the results of both radiologists and surgeons performing the procedure and to provide an estimation of the cost per patient. A retrospective analysis of the use of stereotactic core biopsy (SCBx) to diagnose suspicious breast lesions was performed in 193 patients between December 1995 and February 1997. The study group was compared to a similar group of 106 patients who had needle localization excisional biopsy (NleBx) performed during the same period. Statistical analysis between surgeons and radiologists was performed for the percutaneous procedures. Allowable charges for both specialists were used to compare percutaneous biopsy with open biopsy. Stereotactic percutaneous breast biopsy performed at our institution by either the surgeon or radiologist is an accurate and cost-effective way to evaluate nonpalpable breast abnormalities and saves approximately $1500–$2500 per patient as compared with needle localization excisional biopsy. Adequately trained surgeons and radiologists can achieve similar accuracy in utilizing this new technology for breast diagnosis. ▪     

Diagnostic Accuracy of Fine Needle Biopsy for Metastatic Melanoma and Its Implications for Patient Management

Background The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated. Methods A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up. Results FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results. Conclusions FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma.     

Needle Track Dissemination of Follicular Thyroid Carcinoma Following Fine-Needle Aspiration Biopsy: Report of a Case

Few reports have been concerned with the risk of needle track dissemination of tumor cells following fine-needle aspiration biopsy, especially for follicular thyroid nodules. A 61-year-old woman who underwent fine-needle aspiration biopsy and surgery 5 years previously for follicular thyroid adenoma presented with nodules that had developed in the sternocleidomastoid and omohyoid muscles of the anterior neck. These nodules were located along a line from the skin to the thyroid that coincided with the needle track of the previous biopsy. Following surgical resection, histological diagnosis determined the nodules to be follicular carcinoma. The clinical course and linear arrangement of the lesions were highly suggestive of needle track dissemination of tumor cells following fine-needle aspiration biopsy. Although fine-needle aspiration biopsy is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.     

Role of Fine-Needle Aspiration Biopsy and Frozen Section Analysis in the Surgical Management of Thyroid Tumors

Introduction:The role of fine-needle aspiration (FNA) and frozen section (FS) in the management of thyroid neoplasms continues to generate considerable controversy. We reviewed our recent experience to determine the clinical utility of FNA and FS in our surgical management and intraoperative decision-making.Methods:All patients who had operations for thyroid disease between January 1996 and June 1999 were identified in our prospective database. Completion and incidental thyroidectomies were excluded. Data obtained from the pathology files included FNA, FS, and the final histologic diagnosis.Results:Five hundred sixty-four patients, including 409 women (73%), with a median age of 50 years (range, 6–94) were identified, of whom 293 (52%) had cancer diagnosed on permanent sections. Three hundred twenty-nine patients (58%) had evaluable FNA, of which 91 (28%) were benign, 94 were malignant (28%), and 144 (44%) were suspicious (46% of these were malignant on final). Frozen section was performed in 397 (70%) patients; of these samples, 170 (43%) were found to be benign, 106 (27%) were malignant, and 121 (30%) were deferred (46% malignant on final). Fine-needle aspiration positively identified 51% of confirmed malignancies; 13% of patients with malignancy had a benign FNA result. Total thyroidectomy was performed in 64% of malignant tumors and 29% of benign thyroid disease (P < .001). Logistic regression revealed no association of extent of surgery with FNA results. A frozen section positive for malignancy was associated with total thyroidectomy (P < .001, RR 6 [CI 3–10]), and a negative frozen section report was associated with lobectomy (P < .05, RR 0.5 [CI 0.3–0.96]). Frozen sections results altered the preoperative plan in only 29 patients (5%).Conclusion:Results of preoperative FNA had no direct impact on the selection of the surgical procedure in this selected cohort. Intraoperative FS added very little to surgical management. The majority of thyroid operations at this institution are planned and performed based on known prognostic factors and intraoperative findings.Presented at the 53rd annual meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16–19, 2000     

Cost/Accuracy Ratio Analysis in Breast Cancer Patients Undergoing Ultrasound-Guided Fine-Needle Aspiration Cytology,Sentinel Node Biopsy,and Frozen Section of Node

We evaluated the effectiveness and the cost of axillary staging in breast cancer patients by ultrasound-guided fine-needle aspiration cytology (US-FNAC), sentinel node biopsy (SNB), and frozen sections of the sentinel node to achieve the target of the highest number of immediate axillary dissections. From January 2003 through October 2005, a total of 404 consecutive eligible breast cancer patients underwent US-FNAC of suspicious axillary lymph nodes. If tumor cells were found, immediate axillary dissection was proposed (33% of node-positive cases). If US or cytology was negative, SNB was performed. Frozen sections of the sentinel node allowed immediate axillary dissection in 31% of node-positive cases. The remaining 36% underwent delayed axillary dissection. We compared our policy with clinical evaluation of the axilla, showing better specificity of US-FNAC, the cost balanced by a 12% reduction of SNBs, and a marked reduction of unnecessary axillary dissections resulting from false-positive clinical staging. Moreover, the comparison between our policy and permanent histology of the sentinel node showed an 8% cost saving, mainly associated with the immediate axillary dissections. US-FNAC of axillary lymph nodes in breast cancer patients reliably predicts the presence of metastases and therefore refers a significant number of patients to the appropriate surgical treatment, avoiding an SNB. As cost saving to the health care system in our study is mainly related to one-step axillary surgery, US-FNAC of axillary lymph nodes and frozen section of the sentinel node generate significant cost saving for patients who have metastatic nodes.