Fine-needle aspiration of renal masses in adults: analysis of results and diagnostic problems in 108 cases.

Fine-needle aspiration (FNA) biopsy of the kidney has a traditionally well-defined role in the diagnosis and treatment of renal lesions. Recent improvements in renal imaging techniques have also brought renal FNA to the forefront, since small and asymptomatic renal masses are increasingly being detected. Before the physician institutes a treatment plan, such lesions usually require a definitive diagnosis that is best provided by FNA. To assess various aspects of renal FNA, including specimen adequacy, questionable cytologic patterns, and diagnostic pitfalls, we retrospectively evaluate our experience with 108 FNA biopsies performed for the evaluation of renal masses in adults. For each case, the smears were reviewed and correlated with tissue sections from cell blocks, surgical specimens, or autopsy material, when available. The cytologic diagnoses were confirmed by cell block (59 cases), nephrectomy or autopsy (35 cases), or clinical follow-up. Of the 108 FNA biopsy samples, 17 showed evidence of blood, soft tissue, necrotic material, glomeruli, or tubular cells and were classified as unsatisfactory. The following diagnostic categories were noted in the 91 satisfactory aspirates: renal abscess (four cases), benign cyst (30 cases), suspicious lesions (11 cases), and malignant lesions (46 cases). In four cases of renal abscess, FNA found abundant clusters of neutrophils. For the 30 cases interpreted on cytologic evidence as benign cysts, the diagnosis was confirmed in 28 cases; the two remaining cases were acquired cystic kidney and cystic renal-cell carcinoma, respectively. Among the 11 suspicious lesions, the final diagnoses were one benign simple cyst, one angiomyolipoma, two multilocular cystic nephromas, two adult polycystic kidneys, one acquired cystic kidney, three cystic papillary renal-cell carcinomas, and one solid renal-cell carcinoma. Cases classified as suspicious shared characteristic cytologic patterns that distinguished them from simple benign cysts and from classic renal-cell carcinoma. Among the 46 malignant lesions, as evidenced on cytologic examination, 27 were renal-cell carcinomas, five were transitional-cell carcinomas, four were lymphomas, one was a small-cell undifferentiated carcinoma, and nine were metastatic carcinomas. False-positive or false-negative cases were not encountered in this category. In conclusion, FNA is an excellent method to diagnose space-occupying lesions of the kidney. For cystic lesions, cytologic-radiographic correlation is needed to avoid misinterpretation. Our study defines a spectrum of suspicious patterns characteristic of a group of renal lesions that are distinct from both benign simple cyst and straightforward renal malignancy.     

Diagnostic immunohistochemistry of breast epithelial lesions

Routine H&E sections are sufficient for diagnosis of the vast majority of breast lesions. Development of mammography mass screening and widespread use of preoperative needle biopsy diagnosis have led to diagnostic difficulties for pathologists. The samples are smaller and more and more preinvasive lesions are seen. It is mainly in those situations that immunohistochemistry (IHC) can efficiently back up histopathology. This review details the main applications of diagnostic IHC in breast pathology. The advantages of IHC in various clinical situations are discussed diagnosis of benign breast lesions mimicking malignancy, distinction between simple type ductal hyperplasia and atypical hyperplasia or ductal in situ carcinoma, confirmation of malignancy, distinction between lobular and ductal carcinoma, identification of specific histological subtypes, and, diagnosis of intra and extra mammary metastases.     

Fine needle aspiration cytology of pulmonary lesions: a reliable diagnostic test

The objective of this study was to determine the accuracy of image-guided fine needle aspiration cytology (FNAC) in the diagnosis of pulmonary lesions. A retrospective study was undertaken of 286 patients with 288 lesions, who underwent a total of 302 procedures. The FNAC diagnoses were reported as malignant, suspicious, atypical, benign or non-diagnostic. Subsequently the FNAC diagnoses were correlated with either the histological or clinical diagnoses. Of the 288 lesions, 64.6% were reported on FNAC as malignant, 2.1% suspicious, 2.4% atypical, 20.8% benign and 10.1% nondiagnostic. On review of the suspicious, atypical, selected benign cases and non-diagnostic FNAC by an independent pathologist there was agreement with the original FNAC diagnosis in all cases. All of 186 malignant FNAC diagnoses were confirmed malignant either clinically or on subsequent histology. Four of the six suspicious FNAC diagnoses had a malignant outcome, one patient had organising pneumonia on excision biopsy and one was lost to follow up. Six of the seven atypical FNAC diagnoses were confirmed on histology as malignant, while one lesion resolved spontaneously. Fifty-two of 60 benign FNAC diagnoses were confirmed benign either clinically or on histology. Seven of the lesions diagnosed as benign on FNAC were proven to be malignant. One patient with a benign FNAC diagnosis was lost to follow-up. Ten of the 29 non-diagnostic FNAC group were later shown on clinical or histological follow up to be malignant. This study shows that image guided FNAC for the diagnosis of malignant pulmonary lesions has a sensitivity of at least 92% and a specificity of at least 96%. It is a reliable diagnostic test although its accuracy is limited by technical difficulties in obtaining an adequate sample.     

Needle localization and surgical management of occult breast lesions

Screening mammography can locate small breast cancer lesions not detectable on physical examination. In this study, the records of 57 patients undergoing radiographically guided preoperative needle localization were reviewed for the period August 1986 to May 1988. Of the 57 cases, 15.8% were positive for cancer and 84.2% were benign breast lesions. Invasive ductal carcinoma was the pathologic diagnosis in all malignant biopsies, except for one case of carcinoma in situ. All positive lesions had shown as microcalcifications on mammogram. The authors examine the criteria for biopsy and discuss their experience with needle localization of occult breast lesion suspicious of breast cancer.     

Significance of the diagnostic categories “atypical” and “suspicious for malignancy” in the cytologic diagnosis of solid pancreatic masses

Endoscopic ultrasound guided (EUS) fine‐needle aspiration (FNA) investigation of solid pancreatic lesions has been shown to have good sensitivity and specificity. Many lesions can be definitely classified as benign or malignant but some can only be cytologically classified as “atypical” or “suspicious for malignancy”. Risk for malignancy in these indeterminate categories has not been well categorized. The cytology records of four University Medical centers were searched for all EUS guided FNAs of solid pancreatic lesions. All cases with a diagnosis of “atypical”, or “suspicious for malignancy” were selected for analysis when histologic biopsy or over 18 months clinical follow‐up was available. Two hundred and ninety‐two cases with a diagnosis of “atypical” or “suspicious for malignancy” and adequate follow‐up were obtained from the combined data of the four institutions. The percentage malignant for the categories “atypical” and “suspicious for malignancy” were 79.2 and 96.3%, respectively. If the category “atypical” was classified as benign and “suspicious for malignancy” was classified as malignant, the resulting positive predictive value was 96.3 (95% CI: 92.6–98.5) and the negative predictive value 20.8 (95% CI: 13.4–30.0). The categories of “atypical” and “suspicious for malignancy” stratify risk for malignancy in a fashion, which may aid in patient counseling and selection of follow‐up protocols. Classification of “suspicious for malignancy” as malignant optimizes diagnostic sensitivity and specificity. Diagn. Cytopathol. 2014;42:292–296. © 2014 Wiley Periodicals, Inc.     

Fine-needle aspiration of the breast: A review of 1,995 cases with emphasis on diagnostic pitfalls

Between 1985 to 1989, 1, 95 fine-needle aspirations of palpable breast lesions were performed at our institution. In all cases, the aspirates were procured by cytopathologists using 22- or 23-gauge needles. Direct smears were immediately stained with Diff-Quik and Papanicolaou and assessed for specimen adequacy (criteria as followed in this institution). Tissue follow-up was available in 1,117 cases. The cytologic diagnoses rendered in these cases were: malignant, 690 cases (60.2%); suspicious for carcinoma, 49 cases (4.3%); benign, 343 cases (29.9%), and insufficient specimen, 35 cases (3.1%). There were 28 false-negative and 2 false-positive results. Considering only cases definitively diagnosed as benign or malignant, the sensitivity was 96%, specificity 99%, positive predictive value 99%, negative predictive value 94%, and overall efficiency 97%. Of those specimens considered suspicious, only 11 cases (22%) were proved not to be malignant after excisional biopsy. These were three fibroadenomas, three ductal hyperplasias, two adenosis tumors, two mucocele-like lesions, and one nipple adenoma. The two lesions that resulted in true false-positive diagnoses were an apocrine cyst with atypia and sclerosing adenosis with radial scar. The clinical and cytologic features of the benign conditions that resulted in false suspicious and positive diagnoses and those features that distinguish them from carcinoma are presented.     

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Aims: Breast needle core biopsy (NCB) is now a commonplace diagnostic procedure in breast cancer screening, providing accurate diagnoses of both benign and malignant lesions. However, NCB may result in the borderline diagnoses of lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4). The aim was to study a large series of B3 cases from population‐based screening subjects in order to evaluate positive predictive values (PPVs) for malignancy. Methods and results: The results of 523 NCBs of women screened over a 7‐year period (1999–2006) in the East Midlands region, UK, with a B3 diagnosis who underwent surgical excision, were reviewed and compared with the final excision histology. Five percent of NCBs were reported as B3. The most frequent histological subtypes were atypical intraductal epithelial proliferation (AIDEP) and radial scar/complex sclerosing lesion (RS/CSL). Final excision histology was benign in 417 (80%) and malignant in 106 (20%) subjects (60 ductal carcinoma in situ and 46 invasive carcinoma). Lesion‐specific PPVs were as follows: AIDEP 32%; lobular neoplasia (LN) 30%; RS/CSL with AIDEP or LN 24%; RS/CSL without atypia 9%; papillary lesion with AIDEP or LN 36%; and papillary lesion without atypia 4%. Five of the 32 fibroepithelial lesions with cellular stroma were phyllodes tumours (four benign and one borderline). None of the five mucinous lesions on NCB was malignant. Conclusions: Our results show that approximately one‐fifth of NCB of screen‐detected breast lesions classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes.     

Breast masses in males: multi-institutional experience on fine-needle aspiration

Male breast masses are uncommon pathologic findings. They are rarely aspirated, resulting in limited cytopathologic experience. The following study describes the cytopathology of male breast lesions from data collected for a period of 10 yr from three large institutions. A total of 14,026 breast aspirations were performed of which 614 were from male patients. All cases were reviewed and correlated with the appropriate clinicopathologic follow-up. The FNA diagnoses were as follows: benign, 427 cases (gynecomastia 353, fat necrosis 21, miscellaneous 53); malignant, 32 cases (ductal carcinoma nos 15, metastatic tumors 17); and atypical/suspicious, 61 cases. Ninety-four cases were nondiagnostic due to scant cellularity. Male breast aspirates accounted for 4.3% of the total breast FNAs performed. The clinicopathologic follow-up in both the benign and malignant categories showed 100% correlation. The overall sensitivity was 95.3%, specificity was 100%, and diagnostic accuracy was 98%. A relatively high specimen unsatisfactory rate was seen (>15%). The commonest cytopathologic diagnosis was gynecomastia, followed by ductal carcinoma. Florid duct atypia in gynecomastia may mimic adenocarcinoma, necessitating a higher threshold for cytopathologic interpretation for malignancy in males.     

Rapid staining using toluidine blue: a reliable method for quick diagnosis in ultrasound-guided aspiration cytology

Rapid staining of ultrasound guided aspirates is an accepted procedure for evaluation of adequacy and rapid diagnosis (RD). We have assessed the reliability of Toluidine blue stain in this regard, which has not been previously reported. 295 ultrasound guided aspirates performed over a 13 month period were studied. 59 aspirates were inadequate for RD. 103 cases were called malignant on RD of which 101 were confirmed, and 2 cases were considered highly suspicious on final diagnosis. Of 34 cases considered suspicious on RD, 32 were either signed out as malignant or considered highly suspicious while 2 cases were benign. Of 56 cases considered benign on RD, 49 were confirmed, 2 were suspicious for malignancy and 5 cases had inadequate material on final diagnosis. All 43 inflammatory lesions on RD were confirmed. The overall sensitivity for a malignant/suspicious for malignancy diagnosis was 98.54% on RD while specificity was 97.99%. Sensitivity and specificity for an inflammatory condition was 100%. Toluidine blue staining is not only a reliable method for rapid staining and diagnosis, it also permits preservation of cytological material by destaining and restaining with permanent stains.     

PATHOLOGICAL AND BIOLOGICAL CHARACTERISTICS OF INTERVAL BREAST CANCER

INTRODUCTION: Protocols for excision of mammographically detected lesions following core biopsy include all diagnoses of atypical ductal hyperplasia (ADH) or intraductal atypia of uncertain significance (AUS). The aims of this study were to look at: i) the prevalence of reporting ADH and AUS, ii) the proportion of cases where excision revealed breast carcinoma, iii) whether any cases could be downgraded to hyperplasia on review.
METHODS: Breast core biopsy reports from the SCGH Breast Centre for the years 1999–2000 were retrieved. The results of excision biopsy were obtained and slides reviewed.
RESULTS: There were 1048 core biopsies from 911 women. Breast carcinoma was diagnosed in 197 samples (18.8%) including 88 with invasive carcinoma (8.4%), 109 with ductal carcinoma in situ (10.4%) and 3 samples (2.9%) suspicious of invasive carcinoma. The suspicious cases all proved to be invasive carcinomas. There were 53 samples (5.1%) with a diagnosis of ADH or AUS. 46 were excised, showing 7 invasive carcinomas 15 DCIS, 11 ADH, 2 lobular carcinoma in situ (LCIS), 1 mucocoele-like lesion, 1 fibroadenoma and 9 fibrocystic change (FCC). The 22 malignancies represented 47.8% of the excised lesions. At review, 8 of the 53 original diagnoses were downgraded to benign hyperplasia; 5 underwent excision; 2 showed 'incidental' invasive carcinomas, 1 'incidental' LCIS, 1 ADH and 1 FCC.
CONCLUSIONS: There was a low prevalence of reporting of ADH and AUS in core biopsies (5.1%) and a high rate of carcinoma (47.8%) in subsequent excision biopsies. Very few diagnoses of ADH/AUS were downgraded at review. Current protocols for excision of lesions with a core biopsy diagnosis of ADH/AUS appear to be justified.     

A Bethesda‐like system for breast cytopathology: A retrospective assessment two decades on

Fine‐needle aspiration biopsy (FNAB) has been used for many decades in the investigation of breast lesions. Originally, cases were signed out using the categories benign and malignant. The benign category contained specimens showing fibrocystic change as well as benign neoplasms such as fibroadenoma. The malignant category contained carcinomas, lymphomas, and phyllodes tumors with specific diagnoses often given in place of the term malignant. Categorization was less clear when the cytopathologists could not definitively separate benign from malignant. This led to the use of terms, such as atypical, suspicious for malignancy, and atypical suspicious with variable definitions and utilization among cytopathologists. In 1997, a uniform approach to breast FNAB was proposed with well‐defined diagnostic categories and criteria. This system foreshadowed the recent International Academy of Cytology Standardized Reporting System for Breast Fine‐Needle Aspiration Biopsy. These two systems are compared and contrasted.     

X射线钼靶、超声对乳腺BI-RADS Ⅲ～Ⅳ级病变影像学对照分析

目的探讨X射线钼靶、超声单独与联合应用对乳腺影像报告与数据系统(BI-RADS)Ⅲ～Ⅳ级病变的诊断价值。方法 127例病理证实乳腺良性肿块(BI-RADSⅢ～Ⅳ级病变)患者,均为女性,年龄21～60岁。所有病例均行临床查体、X射线钼靶、超声检查,其中99例手术,28例穿刺活检。回顾性分析X射线钼靶、超声表现,总结两种检查方法在影像学诊断中的特点。结果 X射线钼靶图像表现以片状致密影+结节状影、片状致密影+肿块影+钙化影、肿块影+致密模糊结节影+钙化影多见;超声图像表现以局限性病变为主,有液性、混合性、实质性、边界清晰或不清、或双乳腺多种病变并存等改变;两种检查联合诊断对乳腺肿块的诊断灵敏度为92.9%,误诊率为3.9%,漏诊率为3.1%,明显高于两者单独应用,差异有显著统计学意义(P<0.01)。结论 X射线钼靶与超声因成像原理不同,影像学表现各有其长处和不足,都存在诊断难点,两者联合应用能提高乳腺肿块(BI-RADSⅢ～Ⅳ级)的检出率及良、恶性鉴别诊断的准确性。     

Breast calcifications with percutaneous vacuum-assisted biopsy diagnosis of malignancy or atypical hyerplasia: correlations with surgical findings

Percutaneous, stereotactic, vacuum-assisted biopsy has become a widely used alternative to open surgical biopsy for the initial diagnosis of breast calcifications. We retrospectively assessed the accuracy of the technique in the diagnoses of malignancy and atypical hyperplasia by correlation with the findings of the subsequent surgical excision. We studied 330 consecutive cases of breast calcifications, 216 (65.5%) of which were determined to be benign and 114 (34.5%) to be malignant or atypical at vacuum-assisted biopsy using an 11 gauge instrument. Of the latter 93 were available for comparison with the subsequent surgery, the specific diagnoses as revealed by percutaneous biopsy were as follows: 11 cases of atypical ductal hyperplasia (ADN), 67 cases of ductal carcinoma in situ (DCIS), 6 infiltrating ductal carcinomas (IFDC), 2 cases of atypical lobular hyperplasia and 7 of lobular carcinoma in situ (LCIS). At histological analysis after surgical excision, 3 (27%) of 11 cases previously diagnosed as ADH and 6 (9%) of 67 cases diagnosed as DCIS were shown to actually be higher grade lesions (DCIS/IFDC and IFDC, respectively). Of the 7 lesions diagnosed at vacuum-assisted biopsy as LCIS, surgery and histological analysis showed one infiltrating globular carcinoma and two DCIS. A total of 21 lesions (4 ADH, 14 DCIS, 1 IFDC, 2 LCIS) were completely removed at percutaneous biopsy; the remaining cases were found totally concordant. These data Indicate a substantial accuracy of the percutaneous biopsy: some lesions (particularly those thought to be ADH and DCIS) can be underestimated for sampling error.     

Histological correlation of mammographically detected microcalcifications in stereotactic core biopsies

The aims of this study were to assess the value of specimen radiographs of stereotactic core biopsy, the usefulness of measuring size of calcifications on tissue sections, whether demonstration of calcifications in tissue sections alters the pathological diagnosis when specimen radiograph demonstrates calcifications, and to correlate these assessments with diagnostic outcome. A total of 301 core biopsies from 266 women with 274 mammographically suspicious areas of calcifications were examined. Core biopsies (five cores per procedure) were obtained stereotactically using a 14-gauge needle in an automated Biopty gun. Prior to processing of the tissue, 214 core biopsy specimens from 193 women with 197 lesions were radiographed. Of the 301 core biopsies, 56 (19%) were diagnosed as malignant, 15 (5%) were diagnosed as atypical ductal hyperplasia and 230 (76%) contained benign breast tissue. Of the core biopsies diagnosed as benign, 160 (70%) had specimen radiography prior to processing. Of these, 109 (69%) core biopsies showed calcifications on specimen radiographs. In 96 (88%) of these core biopsies, calcifications measuring > 100 microm were found on the initial tissue sections. In 11 (10%) further deeper sections were required to detect calcifications > 100 microm; however, this did not result in a change of the pathological diagnosis. Two of the 109 (1.8%) "benign" core biopsies, which contained tissue calcifications > 100 microm and at that time were considered representative of the mammographic lesion, have had a malignant outcome on clinical and mammographic follow-up ranging from 2.4 to 7.5 years. Of the 51 (31%) core biopsies where calcifications were not seen on specimen radiographs, histological calcifications were not found in 34 (67%) core biopsies, whereas in 17 (33%) core biopsies, calcifications measuring < 100 microm were found. All of these core biopsies were considered non-diagnostic and therefore not representative of the lesion targeted. Five (9.8%) of these cases had a malignant outcome with either immediate rebiopsy or excision. Accurate diagnosis of all mammographic lesions requires radiological-pathological correlation. This study shows that the presence of calcifications on the specimen radiograph and the demonstration of tissue calcifications > 100 microm are an essential and highly reliable part of core biopsy assessment for mammographically "suspicious" calcifications. Nevertheless, lesions with "highly suspicious" calcifications on mammography should be considered for excision even if the core biopsy diagnosis is benign and calcifications > 100 microm are present.     

Ductal adenoma of the breast: The cytological features of six cases

Ductal adenoma of the breast may simulate malignancy by both clinical, histological, and cytological examination. Fine-needle aspirations from breast lesions are now daily routine and preoperative recognition of this benign lesion is desirable. This study describes the cytologic features of six additional cases of ductal adenoma. The smears from all the lesions were highly cellular with epithelial cells in sheets. Numerous large fragments of purple stroma in tight connection with epithelial cells often making finger-like hyaline structures or globules between cells were seen. Naked oval nuclei in the background were observed in all cases indicating benignancy. We find the cytologic picture in fine-needle aspirations from ductal adenomas sufficiently characteristic for preoperative diagnosis. The differential diagnoses toward other benign and malignant conditions are discussed. © 1994 Wiley-Liss, Inc.     

Adenosis tumor of the breast: cytological and radiological features of a case confirmed by histology

We report the case of a 63-year-old woman who presented with a right breast lump detected by screening mammography. The lesion was nonpalpable, and the ultrasonography revealed suspicious features. In contrast with imaging features, fine-needle aspiration cytology showed benign ductal cells arranged in groups, with fragments of hyalinized eosinophilic stroma, and round or bipolar bare nuclei in the background, findings consistent with a benign tumor. A core needle biopsy performed to rule out a breast cancer revealed an adenosis tumor of the breast.     

Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging

OBJECTIVES:

To evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions.

METHODS:

Eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion.

RESULTS:

In all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion-weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6–1.1]×10^-3 mm²/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymomas.

CONCLUSION:

Functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques.     

Application of fine needle aspiration biopsy to pediatrics

Fine needle aspiration (FNA) biopsy cytology is a technique rarely used in children, although it is increasingly used in a routine fashion for the evaluation of masses in adults. We reviewed our experience with FNA in patients 16 years of age and younger from the period 1973 to 1987. FNA diagnoses were confirmed either by subsequent surgical biopsy, autopsy, or clinical follow-up for a minimum period of 1 year. One-hundred twelve FNA procedures were performed in 107 patients. Patient age distribution was as follows: newborn to 5 years of age, 37 aspirates; 6 to 11 years of age, 39 aspirates; and 12 to 16 years of age, 36 aspirates. Fifty-five patients were female. Of the 112 aspirates, 70 were diagnosed as benign disorders, 39 were diagnosed as malignant, one was diagnosed as unsatisfactory, and two were considered suspicious for malignancy. The most common sites of involvement for benign lesions were lymph node (31 sites), soft tissue (13 sites), and thyroid (12 sites). The most common sites for malignancies were lymph node (12 sites), bone (eight sites), and soft tissue (eight sites). Of the malignant aspirates, 20 were from primary neoplasms, three were from locally recurrent neoplasms, and 16 were from metastatic neoplasms. Two false-positive and one false-negative diagnoses yielded sensitivity and specificity rates of 97%, and a predictive value of a positive FNA of 95%. Our experience indicates that selective application of FNA is a useful and important step in the evaluation and management of mass lesions throughout the entire age range of infancy and childhood.     

Fine-needle aspiration cytology of tongue swellings: A study of 75 cases

Tongue swellings and growths are traditionally evaluated by surgical biopsy. Most of them, however, are easily accessible by fine-needle aspiration (FNA). We reviewed 75 lesions presenting as tongue swellings, which were examined by fine-needle aspiration cytology (FNAC) in our institutions over a period of 11 yr. The lesions included 17 malignant tumors: 12 cases of squamous carcinoma (SQC), 2 metastases, and 3 non-Hodgkin's lymphomas (NHL). In addition, 15 benign tumors and 43 nonneoplastic benign conditions were found. Thirteen of the 17 malignant lesions were diagnosed cytologically as malignant, 3 as suspicious for malignancy, and 1 as atypical, with biopsy recommended. There were no false-positive diagnoses. There were no clinical complications resulting from FNA. We conclude that FNAC of the tongue permits rapid and reliable diagnosis, and we recommend this method as the first diagnostic step in the evaluation of tongue swellings. Diagn. Cytopathol. 1998;18:387–392. © 1998 Wiley-Liss, Inc.     

Ultrasonic assessment of the peri- and postmenopausal ovary

Objective: To analyze the role of B-mode ultrasound, color and power Doppler examination and three-dimensional ultrasound with and without power Doppler facilities in evaluation of the peri- and postmenopausal ovaries. Methods: Review of the literature on ultrasonic assessment of the ovaries in postmenopausal patients. Results: Ultrasound has assumed an increasing role in the evaluation of the peri- and postmenopausal ovaries. Ovarian lesions are a cause of great concern because of their malignant potential and the limited ability to distinguish accurately between benign and malignant lesions using morphological sonographic criteria alone. Superimposed color Doppler imaging enables the visualization of vascularization and blood flow characteristics of the ovaries and/or ovarian lesions. It becomes possible to detect normal, suspicious and pathologic blood flow characteristics even in small blood vessels. Owing to superb quality of the images, three-dimensional sonography enables precise assessment of the ovarian lesions. Three-dimensional power Doppler ultrasound permits effective targeting and rendering of ovarian tumor vasculature, thus providing new diagnostic possibilities for early detection of ovarian malignancy and differentiation of benign from malignant ovarian pathology. Conclusions: Further technological development will contribute to more objective evaluation of ovarian tumor morphology and vasculature which will give us tremendous support in clinical decision making and planning the management.