Intraoperative fine needle aspiration cytology of pancreatic lesions

The aim of the present study was to demonstrate the practicality of intraoperative fine needle aspiration (FNA) cytology of pancreatic lesions in 43 patients. The indication for performing this procedure was to determine the nature of pancreatic masses. Conclusive cytologic diagnoses were reached in 41 patients who represent the present study. On the basis of histologic findings in 30 cases (73.2%) and on clinical findings in 11 cases (26.8%), a final diagnosis of malignant pancreatic disease (MPD) was established in 31 and of benign pancreatic disease (BPD) in 10 patients. Among the 31 cases with MPD, the cytologic diagnosis was correct in 30 patients and falsely negative in one patient. Among 10 patients with BPD, all the cytologic finding were reported as benign. The sensitivity and specificity and positive and negative predictive values for cytologic findings were 96.8%, 100%, 100%, and 90.9%, respectively. The diagnostic accuracy of FNA cytology was 97.6%. No complications followed the procedure. We conclude that intraoperative FNA cytology of pancreatic lesions is a simple, safe, highly sensitive, and specific tool in differentiating benign from malignant pancreatic lesions. This procedure should be carried out in any patient with pancreatic mass incidentally found at laparotomy or in a patient undergoing surgery because of suspected nonmetastasizing MPD in whom repeated imaging guided FNA failed to demonstrate malignancy.     

The fine needle aspiration cytology of mediastinal lesions

Fine needle aspiration cytology was performed in 19 mediastinal lesions. Of seven malignant neoplasms six were correctly diagnosed as malignant and in five of these accurate tumor classification was possible. Of the 12 benign lesions only four cases, all thymomas, could be diagnosed cytologically. No false-positive diagnoses of malignancy were made. The only complication of the procedure was minor pneumothorax in two patients. In five cases the use of the technique spared the patient from more invasive diagnostic procedures; in several others, valuable information was obtained prior to surgery.     

Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions

PurposeEvaluation of accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of different thyroid lesions.Patients and methodsThis is a retrospective study of 296 diagnosed cases of thyroid nodules referred to cytology unit, pathology department, NCI, who underwent FNAC for diagnosis. The results were categorized according to the recent Bethesda classification into: insufficient for diagnosis, benign, atypical follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling. The final histologic diagnosis and/or clinico-radiologic follow-up assessment for non-neoplastic lesions were considered the gold standard.ResultsThe study included 296 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 5.2:1, and the median age was 44 years. Ninety-eight cases (33.1%) were diagnosed as benign, 40 cases (13.5%) as follicular lesion of undetermined significance, 49 cases (16.5%) as follicular neoplasm, 30 cases (10.1%) as suspicious for malignancy, 58 cases (19.5%) as malignant, and 21 cases (7.1%) as unsatisfactory. Nodular hyperplasia represented the majority of benign cases (89.8%), while papillary carcinoma was the most frequent malignant lesion (72.4%). Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 92.8, a specificity of 94.2%, a positive predictive value of 94.9%, a negative predictive value of 91.8%, a false positive rate of 7.2%, a false negative rate of 5.8%, and a total accuracy of 93.6%.ConclusionFNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid swellings.     

Comparative study of fine needle aspiration cytology,imprint smear and excision biopsy in cervical lymphadenopathy

Fine needle aspiration cytology (FNAC) and imprint smears were prepared In 50 cases of cervical lymphadenopathy. The results were confirmed by excisional biopsy. The FNAC established diagnosis in 89.8% and imprint smears in 90% cases. Aspiration cytology was found to be simple and reasonable accurate method of diagnosis. Though, comparable results were obtained by imprint smears, yet this requires open biopsy.     

Fine needle aspiration cytology(fnac) versus hlstopathology in cervical lymphadenopathy

The present series includes 104 cases (36 males and 68 female) of lymph node swellings in the head and neck region in the mean age group of 30.6 years. The aspiration cytology was carried out as an outpatient department procedure and concomittant biopsy was performed in all the cases of this series. The overall diagnoitic accuracy rale of FNAC in the present histopathologically proved cases was found to be 92.3 percent. In 8 out of 104 cases (7.7 percent), the smears were unsatisfactory and therefore diagnosis could not be made by mere cytological examination.     

Fine needle aspiration cytology of ovarian lesions: Is it reliable?

Aim: To assess the diagnostic value of fine needle aspiration cytology (FNAC) in evaluating ovarian lesions. Methods: Over a two‐year period, fine needle aspiration was performed on surgically removed ovarian masses from 75 patients, aged 20 to 56 years. Smears of the aspirated material stained by Papanicolaou, HE and Wright methods were evaluated by a pathologist who was blinded to the final histopathological diagnoses. Results: Smears of approximately half (32 of 75) of the aspirates were acellular. The remaining 43 aspirates consisted of 15 follicular cysts, two endometrioid cysts, three inflammatory processes and 23 neoplastic lesions. The malignant nature of 13 of the 15 (86%) malignant lesions was diagnosed correctly. Of these, three could not be classified into a specific subtype. Fifteen of the 25 (60%) follicular cysts were diagnosed correctly. In our study, the overall sensitivity and specificity of ovarian aspiration cytology for the diagnosis of malignant lesions were 86% and 100%, respectively. Cytological diagnosis of the benign lesions had a sensitivity of 48% and a specificity of 92%. Conclusion: Ovarian masses are easily accessible for cytological evaluation by fine needle aspiration during laparoscopy or sonography. We studied fine needle aspiration material from surgically removed specimens. However, the results can be extrapolated to real practice. Aspiration cytology can provide particularly useful information in young women with functional ovarian cysts, preventing unnecessary operations. Acellular cystic fluids should not be considered non‐diagnostic because they represent benign cysts in the majority of cases.     

Fine needle aspiration cytology and breast cancer diagnosis

The authors report on 315 histologically confirmed consecutive breast cancer (BC) cases undergoing fine needle aspiration cytology (FNAC). Inadequate smears were infrequent (7%), particularly when reaspiration of inadequate cases was employed (1-2%). FNAC suspected BC in 81% of the total or 88% of adequate smears. Univariate and multivariate (Cox's model) analyses showed no correlation between inadequacy or suspect/positive FNAC rate and patient age, T category or histologic type. Differences in the inadequacy and suspect/positive rate were recorded among 30 operators (surgeons, oncologists, radiologists) performing the sampling, but the average results were consistent with literature reports. FNAC was found to be a useful diagnostic tool for BC diagnosis, and proper training of the highest number of operators is recommended to allow the widest diffusion of this diagnostic technique.     

Fine needle aspiration cytology of chondroblastoma of bone

Between 1979 and 1987 12 patients with chondroblastoma underwent fine needle aspiration (FNA). There were eight female and four male patients (age range, 11-35 years) with lesions of the proximal humerus (three cases), distal femur (two cases), proximal tibia (two cases), proximal femur, distal tibia, talus, navicular bone, and fifth metacarpal (one case each). The radiologic features of the tumors were not entirely typical of chondroblastoma in the majority of patients. The aspirate was diagnosed as chondroblastoma in seven cases, was considered strongly suggestive of chondroblastoma in one case, was found to be diagnosable as chondroblastoma on review in one case, and was nondiagnostic in two cases. The remaining case, which showed giant cell tumor-like areas in addition to typical chondroblastoma on histologic sections from the curettage, was interpreted as giant cell tumor on FNA. There was no case in which an aspirate was erroneously diagnosed as chondroblastoma. On FNA, chondroblastoma had three dominant cytologic components: neoplastic mononuclear cells (chondroblasts), multinucleated osteoclast-like giant cells, and chondroid matrix fragments. The chondroblasts tended to lie individually in smears creating a pebbled appearance. They most commonly had round to oval nuclei with fine, evenly distributed chromatin and distinct longitudinal grooves, but indented, lobulated, and pyknotic nuclei were also observed. Their cytoplasm was dense and opaque with rounded well-defined borders. Multinucleated osteoclast-like giant cells were randomly admixed and were indistinguishable from those seen in other bone neoplasms. Chondroid matrix stained magenta with the Diff-Quik stain and green to violet with Papanicolaou. The cytologic features of the chondroblasts are the diagnostic hallmark of chondroblastoma and may allow FNA to become a valuable preoperative technique in the management of these patients.     

全自动DNA图像分析在乳腺细针穿刺细胞学诊断中的应用

目的探讨全自动DNA图像分析（DNA-ICM）系统在乳腺细针穿刺细胞学（FNAC）诊断中的应用价值。方法对95例乳腺肿块患者行细针穿刺,对所获细胞标本分别行常规细胞学诊断及DNA—ICM检测,比较两种诊断方法与组织病理学诊断结果的符合率。结果以组织病理诊断为标准,DNA—ICM与常规细胞学诊断符合率差异无统计学意义[88．4％（84／95）比94．7％（90／95）1（χ^2=2．457,P=0．117）;DNA—ICM检测排除了常规细胞学诊断的2例假阳性（可疑癌细胞）。DNA-ICM检测中,浸润性导管癌异常DNA含量的检出率高于浸润性小叶癌[90．3％（65／72）比50．0％（4／8）]（Fisher精确概率法,P=0．011）。结论DNA—ICM可以降低FNAC的假阳性率,但其对二倍体肿瘤诊断存在局限性。     

Fine needle aspiration cytology in the diagnosis of bone tumors

Two hundred and forty osteolytic lesions were biopsied by means of a fine needle. The procedure yielded adequate material in 92 percent of the cases. A definitive diagnosis with correct cell typing was provided in 89 per cent of the adequate samples. Processing of the aspirated clot in addition, in 142 cases, provided fragments of tumour tissue in its histological milieu, a feature lost in cytologic smears. FNAC can be effectively used in the screening of various musculo-skeletal mass lesions and their management.     

Accuracy of fine needle aspiration cytology of salivary gland lesions: routine diagnostic experience in Bangkok, Thailand

Fine needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimal invasive and cost-effective method for diagnosis of salivary gland lesions. This study evaluated the accuracy and diagnostic performance of FNA cytology in Thailand. A consecutive series of 290 samples from 246 patients during January 2001-December 2009 were evaluated from the archive of the Anatomical Pathology Department of our institution and 133 specimens were verified by histopathologic diagnoses, obtained with material from surgical excision or biopsy. Cytologic diagnoses classified as unsatisfactory, benign, suspicious for malignancy and malignant were compared with the histopathological findings. Among the 133 satisfactory specimens, the anatomic sites were 70 (52.6%) parotid glands and 63 (47.4 %) submandibular glands. FNA cytological diagnoses showed benign lesions in 119 cases (89.5 %), suspicious for malignancy in 3 cases (2.2 %) and malignant in 11 cases (8.3%). From the subsequent histopathologic diagnoses, 3/133 cases of benign cytology turned out to be malignant lesions, the false negative rate being 2.2 % and 1/133 case of malignant cytology turned out to be a benign lesion, giving a false positive rate was 0.8%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.0% (95% CI, 70.6%-99.4%), 81.3% (95% CI, 54.4%-96.0%), 99.1% (95% CI, 95.4%-100%), 92.9% (95% CI, 66.1%-99.8), 97.5% (95% CI, 92.8%-99.5%), respectively. This study indicated that FNA cytology of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.     

A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions

BACKGROUND: Several arguments are used for choosing either fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB) in the evaluation of breast lesions. Comparison of published data on both methods is complicated by differences in study design, calculations, and operator experience. The objective of this study was to make a direct comparison of both methods. METHODS: In 286 breast lesions (cysts and microcalcifications without a soft tissue mass excluded), both ultrasound-guided FNAC and CNB were performed in the same session by the same operator. Histologic follow-up was collected, and for those lesions that were not excised the results of the most recent mammography was used. A combination of the findings of both FNAC and CNB were evaluated. RESULTS: Core needle biopsy and FNAC do equally well for sensitivity (88% vs. 92%), positive predictive value for malignancy (99% vs. 100%), and inadequate rate (7% vs. 7%). However, statistical differences are found for the specificity (CNB, 90%; FNAC, 82%). In addition, differences are found in the positive predictive value of both suspicious (CNB, 100%; FNAC, 78%) and atypia (CNB, 80%; FNAC, 18%) and for the suspicious rate (CNB, 5%; FNAC, 13%) reflecting difficulties in interpreting some FNACs. Combining the findings of both FNAC and CNB results in an increase in absolute sensitivity, a decrease in the positive predictive value of atypia compared with FNAC and CNB per se, and a decrease in the inadequate rate for cancers. CONCLUSIONS: For the lesions selected in this study, FNAC and CNB are comparable for most parameters, but CNB has a higher specificity and lower suspicious rate. Combining results of FNAC and CNB leads to an increase in absolute sensitivity without affecting specificity and a decrease in the inadequate rate for cancers.     

Fine needle aspiration cytology and exfoliative biliary cytology in the diagnosis of hilar cholangiocarcinoma

Nineteen patients with suspected malignant obstruction at the confluence of the bile ducts had exfoliative biliary cytology and fine needle aspiration cytology performed. Of these patients 14 cases were histologically proven to be cholangiocarcinoma, and 3 others followed a clinical course which was clearly malignant. Fine needle aspiration cytology gave a true positive result in 14 patients (87.5%), whereas exfoliative cytology was positive in 11 (73%). There were no false positive results and no complications from either procedure. Both the cytological procedures are rapid and safe and are useful for preoperative planning of surgical and intraoperative diagnosis.     

超声引导细针穿刺细胞学检查在胰腺癌诊断中的应用

目的:评价超声引导下细针穿刺细胞学检查在胰腺癌诊断中的价值以及穿刺相关并发症。方法:2002年5月～2005年12月,我院临床诊断胰腺癌病例232例,对其中行胰腺穿刺的46例患者进行了回顾性分析。结果:46例患者中,男性33例,女性13例,平均年龄62.1岁(40～79岁)。穿刺结果显示:34例呈恶性,2例呈异形细胞,10例呈良性。其中34例恶性病例最终均被证实为胰腺癌,无假阳性病例;10例良性中最终证实5例为良性,5例为恶性。2例异形细胞被证实为恶性。5例真阴性病例包括2例胰腺囊肿、2例胰腺结核和1例胰腺炎。以上结果提示超声引导下细针穿刺其敏感性、特异性、阳性预测值、阴性预测值以及准确性分别为82.9%、100.0%、100.0%、41.7%和84.8%。46例病例中,11例患者出现穿刺后腹部轻微钝痛,但均自愈,未有出血、感染或胰腺炎等穿刺相关并发症,长期随访未发现有腹腔播散或者穿刺道种植等并发症。结论:超声引导下细针穿刺诊断胰腺癌准确性高,并发症少,值得临床进一步推广。     

影像检查在乳腺肿块针吸细胞学诊断中的应用

目的:探讨钼靶摄片与B型超声波(B超)检查联合针吸细胞学检查诊断乳腺肿块的可靠性及对临床的指导意义.方法:选择有病理对照的104例乳房肿块患者,部分患者采用钼靶摄片及超声检查的影像学手段联合针吸细胞学,并将其结果与单一细胞学检查结果比较,评价钼靶摄片和超声检查与针吸细胞学联合检查的准确性.结果: 104例患者中联合钼靶摄片的细胞学诊断准确率为95.2%,联合超声检查的细胞学诊断准确率为90.9%,单一的细胞学诊断准确率为80%.假阳性未见.结论: 通过钼靶摄片及超声检查的影像学手段与细针穿刺细胞学联合诊断较为可靠,对术前诊断有一定的指导意义,但应结合实际情况选择合适的联合检查模式.     

Fine needle aspiration cytology in the diagnosis of prostatic enlargements.

One hundred patients with enlarged prostate were subjected to fine needle aspiration cytology and histopathologic examination of prostate. The results have been found encouraging. The cytodiagnostic accuracy rate was 99 p.c. in identification of benign or malignant nature of the lesions and 94 p.c. in cytologic specific diagnosis (exactly similar to histopathologic diagnosis). The technique was simple, rapid, economical, reliable, easy to repeat and highly suitable for outpatients. The procedure can routinely be adopted in places where facilities for preparation of paraffin section do not exist or when quick diagnosis is required.     

Fine needle aspiration cytology in the diagnosis of primary liver cancer

From Dec. 1979 to Dec. 1984, 171 patients suspicious of primary liver cancer (PLC) were examined by fine needle aspiration cytology (FNAC). In this series, 148 patients were finally diagnosed as PLC. By FNAC, 133 of 148 patients showed positive cytology and 4 suspiciously positive cytology. The overall diagnostic accuracy was 92.6% There was no false positive. Neither spreading or bleeding were observed. The results show that FNAC examination, being simple, rapid and safe, could serve as a reliable way of diagnosing the suspected PLC.     

胰腺肿块术中细针穿刺细胞学与快速组织学诊断的对比研究

目的 探讨术中细针穿刺细胞学与快速病理组织学对胰腺肿块的诊断价值。方法 56例患者行胰腺肿块探变术,术中直视下对胰腺肿块行细针穿刺涂片同时切取活检行快速组织学观察,并与术后病理诊断作对比研究。结果 术中细胞学和术中快速组织学与术后病理诊断对比分析,细胞学的准确性、敏感性和特异性分别为94．6％、95．3％和92．3％;术中快速组织学的准确性、敏感性和特异性分别为92．9％、90．7％和100％。结论 细针穿刺细胞学快速实用,安全可靠,与快速组织学同时使用可以提高胰腺癌的检出率,对肿瘤病理分级和组织起源起到互补作用。