Utility of punch biopsy for lesions that are hard to aspirate by conventional fine-needle aspiration.

BACKGROUND: Fine-needle aspiration (FNA) is a fast, reliable, and cost-efficient technique for diagnosing palpable masses. However, when the lesion is small, dermal in location, shallow in depth, or fibrotic, the cellular yield by FNA may be limited and thus hinder an accurate diagnosis. The authors examined the value of punch biopsy (PB) in diagnosing such hard-to-aspirate lesions. METHODS: The authors reviewed 49 PB specimens from 47 patients who presented in their FNA clinic from June 1994 to July 1997. RESULTS: The lesions were typically described as ill-defined erythematous skin lesions or as papules or small, firm, subcutaneous nodules (average size, 0.7 cm). Patients' previous history included breast carcinoma (in 36 cases), nonmammary carcinoma (in 3 cases), melanoma (in 2 cases), squamous carcinoma of the skin (in 2 cases), cutaneous T-cell lymphoma (in 2 cases), small lymphocytic lymphoma (in 1 case), and no history of malignancy (in 1 case). PB sites included chest wall, breast, extremities, abdominal wall, neck, back, scalp, and forehead. Of the 37 cases in which FNA was performed before PB, 21 aspirates (57%) were nondiagnostic because of scant cellularity, 11 aspirates (31%) were positive (9) or suspicious/atypical (2) for malignancy, and 5 aspirates (14%) were negative for malignancy. Seventeen (81%) of the 21 nondiagnostic aspirates and 10 of the 11 suspicious/atypical aspirates were positive for malignancy on PB specimens. Twelve PBs were done without prior FNA, 8 (67%) were positive for malignancy, and 4 (33%) were negative. In 7 patients, the findings from the PB specimens (new diagnosis of malignancy in 5 cases and recurrence of disease in 2 cases) led to surgical excision of the lesion. CONCLUSIONS: PB is a valuable adjunct to FNA for diagnosing hard-to-aspirate lesions.     

Fine needle aspiration diagnosis of intraabdominal and retroperitoneal lymphomas by a morphologic and immunocytochemical approach

We reviewed 238 fine needle aspiration biopsies (FNA) of intraabdominal or retroperitoneal (IA/RP) masses in 192 patients with known or suspected lymphoma. A limited battery of immunocytochemical stains, including kappa (k) and lambda (l) light chains and Leu-4, was performed in 104 aspirates. On hundred twenty-eight of the FNA were diagnostic of or consistent with lymphoma, and three were diagnostic of carcinoma. Twenty-eight were considered negative for malignancy and 79 were suspicious for lymphoma or were nondiagnostic. For 135 of the FNA, a histologic biopsy specimen was available for comparison purposes. Overall, only one false-positive result was seen in a specimen lacking immunocytochemical data. The sensitivity of FNA lymphoma diagnosis was 66%. False-negative results due to sampling error were not uncommon, giving a predictive value of a negative result as 42%. The classification of the lymphomas by FNA was identical to that of the surgical biopsy in 86% of specimens and concurrently discrepant in 6%. We conclude that the routine performance of immunocytochemical studies on FNA of IA/RP masses is a feasible and valuable technique. Whereas suboptimal sensitivity and sampling error may make a negative diagnosis unreliable, lymphoma marker studies (combined with morphology) allow for an accurate and confident diagnosis and subclassification of lymphoma in the majority of cases.     

Tru-Cut穿刺活检联合细针针吸活检在胰腺癌术中病理诊断中的应用

目的 探讨Tru-Cut穿刺活检(TCB)联合细针针吸活检(FNA)在胰腺癌术中病理诊断中的应用价值.方法 对22例术前诊断为胰腺癌的患者,术中进行肿物的TCB联合FNA,进行前瞻性研究.结果 22例患者中,TCB联合FNA诊断胰腺癌19例,3例既未见癌组织,亦未发现癌细胞.其中1例术中肝结节活检证实为肝转移,结合临床考虑胰腺癌肝转移;1例诊为自身免疫性胰腺炎;1例随访9个月,肿物无变化,诊为慢性胰腺炎.TCB诊断准确率为90.9%,FNA诊断准确率为86.4%,TCB联合FNA诊断准确率为95.5%.术后无胰瘘、出血等并发症发生.结论 TCB联合FNA的方法提高了胰腺癌术中诊断的准确率,是一种安全有效的诊断方法.     

Role of fine needle aspiration in the diagnosis of lesions of the oral cavity, oropharynx, and nasopharynx

The oral cavity, oropharynx and nasopharynx are readily accessible to fine needle aspiration (FNA). This study reviews the author's experience with 93 FNA from these sites: 76 from the oral cavity, eight from the oropharynx, and eight from the nasopharynx. Thirty-nine (42%) of the FNA were positive for malignancy with no false-positive diagnoses. In 15 cases the FNA provided the initial diagnosis of cancer and in 24 cases documented recurrence. Five (5%) of the FNA interpreted as suspicious for malignancy were subsequently proven malignant by biopsy. There were 33 (36%) negative FNA with seven false-negative diagnoses confirmed by biopsies. Fifteen FNA (16%) were unsatisfactory and malignancy was found by biopsy in two of these cases. These results emphasize the importance of repeating the FNA or recommending biopsies in negative and unsatisfactory FNA when clinically indicated to assure accuracy in diagnosis. A positive FNA may be regarded as a definitive diagnostic test and treatment instituted accordingly. No complications resulted from these FNA. This study demonstrates the application, safety, and accuracy of FNA in these anatomic sites.     

Clinical utility of fine-needle aspiration for diagnosis of head and neck lymphoma

Background

Although fine-needle aspiration (FNA) is currently used for the diagnosis of lymphoma, its diagnostic utility in patients with head and neck (HN) lymphoma is unclear. We therefore assessed the utility of initial clinical and FNA diagnoses for HN lymphoma in a clinician's perspective.

Methods

We conducted a retrospective study of total 109 patients with HN lymphoma underwent both FNA and tissue diagnoses from January 2000 through December 2005. The diagnostic sensitivity of FNA was compared with that of histopathology. FNA diagnosis was based on cytomorphology alone in 69 patients and on immunophenotyping plus morphology in 40.

Results

On clinical diagnosis, lymphoma was suspected in 54 patients, nonlymphoma/metastatic malignancy in 31, and benign disease in 24. FNA diagnosed lymphoma in 41 patients; suspicious of lymphoma in 23; atypical lymphoma in 20; benign disease in 19; and was nondiagnostic in 6 patients. Diagnostic accuracy of FNA was not significantly improved by repeat core needle biopsy and immunophenotyping. Delay from FNA to tissue diagnosis was significant in the benign FNA-diagnostic group, with a mean 49 days.

Conclusions

The clinical and FNA diagnoses of HN lymphoma may be incomplete and include the potential pitfall of significant diagnostic delay.     

Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic,gallbladder and biliary tract Lesions

Endoscopic ultrasound(EUS)-guided fine needle aspira-tion(FNA) of the liver is a safe procedure in the diag-nosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modali-ties of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the con-ventional endoscopic brushing and biopsy.     

Diagnostic Aspects of Fine Needle Aspiration for Lung Lesions: Series of 245 Cases

Background: Transthoracic fine needle aspiration (FNA) is one of several methods for establishing tissuediagnosis of lung lesions. Other tissue or cell sources for diagnosis include sputum, endobronchial biopsy, washingand brushing, endobronchial FNA, transthoracic core needle biopsy, biopsy from thoracoscopy or thoracotomy.The purpose of this study was to compare the sensitivity and specificity of FNA and other diagnostic tests indiagnosing lung lesions. Materials and Methods: The population included all patients undergoing FNA for lunglesions at Meir Medical Center from 2006 through 2010. Information regarding additional tissue tests was derivedfrom the electronic archives of the Department of Pathology, patient records and files from the Department ofOncology. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculatedfor each test. Results: FNA was carried out in 245 patients. Malignant tumors were diagnosed in 190 cases(78%). They included adenocarcinoma (43%), squamous cell carcinoma (15%), non-small cell carcinoma, nototherwise specified (19%), neurondocrine tumors (7%), metastases (9%) and lymphoma (3%). The specificityof FNA for lung neoplasms was 100%; sensitivity and diagnostic accuracy were 87%. Conclusions: FNA is themost sensitive procedure for establishing tissue diagnoses of lung cancer. Combination with core needle biopsyincreases the sensitivity. Factors related to the lesion (nature, degenerative changes, location) and to performanceof all stages of test affect the ability to establish a diagnosis.     

Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases

Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient’s safety and condition.     

False-positive and false-negative cases of fine-needle aspiration cytology for palpable breast lesions.

BACKGROUND: Fine-needle aspiration cytology (FNA) is less traumatic and technically easy to apply to small breast tumors. METHODS: A total of 382 cases of palpable breast lesions that had undergone fine needle aspiration and histopathologic diagnosis were reviewed with an emphasis on the rate of false positive diagnoses in benign breast lesions. RESULTS: A diagnosis of " malignant " was made in 98 of the 382 specimens (25.6%). The predictive value for malignancy was 97.9%. The sensitivity, specificity, and accuracy of FNA were 86.3%, 98.2%, and 93.2%, respectively, when the " suspicious " group was considered positive for malignancy. The histologic subtypes of the 4 false-positive cases were epithelial proliferative lesions, ductal or lobular hyperplasia. None of these 4 cases were definitely diagnosed as " malignant " by radiological studies. Four false-negative cases by FNA were suspicious for malignancy radiologically. There was no specific pathological subtype associated with false-negative status on FNA in this study. CONCLUSION: Palpable breast tumors can be definitively diagnosed based on a combination of physical examination, radiological studies and FNA, when the radiological studies concur with the diagnosis by FNA.     

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.     

Accuracy of Fine Needle Aspiration Cytology from Breast Masses in Thailand

Objective: To evaluate the accuracy and diagnostic performance of fine needle aspiration FNA cytology indiagnoses of breast masses. Methods: Women who had FNA diagnoses for breast masses and underwentsubsequent histopathologic evaluation during January 2003-December 2006 were accessed from the archive ofthe Anatomical Pathology Department of our institution. Cytologic diagnoses were classified as unsatisfactory,benign, atypical probably benign, suspicious probably malignant, and malignant, and were compared to thehistopathologic diagnoses obtained from core needle biopsy, excisional biopsy, or mastectomy to give an assessmentof the diagnostic performance of FNA. Results: A series of 190 breast masses were identified during the studyperiod. The FNA cytological diagnosis was unsatisfactory due to inadequate specimens in eight cases (4.2%).The diagnoses in the remaining 182 cases were: benign lesions in 98 (53.9%); suspicious for malignancy in 31(17.0%); and malignant in 53 (29.1%). From the subsequent histopathologic diagnoses, 6/98 cases of benigncytology turned out to be malignant lesions (false negatives); 22/31 cases of suspicious cytology were trulymalignant while the other nine were benign; and only 1/53 with malignant cytology was benign (false positive),the lesion being a fibroadenoma . The overall accuracy, sensitivity, specificity, positive predictive value, andnegative predictive value were 91.2% (95% confidence interval [CI], 87.6%-94.8%), 92.5% (95% CI, 88.7%-96.3%), 90.2% (95% CI, 85.9%-94.5%), 88.1% (95% CI, 83.4%-92.8%) and 93.9% (95% CI, 90.4%-97.4%),respectively. Conclusions: FNA cytology is highly accurate for diagnosis of breast masses. However, the clinicianshould correlate FNA cytological results with physical examination and imaging findings to prevent false negativeand false positive events and to obtain optimal management for their patients.     

Cytologic criteria for well differentiated adenocarcinoma of the pancreas in fine-needle aspiration biopsy specimens

BACKGROUND: Fine-needle aspiration biopsy (FNAB) of pancreatic lesions has become popular to establish a tissue diagnosis before chemotherapy and/or surgery. The diagnostic sensitivity and specificity of FNAB have improved as a result of several articles regarding cytologic criteria for pancreatic adenocarcinoma. However, false-negative and "suspicious for malignancy" rates remain relatively high, in part because of the underdiagnosis of well differentiated adenocarcinoma (WDA). Existing cytologic criteria do not specifically focus on WDA. In this study, the authors attempt to add to, redefine, and test cytologic criteria for WDA of the pancreas in FNAB specimens. METHODS: The authors retrospectively reviewed the specimens of 291 consecutive computed tomography-guided FNABs of pancreatic lesions performed at the study institution between 1995 and 1999. The original cytologic diagnoses were confirmed by cell blocks (131), surgical tissue (84), or clinical follow-up. The FNAB specimens were evaluated for the presence of 10 cytologic criteria: 1) anisonucleosis, 2) nuclear membrane irregularity, 3) nuclear crowding/overlapping/three-dimensionality, 4) nuclear enlargement (if there are more than two red blood cells), 5) gap versus confluent cell spacing, 6) hyperchromasia, 7) macronucleoli, 8) mitosis, 9) chromatin clearing, and 10) necrosis. RESULTS: The original cytologic diagnoses were nondiagnostic in 24 cases, benign in 27, suspicious for malignancy in 15, and malignant in 225. Among the 225 malignant lesions, 74 cases were diagnosed as WDA. Cytologic criteria 1-4 were observed in 92-99% of WDA cases, whereas criteria 5-10 were present in only 7-38% of WDA cases. Six of 15 suspicious and 4 of 27 negative cases were of low cellularity but retrospectively met the cytologic criteria 1-4 for WDA (the diagnosis was confirmed on clinical follow-up). CONCLUSIONS: The diagnosis of pancreatic WDA can be made in FNAB specimens by the observance of anisonucleosis, nuclear membrane irregularity, nuclear crowding/overlapping/three-dimensionality, and nuclear enlargement. Necrosis, chromatin clearing, mitosis, macronucleoli, and hyperchromasia are of limited diagnostic significance because they are commonly absent in pancreatic WDA.     

Predictors of malignancy in thyroid fine‐needle aspirates “cyst fluid only” cases

BACKGROUND:

A recent consensus conference on thyroid fine‐needle aspiration (FNA) cytology concluded that specimens with abundant histiocytes and few or no follicular cells should be interpreted as “cyst fluid only,” under the category of “nondiagnostic.” The purpose of the current study was to identify any cytomorphologic characteristics in this type of specimen that are predictive of an underlying malignancy.

METHODS:

Thyroid FNA cases with a report of cyst fluid only and a follow‐up thyroidectomy specimen were identified during a 3‐year period. A blinded retrospective review of 6 morphologic features in the thyroid FNA specimens was conducted. These review findings were then correlated with the histopathologic diagnosis (benign or malignant).

RESULTS:

Of the 76 cyst fluid only cases with subsequent thyroidectomy, 10 cases had an ipsilateral diagnosis of papillary carcinoma measuring ≥1.0 cm. There was no association found between the number or amount of acute inflammatory cells, blood, colloid, macrophages, and pigmented macrophages and the histologic outcome. In only 4 of the 10 cases with a malignant outcome was the specimen assessed as being truly inadequate on retrospective review, and in 1 of these cases, the cytology was suggestive of malignancy.

CONCLUSIONS:

The only cytomorphologic characteristic found to be predictive of subsequent malignancy in cyst fluid only cases was the presence of follicular epithelium with atypical or suspicious features. Therefore, cases containing atypical epithelial cells should not be categorized as nondiagnostic or cyst fluid only, but rather diagnosed as atypical or suspicious. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

The role of Tc99m-sestamibi scintimammography in combination with the triple assessment of primary breast cancer.

AIM: The aim of this study was to evaluate if Tc99m-sestamibi scintimammography in addition to the triple assessment consisting of clinical examination, mammography, breast ultrasonography and fine needle aspiration cytology (FNA) enhances the diagnosis of breast cancer and helps in avoiding unnecessary operative biopsies. METHODS: Pre-operational scintimammography was performed within 2 weeks of operation to 46 consecutive patients with abnormal findings in clinical breast examination, mammography or ultrasonography. Three patients had abnormalities in both breasts. Histological diagnosis was obtained in all 49 cases. RESULTS: The histological diagnosis was benign in 18 (37%) cases and malignant in 31 (63%) cases. The overall sensitivity of scintimammography was 77% and the specificity was 61%. The sensitivity of scintimammography was 95% in invasive ductal carcinoma, 50% in invasive lobular carcinoma and 25% in ductal carcinoma in situ. Scintimammography showed 100% sensitivity in cases with invasive carcinoma, with highly suspicious findings for malignancy in the other examinations. The sensitivity was 63% in cases with indeterminate or contradictory findings in mammography, ultrasonography and FNA. CONCLUSIONS: Adding scintimammography to the triple assessment does not seem to be helpful in the diagnosis of breast abnormalities because of low sensitivity in malignant cases with a challenging diagnosis by mammography, ultrasonography and FNA, and because of low overall specificity. Copyright Harcourt Publishers Limited.     

Fine-needle aspiration cytology of Hodgkin disease: a study of 89 cases with emphasis on false-negative cases

INTRODUCTION. Although the cytologic features of Hodgkin disease (HD) has been well described, HD accounts for most of the false-negative fine-needle aspiration (FNA) biopsies of malignant lymphomas. In this study, the authors examined the factors contributing to a false-negative diagnosis of HD. METHODS: Eighty-nine cases from 72 patients (23 females and 49 males) with HD evaluated by FNA were identified between 1990 and 1999. The patients' ages ranged from 5 to 90 years (median, 38 years). Eighty-five FNAs were from lymph nodes, and 4 were from extranodal sites. Histologic correlation was available for all patients. RESULTS: Based on the original cytologic diagnosis, 43 (48.3%) cases had a positive diagnosis of HD, 20 (22.5%) suspicious or atypical diagnosis, 13 (14.6%) a benign diagnosis (false-negative cases), and 10 (11.2%) were nondiagnostic. Three (3.4%) additional cases had a malignant diagnosis other than HD. After review, three false-negative cases were reclassified as HD and seven as atypical lymphoid proliferation. Three of these 10 cases also showed conspicuous collections of histiocytes mimicking poorly formed granulomas. In those "atypical" cases, only rare Reed-Sternberg (R-S) cells variants were identified. No R-S cells or its variants were identified in the remaining three false-negative cases; subsequent excisional biopsy showed partial involvement of the lymph node by HD in two cases. Among the nondiagnostic cases, nine cases showed considerable fibrosis in the resected lymph node. In addition, six cases were performed without on-site assessment. CONCLUSIONS: The cytologic diagnosis of HD can be challenging when classic R-S cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node by HD, sampling error, and misinterpretation. On-site assessment significantly minimizes the false-negative diagnostic rate. Furthermore, additional material can be obtained for ancillary studies. Cancer (Cancer Cytopathol) Copyright 2001 American Cancer Society.     

Umbilical metastasis diagnosed by fine needle aspiration

Fine needle aspiration (FNA) is emerging as a useful diagnostic tool in the evaluation of tumor masses, providing high diagnostic yield. Fine needle aspiration for cytologic evaluation was performed on 14 patients suspected of having umbilical metastasis. The site of the primary tumor was known in 12 patients. In nine patients with previously documented malignancy, FNA of the umbilical nodule demonstrated malignant cells compatible with the histologic diagnosis of the primary cancer. In five other patients metastatic umbilical nodule was the first or the only sign for the presence of primary cancer elsewhere and in four of them FNA revealed malignant cells prior to the diagnosis of internal carcinoma. In one case, FNA demonstrated only inflammatory cells while surgery revealed adenocarcinoma associated with inflammation. The sensitivity of FNA in diagnosing malignant umbilical nodule, and the accuracy of FNA findings were 98.2%, while the predictive value of a FNA cytologic finding of malignancy was 100%. It is recommended that an umbilical nodule should alert the clinician to the possibility of malignancy and FNA should be performed as the first diagnostic procedure. This safe, rapid, reliable, and inexpensive method may diagnose malignancy and preclude the need for umbilical biopsy or more complicated diagnostic intervention.     

The role of fine needle aspiration in the diagnosis of thyroid nodules: analysis of 795 consecutive cases.

The utility of fine needle aspiration (FNA) and physical examination for selecting patients with palpable thyroid nodules for surgery was evaluated in 795 consecutive cases. Surgery was performed in 216 patients based upon the cytological diagnosis and clinical criteria. Excluding 42 patients who were lost to follow-up, the remaining 537 were regularly followed up (range, 2-10 years). Cytological findings were classified as malignant, histologic control recommended (suspicious), follicular tumor, benign, and unsatisfactory. Thirty-six aspiration biopsies were positive for malignancy and the diagnosis was confirmed histologically in 34 of them. In 65 patients with final histological diagnosis of malignancy, cytology was positive in 34, suspicious in 20, benign in 3 cases, and unsatisfactory in 8. All patients with cytological diagnosis of follicular tumor had a benign lesion at histology. There were two false positive and three false negative cytological results among the 216 histologically confirmed cases. Excluding unsatisfactory specimen sensitivity, specificity and the predictive value for a positive and a negative result were respectively 95%, 97.5%, 94.5%, and 97%. We conclude that FNA is a very reliable diagnostic test in the evaluation of thyroid nodules and is the best guidance in addition to clinical criteria for selecting patients to be submitted to surgery.     

Fine-needle aspiration biopsy of hepatic lesions: computerized tomographic-guided versus endoscopic ultrasound-guided FNA

BACKGROUND: Computerized tomographic (CT)-guided fine-needle aspiration (FNA) cytology is a well-established tool in the diagnosis of hepatic lesions. Endoscopic ultrasound-guided FNA (EUS-FNA), developed recently and used predominantly in evaluating mediastinal and pancreatic lesions, provides access to a significant portion of the liver and to perihepatic structures not readily accessible by a percutaneous approach. METHODS: A recent experience (1997-2002) with CT-guided FNA of liver lesions at the University of Alabama Birmingham (UAB) was compared with the first 2.5 years of EUS-FNA experience (2000-2002). Cases were identified using a SNOMED search and all reports and cytologic slides were retrieved for review. RESULTS: In 6 years, 34 percutaneous CT-FNA liver biopsies were performed at UAB; in approximately 2.5 years, 16 EUS-FNA liver biopsies were done. In both groups the primary clinical indication was suspected metastatic carcinoma (CT, 41% of cases vs. EUS, 56%). The 2 techniques yielded a similar range of benign, atypical, and malignant diagnoses (CT: 26%, 18%, and 56% vs. EUS: 19%, 25%, and 56%). Because of the clinical setting in which EUS-FNA is usually performed, a much narrower range of neoplasms was sampled by EUS-FNA. Benign gastrointestinal epithelial cells were identified in 60% of the EUS-FNA specimens. CONCLUSIONS: Early experience suggests EUS-FNA is comparable to CT-FNA in terms of diagnostic utility for hepatic lesions. Anatomy limits EUS-FNA to only a fraction of the hepatic parenchyma, but that fraction includes the hilum and left lobe of the liver and the proximal biliary tract. The gallbladder, extrahepatic biliary system, and perihilar lymph nodes are readily accessible. Proximate high-resolution ultrasound imaging and cytopathologist involvement in the EUS-FNA process are further advantages. Awareness of artifacts inherent in EUS-FNA sampling (i.e., gut epithelial cells) can minimize a potential diagnostic pitfall.     

DNA image analysis combined with routine cytology improves diagnostic sensitivity of common bile duct brushing

BACKGROUND: Cytologic evaluation of common bile duct brushings has a low sensitivity for diagnosing malignancy because of scant cellularity, poor cellular preservation, or sampling errors occur. The aim of this study was to evaluate whether cytology combined with image analysis improves the diagnostic accuracy of bile duct brushing in comparison with cytology alone. METHODS: Forty-nine specimens of bile duct brushings obtained from 45 patients during endoscopic retrograde cholangiopancreatography were evaluated using cytology and image analysis. Specimens were classified as negative, atypical, suspicious, or malignant by using cytologic evaluation. DNA histograms were classified as diploid (D), broad diploid (BD), aneuploid (A), or tetraploid (T). Degree of hyperploidy (DH), representing cells with a DNA content > 5C was evaluated using a cutoff value of > or = 1%. Final diagnosis of cancer was based on tissue specimens that were obtained by fine-needle aspiration or surgical biopsy and clinical fol- low-up. RESULTS: Thirty-four patients ultimately proved to have a malignancy. Cytology revealed 19 negative cases, 15 atypical cases, 9 suspicious cases, and 6 malignant cases. Together, suspicious and malignant cytology cases yielded a sensitivity of 44% and a specificity of 100% for a cytologic diagnosis of cancer. The DNA histogram pattern was D in 24 cases, BD in 9 cases, and A in 16 cases. BD and A patterns were significantly associated with malignancy (P < 0.001). A DH > or = 1% was noted in 22 cases. DH alone had a sensitivity of 62% and a specificity of 91% and was significantly associated with malignancy (P < 0.004). Atypical cytology alone had a false-negative rate of 29%, but in combination with a DH > or = 1%, the false-negative rate decreased to 7%. Additionally, when the authors combined atypical, suspicious, and malignant cytology with a DH > or = 1%, the diagnostic sensitivity increased to 88%, but the specificity decreased to 73%. CONCLUSIONS: Combined cytology and image analysis of bile duct brushing increased diagnostic sensitivity compared with cytology alone. The findings suggest that image analysis may help select patients having atypical cytology who should undergo a more rigorous evaluation for malignancy. A larger prospective study of the usefulness of combined cytology and image analysis of bile duct brushing is warranted.     

Cyclin A and cyclin B1 overexpression in differentiated thyroid carcinoma

Approximately 30% of patients with thyroid nodules have indeterminate or suspicious fine-needle aspiration (FNA) biopsy results. These patients usually undergo thyroidectomy because of cancer risk. Our aim was to determine diagnostic value of cyclin A and cyclin B1 immunohistochemistry added to routine cytology and their expression on histological sections. We studied the expression of cyclin A and cyclin B1 in FNA biopsies and resection specimens of 168 indeterminate or suspicious FNA biopsy results retrospectively at an academic hospital using immunohistochemistry. Malignant histopathology consisted 64 of resection specimens (58 papillary, 4 follicular, 1 medullary, and 1 Hürthle cell carcinoma). Cyclin A was overexpressed in 51.5% of malignant cases in contrast to 31.7% of 104 benign pathology specimens (P = 0.025). Cyclin B1 was positive in 39.1% of malignant specimens in contrast to 15.4% of benign cases (P = 0.001). Cyclin A overexpression was not linked to cyclin B1 overexpression. No association was found between overexpression of cyclin A, cyclin B1 and age, thyroiditis, multifocality, tumor size, extra-thyroidal extension, capsule infiltration, lymph node and distant organ metastases and TNM stage in malignant cases. Female patients with thyroid carcinoma overexpressed significantly more cyclin B1 than male patients (P = 0.015). Retrospective analysis of cyclin A and cyclin B1 in FNA biopsies yielded negative results for both benign and malignant cases. In conclusion, cyclin A and cyclin B1 are useful markers in the distinction of benign and malignant thyroid tumors and can increase diagnostic accuracy.