Cytologic diagnosis of prostatic carcinoma by fine-needle aspiration biopsy. Community hospital experience

Transrectal fine-needle aspiration and transrectal or perineal core biopsies were simultaneously performed on 31 patients with suspected prostatic cancer over an eighteen-month period. Of the 29 aspirations that were adequate for cytologic diagnosis, there was histologic correlation in 24 (83%). The sensitivity of aspiration for the diagnosis for prostatic cancer was 92 per cent (11 of 12) compared with 85 per cent (11 of 13) for the core biopsy method. There were no apparent false negative or false positive diagnoses with the aspiration biopsy technique. Insufficient material was obtained by aspiration in 2 cases. A febrile urinary tract infection occurred in 1 patient after transrectal aspiration and core biopsy. Our results suggest that fine-needle aspiration may be utilized by the practicing urologist in conjunction with a pathologist trained in the interpretation of fine-needle aspirates as a safe, relatively inexpensive, and sensitive diagnostic procedure for suspected prostatic cancer.     

Combined biopsy techniques: an approach to the diagnosis of prostatic malignancy

We present our results of 3 biopsy techniques applied to each of 62 patients with clinically suspicious prostatic nodules. Transrectal digitally guided and sonographically guided transperineal fine needle aspiration biopsies were followed by digitally guided transperineal core biopsy in all cases. Adenocarcinoma was confirmed in 25 patients by 1 or more of these techniques. Our results indicated that 7 of 25 cancer cases (28 per cent) were detected by only 1 of 3 applied methods of biopsy and 56 per cent were detected by all 3 techniques. When a clinical suspicion of malignancy remains after a negative aspiration or core biopsy consideration should be given to alternative forms of biopsy to establish a diagnosis.     

The role of transrectal aspiration biopsy in the diagnosis of prostatic cancer

We reviewed our experience with transrectal aspiration biopsy during an 18-month period. This procedure was the sole technique used in 75 men and prostatic cancer was diagnosed in 19. Two of these patients were not treated because a core biopsy performed at another hospital was negative for carcinoma. Aspiration and transperineal core biopsies were performed in 62 other cases. The sensitivity of aspiration to diagnose prostatic cancer was 98 per cent (45 of 46 biopsies) compared to only 81 per cent (37 of 46) for the core biopsy method. No patient suffered a complication following the aspiration biopsy. These data further support the value of transrectal aspiration biopsy as a sensitive, easy to perform method for sampling an abnormal prostate. More widespread use of this technique in the United States should be encouraged.     

Transrectal aspiration biopsy of the prostate: the importance of atypia

Transrectal aspiration biopsy is useful as an alternative method to examine the prostate. As a means to improve the sensitivity of this method we investigated the significance of cellular atypia. Transrectal aspiration biopsy revealed highly atypical cells in 30 of 225 patients and in 17 patients slightly atypical cells were found. Biopsy was repeated in 22 patients with highly atypical cells and cancer was confirmed in 17 (77 per cent). In the group with only slight atypia 2 of 6 patients had cancer upon repeat prostatic biopsy. When transrectal aspiration biopsy contains highly atypical cells biopsy should be repeated to avoid a false negative diagnosis. These results suggest that atypia is an abnormal finding that must be followed clearly to maintain a high sensitivity with this biopsy method.     

Ultrasonically guided fine needle aspiration biopsy of renal masses

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

A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer

Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.     

Transrectal needle aspiration versus transperineal needle biopsy in diagnosis of carcinoma of prostate

Transrectal needle aspiration of the prostate was compared to transperineal biopsy in 28 patients with suspected carcinoma of the prostate. This technique was found to have a high sensitivity and specificity for diagnosing carcinoma of the prostate, and no complications were seen. The addition of Nuclear Flow DNA analysis may give further prognostic information from needle aspiration and core biopsy specimens. Transrectal needle aspiration of the prostate is a safe, inexpensive, and accurate method of diagnosing carcinoma of the prostate.     

Intraoperative pancreatic fine needle aspiration biopsy. Results in 166 patients

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

Prostatic aspiration biopsy: an assessment of accuracy based on long-term observations

We present the results of transrectal thin needle aspiration biopsy of the prostate in 133 patients. Test specificity was 94 per cent and sensitivity also appeared to be high initially. However, with repeated rectal examinations and biopsies during an 11-year period a number of additional false negatives became apparent, which resulted in an apparent test sensitivity of 82 per cent, lower than most previously published reports. Our data suggest that aspiration biopsy has specificity and sensitivity similar to core biopsy, it is important to re-test patients who have a palpable abnormality and an initially benign biopsy, and aspiration biopsy simplicity allows for a low threshold of suspicion of subtle abnormalities and for repeating biopsies after negative findings.     

Fine needle aspiration biopsy of the prostate gland: a study of 103 cases with histological followup

Fine needle aspiration specimens of the prostate gland were compared to histological material in 103 patients. The sensitivity was 95 per cent, specificity 97 per cent and efficiency 87 per cent. Initial core needle biopsy compared to the final histological diagnosis in this study had a sensitivity of 76 per cent, specificity 100 per cent and efficiency 71 per cent. Fine needle aspiration by a well trained cytopathologist is less traumatic, and has fewer side effects and a higher sensitivity rate than conventional core needle biopsy.     

Transrectal ultrasonography in the diagnosis and staging of carcinoma of the prostate

Transrectal prostatic ultrasonography is a potentially valuable means to evaluate the prostate of men with suspected carcinoma. We studied 118 patients with this modality before histological evaluation of the prostate (20 underwent radical prostatectomy, 75 core needle biopsy and aspiration cytology, and 23 transurethral resection of the prostate). Transrectal ultrasonography was more efficient than digital rectal examination in the staging of carcinoma of the prostate before radical prostatectomy. The value of transrectal ultrasonography in the diagnosis of prostatic cancer in men with an abnormal-feeling prostate on digital rectal examination is less certain, since 10 of 75 patients (13 per cent) in this group had a falsely positive scan. The predictive value of a scan positive for malignancy was 37 per cent. Further refinements in the technique of transrectal prostatic ultrasonography are needed to realize fully the diagnostic potential of this imaging modality.     

Transrectal fine-needle aspiration and truecut needle biopsy of the prostate: a blinded comparison of accuracy

Transrectal needle aspiration biopsy and core biopsy of the prostate were performed simultaneously on 88 men with prostatic nodules. Cytologic and histologic assessments were made in a blinded, independent fashion, and the results were compared. All patients with positive findings on aspiration also had positive findings on core biopsy, for a positive predictive value for aspiration of 100%. However, five negative and six "insufficient" results obtained by aspiration were positive on core biopsy, for a negative predictive value for aspiration of 88%. This experience support the use of needle aspiration as an initial diagnostic maneuver in the assessment of prostatic nodules.     

Fine-needle aspiration biopsy and the diagnosis of thyroid cancer

Conventional criteria for the evaluation of thyroid nodules are inaccurate in identifying the small proportion of malignant neoplasms. The diagnostic accuracy of fine-needle aspiration biopsy (FNAB) for cytology was therefore assessed in 562 patients with nodular thyroid disease, 373 of whom (66.4 per cent) had histological confirmation of the cytological diagnosis. Sixty-one aspiration biopsies were positive for malignancy, and the diagnosis was confirmed histologically in 59 of these (96.7 per cent). Thus, there were two false positive cytology results among 310 patients with proven benign disease (0.6 per cent). Four of sixty-three patients with proven carcinoma had a benign cytological diagnosis, a false negative rate of 6.3 per cent. In 57 of the 59 malignancies (96.6 per cent) correctly diagnosed by FNAB the histological type of tumour was successfully identified. Overall 367 of 373 patients received correct cytological discrimination between benign and malignant nodules, an overall accuracy of 98.4 per cent for FNAB. The sensitivity of the test was 93.7 per cent and the specificity 99.4 per cent. Besides being safe, cost-effective and reliable, FNAB directs the appropriate selection of patients for surgery and enables the correct operation to be performed for each type of tumour.     

Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors

Transrectal ultrasound-guided needle biopsy of the prostate is routinely performed to diagnose prostate cancer. We performed a prospective study to assess the pain and identify risk factors of pain during prostate biopsy. Prospectively, 131 patients were enrolled. Transrectal ultrasound-guided needle prostate biopsies were performed without any anesthesia. Pain was assessed by using an immediate postbiopsy anonymous questionnaire including a linear visual analog scale (VAS). Six factors were studied (age, prostate volume, cores number, operator, previous biopsy and first core location). Most of the patients tolerated the biopsy with acceptable discomfort. Among the risk factors studied, only first core location influenced the pain. Apex biopsy first was more painful. We recommend starting biopsy with the base.     

Additional value of fine-needle aspiration biopsy in a mammographic screening trial

The Stockholm breast cancer screening trial used single-view mammography as the sole screening method. A majority (63 per cent) of the mammographic selected cases from the first two screening rounds had uncertain mammograms, coded as 3 on an ordinal scale from 1 to 5, where 1 and 2 are dismissed as normal mammograms and 5 stands for a typical cancer. In this group of uncertain mammograms 30 cases were malignant and 431 were non-malignant. The aim of this study was to examine whether surgical biopsy in this group could be replaced by fine-needle aspiration (FNA) biopsy, combined with the information from the mammogram and clinical examination, and whether this diagnostic strategy could select the malignant cases with a high sensitivity. FNA biopsy selected 25 of the 30 mammary carcinomas as definite malignancy or atypia, with a sensitivity of 83 per cent (95 per cent confidence interval: 69-96 per cent), and combined with the information from the mammogram and clinical examination 29 of the malignancies were selected with a sensitivity of 97 per cent (95 per cent confidence interval: 83-100 per cent). In 398 of 431 non-malignant cases the diagnosis was established with the triple diagnostic approach without needing a surgical biopsy. In a clinical follow-up study, up to 64 months after the first screening round, only one false negative case was found, included in the group of 30 malignancies described above. With this strategy the rate of negative surgical biopsies was reduced by 90 per cent in the group with uncertain mammograms and without considerably impairing the reliability of the results.     

Comparison of transrectal prostate digital aspiration and ultrasound-guided core biopsies in 99 men

We compared digital transrectal needle aspiration and transrectal core prostate biopsies obtained with ultrasound guidance in 99 men. Both procedures were effective in identifying prostate cancer; complete sensitivity was 94 percent for aspiration and 90 percent for core biopsy. Aspiration confirmed 87 percent of 38 known cancers and 94 percent of 81 cancers overall, compared with 82 percent and 90 percent with core biopsies. The greatest number of cancers was found when both procedures were considered (95% of known and 98% of all cancers). Grading of both specimens was performed but was not equivalent. Unsatisfactory or inconclusive results by either procedure often obtained when cancer was present. We suggest digital transrectal needle aspiration as a first means of identifying most palpable prostate lesions. Transrectal core biopsies guided by ultrasonography should be used when suspicion of cancer cannot be confirmed by aspiration and when there is no palpable lesion (but clinical suspicion of cancer).     

The prognostic significance of post-irradiation biopsy results in patients with prostatic cancer

To evaluate the prognostic significance of post-irradiation biopsy results in patients with prostatic cancer, we reviewed the records of 803 patients who had been treated with pelvic lymph node dissection, radioactive gold seed implantation and external beam irradiation. Of the patients 124 had 1 or more biopsies within 6 to 36 months after completion of radiotherapy when there was no evidence of local or distant recurrence of tumor. Patients were followed for a mean of 64 months (range 14 to 175 months) and received no other therapy before relapse. Over-all, 43 of these patients (35 per cent) had a positive biopsy result. The incidence of positive biopsy results correlated directly with the initial stage of the tumor, ranging from 22 per cent of stage B1N to 50 per cent of stage C1 lesions. However, biopsy results did not correlate with the grade of the tumor. Local recurrence and distant metastases were much more common among patients with a positive biopsy result (p equals 0.0006). Local recurrence developed in 58 per cent of the patients with a positive biopsy by 5 years and in 82 per cent by 10 years. Of those in whom all biopsies were negative only 18 per cent had local recurrence by 5 years and 32 per cent by 10 years. Biopsy results retained their prognostic significance even among the more favorable subset of patients whose pelvic lymph nodes were negative initially and those with a normal prostatic examination at biopsy. These results indicate that a post-irradiation prostate biopsy 6 to 36 months after completion of treatment can be used to determine the efficacy of a particular radiotherapeutic regimen as well as the success or failure of radiotherapy in an individual patient.     

Accuracy and upgrade rates of percutaneous breast biopsy: the surgeon's role

We sought to evaluate the impact of needle core size and number of core samples on diagnostic accuracy and upgrade rates for image-guided core needle biopsies of the breast. A total of 234 patients underwent image-guided percutaneous needle biopsies and subsequent surgical excision. Large-core needles (9 gauge or less) were used in 14.5 per cent of cases and the remainder were performed with smaller core needles. More than four core samples were taken in 78.9 per cent of patients. In 71.8 per cent of cases, needle biopsy pathology matched surgical excision pathology. After surgical excision, upgraded pathology was revealed in 10.7 per cent of cases. Of 11 patients (52.4%) with benign needle core pathology who had upgraded final pathology on surgical excision, 10 had a Breast Imaging Recording and Data System score 4 or 5 imaging study. Lesions smaller than 10 mm were more likely to be misdiagnosed (P = 0.01) or have upgraded pathology (P = 0.009). Other predictors of upgraded pathology were patient age 50 years or older (P = 0.03) and taking four or fewer core samples (P = 0.003). Needle core size did not impact accuracy or upgrade rates. Surgeons should exercise caution when interpreting needle biopsy results with older patients, smaller lesions, and limited sampling. Discordant pathology and imaging still mandate surgical confirmation.     

Comparison of digital examination and transrectal ultrasonography for the diagnosis of prostatic cancer

The ability to detect prostatic cancer by transrectal ultrasonography was evaluated in a prospective blind study of 216 men. The sensitivity of transrectal ultrasonography was 86 per cent but the specificity was only 41 per cent. Tumors less than 1 cm. in diameter were most difficult to detect by transrectal ultrasonography. The positive and negative predictive values of transrectal ultrasonography were 36 and 89 per cent, respectively. Abnormal scans that strongly suggested carcinoma were present in 10 per cent of the men who had a normal digital examination but no biopsy was performed. Transrectal ultrasound is a sensitive method to detect all but small prostatic tumors and it can detect tumors that are not evident by digital examination. To date, however, transrectal ultrasonography may be difficult to use for routine screening in the United States because of the low positive predictive value. Nevertheless, further investigation of this technique is warranted to define its role in improving the diagnosis of prostatic cancer.     

Use of fine needle aspiration cytology with immediate reporting in the diagnosis of breast disease

Fine needle aspiration biopsy for cytological examination (FNAC) is becoming increasingly accepted as a means of tissue diagnosis in breast disease. This study examines the feasibility and accuracy of FNAC in 'immediate reporting' by a consultant cytopathologist in a busy breast clinic. Over a 2-year period, 884 cytology reports were analysed. An initial clinical report and subsequent final cytological diagnosis was made. Fine needle aspiration provided adequate material for cytological evaluation in 635 of the 884 biopsies (71.6 per cent) and this proportion was greater when discrete lumps were considered (463 of 562 biopsies = 82.4 per cent). In diffuse and cystic disease, however, the adequacy of specimens was reduced: 50 per cent and 65 per cent respectively. On immediate reporting the diagnostic sensitivity for all patients was 88 per cent (discrete lumps only, 92.5 per cent) and the specificity was 99.8 per cent (discrete lumps only, 100 per cent). FNAC retains its diagnostic accuracy when immediate reporting is employed and this study demonstrates that this technique can be used in making a diagnosis in patients with breast disease.