Fine-needle aspiration cytology of articular and periarticular lesions

BACKGROUND: The cytologic diagnosis of joint and articular surface-based lesions traditionally has been accomplished by examination of fluids or effusions. Although exfoliative cytology remains an accurate diagnostic test, not all joint-based lesions will produce effusions that are amenable to this type of examination. Fine-needle aspiration (FNA) represents an excellent alternative to traditional cytologic or histologic methods of diagnosis in joint pathology.METHODS: The authors reviewed FNA materials for the period 1992-2001 from lesions of joint spaces and periarticular soft tissues. All diagnoses based on cytologic materials that were included in this study were confirmed with histologic follow-up. Cytologic and histologic materials were prepared using standard methods.RESULTS: The authors found six relatively common lesions that were amenable to diagnosis by FNA. These included rheumatoid nodule, gouty tophi, ganglion cysts, pigmented villonodular synovitis, synovial chondromatosis, and synovial sarcoma. There are potential pitfalls in discriminating gout from pseudogout and synovial chondromatosis from chondrosarcoma.CONCLUSIONS: In most instances, mass-producing lesions of the joint space or the periarticular soft tissues can be diagnosed successfully by FNA. The common lesions are easily recognizable and are cytologically distinctive.     

Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations

BACKGROUND: The Papanicolaou Society of Cytopathology recently proposed 6 diagnostic categories for the classification of thyroid fine-needle aspiration (FNA) cytology. Using these categories, the experience with FNA from 2 institutions was studied with emphasis on cytologic-histologic correlation, source of errors, and clinical management. METHODS: Patient cytology data were retrieved by a retrospective search of thyroid FNA in the institutional databases. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion (ACL), follicular neoplasm (FN), suspicious for malignancy, and positive for malignancy. Samples with a histologic discrepancy were re-evaluated, and clinical follow-up information was recorded. RESULTS: Of 4703 FNA samples, 10.4% were classified as unsatisfactory, 64.6% were classified as benign, 3.2% were classified as ACL, 11.6% were classified as FN, 2.6% were classified as suspicious, and 7.6% were classified as malignant. Five hundred twelve patients had at least 1 repeat FNA, mainly for results in the unsatisfactory and ACL categories. One thousand fifty-two patients had surgical follow-up, including 14.9% of patients with unsatisfactory FNA results, 9.8% of patients with benign results, 40.6% of patients with ACL results, 63.1% of patients with FN results, 86.1% of patients with suspicious results, and 79.3% of patients with malignant results. The rates for histologically confirmed malignancy in these categories were 10.9%, 7.3%, 13.5%, 32.2%, 64.7%, and 98.6%, respectively. The cytologic-histologic diagnostic discrepancy rate was 15.3%. Sources of errors included diagnoses on inadequate specimens, sample errors, and overlapping cytologic features between hyperplastic nodules and follicular adenoma. The sensitivity and specificity of thyroid FNA for the diagnosis of malignancy were 94% and 98.5%, respectively. CONCLUSIONS: The current results indicated that FNA provides an accurate diagnosis of thyroid malignancy. The 6 diagnostic categories were beneficial for triaging patients for either clinical follow-up or surgical management.     

Fine-needle aspiration of the breast: diagnoses and pitfalls. A review of 3545 cases.

Fine-needle aspiration is now a recognized diagnostic tool. In the past eight years we have studied 3545 aspirates from the breast, including both cystic and solid masses. All were prepared according to the method of Papanicalaou. The cellular findings are described and discussed. Abnormal cells were found in the aspirates from 90% of the 368 malignancies. Reliable criteria for diagnosis are emphasized and diagnostic pitfalls discussed. Aspiration biopsy was helpful in the management of all patients with breast lesions. The method is rapid, accurate, and essentially complication-free. It should be used with the idea of complementing, not competing with, routine histologic biopsy.     

Fine-needle aspiration findings in patients with polymorphous low grade adenocarcinoma of the salivary glands

BACKGROUND: Polymorphous low grade adenocarcinoma of the salivary glands (PLAC) is a low grade neoplasm that predominantly occurs in the minor salivary glands. In this site it is amenable to biopsy and histologic diagnosis. However, experience with fine-needle aspiration (FNA) biopsy findings in these tumors is limited. The authors describe the FNA cytology of this entity. METHODS: Fine-needle aspirates from two primary parotid and three metastatic PLACs were reviewed and correlated with their histology. RESULTS: All aspirates showed similar cytologic features, with hypercellular smears showing branching papillae, sheets and clusters composed of bland uniform cells with round-to-oval nuclei, dispersed chromatin, and absent or inconspicuous nucleoli. The cells generally had a scant-to-moderate amount of eosinophilic cytoplasm. Mitoses and nuclear pleomorphism were absent. These cells formed tubular structures containing hyaline globules in all cases and often a dispersed myxohyaline stroma. Bare nuclei also frequently appeared in the background. Two cases, which had prior histologic diagnoses, were diagnosed on FNA as metastatic PLAC. One metastatic case was diagnosed as benign metastasizing pleomorphic adenoma. One primary case was diagnosed as adenoid cystic carcinoma and one case as PLAC on FNA. CONCLUSIONS: The cytologic differential diagnosis of PLAC includes adenoid cystic carcinoma, pleomorphic adenoma, and monomorphic adenoma. PLAC should be considered in the differential diagnosis of head and neck masses, where the cytology suggests one of these tumors, even when the clinical context (involvement of a major salivary gland, lymph node metastasis) is not typical of PLAC.     

Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland: A cytomorphologic study of 139 cases with statistical analysis

BACKGROUND: Lesions of the thyroid gland composed of Hurthle cells encompass pathologic entities ranging from hyperplastic nodules with Hurthle cell metaplasia to Hurthle cell carcinomas. The cytologic distinction between these entities can be diagnostically challenging. Many cytologic features of Hurthle cell lesions that distinguish neoplastic Hurthle cell lesions requiring surgery from those that are benign and nonneoplastic have been described, but with variable usefulness. This is due, in part, to the small numbers of cases examined in previous studies and the limited application of statistical analysis. A morphologic study was made of 139 Hurthle cell lesions of the thyroid gland and statistical analysis applied to identify a set of cytomorphologic features that distinguish benign Hurthle cell lesions (BHCL) from Hurthle cell neoplasms (HCN). METHODS: Fine-needle aspiration biopsies (FNABs) of thyroid nodules with a predominant Hurthle cell component and corresponding histologic followup were included in the study. Cases were divided into BHCL and HCN groups on the basis of the histologic diagnosis. All cases were reviewed to assess the following 14 cytologic features: overall cellularity, cytoarchitecture, percentage of Hurthle cells, percentage of single cells, percentage of follicular cells observed as naked Hurthle cell nuclei, background colloid, chronic inflammation, cystic change, transgressing blood vessels (TBV), intracytoplasmic lumina, presence of multinucleated Hurthle cells, nuclear to cytoplasmic ratio, nuclear pleomorphism/atypia, and nucleolar prominence. The results were evaluated by using univariate and stepwise logistic regression (SLR) analysis; statistical significance was achieved at P-values < 0.05. RESULTS: One hundred thirty-nine FNAB specimens, corresponding to 56 HCN and 83 BHCL, fulfilled the study criteria. Six of the 14 cytologic features evaluated were shown by univariate analysis to be statistically significant in predicting HCN: nonmacrofollicular architecture (P < 0.001), absence of background colloid (P < 0.001), absence of chronic inflammation (P < 0.001), presence of TBV (P < 0.001), > 90% Hurthle cells (P < 0.001), and >10% single Hurthle cells (P = 0.014). The first four of these features were also shown to be statistically significant in the SLR analysis (P = 0.005, 0.010, 0.016, and 0.045, respectively), and when all four of these features were present HCN was correctly identified 86% of the time. CONCLUSIONS: In the current study of 139 FNAB specimens of thyroid Hurthle cell nodules, 14 cytologic features were examined and 6 were found to be statistically significant in identifying HCN. The following four features, when found in combination, were found to be highly predictive of HCN: nonmacrofollicular architecture, absence of colloid, absence of inflammation, and presence of TBV.     

Fine-needle aspiration cytology of spindle cell lesions of the breast

BACKGROUND: Fine-needle aspiration biopsy (FNA) has been successful in diagnosing epithelial lesions of the breast. Its role in the evaluation of spindle cell and mesenchymal lesions of the breast, which include a variety of benign and malignant conditions, is less clear. This article discusses the cytologic features and differential diagnosis of these lesions, as well as the potential diagnostic pitfalls associated with them. METHODS: FNAs of the breast, in which a spindle cell or mesenchymal component was a key or dominant feature, were retrieved. Fibroadenomas without cellular stroma and typical lipomas were excluded. RESULTS: Forty-six aspirates (0.87%) in a series of 5306 breast FNAs contained a significant spindle cell or mesenchymal component. The aspirates were classified into 4 categories: 1) reactive conditions, including 2 diabetic mastopathies, 3 granulation tissue specimens, and 7 granulomatous lesions; 2) benign neoplastic conditions, including 1 mammary hamartoma, 1 dermatofibroma, 1 fibromatosis, 2 granular cell tumors, 2 angiolipomas, and 7 cellular fibroadenomas; 3) low grade malignant neoplastic lesions, including 10 low grade phyllodes tumors; and 4) high grade malignant neoplastic lesions, including 1 metaplastic carcinoma with chondroid stroma, 1 pleomorphic liposarcoma, 2 malignant fibrous histiocytomas, 2 osteosarcomas, and 4 metastatic melanomas. A specific diagnosis was rendered in 38 cases (82.6%). The mammary hamartoma was diagnosed as fibrocystic changes; the dermatofibroma as benign spindle cell lesion, not otherwise specified (NOS); and the primary osteosarcoma as an atypical spindle cell proliferation, NOS. The reactive ductal epithelial cells in one of the granulomatous mastitis specimens, as well as the hyperplastic ductal epithelial cells in one of the phyllodes tumors, were interpreted as atypical ductal proliferation. The marked cytologic atypia displayed by one granular cell tumor was interpreted as low grade adenocarcinoma and the primary liposarcoma as poorly differentiated carcinoma. CONCLUSIONS: Breast lesions with a significant spindle cell or mesenchymal component are rarely encountered in FNA and constitute a heterogeneous group that may pose a diagnostic dilemma. FNA should be the initial diagnostic procedure for investigating these lesions, as a specific diagnosis was rendered in the majority of cases. Cancer (Cancer Cytopathol) Copyright 1999 American Cancer Society.     

Adenoid cystic carcinoma of salivary glands. A study of 61 cases with clinicopathologic correlation

Sixty-one cases of adenoid cystic carcinoma of the head and neck region, excluding the ear canal, lacrimal glands, larynx, esophagus, and trachea, were studied, and their different clinicopathologic aspects were analyzed. Adenoid cystic carcinoma occurred more commonly in the minor salivary glands; the palate was affected in 31% of the cases. The fifth decade of life was the age at which patients were most commonly affected, and there was a slight predominance of white women. In most patients a mass was the main complaint; in 63% the duration of symptoms was 1 year or less. Forty-one patients had Stages 3 or 4 disease when first seen, and 51.7% of the patients died of disease, with a mean survival period of 35.4 months. Three basic patterns of growth, solid, cribriform, and tubular, were identified in the histopathologic examination of the cases. Other pathologic aspects analyzed were cellular pleomorphism, mitotic activity, necrosis, vascular invasion, and perineural infiltration. The study revealed a positive correlation between location of the tumor, clinical staging, duration of symptoms, and histologic pattern of growth with the prognosis of the lesion. Tumors located in the minor salivary glands, those in which the duration of symptoms was less than 1 year, and those that showed advanced clinical staging and a predominantly solid pattern of growth had an extremely poor prognosis. Surgery is the treatment of choice of adenoid cystic carcinoma, and microscopically free surgical lines of resection must be obtained. Radiation therapy, although not curative, plays an important role in prolonging survival.     

Fine-needle aspiration of epithelioid sarcoma: cytology findings in nine cases

BACKGROUND: Epithelioid sarcoma is a rare tumor with characteristic morphologic and immunohistochemical features. It can be confused histologically and cytologically with a variety of benign and malignant lesions, including a granulomatous process, synovial sarcoma, melanoma, squamous cell carcinoma, and adenocarcinoma. The objective of this study was to define the cytologic features of this rare tumor. METHODS: The cytologic features of nine histologically confirmed epithelioid sarcomas were analyzed. The criteria evaluated included cell size and shape, cell borders, cluster organization, cytoplasmic characteristics, nuclear and nucleolar features, and background characteristics. RESULTS: In most cases, single, dispersed cells represented the predominant pattern, with only a few small clusters present. The cells were mostly round with interspersed spindle cells and mild to moderate pleomorphism. The nuclei were large and eccentrically located, with a plasmacytoid appearance. A pale zone in the perinuclear area was evident in three of nine cases. Well-defined cell borders with intercellular spaces between malignant cells were observed in eight cases. In three cases, a granuloma-like structure was identified. In two cases, the cells were mostly spindle and showed greater cellular pleomorphism. CONCLUSION: Epithelioid sarcoma is an uncommon tumor with a wide range of differential diagnoses, especially in cytology specimens. Awareness of its existence and knowledge of its cytologic features are important for a correct diagnosis.     

Fine-needle aspiration cytology of large cell neuroendocrine carcinoma of the lung: a cytohistologic correlation study of 11 cases

BACKGROUND: The classification of pulmonary neuroendocrine neoplasms is particularly controversial. Large cell neuroendocrine carcinoma (LCNEC) has emerged as a separate entity among pulmonary endocrine neoplasms and the criteria for its histologic diagnosis are now well-described. However, cytologic diagnosis presents more difficulties and to the authors' knowledge, few cytologic studies concerning the entity have been published to date. The objective of the current study was to describe the cytologic features of LCNEC in an attempt to distinguish it from other pulmonary carcinomas. METHODS: A cytohistologic study of 11 surgical lobectomy specimens classified as LCNEC was performed. In all these cases, preoperative fine-needle aspiration cytology (FNAC) material was available for review. RESULTS: The cytologic features of the cases were rather similar, resulting in a repetitive pattern. The majority of smears were hypercellular with numerous single, medium-to-large cells. Naked nuclei were abundant but a variable subset of cells demonstrated evident cytoplasm. Groups were 3-dimensional and of variable size, some of them large. Nuclear pleomorphism, molding, and mitosis were common findings. A necrotic background was evident in 6 cases. In 6 cases, neoplastic groups demonstrated peripheral nuclear palisading. Rosette-like structures were present in samples from 5 patients. In 4 cases, immunocytochemistry for the detection of synaptophysin was performed, with positive results. CONCLUSIONS: The authors' experience with 11 FNAC cases of LCNEC, has led them to believe that the cytologic image of LCNEC is peculiar and recognizable in many cases. Nevertheless, it is a difficult diagnosis to make and immunocytochemistry plays a critical diagnostic role.     

Fine-needle aspiration biopsy of high-grade sarcoma: a report of 107 cases

BACKGROUND: To the authors' knowledge, few studies exist demonstrating the reliability of fine-needle aspiration (FNA) biopsy for high-grade sarcoma (HGS). METHODS: In the current study, the authors reviewed their cytopathology database (March 2001 through January 2007) and identified all FNA cases diagnosed as HGS. They also searched their tissue database for all HGS cases that had prior FNA biopsy findings. RESULTS: A total of 107 FNA samples from 98 patients (age range, 13-90 years, with a male:female ratio of 1:1) had an FNA diagnosis of HGS, or had HGS and a prior FNA diagnosis of another entity. Ten cases were nondiagnostic. Of the 97 remaining samples, 6 were diagnosed as something other than HGS (sensitivity of 94%). The positive predictive value of an FNA diagnosis of HGS was 97% (88 of 91 cases). Fifty-four cases were diagnosed as HGS, not otherwise specified, 8 as myxofibrosarcoma, 8 as osteosarcoma, 5 as malignant peripheral nerve sheath tumor, 5 as leiomyosarcoma, 4 as Ewing sarcoma, 4 as liposarcoma, 2 as epithelioid sarcoma, and 1 as angiosarcoma. Approximately 71% of patients presented with a primary tumor, 23% with disease recurrence, and 7% with metastasis. Sites of disease included the lower extremity (59%), upper extremity (19%), trunk (15%), groin (4%), and head and neck (4%). FNA diagnosis was confirmed histologically in 88% of cases, clinically in 7% of cases, and cytogenetically in 1% of cases; 3% of cases had false-positive results and 1 patient was lost to follow-up. Sixteen of 19 patients received neoadjuvant chemotherapy based on the FNA diagnosis alone. CONCLUSIONS: A cytopathologic diagnosis of HGS was found to be accurate in 88 of 97 cases (91%) with follow-up. A FNA biopsy diagnosis of HGS appears to be clinically reliable in a high percentage of cases when used in close conjunction with the orthopedic team.     

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.     

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.     

Fine-needle aspiration cytology of hemangiopericytoma: A report of five cases.

BACKGROUND: Hemangiopericytoma (HPC) is a relatively rare neoplasm, accounting for approximately 2.5% of all soft tissue tumors. Its histopathology has been well documented but to the authors' knowledge reports regarding its fine-needle aspiration (FNA) cytology rarely are encountered. In the current study the authors report the cytologic findings in FNA specimens from nine confirmed cases of HPC and attempt to correlate the cytologic features with the biologic outcomes. METHODS: FNA was performed with or without radiologic guidance. Corresponding sections of tissue were reviewed in conjunction with the cytologic preparations. RESULTS: Nine FNAs were performed in 5 patients (3 men and 2 women) with an age range of 38-77 years (mean, 56 years). Two lesions were primary soft tissue lesions arising in the lower extremities; seven were recurrent or metastatic lesions from bone (one lesion), kidney (one lesion), pelvic fossa (one lesion), lower extremities (two lesions), trunk (one lesion), and breast (one lesion). All aspirates were cellular and were comprised of single and tightly packed clusters of oval to spindle-shaped cells aggregated around branched capillaries. Basement membrane material was observed in 6 cases (67%). The nuclei were uniform and oval, with finely granular chromatin and inconspicuous nucleoli in all cases except one. No mitotic figures or areas of necrosis were identified. A correct diagnosis of HPC was made on one primary lesion and all recurrent or metastatic lesions. CONCLUSIONS: HPCs show a spindle cell pattern in cytologic preparations and must be distinguished from more common spindle cell lesions. The presence of branched capillaries and abundant basement membrane material supports a diagnosis of HPC. Immunohistochemistry and electron microscopy performed on FNA samples may be helpful in the differential diagnosis. FNA is a useful and accurate tool with which to confirm recurrent or metastatic HPC; however, prediction of the biologic behavior of HPC based on cytologic features is not feasible. Cancer (Cancer Cytopathol) Copyright 1999 American Cancer Society.     

Fine-needle aspiration biopsy of granulocytic sarcoma: a clinicopathologic study of 27 cases

BACKGROUND: Because of morphologic similarities, the differential diagnosis of granulocytic sarcoma (GS) in fine-needle aspiration (FNA) specimens includes non-Hodgkin or Hodgkin lymphoma, extramedullary hematopoiesis, poorly differentiated carcinoma, and infection. METHODS: Twenty-six FNAs and 1 pleural effusion fluid specimen of GS obtained from 23 patients were reviewed for cytomorphologic features and clinical characteristics. The cases were categorized as blastic, immature, or mature GS based on the population of the cells present on the smears. RESULTS: The patients included 18 men and 5 women (mean age, 54 years). Aspiration sites included subcutaneous or soft tissue (15 cases), lymph nodes (5 cases), bones (3 cases), testis (1 case), ileum (1 case), and liver (1 case). One sample of pleural effusion fluid also was included. Review of the patients' clinical history revealed that GS was secondary to chronic myelogenous leukemia (CML) in 17 patients, was secondary to chronic myelomonocytic leukemia (CMML) in 2 patients, and was secondary to acute myelogenous leukemia in 2 patients. GS preceded the manifestation of CML in one patient and of CMML in another patient. Based on the proportions of cells, morphologic classification was attempted and revealed blastic GS in 8 aspirates and 1 pleural effusion fluid specimen, immature GS in 13 aspirates, and mature GS in 5 aspirates. Twelve of 22 specimens from extranodal sites (55%) demonstrated lymphoglandular bodies in the background. Five aspirates showed rare eosinophilic myelocytes. Auer rods were not identified in any of the aspirates. Immunophenotypic and histochemical studies confirmed myeloid and/or myelomonocytic differentiation. CONCLUSIONS: GS especially can be confused with non-Hodgkin lymphoma because of morphologic similarities of the blasts to large cell lymphoma, the presence of lymphoglandular bodies, and the rarity of Auer rods and eosinophilic myelocytes. In conjunction with careful cytomorphologic evaluation, knowledge of the patient's clinical history and use of appropriate immunophenotypic studies should lead to a correct diagnosis.     

Fine-needle aspirations of papillary carcinoma with oncocytic features: an expanded cytologic and histologic profile

BACKGROUND:

Although a wide variety of papillary carcinomas of the thyroid can have abundant granular cytoplasm and may be difficult to distinguish from Hürthle cell lesions in fine‐needle aspirations (FNAs), the literature on these tumors is limited. The author described 18 cases with a spectrum of cytologic appearances.

METHODS:

A series of 7089 FNAs was correlated with 1331 subsequent resection specimens. Cases in which the original cytologic and histologic diagnoses included the differential diagnosis of papillary carcinoma or Hürthle cell lesions were identified.

RESULTS:

A total of 18 (1.3% of cases with resection) cases were identified. On review, 3 cases had classic features of papillary carcinoma, including nuclear crowding, along with a moderate amount of granular cytoplasm. Four cases had a population of cells that mimicked repair and/or cyst‐lining cells with almost no other epithelial cells. In 2 of those 4 cases, the cells were extremely large, and in 2 other cases, they could not be distinguished from typical cyst‐lining cells. The remaining 11 cases had cells with overlapping features including pale to granular chromatin, small to medium nucleoli either centrally or eccentrically, occasional grooves, and rare intranuclear inclusions. Typical Hürthle cells also were commonly present. Nuclear crowding was not present, and the cells were in sheets, follicles, or appeared alone. No papillae were identified. On resection, 7 cases were follicular variants of papillary carcinoma, 2 cases occurred in the setting of Hashimoto thyroiditis, and 2 cases had features of the tall‐cell variant.

CONCLUSIONS:

The author concluded that a subset of papillary carcinomas of the thyroid were difficult to distinguish from Hürthle cell lesions or repair and/or cyst‐lining cells because of the presence of abundant granular cytoplasm and a lack of nuclear crowding. These tumors were often follicular or cystic variants of papillary carcinoma. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.     

Fine-needle aspiration and cytologic findings of surgical scar lesions in women with breast cancer.

Benign and/or malignant lesions may occur in surgical scars after mastectomy or lumpectomy (SML) in patients with breast cancer (BC). Early diagnosis of these lesions is essential for both therapeutic and prognostic evaluation. The diagnostic value of fine-needle aspiration (FNA) was determined for these scar lesions. The findings of cytologic and histologic specimens obtained from the same lesion of SML in 83 women with BC were correlated. Twenty-five FNA yielded only acellular specimens. Of the FNA done by the cytopathologist, only 6.2% were not representative. However, 45% of those done by less experienced clinicians were not representative. Representative FNA were obtained from 58 of the women who took part in the study. Based on the histologic diagnosis, 38 patients had malignant scar lesions (MSL), and 20 had benign scar lesions (BSL). In one patient of the 38 with MSL, cytologic examination did not show that the malignant lesion; in four women, the tumor was suspected cytologically; and in the remaining 33, the cytologic findings were consistent with malignancy. In 18 of the 20 patients with BSL, cytologic findings were reported as benign and in the other two, as inconclusive. The sensitivity, specificity, and positive and negative predictive values for the cytologic findings were 97.4%, 100%, 100%, and 94.7%, respectively. The diagnostic accuracy of FNA cytology was 98.2%. No complications followed the procedure. It was concluded that FNA cytologic examination of lesions in SML is a simple, safe, highly accurate, and cost-effective method to distinguish malignant from benign lesions in women with BC. Lesions in SML should be explored routinely by FNA, rather than by the traditional biopsy, provided the FNA is done by an experienced operator.     

Fine-needle aspiration of metastatic nonlymphomatous tumors to the major salivary glands: a clinicopathologic study of 40 cases cytologically diagnosed and histologically correlated

BACKGROUND: Metastatic tumors to the salivary glands are common, but documentation in the cytologic literature has been limited. The current study presents the authors' experience with fine-needle aspiration (FNA) in metastatic nonlymphomatous tumors to the salivary glands. METHODS: From a retrospective review of 1675 salivary gland lesions (1535 patients), the authors collected 40 salivary gland lesions (39 patients who had histories of extrasalivary cancer) that were diagnosed cytologically as metastases to the salivary glands and were correlated histologically. RESULTS: FNAs of 34 parotid gland and 6 submandibular gland tumors were performed. The cytologic diagnoses of metastases of squamous cell carcinoma (15 cases), melanoma (12 cases), carcinoma (5 cases), rhabdomyosarcoma (3 cases), and retinoblastoma (2 cases) were confirmed (95%) histologically. Two (5%) FNAs were false-negative. CONCLUSIONS: In patients who had a history of extrasalivary cancer, cytology examination was very helpful and sufficient for adequate patient management.     

Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: a systematic review

Background

Lung cancer leads cancer-related mortality in the world. The objective of the present systematic review was to compare fine-needle aspiration biopsy (fnab) with core-needle biopsy (cnb) for diagnostic characteristics and yields for diagnosing lung cancer in patients with lung lesions.

Methods

The medline and embase databases (from January 1, 1990, to September 14, 2009), the Cochrane Library (to Issue 4, 2009), and selected guideline Web sites were searched for relevant articles.

Results

For overall diagnostic characteristics (benign vs. malignant) of fnab and cnb, the ranges of sensitivity were 81.3%–90.8% and 85.7–97.4% respectively; of specificity, 75.4%–100.0% and 88.6%–100.0%; and of accuracy, 79.7%–91.8% and 89.0%–96.9%. For specific diagnostic characteristics of fnab and cnb (identifying the histologic subtype of malignancies or the specific benign diagnoses), the ranges of sensitivity were 56.3%–86.5% and 56.5–88.7% respectively; of specificity, 6.7%–57.1% and 52.4%–100.0%; and of accuracy, 40.4%–81.2% and 66.7%–93.2%. Compared with fnab, cnb did not result in a higher complication rate (pneumothorax or hemoptysis). No study has yet compared the diagnostic yields of fnab and of cnb for molecular predictive-marker studies in patients with lung lesions.

Discussion and Conclusions

The evidence is currently insufficient to support a difference between fnab and cnb in identifying lung malignancies in patients with lung lesions. Compared with fnab, cnb might have a higher specificity to diagnose specific benign lesions. Well-designed, good-quality studies comparing fnab with cnb for diagnostic characteristics and yields in diagnosing lung cancer should be encouraged.