Metachronous soft-tissue masses in children and young adults with cancer: correlation of histology and aspiration cytology

We describe a series of 28 fine needle aspiration biopsies (FNAB) of soft tissue from 22 patients. Four patients had two separate FNABs, and one had three aspiration procedures. The patient population was limited to children and young adults (age range, 2 months to 29 years; mean, 16 years) who were known to have diverse forms of cancer, and who subsequently developed a mass in the peripheral soft tissues (including breast). The interval between the time of diagnosis of the primary malignant neoplasm and FNAB ranged from 1 day to 17 years (mean, 39 months). All FNAB diagnoses were confirmed by subsequent surgical open biopsy or clinical follow-up greater than 1 year. No complications occurred from the procedure. The cytomorphology is presented in selected cases and correlated with the patient's original tissue histopathology. Twenty aspirates were diagnosed as cytologically malignant, one as suspicious for malignancy. Seven were considered benign. None were unsatisfactory. One false-positive and no false-negative cytologic diagnoses were obtained. The overall accuracy of FNAB diagnoses was 96%, while sensitivity was 100% and specificity 88%. Sites of aspiration included soft tissues of the head and neck (seven cases), trunk (eight cases), breast (four cases), and extremities (nine cases). Malignant cytologic diagnoses included sarcoma (thirteen), seminoma (two), lymphoma/leukemia (two), melanoma (one), undifferentiated neoplasm (one), and neuroblastoma (one). Electron microscopy of aspirated cells was used to confirm the diagnosis in two cases. Fine needle aspiration biopsy of soft tissue masses from children and young adults with cancer demonstrates a high diagnostic accuracy, and its use is justified in this population.     

Fine-needle aspiration biopsy of vertebral body lesions: Cytologic,pathologic, and clinical correlations of 57 cases

We reviewed 57 cases of fine-needle aspiration biopsy (FNAB) specimens of vertebral body lesions at our institutions and sought correlations between clinical histories, aspirates, and tissue specimens. Patients'ages ranged from 10–86 yr (mean 62 yr). Previous clinical histories included malignancy (n = 33), osteomyelitis or systemic infection (n = 18), and nonspecific (n = 6). FNAB diagnoses were rendered in 81% of cases (n = 46) and were correlated with previous clinical history (P < 0.004). Tissue diagnoses were also correlated with previous clinical history (P < 0.02). In 19% of cases (n = 11), FNAB was unsatisfactory; of these, tissue specimens were diagnostic for five cases. In 19% of cases (n = 11), both aspirates and tissue specimens were available, and the diagnoses coincided in all cases; tissue specimens did not enhance the results of aspirates which produced positive results. Aspirates which showed normal bone marrow elements appeared to effectively rule-out metastatic malignancy based on clinical follow-up (mean 3.7 yr). Diagn Cytopathol 1994;11:348–351. © 1994 Wiley-Liss, Inc.     

Accuracy of fine needle aspiration biopsy processed by cytologic smear and cell block techniques for the diagnosis of lacrimal gland tumors: a study of 48 cases

Objective: To study the accuracy of fine needle aspiration biopsy (FNAB) processed by smear cytology and cell block (CB) techniques for the diagnosis of lacrimal gland tumors (LGTs). Study Design: In a prospective study, we enrolled 48 consecutive patients with LGTs. Immediately after excision of LGTs, the tissues were underwent FNAB with 23-gauge needles. The FNAB samples were processed to produce cytologic smears and CB from which slides were cut for immunohistochemical staining. The remainders were submitted for routine histopathologic processing. The diagnostic value of FNAB was assessed by comparing the FNAB diagnoses to those made by routine histopathology. Results: Cytopathologic evaluations based on smear cytology and CB with sections stained immunohistochemically can distinguish non-epithelial lesions from epithelial ones in all cases. The diagnostic sensitivities, specificities, and accuracies for distinguishing benign from malignant lesions were: cytologic smears--76%, 68%, and 71%, respectively; CB with immunohistochemical staining--88%, 87%, and 88%, respectively. The accuracy of the tissue diagnosis compared to routine histopathology was less for cytologic smears (58%) than for CB with immunohistochemistry (81%; P < 0.05). Conclusions: FNAB of LGT processed using a CB technique capable of producing immunohistochemically stained slides results in a greater percentage of accurate tissue diagnoses than do cytologic smears, when compared to routine histopathology.     

The reliability of fine-needle aspiration biopsy in the diagnosis of deep lesions of the lung and mediastinum: experience with 250 cases using a modified technique

Two-hundred and fifty discrete lesions of the lung and mediastinum were sampled by a modified fine-needle aspiration biopsy (FNAB) technique. Aspirates were collected directly into 15 ml of Saccomanno's fixative, and all preparative work was carried out in the cytopathology laboratory. Only seven aspirates were "insufficient for diagnosis," giving a productivity rate of 97%. Five insufficient aspirates later proved to be neoplasms. Of the 243 cases with a primary FNAB diagnosis, 21 had insignificant disease, 29 had benign neoplasms or nonneoplastic disease, and 193 had malignant tumors. Most malignancies could be assigned to a specific histologic type by FNAB; those that proved difficult by FNAB were usually difficult on histopathologic examination. There were no false-positive diagnoses of malignancy and only eight false-negative results. Of 12 results interpreted as "suspicious," 10 proved to be malignant on follow-up. This modified method has proven to have a low complication rate and to be both highly productive and reliable in the diagnosis of malignant and nonmalignant disease.     

Posttransplant lymphoproliferative disorders: A fine-needle aspiration biopsy study

Fine-needle aspiration biopsy (FNAB) has been used with high sensitivity and specificity in the diagnosis of both Hodgkin's and non-Hodgkin's lymphoma. However, studies of FNAB of posttransplant lymphoproliferative disorders (PTLDs) are rare. The clinical course of 593 allograft recipients (cardiac, 288; renal, 250; lung, 50; and heart/lung, 5) was reviewed. Twenty-six patients developed PTLD with an overall incidence of 4.4%. Of these patients, 12 underwent FNAB. Their age ranged from 33–67 yr (mean, 55 yr). The interval between transplantation and FNAB ranged between 2–14 mo (average, 8.4 mo). The lungs were the most common site aspirated (7 cases), followed by lymph nodes (3 cases) and other extranodal sites (2 cases, liver and paraspinal mass). The cytologic features of these aspirates could be classified into two categories: a polymorphous smear composed of a spectrum of mature and immature lymphocytes with scattered plasma cells and histiocytes; and a monotonous population of large lymphoid cells consistent with malignant lymphoma, large-cell type. Surgical biopsies were available in 10 (83.3%) cases and confirmed the FNAB diagnosis. In summary, FNAB appears to be a highly sensitive and specific diagnostic tool in patients with PTLD. Diagn. Cytopathol. 16:392–395, 1997. © 1997 Wiley-Liss, Inc.     

Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum

Interpreting a fine needle aspiration biopsy (FNAB) from the mediastinum is challenging as this location may harbor many lesions, including primary and metastatic tumors. Image-guided transthoracic (percutaneous) FNAB is less invasive than mediastinoscopy or endoscopic-guided FNAB. The aim of this study was to determine the diagnostic accuracy of FNAB performed percutaneously for evaluating mediastinal lesions.A retrospective study of 157 consecutive CT-guided transthoracic FNAB of the mediastinum was performed (1988-2004). Direct smears (N = 145; average 13 slides/case), ThinPrep slides (N = 25), and adequate cell blocks (N = 131) were prepared from procured cytologic material. When needed, ancillary studies included immunocytochemistry (N = 53) and flow cytometry (N = 8). Subsequent histologic tissue diagnoses available for 68 cases were also reviewed.Patients were of average age 57 yr (range 1-88 yr), including 75 males and 82 females. A definitive diagnosis was rendered in 128 (82%) cases. Primary neoplasms (N = 38) included 24 lymphomas (6 Hodgkin and 18 non-Hodgkin), 7 thymomas, 1 thymic carcinoma, and 6 peripheral nerve sheath tumors. Metastases (N = 72) were mainly carcinomas (N = 71) and 1 melanoma. There were 4 non-neoplastic lesions (1 granulomatous process; 2 bronchogenic and 1 pericardial cyst), 1 case of undifferentiated malignant large cell neoplasm, 13 cases negative for malignancy, and 29 (18%) that were indeterminate, due largely to insufficient cellularity. Subsequent histologic diagnoses were concordant with FNAB diagnoses in 53/68 cases (78%). Nine FNAB were inadequate/nondiagnostic. There were 6 discordant cases, including 5 FNAB that were of adequate cellularity but interpreted as negative for malignant cells (on subsequent histology 2 turned out to be Hodgkin lymphoma, 2 carcinomas, and 1 diffuse large cell lymphoma), and 1 diagnosed as thymoma that on histologic evaluation was a thymic large cell lymphoma.Adequate diagnostic cytologic material was obtained by image-guided percutaneous FNAB of mediastinal lesions in 82% of our cases. Sufficient material was available to make cell blocks and perform ancillary studies when necessary. These data also show a high proportion of agreement (78%) between FNAB and subsequent histologic diagnoses for a wide variety of mediastinal lesions. The majority of discordant cases were primarily interpretive, with a final cytologic diagnosis negative for malignancy. Only one problematic case misdiagnosed on FNAB as thymoma was found on subsequent surgical excision to be a thymic large B cell lymphoma. Cases with nondefinitive FNAB diagnoses were largely due to sampling error and/or insufficient cellularity. Therefore, percutaneous FNAB of the mediastinum is a diagnostically helpful, minimally invasive procedure that can be performed in patients of all ages as part of the evaluation of a mediastinal mass lesion.     

Fine needle aspiration biopsy of thyroid nodules in children and adolescents

Thyroid nodules are uncommon in children and adolescents compared with adults, but the risk of malignancy is much higher. In adults, fine needle aspiration biopsy (FNAB) has been used extensively to select patients for surgical exploration with a high degree of reliability. The purpose of this study was to assess the utility of FNAB for the management of thyroid nodules in children and adolescents. We reviewed our experience with 60 FNABs of thyroid nodules in 51 children and adolescents. Of the 60 aspirates, 45 aspirates (74%) were diagnosed as "benign", 5 aspirates (8%) as "suspicious for malignancy", and 6 aspirates (10%) as "malignant", and 4 aspirates (7%) as "unsatisfactory". Thyroidectomy was performed in 17 patients, and 5 with a cytological diagnosis of "benign" revealed nodular hyperplasia in three and follicular adenoma in two; 5 with a cytological diagnosis of "suspicious" revealed nodular hyperplasia in one, follicular adenoma in two, and papillary carcinoma in two; and 6 with a cytological diagnosis of "malignant" revealed papillary carcinoma. One patient with a cytological diagnosis of "unsatisfactory" revealed papillary carcinoma. The diagnostic accuracy was 81% with 100% sensitivity and 63% specificity. The positive and negative predictive values of FNAB were 73% and 100%, respectively. We conclude that FNAB is a good screening test for thyroid nodules in children and adolescents because of its high sensitivity.     

Diagnosis and subclassification of primary and recurrent lymphoma. The usefulness and limitations of combined fine-needle aspiration cytomorphology and flow cytometry

The primary diagnosis of non-Hodgkin lymphoma/leukemia by fine-needle aspiration (FNA) is still controversial and relatively underused. We evaluated our FNA experience with lymphomas using the revised European-American classification of lymphoid neoplasms to determine the reliability of FNA when combined with flow cytometry in the diagnosis of lymphoma, the types of diagnoses made, and the limitations of this technique. Slides and reports from all lymph node and extranodal FNAs performed during the period January 1, 1993, to December 31, 1998, with a diagnosis of lymphoma or benign lymphoid process were reviewed. There were 290 aspirates from 275 patients. These included 158 cases of lymphoma, of which 86 (54.4%) were primary and 72 (45.6%) were recurrent. There were 44 aspirates suggestive of lymphoma and 81 benign/reactive diagnoses. With diagnoses suggestive of lymphoma considered as positive for lymphoma, levels of diagnostic sensitivity and specificity were 95% and 85%, respectively. Specificity was 100% when only definitive diagnoses of lymphoma were considered. Clearly, FNA and immunophenotyping by flow cytometry are complementary and obviate a more invasive open biopsy for many patients with lymphadenopathy.     

Diagnosis of disseminated mycobacterial infection in AIDS patients by US-guided fine needle aspiration biopsy of lymphnodes and spleen

Our aim was to evaluate the efficacy of abdominal US and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in patients with Acquired Immunodeficiency Syndrome (AIDS). We reviewed the US and clinical records of 18 AIDS patients (12 males; 22-43 years) with DM studied with abdominal US. 18 patients underwent fine-needle aspiration biopsy of enlarged abdominal lymphnodes and 11 underwent FNAB of the spleen. All aspirates were studied with acid-fast stain for fast examination and cultures for isolation of mycobacteria. Abdominal US showed: enlarged abdominal lymphnodes (diameter range: 5-35 mm; mean 17 mm) splenomegaly (spleen diameter range: 14-22 cm; mean: 16.2 cm) and hepatomegaly (right hepatic lobe thickness range: 14.5-18.5 cm) in all patients; multiple splenic abscesses (diameter range: 3-20 mm) in 11 patients; small intestine wall thickening in 5 patients (maximum bowel wall thickness range: 7-15 mm); mild to moderate ascites in 8 patients; pleural effusion in 4 patients; hyperechogenicity of the kidney cortex in 5 patients; peritoneal abscesses in one and a retroperitoneal abscess in one patient. fast-acid-stain of spleen and/or lymphnode FNAB specimens allowed early diagnosis of mycobateriosis in 18/18 cases (100%). Cultures of lymphnode aspirates grew mycobacteria in 10/18 patients (56%). Spleen aspirates grew mycobacteria in 11/11 patients (100%) Blood cultures were positive in 6/18 patients (33%). Diagnosis of species was M. tuberculosis in 9 and M. avium in 6 patients. In 3/18 patients (17%) all cultures were negative. In conclusion, abdominal US features suggest DM in AIDS patients. Spleen and/or lymphnode FNAB allows a specific diagnosis in 100% of the patients.     

Role of immunocytochemistry,electron microscopy,and DNA analysis in fine-needle aspiration biopsy diagnosis of Wilms' tumor

We reviewed the cytologic features and results of ancillary studies in eight fine-needle aspiration biopsies (FNAB) performed by posterior approach in 8 patients with unresectable Wilms' tumor (WT). Chemotherapy was given following the FNAB diagnosis of WT, which was confirmed subsequently by histologic examination of surgically resected specimens. Indications for FNAB included: unresectable tumor, bilateral disease, initial presentation with metastatic disease, uncertainty regarding tumor site, and documentation of recurrence. Cytologic examination revealed blastemal cells (8/8 aspirates), spindle cells (3/8 aspirates), and epithelial differentiation or tubules (3/8 aspirates). There was no cytologic evidence of anaplasia in any of the cases. Immunocytochemical studies on cell blocks and/or smears showed cytokeratin positivity in 5/8 and vimentin positivity in 5/5 of the aspirates in which these studies were performed. Focal positivity for neuron-specific enolase (NSE) was seen in 3/3 aspirates. Stains for actin and leukocyte-common antigen were negative (0/3 and 0/2 aspirates, respectively). DNA ploidy analysis of the aspiration material by flow cytometry revealed near-diploid populations in three aspirates. Electron microscopic findings helpful for diagnosis included: cell junctions, microvilli, flocculent basement membrane-like material, cilia, autophagolysosomes, and lack of neuroectodermal differentiation. Diagnostic morphologic pitfalls for an incorrect diagnosis of neuroblastoma included nuclear molding (all aspirates), pseudorosette formation (one aspirate), and focal NSE positivity (3/3 aspirates). None of the tumors showed anaplasia on histologic examination. Cytologic recognition of the triphasic cellular components of WT (blastemal cells, spindle cells, and epithelial cells) can be helpful for a correct diagnosis; however, in 5/8 aspirates in this study, only the blastemal component was present. In these cases, immunocytochemical stains and electron microscopy proved useful in arriving at a correct FNAB diagnosis of WT. However, NSE positivity can be a pitfall for a diagnosis of neuroblastoma if the radiologic, clinical, and other cytologic features are not clearly delineated. Presence of cytokeratin and vimentin positivity would be helpful in the diagnosis of WT in such instances. Diagn Cytopathol 1996; 14:101–107. © 1996 Wiley-Liss, Inc.     

Reliability of fine-needle aspiration biopsy in the initial diagnosis of soft-tissue lesions

We retrospectively reviewed fine-needle aspiration biopsy (FNAB) specimens of 301 soft tissue lesions of the extremities and trunk. Final diagnoses were 137 benign and 86 malignant neoplasms and 78 nonneoplastic lesions. Of the 301 FNAB samples, 279 (93%) were adequate for cytologic diagnosis. The adequate FNAB specimens were initially grouped into three broad categories: benign (197 cases), malignant (57 cases), and suspicious for malignancy (25 cases). Sensitivity and specificity for diagnosis of a malignant lesion were 92% and 97%, respectively. The specimens were cytomorphologically classified into nine categories: small round (14 cases), spindle cell (77 cases), epithelioid/polygonal (16 cases), pleomorphic (29 cases), myxoid (19 cases), lipomatous (37 cases), epithelial (23 cases), inflammatory lesions (28 cases), and others (36 cases). Specific FNAB diagnoses were correct in 151 of 279 cases (54%) in combination with clinical and radiologic findings. FNAB is a valuable technique for the primary diagnosis of soft-tissue lesions.     

Fine-needle aspiration of chondrosarcoma

Fine-needle aspiration (FNA) is a reliable, safe and cost-effective procedure with an established role in the diagnosis of various solid tissue neoplasms. However, the role of FNA in the diagnosis of primary bone tumors, including chondrosarcoma (CS) is controversial. To determine the accuracy of FNA as a diagnostic procedure, the author reviewed the institutional experience of a series of patients with CS who underwent FNA for diagnosis. The author's objectives were to determine the accuracy of the technique as well as possible limitations to sensitivity and specificity, and perhaps to suggest the most appropriate use for this procedure. Computer records and then subsequently archives of the department were searched for patients diagnosed and treated for CS between 1993 and 2003. Patients without adequate clinical follow-up, missing materials or records otherwise unavailable for review were eliminated from study. All patients who underwent FNA for a diagnosis had to have a subsequent histological confirmation to be included in the study. FNAs were largely performed with image-guided assistance. In those that were palpable, the aspiration was performed by the aspiration cytologist using standard methods. Histologic materials were processed according to standard methods. All cytological and histologic materials were reviewed for accuracy and appropriateness of diagnosis by the author. There were 34 aspirates from 32 patients with CS (2 patients with 2 aspirates each). Attempts at diagnoses were made from 27 primary lesions, 6 recurrent lesions, and one metastatic lesion. There were an additional two patients who were assigned a diagnosis of CS on FNA who ultimately were proven to have chondroblastic osteosarcoma. Of the primary CS, 18 were definitively diagnosed as CS or "malignant chondroid neoplasm," 8 of the aspirates were considered equivocal in that an additional diagnostic procedure was required to clarify or confirm the diagnosis. Two aspirates were diagnosed as negative. Both of the false negatives were due to inadequate sampling of the lesion on FNA. Diagnostic accuracy of FNA for primary CS in this series was 67% (18/27). Accuracy for recurrent or metastatic lesions was higher at 86% (6/7). FNA appears to be a reliable means of diagnosis of recurrent and/or metastatic CS in patients with a documented history. In primary lesions, however, the accuracy of the technique is lower. In addition, there are problems of sampling chondroid components of non-CS lesions such as this study's experience with chondroblastic osteosarcoma.     

Analysis of inconclusive fine-needle aspiration of thyroid follicular lesions

To evaluate all inconclusive fine-needle aspiration biopsy (FNAB) specimens from thyroid follicular lesions with subsequent histologic diagnosis at St John Hospital and Medical Center, Detroit, MI. The criterion for specimen adequacy used in our institution was also reexamined to determine whether it was too stringent. We reviewed 45 inconclusive FNAB samples. Only cases that underwent surgical intervention were considered. Specimen adequacy was determined by the presence of at least 8–10 tissue fragments of well-preserved follicular epithelium on at least two slides; each tissue fragment should have a minimum of 8–10 cells. Different cytologic characteristics—cellularity, cellular architecture, nuclear pleomorphism, inclusion/grooves, chromatin, Hürthle cell change, lymphocytes, macrophages, colloid, and multinucleated giant cells—were scored and compared with final surgical diagnosis. The surgical procedure performed was also analyzed. Review of these 45 surgical specimens found 28 (62.2%) multinodular goiters, 14 (31.1%) nodular hyperplasias, 2 (4.4%) follicular adenomas, and one (2.2%) with invasive follicular carcinoma. Forty-three (95.6%) of these cases were female and 2 (4.4%) were male. Cytologic review showed 2 acellular samples, 10 cases containing macrophages only, 10 aspirates with macrophages and an inadequate number of follicular cells, and 23 specimens with an inadequate number of follicular cells. Twenty-three patients underwent total thyroidectomy; 20, lobectomy; and 2, isthumusectomy. Almost 98% of the patients with inconclusive FNAB had benign lesions. This finding encouraged us to continue using our criteria for adequacy because of the importance of a negative report. Patients in our series, who underwent thyroidectomy after an inconclusive or nondiagnostic aspirate, had a malignancy rate of 2.2%, which was no worse than patients with a benign preoperative diagnosis. A balanced approach with careful follow-up for nondiagnostic cytology is prudent.     

A morphologic and statistical comparative study of small-cell carcinoma and non-Hodgkin's lymphoma in fine-needle aspiration biopsy material from lymph nodes

Small-cell carcinoma (SmC) and high-grade non-Hodgkin's lymphoma (NHL) are aggressive neoplasms that require prompt diagnosis and treatment. An immediate diagnosis can be obtained using fine-needle aspiration biopsy (FNAB) material from lymph nodes (LNs), which are clinically or radiologically suspicious for tumor involvement. However, in aspirates from LNs, the cytologic distinction of SmC from NHL can be challenging. The purpose of this study was to evaluate the usefulness of various cytologic features that can be used during a rapid on-site evaluation to differentiate these two entities. Twenty-seven metastatic SmC and 50 NHLs cases diagnosed by FNAB of LNs were reviewed. All NHL diagnoses (neck, 29; abdomen, 9; axilla, 6; groin, 5; and parotid, 1) were confirmed with tissue sections, flow cytometry, or immunohistochemistry. These cases were classified as follicular, 21 (42%); diffuse large B cell, 13 (26%); small lymphocytic, 7 (14%); mantle cell, 4 (8%); anaplastic large cell, 2 (4%); and 1 each (2%), Burkitt, lymphoplasmacytic, and peripheral T-cell lymphomas. Immunochemistry confirmed the cytologic diagnoses of all SmC cases (neck, 16; mediastinum, 9; abdomen, 1; and axilla, 1) with either positive chromogranin or synaptophysin. All specimens were reviewed independently by three cytopathologists who were unaware of the original diagnoses. The presence and proportion of single (noncohesive) tumor cells, lymphoglandular bodies, nuclear fragments, paranuclear blue inclusions, nuclear molding, evenly dispersed fine-granular chromatin, crush artifact, and composition of cell clusters (monomorphic vs. polymorphic) were statistically evaluated. The presence of evenly dispersed fine-granular chromatin, paranuclear blue inclusions, and nuclear fragments was each statistically significant in differentiating SmC when compared with NHL (P < 0.01). The remaining features were not significant in distinguishing SmC from NHL in LN aspirates. The identification of distinct cytologic findings such as evenly dispersed fine-granular chromatin, paranuclear blue inclusions, and nuclear fragments can be a valuable aid to accurately diagnose and differentiate metastatic SmC from NHL in FNAB preparations from LNs.     

An interinstitutional review of the value of FNAB in pediatric oncology in resource-limited countries

Fine‐needle aspiration biopsy (FNAB) has been widely accepted as a reliable diagnostic modality in the general pediatric population, but its role in pediatric oncology still remains elusive. With new treatment protocols subscribing to preoperative chemotherapy, the need for a quick, minimally invasive, and accurate diagnostic procedure has arisen. This study assesses the feasibility of FNAB in childhood malignancies to render a specific diagnosis on which treatment can be initiated. An 11‐year retrospective study was done on FNABs in patients 19 years and under referred for clinically malignant mass lesions. Cases were confirmed with histology, immunocytochemistry, flow cytometry, or clinical follow‐up. Of the 357 patients referred for FNABs, 36 patients were lost to follow‐up and 31 FNABS were inadequate. A total of 290 cases were included in the study, of which 68 (23%) cases were benign and 222 (77%) were malignant. The most frequently occurring tumors were nephroblastoma (68), non‐Hodgkin's lymphoma (39), rhabdomyosarcoma (22), Hodgkin's lymphoma (22), and neuroblastoma (22). The sensitivity of the procedure for neoplasia was 96.6%, the specificity 97.0%, positive predictive value 99.0%, and negative predictive value 90.1%, with a diagnostic accuracy of 96.7%. The ability of FNAB to enable a specific diagnosis to be made, that is correct and accurate subtyping of the tumor on which chemotherapy or radiotherapy could be commenced was 75.7%. This study shows that FNAB can be used with confidence to confirm malignancy in children. With clinicoradiological correlation and the aid of ancillary techniques, FNAB allows a rapid and accurate preoperative diagnosis for definitive therapy commencement in most cases. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.     

Correlation of thyroid nodule fine-needle aspiration cytology with corresponding histology at Mayo Clinic, 2001-2007: an institutional experience of 1,945 cases

Following the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference, the thyroid fine‐needle aspiration biopsy (FNAB) practice at Mayo Clinic, Rochester, Minnesota, conducted retrospective analyses correlating cytologic and histologic evaluations of thyroid nodules. Cytologic and histologic reports were retrieved for patients with thyroid nodules who underwent thyroid FNAB between January 2001 and December 2007, with subsequent surgical thyroid resection. Cases were classified by major cytologic and histologic diagnosis and specific diagnostic subcategories. Of 1,945 FNAB cytologic results, 180 (9.3%) were nondiagnostic; 512 (26.3%) were negative for malignancy; 27 (1.4%) were atypical; 729 (37.5%) were suspicious for malignancy; and 497 (25.6%) were positive for malignancy. Histology was benign in 1,179 (60.6%) and malignant in 766 (39.4%). For thyroid malignancy as the disease outcome, at cytologic thresholds of atypical, suspicious, and positive, overall sensitivity of thyroid FNAB was 94.5%, 94.1%, and 65.0%, respectively, and specificity was 46.0%, 48.3%, and 98.5%, respectively. Positive predictive value for all malignancies was 97.0%, and negative predictive value was 92.0%. When separated by specific malignant outcomes, diagnoses of papillary carcinoma, medullary carcinoma, and lymphoma had specificity of suspicious FNAB diagnoses ranging from 90.5% to 99.6%; positive predictive value ranged from 87.5% to 91.4%. For follicular or Hürthle carcinoma, suspicious FNAB diagnoses had a specificity of 52.5% and a positive predictive value of 5.9%. Sensitivity of indeterminate FNAB diagnoses ranged from 72.7% to 95.3%. For follicular or Hürthle pattern malignancies, indeterminate cytologic diagnoses should be interpreted with caution by the clinician considering surgical management. Diagn. Cytopathol. 2012;40:E27–E32. © 2010 Wiley Periodicals, Inc.     

Cytological diagnosis of cystic brain tumors: a retrospective study of 88 cases

The stereotaxic aspiration of cystic brain tumors is performed to provide cyst decompression and/or to facilitate surgical resection. The purpose of our study was to determine the diagnostic value of brain cyst fluid cytology, especially in clinically suspected recurrent tumors with no histological follow-up (HF), when a diagnosis is most needed. We reviewed the cytological diagnoses of 88 aspirates from 70 patients with cystic brain tumors between 1995 and 2001, of which 31 had a prior known malignancy including 18 primary brain tumors (PBTs) and 13 adenocarcinomas (ACAs). Sixty-nine of 88 aspirates were obtained intraoperatively. Nineteen of 88 aspirates were obtained from 10 patients with recurrent or persistent cystic brain tumors (8 patients with PBT and 2 patients with ACA), with available clinicoradiological correlation (magnetic resonance imaging/computed tomography [MRI/CT] scans) in 13 of them. The 88 aspirates were classified in three categories: 28 positive (32%), 15 atypical (17%), and 45 negative (51%). Eight of 28 positive cases (5 case of PBT, 2 cases of ACA, and 1 case of melanoma) were given a nonspecific diagnosis of malignant neoplasm (9% of all cases). Fifteen of 28 positive cases (6 cases of PBT, 8 cases of ACA, and 1 case of melanoma) were diagnosed correctly and confirmed by HF (17% of all cases). Four of 28 cases were ACA diagnosed solely by cytology (<4% of all cases). One neurocytoma (1/28) case was mistaken for an oligodendroglioma despite cell blocks (CBs) and immunophenotyping (IPT) (<1% of all cases). Eleven of 15 atypical cases were 8 cases of PBT, 2 cases of ACA, and 1 case of postoperative change (PC). Four of 15 atypical cases (from three patients with suspected PBT recurrence) could not be further characterized by CB/IPT and had no HF. Twenty-seven of 45 negative cases were falsely negative (23 cases of PBT, 3 cases of ACA, and 1 case of malignant neoplasm); 11/45 cases were PC, and 7/45 (from five patients with clinically suspected tumor recurrence) cases had no HF. Cytological evaluation of brain cyst fluid is not a reliable means of diagnosing cystic brain neoplasms (including recurrences) due to a high false negative rate and a low sensitivity. Most of the negative or atypical cases (68% of all cases) were recurrent PBT of glial origin that may not be prone to exfoliate. These cytological specimens consisted of lysed blood, obscuring inflammatory cells, and degenerated diagnostic cells if any, yielding inconclusive results.     

Unsatisfactory aspirates from fine-needle aspiration biopsies: A review

While there is much evidence that fine-needle aspiration biopsy (FNAB) is sensitive and specific, there is little information comparing the proportions of unsatisfactory aspirates obtained by clinicians or pathologists. We reviewed 2,199 FNAB reports of superficial lesions. Cases were grouped by organ/site and according to who performed the biopsy. the proportions of unsatisfactory aspirates were computed for clinicians and pathologists. Both groups performed approximately equal numbers of procedures. Overall, 9% of aspirates obtained were unsatisfactory (n = 191). Pathologists had lower proportions of unsatisfactory aspirates in all sites. of aspirates obtained by clinicians, 14% were unsatisfactory, compared to 3% of those obtained by pathologists (P < .00001). the proportion of unsatisfactory aspirates appears to decrease as physician experience increases, and pathologists may have more experience with FNAB than do clinicians. Other advantages pathologists may have include technique and working with tissue regularly. Both clinicians and pathologists can expect to decrease their proportions of unsatisfactory aspirates by performing FNABs frequently. © Wiley-Liss, Inc.     

Aneurysmal bone cyst: fine-needle aspiration findings in 23 patients with clinical and radiologic correlation

Aneurysmal bone cyst (ABC) is an osseous mass lesion that accounts for 1% of primary bone tumors. We describe 23 cases of ABC initially evaluated by fine-needle aspiration biopsy (FNAB). In 4 cases, the ABC was secondary to another primary tumor. Aspirates from 6 cases (26%) were insufficient. Twelve aspirates diagnosed as ABC by FNAB were confirmed as ABC by histologic examination. The accuracy of FNAB was 82% when cases insufficient for evaluation were excluded. One case diagnosed as ABC cytologically was subsequently found to be metastatic carcinoma. In another, the specimen was interpreted as ABC vs giant cell tumor. In the remainder, a diagnosis of ABC was favored cytologically. Owing to the nonspecific findings, ABC cannot be definitively diagnosed by FNAB. However, the presence of typical clinical and radiographic features in conjunction with a blood-rich, mesenchymal cell containing aspirate devoid of overtly malignant cells strongly suggests the diagnosis of ABC.