Fine needle aspiration cytology in the head and neck region

Although needle aspiration diagnosis was described over 50 years ago, many patients with neck swellings are still subjected to hazardous and unnecessary open diagnostic surgical biopsy. In a six-month period, over 200 fine needle aspirates were performed on tumours from the head and neck region, 44% of which were positive for cancer. The technique of aspiration, its advantage for the patient, clinician and cytopathologist, and the results of the study will be discussed. Close cooperation between the clinician and the cytopathologist is essential.     

Fine needle aspiration cytology of breast masses: an evaluation of its accuracy and reasons for diagnostic failure

A study of 1458 patients who had undergone breast aspiration cytology was conducted to determine the diagnostic accuracy of the technique. The effect of tumour histology and size on the unsatisfactory aspirate and false negative rate was examined. Seven hundred and thirty one patients (50%) had histological diagnoses. The sensitivity of aspiration cytology for malignancy was 64% for the first aspiration, but was 91% in patients who had had 3 aspirates. The specificity was 56%, this low figure was almost entirely due to inadequate or unsatisfactory cytological preparations. The positive and negative predictive values of aspiration cytology were 99.4% and 85% respectively demonstrating high diagnostic accuracy given a satisfactory aspirate. Invasive lobular carcinoma yielded a significantly higher unsatisfactory rate than invasive ductal carcinoma (P less than 0.001) and fibroadenoma yielded a significantly lower unsatisfactory rate than fibroadenosis (P less than 0.001). Mass size influenced the unsatisfactory rate for invasive ductal carcinoma (P less than 0.05) and fibroadenoma, but not for invasive lobular carcinoma or fibroadenosis. Only 2 of the 32 false negatives were due to misinterpretation, the remainder resulted from the aspiration needle missing the mass. We conclude that aspiration cytology is an accurate preoperative diagnostic procedure for the evaluation of breast masses. Unsatisfactory or negative aspirates should be regarded as 'non-results' if there is clinical or radiological suspicion of malignancy.     

肝囊腺癌的细针吸取细胞学诊断及文献复习

目的 探讨肝内胆管囊腺癌的穿刺方法 ,结合文献复习并总结其术前细胞学诊断特点.方法 2例肝脏囊实性占位患者在B超引导下行细针吸取细胞学(fine needle aspiration cytology,FNAC)检查,抽取囊液离心涂片,实质区吸取组织颗粒涂片,常规HE染色,部分吸取组织制作细胞蜡块,切片行HE染色及黏液AB染色,光镜观察,并与术后组织切片对照.结果 2例患者均未出现出血、感染等并发症,两者均抽出多量淡咖啡色及淡黄色黏稠液体,囊液未找到肿瘤细胞;实质区穿刺涂片细胞丰富,上皮细胞形成团状或乳头状,核大深染、重叠拥挤.可见细胞异型.细胞蜡块切片可见腺管状、乳头状、团状的腺上皮,细胞排列杂乱无极性,AB染色显示背景及胞质内淡蓝色黏液的存在.结合影像学及临床资料.2例FNAC诊断考虑为胆管黏液性囊腺癌(例1结合细胞蜡块切片考虑黏液性乳头状囊腺癌).穿刺诊断与术后组织切片基本一致.结论 结合影像学及临床资料,B超引导下的肝脏FNAC是术前诊断肝囊腺癌的一种安全有效的检查方法 ,制作细胞蜡块有利于诊断的进一步完善.有关肝囊腺癌与囊腺瘤的FNAC的鉴别有待进一步积累资料.     

Aspiration cytology of head and neck masses

Fine needle aspiration biopsy and cytologic examination of the aspirate were performed on 203 masses involving glandular and nodal structures of the head and neck: thyroid gland (85); salivary glands (31); and lymph nodes (87). Overall cytologic-histologic correlation was 91 per cent, with a 10 per cent false-negative rate. The ease of the procedure coupled with the rapidity of obtaining a pathologic diagnosis allows a more intelligent therapeutic approach.     

Fine needle aspiration biopsy and cytology in renal transplantation

Fine needle aspiration biopsy with cytology provides a useful and easily repeated method of obtaining cell samples from a grafted kidney, enabling a more accurate diagnosis of rejection. The technique is simple to perform and is minimally invasive. It is easily repeated, daily if necessary, to evaluate events within the graft and the response to therapy. In addition to the findings of rejection (high total corrected incremental score and activated lymphocytes), both cyclosporin toxicity and acute tubular necrosis can be diagnosed. In the patient with a non-functioning graft with acute tubular necrosis, repeated fine needle aspiration biopsy may reveal early rejection. In rare cases, unusual graft infections have also been diagnosed by means of fine needle aspiration biopsy.     

Fine needle aspiration cytology: the Auckland experience.

Fine needle aspiration cytology is a widely recognized and yet sensitive technique which can provide diagnosis in lesions in the head and neck, enabling appropriate management plans for individual patients to be made. One hundred and eighty-seven fine needle aspirates from head and neck masses in 128 patients seen at Green Lane Hospital were studied. The ages ranged from 9 to 87 years with a median of 63 years. Ninety-five fine needle aspirates were of malignant lesions, mainly squamous cell carcinoma and lymphomas and 94 were nonmalignant. Comparisons were made between the fine needle aspirate cytology and the histological and clinical diagnosis. Overall, the sensitivity was 81%, specificity 89%, positive predictive value 91% and negative predictive value 78%. With respect to 72 lymph node aspirates there were no false positive values resulting in a sensitivity of 84%, specificity 100%, positive predictive value 100% and negative predictive value 65%. With respect to salivary gland lesions, there were no false positive or false negative fine needle aspirates. It was noted that diagnostic accuracy improved with experience and good communication between the cytopathologist and the clinician. Most of the non-diagnostic smears occurred during the early part of the study. The study confirms the useful application of fine needle aspiration cytology in managing head and neck disease appropriately.     

Fine needle aspiration cytology of pseudopapillary tumour of pancreas

The solid-cystic pseudopapillary neoplasm is a rare pancreatic tumor having indolent course and amenable to complete excision. This is a report of two cases of this tumour, diagnosed on fine needle aspiration cytology. One of the cases had complete surgical excision of the mass and subsequent histological evaluation. This benign and rare neoplasm of pancreas often causes few symptoms. The characteristic cytomorphological features point towards the diagnosis.     

Needle aspiration cytologic biopsy in head and neck masses

Over 500 fine (no. 22) needle aspiration biopsies were done on head and neck lesions. The total accuracy for the series was 94.5 percent. The accuracy rates for thyroid, salivary and metastatic or benign lymph node lesions were similar: approximately 95 percent. Only lymphomatous lesions gave a lower accuracy rate: 75 percent. This method of evaluating masses in the head and neck is simple, rapid, inexpensive, well-tolerated and harmless, and is very accurate when there is close cooperation between the clinician and the cytopathologist.     

Fine needle aspiration cytology for soft tissue tumours of the hand

The purpose of this study was to evaluate the usefulness of fine needle aspiration cytology for the preoperative diagnosis of soft tissue tumours of the hand. Fine needle aspiration cytology was performed on 93 soft tissue tumours of the hand which were classified as malignant, benign or unclassified based on cytological findings. We also attempted to make specific diagnosis by cytology. The cytological diagnosis was then compared with the postoperative histopathological diagnosis. The cytological differentiation between benign and malignant tumours showed neither false-positive nor false-negative results. Of the 47 lesions with sufficient material for cytology and that were postoperatively diagnosed histologically, 35 (including one recurrent lesion) were correctly diagnosed by fine needle aspiration cytology. No complications were encountered. Fine needle aspiration cytology has a high degree of diagnostic accuracy and safety for soft tissue tumours of the hand.     

超声检查在甲状腺疾病诊断中的价值

随着超声医学的发展，超声检查在临床应用日益广泛，尤其在浅表器官的疾病检查中，它不仅能观察病变组织形态、结构、边缘、内部回声等二维表现，而且可了解病变部位的血流分布情况并得到血流频谱参数及测值，通过超声造影新技术反应局部组织血流灌注状态。由于超声检查具有非侵入性、无辐射、可反复检查等优点，它已成为甲状腺疾病诊断中的不可或缺的手段，在甲状腺疾病的诊断和鉴别诊断方面发挥着十分重要的作用。现就超声检查在甲状腺疾病中的诊断价值简述如下。     

Fine needle aspiration cytology in breast disease management--a 4 year experience

At the Queen Victoria Medical Centre between 1981 and 1984, 2920 fine needle aspirates of the breast were examined with an overall diagnostic accuracy of 97% and a sensitivity of 80%. This high diagnostic accuracy combined with the ease and complication-free nature of the procedure has meant that fine needle aspiration (FNA) has become an important part of the investigation and management of breast disease within the breast service of the Queen Victoria Medical Centre.     

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.     

穿刺细胞学结合免疫组化诊断甲状腺癌

目的：探讨术前运用细针穿刺甲状腺结节行细胞学检查,结合穿刺细胞液相关免疫组化分析,进一步提高对甲状腺癌的术前诊断的准确率。方法：回顾分析本院2006年10月至2007年3月收治的甲状腺结节43例。术前均穿刺有疑问之甲状腺结节,作细胞学检查,同时结合免疫组化半乳凝集素-3、CK19、TPO进行分析,与手术后石蜡病理结果作比较。①在细胞学检查确诊的良、恶性病例中,细胞免疫组化指标仅作为参考。②而在细胞学诊断为可疑恶性时,免疫组化表达为半乳凝集素-3、CK19均阳性、TPO阴性者,作恶性诊断论;当表达为半乳凝集素-3、CK19均阴性、TPO阳性时,则作良性诊断论;其他种类表达归为可疑诊断。所有病例均接受手术治疗并经病理学检查证实。结果：术前细胞学诊断为乳头状癌者21例,可疑恶性14例,良性病变8例;14例细胞学诊断为可疑恶性的病例,结合免疫组化,10例诊断为乳头状癌,1例髓样癌,3例腺瘤。术后病理确定为乳头状癌31例,滤泡状癌2例,髓样癌1例,腺瘤8例,结节性甲状腺肿1例。43例细胞学诊断与术后病理符合率达62．8％。细胞学结合免疫组化诊断与术后病理符合率达90．7％,敏感性82.4％,特异性100％,阳性预测值100％,阴性预测值均为60％。结论：半乳凝集素-3、TPO和CK19检查有助于判断甲状腺结节的良、恶性;联合检查可提高诊断的准确性。甲状腺细针穿刺细胞学结合穿刺液的免疫组化分析,有助于提高甲状腺癌尤其是乳头状癌的检出率,减少漏诊和误诊。     

Fine needle aspiration cytology: its role in the management of breast tumours

Fine needle aspiration (FNA) cytology is a cost-effective and clinically reliable tool in the management of breast tumours. This report summarizes the experience with 364 patients who had FNA of the breast. There was a total of 115 cancers of which 108 (93.9%) were diagnosed on FNA. There were no false positives amongst aspirates diagnosed as 'malignant'. Thirty-one patients had mastectomy with prior frozen section and nine had advanced or recurrent disease with no biopsy confirmation. FNA was 'suspicious of malignancy' in 12 patients of which 10 were malignant and two were benign on histology. There were 216 patients with 'benign' FNA and 28 FNA were 'unsatisfactory'. Biopsy confirmation was recommended in all clinically malignant or doubtful cases. Forty-one (19%) of the patients with 'benign' FNA and 13 (46%) of the 'unsatisfactory' group had excision biopsies which revealed six cancers, giving a false negative rate of 5.2%. FNA cytology gives rapid and reliable results which contribute towards planning of further management of the patient. It can replace the more painful tru-cut biopsy and reduce the need for excision biopsy and frozen section in the initial diagnosis of breast tumours. It is also an effective modality to monitor and confirm suspected recurrences. Although a negative FNA does not completely exclude malignancy, it can be used to reassure the surgeon and the patient and to support their decision not to operate.