A comparison of the results of monolayer versus smear cytopreparatory techniques for fine-needle aspiration in 100 consecutive patients undergoing thyroidectomy: A surgeon’s perspective

OBJECTIVE: To compare thyroid fine-needle aspiration (FNA) using monolayer (MT) versus conventional smear (CS) cytopreparatory techniques with final histology. STUDY DESIGN: Retrospective review of 100 consecutive thyroidectomies. Setting Tertiary care university affiliated medical center. RESULTS: 26% of MT aspirates were inadequate compared with 3% of CS aspirates (P < 0.05). The negative predictive values for MT and CS were 86% and 100%, respectively. The positive predictive values for MT and CS were 69% and 90%, respectively. CONCLUSIONS: Fewer inadequate specimens will be obtained with CS than with MT. A clinician performing FNA can obtain adequate specimens at a rate comparable to that of a hospital-based cytopathologist. SIGNIFICANCE: CS provides greater assurance to the patient and the surgeon that a thyroid nodule with a FNA interpreted as benign can be observed. A higher percentage of patients with malignant tumor will receive thyroidectomy with the use of CS technique for FNA. EBM RATING: B-3.     

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.     

Evaluation of fine-needle aspiration cytology for renal masses

OBJECTIVE: To evaluate the accuracy and use of fine-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (< 5 cm) tumours, are being discovered more frequently. PATIENTS AND METHODS: Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42-88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (< 5 cm and >/= 5 cm). Patients were followed up to the determination of a final diagnosis on tissue histology, after nephrectomy where possible. RESULTS: Thirty-six patients had histologically confirmed carcinoma at nephrectomy, and nine had presumed carcinoma (four unfit for surgery, five with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insufficient sample in eight cases (16%). The sensitivity was 89% for large (>/= 5 cm) solid masses, 64% for small (< 5 cm) solid masses and 50% for complex cysts. CONCLUSION: FNA does not contribute to the diagnosis of malignancy in large (> 5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (< 5 cm) masses and complex cysts, FNA can occasionally confirm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.     

Comparison between echo-guided fine-needle aspiration cytology and microhistology in diagnosing pancreatic masses

Summary Echo-guided fine-needle aspiration biopsy of pancreatic masses is a well-established diagnostic procedure. However, there is no consensus as to the superiority of cytology or microhistology. We compared the results of cytology and microhistology in 50 consecutive patients who underwent fine-needle aspiration biopsy for pancreatic masses. Aspirates were positive for malignant disease in 42 patients; the other eight had chronic focal pancreatitis. In the 42 cases of cancer, cytology provided conclusive results in 40 (95.2%); sampling was inadequate in two. Microhistology proved accurate in 30 cases (71.4%); insufficient tissue was obtained in 12, giving a statistically significant difference in favor of cytology (P<0.01). In the eight patients with benign disease both techniques ruled out malignancy; in five microhistology gave further indications confirming suspected chronic pancreatitis (fibrosis, lymphocyte and histiocyte-cell infiltrate). Our results show that cytology is the method of choice in diagnosing pancreatic carcinoma. Microhistology can be a useful adjunct in patients with suspected chronic pancreatitis.     

Fine needle aspiration cytology in the evaluation of head and neck masses

One hundred eighty-two fine needle aspirations (FNAs) of head and neck masses performed between the years 1981 and 1987 were studied retrospectively. Seventeen FNAs were unsatisfactory. Of the remaining 165, 148 (90%) were followed up with either surgery or clinical follow-up of at least 12 months' duration. Seventy-one of these aspirates were malignant. Fifty-six cases of metastatic carcinoma and 13 cases of lymphoma were diagnosed. The positive predictive value for metastatic carcinoma and lymphoma was 100%, and the sensitivities were 92% and 100%, respectively. For benign salivary gland lesions, the positive predictive value was 94%, whereas for malignant lesions it was 100%. One case of carcinoma ex-pleomorphic adenoma was missed by FNA. No complications were associated with FNA. We conclude that FNA is a safe and accurate technique, well suited to the in-office evaluation of neck masses of differing causes.     

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.     

Nd: YAG laser scalpel compared with conventional techniques in head and neck cancer surgery

Many theoretical advantages over conventional surgical techniques have been attributed to the Nd: YAG contact laser. Clinically significant differences in perioperative results between the Nd: YAG contact laser and standard surgery, however, are not well defined. The present study was undertaken to evaluate the Nd: YAG contact laser compared with standard scalpel and/or electrocautery in curative operations for head and neck cancer. Clinical records of 36 patients undergoing head and neck cancer surgery were reviewed retrospectively. Patients were studied in three groups: 9 previously irradiated patients operated upon using the Nd: YAG laser (Nd:YAG); 9 previously irradiated patients operated upon using conventional techniques (conventional/RT); 18 nonirradiated patients operated upon using conventional techniques (conventional/no RT). These groups underwent 14,14, and 25 procedures, respectively. Differences between the Nd: YAG, conventional/RT, and conventional/no RT groups regarding cancer staging, age, procedures performed, operative time, intraoperative blood loss, and hospital and ICU stay were not statistically significant. Preoperative radiotherapy dosages in the Nd: YAG and conventional/RT groups were similar (5,127 ± 842 vs. 604 ± 2,373 cGy). Postoperative morbidity in Nd: YAG patients (11%) was similar to that of the conventional/no RT group (17%) and was significantly reduced compared to conventional/RT (11% vs. 56%, P < 0.05). Clinical outcome, including operative time, blood loss, and hospital and ICU stay using the Nd: YAG contact laser in curative operations on previously irradiated patients with head and neck cancer, is equal to that of conventional surgical techniques, with or without preoperative radiotherapy. Among patients operated upon after receiving radiation therapy for head and neck cancer, the Nd: YAG contact laser significantly reduces postoperative morbidity. The data indicate that the Nd: YAG contact laser is an effective surgical technique in head and neck oncology. © 1994 Wiley-Liss, inc.     

Comparison of smear and imprint techniques for rapid diagnosis in neuro-oncology

The smear and imprint techniques were applied to brain tumor biopsy specimens and the resultant preparations compared for preservation of architecture and cell morphology. The imprint gave excellent detail of cell morphology and good preservation of architecture, especially in soft tumors. The method has enabled a rapid diagnosis to be made in 100 cases of intracranial lesions and is a valuable complement to smear and cryostat sections.     

The relative value of fine-needle aspiration and imaging in the preoperative evaluation of parotid masses

BACKGROUND: To establish the sensitivity, specificity, and accuracy of imaging and fine-needle aspiration (FNA), alone or in combination, in distinguishing benign from malignant histologic findings for parotid lesions. METHODS: Retrospective blinded review of preoperative imaging and FNA studies of parotid masses and comparison with histologic findings after excision. RESULTS: Forty-eight patients were identified (13 with CT, 35 with MRI); 23 (48%) of the lesions were malignant, 25 (52%) were benign. MRI, CT, and FNA misclassified 17%, 46%, and 21% of the lesions, respectively. The sensitivity/specificity/accuracy of these tests for detecting malignant lesions were as follows: MRI (88%,77%,83%), CT (100%,42%, 69%), and FNA (83%,86%,85%) and were not significantly different. Combinations of imaging and FNA were not significantly better in detecting malignancy. CONCLUSIONS: Imaging and FNA are comparable in their ability to correctly identify malignant parotid lesions preoperatively. Combining these two modalities yields no advantage in terms of specificity, sensitivity, or accuracy of a malignant diagnosis.     

Single versus sequential fine-needle aspiration biopsy in the management of thyroid nodular disease.

Fine-needle aspiration biopsy (FNAB) is considered a safe, reliable and cost-effective means of selecting thyroid nodules with risk for malignancy. However, there are limitations of this method including false positive/negative and "nondiagnostic" results that may be reduced by repeating FNAB. OBJECTIVE: To evaluate accuracy, sensitivity, specificity and costs of sequential FNAB in the management of thyroid nodular disease. METHODS: Charts of all patients who underwent thyroidectomy at a university teaching hospital in Toronto from 1998 to 2000 were reviewed. FNAB reports of "suspicious for malignancy," "follicular lesion" and "cellular atypia" were considered to be positive. Data were analyzed with chi2 and z tests. RESULTS: There were 268 patients (225 women and 43 men; age range 18-89 yr; mean age 47 yr) who underwent a total of 449 FNABs (mean 1.7 FNABs/patient) within a year before thyroidectomy. Accuracy (63.8%), sensitivity (73.8%) and specificity (69%) were determined for single FNABs. Sequential FNAB increased the accuracy of method by 22.6%, sensitivity by 13.8% and specificity by 6.2%, with reduction of false positive/negative results by 14.2% and "nondiagnostic" results by 100%. However, the costs of sequential cytology per patient were 70% higher than single FNAB. CONCLUSIONS: Multiple FNABs are unpleasant for patients, but useful in the selection for treatment of patients with thyroid nodular diseases. Although sequential FNAB increases the costs of method, the improvement of precision of FNAB may imply a reduction in overall health-care costs.     

Comparison of fine-needle aspiration biopsy and histology in human liver transplants

The findings in 50 fine-needle aspiration biopsies obtained from 27 liver transplants in 24 patients were compared with concomitant histologic findings. When histology showed rejection, rejection was diagnosed in 20 out of 29 FNAB specimens; when rejection was absent histologically, FNAB was negative in 20 out of 21 specimens (sensitivity 69%, specificity 95%). There was a statistically significant correlation between the degree of immunoactivation as reflected by total corrected increment (TCI) in FNAB specimens and the portal triad cell density during rejection, while no correlation existed between the 2 parameters in situations other than rejection. When cholestasis was demonstrated histologically, FNAB showed cholestasis in 30 out of 31 specimens. Furthermore, FNAB showed fatty change in the hepatocytes in 29 out of 43 specimens from livers with histologically evident steatosis. Histology showed necrotic areas in 40 specimens; however, only in 12 concomitant FNAB specimens were necrotic clumps observed. In conclusion, FNAB is a good method for diagnosing acute liver transplant rejection as well as for evaluating intracellular cholestasis or fatty change. Furthermore, TCI seems to reflect the severity of cellular infiltration in the portal triads during rejection.     

Retroauricular endoscopic and robotic versus conventional neck dissection for oral cancer

There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. The aim of the current study is to assess the feasibility and oncological outcome of the retroauricular approach for endoscopic and robot-assisted selective neck dissection (SND) for oral cancer in comparison with the conventional SND. A retrospective single institute cohort study was designed. Patients undergoing an SND for oral cavity carcinoma were included and allocated into two groups: (1) retroauricular approach group for endoscopic-assisted or robot-assisted SND or (2) transcervical approach group for the conventional SND. Primary endpoint was the perioperative and postoperative treatment outcomes. Secondary endpoint was the early oncologic outcome. Sixty patients were included (17 retroauricular; 43 conventional). For the primary outcome, only a significant longer operative time in the retroauricular group was identified. No unintentional injury or conversion to the conventional surgery was recorded. There was no significant difference identified in the early oncologic outcome, including number of retrieved lymph nodes and disease-free survival. Postoperative aesthetic results were considered superior when subjectively compared to the conventional approaches. Endoscopic and robot-assisted SND via a retroauricular approach is feasible, safe, and oncologically efficient when compared with the conventional surgery in a short follow-up scenario. It can be used for selected cases with a clear cosmetic benefit. However, further research with longer follow-up and patient satisfaction analysis is mandatory.