Fine-needle aspiration biopsy and the diagnosis of thyroid cancer

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

Ultrasound-Guided Fine Needle Aspiration Biopsy Update 1998

Abstract: Breast ultrasound using a high-resolution, realtime, hand-held probe was performed on 19, 714 patients. Ultrasound-guided fine needle aspiration biopsy was done on 2,453 solid masses. We report on 2,075 of these lesions, 629 malignant and 1,446 benign, confirmed either by excisional biopsy or adequate follow-up. Of the cancers, 597 (95%) had either malignant or suspicious cytology with 1 false positive case and 32 false negative cytologic results. The diagnosis of cancer was delayed in four patients because of benign appearances on imaging and cytology. Surgery was performed promptly after the first imaging follow-up in each case. There was no delay in diagnosis in the remaining 11 patients because of the suspicious appearance of the masses on mammogram. Mammography missed 147 (23%) of the 629 cancers, 102 of which were clinically palpable. Forty-five cancers were both nonpalpable and not seen by mammogram (incidental cancers). A correct cytologic diagnosis, either fibroadenoma or nonspecific benign, was made in 1,339 of the 1,446 benign masses. The sensitivity of this technique in the diagnosis of solid breast lesions was 95%, the specificity was 93%, and the overall accuracy was 93%. We conclude that real-time, ultra sound-guided fine needle aspiration cytology is a valuable adjunct to the clinical, mammographic, and sonographic assessment of solid breast lesions.     

Accuracy of aspiration cytology in the diagnosis of breast disease

The accuracy of fine needle aspiration cytology has been assessed in 480 consecutive breast lesions where definitive histology was later available. The results in terms of specificity and sensitivity have also been compared to mammography and clinical examination. With adequate smears aspiration cytology was 100 per cent specific with no false positive diagnosis. This compares with 15 false positive mammograms and 12 false positive diagnoses on clinical examination. Cytology was unsatisfactory in 36 per cent of benign lesions owing to poor cellularity of the sample but when considered with mammography and examination led to a reduction in biopsies for benign disease. A definitive cytological diagnosis of malignant tumours resulted in a reduction in frozen sections with a substantial saving of resources and improvement in patient counselling. No mastectomy was performed for benign disease.     

Combined radiology and cytology in the diagnosis of bone lesions: a retrospective study of 370 cases

BACKGROUND: Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied. PATIENTS AND METHODS: We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied. RESULTS: Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%. INTERPRETATION: Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.     

Aspiration cytology is superior to Tru-Cut needle biopsy in establishing the diagnosis of clinically suspicious breast masses.

Eighty-one consecutive patients with breast masses clinically suspicious for malignancy were evaluated prospectively. There were 31 benign lesions and 50 malignancies. Clinical diagnosis was correct in 85% (2.5% false negative, 12.5% false positive). Mammography was diagnostic in 52.8% (31.5% false negative, 15.7% false positive). Needle biopsy was accurate in 78.9% (21.1% false negative, 0% false positive). Aspiration cytology was diagnostic in 96.2% (3.8% false negative, 0% false positive). Statistical comparison of all four tests revealed that aspiration cytology was slightly more accurate than physical examination for all lesions (p = 0.07), but significantly more accurate for benign lesions (p = 0.005). Overall, aspiration cytology was significantly more accurate than mammography (p = 0.000001) and needle biopsy (p = 0.008). Only one minor complication, a superficial infection, occurred with aspiration cytology and needle biopsy. Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.     

Combined radiology and cytology in the diagnosis of bone lesionsA retrospective study of 370 cases

Background?Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied. Patients and methods?We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied. Results?Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%. Interpretation?Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.     

Aspiration cytology of soft-tissue tumors. The 10-year experience at an orthopedic oncology center

Since 1972, we have included fine-needle aspiration cytology in the pre-operative evaluation of soft tissue lesions referred to our Orthopedic Oncology Group. In 365 consecutive patients the cytodiagnosis was correctly malignant in 66/74 tumors and correctly benign in 260/271 lesions; cytology was non-diagnostic in four sarcomas and 16 benign lesions. The final pre-operative diagnosis should be based on all pre-operative data to minimize the effect of any misjudgement as regards cytodiagnosis; only two of the 19 false cytodiagnoses were of consequence for the patient. We conclude that aspiration cytology used in this way is a valuable adjunct to determine the further management of soft tissue tumors.     

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.     

Aspiration cytology of soft-tissue tumors: The 10-year experience at an Orthopedic Oncology Center

Since 1972, we have included fine-needle aspiration cytology in the pre-op-erative evaluation of soft tissue lesions referred to our Orthopedic Oncology Group. In 365 consecutive patients the cytodiagnosis was correctly malignant in 66/74 tumors and correctly benign in 260/271 lesions; cytology was non-diagnostic in four sarcomas and 16 benign lesions. The final pre-operative diagnosis should be based on all pre-operative data to minimize the effect of any misjudgement as regards cytodiagnosis; only two of the 19 false cytodiagnoses were of consequence for the patient.

We conclude that aspiration cytology used in this way is a valuable adjunct to determine the further management of soft tissue tumors.     

Aspiration cytology of soft-tissue tumors: The 10-year experience at an Orthopedic Oncology Center

Since 1972, we have included fine-needle aspiration cytology in the pre-op-erative evaluation of soft tissue lesions referred to our Orthopedic Oncology Group. In 365 consecutive patients the cytodiagnosis was correctly malignant in 66/74 tumors and correctly benign in 260/271 lesions; cytology was non-diagnostic in four sarcomas and 16 benign lesions. The final pre-operative diagnosis should be based on all pre-operative data to minimize the effect of any misjudgement as regards cytodiagnosis; only two of the 19 false cytodiagnoses were of consequence for the patient.

We conclude that aspiration cytology used in this way is a valuable adjunct to determine the further management of soft tissue tumors.     

Use of percutaneous needle biopsy in the investigation of solitary pulmonary nodules.

Percutaneous needle biopsies were performed on 683 patients with solitary pulmonary nodules during 1976-84. A cytological diagnosis of malignancy was made from the first biopsy in 473 patients (69%). A second biopsy was performed in 43 patients, a diagnosis of malignancy being made in a further 16 cases (37%). Histological material was available for comparison with cytological findings in 203 patients. Cytological examination was reliable in the diagnosis of malignancy with a high yield (75%) and low false positive rate (1.5%). Specific benign lesions were correctly diagnosed in 10 patients (1.5%). There was a false negative rate for the diagnosis of malignancy of 18% for the patients with a subsequent histological diagnosis. This compares with a false negative rate of 9% overall; the true rate probably lies between these figures. These results imply that a cytology report indicating no evidence of malignancy, but not diagnostic of a specific benign condition, does not reliably exclude a malignant lesion. In this series cytological typing was not accurate at predicting the cell type determined by histological examination (61% agreement) and was not able to discriminate between small cell and non-small cell lung cancer.     

Fine needle aspiration cytology, with immediate reporting, in the outpatient diagnosis of breast disease

One hundred and fifty one new patients attending a breast clinic over a 6 month period underwent fine needle aspiration cytology (FNAC), with immediate reporting of the smears in the clinic. Thirty nine smears (25.8%) were classified as unequivocally malignant, 10 (6.6%) as being suspicious of malignancy, 61 (40.3%) as benign and 41 (27.1%) were acellular. There were no false positive diagnoses and only one false negative cytological diagnosis of breast cancer [corrected]. Immediate reporting of results enabled the diagnosis to be discussed with the patient at the first attendance and allowed improved surgical management of both benign as well as malignant breast disease.     

Fibro-adenoma of the breast

A retrospective study of 134 patients with a clinical diagnosis of fibro-adenoma of the breast indicated that histological confirmation of this diagnosis is made in only 50 per cent. The majority of the others have a diagnosis of benign mammary dysplasia. Eight patients had an unsuspected carcinoma, all but one being above the mean age for the fibro-adenoma group. The natural history of fibro-adenoma is not known precisely. In view of the high sensitivity of fine needle aspiration cytology in the diagnosis of malignant disease, we believe that there is justification to carry out a prospective study to determine this. In this study women with a clinical diagnosis of fibro-adenoma will be carefully observed provided they are less than 35 years of age and fine-needle aspiration cytology reveals no malignant cells.     

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: 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 non-malignant. 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 cyto-pathologist 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.     

Usefulness of fine needle aspiration cytology in the diagnosis of prostatic carcinoma

Eighty-six cases of cytological diagnosis of the prostate by fine needle aspiration performed between January, 1986 and December, 1987 were reviewed. Twenty patients were diagnosed as positive cytology in prostate (malignant: class V, suspicious: class IV or atypical: class III) and were admitted and further evaluated with conventional needle biopsy followed by histological diagnosis. Then, 18 of them were diagnosed with prostatic carcinoma. False positive rate and false negative rate of this aspiration cytology were 10% and 3.0%, respectively. There was only one minor complication (fever onset) (1.2%) following this procedure. These results indicate that fine needle aspiration cytology of the prostate gland is an easily performed, diagnostically reliable outpatient procedure with minimal complications.     

Interpretation of negative results in fine needle aspiration of discrete pulmonary lesions.

A retrospective analysis was carried out on a consecutive series of 181 percutaneous fine needle aspiration biopsies of discrete pulmonary lesions, in which the outcome was established in 95%. In primary bronchial carcinoma the technique had a sensitivity of 86%. There was no relationship between the size, location, or radiological appearance of the lesion and the incidence of false negative results. The principal reason for failure to diagnose malignancy was inadequacy of the material provided for cytological examination. For metastatic neoplasms of non-bronchial origin the procedure had a sensitivity of 42% and a significantly greater false negative rate than for primary bronchial malignancy. For the entire series 72 (40%) of the procedures failed to produce a definite diagnosis, 29 (40%) of these cases subsequently proving to be malignant. A positive diagnosis was established in only 16% of patients with benign conditions. Review of published reports and consideration of the role of this and other biopsy techniques in the investigation of discrete pulmonary lesions lead to the conclusion that needle aspiration biopsy seems particularly appropriate in the investigation of inoperable patients with probable bronchial carcinoma in whom sputum cytology and bronchoscopy do not yield a diagnosis.     

Operative fine needle aspiration cytology of pancreatic tumours

Thirty-one patients undergoing laparotomy for tumours in the region of the pancreas had both fine needle aspiration cytology (FNAC) and histological biopsy specimens taken to assess the accuracy of the FNAC technique. There were no false positive results but there were six false negative results following FNAC with only one false negative result of histological biopsy. However, there was sampling bias in favour of histology in each of the five patients with negative FNAC and positive histology; two had metastatic disease and three had histology repeated because the initial frozen section was negative. Two major complications may have resulted from the histological biopsy procedure. It is concluded that fine needle aspiration cytology is the ideal method of biopsying pancreatic lesions because of the inherent risk of complications following histological biopsy.     

Fine needle aspiration biopsy cytology in the diagnosis of thyroid cancer: comparative study of 213 operated patients

Between 1982 and 1984, fine needle aspiration biopsy cytology (ABC) was performed in 1100 patients (aged 14-80, 993 women), with nodular goitre, who had either a solitary cold nodule or dominant hypofunctioning nodule(s) within a multinodular or diffusely enlarged gland. Surgery was performed in 213 patients based on clinical and cytological criteria, and the histology of the surgical specimens was correlated with the cytological findings. ABC specimens were sufficient for cytological diagnosis in 190 patients and were classified as malignant (positive), suspicious or benign. In 37 patients who had a final histological diagnosis of malignancy, cytology was positive or suspicious in 33 and benign in 4. In the remaining 153 patients with benign histology there were 7 positive or suspicious aspirates, and 146 benign. The 37 malignancies included papillary carcinomas in 26 patients (24 positive or suspicious and 2 benign on cytology), Hürthle-cell tumours in 6 (6 positive), follicular carcinoma in 1 (negative), anaplastic carcinoma in 1 (suspicious), medullary carcinoma in 2 (1 positive, 1 negative), and lymphoma in 1 (positive). Our results indicate that the overall sensitivity rate of the ABC method for cancer was 89.2 per cent, the diagnostic specificity 95.4 per cent, the false-positive rate 17.5 per cent and the false negative rate 2.6 per cent. The overall accuracy of the method was 94.2 per cent. It is concluded that papillary and Hürthle-cell carcinomas can be diagnosed accurately with ABC but we recommend that the method be used in conjunction with clinical information and other conventional diagnostic procedures.     

Role of fine-needle aspiration cytology in the evaluation of parotid tumours

BACKGROUND: The aim of this study was to evaluate the accuracy of fine-needle aspiration cytology in the diagnosis of parotid tumours. METHODS: A retrospective review was conducted to examine the preoperative cytological and final histological results of patients who underwent parotidectomies at our institution. RESULTS: Sensitivity and specificity for diagnosing malignant and benign tumours were 80%, 100%, and 98.5%, 87.5%, respectively, and 85.1% of benign tumours were accurately typed on fine-needle aspiration cytology compared with only 40% in the malignant group. Using the clinical parameters of associated facial nerve palsy or presence of cervical lymphadenopathy to indicate the presence of malignancy, the diagnostic yield was only 30%. CONCLUSION: Fine-needle aspiration cytology is useful in the preoperative assessment of parotid tumours as it is more reliable than clinical examination to diagnose malignant parotid tumours. Although it may not accurately type the malignant tumours, the diagnosis of malignant tumours preoperatively may allow for appropriate surgical planning by the surgeon.