Experiences with fine needle aspiration biopsy of the thyroid gland]

It is reported on 155 fine needle aspiration biopsies of the thyroid gland which above all were performed in cold nodes. In 81.9% of the cases unconspicuous cell pictures or cystico-regressive changes were present. Of the 17 findings suspicuous of malignoma (11%) hitherto 2 could histologically be diagnosed as carcinomas and 3 as adenomas with considerable regressive changes. The additionally established frequency of nodular strumas and cold nodes in 547 scintigraphically examined patients had the results of 54% nodular strumas and 48.4% of cold nodes in the total material. In 90.2% the nodular strumas revealed cold nodes. The rate of malignomas of all preparations of operations of the thyroid gland was altogether at 2.9% subtracting the secondary malignant processes 2.4% were found. These findings as well as the positive data from literature give the fine needle aspiration biopsy an important role in supplementing the morphologic diagnostics and the early recognition of malignomas of the thyroid gland.     

The diagnosis of mass lesions in the pancreas by fine needle aspiration biopsy

Fifty-eight cases of pancreatic mass lesions investigated by fine needle aspiration biopsy (FNAB) are reported. Biopsies were performed either at laparotomy or percutaneously using ultrasound or computer to mography scanning as a guide. Twenty-seven biopsies were reported as consistent with or highly suspicious of adenocarcinoma of the pancreas; five with metastatic carcinoma, one with lymphoma and two with islet cell tumours. Nineteen patients had negative biopsies. The false-negative rate was 11% and four biopsies were unsatisfactory. There were no false-positive diagnoses. FNAB is an effective way to obtain cytological confirmation of a pancreatic mass lesion.     

Efficacy and complications of transthoracic needle biopsy of lung in patients with Pneumocystis carinii pneumonia and AIDS

Transthoracic needle biopsy of lung was performed under fluoroscopic guidance in 16 patients with AIDS or suspected AIDS for diagnosing 18 episodes of possible P carinii infection. Diagnostic information was obtained in 15 of 18 cases. P carinii (10) and other infections agents (5) were diagnosed by TNB. The complications were pneumothorax in 44% (17% requiring chest tube drainage) and minor hemoptysis in 11%. Our incidence of pneumothorax following TNB in patients with diseases other than AIDS is 17% with 4.8% requiring chest tube drainage. Although TNB under fluoroscopic guidance is a cost-effective, rapid procedure with a high diagnostic yield, it is frequently complicated by pneumothorax in AIDS patients with diffuse pulmonary disease. This procedure should therefore only be performed in AIDS patients when transbronchial biopsy has failed to provide the diagnosis and prior to considering such patients for open lung biopsy.     

B超引导下细针穿刺对触诊阴性甲状腺结节的诊断价值

本研究对75例触诊阴性的甲状腺结节行B超检查及B超引导下的细针穿刺活检.结果 显示B超特征有助于区分触诊阴性的甲状腺结节的良恶性,B超引导下的细针穿刺细胞学检查对其有较高的诊断价值.     

Endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of pancreatic masses

Endoscopic ultrasound (EUS) represents a highly sensitive method for the detection of pancreatic masses. When available, EUS-guided fine needle aspiration (FNA) is the best technique for the diagnosis and staging of pancreatic cancer due to its ability to obtain tissue for diagnosis. The standardized indications for pancreatic EUS-FNA comprise the definite diagnosis of malignancy and histopathological confirmation of adenocarcinoma before surgical resection, chemo/radiotherapy, or celiac plexus neurolysis. The technique of performing EUS-FNA is described in detail, from the vizualization of the target lesion and adequate placement of the transducer to allow optimal needle access, to needle penetration and sampling of the targeted lesion. We report a series of 9 patients who underwent EUS-FNA and shortly review the indications, technique, results and impact of EUS-FNA on the management of these patients.     

Dapsone-induced hypersensitivity pneumonitis mimicking Pneumocystis carinii pneumonia in a patient with AIDS

Interstitial pneumonitis, often related to infectious etiologies, occurs commonly in HIV-infected patients. However, hypersensitivity pneumonitis from noninfectious etiologies, including environmental stimuli or drug exposure, is an unusual etiology of interstitial pneumonitis in HIV-infected patients. We report a patient with AIDS who developed a dapsone-induced hypersensitivity pneumonitis mimicking Pneumocystis carinii (PCP) pneumonia. We believe drug-induced hypersensitivity pneumonitis should be considered in the differential diagnosis of interstitial pneumonia in HIV-infected patients in whom infectious etiologies have been ruled out.     

Endoscopic ultrasonography-guided fine needle aspiration biopsy using 22-gauge needle in diagnosis of autoimmune pancreatitis

Backgrounds

The effectiveness of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has not been fully evaluated in the diagnosis of autoimmune pancreatitis (AIP).

Aim

To evaluate the effectiveness of EUS-FNA using 22-gauge needles in the diagnosis of AIP.

Methods

EUS-FNA was examined in 85 patients with pancreatic mass, including 64 patients with pancreatic cancer and 21 patients with AIP. We investigated ability of EUS-FNA using 22-gauge needle for the differential diagnosis between AIP and pancreatic cancer. We also compared the factors concerning FNA procedures (number of needle passes, size of lesion, device, and amount of obtained pancreatic tissue) between two diseases.

Results

Tissues obtained from 21 patients with AIP, although none of them demonstrated histology suspicious for malignancy, did not show histological evidence definitive for AIP. The amount of obtained pancreatic tissue was almost equal between two diseases in each pancreatic location. Sensitivity, specificity, overall accuracy, and negative predictive value of histological diagnosis of pancreatic cancer were 92.2%, 100%, 94.1%, and 80.8%, respectively.

Conclusion

EUS-FNA using 22-gauge needle distinguished benign from malignant pancreatic mass with >90% of accuracy, regardless of the location. Hence, it was helpful for the clinical diagnosis of AIP, however not providing satisfactory samples for the histological diagnosis of AIP.     

Hepatocellular carcinoma: diagnosis by percutaneous fine needle biopsy

One hundred fifty-nine cases of hepatocellular carcinomas (HCCs) were reviewed from a series of 1060 cases of percutaneous fine needle biopsies of the liver. The biopsies were performed under ultrasonic guidance using a 22-gauge needle with a beveled tip. Specimens were obtained from the lesion and from areas of normal-appearing liver for comparison. Two sets of slides were prepared for Papanicolaou and Giemsa staining. In 147 cases (92%), the diagnosis of malignancy was established. In 134 cases (84%), the specific diagnosis of HCC was made. Fifty-four percent of the HCCs were well differentiated without cytonuclear abnormalities. In these cases, the diagnosis was made by comparison of specimens from the tumor with those obtained from the normal liver. Thirty-seven percent of the HCC were moderately differentiated with cytonuclear abnormalities. Nine percent of the HCCs were poorly differentiated, and in these cases, identification of glycogen on periodate-Schiff's procedure staining permitted differentiation from a metastatic tumor. In 9 cases, the aspirate was inadequate: there was insufficient tissue in 3 cases and the lesion was missed in the 6 other cases. In 3 cases, a biopsy of normal liver was not obtained and the diagnosis of HCC could only be suspected. Significant bleeding after biopsy occurred in 4 of 1060 cases, all with HCC.     

Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view

INTRODUCTION: The rates of sensitivity and specificity of fine needle aspiration biopsy (FNAB) for the diagnosis of thyroid malignancy differ considerably among various reported series. These values are influenced by three factors: (a) whether only clearly positive and negative results are considered, or whether the commonly encountered 10-20% of indeterminate/suspicious ones are included; (b) whether adenomas are considered as neoplasms in one group with carcinomas; and (c) whether only histologically proven cases are used in calculations or whether patients with benign clinical follow-up are included. AIM: The aim of the study was to evaluate the sensitivity and specificity of FNABs performed at this institution in the last 7 years from the clinical point of view, considering only benign vs. suspicious/malignant FNAB results (indicating surgery), and benign (including adenomas) vs. malignant definitive histology. STUDY DESIGN: Retrospective study comparing pre-operative FNAB results with definitive histological examination after operation. PATIENTS: A total of 2492 FNABs were performed in 2100 patients (1875 women and 225 men); their ages ranged from 9 to 85 years, with a median of 46 years. Clinical diagnosis was multinodular goitre in 1330, single nodule in 591, Hashimoto's thyroiditis in 147 and subacute thyroiditis in 32 cases. In 148 instances, the nodule was cystic. A history of previous treatment for carcinoma of the thyroid was present in 12 patients. Five hundred and thirty-six patients subsequently underwent thyroid surgery. STATISTICS: The values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were calculated. RESULTS: The sensitivity was 86%, specificity 74%, PPV 34%, NPV 97% and diagnostic accuracy 75%. CONCLUSIONS: The specificity and positive predictive value are low when fine needle aspiration biopsy results are divided into two categories only (these being indication for surgery or not), and when only suspicious/malignant fine needle aspiration biopsies with subsequent malignant histology are considered to be true positive. Nevertheless, the ability to discriminate 11.7% of patients with a 34% probability of malignancy (suspicious/malignant cytology) from 81.2% of patients (benign cytology) with a probability of only 3% is very helpful.     

Endoscopic fine needle aspiration biopsy of gastroesophageal malignancies

We have evaluated the results of endoscopic fine needle aspiration cytology in 50 consecutive cases of suspected malignancy of the esophagus and stomach and compared them with those of forceps biopsy and brush cytology. The diagnostic yield with forceps biopsy, fine needle aspiration, and brush cytology in 46 cases of carcinoma was 88.8%, 89.1%, and 80.4%, respectively. A combination of forceps biopsy and brush cytology gave an accuracy of 93.5% while the addition of fine needle aspiration increased the yield to 100%. This was due to a very high positive yield of fine needle aspiration in infiltrative tumors.     

Retroperitoneal choriocarcinoma diagnosed by endoscopic ultrasonography-guided fine needle aspiration biopsy

A 25-year-old man, with a retroperitoneal bulky mass invading the posterior pancreas head, was referred to investigate and treat his rapidly advancing disease. An endoscopic ultrasonography guided-fine needle aspiration biopsy (EUS-FNAB), performed the next day, and followed by immunostaining for human chorionic gonadotropin (hCG), led to a histological diagnosis of choriocarcinoma. An elevated level of serum hCG also supported the diagnosis. Systemic chemotherapy by etoposide and cisplatin was initiated within a week, with precautions taken to avoid tumour lysis syndrome and choriocarcinoma syndrome. EUS-FNAB enabled a prompt diagnosis and suitable treatment for choriocarcinoma and was considered as an effective diagnostic tool for rare tumours with rapid progression.