US-guided fine-needle aspiration biopsy of thyroid nodules

Purpose: To determine which nodular areas provide most adequate and accurate material for cytology during US-guided fine-needle aspiration biopsy (FNAB) of thyroid nodules.Material and Methods: In a prospective multicentre study, US-guided FNAB (0.8 mm) was performed in 342 thyroid nodules (338 patients, 285 women, 18-83 years, 285 palpable). Histology was obtained in 169 nodules, revealing 75 neoplasms (44.4%) including 18 cancers (10.7%). In 206 solid nodules, 2 passes (central and peripheral) were compared. In 82 complex nodules, 2 passes (solid area and cystic area) were compared.Results: The inadequacy rate was 16.4% and the false-negative rates were 2.2% and 28.1% for the diagnosis of cancer and neoplasm, respectively. In solid nodules, material was more adequate with peripheral passes compared to central passes, but the difference was not significant. In complex nodules, the inadequacy rate was much higher for passes in cystic areas (80.5%) compared to passes in solid areas (46.3%).Conclusion: Cystic areas due to degeneration seldom provided adequate material when aspirated. Aspiration should always be obtained from solid areas, at best using US-guidance. Adenomas and non-neoplastic nodules were difficult to distinguish.     

Stereotactic fine-needle aspiration for cytologic diagnosis of nonpalpable breast lesions

Fine-needle aspiration for cytologic diagnosis was performed on 219 nonpalpable breast lesions by using a stereotactic localization technique. Cytologic results were correlated with mammographic findings, and therapeutic decisions were based on the results of both procedures. Representative cytologic material was obtained in 74% of the lesions. Strict criteria of representativeness were observed. If only cases with representative cytologic yield are considered, the sensitivity was 93% and the specificity was 97%. The predictive values were high except for the predictive value of a negative cytologic finding in a spiculated lesion (50%). Sampling errors caused by abundant fibrosis, needle deviation, and difficulty in defining the lesion on the stereoscopic views are discussed. Another source of sampling error may be the mixed nature of some lesions consisting of benign and malignant components. Fine-needle aspiration of 219 nonpalpable breast lesions by using a stereotactic localization device yielded representative cytologic samples in 74% of the lesions.     

Mammography-guided stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: prospective comparison with surgical biopsy results

We assessed the usefulness of fine-needle aspiration cytology (FNAC) in evaluating nonpalpable breast abnormalities by prospectively performing stereotactic mammography-guided FNAC on 100 women undergoing surgical excisional biopsy. Mammographic and cytologic diagnoses, on a scale of 1 (benign) to 4 (malignant), were assigned for each case and compared with the surgical pathologic diagnosis. Sensitivity and specificity were examined at different diagnostic cutoff points for regarding a mammographic or cytologic diagnosis as positive or negative. Of the 100 breast biopsy specimens, 70 were benign and 30 were malignant. For both mammography and FNAC, the optimal diagnostic cutoff point was between diagnosis 2 (mammography, probably benign; cytology, atypical) and 3 (mammography and cytology both suspicious for malignancy). At this cutoff point, FNAC had a sensitivity of 0.77 and specificity of 1.00, vs 0.73 sensitivity and 0.79 specificity for mammography. Pearson coefficient analysis revealed significant correlations between both mammographic and FNAC diagnoses and surgical pathology (p less than .001 for both). Our results suggest that use of mammography-guided FNAC may reduce the number of breast biopsies performed for benign lesions.     

Needle localization and fine-needle aspiration biopsy of nonpalpable breast lesions with use of standard and stereotactic equipment

Recent development of mammographic stereotactic localization devices has created considerable interest in the possibility of fine-needle aspiration biopsy (FNAB) of non-palpable breast lesions. The results of FNAB performed during the course of 50 breast lesion localizations were evaluated. The authors compared two methods of lesion localization, one using a standard mammographic unit and localization technique and the other a stereotactic unit and localization technique. The results of FNAB were similar regardless of technique. With all inadequate specimens considered benign, sensitivity, specificity, and diagnostic accuracy for the standard technique were 71%, 100%, and 93%, respectively, and for the stereotactic technique, 80%, 100%, and 95%. Although these results are preliminary and the number of cases is small, the findings suggest that needle placement for FNAB with the standard localization technique may be as accurate as that with the stereotactic technique.     

Orbital mass lesions: US-guided fine-needle aspiration biopsy--experience in 37 patients.

PURPOSE: To evaluate the safety and effectiveness of using ultrasonographic (US) guidance for performing fine-needle aspiration biopsies of orbital mass lesions. MATERIALS AND METHODS: Thirty-seven patients with mass lesions in the orbit underwent US-guided fine-needle aspiration biopsy. Computed tomographic scans were available in all patients. In 19 patients, the lesions were located in posterior orbit, whereas in 18 patients the lesions were located in (n = 3) or extended up to (n = 15) the anterior compartment. Fine-needle aspiration biopsy was performed with 22-25-gauge needles and use of the freehand technique. RESULTS: Needle biopsies were performed safely and easily, and real-time US monitoring of the needle position was used to avoid injury to the eyeball. No major complications were encountered. Diagnostic specimens were obtained in 29 (78%) of the 37 patients, and 19 benign and 10 malignant disease processes were diagnosed. In eight patients (22%), an appropriate diagnosis could not be made, as aspiration samples yielded insufficient tissue. CONCLUSION: US provides safe and effective guidance for performing fine-needle aspiration biopsy in orbital mass lesions and is especially useful in deep-seated nonpalpable retrobulbar lesions.     

Nonpalpable breast lesions: evaluation by means of fine-needle aspiration cytology

A prospective study was undertaken to assess the utility of fine-needle aspiration (FNA) cytology in women with nonpalpable suspicious microcalcifications or masses detected at mammography. Ninety-six breast lesions were aspirated during wire localization with standard mammographic technique. Cytologic results were compared with surgical pathology results. Sixty-one of the 96 aspirates were adequate for diagnosis. Nine were positive for malignant cells; seven, suspicious; 12, atypical; and 33, negative. All lesions demonstrating positive or suspicious cytologic findings were found to be malignant at biopsy; five of the 12 with atypical cytologic findings were malignant. Of 33 lesions deemed negative by means of cytology, two were biopsy-proved carcinomas. Cytologic examination permitted accurate diagnosis of 21 of the 23 (91%) carcinomas in which an adequate sample was obtained. Insufficient cellular material was obtained from 35 lesions, 16 of which showed marked fibrosis at histologic examination. The authors conclude that FNA cytology can aid in establishing a diagnosis in many cases in which nonpalpable breast lesions are detected at mammography.     

立体定位导丝导向活检不能触及的乳腺病灶

目的 探讨立体定位导丝导向活检不能触及的乳腺病灶的价值。方法 对25例不能触及的乳腺病灶行立体定位导丝导向活检26处,对每处病灶计算出穿刺针针尖至病灶中心的距离（D）,并直接测量出留置的导丝头端至病灶中心的距离作对照,判断标准：优：D小于等于2．5mm;良：D＝2．6－4．9mm;差：D大于等于5．0mm。结果 定位优20例次,良5例次,差1例次。穿刺针针尖至病灶中心距离的计算值与直接测量值相符,1次性病灶切除26例次,标本体积的中位数为10．5cm3,检出乳腺癌6（6／26）处;结论 立体定位导丝导向活检不能触及的乳腺病灶能以最小的手术范围完整切除病灶,定位定性效果确切,可避免假阴性,提高了乳腺癌的早期检出率及诊断准确性。     

Light scan evaluation of nonpalpable breast lesions

Transillumination light scanning of the breast was performed immediately before needle localization of 112 nonpalpable mammographic abnormalities detected in 103 patients. Twenty-four cancers were diagnosed in 23 patients. The positive predictive value for mammography was 21%. Ten (42%) of these nonpalpable cancers were not visible on transillumination light scanning. Eleven of 16 invasive ductal cancers and three of seven intraductal cancers were evident on transillumination light scans, but a single case of lobular carcinoma in situ was not evident. There were 12 false-positive light scan examinations. Transillumination light scanning had a 58% sensitivity, an 86% specificity, a 54% positive predictive value, and an 88% negative predictive value for small breast lesions. Therefore, the authors are unable to recommend delaying biopsy in patients with mammographic abnormalities on the basis of a negative light scan study.     

Stereotaxic needle-core biopsy and fine-needle aspiration biopsy in the diagnosis of nonpalpable breast lesions: controversies and future prospects

Objective: To determine the advantages and limitations of a combined stereotaxic fine-needle aspiration biopsy and needle-core biopsy in the diagnosis of 353 nonpalpable breast lesions with special attention given to the collection of follow-up data. Methods and material: 353 nonpalpable breast lesions underwent ‘one pass’ stereotaxic fine-needle aspiration (21 gauge needle) and needle-core biopsy (18 gauge needle) at our institution from January 1990 to October 1993. Stereotaxic biopsies were carried out by means of an ‘add-on unit’. Surgical biopsy was usually recommended for highly suspicious radiologic patterns and/or needle biopsy reports classified as atypical or malignant. In all other cases mammographic follow-up was advised at 6 months and then annually for 3 years. The data were collected retrospectively during September 1995 (theoretical average follow-up of greater than 3 years). Results: Following the combined needle biopsy technique procedure, surgery was recommended for 83 lesions. Fifty-four cancers were associated to these suspicious lesions. Because of changing radiological or clinical pattern during follow-up (mean follow-up: 22 months), 11 cancers were detected among the 270 lesions initially considered not to need surgery. Forty-three percent of the 65 malignant lesions were initially read as having less than highly suspicious mammographic features. There was no significant difference between the sensitivity and the specificity of one pass fine-needle aspiration biopsy (57% and 96% respectively) and needle-core biopsy (60% and 97% respectively), but noncontributive samples were not included in the false negative diagnoses and atypical samples were included in the true positive diagnoses. Of the 11 missed cancers, nine were manifested initially by clusters of calcifications. Our diagnostic approach was significantly less sensitive (P = 0.006) and less specific (P = 0.032) in cases of clusters of calcifications (31% false negative diagnoses) than in cases of soft-tissue masses (5.5% false negative diagnoses). In this study, an average delay in diagnosis of 22 months was responsible for a significantly increased percentage of axillary node positive invasive cancer (P < 0.001) and six of the 11 missed cancers were palpable at the time of the delayed diagnosis. For the nine cancers initially manifested by calcifications, the 22 months delay in diagnosis was responsible for a nonsignificant increase of microinvasive type at the expense of carcinoma in situ. Conclusion: Our enthusiasm with the sensitivity of this double stereotaxic needle sampling has been tempered by the results of this reanalysis in the light of a mean theoretical follow-up of three years. Our diagnostic approach was adequate in the presence of soft-tissue masses but not valid in the presence of clustered calcifications. When dealing with calcifications, multiple samplings must be done in order to improve the sensitivity of the diagnosis. Furthermore, this study does not favour the theory that the majority of mammographically detected cancers are indolent and highlights the poor sensitivity of the mammographic follow-up of nonpalpable lesions.     

Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy

PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior mediastinal regions. MATERIALS AND METHODS: Eighty-six consecutive patients with mediastinal lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US-guided FNAB of mediastinal lymphadenopathy was performed as a component of staging non-small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS: In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US-guided FNAB in distinguishing benign from malignant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who underwent staging of NSCLC, endoscopic US-guided FNAB had superior mediastinal lymph node staging accuracy compared with endoscopic US alone (79%) and CT alone (79%) (P =.01). The results of endoscopic US-guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postprocedural fever that resolved with oral antibiotics, occurred (1%; 95% CI: 0%, 6%). CONCLUSION: Endoscopic US-guided FNAB is accurate and safe for biopsy of mediastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or examine patients with prior inconclusive biopsy results.     

Vacuum-assisted breast biopsy on digital stereotaxic table of nonpalpable lesions non-recognisable by ultrasonography

The aim of this study was to evaluate accuracy of 11 G vacuum-assisted percutaneous biopsy (VAPB) carried out on digital stereotaxic table, on breast non-palpable lesions (NPLs), non-visible by US. Prospective study on 132 consecutive NPLs (126 patients) not reliably found by US; 82% showed microcalcifications. Surgical confirmation was obtained in all malignant cases and when VAPB reported atypical lesion (ductal or lobular), radial scar or atypical papillary lesion. All patients with benign results were included in a mammographic follow-up programme. Two cases could not be dealt with due to technical difficulties. One to 26 cylinders were obtained from the remaining 130 NPLs. Sixty-four lesions were surgically confirmed. Forty-six of the 47 malignancies were correctly diagnosed. In one case of a malignant tumour, an atypical lesion was classified with VAPB. All cases of histologically verified lobular carcinoma in situ, atypical ductal or lobular hyperplasia, radial scar or atypical papillary lesion were correctly diagnosed preoperatively. The remaining lesions were benign in VAPB, and after 1 year of follow-up, no false negative has been found. Based on this short-term follow-up, absolute sensitivity was 97.9%, absolute specificity 84.3% and accuracy was 99.2%. For predicting invasion, accuracy was 89.1%. Vacuum-assisted percutaneous biopsy is a very accurate technique for NPLs which are not detectable by US. It can replace approximately 90% of DSB with no important complications, avoiding scars and providing a higher level of comfort.     

超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径>3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。