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Saoud C, Lam H, Gross JM, Ali SZ. Fine needle aspiration of bone lesions: A tertiary care centre experience. Cytopathology 2023; 34:562-572. [PMID: 37434498 DOI: 10.1111/cyt.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Bone fine needle aspiration (FNA) presents several diagnostic challenges including limited sample material, reduced ability to assess the architecture, and lack of a standardised reporting system. The aim of our study is to present our experience regarding bone FNA. METHODS We performed a 6-year retrospective search of our archives to identify all FNA cases of bone lesions. Available data regarding patients' demographics, cytopathology, and surgical pathology were recorded. The FNA cases were then grouped into five categories (atypical, neoplasm-benign, neoplasm of unknown malignant potential, suspicious for malignancy, and malignant) and the risk of malignancy (ROM) was calculated. RESULTS A total of 341 FNA cases performed in 337 patients (M = 173, F = 164; mean age = 57.2 years) were identified. The iliac crest was the most commonly biopsied site (n = 134). The adequacy of bone FNA was 77.4%. The sensitivity and specificity regarding the nature of the lesion were 96.5% and 100%, respectively. The overall diagnostic accuracy of bone FNA was 77%. The accuracy of bone FNA for non-metastatic bone lesions including non-neoplastic lesions was 74%, while the diagnostic accuracy of bone FNA for a metastatic disease was 83.5%. The diagnostic accuracy for primary neoplastic lesions was 70%. The frequency (n,%) of cytomorphological categories were as follows: atypical (30, 8.8%); neoplasm-benign (6, 1.8%); neoplasm of unknown malignant potential (18, 5.3%); suspicious for malignancy (4, 1.2%); and malignant (145, 42.5%). The ROM in these categories was respectively as follows: 51.7%, 0%, 46.7%, 100%, and 99.1%. CONCLUSION FNA is a sensitive and specific technique for the diagnosis of bone lesions. In most instances, an accurate diagnosis can be achieved if adequate material, ancillary studies, and radiological correlation are available.
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Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hansen Lam
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jager L, Johnson DN, Sukhanova M, Streich L, Chapa AR, Alexiev BA. Diagnosis of giant cell-rich bone tumors on core needle biopsy: a practical approach. Pathol Res Pract 2022; 231:153777. [DOI: 10.1016/j.prp.2022.153777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
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Gupta P, Gupta N, Bharani V, Kumar R, Kakkar N, Dey P, Srinivasan R, Rajwanshi A. Cytological diagnosis of osteosarcoma with emphasis on diagnostic pitfalls. Cytopathology 2020; 32:243-249. [PMID: 33090567 DOI: 10.1111/cyt.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/17/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fine needle aspiration is a well-established technique for evaluating primary and secondary bony lesions. With use in selected cases, it achieves a diagnostic yield comparable to biopsies. METHODS Cases of osteosarcoma (OS) with available histological follow-up were retrieved over a 10-year period. Detailed morphological evaluation was done, with special emphasis on pitfalls in the diagnosis of OS on cytology and the various variants of OS. RESULTS Of the 41 cases with available follow-up histology, 56% were correctly diagnosed as OS on cytology. The most common false-negative cytological diagnosis of OS, in 17% cases, was giant cell tumour. The possible explanations for this included low cellularity, minimal atypia, absence of typical osteoid, misinterpretation of metachromatic osteoid material as fibro-collagenous material and non-availability of radiology at time of aspiration. CONCLUSION A triple-phase evaluation including clinical evaluation, appropriate radiological correlation and cytology/histopathology, is important to clinch an accurate diagnosis.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Vani Bharani
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Rajesh Kumar
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | | | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
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Updates in Primary Bone Tumors: Current Challenges and New Opportunities in Cytopathology. Surg Pathol Clin 2018; 11:657-668. [PMID: 30190146 DOI: 10.1016/j.path.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The review summarizes the current diagnostic challenges in fine-needle aspiration of primary bone tumors, with focus on the application of new molecular and immunohistochemical techniques in the diagnosis of giant cell-rich neoplasms, chondrosarcomas, and notochordal tumors.
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Goyal A, Pathak P, Sharma P, Sharma S. Role of FNAC in diagnosing lesions of hand and wrist. Diagn Cytopathol 2018; 46:853-858. [PMID: 30144350 DOI: 10.1002/dc.24050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC. METHODS All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively. RESULTS 1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases. CONCLUSION FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.
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Affiliation(s)
- Aditi Goyal
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Priya Pathak
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Pooja Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Song W, van Hemel BM, Suurmeijer AJH. Suitability of the Cellient TM cell block method for diagnosing soft tissue and bone tumors. Diagn Cytopathol 2018; 46:299-305. [PMID: 29318761 PMCID: PMC5888188 DOI: 10.1002/dc.23887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The diagnosis of tumors of soft tissue and bone (STB) heavily relies on histological biopsies, whereas cytology is not widely used. CellientTM cell blocks often contain small tissue fragments. In addition to Hematoxylin and Eosin (H&E) interpretation of histological features, immunohistochemistry (IHC) can be applied after optimization of protocols. The objective of this retrospective study was to see whether this cytological technique allowed us to make a precise diagnosis of STB tumors. METHODS Our study cohort consisted of 20 consecutive STB tumors, 9 fine-needle aspiration (FNAC) samples, and 11 endoscopic ultrasonography (EUS) FNACs and included 8 primary tumors and 12 recurrences or metastases of known STB tumors. RESULTS In all 20 cases, H&E stained sections revealed that diagnostically relevant histological and cytological features could be examined properly. In the group of 8 primary tumors, IHC performed on CellientTM material provided clinically important information in all cases. For instance, gastrointestinal stromal tumor (GIST) was positive for CD117 and DOG-1 and a PEComa showed positive IHC for actin, desmin, and HMB-45. In the group of 12 secondary tumors, SATB2 was visualized in metastatic osteosarcoma, whereas expression of S-100 was present in 2 secondary chondrosarcomas. Metastatic chordoma could be confirmed by brachyury expression. Two metastatic alveolar rhabdomyosarcomas were myf4 positive, a metastasis of a gynecologic leiomyosarcoma was positive for actin and estrogen receptor (ER) and a recurrent dermatofibrosarcoma protuberans expressed CD34. CONCLUSION In the proper clinical context, including clinical presentation with imaging studies, the CellientTM cell block technique has great potential for the diagnosis of STB tumors.
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Affiliation(s)
- W Song
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, RB Groningen, 9700, The Netherlands
| | - B M van Hemel
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, RB Groningen, 9700, The Netherlands
| | - A J H Suurmeijer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, RB Groningen, 9700, The Netherlands
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McHugh KE, Emory CL, Parks GE, Kilpatrick SE. Fine needle aspiration biopsy diagnosis of primary clear cell chondrosarcoma: A case report. Diagn Cytopathol 2017; 46:165-169. [PMID: 28925593 DOI: 10.1002/dc.23808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/24/2017] [Indexed: 12/14/2022]
Abstract
Clear cell chondrosarcoma is a rare chondrosarcoma variant often involving the long bone epiphyses of young to middle aged adults. We report herein a case involving the left femoral head in a 25-year-old female with a 3-month history of worsening left hip pain. Radiographs revealed a complex, multifocal and lytic lesion centered in the left proximal femoral epiphysis with involvement of the femoral neck. Computed tomography-guided fine needle aspiration biopsy with concomitant core needle biopsy was performed, and a diagnosis of clear cell chondrosarcoma was rendered. Cytologic smears revealed aggregates of matrix material accompanied by a population of mostly uniform spindled to epithelioid and histiocytoid cells, rarely accompanied by osteoclast-type giant cells. The patient underwent surgical resection with -total hip replacement, and subsequent pathologic examination confirmed the initial needle biopsy diagnosis. There has been no evidence of local recurrence or distant metastases with 3-years follow-up. To our knowledge, this is the first reported example of a primary clear cell chondrosarcoma initially evaluated by fine needle aspiration biopsy.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157
| | - Graham E Parks
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157
| | - Scott E Kilpatrick
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
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Shergill U, Vitkovski T, Stoffels G, Klein M, Gimenez C, Laser A, Cocker R, Chau K, Das K. Fine-needle aspiration biopsy of lytic bone lesions: An institution's experience. Diagn Cytopathol 2017; 45:989-997. [PMID: 28862793 DOI: 10.1002/dc.23807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fine needle aspiration (FNAB) is an effective, minimally-invasive, inexpensive, diagnostic technique. The objective of this study was to evaluate the accuracy of FNAB in the diagnosis of bone lesions. METHODS FNABs of bone lesions diagnosed at our institution over a 2-year period were retrospectively analyzed. RESULTS 241 samples were reviewed. Patients included 121 males and 120 females, with ages ranging from 4-95 years (mean = 66 years). Of these 241 cases, 43.2% had FNAB and 56.8% had FNAB with core needle biopsy (CNB). The cytologic diagnoses were categorized as nondiagnostic, benign, atypical, suspicious, and positive for malignant cells. Total of 84.3% of FNABs were diagnostic. Of the malignant cases, 78.5% were metastases from nonosseous primary sites, 17.1% were lymphoproliferative lesions, and 4.4% were primary bone tumors. The most common site of metastasis was the pelvic bones (43.5%) followed by the vertebral column (38.7%). Breast (21%), lung (12.7%), and prostate (11.3%) were the most common identifiable primary site in metastatic cases. FNA smears and cell blocks allowed identification of metastatic lesions in 94.3% cases with immunohistochemistry (IHC). Obtaining a concomitant CNB did not result in a statistically significant increase in overall diagnostic yields (P = .20), ascertaining presence of metastatic lesion (P = .96) or ability to identify site of primary tumor in cases of metastasis (P = .53) compared to FNAB alone. Diagnostic accuracy was improved by reviewing clinical history, performing cell block, and IHC. CONCLUSIONS FNAB is a reliable tool for diagnosis of bone lesions with comparable diagnostic sensitivity to CNB.
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Affiliation(s)
- Uday Shergill
- Department of Pathology, Lenox Hill Hospital-Hofstra Northwell Health School of Medicine, 100 East 77th Street, 12th Floor, New York, New York, 10075
| | - Taisia Vitkovski
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Guillaume Stoffels
- Biostatistics Unit, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, New York, 11030
| | - Melissa Klein
- Department of Pathology and Laboratory Medicine, Division of Cytopathology, Northwell Health Laboratories, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Alice Laser
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Rubina Cocker
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Karen Chau
- Department of Pathology and Laboratory Medicine, Division of Cytopathology, Northwell Health Laboratories, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, 6 Ohio Drive, Suite 202, Lake Success, New York, 11042
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Song Y, Kwon JW. Percutaneous CT-guided sternal biopsy: factors affecting the diagnostic yield. Acta Radiol 2017; 58:825-833. [PMID: 27852642 DOI: 10.1177/0284185116676652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Sternal lesions are occasionally seen in clinical practice and their diagnosis can be important, especially for oncologic patients. However, percutaneous computed tomography (CT)-guided biopsy of sternal lesions is rarely performed. Purpose To assess the diagnostic yield of percutaneous CT-guided sternal biopsies and to analyze the factors that affect diagnostic yield. Material and Methods A retrospective review of 34 patients who underwent CT-guided sternal biopsy was carried out at a single institution. Pre-biopsy CT density, location, penetration length of biopsy needle, number of biopsy attempts, angle of needle approach, final diagnosis, and operator experience level were recorded. A biopsy was considered as diagnostic if it provided a confident pathologic result. All variables were compared using Chi-square tests. Results Twenty-two of the 34 (64.7%) biopsy procedures yielded a diagnostic sample and 12 (35.3%) were non-diagnostic. Eight participants in the non-diagnostic group were clinically diagnosed with inflammatory arthritis of the manubriosternal or costosternal joints. Longer penetration distance of the tumor by the biopsy needle showed higher diagnostic yield ( P = 0.031). Osteoblastic lesions ( P < 0.001), lesions in the manubriosternal joint ( P = 0.018) and approaches using more obtuse angles ( P = 0.009) were associated with significantly lower diagnostic yields. Malignancy in the final diagnosis led to a higher diagnostic yield than benign lesions ( P < 0.001). Conclusion CT-guided percutaneous sternal biopsy has a relatively lower diagnostic yield. However, acute angle of needle approach may help increase biopsy success rate. Osteoblastic lesions and lesions in the manubriosternal joint tend to have lower diagnostic yield.
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Affiliation(s)
- Yoonah Song
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Yu GH, Maisel J, Frank R, Pukenas BA, Sebro R, Weber K. Diagnostic utility of fine-needle aspiration cytology of lesions involving bone. Diagn Cytopathol 2017; 45:608-613. [PMID: 28470965 DOI: 10.1002/dc.23735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is utilized in the diagnostic work-up of bone lesions in a number of institutions, either in isolation or in conjunction with core biopsy. We report our experience with FNA of bone-based lesions, including comparison of this approach with concurrent core biopsy specimens. METHODS Retrospective review over a 5-year period (2011-2015) revealed 233 cases of bone FNAs. RESULTS The most commonly encountered diagnosis was malignant neoplasm (160 cases, 68.7%); within this group of malignancies, 103 cases (64.4%) represented metastatic carcinoma. Benign lesions were encountered infrequently (9 cases, 3.9%). While 37 cases (15.9%) revealed "no evidence of malignancy," 12 cases (5.2%) showed atypical findings, 3 cases (1.3%) demonstrated inflammatory conditions, and 12 aspiration biopsies were deemed nondiagnostic (5.2%). In 202 cases, concurrent core biopsies were performed following FNA and rapid on-site evaluation (ROSE). Comparison of the FNA and core biopsy diagnoses among malignant neoplasms revealed 19 diagnostic discrepancies, including 16 cases with a false-negative FNA (7.9% of all FNAs with concurrent core biopsy) and 3 cases with a false-negative core biopsy (1.5% of all cases with corresponding FNA). CONCLUSION Our findings indicate that FNA of bone lesions is a useful diagnostic technique with high sensitivity, particularly when the cytologic findings are interpreted in conjunction with the core biopsy and pertinent clinical and radiologic findings. In addition, ROSE followed by open, dynamic communication with the performing radiologist leads to an extremely low rate of inadequate core biopsy specimens, resulting in optimal patient diagnosis and management. Diagn. Cytopathol. 2017;45:608-613. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Gordon H Yu
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Julia Maisel
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Renee Frank
- Department of Pathology & Laboratory Medicine, Geisinger Medical Laboratories, Danville, Pennsylvania
| | - Bryan A Pukenas
- Department of Radiology, Neuroradiology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Ronnie Sebro
- Department of Radiology, Musculoskeletal Radiology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Kristy Weber
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Benign chondroblastoma on fine-needle aspiration smears: A seven-case experience and review of the literature. Diagn Cytopathol 2015; 43:734-8. [DOI: 10.1002/dc.23286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/09/2015] [Accepted: 03/30/2015] [Indexed: 12/23/2022]
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Venugopal SB, Prasad S. Cytological diagnosis of osteoblastoma of cervical spine: a case report with review of literature. Diagn Cytopathol 2014; 43:218-21. [PMID: 24853790 DOI: 10.1002/dc.23175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/30/2014] [Accepted: 05/09/2014] [Indexed: 12/14/2022]
Abstract
Osteoblastomas are rare benign but sometimes aggressive primary bone tumors (1%), usually seen in males in the 2nd decade. Osteoblastomas, occurring in the spine, constitute a medical emergency due to impending cord compression. Hence a rapid and simple diagnostic modality, such as fine-needle aspiration (FNA) plays an important role in clinical decision making. Cytological diagnosis of osteoblastoma is rare. We report a case of a young female patient presenting with a swelling in the left cervical paravertebral region. The X-ray findings were non-diagnostic and the patient was sent for an FNA. Aspiration yielded moderately cellular hemorrhagic smears with plasmacytoid cells, spindle cells, and osteoclastic giant cells in a background of matrix material. A diagnosis favoring osteoblastoma was made. The CT scan findings were in agreement with the cytological diagnosis and the lesion was excised. Histopathological examination confirmed the same. We describe here, the clinical and cytological features of osteoblastoma with their differential diagnosis, along with review of the literature. FNA can be used as an important tool in the pre-operative diagnosis of osteoblastoma.
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Affiliation(s)
- Suguna Belur Venugopal
- Department of pathology, Kempegowda Institute of Medical Sciences, Bangalore, 560070, India
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Accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance: Experience from the National Cancer Institute, Cairo University, Egypt. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Jiang XS, Pantanowitz L, Bui MM, Esther R, Budwit D, Dodd LG. Clear cell chondrosarcoma: Cytologic findings in six cases. Diagn Cytopathol 2013; 42:784-91. [DOI: 10.1002/dc.23043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/07/2013] [Accepted: 08/27/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Xiaoyin Sara Jiang
- Department of Pathology; Duke University Medical Center; Durham North Carolina
| | - Liron Pantanowitz
- Department of Pathology; University of Pittsburgh Medical Center, UPMC Shadyside UPMC Cancer Pavilion; Pittsburg Pennsylvania
| | - Marilyn M. Bui
- Department of Anatomic Pathology; Moffitt Cancer Center; Tampa Florida
| | - Robert Esther
- Department of Orthopaedics; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Debra Budwit
- Department of Pathology and Laboratory Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Leslie G. Dodd
- Department of Pathology and Laboratory Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Pohlig F, Lenze U, Lenze FW, Mühlhofer H, Schauwecker J, Rechl H, von Eisenhart-Rothe R. [Biopsies from bone and soft tissue sarcoma : a nationwide survey in Germany]. DER ORTHOPADE 2013; 42:934-40. [PMID: 24145965 DOI: 10.1007/s00132-013-2175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY A biopsy is an essential step in the diagnostic cascade of malignant bone and soft tissue tumors. The objective is always the extraction of a representative tissue specimen in line with the approach for the definitive operation. The aim of this study therefore was to assess the diagnostic approaches regarding the biopsy of tumors in orthopedic centers in Germany. MATERIAL AND METHODS In total 60 hospitals with an orthopedic focus on tumors were contacted and provided with a newly developed questionnaire with 13 items regarding biopsy technique, indication criteria, execution, supportive imaging and histopathological results. Evaluation of the responses was performed by means of binary systems and proportional consent to every answer possibility was calculated. RESULTS The results of the questionnaire showed that open biopsies are performed in all centers and in 72 % of the hospitals percutaneous techniques are additionally applied. The most important criterion for an open or percutaneous procedure was the tumor location (80 %). The indications for either technique are assessed by a tumor orthopedic consultant in 68 % of the centers and special imaging is applied in 36 % of the institutions. The approach for the biopsy is defined by the orthopedic surgeon in 88 %. Percutanous biopsies are carried out by interventional radiologists in 60 % of the centers. Open biopsies are performed by residents under supervision by a tumor orthopedic consultant in 88 %. The histopathological results are discussed in 88 % of the hospitals in an interdisciplinary tumor board and in 64 % patients are informed about the diagnosis in an outpatient clinic. CONCLUSIONS Overall, biopsy of musculoskeletal tumors is performed according to the guidelines in most institutions. Only small differences were identified regarding the definition of the surgical approach and the application of imaging techniques during biopsy.
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Affiliation(s)
- F Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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Zhang S, Gong Y. From cytomorphology to molecular pathology: maximizing the value of cytology of lymphoproliferative disorders and soft tissue tumors. Am J Clin Pathol 2013; 140:454-67. [PMID: 24045541 DOI: 10.1309/ajcphdovgw64fipb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The field of cytopathology has been rapidly advancing in the era of molecular pathology and personalized medicine. On-site cytologic evaluation for adequacy and triaging specimens for small core biopsy or fine-needle aspiration (FNA) are often required. Cytopathologists face the challenge of how to best triage small specimens for diagnosis, molecular testing, and personalized treatment. Owing to its minimally invasive nature, FNA alone or combined with core biopsy for lymphoproliferative disorders and soft tissue tumors has gained popularity. METHODS Literature review and author's institutional experience are used for this review article. This article will focus mainly on lymphoproliferative disorders and soft tissue tumors. RESULTS Evaluation combining cytomorphology, immunohistochemistry, and/or molecular pathology is often needed to accurately diagnose and classify lymphomas and soft tissue tumors. Many molecular tests have been performed on cytologic specimens, such as tests for BRAF and RET in thyroid FNA. CONCLUSIONS Molecular pathology has been widely integrated into conventional cytopathology for diagnosing lymphoproliferative disorders and soft tissue tumors, and the diagnostic value of FNA on those tumors has increased significantly. Cytology will play a more important role in the era of personalized medicine.
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Affiliation(s)
- Songlin Zhang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, TX, and the Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Gong
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, TX, and the Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Chakrabarti S, Datta AS, Hira M. Critical Evaluation of Fine Needle Aspiration Cytology as a Diagnostic Technique in Bone Tumors and Tumor-like Lesions. Asian Pac J Cancer Prev 2012; 13:3031-5. [DOI: 10.7314/apjcp.2012.13.7.3031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
This article presents the use of bone cytology for diagnosis of bone tumors. It discusses critical factors and considerations of fine-needle aspiration and bone cytology and presents diagnostic options and differential diagnosis for benign and malignant bone lesions. Osteomyelitis, chrondroblastoma, Langerhans cell histiocytosis, chondromyxoid fibromas, enchondromas, giant cell tumor of bone, osteosarcoma, chondrosarcoma and variants, Ewing sarcoma, chordoma, plasmacytoma, multiple myeloma, lymphoma, and metastatic bone disease are presented.
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Affiliation(s)
- Diana M Cardona
- Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, USA
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Neihaus SA, Locke JE, Barger AM, Borst LB, Goring RL. A Novel Method of Core Aspirate Cytology Compared to Fine-Needle Aspiration for Diagnosing Canine Osteosarcoma. J Am Anim Hosp Assoc 2011; 47:317-23. [DOI: 10.5326/jaaha-ms-5676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is little information in veterinary literature regarding the diagnostic accuracy of aspirate cytology for the diagnosis of canine osteosarcoma (OSA). The authors compared the diagnostic accuracy of a novel method of cytologic collection, termed core aspirate cytology (CA), with fine needle aspiration (FNA) and histopathology in 27 dogs with lytic and/or proliferative bone lesions. Alkaline phosphatase (ALP) staining was performed to confirm the diagnosis of OSA cytologically. OSA was accurately diagnosed in 85% and 95% of FNA and CA, respectively. ALP staining was 100% sensitive for the diagnosis of OSA. CA using a bone marrow biopsy needle allowed for penetration of cortical bone and aspirate cytology with a larger bore needle than FNA; however, there was no significant difference in diagnostic accuracy between techniques. Aspirate cytology with ALP staining was a safe, accurate, and minimally invasive diagnostic test for the evaluation of suspected OSA lesions in dogs.
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Affiliation(s)
- Steven A. Neihaus
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); Southeast Veterinary Oncology, Orange Park, FL (J.L.); Department of Veterinary Pathology, University of Illinois, College of Veterinary Medicine, Urbana, IL (A.B.); and Department of Population Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, NC (L.B.)
| | - Jennifer E. Locke
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); Southeast Veterinary Oncology, Orange Park, FL (J.L.); Department of Veterinary Pathology, University of Illinois, College of Veterinary Medicine, Urbana, IL (A.B.); and Department of Population Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, NC (L.B.)
| | - Anne M. Barger
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); Southeast Veterinary Oncology, Orange Park, FL (J.L.); Department of Veterinary Pathology, University of Illinois, College of Veterinary Medicine, Urbana, IL (A.B.); and Department of Population Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, NC (L.B.)
| | - Luke B. Borst
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); Southeast Veterinary Oncology, Orange Park, FL (J.L.); Department of Veterinary Pathology, University of Illinois, College of Veterinary Medicine, Urbana, IL (A.B.); and Department of Population Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, NC (L.B.)
| | - Robert L. Goring
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); Southeast Veterinary Oncology, Orange Park, FL (J.L.); Department of Veterinary Pathology, University of Illinois, College of Veterinary Medicine, Urbana, IL (A.B.); and Department of Population Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, NC (L.B.)
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Walther C, Domanski HA, von Steyern FV, Mandahl N, Mertens F. Chromosome banding analysis of cells from fine-needle aspiration biopsy samples from soft tissue and bone tumors: is it clinically meaningful? Cancer Genet 2011; 204:203-6. [DOI: 10.1016/j.cancergen.2011.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 01/08/2011] [Accepted: 01/21/2011] [Indexed: 02/08/2023]
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Giusti L, Iacconi P, Lucacchini A. Fine-needle aspiration for proteomic study of tumour tissues. Proteomics Clin Appl 2011; 5:24-9. [PMID: 21246744 DOI: 10.1002/prca.201000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/08/2010] [Accepted: 11/08/2010] [Indexed: 12/18/2022]
Abstract
Fine-needle aspiration (FNA) is a technique largely applied in the diagnosis of tumours. FNA is a safe diagnostic procedure that is widely employed in the examination of masses at relatively low cost and minimal risk to the patient. In this review, we report on the state-of-the-art and the potential role of FNA to search for protein biomarkers by the proteomic approach.
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Affiliation(s)
- Laura Giusti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
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Rahman K, Asif Siddiqui F, Zaheer S, Sherwani MKA, Shahid M, Sherwani RK. Intraoperative cytology-Role in bone lesions. Diagn Cytopathol 2010; 38:639-44. [DOI: 10.1002/dc.21260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Layfield LJ, Dodd LG, Hirschowitz S, Crabtree SN. Fine-needle aspiration of primary osseous lesions: A cost effectiveness study. Diagn Cytopathol 2010; 38:239-43. [PMID: 19795486 DOI: 10.1002/dc.21172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fine-needle aspiration (FNA) is not widely used in the work-up of osseous lesions because of concerns regarding its high incidence of nondiagnostic specimens. Although several studies have shown that FNA is less expensive than surgical biopsy, the authors are aware of only one prior study evaluating the cost effectiveness of FNA, which includes the cost of incisional or core needle biopsies necessary to establish a diagnosis when the initial FNA was noncontributory. A computerized search of the pathology records of three medical centers was performed to obtain all FNAs of primary osseous lesions. For each FNA case, all subsequent core needle, incisional or excisional biopsies were recorded as was the result of the definitive operative procedure. The cost of obtaining the definitive diagnosis was calculated for each case including the cost of FNA, imaging guidance utilized, and cost of subsequent surgical biopsy when necessary. The cost of an alternate approach using only surgical biopsy was calculated. The average per patient costs of these two protocols were compared.A total of 165 primary bone tumors underwent FNA. One hundred six of these yielded a definitive cytologic diagnosis. In 59 cases, FNA yielded a result insufficient for definitive therapy necessitating surgical biopsy. FNA investigation of the 165 bone lesions cost 575,932 (average of 3,490 per patient). Surgical biopsy alone would have cost 5,760 per patient. FNA resulted in a cost savings of 2,215 per patient.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology, University of Utah Medical Center, Salt Lake City, UT 84112, USA.
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Khalbuss WE, Teot LA, Monaco SE. Diagnostic accuracy and limitations of fine-needle aspiration cytology of bone and soft tissue lesions: a review of 1114 cases with cytological-histological correlation. Cancer Cytopathol 2010; 118:24-32. [PMID: 20091838 DOI: 10.1002/cncy.20058] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) cytology is increasingly being used as a diagnostic modality for soft tissue and bone lesions. These diagnoses can be challenging because of a variety of factors, including interpretation and sampling issues. This study investigates the diagnostic utility of FNA biopsy, in addition to the diagnostic pitfalls, in soft tissue and bone cytopathology. METHODS We retrospectively reviewed the soft tissue and bone FNAs over a 4-year period (2004-2008), along with available ancillary studies, pathological follow-up, and clinical data. The cases with a cytologic-histologic discrepancy were then reviewed. RESULTS A total of 1114 soft tissue and bone FNAs were identified. Of the 1114 aspirates, 525 (47%) were positive for malignant cells, 505 (45.5%) were benign aspirates (including 189 benign lesions/neoplasms), 37 (3.5%) were inadequate, 34 (3%) had atypical cells, and 13 (1%) were suspicious for malignancy. Of the 586 cases (53%) with follow-up, including 445 cases with histological follow-up and 141 with ancillary studies, the overall sensitivity was 96%, the specificity was 98%, the positive predictive value was 99%, and the negative predictive value was 92%. A total of 15 false negatives and 3 false positives were identified with errors because of sampling (9 cases), interpretation (7 cases), and screening (2 cases). CONCLUSIONS This large series demonstrates that there can be a high sensitivity and specificity in diagnosing bone and soft tissue lesions by FNA. Our data supports prior studies in the literature in showing that FNA cytology can be a valuable method for diagnosing these lesions.
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Affiliation(s)
- Walid E Khalbuss
- Department of Pathology, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania 15232, USA.
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