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

Pathology of Liver Metastases

BACKGROUND

The liver is the most frequent site of metastatic disease, and metastatic disease to the liver is far more common than primary liver carcinoma in the United States. Pathologic evaluation of biopsy samples is key to establishing a correct diagnosis for patient management. Morphologic and immunoperoxidase studies, which are the standard for pathologic practice, accurately classify most tumors. Subclassification of carcinoma of unknown primary remains problematic.

METHODS

The author reviewed the literature for articles pertaining to liver biopsy, diagnosis of specific tumor types, utility of immunohistochemical markers, and microarray and proteomic analysis.

RESULTS

Sampling of liver lesions is best accomplished by combining fine-needle aspiration and needle core biopsy. Many malignancies have distinct morphologic and immunohistochemical patterns and can be correctly subclassified. Adenocarcinoma of unknown primary remains enigmatic since current immunohistochemical markers for this differential diagnosis lack specificity. Microarray analysis and proteomic analysis of tumors can provide distinct gene or protein expression profiles, respectively, for tumor classification. These technologies can be used with fine-needle aspiration and needle core biopsy samples.

CONCLUSIONS

Most metastatic malignancies in the liver may be correctly diagnosed using standard morphology and immunohistochemical techniques. However, subtyping of some carcinomas and identification of site of unknown primary remains problematic. New technologies may help to further refine our diagnostic capabilities.

Comparison of Ultrasound-Guided Core Needle Biopsy and Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Solid Pancreatic Lesions

OBJECTIVES

The objective of our study was to compare the diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using a 25-gauge needle and ultrasound (US)-guided core needle biopsy (CNB) using an 18-gauge core needle for diagnosis of solid pancreatic lesions.

METHODS

This retrospective study was approved by our Institutional Review Board, and the requirement for informed consent was waived. Patients who underwent either EUS-guided FNA or US-guided CNB for a solid pancreatic lesion from January 2008 to December 2012 were included and reviewed. Fine-needle aspirations and CNBs were performed by experienced endoscopists and radiologists. The diagnostic yield, accuracy, technical failure rate, sensitivity, and specificity for malignancy were calculated and compared.

RESULTS

A total of 106 biopsy attempts were undertaken in 89 patients (EUS-guided FNA, n = 70; US-guided CNB, n = 36). Biopsy specimens were successfully obtained in 98 biopsy attempts (EUS-guided FNA, n = 63; US-guided CNB, n = 35). The accuracy, technical failure rate, sensitivity, and specificity of EUS-guided FNA for malignancy (73.02%, 10.00%, 77.78%, and 44.44%, respectively) was not significantly different from those of US-guided CNB (88.57%, 2.78%, 87.10%, and 100%, respectively; P ≥ .089). Diagnostic performance did not differ between the modalities according to the size and the location of the lesion in the pancreas. However, the diagnostic yield of US-guided CNB (86.11%) was higher than that of EUS-guided FNA (65.71%, P = .035).

CONCLUSIONS

The diagnostic yield of US-guided CNB for solid pancreatic lesions is superior to that of EUS-guided FNA.

CT-guided biopsy of lesions of the lung, liver, pancreas or of enlarged lymph nodes: value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in an offsite pathologist setting

RATIONALE AND OBJECTIVES

To assess the value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in computed tomography-guided biopsy of lesions of the lung, liver, pancreas, or of enlarged lymph nodes in an offsite cytopathologist setting.

MATERIALS AND METHODS

This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by the Institutional Review Board (IRB); informed consent (IC) was waived. Data of 377 patients who underwent computed tomography-guided FNA and CNB of lesions of the lung, liver, pancreas, or enlarged lymph nodes were enrolled. An onsite cytopathologist was not available. Sensitivity and specificity were calculated for FNA, CNB, and combined FNA/CNB. For the purpose of our study, positive diagnoses from CNB specimens or subsequent biopsy or surgical resection specimens or clinical follow-up data were considered as the standard of reference.

RESULTS

CNB yielded a significantly higher sensitivity than FNA in all sites, except the pancreas, where the difference did not reach statistical significance. Additional FNA to CNB did not significantly increase the sensitivity. Specificity did not significantly differ between FNA, CNB, and combined FNA/CNB in all sites. Malignancies of 1.7% were detected only with FNA, without evidence of malignancy in CNB; for the remaining malignancies, CNB was positive or indeterminate.

CONCLUSION

Additional FNA to CNB without an onsite cytopathologist does not yield higher sensitivity or specificity compared to CNB alone.

Fine-needle trucut biopsy versus fine-needle aspiration cytology with ultrasound guidance in the abdomen

Historically, fine-needle aspiration cytology (FNAC) has varying sensitivity, specificity and accuracy in the diagnosis of abdominal lesions with a high insufficient sampling rate. We compared 20-G fine-needle trucut biopsy (FNTB) with FNAC results in the biopsy of solid abdominal tumours. A retrospective review of 171 (128x 20-G FNTB and 43x FNAC) ultrasound-guided biopsies of abdominal tumours on 157 patients (male : female 85:72, mean age 61.25 years) were carried out. One hundred and seventy-one biopsies were carried out: liver 109, pancreas 19, lymph node 10, omentum 5, right iliac fossa mass 6, adrenal 6 and others 16. An average of 2.06 and 1.97 passes (range 1-4) were carried out per FNTB and FNAC, respectively. A definitive diagnosis was made in 122/128 biopsies (95.3%) and 32/43 biopsies (74.4%) for FNTB and FNAC, respectively. Diagnoses consisted of metastatic liver disease (74/171), pancreatic adenocarcinoma (10/171), lymphoma (8/171) and others (33/171) and benign (29/171). No significant complications occurred in either group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87, 100, 100, 50, 84.4 and 93.1, 100, 100, 60, 71.4 for FNTB and FNAC, respectively. A greater and more consistent positive diagnosis rate is yielded by 20-G FNTB (95.3%) than FNAC (74.4%). The diagnostic accuracy of FNTB is 84.4% compared with 69.8% for FNAC. A greater insufficient sampling rate occurs with FNAC (25.6%) than with FNTB (4.7%). For abdominal biopsy, 20-G FNTB needles have a much higher yield than FNAC with no increase in complications. FNTB is the preferred choice, particularly where cytological assistance at the time of biopsy is unavailable.

CT-guided core needle biopsy in the diagnosis of pancreatic diseases with an automated biopsy gun

PURPOSE

To evaluate the safety and diagnostic accuracy of computed tomographic (CT)-guided core needle biopsy (CNB) in the diagnosis of pancreatic diseases by using an automated biopsy gun with a cutting-type needle.

MATERIALS AND METHODS

From January 2000 to January 2006, CT-guided CNB was performed in 80 patients suspected of having pancreatic diseases in the absence of liver metastasis. Biopsies were performed with an 18-20-gauge cutting needle driven by a spring-loaded biopsy gun. Histologic reports and medical records of all patients were retrospectively reviewed. An institutional review board exemption was obtained to perform this retrospective study.

RESULTS

All patients tolerated the biopsies well, with no serious complications. Three patients had mild abdominal pain after the procedure, and a limited abdominal CT scan did not reveal any marked abnormality. Two patients had an elevated serum amylase level, which returned to normal within 2 weeks. A definitive diagnosis and accurate histologic diagnosis were obtained for 69 patients, for a successful diagnosis rate of 86%. Surgical sampling was performed in 11 patients with neoplasms and nondiagnostic core-needle biopsies. Only 50% of patients with well-differentiated adenocarcinomas were definitely diagnosed with CT-guided CNB.

CONCLUSIONS

CT-guided CNB with an automated biopsy gun is a safe and effective method for obtaining tissue for the histologic evaluation of pancreatic diseases. However, CT-guided CNB requires further development for the accurate diagnosis of well-differentiated adenocarcinomas.

Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions

AIMS

To compare the sensitivity and specificity of percutaneous fine needle aspiration (FNA) cytology and needle core biopsy (NCB) in the diagnosis of suspected intra-abdominal tumours.

METHODS

One hundred and forty one consecutive patients who underwent radiologically guided combined FNA/NCB of abdominal lesions over a four year period were reviewed. The diagnostic accuracy of both techniques and the value of rapid staining and assessment of cytological preparations were assessed.

RESULTS

FNA cytology and NCB identified 111 of 129 (86%) and 104 of 129 (80.6%) malignant lesions, respectively; in combination, the sensitivity increased to 90.7%. The diagnostic specificity was 100% for both methods, although one case of phaeochromocytoma was misinterpreted as undifferentiated carcinoma on biopsy. More accurate tumour subtying was possible in two cases with FNA and four cases on NCB. The series included 12 benign lesions, of which 11 and nine were accurately identified on FNA and NCB, respectively. Two specific benign diagnoses (Budd-Chiari syndrome and hepatic infarct) were made only on biopsy. The use of rapid assessment cytology preparations ensured that appropriate samples were submitted for microbiology in three liver abscesses, and provided an accurate cytological diagnosis at the time of the procedure in 103 of 141 (73%) cases. None of the patients suffered biopsy related complications.

CONCLUSIONS

FNA cytology is more sensitive and accurate than NCB in the diagnosis of abdominal lesions, and also offers more rapid diagnosis. However, the combination of these sampling techniques increases diagnostic sensitivity and occasionally provides more accurate classification of tumours and benign lesions. The techniques should be considered complementary in the investigation of abdominal lesions.

Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study

OBJECTIVE

The aim of this study was to investigate the results of ultrasound-guided fine needle biopsy of pancreatic masses in a large multicenter series.

METHODS

This study collected the data of 510 patients who had a final diagnosis available and who had undergone ultrasound-guided fine needle biopsy of the pancreas. Retrieval rate, sensitivity, specificity, and overall diagnostic accuracy of the whole series, by three different bioptic procedures (cytology, histology, and cytology plus histology) were evaluated. The reliability of ultrasound-guided fine needle biopsy to allow a correct diagnosis in the different pancreatic pathologies was calculated. Finally, any complications were collected.

RESULTS

For cytology, histology, and cytology plus histology, retrieval rate values were: 94%, 96%, and 97%; sensitivity was: 87%, 94%, and 94%, specificity: 100%; and diagnostic accuracy: 91%, 90%, and 95%, respectively. Ultrasound-guided fine-needle biopsy correctly diagnosed all the cases of pancreatic metastases or non-Hodgkin's lymphoma (23 of 510 cases as 5%; in eight of 23 it led to the first diagnosis of the primary tumor) and all the cases of abscesses, 97% of the cases of pseudocysts, 86% of pancreatic adenocarcinomas, 62% of cystic neoplasms, 35% of the cases of chronic pancreatitis (in this case, the bioptic procedures were reviewed), and 33% of neuroendocrine tumors. There were complications in one case of asymptomatic peripancreatic hematoma, three cases of vaso-vagal reactions, and 21 cases of pain.

CONCLUSION

Ultrasound-guided fine needle biopsy of the pancreas is efficacious, without any difference between the various bioptic modalities (with the exception of chronic pancreatitis, in which histology is better). The technique is safe. Moreover, the procedure allows the identification of patients affected by pancreatic tumors other than adenocarcinoma (in our survey 5% of the total); in about one third of these patients it leads to the diagnosis of the primary tumor, thus avoiding inappropriate treatments.

Aspects of percutaneous fine-needle aspiration biopsy in the diagnosis of pancreatic carcinoma

BACKGROUND

Morphologic verification of malignancy is usually a prerequisite before initiating nonsurgical therapy for pancreatic carcinoma. Fine-needle biopsy has been widely used, but the method has also been criticized because of inadequate sampling material and the risk of intra-abdominal seeding.

METHODS

Cytologic material from 334 patients with suspected pancreatic malignancy was evaluated with regard to the sensitivity, specificity, and overall accuracy of the technique. The outcome (positive versus negative yield of cancer cells) was also entered in a Cox bivariate regression analysis and tested against multiple prognostic variables.

RESULTS

In all, 270 patients had malignant disease, which was verified cytologically in 187. The sensitivity, specificity, and accuracy were 69%, 100%, and 75%, respectively. Statistically significant prognostic factors with regard to patient survival time were type of therapy (P <0.001), tumor location (P <0.001), jaundice (P <0.001), pain (P <0.001), and palpable mass (P <0.05).

CONCLUSION

Fine-needle aspiration biopsy is still found to be a safe and feasible method for diagnosing pancreatic cancer, providing the requisite diagnostic information before initiating nonsurgical therapy.