Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses

Sensitivity of cytology in the diagnosis of paediatric malignancies in Nigeria

BACKGROUND

Prompt and accurate diagnosis of solid malignant childhood neoplasms requires ancillary diagnostic techniques to supplement clinical acumen. This study aims to assess the role and sensitivity of Fine Needle Aspiration Cytology (FNAC) as a tool to meet these needs in a developing country like Nigeria.

MATERIALS AND METHODS

Primary working diagnosis and cytological reports for all solid malignant neoplasms in children over a 4-year period were extracted from archives. These were then compared with histological diagnosis and/or response to therapy and clinical versus cytological sensitivity calculated.

RESULTS

Clinical sensitivity for head/neck vs. abdominal cavity malignancies was (83% vs. 46%) compared with cytological sensitivity (100% vs. 90%). Cytological positive predictive value for malignancy at all sites was 100%.

CONCLUSION

This study concludes that FNAC should be included in the routine investigation of these tumours in view of its high sensitivity and positive predictive value for malignancy.

Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer

Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of the pancreas allows the diagnosis of pancreatic cancer to be established without exploratory surgery. We reviewed our recent experience with EUS-FNA in patients with presumed pancreatic cancer and report the diagnostic accuracy and complications of this procedure. Data were reviewed from all patients who presented with CT evidence of a pancreatic mass or a malignant biliary stricture and underwent EUS-FNA at our institution between November 1, 1999, and October 1, 2001. Based on the findings of contrast-enhanced, multislice CT scanning, patients were categorized as having resectable, locally advanced, or metastatic disease. EUS-FNA was performed in 233 patients. A final diagnosis of cancer was established in 216 patients (93%), 15 patients (6%) were found to have benign disease, and the final diagnosis remains unknown in two patients (1%). The sensitivity, specificity, and accuracy of EUS-FNA for diagnosis of a pancreatic malignancy were 91%, 100%, and 92%, respectively. For the 216 patients subsequently proven to have cancer, the results of EUS-FNA were diagnostic in 197 (91%); 96 (90%) of 107 patients with resectable disease, 62 (97%) of 64 with locally advanced disease, and 39 (87%) of 45 with metastatic disease. Four patients (2%) developed a clinically apparent complication that required hospital admission, including two patients who required surgery for duodenal perforation. There were no EUS-related deaths. We conclude that EUS-FNA can safely and accurately establish a cytologic diagnosis in patients with both early-stage and advanced pancreatic cancer. This enables consideration of all treatment options including protocol-based therapy.

Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery

OBJECTIVE

Organ preserving pancreatic resections are considered whenever malignant disease is ruled out. In tumors of low malignant potential such as cystadenomas and neuroendocrine tumors, the diagnosis is rarely established preoperatively. We studied the feasibility of cytodiagnosis using endosonography-guided fine-needle aspiration in determining the operative approach.

METHODS

A total of 78 patients (16 female, 62 male; mean age 61.4 yr, range 31-82 yr) with focal pancreatic lesions underwent EUS-FNA. Final diagnosis was confirmed by histology, cytology, or clinical follow up (>9 months). Patients with tumors of low malignant potential were managed by customized pancreatic resections.

RESULTS

Final diagnosis was malignant tumors in 36 patients, tumors of low malignant potential in nine (six, neuroendocrine, two, borderline mucinous cystadenomas, one, borderline adenocarcinoma), and benign in 31 (two inadequate smears). No complications occurred. With six false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 92%, 84%, 100%, 100%, and 86%, respectively. Five patients with low malignant tumors underwent duodenum-preserving pancreatic head resection, three mid segment resection, and one pylorus-preserving pancreatoduodenectomy.

CONCLUSIONS

EUS-FNA is useful in the preoperative cytodiagnosis of pancreatic tumors of low malignant potential. It extends the indication for organ-preserving pancreatic resections and avoids the unnecessary sacrifice of adjacent organs.

Non-imaging-guided fine-needle aspiration of liver lesions: a retrospective study of 279 patients

AIM To determine the value of nonimaging-guided (direct) fine-needle aspiration cytology in diagnosing liver lesions.

METHODS Detection by technetium-99 m, ultrasound or computed tomographic scanning of the liver was made in 279 patients with 332 aspirations.

RESULTS Based on histologic, cytologic and clinical findings, final liver diagnoses were reached in 265 patients, of whom 171 had malignant and 94 benign liver disease. Among the 171 patients with malignant liver disease, the cytologic findings indicated suspected malignancy in 8 patients, suggested definite malignancy in 130, but failed to disclose malignancy in 33 patients. In 93 of the 94 patients with benign liver disease, the cytologic findings were repo rted as benign, while in one patient the report of malignancy was false. The overall sensitivity, specificity, and positive and negative predictive values for cytologic results were 80.7%, 98.9%, 99.3% and 73.8%, respectively. The diagnostic accuracy of fine-needle aspiration cytology was 87.2%. The only major complication attributable to the procedure consisted of one case of pneumothorax.

CONCLUSION Direct fine-needle aspiration of palpable liver mass and blind fine-needle aspiration of non-palpable liver lesions for cytodiagnosis are simple, safe, and cost-effective diagnostic method for evaluating the nature of liver lesions. The aspiration procedure including potential complications could be cut short by early finding of abnormal cells.

Diagnostic workup of patients with suspected pancreatic carcinoma: the University of California-Los Angeles approach

BACKGROUND

A large number of diagnostic procedures (e.g., ultrasound, computed tomography [CT] scan, fine-needle aspiration [FNA], angiography, endoscopic retrograde cholangiopancreatography [ERCP], and laparoscopy), are available to the clinician as he/she pursues the workup of patients who are thought to have a pancreatic (periampullary) malignancy. Not all of these procedures should be used in every patient and some have been overused.

METHODS

Based on a current literature review and their own experience, the authors describe the rationale of the diagnostic workup in patients with suspected pancreatic carcinoma in a single institution (a university medical center).

RESULTS

Helical CT scan provides the best overall assessment of patients with periampullary malignancies, and it is often the only test required. If the patient's history and blood test abnormalities suggest pancreatic carcinoma and the helical CT scan shows a mass in the head of the pancreas that appears to be resectable, the patient should be prepared for surgery. If no mass is apparent on the helical CT scan, a diagnostic ERCP is indicated. If microscopic proof of the diagnosis will avoid surgery, then an FNA for cytology should be performed. When unresectability appears likely and cannot be confirmed in less invasive ways, laparoscopy is indicated.

CONCLUSIONS

In patients with periampullary malignancies, helical CT scan provides the best overall assessment. Guidelines are presented for the selective use of ultrasound, FNA, ERCP, and laparoscopy, which are important for the most cost-effective workup of these patients.

The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma

BACKGROUND

Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) of pancreatic lesions is being increasingly used. Our aim was to determine the safety, accuracy, and clinical utility of EUS-guided FNA in both the diagnosis and staging of pancreatic cancer.

METHODS

Forty-four patients (24 men/20 women) had EUS-guided FNA of pancreatic lesions (39 head/neck, 5 body, 3 tail) and/or associated lymph nodes. The mean age was 61 (range, 28 to 88 years). The indication for EUS-guided FNA was a pancreatic lesion seen initially on CT (39%), ERCP (43%), or EUS (18%). Follow-up data were collected on all patients for mean of 14.5 months (range 1 to 33 months).

RESULTS

CT detected only 15 of 61 (25%) focal lesions seen by EUS, Adequate specimens were obtained by EUS-guided FNA in 44 of 47 (94%) pancreatic lesions and 14 of 14 (100%) associated lymph nodes (overall adequacy was 95%). Of the 46 lesions in which specimens were adequate and a final diagnosis was available (32 malignant, 14 benign), EUS-guided FNA had a sensitivity of 92%, specificity of 100%, and diagnostic accuracy of 95% for pancreatic lesions and 83%, 100%, and 88% for lymph nodes, respectively. Six percent of pancreatic cases had inadequate specimens and, if included, lowered the sensitivity to 83%, specificity to 80%, and diagnostic accuracy to 88% for pancreatic lesions. In 3 patients with enlarged celiac nodes on EUS, EUS-guided FNA was able to make a tissue diagnosis of metastasis, which changed the preoperative staging and precluded surgery. EUS in combination with EUS-guided FNA precluded surgery in 12 of 44 (27%) and may have precluded surgery in an additional 6 of 44 (14%). EUS-guided FNA avoided the need for further diagnostic tests, thus expediting therapy in a total of 25 (57%) patients and influenced clinical decisions in 30 of 44 (68%) patients. The estimated cost savings based on surgeries avoided was approximately $3300 per patient. There was only one complication (2%), a post-FNA fever.

CONCLUSION

EUS-guided FNA of the pancreas appears to be a safe and effective method that increases both the diagnostic and staging capability of EUS in pancreatic cancer. The clinical impact of EUS-guided FNA includes avoiding surgery and additional imaging studies with a substantial cost savings.