Fine Needle Aspiration Cytology for Soft Tissue Tumours of the Hand

Optimal Treatment for Tenosynovial Giant Cell Tumor of the Hand

This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.

Role of FNAC in diagnosing lesions of hand and wrist

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.

Diagnostic accuracy and clinical utility of biopsy in musculoskeletal lesions: a comparison of fine-needle aspiration, core, and open biopsy techniques

Selection of biopsy technique for musculoskeletal lesions is complex. Fine-needle aspiration (FNA) is uncommonly used due to concerns regarding accuracy. We compared diagnostic accuracy of FNA, core, and open biopsy in a series of musculoskeletal lesions. Records of the University of Utah were searched for biopsy and resection specimens of musculoskeletal lesions. Results of corresponding imaging studies were obtained. Biopsy and FNA diagnoses were correlated with resection diagnoses. For each technique, diagnostic accuracy, utility, and frequency of subsequent biopsy were calculated. Open biopsy had the highest diagnostic accuracy (89%) followed by FNA (82%) and core biopsy (78%). Clinically significant errors occurred with all methods. The likelihood of an open biopsy being performed was affected by prior performance of an FNA or core biopsy and by diagnostic imaging and FNA results.

Diagnostic accuracy and limitations of fine-needle aspiration cytology of bone and soft tissue lesions: a review of 1114 cases with cytological-histological correlation

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.

Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases

We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.

Biopsy of hand, wrist, and forearm tumors

This article describes three biopsy methods currently used for treating masses arising in the hand, wrist, and forearm: open biopsy, fine needle aspiration, and core needle biopsy. The forearm, wrist, and hand comprise a complex and diverse anatomic region, and biopsy is emphasized as the most important element in the diagnosis of the musculoskeletal tumor. Biopsy methods for assessing true neoplasms, bony protuberances, cysts,infection and abscesses, foreign bodies, reactive granulomas, tenosynovial proliferation,and skin and fascial lesions are discussed.