Fine needle aspiration (FNA) of bone tumours: with special emphasis on definitive treatment of primary malignant bone tumours based on FNA

Effectiveness of histology and cytology on musculoskeletal tumor diagnosis

OBJECTIVE:

To compare cytology and histology on the diagnosis of musculoskeletal neoplasms.

METHOD:

Fifty eight cases available to evaluation were analyzed both by cytology and histology. The results of the biopsies studied by histology and cytology were compared to the results obtained on the surgical specimen or immunohistochemistry. We determined the percentage of correct results, sensitivity, specificity, positive and negative predictive values and accuracy of each method.

RESULTS:

Twelve per cent of biopsies were inconclusive by cytology. The percentage of correct diagnosis was 70.7% and 81% (p=.179), the ability to differentiate benign lesions from malignant ones was 84.5% and 93.1% (p=0.18) respectively, for cytology and histology. Cytology showed sensitivity of 87.8%, specificity of 76.5%, positive predictive value of 90%, negative predictive value of 72% and accuracy 84.5%. Histology showed sensitivity of 90.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81% and accuracy of 93.1%. The Youden index for cytology was 64.3% and for histology it was 90.2%.

CONCLUSION:

Despite promising, cytology obtained by thin needle aspiration is less accurate and reliable than the histological evaluation on musculoskeletal tumors diagnosis.

Level of Evidence II, Diagnostic Studies.

Cytological diagnosis of osteoblastoma of cervical spine: a case report with review of literature

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.

Cytodiagnosis of benign fibrous histiocytoma of rib and diagnostic dilemma: a case report

Benign fibrous histiocytoma (BFH) of bone is rare in occurrence, and rib is an unusual site. There are limited case reports of this entity in the literature, and cytodiagnosis of this tumor is not described. A 24-year-old man presented with a firm mass and pain in the right lateral chest wall. Radiological investigations (plain radiograph and computed tomography) revealed a lytic bone lesion involving the 5th rib. Radiologically, giant cell tumor (GCT), BFH, and plasmacytoma were suspected. In fine-needle aspiration cytology (FNAC), admixture of benign stromal cells and scattered osteoclast type giant cells were found in the smears. Differential diagnoses of BFH, GCT (non-epiphyseal type), fibrous dysplasia, and aneurysmal bone cyst were made on cytology. Subsequent histologic examination confirmed the diagnosis of BFH. Cytologic diagnosis of BFH of rib is difficult as this tumor may mimic other giant cell containing tumors of bone in FNAC. The final diagnosis should always be made after correlation with histological, radiological, and clinical features.

Combined radiology and cytology in the diagnosis of bone lesionsA retrospective study of 370 cases

BACKGROUND

Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied.

PATIENTS AND METHODS

We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied.

RESULTS

Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%.

INTERPRETATION

Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.

Fine-needle aspiration of primary osteosarcoma: A cytological-histological study

This study aims to determine the diagnostic accuracy of fine-needle aspiration (FNA) evaluation of primary osteosarcoma (OS) and to review diagnostic criteria and adjunctive methods that can contribute to a confident diagnosis of OS in cytological smears. We evaluated FNA smears of OS in 59 patients for the following: cytomorphology and occurrence of osteoid, usefulness of adjunctive methods in evaluation of FNA smears and correspondence of FNA to the clinical data, and the histological features of excised tumors. Reliable cytological criteria of malignancy were found in 49 smears of high-grade OS. These criteria, correlated with radiographic studies and complemented by ancillary techniques, allowed diagnosis of OS or suspicion of OS in 44 cases. An additional four smears were diagnosed as sarcoma and one case was diagnosed erroneously as being carcinoma metastasis. There were no false positive or false negative diagnoses. We conclude that FNA smears from high-grade OS have characteristic features, which together with clinical and radiological data and ancillary studies allow correct diagnosis in most tumors.

Alarming wear of the first-generation polyethylene liner of the cementless porous-coated Biomet Universal cup: 107 hips followed for mean 6 years

Wear of the socket liner and resulting osteolysis are the major causes of failure in cementless hip arthroplasties. We report alarming wear of the first-generation polyethylene liner of the cementless porous-coated Biomet Universal cup. Radiographs of 107 primary hip arthroplasties were analyzed retrospectively. The mean follow-up time was 74 (47-91) months. The linear wear of the polyethylene liners was assessed using a modification of the Livermore method. The median linear wear was 1.0 (0-6.2) and the median linear wear rate was 0.17 mm/year. There was a statistically significant difference between the 28 mm and 32 mm femoral head groups both in the volumetric wear and in the volumetric wear rate. The median linear wear was 0.28 mm/year and 0.14 mm/year for the 32 mm and 28 mm heads, respectively. So far, 14 revisions have been performed or have been scheduled because of excessive wear of the polyethylene liner. In regression analysis, the factors related to the wear rate were the 32 mm size of the femoral head and screw fixation of acetabular shell. We found that the cases with calcar rounding were associated with significantly greater wear. Possible reasons for increased wear of the Hexloc liner may be the cylindrical design, thin polyethylene, and poor quality of the polyethylene. Regular clinical and radiographic follow-ups are recommended especially for hips with 32 mm femoral heads or with screw fixation. If progressive wear of the liner is observed, revision must be considered.