Fine needle aspiration cytology

Comparison of Fine-Needle Aspiration and Core Needle Biopsy for the Pre-Operative Diagnosis of Canine and Feline Mammary Gland Tumours

Mammary gland tumours are common neoplasms that affect female dogs and cats. We compared the accuracy of pre-surgical fine-needle aspiration (FNA) and core needle biopsy (CNB) diagnosing feline (n = 64) and canine (n = 83) mammary gland tumours with excisional histopathology as the gold standard for the definitive diagnosis. We also explored the impact of CNB needle sizes (18G and 16G). FNA, 18G CNB and 16G CNB demonstrated similar accuracy regarding the diagnosis of feline mammary tumours, ranging from 90% to 97.7% (p > 0.05). However, these techniques displayed lower diagnostic accuracy for canine mammary gland tumours: 46.7%-50.9% for FNA, 63.3% for 18G CNB and 73.6% for 16G CNB. In conclusion, FNA and CNB can be used optionally as pre-surgical diagnostic methods for feline and canine mammary gland tumours. However, factors that affect diagnostic accuracy, such as species and diagnostic techniques, should be considered.

Development and characterization of a disposable submillimeter fiber optic Raman needle probe for enhancing real-time in vivo deep tissue and biofluids Raman measurements

We report on the development and characterization of disposable submillimeter fiber optic Raman needle probe for enhancing real-time in vivo tissue and biofluids Raman measurements. The submillimeter Raman probe is designed and fabricated using an aluminum-coated multimode fiber tapered with a semispherical lens, resulting in the coaxial laser excitation/Raman collection configuration for maximizing tissue and biofluid Raman measurements. We demonstrate that, with the use of the Raman needle probe associated with the structured background subtraction algorithms developed, high quality tissue Raman spectra covering both the fingerprint (FP) (800-1800cm^-1) and high-wavenumber (HW) (2800-3300cm^-1) regions can be acquired within subseconds from different tissue types (e.g., skin, muscle, fat, cartilage, liver, and brain) and biofluids (e.g., blood, urine). By advancing the Raman needle probe into the murine brain tissue model, high quality depth-resolved deep tissue Raman spectra can also be acquired rapidly. This work shows that the submillimeter fiberoptic Raman needle probe is capable of achieving real-time collection of deep tissue and biofluids FP/HW Raman spectra with high signal to noise ratios. This opens a new avenue with dual functioning of Raman optical biopsy and fine needle aspiration biopsy for enhancing in vivo deep tissue and biofluids diagnosis and characterization in different organs.

Cytopathology practice in Kumasi: A 2-year retrospective audit

Aim:

Surgical pathology service is generally unavailable in most developing countries and comes with challenges. Cytopathology is a reliable, inexpensive adjunct to surgical histopathology. We present a retrospective review of the various cytopathology cases received at the department.

Materials and Methods:

A retrospective review of 836 cytopathology cases from January 2010 to December 2011 at the Department of Pathology of our hospital was conducted. All cytopathology reports and records from the department were retrieved and analyzed using the Statistical Package for the Social Sciences version 16 for windows.

Results:

A total of 836 (mean age 38.18 ± 22.18) cases were reviewed, at an average of approximately 418 cases performed a year (5.7% of the total workload). More than half (58.0%) of the cases received had no clinical diagnosis indicated on request forms. Seventy-seven percent (77%) of the cases were diagnosed as either definite or nondefinite. The breast was the most aspirated specimen site (20.2%). Benign cases formed 45.0% of all the cases and 29.0% were malignant. There were more benign than malignant cases with respect to all sites aspirated except the breast (18.3%), lymph nodes (35.0%), and soft tissues (11.7%) where the reverse occurred.

Conclusion:

Patronage of cytopathology in Kumasi is increasing and serves as a quick, cheap, and effective alternate means for diagnosis. Improving and expanding on the current practice will ensure that pathologists in practice sustain and improve diagnostic cytopathology and provide material for training young pathologists.

Clinical next-generation sequencing successfully applied to fine-needle aspirations of pulmonary and pancreatic neoplasms

BACKGROUND

Next-generation sequencing was performed on pulmonary and pancreatic fine-needle aspirations (FNAs) and on paired FNAs and resected primary tumors from the same patient.

METHODS

DNA was isolated in formalin-fixed, paraffin-embedded cell blocks from 16 pulmonary FNAs, 23 pancreatic FNAs, and 5 resected pancreatic primary tumors. Next-generation sequencing was performed for 4561 exons of 287 cancer-related genes and for 47 introns of 19 genes on indexed, adaptor-ligated, hybridization-captured libraries using a proprietary sequencing system (the Illumina HiSeq 2000).

RESULTS

Genomic profiles were generated successfully from 16 of 16 (100%) pulmonary FNAs, which included 14 nonsmall cell lung cancers (NSCLCs) and 2 small cell lung cancers (SCLCs). The NSCLC group included 6 adenocarcinomas, 5 squamous cell carcinomas, and 3 NSCLCs not otherwise specified. Genomic profiles were successfully obtained from 23 of 23 (100%) pancreatic FNAs and from 5 of 5 (100%) matched pancreatic primary tumors, which included 17 ductal adenocarcinomas, 3 mucinous adenocarcinomas, 2 adenocarcinomas NOS, and 1 neuroendocrine tumor. Eighty-one genomic alterations were identified in the 16 pulmonary FNAs (average, 5.1 genomic alterations per patient); and the most common genomic alterations were TP53, RB1, SOX2, PIK3CA, and KRAS. Eighty-seven genomic alterations were identified in the 23 pancreatic tumor FNAs (average, 3.8 genomic alterations per patient); and the most common genomic alterations were KRAS, TP53, CDKN2A/B, SMAD4, and PTEN. Among the pancreatic tumors, there was 100% concordance of 20 genomic alterations that were identified in 5 patient-matched FNA and surgical primary tumor pairs.

CONCLUSIONS

The authors were able to perform next-generation sequencing reliably on FNAs of pulmonary and pancreatic tumors, and the genomic alterations discovered correlated well with those identified in matched resected pancreatic tumors.

Solid probe assisted nanoelectrospray ionization mass spectrometry for biological tissue diagnostics

To perform remote and direct sampling for mass spectrometry, solid probe assisted nanoelectrospray ionization (SPA-nanoESI) has been newly developed. After capturing the sample on the tip of the needle by sticking it to the biological tissue, the needle was inserted into the solvent-preloaded nanoESI capillary from the backside. NanoESI gave abundant ion signals for human kidney tissues and the liver of a living mouse. The method is easy to operate and versatile because any biological specimen could be sampled away from the mass spectrometer. Minimal invasiveness is another merit of this method.

Biological tissue diagnostics using needle biopsy and spray ionization mass spectrometry

Needle biopsy is a routine medical procedure for examining tissue or biofluids for the presence of disease using standard methods of pathology. In this work, spray ionization directly from tissue in the biopsy needle is shown to provide highly specific molecular information through mass spectrometry analysis. The data are available within a minute after the tissue biopsy, a time scale that allows immediate medical decisions to be made. This method has been performed for tissues in a variety of organs including brain, liver, kidney, adrenal gland, stomach, and spinal cord. Amino acids, hormones, fatty acids, anesthetics, and phospholipids are detected from the tissues and identified using exact mass measurement and tandem mass spectrometry. Lipid profiles are rich in information and, as in imaging MS methods, they have the potential to serve to distinguish diseased from healthy tissue. Needle biopsies allow a crude form of depth profiling that is demonstrated with the analysis of tissue samples taken by a needle inserted into a porcine kidney at various depths.

Direct analysis of biological tissue by paper spray mass spectrometry

Paper spray mass spectrometry (PS-MS) is explored as a fast and convenient way for direct analysis of molecules in tissues with minimum sample pretreatment. This technique allows direct detection of different types of compounds such as hormones, lipids, and therapeutic drugs in short total analysis times (less than 1 min) using a small volume of tissue sample (typically 1 mm(3) or less). The tissue sample could be obtained by needle aspiration biopsy, by punch biopsy, or by rubbing a thin tissue section across the paper. There exists potential for the application of paper spray mass spectrometry together with tissue biopsy for clinical diagnostics.

Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis

OBJECTIVE

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method to obtain specific diagnosis in various diseases. The optimal method of EUS-guided sampling of material for pathologic diagnosis has not been clearly established. The aim of our study was to compare two different techniques of EUS-guided sampling of solid masses, using either non-suction or suction with a 10-ml syringe.

MATERIAL AND METHODS

Patients assessed during a 6-month period were randomized to three passes of EUS-guided sampling with suction (26 patients) or non-suction (26 patients). The samples were characterized for cellularity and bloodiness, with a final cytology diagnosis established blindly. The final diagnosis was reached either by EUS-FNA if malignancy was definite, or by surgery and/or clinical follow-up of a minimum of 6 months in the cases of non-specific benign lesions.

RESULTS

EUS-guided fine-needle sampling with suction of solid masses increased the number of pathology slides (17.8+/-7.1 slides for suction as compared with 10.2+/-5.5 for non-suction, p=0.0001), without increasing the overall bloodiness of each sample. Sensitivity and the negative predictive values were higher when suction was applied, as compared to the non-suction group (85.7% as compared with 66.7%, p=0.05).

CONCLUSIONS

This prospective randomized study showed that EUS-guided fine-needle sampling of solid masses using suction yields a higher number of slides without increasing bloodiness. Although, the proportion of target cells was relatively similar between the suction and non-suction sampling techniques, the sensitivity and negative predictive values of the procedure were significantly higher when suction was added.

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.

Measurement of Signaling Pathway Activities in Solid Tumor Fine-needle Biopsies by Slide-based Cytometry

The application of molecular targeted therapies is expected to cause a modulation of cellular signaling pathway(s) that can be monitored by sequential biopsies. Fine-needle sampling (FNS) is an atraumatic and safe technique that can be repeated at numerous points during the clinical or experimental administration of a drug. However, small volume and paucicellularity of fine-needle samples may preclude a comprehensive analysis. We describe here the image-based detection of phosphorylated signaling proteins, an approach for the measurement of pathway activities and preliminary concepts for a multiplexed analysis in these specimens. Fine-needle samples were obtained from xenograft tumors and used for cell block preparations. Preanalytical parameters for the detection of phosphorylated Stat3 and nuclear factor kappaB were determined. A cytometric approach for the measurement of pathway activities was tested using 2 different slide-based analysis techniques applied to immunofluorescence and immunohistochemistry. Changes in the phosphorylation state of Stat3 and nuclear factor kappaB were observed due to delayed fixation and reproducibly quantified. Data obtained from xenografts after drug treatment suggest that slide-based cytometry gives results that are comparable to conventional analysis methods. The applicability of quantum dot nanocrystals for the detection of phosphorylated Stat3 and the combination of different labeling techniques suggest a potential for a multiplexed analysis. We propose here that FNS of solid tumors may be useful in anatomic sites where core-needle biopsies are not possible or not well tolerated. FNS can be used for biomarkers with a homogeneous distribution throughout the tumor, and slide-based analysis techniques may be applied to quantify pathway activities.

Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland

BACKGROUND

Both fine-needle aspiration (FNA) and frozen section (FS), although useful in preoperative and intraoperative management, have their advantages and pitfalls when used in the diagnosis of salivary gland lesions. The accuracy of each of these modalities has been assessed separately in many studies; a direct comparison of these techniques on a large cohort has not been well studied. Herein, we determine the relative accuracies of both FNA and FS in the diagnosis of salivary gland lesions.

METHODS

We reviewed a cohort of 220 cases of parotid gland FNA with histologic follow-up; FS was performed in 57 cases (26%). The sensitivity, specificity, and accuracy of FNA and FS were determined with respect to the final histologic diagnosis. For these calculations, benign diagnosis was considered negative, whereas a malignant diagnosis was considered positive. In addition, we re-reviewed the FNA and FS slides in cases that had conflicting FNA and FS results.

RESULTS

Of the 220 cases examined, the FNA diagnoses were as follows: benign (n = 142), malignant (n = 52), indeterminate (n = 14), and nondiagnostic (n = 12). Correlating these findings with the histologic findings, nine cases (4%) were false negative, whereas 12 (5%) were false positive. The sensitivity, specificity, and accuracy for FNA when diagnostic were 86%, 92%, and 90%, respectively. In 57 cases with FS, seven (12%) were false negative, whereas none were false positive. The FS was able to change to benign four diagnoses that were malignant by FNA and provide a diagnosis for five nondiagnostic FNAs. The sensitivity, specificity, and accuracy for FS were 77%, 100%, and 88%, respectively. The sensitivity, specificity, and accuracy for FNA and FS combined were 90%, 100%, and 95%, respectively.

CONCLUSIONS

Both FNA and FS provide a similar accuracy. FS may be useful if FNA is nondiagnostic and may also be useful in confirming or refuting malignancy in some cases. Hence, both techniques are complementary to each other in the diagnosis of salivary gland lesions.

Fine-needle aspiration cytology of tumors: diagnostic accuracy and potential pitfalls

FNA biopsy is a quick, safe, and inexpensive method for obtaining material for pathological diagnosis. It is most useful in the diagnosis of a malignant tumor. In experienced hands it is highly accurate, and many of the pitfalls in cytological interpretation can be avoided with increased practice. Special training is required to become proficient in both obtaining and interpreting aspirated material. It is not sufficient for pathologists to apply personal experience from tissue pathology to the diagnosis of cytological specimens. Current indications are the FNA biopsy will be used with increasing frequency for reasons involving both clinical practice and cost containment.

Evidence that the sensitivity is increased and the inadequacy rate decreased when pathologists take aspirates for cytodiagnosis

The results of the diagnostic accuracy of breast fine needle aspiration specimens taken by the pathologist in a joint surgical clinic are compared with those taken by a surgeon. In the joint clinic the complete sensitivity rose by 15% and the number of missed malignancies fell by half.

Contribution of fine needle aspiration cytology to diagnosis and management of thyroid disease

AIMS

To determine the role of fine needle aspiration cytology (FNAC) in the diagnosis and management of thyroid disease.

METHODS

Clinical histories of 144 patients who had undergone FNAC of the thyroid were analysed. Clinical presentation, non-invasive investigations including hormone assays, ultrasound, and isotope scan procedures were compared with FNAC diagnoses in all cases and with histological diagnosis in the 28 cases (19%) that had undergone surgery. Clinical management was decided upon combining all of the above investigations. The relative contribution of the FNAC was divided into: essential, additional and non-contributory, misleading.

RESULTS

FNAC diagnoses included: 29 (16%) benign colloid goitre, 56 (39%) benign cystic goitre, 24 (17%) thyroiditis, and 22 (15%) neoplasms. Nineteen (13%) of the specimens were unsatisfactory. When compared with clinical diagnoses based on non-invasive diagnostic investigations FNAC represented no improvement on the diagnosis of benign colloid/cystic goitre (55% v 54% respectively). It represented an improvement on the diagnosis of thyroiditis (9% v 17% respectively). FNAC decreased clinically suspicious lesions in which 22 neoplasms were diagnosed from 37% to 15%. Eleven patients with neoplasms underwent surgery and neoplasms were confirmed histologically. Others including lymphoma, metastatic carcinoma, and analplastic carcinoma were managed conservatively. There were four false negative FNAC diagnoses (3%) in clinically suspicious lesions, found on histology to be benign follicular adenomas.

CONCLUSIONS

FNAC had an essential role in the diagnosis and management of 23% of our patients, a confirmatory role in 61% of patients, a non-contributory role in 13% when specimens were inadequate, and was misleading in 3% where results were false negative. The positive identification of thyroiditis and neoplasia stands on its own as a justification for FNAC.

DNA flow cytometry and response to preoperative chemotherapy for primary breast cancer

Between October 1988 and June 1990, 22 patients with locally advanced, inoperable breast cancer entered a pilot study of four cycles of anthracycline based cytotoxic chemotherapy followed by surgery and tamoxifen. Fine needle aspirate samples of tumour were obtained for DNA flow cytometry before treatment and during the first cycle of chemotherapy. 21 patients are eligible for assessment of response and toxicity. Chemotherapy was well tolerated with greater than WHO grade 2 vomiting or stomatitis in 4 patients. Granulocytopenia less than 10(9)/l was noted in 16/21 patients but there were no episodes of neutropenic sepsis. There were 7 complete responses (CR) and 11 partial responses (PR), giving an overall response rate to chemotherapy (CR+PR) of 18/21 (86%). Responses were observed more commonly in patients who had aneuploid tumours (P = 0.06) and in patients whose tumours had a high S-phase fraction (P = 0.1). Tumours which responded to chemotherapy (CR or PR) had a significantly higher median SPF compared with tumours which did not regress (P less than 0.05). There was no consistent pattern of change in SPF values during the first cycle of chemotherapy, either for patients who responded to treatment or for those whose tumours did not regress. This combination therapy is well tolerated with a high response rate. The results of this pilot study support the recent suggestion that tumours with rapidly proliferating, aneuploid populations of cells exhibit the best short-term response to chemotherapy.

Fine needle aspiration of palpable breast lumps: a 1-year audit using the Cytospin method

A fine-needle aspiration (FNA) service for the diagnosis of palpable breast lumps was started at the Royal Preston Hospital, Preston, UK, in November 1989. Over the subsequent year, 407 FNAs were taken from 393 women. A simple technique was used which involved the surgeon flushing the aspirate into 10 ml of Cytospin collection fluid; cytocentrifuge preparations were then safely and conveniently prepared in the laboratory. Slides were stained with Papanicolaou and H&E. The method detected 112 out of a total of 121 cancers (92.6%); of the nine that were undetected, five aspirates were inadequate and four were falsely reported as negative. There were no false positives. The overall inadequate rate was 11.0%. Excluding inadequate samples, the absolute sensitivity was 89.7% and complete sensitivity 96.6% with 94.4% specificity. This 1-year audit has shown the Cytospin method of FNA in palpable breast disease to have a favourable sensitivity and specificity, and therefore to be an alternative to conventional FNA using direct smears.

Fine-needle aspiration for diagnosis of intranodal squamous-cell carcinoma metastatic from the skin

Fine-needle aspiration is a useful way to determine the presence of squamous-cell carcinoma in enlarged lymph nodes of patients at high risk for metastases. Advantages include a high degree of accuracy, outpatient as well as inpatient availability, and negligible potential for seeding of malignant cells. Cutaneous oncologists should consider using this technique in patients with lymphadenopathy and a previous history of cutaneous squamous cell carcinoma.

Fine-needle aspiration cytology of abdominal masses

An investigation of the role of blind fine-needle aspiration cytology (FNAC) in the assessment of palpable abdominal masses was carried out on 196 patients: 124 hepatic, 30 retroperitoneal, and 42 other masses. All of the smears were stained either by Papanicolaou stain or by hematoxylin and eosin stain. The results of FNAC were confirmed by further investigations in all cases. FNAC correctly diagnosed 166 (84.6%) cases. Twenty (10.2%) reports were false negative, and 10 (5.1%) smears were unsatisfactory for any diagnosis. Of 124 hepatic masses, the correct diagnosis was obtained in 106 (85.4%), false-negative reports in 14 (11.2%), and unsatisfactory smears in 4 (3.2%). There were no false-positive reports. For all the lesions, the sensitivity of FNAC was 87.8%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 52.4%. Five (2.5%) patients had considerable pain after the procedure.

Immunocytochemical Analysis of Lymphoid Lesions Using -Fine Needle Aspiration Biopsy

Sixty-four cases of mainly lymphoid lesions were investigated by fine needle aspiration. Both conventional smears and cytospin preparations were made from this material. Diagnoses based on cytological and immunocytological criteria were made in 57 of these cases and include reactive hyperplasia, non-Hodgkin's and Hodgkin's lymphoma and metastatic carcinoma. Five cases were inadequate for diagnostic purposes and in 2 cases no definite diagnosis could be made. These diagnoses were confirmed using tissue sections in 48/51 cases (with only 3 cytological diagnoses significantly altered by histology) and supported by supplementary clinical information in 8 cases. These results demonstrate the value of FNA biopsy in the investigation of lymphoid lesions using both conventional cytology and immunocytochemistry.

Rapid reporting on fine needle aspiration of breast lumps in outpatients

A retrospective analysis of the performance and value of fine needle aspiration of symptomatic breast masses in a special outpatient "breast clinic" within a district general hospital was carried out. All but a few aspirations were performed by a group of histopathologists, with, immediate cytological reporting. Fine needle aspiration was more sensitive for detecting malignancy than clinical assessment alone, the sensitivity increasing with the experience of the aspirator. The results compared favourably with those in reported series from specialist centres in the United Kingdom. The value of fine needle aspiration extends to the overall management of patients with breast masses but the results must be assessed in conjunction with the clinical context in view of the possibility of false negative or, more rarely, false positive cytological diagnoses.

Aspiration biopsy of palpable lymph nodes and the diagnosis of lung carcinoma

Over a six-year period at this institution aspiration biopsy of palpable lymph nodes has been used in the diagnosis and follow-up of 40 primary lung cancers. Small cell carcinoma was the commonest cell type. In the majority of the patients this was the initial diagnosis of lung cancer, however, there were patients with recurrence after chemotherapy and after surgical management. Diagnosis and classification of tumour using this simple, rapid and safe procedure negates the need for more invasive and costly investigations.

Percutaneous fine needle aspiration of pulmonary mass lesions--a critical examination of the accuracy of cell typing of malignant tumours

All the biopsies of pulmonary mass lesions obtained by percutaneous needle aspiration over a seven year period were reviewed. Emphasis is laid upon the differences in cell typing of malignant tumours when two types of preparation of the same tissue, cytological smears and tissue sections are examined. Some problems in cell typing are discussed and suggestions for improved proficiency are made.

Sensitivity of Campylobacter pylori to colloidal bismuth subcitrate

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Fine needle aspiration of thyroid nodules: three years' experience

To overcome the difficulties arising in the management of cold nodules of the thyroid--many are unnecessarily resected because of the risk of malignancy--fine needle aspiration cytology was used in the assessment of thyroid lesions in 113 patients. Aspirates were categorised into three groups as follows: group (i), consistent with simple goitre or cyst; group (ii), suspicious of underlying cellular lesion or tumour; group (iii), malignant. Resections for simple goitre were reduced from eight of 14 (40%) to two of 42 (3%) over three years, and the yield of neoplastic lesions coming to surgery as a result of aspiration increased from two of 12 (16%) to nine of 14 (69%) over the same period. It is concluded that fine needle aspiration cytology is an effective means of discriminating between simple and neoplastic thyroid lesions. This permits more appropriate patient management and a beneficial saving of resections for simple goitre. False negative diagnoses (two cases) in our series are of more concern than false positive results, but can be minimised by careful attention to sampling and cytological detail.

Fine needle aspiration cytology in the management ENT of patients

Aspirates were obtained from 142 masses in 120 patients who presented with palpable swellings in the head and neck region. 120 specimens (84.51 per cent) were adequate for diagnostic purposes and the remaining 22 (15.49 per cent) were unsatisfactory. Final diagnosis was based on resection histology in 87 cases and close clinical follow-up in 55 patients. The overall sensitivity and specificity including unsatisfactory aspirates was 81.37 per cent and 93 per cent respectively (if the technically inadequate specimens were deleted 98.81 per cent and 94.44 per cent). In comparison with the final diagnosis typing of malignant tumours was possible in 58.33 per cent. The correct diagnosis was made in 63.89 per cent of benign lesions.

What is colitis? Statistical approach to distinguishing clinically important inflammatory change in rectal biopsy specimens

Measurements of mucosal dimension, architecture, and cell counts in both lamina propria and epithelium were made on rectal biopsy specimens from 20 patients with irritable bowel syndrome ("normal" controls); 54 patients with ulcerative colitis, Crohn's disease, and non-specific proctitis; eight patients with small bowel Crohn's disease; and 34 in whom the rectal biopsy specimen was not diagnostic. Discriminant analysis was applied to multiple variables based on the measurements, and three variables were identified as of high predictive value. The most powerful discriminant was increased lamina propria cellularity in all forms of chronic colitis. The ratios of surface length to mucosal length and of surface epithelial height to crypt epithelial height also emerged as discriminants. Chronic inflammatory bowel disease was distinguished from normal in 95% of cases with a definite pathological diagnosis, and 85% of borderline cases were correctly classified as either normal or inflammatory when judged by the final diagnosis after follow up. This study provides a basis for automated diagnosis of rectal biopsy specimens and provides objectively validated criteria which can also be applied in routine histological diagnosis.

DNA analysis of breast tumour fine needle aspirates using flow cytometry

Cellular DNA was analysed by flow cytometry in fine needles aspirates (FNA) from both benign and malignant breast lesions in order to determine the feasibility of flow cytometric analysis. In 22 of 26 (84%) benign and 69 of 74 (93%) malignant aspirates, sufficient cells were present to produce good quality DNA histograms. DNA in all 22 benign lesions was diploid. In contrast, of the 69 cancers with sufficient cells for analysis, 40.6% had a diploid DNA content alone, whilst 59.4% had an additional DNA aneuploid line. These results indicate that the majority of FNAs provide sufficient material for flow cytometric analysis of DNA profiles. Such aspirates taken in a sequential manner may also prove to be an ideal method of studying tumour response to therapy.

Role of fine needle aspiration cytology in breast cancer screening

In a six year period up to the end of December 1985 fine needle aspiration cytology specimens of the breast were obtained from 562 apparently healthy women invited to participate in a breast cancer screening programme. Of these, 397 had a biopsy and 173 cancers were confirmed histologically. For the diagnosis of cancer, the procedure was less successful than in symptomatic cases. The main factors influencing success were the aspirator, the small size of many cancers, and the occult nature of the lesions seen only on mammography. Retrospective analysis of the figures shows that combining the results of FNA cytology in a triple assessment with physical and mammographical findings for restricted selection means that the number of benign biopsy specimens could be reduced considerably.

Neutrophil chemotaxis in sickle cell anaemia, sickle cell beta zero thalassaemia, and after splenectomy

Neutrophil chemotaxis was evaluated in 28 patients with sickle cell anaemia, 10 patient with sickle cell beta zero thalassaemia, 25 patients who had undergone splenectomy, and 38 controls. The mean distance migrated by patients' neutrophils was not significantly different from that of neutrophils from controls. Although several immunological variables have been reported to be changed after loss of splenic function, we were unable to show a defect in neutrophil chemotaxis that could account for the increased susceptibility to infection.

Prevalence of Chlamydia trachomatis infection in homosexual men

Chlamydial cell culture isolation rates from 51 unselected homosexual men were 9.3% from the urethra, 4.3% (pharynx), and 6.5% (rectum). All the positive cultures showed extremely few inclusions. Direct immunofluorescence with the Microtrak reagent (Syva) was an acceptable alternative technique for non-genital sites, whereas the infectious disease enzyme immunoassay (IDEIA) (Boots-Celltech) was unsuitable.

Retroperitoneal lymph node aspiration biopsy in staging of pelvic cancer: a cytological study of 228 consecutive cases

Knowledge of the status of the pelvic lymph nodes is important for accurate staging and adequate treatment of patients with genitourinary tract cancer (bladder and prostatic carcinoma, testicular tumors, and uterine carcinoma). A total of 228 consecutive patients underwent preoperative evaluation of the lymph node status by lymphangiography combined with fine-needle aspiration biopsy. A lymphadenectomy was performed in 94 patients. The overall diagnostic accuracy was 93%. There were 5% false-negative results and no false-positive diagnoses. Fine-needle aspiration biopsy is an inexpensive method with which to detect the presence of metastatic lymph nodes visualized by bipedal lymphangiography. It is also a safe and well-tolerated method, with a low morbidity and no mortality. The various cytological features are described as are some possible pitfalls.

Fine needle aspiration biopsy and the otolaryngologist

A survey of the diagnostic value of fine needle aspiration cytology in ENT practice was carried out over a 3-year period. The 119 aspirates were taken from a variety of head and neck sites and examined by an experienced cytopathologist. Cytology was accurate in 111 (93 per cent), with two false negative aspirates (1.7 per cent) and no false positive results. There were no complications and the technique was found to be a rapid, safe and cost-effective diagnostic tool.

Laboratory diagnosis of megaloblastic anaemia: current methods assessed by external quality assurance trials

The results of an Interregional quality assurance scheme for tests in the diagnosis of megaloblastic anaemia were reviewed to assess the methods used. Serum folate assays showed great variation between methods, partly due to limitations in assessment by external quality assurance. Red cell folate assays yielded widely different results and much imprecision due both to the differences in preparation of the haemolysate and to the problems inherent in radioassay of a mixture of folate compounds. Intrinsic factor antibody tests showed appreciable variation in sensitivity. There was considerable inconsistency in the detection of polymorph nuclear hypersegmentation.

Lysosomal enzyme abnormalities in preleukaemic Sweet's disease: case report

Quantitative and qualitative abnormalities in marrow lysosomal enzymes, suggestive of acute myeloid leukaemia, were detected in a patient with Sweet's disease and monocytosis 12 months before she presented with acute myelomonocytic leukaemia. Biochemical characterisation of blood and marrow cell extracts may help to identify those patients with Sweet's disease and other preleukaemic conditions who are most at risk of developing leukaemia.

Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens

Five years experience in the application of electron microscopy to fine needle aspiration biopsy specimens is reviewed. In an initial evaluation, 200 consecutive unselected specimens were examined; 89 proved diagnostic and, in a third of these, electron microscopy gave additional information that was often essential to diagnosis. Negative specimens resulted almost entirely from failure to obtain an adequate amount of material. Results were improved by the adoption of a preparation technique involving concentration of the cells in bovine serum albumin and by the inspection of a rapidly stained smear at the time of the aspiration procedure, with a further needle pass for electron microscopy being performed if necessary. Despite the small size of specimens, adequate examination was usually possible and electron microscopy has proved of value in the diagnosis of tumor samples acquired by fine needle aspiration in the same way as has been established with the larger sized specimens obtained by conventional biopsy and surgical resection.

Fine needle aspiration cytology in dermatology: a clinicopathological appraisal

The possible clinical value of fine needle aspiration cytology (FNAC) has been assessed prospectively in 60 patients presenting with cutaneous lesions. The cytological diagnosis in each case has been compared with the clinical diagnosis and biopsy result. The principal potential use appears to be the rapid confirmation of the clinical diagnosis of basal cell carcinoma to allow immediate referral for radiotherapy or plastic surgery. FNAC could also prove useful when the clinical diagnosis of malignant melanoma is in doubt and primary diagnostic excision is difficult or disfiguring. Accurate distinction could usually be made between benign and malignant lymphoproliferative conditions, but further classification was difficult. Metastatic malignancy could be diagnosed with ease and other characteristic cytological appearances were seen with naevocellular naevi, pyogenic granuloma and pilar cysts. However, there were limitations in achieving an accurate diagnosis in approximately half the cases, and consequently, FNAC cannot be regarded in general as a substitute for histological diagnosis.

Impaired neutrophil function in intestinal lymphangiectasia

Impaired neutrophil chemotaxis and phagocytosis were shown in three patients with intestinal lymphangiectasia. Abnormalities in cell associated and serum derived activity occurred, and possible mechanisms are suggested.

Fibrinogen mediated activation of platelet aggregation

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