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Dosi S, Gupta G, Kawatra M, Chakrabarti PR, Agrawal P, Jain MR. Role of radiological-assisted cytology in intra-abdominal lesions: A 3 years' experience in a tertiary care center. Int J Appl Basic Med Res 2016; 6:101-5. [PMID: 27127738 PMCID: PMC4830147 DOI: 10.4103/2229-516x.179022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) with assistance of radiological tools such as ultrasonography (USG) and computed tomography (CT) is an effective and safe technique for diagnosing intra-abdominal neoplastic and nonneoplastic lesions. AIMS AND OBJECTIVES (1) To assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. (2) To categorize various intra-abdominal lesions according to their site of occurrence and study their cytomorphological features. MATERIALS AND METHODS A cross-sectional study was conducted in the Department of Pathology between January 2012 and January 2015. A total of 174 cases with intra-abdominal lesions were included in the study. RESULTS In our study, diagnostic yield was 84.5%. The mean age was found to be 52 years with M: F ratio 1.1:1. We found that 92 (52.87%) cases were in hepatobiliary region, 33 (18.96%) in adnexa, 13 (7.47%) in pancreatic-ampullary region, 14 (8.04%) in unknown abdominal lumps, 8 (4.6%) in lymph nodes, 6 (3.4%) in renal, 5 (2.87%) in retroperitoneum, 2 (1.1%) in omental nodules, and 1 (0.5%) in splenic mass. Of total 174 cases, 106 (61%) cases were malignant, 10 (5.7%) benign, 16 (9.1%) inflammatory, 27 (15.5%) inadequate, and 15 (8.7%) suspicious for malignancy. CONCLUSION Ultrasound and CT-guided FNA cytology had a significant role in diagnosis of palpable and nonpalpable intra-abdominal lesions. Being a relatively quick and safe method, it also avoids invasive diagnostic procedures.
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Affiliation(s)
- Shilpi Dosi
- Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Garima Gupta
- Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Mallika Kawatra
- Department of Lab Operations, Diagno Lab, Medanta Hospital, Indore, Madhya Pradesh, India
| | - Preeti Rihal Chakrabarti
- Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Purti Agrawal
- Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Mukul Raj Jain
- Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
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Ronot M, Vilgrain V. Hepatocellular carcinoma: diagnostic criteria by imaging techniques. Best Pract Res Clin Gastroenterol 2014; 28:795-812. [PMID: 25260309 DOI: 10.1016/j.bpg.2014.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/12/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Imaging plays a very important role in the diagnosis of HCC. Indeed, in high-risk patients a noninvasive diagnosis can only be obtained by imaging in presence of typical features. These features include arterial enhancement followed by washout during the portal venous and/or delayed phases on CT scan or MRI. This pattern is quite specific and has been endorsed by both Western and Asian diagnostic guidelines. However, its sensitivity is not very high, especially for small lesions. Therefore ancillary signs may be needed to increase the reliability of the diagnosis. Recent hepatobiliary MRI contrast agents seem to be interesting to improve characterization of small nodules in the cirrhotic liver.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
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Simsek GG, Ertuğrul DT, Guresci S, Şimşek H. Is there a role for on-site evaluation of thyroid fine needle aspiration to reduce the nondiagnostic rate? Endocr Pathol 2013; 24:57-61. [PMID: 23512283 DOI: 10.1007/s12022-013-9238-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of immediate on-site evaluation of fine-needle aspiration biopsy (FNAB) specimens can determine the adequacy of specimens and provides a specific preliminary diagnosis. In this prospective study, we evaluated the impact of on-site assessment of thyroid FNAB performed under ultrasound guidance. Totally, 204 (170 female, 34 male) patients (102 on site, 102 control group) were included. The patients were randomized on site and regular cytologic examination groups. Quick May-Grünwald Giemsa stain was used for on-site examination and FNA was continued until adequate aspirate for optimal cytological examination. Two (2.0 %) of the 102 patients evaluated with on-site examination had a nondiagnostic result. However, 16 (15.7 %) of the 102 patients examined by regular cytologic examination method, had nondiagnostic result. The difference between these two groups was statistically significant (p < 0.0001). The major cause of a nondiagnostic thyroid FNAB specimen is the failure to aspirate a sufficient number of cells necessary for diagnosis cystic lesions. Immediate on-site evaluation can significantly decrease the nondiagnostic rate of thyroid FNAB specimens.
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Affiliation(s)
- Gulcin Guler Simsek
- Department of Pathology, Kecioren Training and Research Hospital, C Atuf Kansu Street 166-4, Çankaya Ankara, Turkey.
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Wee A. Fine needle aspiration biopsy of malignant mass lesions in the liver: a revisit of diagnostic profiles and challenges. J Gastrointest Oncol 2013; 4:5-7. [PMID: 23451329 DOI: 10.3978/j.issn.2078-6891.2012.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 12/20/2012] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aileen Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, National University Health System, Singapore, 119074
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Wee A. Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies and approach to diagnosis. Cytopathology 2011; 22:287-305. [PMID: 21762411 DOI: 10.1111/j.1365-2303.2011.00882.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The role of fine needle aspiration (FNA) biopsy of the liver has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in clinically classic hepatocellular carcinoma (HCC). The risks of needle tract seeding and haematogenous dissemination have been actively debated. Nowadays, cytopathologists are confronted by smaller and smaller nodules, detected due to increased surveillance of high-risk cirrhotic patients. Tissue characterization of small well-differentiated hepatocellular nodular lesions (size less than and equal to 2 cm) is extremely challenging and has therapeutic implications. Major issues in the cytodiagnosis of HCC include: (i) distinguishing benign hepatocellular nodular lesions, namely, large regenerative nodules, dysplastic nodules, focal nodular hyperplasia and hepatocellular adenoma from reactive hepatocytes; (ii) distinguishing well-differentiated HCC from benign hepatocellular nodular lesions; (iii) distinguishing poorly differentiated HCC from intrahepatic cholangiocarcinoma and metastatic carcinomas; (iv) determining the histogenesis of a malignant tumour; and (v) determining the site of origin of a malignant tumour. An overview of the biological evolution and histopathological aspects of dysplastic nodules, small HCCs and 'nodule-in-nodule' lesions is presented in tandem with clinically relevant nomenclature. An algorithmic approach to FNA diagnosis of HCC and hepatocellular nodular lesions is outlined. Optimal results depend on (i) a dedicated radiologist-cytopathologist team; (ii) an on-site cytology service, (iii) a combined cytohistological approach, (iv) immunohistochemistry, and (v) clinicopathological correlation. As we move towards personalized medicine, it is envisaged that hepatic FNA is likely to become a point of care in the management protocol as it takes on the additional role of procurement of tumour and peritumoural tissues for genomic and proteomic profiling to enable targeted molecular therapy.
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Affiliation(s)
- A Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore
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Meskine N, Vullierme MP, Zappa M, d'Assignies G, Sibert A, Vilgrain V. Evaluation of analgesic effect of equimolar mixture of oxygen and nitrous oxide inhalation during percutaneous biopsy of focal liver lesions: a double-blind randomized study. Acad Radiol 2011; 18:816-21. [PMID: 21511500 DOI: 10.1016/j.acra.2011.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/19/2011] [Accepted: 01/28/2011] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Percutaneous liver biopsy for tumors performed under local anesthesia is still a painful procedure. The aim of this study was to evaluate the patient's reaction and the analgesic efficacy and safety of an equimolar mixture of oxygen and nitrous oxide (EMONO) inhalation. MATERIALS AND METHODS A monocenter, prospective, randomized and double-blind controlled study was performed including 99 adult patients undergoing ultrasound controlled liver biopsy for tumors. 50 patients received an EMONO and 49 patients received a placebo. Pain was evaluated by patients before and after the procedure using a Visual Analog Scale. RESULTS Analgesic control, defined by the difference between the final and initial VAS scores (Δ), was significantly better in the EMONO group than in the placebo group (Δ = 17.8 ± 25.5 mm vs 30.1 ± 32.6 mm; P = .045. The number of patients who would agree to undergo another liver biopsy under the same conditions was significantly higher in the EMONO group than the placebo group (92.0% vs 75.5%, P = .026). There were no side-effects from the administration of an EMONO. CONCLUSION This study shows that patients receiving an EMONO had a higher analgesic control after percutaneous biopsy of focal liver lesions than patients in the placebo group. Moreover, acceptance of additional biopsies was higher in the EMONO group.
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Affiliation(s)
- Nawel Meskine
- Assistance Publique des Hôpitaux de Paris, APHP, Department of Radiology, Hôpital Beaujon, 100 bd du Général Leclerc 92110 Clichy, France
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Wee A. Fine-needle aspiration biopsy of hepatocellular carcinoma and related hepatocellular nodular lesions in cirrhosis: controversies, challenges, and expectations. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:587936. [PMID: 21789263 PMCID: PMC3135134 DOI: 10.4061/2011/587936] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 05/03/2011] [Indexed: 12/13/2022]
Abstract
The role of hepatic fine-needle aspiration (FNA) biopsy has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in most hepatocellular carcinomas (HCCs). There is risk of needle-tract seeding. Increasingly, small nodules are being detected on ultrasound surveillance of high-risk patients. Diagnostic challenges associated with cirrhosis include distinction of benign hepatocellular nodules, namely, large regenerative nodules and dysplastic nodules, from reactive hepatocytes; and distinction of well-differentiated HCCs from benign hepatocellular nodules. This paper will discuss (i) controversies regarding preoperative/pretransplantation FNA diagnosis of HCC, (ii) update of biological evolution, nomenclature, and histopathologic criteria for diagnosis of precancerous nodules and small HCCs, and (iii) algorithmic approach to FNA diagnosis of hepatocellular nodules. Optimal results depend on dedicated radiologist-cytopathologist team, on-site cytology service; combined cytohistologic approach, immunohistochemistry, and clinicopathologic correlation. Hepatic FNA is likely to be incorporated as a point of care as we move towards personalized medicine.
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Affiliation(s)
- Aileen Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Xie L, Jessurun J, Manivel JC, Pambuccian SE. Hepatic epithelioid angiomyolipoma with trabecular growth pattern: a mimic of hepatocellular carcinoma on fine needle aspiration cytology. Diagn Cytopathol 2011; 40:639-50. [PMID: 21563318 DOI: 10.1002/dc.21703] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 02/25/2011] [Indexed: 01/10/2023]
Abstract
Epithelioid angiomyolipomas (AMLs) of the liver are rare tumors with imaging and cytologic features overlapping with those of hepatocellular carcinomas. We report the fine needle aspiration and core biopsy findings of an epithelioid AML in the right hepatic lobe of a 32-year-old female with tuberous sclerosis. She had undergone renal transplantation 8 years previously after bilateral nephrectomy for renal AMLs and a 3-cm chromophobe renal cell carcinoma. Hepatocellular carcinoma was suspected during the initial cytologic and histologic examination based on the presence of numerous large polygonal cells with ample finely vacuolated or granular cytoplasm, low nucleocytoplasmic ratio, and mild nuclear pleomorphism in the smears, as well as a distinctive trabecular histologic pattern in the core biopsies. Immunoperoxidase stains showed that the neoplastic cells were negative for cytokeratins and positive for HMB45, Melan-A, and smooth muscle actin, establishing the diagnosis of epithelioid AML. To determine the distinguishing cytomorphologic features between epithelioid AML and HCC, we have compared the cytologic features of 15 cases of hepatic AML reported in the literature, including the present case, to the FNA cytologic findings of 38 consecutive cases of HCC diagnosed at out institution.
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Affiliation(s)
- Linjun Xie
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
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Bando K, Haba R, Kushida Y, Kadota K, Katsuki N, Ohmichi K, Kouno K, Hayashi T. Utility of immediate cytologic diagnosis of lung masses using ultrafast Papanicolaou stain. Lung Cancer 2011; 72:172-6. [DOI: 10.1016/j.lungcan.2010.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/30/2010] [Accepted: 08/19/2010] [Indexed: 11/30/2022]
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Pitman MB. Liver. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wu YF, Shi XL, Xu QX, Ding YT. Clinical features of intraheptic cholangiocarcinoma: an analysis of 90 cases. Shijie Huaren Xiaohua Zazhi 2009; 17:838-840. [DOI: 10.11569/wcjd.v17.i8.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To explore clinical features of intraheptic cholangiocarcinoma (ICC) and to guide clinical practice.
METHODS: Clinical data of 90 cases with ICC undergoing surgery during 1985-01 and 2003-01 were retrospectively studied.
RESULTS: Sixty two patients had chief complaint of abdominal pain. Thirty two patients had HBV infection history, and 42 patients experienced cirrhosis. Before operation, AFP was positive in 29 cases and CA199 was positive in 56 cases, and γ-GT was significantly increased in 61cases. Thirty one patients and 58 patients had characteristic B-mode manifestation and CT manifestations. Statistic analysis demonstrated that 1-, 3-, 5-year survival rates for patients who underwent radical operation were significantly different those who underwent palliative operation (81.1% vs 16.7%, 43.6% vs 0.0%, 43.6% vs 0.0%, all P < 0.01).
CONCLUSION: ICC has non-specific clinical manifestations. CA199 and r-GT are useful in the diagnosis of ICC. B-mode ultrasonography and CT are important for diagnosis of ICC. The radical surgical resection is the only method to ensure a long-term survival.
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