Investigation on tumour spread in connection with aspiration biopsy

Role of fine needle aspiration in malignant parotid tumors at a single-center experience: A retrospective cohort study

Background

Parotid gland tumors are mostly benign with good prognosis. On the other hand, malignant tumors of the parotid gland often have poor prognosis and metastasize. Mucoepidermoid carcinoma is the most common cancer in the parotid gland accounting for nearly 40–50% of the cases. Therefore, it is important to define the role of fine needle aspiration in differentiating between different types of parotid malignancies.

Method

This is a retrospective chart review study that was done on 49 consecutive patients who underwent parotid surgeries in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, between Jan 2003 and Feb 2020. The records of 49 patients were obtained, fine needle aspiration and pathology reports were reviewed to define the role of fine needle aspiration in diagnosing malignant parotid tumors by calculating the sensitivity, specificity, positive predictive value, and negative predictive value.

Results

Retrospective analysis of 39 cases revealed that there was one case which was diagnosed for cancer was missed by fine needle aspiration. Meanwhile, six cases were diagnosed as malignant lesions using both fine needle aspiration and histopathology. Furthermore, 30 cases were determined benign based on fine needle aspiration and histopathology. The sensitivity of fine needle aspiration for detecting malignancy was 85.7%, specificity was 93.8%. positive predictive value of 75% and negative predictive value of 96.7%.

Conclusion

Fine needle aspiration is highly sensitive and specific for parotid tumors. We support the role of pre-operative FNA for all parotid tumors as its accurate in differentiating between benign and malignant lesions.

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40–50% of the cases of parotid gland carcinoma is Mucoepidermoid.

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It is important to be able to differentiate between types of parotid tumors.

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FNA accuracy is variable among studies in Saudi Arabia.

Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors

Objectives:

To determine the diagnostic accuracy of fine needle aspiration (FNA) for detecting malignant parotid tumors.

Methods:

We conducted a retrospective study of all patients diagnosed with benign or malignant parotid gland tumors in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2004 and May 2015. The records of 65 subjects were obtained. Histopathological findings and data from FNA examinations were obtained from medical records. Twenty-three subjects were excluded due to missing FNA, histopathology results or both. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA for detecting malignant lesions were estimated and compared with the gold standard, histopathology.

Results:

The specimens of 5 cases were insufficient for diagnosis; therefore, 38 cases were diagnosed by FNA and had histopathological reports. Three cases were diagnosed positive for cancer using histopathology and missed by FNA, 3 were diagnosed as malignant lesions using both FNA and histopathology, and 32 cases were determined benign based on histopathology and FNA analysis. The total prevalence of parotid malignancies was 15.8%. The sensitivity of FNA for detecting malignancy was 50%, and the specificity was 100%; with a positive predictive value of 100% and negative predictive value of 91.4%.

Conclusion:

Fine needle aspiration is a highly specific, but only moderately sensitive test. We support the use of this method as an initial tool for diagnosing parotid gland malignancies, as it is a safe, rapid, and painless procedure, compared to histopathology.

Core-needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy

BACKGROUND

The literature offers discordant results regarding whether diagnostic biopsy is associated with the dissemination of cancer cells, resulting in local and/or distant metastasis. The long-term outcomes of patients with breast cancer were compared between those who were diagnosed using either fine-needle aspiration biopsy (FNAB) or core-needle biopsy (CNB) during 2 decades: the 1970s and 1990s.

METHODS

In the 1970s, the only diagnostic needle biopsy method used for breast cancer in Sweden was FNAB. CNB was introduced 1989 and became established in Stockholm Gotland County in the early 1990s. The authors compared the clinical outcomes of patients diagnosed using FNAB from 1971 to 1976 (n = 354) versus those of patients diagnosed using CNB from 1991 to 1995 (n = 1729). Adjusting for differences in various treatment modalities, mammography screening, tumor size, DNA ploidy, and patient age between the 2 decades, 2 strictly matched samples representing FNAB (n = 181) and CNB (n = 203) were selected for a 15-year follow-up study.

RESULTS

In a comparison of the rates of distant metastasis in the strictly matched patient groups from the FNAB and CNB cohorts, significantly higher rates of late-appearing (5-15 years after diagnosis) distant metastasis were observed among the patients who were diagnosed on CNB compared with those who were diagnosed on FNAB. No significant difference in local metastasis was observed between the 2 groups.

CONCLUSIONS

At 5 to 15 years after diagnosis of the primary tumor, CNB-diagnosed patients had significantly higher rates of distant metastases than FNAB-diagnosed patients. Cancer Cytopathol 2017;125:748-56. © 2017 American Cancer Society.

The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients

Objective

Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.

Material and Methods

Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined.

Results

Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthin’s tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue.

Conclusion

FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.

Needle tract seeding: an avoidable complication

Needle tract seeding refers to implantation of tumor cells by contamination when instruments like biopsy needles are used to examine, excise or ablate a tumor. Implantation along needle tract may lead to change of stage of the tumor, converting a resectable tumor into an inoperable one. In this paper we have reviewed the cases of needle tract seeding due to fine needle aspiration cytology (FNAC) procedure. We analyzed the various aspects of needle tract seedling and suggested how to take precautionary measures to prevent it.

[The importance of fine needle aspiration cytology in the management of recurrent and metastatic melanoma]

Fine needle aspiration cytology is a widely accepted, reliable diagnostic modality for the early detection of metastases.

OBJECTIVE

Quality assurance analysis of fine needle aspiration cytology in melanoma patients.

METHOD

A total of 194 biopsies performed in 142 melanoma patients were analyzed retrospectively.

RESULTS

138 (71.13%) cutaneous or subcutaneous nodules and 56 (28.87%) palpable lymph nodes were studied. 87 (44.85%) true positive, 92 (47.42%) true negative, 3 (1.55%) false positive and 12 (6.19%) false negative cytology results were found. High sensitivity (87.89%), specificity (96.84%) and diagnostic accuracy (93.72%) were confirmed.

DISCUSSION

The quality assurance of fine needle aspiration biopsy in these patients with recurrent and metastatic melanoma meets the international requirements.

Role of fine-needle aspiration cytology in swellings of the parotid region

To report the role of preoperative fine-needle aspiration cytology (FNAC) in patients with swellings in the parotid region at a tertiary care center. Prospective study of FNAC results compared with final histologic diagnosis as the standard criterion. An academic tertiary care center. A consecutive series of 51 patients who underwent FNAC of swellings in the parotid region between 2007 and 2009, of whom 41 had surgical resection. Predictive value, sensitivity, specificity, and accuracy. FNAC was performed in all the 51 patients who presented with a swelling in the parotid region in the out patient department in our hospital. Sixteen patients (31.4 %) were diagnosed to have malignancy, thirty patients (58.8 %) were diagnosed as benign condition. The FNAC was not satisfactory in 5 patients (9.8%) even after repeated aspiration. The FNAC diagnosis of malignant or suspicious lesion of the parotid region had positive and negative predictive values of 90 % and 96.66%, respectively. The diagnostic accuracy of FNAC is 95 %. We strongly recommend FNAC as a safe and accurate and less expensive method for preoperative diagnosis of the swellings in the parotid region.

Extrathyroidal implantation of thyroid tumor cells after needle biopsy and other invasive procedures

BACKGROUND

Implantation of thyroid cells (ITC) into extrathyroidal locations is a rare complication of thyroid fine-needle biopsy (FNB) and thyroid surgery. Here we review the prevalence, likely pathogenesis, treatment, and likely ways to minimize this complication of invasive thyroid procedures and present an illustrative patient.

SUMMARY

Tumor aggressiveness more likely leads to ITC after FNB. Large needle size may be associated with increased risk of ITC. Number of passages during biopsy, excessive suction, needle withdrawal without releasing suction, and injection of tumor cells during biopsy may be associated with ITC after FNB. This statement is based on rational hypotheses. Cutting or rupture of a thyroid nodule during surgery leads to ITC into extrathyroidal soft tissue.

CONCLUSIONS

ITC occurs rarely with needles smaller than 23 gauge. Some authorities suggest the use of gentle suction and release suction during extraction and a reduced number of passes based on entirely theoretical grounds. In conventional surgery, lobectomy for all thyroid nodules rather than nodulectomy or partial lobectomy should be performed. If endoscopic surgery is performed on larger nodules, the surgeon should take great care to avoid rupturing the tumor.

Ultrasound-guided fine needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients

BACKGROUND

Sentinel lymph node biopsy (SLNB) allows early detection of metastases, thereby enabling early treatment in melanoma patients likely to benefit from adjuvant therapies. This prospective study analyzes the possible benefits of additional ultrasound (US) and fine needle aspiration cytology (FNAC) of sentinel nodes (SN) prior to SLNB.

METHOD

Over a 2-year period 127 melanoma patients with 151 SN were scheduled for SLNB. All SN were initially identified with lymphoscintigraphy, then identified and evaluated by US and the cells aspirated for cytology (FNAC). US findings and FNAC results were compared to surgical findings.

RESULTS

Of 127 patients, 114 had one SN each, 12 had two, and one had three. In vivo US achieved a sensitivity of 79% (95% CI: 62-91%) and a specificity of 72% (95% CI: 62-81%). FNAC showed a sensitivity of 59% (95% CI: 41-76%) and a specificity of 100% (95% CI: 95-100%). The combination of these two in vivo methods achieved an overall sensitivity of 82% (95% CI: 65-93%) and an overall specificity of 72% [95% CI: 62-81%].

CONCLUSION

Combined US and FNAC provides important information prior to SLNB in that both procedures identify metastases in the lymph nodes (sensitivity > 80%). Patients with positive FNAC may proceed directly to complete lymph node dissection (cLND) instead of having initial SLNB. Thus, combined US and FNAC may prevent unnecessary anesthesia and surgical management as well reduce costs. In our study 16% (19/121) fewer SLNB procedures were carried out, subsequently replaced by cLND. For patients with a negative combination of in vivo US and FNAC, SLNB remains the best diagnostic option.

Fine needle aspiration

Fine needle aspiration (FNA) has been widely used as a diagnostic tool for the past half century. Differing from large bore cutting needle biopsy, FNA utilizes 22- to 27-gauge needles. The cell samples aspirated from a lesion are characteristically smeared on glass slides for immediate microscopic evaluation. An adequacy report and a preliminary diagnostic impression are rendered in approximately 10 to 15 minutes. A final report is generally rendered within 24 hours. The method has been used as one of the most cost-effective, complication-free, and rapid techniques for preoperative investigation of tumors and tumor-like conditions. Its usefulness in the diagnosis and management of oncology patients is emphasized in this article.

Preoperative diagnostic values of fine-needle cytology and MRI in parotid gland tumors

The aim of this retrospective study was to assess and compare the diagnostic value of fine-needle cytology and MRI for the prediction of malignancy in parotid tumors. During an 11-year period, 148 patients underwent preoperative fine-needle aspiration cytology in our institution. Eighty-seven patients underwent a preoperative MRI study, and 54 had both MRI and cytology. The study compares results of cytology and MRI with histological reports. The sensitivity, specificity and accuracy for detecting malignant lesions were 87, 94 and 93% respectively for MRI, 81, 95 and 92% respectively for cytology and 100, 88 and 91% respectively for both studies combined. Fine-needle cytology provided better information than MRI concerning precise histological diagnoses. Conversely, the proportion of non-diagnostic smears reached 10%. Fine-needle cytology and MRI are simple, well-tolerated diagnostic means with an impact on the management of salivary gland tumors. The associated anatomic information obtained by MRI imaging makes it the test of first choice in an optimal medical environment.

Local recurrence of breast cancer after breast conservation therapy in patients examined by means of stereotactic core-needle biopsy

PURPOSE

To evaluate the incidence of locally recurrent breast cancer in patients treated with breast conservation surgery and radiation therapy to determine if increased local recurrence is observed in women examined by means of stereotactic core-needle biopsy (SCNB).

MATERIALS AND METHODS

Records of 551 consecutive patients with breast cancer who were treated with conservation surgery and radiation therapy were reviewed retrospectively. The 551 cases were divided into three groups: those examined by means of SCNB (n = 86), those examined by means of excisional biopsy preceded by needle localization (n = 242), and those in which the masses were palpable and who underwent biopsy without imaging guidance (n = 223). The local recurrence rate and the Mantel-Haenszel statistic for survival curves were calculated for each group. To test for statistical significance, chi(2) analysis was performed for categorical variables and a t test or analysis of variance was performed for calculation of continuous variables.

RESULTS

With a mean follow-up of 4.9 years (range, 2.0-8.9 years), tumor recurrence rate in the SCNB group was 2.3% (two of 86), resulting in a 5-year actuarial recurrence-free rate of 0.96 +/- 0.03. For the needle-localized biopsy group, recurrence rate was 5.4% (13 of 242), with a 5-year actuarial tumor recurrence-free rate of 0.88 +/- 0.03. For the non-image-guided biopsy group, the recurrence rate was 10.3% (23 of 223), with a 5-year actuarial recurrence-free rate of 0.84 +/- 0.03. These rates were not significantly different when the SCNB group was compared with the needle-localized biopsy group. However, the recurrence-free rate was significantly greater for the SCNB group than that for the non-image-guided biopsy group (P =.03).

CONCLUSION

In the present series to date, cancers diagnosed by means of SCNB were not associated with an increased incidence of local recurrence after breast conservation surgery and radiation therapy.

F. N. A. C. of salivary glands

During a period of 12 years, 874 salivary gland lesions were aspirated of which 740 (86.85%) were from parotid gland. Cystic, inflammatory & neoplastic lesions were 25.25%. 54.45% & 20.30%, respectively. Plcomorphic adenoma was the commonest benign & adenoid cystic carcinoma was the most frequent malignant tumors.On cytohistologic correlation, sensilitvity of cytology for diagnosing cystic, inflammatory, neoplastic lesions proved to be 93.3%. 95.7% & 100% respectively. Overall accuracy for cytodiagnosis of malignant salivary gland lesions in our study was 96.07%.

Incisional biopsy and melanoma prognosis

BACKGROUND

There are many circumstances in clinical practice in which it is helpful to have a definitive diagnosis of melanoma before subjecting a patient to mutilating surgery. Previous studies on the effect of incisional biopsy on melanoma prognosis were conflicting and lacked a matched control group to account for the other prognostic indicators.

OBJECTIVE

We set up this study to investigate the effect of incisional biopsy on melanoma prognosis.

METHODS

The design was of a retrospective case control. Data were obtained from the database of the Scottish Melanoma Group; the database was set up in 1979 to collect detailed clinical, pathologic, and follow-up data on all patients diagnosed with melanoma in Scotland. Each incisional case was matched against 2 excision cases controlling for age, sex, sites, and Breslow thickness. The main outcome measures were time from initial biopsy to recurrence and to melanoma-related death.

RESULTS

Two hundred sixty-five patients who had incisional biopsy before definitive excision of melanoma were included in the study; these were matched with 496 cases of excisional biopsy specimens. Cox's proportional hazard model for survival analysis showed that biopsy type had no significant effect on recurrence (P =.30) or melanoma-related death (P =.34).

CONCLUSIONS

This study is the largest series on the effect of incisional biopsy on melanoma prognosis to date and the first to include matched controls. Melanoma prognosis is not influenced by incisional biopsy,. before definitive excision.

Needle-tract implantation following us-guided fine-needle aspiration biopsy of transitional cell carcinoma of the bladder, urethra, and prostate

Localized tumor implantation of the ventral abdominal wall was found at 2, 5, and 8 months following percutaneous ultrasound-guided fine-needle aspiration biopsy (FNAB) of transitional carcinoma of the bladder, urethra, or prostate in 3 dogs. To our knowledge this complication has not been reported in dogs following FNAB. Despite the rarity of needle-tract implantation, the potential for this complication with transitional cell carcinomas is apparently not negligible and warrants consideration. We recommend traumatic urethral catheterization to obtain a cytologic diagnosis of potential transitional cell carcinomas of the lower urinary tract or prostate whenever possible until more information becomes available. However, needle-track implantation is so rare that it should not influence the decision to perform a percutaneous FNAB if the urethra cannot be catheterized.

Implantation metastasis of head and neck cancer after fine needle aspiration biopsy

One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.

Fine-needle aspiration: survey of clinical utility

OBJECTIVES

The goal was to determine the features of clinical usage of fine-needle aspiration (FNA) in this country in terms of utilization, indications, and practice and demographic characteristics of those who use FNA.

STUDY DESIGN

A survey was mailed to otolaryngologist-head and neck surgeons (OTO-HNSs) in the United States. The results were totaled and analyzed for indications for FNA performance, practice setting, age, and geographic location of practitioners.

RESULTS

The most common indications for use of FNA were in the diagnoses of neck, thyroid, salivary, and other masses in the head and neck. In the survey group the average number of FNAs performed per month was 4.7 per respondent practitioner. FNA was statistically related to age (older physicians performed it less) and region of the country. FNAs are performed at a lower rate in the West.

CONCLUSIONS

FNA is a commonly performed procedure. Certain groups of OTO-HNSs (older, located in western states) do not perform FNA as commonly as other OTO-HNSs. Further education regarding the merits of FNA is needed.

Fine needle aspiration biopsy (FNAB) for lesions of the salivary glands

We examined 112 fine needle aspiration biopsy (FNAB) specimens of salivary glands (80 parotid and 32 submaxillary) taken between January 1989 and December 1995. Cytologic diagnoses were compared with the final histological diagnoses of the surgical specimens. The sensitivity and specificity were 84.8% and 93.7% respectively, and the accuracy was 91.1%. We conclude that FNAB by itself does not provide total security because of the high percentage of false-negatives. It is nevertheless useful when combined with an adequate clinical history, examination and radiological tests.

The role of fine-needle aspiration cytology in the management of parotid tumors: a critical clinical appraisal

BACKGROUND

Fine-needle aspiration cytology (FNA) is a well-established tool for investigating many head and neck conditions. It application in parotid tumors is, however, very controversial. This article is aimed at defining the exact role of FNA in the diagnostic workup of patients.

METHODS

A retrospective review of a 12-years' experience in a university surgical unit of 186 consecutive patients. Clinical opinion, FNA results, and final pathologic findings were examined.

RESULTS

FNA obtained the correct final pathologic condition in 54.3% of cases. It increased the identification of malignancy to 64.5% compared with 26% based solely on clinical signs. Malignant FNA diagnoses (85.7%) and repeatedly inconclusive reports (25.7%) were associated with a higher incidence of malignancy.

CONCLUSIONS

Methodological interpretation of FNA results provides useful preoperative information and enables more reliable patient counseling and reduces pathologic surprises. Its enhancement of the preoperative recognition of malignant parotid tumors may alert more stringent attention to the operative margin and hence better tumor clearance.

Fine needle aspiration in the diagnosis of metastatic melanoma

BACKGROUND

Fine needle aspiration is an accurate technique to diagnose metastatic melanoma. Few reports exist in the literature describing its usefulness in many patients with melanoma confirmed by open biopsy.

OBJECTIVE

The purpose of this study was to determine the utility and predictive value of fine needle aspiration in patients with malignant melanoma who presented with lesions suspected to be metastatic.

METHODS

We retrospectively reviewed 99 cases of fine needle aspiration and the corresponding histologic findings obtained by open biopsy in 82 patients.

RESULTS

Of the 99 cases, 86 were positive for melanoma, 12 were negative, and one was indeterminate. The positive predictive value of fine needle aspiration was 99%. One patient had a false-positive diagnosis.

CONCLUSION

Fine needle aspiration is a rapid, accurate, and minimally invasive procedure that is useful in the diagnosis of metastatic melanoma. Patients with a positive aspirate of palpable regional nodes can proceed directly to surgery, bypassing the need for an open biopsy.

Histological identification of carcinoma in 21 gauge needle tracks after fine needle aspiration biopsy of head and neck carcinoma

Six cancer resection specimens were thoroughly sectioned and microscopically examined at areas known to have been around 21 gauge fine needle aspiration (FNA) biopsy sites, in an attempt to identify needle tracks. All cases had an interval of not less than 10 days between FNA biopsy and surgery. Foci of tumour were identified histologically in needle tracks from two patients with carcinoma. This is the first instance, outside of experimental animal models, of histologically confirmed, viable tumour spread in FNA biopsy tracks. Although this complication is not common and is of unknown clinical significance, it is one that all clinicians who undertake FNA of malignant neoplasms should be aware of.

Fine needle aspiration of salivary gland tumors

The usefulness of fine needle aspiration (FNA) as a preoperative diagnostic procedure was studied in 43 patients with salivary gland tumors. Nine of the tumors were malignant and 34 benign. The diagnostic sensitivity of FNA was 88.9% (8/9), the specificity 94.1% (32/34) and the accuracy 93.0% (40/43). These results indicate that FNA is a highly sensitive and specific screening procedure.

Implantation metastasis of primary malignant rhabdoid tumor of the brain in an adult (one case report)

Primary malignant rhabdoid tumor (PMRT) of the brain is a rare and recently described neoplasm of youth. We report magnetic resonance imaging (MRI), computed tomography (CT), and pathology of one case of PMRT in an adult which seeded along the needle track for stereotactic biopsy.

The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes

BACKGROUND

Prompt and accurate diagnosis of melanoma metastatic to the lymph nodes is important with respect to prognosis and treatment.

OBJECTIVE

The purpose of this study was to determine the utility and diagnostic reliability of fine needle aspiration (FNA) of enlarged nodules in lymph node basins in patients with melanoma.

METHODS

We retrospectively reviewed the charts of 46 patients with melanoma who underwent a total of 56 FNAs of palpable nodules in lymph node basins.

RESULTS

Of the 56 FNAs, 24 showed melanoma, 26 did not demonstrate melanoma, five were inadequate, and one gave inconclusive but suspect results. Findings were confirmed by open biopsy (n = 35) or clinical follow-up (n = 21). Fifty of 56 FNAs (89%) yielded a definitive diagnosis (sensitivity/specificity = 100% in these 50).

CONCLUSION

FNA biopsy of enlarged palpable nodules in nodal basins in patients with melanoma is accurate, rapid, and cost-efficient. An algorithm for management of patients with melanoma who have palpable nodes is provided.

Fine-needle sampling of salivary gland lesions. I. Cytology and histology correlation of 412 cases of pleomorphic adenoma

Fine-needle sampling (FNS) of 412 pleomorphic adenomas, corresponding to 378 primary tumors and 34 local recurrences, was performed preoperatively in 378 patients. Concordant cytologic diagnoses were established in 376 tumors (91.3%), whereas seven (1.7%) were only classified as benign. Sixteen (3.9%) tumors were considered to be suspicious and two (0.5%) were diagnosed as adenoid cystic carcinomas. Insufficient material for cytologic evaluation was found in 11 (2.6%) tumors. Pleomorphic adenomas were retrospectively classified according to the predominant histological differentiation: chondromyxoid, cellular, myoepithelial, or metaplastic. FNS performances were higher in chondromyxoid than in other types, with 95.2% concordant and 1.4% suspicious/ false-positive, vs. 81.8% concordant, and 11.5% suspicious/false-positive cytodiagnoses, respectively.

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors

We herein report the usefulness of ultrasound-guided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and "other" in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the postoperative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.

Determining factors which predict response to primary medical therapy in breast cancer using a single fine needle aspirate with immunocytochemical staining and flow cytometry

The increasing use of neoadjuvant chemotherapy and endocrine therapy in the management of breast cancer has lead us to evaluate and optimise the standard technique of cytocentrifugation of a single fine needle aspirate (FNA) taken from a breast tumour in-vivo, to determine a range of both immunocytochemical and flow cytometric factors which are predictive of response to primary medical therapy. Some of these factors are also of prognostic significance in early stage disease. An analysis of the cellularity and immunocytochemical staining characteristics of FNAs obtained from a series of 206 patients with palpable breast cancers indicate that in a sample of 46 cases it is possible to measure oestrogen receptor, progesterone receptor and c-erbB-2 providing over 400 cells per slide are obtained, with material obtained in a single FNA prepared by cytocentrifugation, using standard immunocytochemical methods. The staining results obtained were comparable to those obtained using frozen or paraffin embedded tissue sections taken from the same tumour. In addition an estimate of the proliferation indices could be made by flow cytometric analysis of the residual cell suspension fluid with measurement of DNA index and S-phase fraction in 131/164 (80%) and 110/164 (67%) of cases respectively. Providing all FNAs obtained for cytocentrifugation were taken at first presentation rather than immediately following a standard FNA, then it was possible to obtain adequately cellular (> 400 cells/slide) samples in 96 out of 126 (75%) of the last cohort of breast aspirates. These effects may be independent of T stage but not histological type as patients with lobular tumours only produced cellular aspirates in 1/7 (14%) of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Fine needle aspiration cytology in maxillofacial surgery--experience in a district general hospital

101 fine needle aspirations of 82 head and neck masses in 72 patients performed in one maxillofacial unit over a 5-year period were studied retrospectively. Satisfactory reports were obtained for 69 masses. Fifty six (81.2%) were confirmed histologically and 13 (18.8%) by clinical follow up of at least 6 months' duration. The sensitivity was 96.7% and specificity 100% with a positive predictive value of 100%. No complications were recorded. Provided the unsatisfactory specimens are correctly recognised this technique provides a useful aid in the management of head and neck masses.

Implantation metastasis of carcinoma after percutaneous fine-needle aspiration biopsy

Implantation of malignant cells along the needle tract is an extremely rare but potential complication following percutaneous needle aspiration biopsy of malignant lesions. Percutaneous fine-needle aspiration biopsy (FNAB) has recently received more attention for cytologic diagnosis of bronchogenic carcinoma because of its high diagnostic yield, simplicity, and low morbidity. On the other hand, dissemination of cancer cells by needle aspiration biopsy can change a potentially resectable localized lung cancer to an unresectable one. We report two cases: one patient underwent FNAB of a metastatic left adrenal mass that seeded a paraspinal muscle implantation of malignant cells that subsequently developed a tumor mass, and the second patient had tumor cell implantation in the chest wall after FNAB of a pleural-based adenocarcinoma of the lung. The theoretical and practical importance of tumor cell spread along the needle tract is discussed. Because of its rare incidence, however, this complication should not affect the use of needle aspiration biopsy in bronchogenic carcinoma, although care should be undertaken during the procedure.

Fine needle cutting biopsy of lesions of the head and neck

One hundred and twenty-four fine needle cutting biopsies of lesions of the head and neck have been carried out over the last 7 years. While the overall accuracy of diagnosis was 79%, the accuracy of the 43 biopsies carried out during the last 2 years was 93%. These results compare very favourably with published results of the accuracy of fine needle aspiration cytology.

Fine needle aspiration biopsy in orbital tumours

Fine needle aspiration biopsy (FNAB) was performed in 46 patients with an orbital mass. Positive cytological identification was made in 43 biopsy specimens. In 26 cases with histopathological control the accuracy was 81%. In experienced hands FNAB is safe and appears to be a valuable tool in establishing a diagnosis of malignancy in orbital tumours.

Fine-needle aspiration biopsy of head and neck lesions

The case records of 213 fine-needle aspiration biopsies (FNAB) of head and neck masses performed on 209 patients over a 3-year period were reviewed to assess the diagnostic accuracy and safety of this technique in comparison with surgical histologic examination. Cytologic diagnoses based on FNAB were compared with histologic diagnoses in 110 patients who underwent surgery. Based on cytology alone, 40.3% of the lesions were reported as malignant, 45.1% as benign, and 14.6% as indeterminant. A specific cytologic diagnosis was made in 85.5% of the cases. Cytologic diagnoses concurred with surgical histologic diagnoses 90% of the time. Fine-needle aspiration biopsy was found to have a false-positive rate of 0.5% and a false-negative rate of 2.3%. The sensitivity and specificity of FNAB in determining a malignant diagnosis were 81.1% and 99%, respectively. Positive and negative predictive values were calculated at 98.9% and 82.8%, respectively. Diagnostic rate, sensitivity, and negative predictive value increased consistently throughout the study period, indicating that the diagnostic accuracy of FNAB improved with experience.

Fine needle aspiration cytology of salivary gland lesions

Eighty-eight fine needle aspirates from 79 salivary gland lesions in 77 patients were examined. The overall diagnostic sensitivity was 84% and the specificity 98.41%. When the 14 unsatisfactory specimens were excluded the sensitivity rose to 95.45%. Correct identification of the disease process was possible in nearly 80% of cases with a final benign diagnosis. The histological tumour type was correctly predicted in 75% of the malignancies. In the others the cytological diagnosis was anaplastic malignant neoplasm.

Percutaneous intrathoracic aspiration biopsy

An analysis of 617 percutaneous intrathoracic aspiration biopsies (PIAB) performed on 587 patients with pulmonary and mediastinal lesions between 1954 and 1985 are presented. The effectiveness of the procedure between 1954 and 1980 and between 1981 and 1985 with a positivity of 71.6% and 84.9%, respectively, was compared. These results are statistically significant and reflect improvement in the technique employed. A greater positivity was found where the lesion measured 2 to 3 cm in diameter. Complications for this series were 7.8%. In diffuse infiltrating lesions, the positivity is less than that obtained for the whole series, and the risk of developing a pneumothorax is greater. The false-negative cases include those in which an inadequate sample was obtained for diagnosis (13.9% of the total series) and samples containing elements of the chest wall or blood (5.2%).

The value of fine-needle aspiration biopsy in the cytodiagnosis of salivary gland lesions

Fine-needle aspiration cytology (FNAC) was performed on 195 cases of salivary gland lesions. The smears were technically adequate in 178 cases. Tissue examination was available for subsequent histocytologic correlation in 57 cases. The cytodiagnosis included inflammatory lesions (59) and benign (68) and malignant (51) tumors (total, 119). The accuracy of cytodiagnosis was 87.7% with a sensitivity of 80.9% and a specificity of 94.3%. Exact histologic typing was possible in 61.9% of the malignant tumors. Mucoepidermoid tumors and cellular-atypical pleomorphic adenoma posed difficulties in cytodiagnosis.

Fine-needle aspiration biopsy in the diagnosis of recurrent and metastatic intraabdominal malignancies

To evaluate the efficacy of directed percutaneous fine-needle aspiration (FNA) biopsy in the diagnosis of recurrent and metastatic intraabdominal malignancies, we reviewed our experience from 1981 to 1988. Seventy-three aspirations were performed in 73 patients. Forty-six patients with a previously treated malignancy had aspiration to diagnose either locally recurrent or metastatic disease. The remaining 27 patients had liver aspiration to rule out metastases from suspected or unknown primary sites. Computed tomography and ultrasonography were equally effective in providing diagnostic material, which was obtained from 68 of 73 aspirates. No serious morbidity occurred. Fifty-seven patients had a metastatic or recurrent malignancy, and 3 had primary hepatocellular carcinoma. Fine-needle aspiration biopsy correctly identified 51 (85 percent) of these 60 cases. There were no false-positive results and five false-negative results. Aspiration results obviated the need for a diagnostic laparotomy in 49 of the 60 patients with malignancy (82 percent). We conclude that directed percutaneous FNA biopsy is a safe and accurate method of diagnosing recurrent and metastatic intraabdominal malignancies.

Management of high grade parotid carcinomas

Thirty-four patients admitted to the Bristol Royal Infirmary during the 20-year period 1966-85 and diagnosed as suffering from high grade parotid carcinoma were studied. The male:female ratio was 2.4:1, with a mean age at presentation of 68 years. Facial swelling was present in all patients with a mean duration of 9.9 months before treatment. Pain, deep fixation, facial nerve involvement, ulceration and distal metastases were all associated with a poor prognosis. Diagnosis was made either at operation or by fine needle biopsy. All 34 patients received radiotherapy. Fourteen patients (41 per cent) underwent a definitive surgical procedure. The local recurrence rates for the non-surgical and surgically treated groups were 30 per cent (six patients) and 36 per cent (five patients) respectively; twelve patients (60 per cent) in the non-surgical group developed distant metastases as opposed to six patients (43 per cent) in the surgical group. Both local and distant recurrent disease are indicators of poor prognosis, with only one patient alive at 104 months. Seven patients (21 per cent) remain recurrence free. Definitive surgery, combined with radiotherapy, improved survival in those with amenable localized disease.

Percutaneous fine needle aspiration biopsy of pancreatic cancer guided by ultrasonography

Fine needle aspiration biopsy guided by ultrasonography was performed in 39 patients with pancreatic cancer to evaluate the value of the technique for establishing a proved histologic diagnosis. Aspirated material suitable for cytologic evaluation of smear preparation was obtained from 33 patients (84.6%). Among the 33 patients, cytologic diagnosis of pancreatic cancer was possible in 28 patients (84.9%). There was mild abdominal pain only in one patient (2.6%). In conclusion, percutaneous fine needle aspiration biopsy guided by ultrasonography proved to be a safe and useful method for histologic diagnosis of pancreatic cancer.

Percutaneous fine needle aspiration cytology of the pancreas: advantages and pitfalls

Fine needle aspiration of the pancreas was performed in 62 patients with radiological suspicion of malignancy. All fine needle aspirates were taken under computed tomography or ultrasound guidance. Fine needle aspirates were positive in 31 of 41 patients with histologically or clinically confirmed pancreatic carcinoma. There were no false positive results. The sensitivity of this method for detecting malignant disease was 86%. Cytology was not able to provide conclusive results of benign conditions. Difficulties were encountered in diagnosing well differentiated carcinoma and neuroendocrine tumours and distinguishing them from reactive epithelium and islet cell hyperplasia, respectively. This resulted in a 12.1% false negative rate. There were no complications in our series. Percutaneous fine needle aspiration proved a reliable method of diagnosing pancreatic carcinoma.