Needle biopsy of primary bone lesions. M.D. Anderson experience.
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Biopsy, Needle↗
Biomedical subjects
C V Fanning
Publications and source records attributed to C V Fanning.
Leukemic lymphadenopathy: diagnosis by fine needle aspiration.
We report cytologic findings in 6 patients (2 with a history of chronic myelogenous leukemia and 2 with a history of acute lymphoblastic leukemia) who presented with generalized or localized lymphadenopathy of undetermined etiology. Fine needle aspiration of enlarged lymph nodes resulted in the initial diagnosis of leukemia (1 case) or blast crisis of leukemia (2 cases), confirmation of involvement by leukemia at presentation (1 case), or confirmation of relapse of leukemia (2 cases). The average number of cells in the aspirates was 20 million, sufficient for performing immunophenotypic studies, flow cytometry, cytogenetic studies, and electron microscopy. The cytological features, combined with the ancillary studies, resulted in the diagnosis and subclassification of the leukemias as follows: chronic myelogenous leukemia, blast crisis (lymphoid); chronic myelogenous leukemia, blast crisis (undifferentiated); common acute lymphoblastic leukemia; acute lymphoblastic leukemia (T-cell), acute lymphoblastic leukemia (T-cell); and malignant lymphoma, small lymphocytic type.
Adolescent↗
Osteosarcoma and the role of fine-needle aspiration. A study of 51 cases.
Fifty-one patients were evaluated by fine-needle aspiration (FNA) as part of the diagnosis, staging, and management of osteosarcoma. All patients had histologic confirmation of osteosarcoma. Five patients underwent two aspirations each; thus, the total number of aspirates reviewed was 56. Aspirations were performed by interventional radiologists using fluoroscopic guidance. The cytologic features of osteosarcoma were divided into five groups: (1) pleomorphic (malignant fibrous histiocytoma-like); (2) epithelioid; (3) chondroblastic; (4) small cell; and (5) mixed. Although osteoid-like material was seen, it could not be distinguished readily from dense collagen. The chondroid matrix of chondroblastic osteosarcoma was recognized as a granular film with scattered clear bubbles. Fine-needle aspiration was diagnostic of sarcoma in 45 of 56 aspirates (80.4%). In eight aspirates, the cellularity of the smears was insufficient for diagnosis due to extensively osteoblastic tumors (six), necrotic tumor (one), and undetermined causes (one). In three aspirates, failure was attributed to poor cellular preservation due to unknown factors. The authors conclude that FNA is a useful tool in the multidisciplinary diagnosis and management of osteosarcoma. Aspirates should only be evaluated with full knowledge of the clinical and radiographic findings. The most significant limitation of FNA is the inability to detect osteoid.
Adult↗
Osteosarcoma chemotherapy effect: a prognostic factor.
Chemotherapy has become a routine part of the treatment of osteosarcoma. However, the precise role of preoperative chemotherapy remains in question. Between 1979 and 1982, a group of 40 patients were treated by multimodality therapy consisting of preoperative chemotherapy (intra-arterial cis-platinum and systemic adriamycin), surgery, and postoperative chemotherapy. Survival in this group is 64%, while continuous disease-free survival is 58%. Although age, sex, tumor size, site, and classification were found to be prognostic factors, histologic evidence of response to preoperative chemotherapy, measured as percent tumor necrosis, was found to be the most significant prognostic factor. When continuous disease-free survival was calculated as a function of tumor necrosis it was 91% in patients with greater than or equal to 90% tumor necrosis, while it was 14% in patients with less than 90% tumor necrosis. At initial presentation, 7% of patients were judged limb-salvage candidates. But due to the local effects of preoperative chemotherapy, 60% ultimately underwent limb-salvage surgery. Preoperative arteriograms were a reliable means of monitoring response to chemotherapy and served as an indicator of residual viable tumor. Using arteriogram directed planes of section, postchemotherapy, specimens were "mapped" and analyzed for chemotherapy effect. When present, residual viable tumor was preferentially found at the interface of tumor and normal anatomic structures; "sanctuary sites." It is necessary that standard methods for analyzing postchemotherapy specimens be developed; a technique is described.
Bone Neoplasms↗