Benign and/or malignant lesions may occur in surgical scars after mastectomy or lumpectomy (SML) in patients with breast cancer (BC). Early diagnosis of these lesions is essential for both therapeutic and prognostic evaluation. The diagnostic value of fine-needle aspiration (FNA) was determined for these scar lesions. The findings of cytologic and histologic specimens obtained from the same lesion of SML in 83 women with BC were correlated. Twenty-five FNA yielded only acellular specimens. Of the FNA done by the cytopathologist, only 6.2% were not representative. However, 45% of those done by less experienced clinicians were not representative. Representative FNA were obtained from 58 of the women who took part in the study. Based on the histologic diagnosis, 38 patients had malignant scar lesions (MSL), and 20 had benign scar lesions (BSL). In one patient of the 38 with MSL, cytologic examination did not show that the malignant lesion; in four women, the tumor was suspected cytologically; and in the remaining 33, the cytologic findings were consistent with malignancy. In 18 of the 20 patients with BSL, cytologic findings were reported as benign and in the other two, as inconclusive. The sensitivity, specificity, and positive and negative predictive values for the cytologic findings were 97.4%, 100%, 100%, and 94.7%, respectively. The diagnostic accuracy of FNA cytology was 98.2%. No complications followed the procedure. It was concluded that FNA cytologic examination of lesions in SML is a simple, safe, highly accurate, and cost-effective method to distinguish malignant from benign lesions in women with BC. Lesions in SML should be explored routinely by FNA, rather than by the traditional biopsy, provided the FNA is done by an experienced operator.

Adult↗

PubMed1992

Umbilical metastasis from urinary bladder carcinoma.

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Abdominal Neoplasms↗

PubMed1992

Penile metastasis of testicular teratocarcinoma diagnosed by fine-needle aspiration.

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Adult↗

PubMed1992

Ultrasonically guided fine-needle aspiration of liver lesions.

The aim of the present study was to determine the diagnostic accuracy of ultrasonically guided fine-needle aspiration for liver lesions detected by ultrasound scan. A total of 142 aspirations were carried out in 129 patients with unifocal or multifocal liver lesions suspected of malignancy. The aspiration was made with a 22-gauge needle, guided by ultrasound. Based on histological, cytological, and clinical findings, final diagnoses were reached in 123 patients, 96 of whom had malignant liver disease and 27 benign liver disease. Among the 96 patients with malignant liver disease, the cytological findings revealed malignancy in 78 patients (81.3%) and suspected malignancy in five patients (5.1%), but failed to demonstrate malignancy in 13 patients (13.3%). Among 27 patients with benign liver disease, all the cytological findings indicated benignancy. The overall sensitivity, specificity, and positive and negative predictive values for cytological findings were 86.5%, 100%, 100%, and 76.9%, respectively. The diagnostic accuracy of ultrasonically guided fine-needle aspiration was 89.4%. In one patient with incipient chronic disseminated intravascular coagulation, a fatal intraperitoneal bleeding complicated the procedure. We conclude that ultrasonically guided FNA for cytologic diagnosis of liver lesions is highly accurate and is only rarely associated with fatal complication.

Adolescent↗

PubMed1992

Fatal hemoperitoneum after fine-needle aspiration of a liver metastasis.

Fine-needle aspiration (FNA) of the liver is a procedure considered virtually risk-free. We report here a patient with carcinoma of the pancreas, who suffered a fatal hemoperitoneum (HP) subsequent to FNA of the liver under the guidance of ultrasound. The patient had presented with migratory deep vein thrombosis (DVT), and recurrent cerebral embolism. The prothrombin time (PT) and partial thromboplastin time (PTT) had been normal, and FNA demonstrated adenocarcinoma cells. Autopsy findings demonstrated carcinoma in the tail of the pancreas with liver and adrenal metastases, massive HP, and findings of chronic disseminated intravascular clotting (DIC). Since chronic DIC with enhanced fibrinolysis might have participated in the fatal bleeding, we recommend that FNA should be contraindicated in patients suspected of having malignancy with migratory DVT and recurrent arterial embolism, despite normal PT and PTT tests, unless the appropriate laboratory tests succeed in excluding DIC.

Adenocarcinoma↗

PubMed1991

Intraoperative fine needle aspiration cytology of pancreatic lesions.

The aim of the present study was to demonstrate the practicality of intraoperative fine needle aspiration (FNA) cytology of pancreatic lesions in 43 patients. The indication for performing this procedure was to determine the nature of pancreatic masses. Conclusive cytologic diagnoses were reached in 41 patients who represent the present study. On the basis of histologic findings in 30 cases (73.2%) and on clinical findings in 11 cases (26.8%), a final diagnosis of malignant pancreatic disease (MPD) was established in 31 and of benign pancreatic disease (BPD) in 10 patients. Among the 31 cases with MPD, the cytologic diagnosis was correct in 30 patients and falsely negative in one patient. Among 10 patients with BPD, all the cytologic finding were reported as benign. The sensitivity and specificity and positive and negative predictive values for cytologic findings were 96.8%, 100%, 100%, and 90.9%, respectively. The diagnostic accuracy of FNA cytology was 97.6%. No complications followed the procedure. We conclude that intraoperative FNA cytology of pancreatic lesions is a simple, safe, highly sensitive, and specific tool in differentiating benign from malignant pancreatic lesions. This procedure should be carried out in any patient with pancreatic mass incidentally found at laparotomy or in a patient undergoing surgery because of suspected nonmetastasizing MPD in whom repeated imaging guided FNA failed to demonstrate malignancy.

Adult↗

PubMed1991

Imaging-guided and nonimaging-guided fine needle aspiration of liver lesions: experience with 406 patients.

The aim of the present study was to determine the diagnostic accuracy of different modes of fine needle aspiration (FNA) of liver lesions. A total of 492 FNAs were performed on 406 patients in order to confirm or to rule out focal or multifocal neoplastic disease: 29% under ultrasound (US) guidance, 3% with computed tomographic (CT) guidance, 67% preoperatively, and 1% intraoperatively without imaging guidance. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 387 patients, of whom 264 had malignant liver disease and 123 had benign liver disease. Of 321 aspirations performed in patients with malignant liver disease, the cytologic findings suggested malignancy in 225 (70.1%), suspected malignancy in 25 (7.8%), and did not reveal malignancy in 71 aspirations (22.1%). Among the 123 patients with benign liver disease, the cytologic findings were reported as benign in all but two patients, who had false-positive cytologic findings. The overall sensitivity, specificity, positive, and negative predictive values for cytologic findings were 85.6, 98.4, 99.1, and 76.1%, respectively. The overall diagnostic accuracy was 89.7%. In one patient, fatal intraperitoneal bleeding due to chronic intravascular coagulation complicated the FNA procedure. We conclude that imaging-guided FNA as well as nonguided FNA for cytologic diagnosis of liver lesions are highly accurate and only rarely may be associated with a fatal complication.

Adolescent↗

PubMed1991

Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses.

PURPOSE: Fine needle aspirative cytology is a well-established diagnostic tool for evaluating tumor masses. The goal of the current study was to determine the diagnostic accuracy of direct (nonimaging-guided) fine needle aspiration of palpable abdominal masses excluding the liver. PATIENTS AND METHODS: Direct aspiration of a palpable abdominal mass was performed in 190 patients in order to confirm or to rule out malignancy. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 165 patients, of whom 130 had a malignant abdominal mass and 35 a benign abdominal mass. The cytologic findings were verified by correlation with histologic, cytologic, and clinical findings. RESULTS: Among the 130 patients with a malignant abdominal mass, the cytologic findings failed to reveal malignancy in 12 patients (9.2%), but did reveal suspected malignancy in five (3.8%) and malignancy in 113 patients (86.9%). Among all 35 patients with a benign abdominal mass, the cytologic findings were reported as nonmalignant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of cytologic findings were 90.8%, 100%, 100%, 74.5%, and 92.7%, respectively. A nonfatal case of bile peritonitis and a case of localized peritonitis that, in retrospective, could have been avoided were the only major complications that followed the fine needle aspirative procedure. CONCLUSION: With careful patient selection and meticulous attention to the proper procedure, direct fine needle cytology is a simple, safe, and highly accurate method for diagnosing palpable abdominal masses.

Abdominal Neoplasms↗

PubMed1991

Fine-needle aspiration cytology of abdominal wall scar lesions for diagnosing recurrent colorectal cancer.

Nodules in the abdominal wall scar after resection of colorectal cancer may represent nonmalignant or malignant lesions. We report clinical and fine-needle aspiration (FNA) cytologic findings in five patients with nodules suspected of being malignant. All patients had had adenocarcinoma, four of the colon and one of the rectum. Postoperative abdominal wall irradiation had been administered to three patients. The median time from surgical removal of the cancer to FNA of scar nodules was 27 months. Three patients had malignant and two patients had nonmalignant FNA cytology, histologically confirmed at surgical biopsy of scar nodules. The malignant histologic cell type demonstrated by FNA cytology of the scar lesions was identical to that exhibited by histology. The survival of patients with positive cytology and histology ranged between 9 and 43 months; survival of patients with negative cytology and histology was between 53 and 138 months. We conclude that FNA cytology is a simple, sensitive, and specific procedure to evaluate patients with scar nodules appearing after resection of colorectal cancer. This procedure may safely replace surgical biopsy in the initial evaluation of scar nodules.

Abdominal Muscles↗

PubMed1991

Renal extramedullary hematopoiesis simulating hypernephroma.

We report a 63-year-old woman who presented with anemia and a left kidney mass. Guided fine-needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary operation. Subsequent bone marrow biopsy demonstrated myelofibrosis. Twenty-four months later the mass remained stable.

Carcinoma, Renal Cell↗

PubMed1991

Preoperative and intraoperative fine needle aspiration cytology of pancreatic lesions.

UNLABELLED: The aim of the present study was to describe our experience from 1976 through 1988 with fine needle aspiration (FNA) cytology of pancreatic lesions in 90 patients. Fine needle aspirations were performed preoperatively under ultrasound guidance (USG) in 46 patients, under computed tomographic guidance (CTG) in seven patients, and intraoperatively in 37 patients. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 80 patients, of whom 62 had malignant pancreatic disease (MPD) and 18 had benign pancreatic disease (BPD). The accuracy of cytologic diagnoses was verified by histologic, cytologic, and clinical findings. In 62 patients with MPD, the cytologic findings suggested malignancy in 54 patients, suspected malignancy in five, and did not reveal malignancy in three patients. Among 18 patients with BPD, all of the cytologic findings were reported as benign. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for intraoperative FNA cytologic results were 96%, 100%, 100%, 91%, and 97%, respectively, and for USG FNA cytologic results were 94%, 100%, 100%, 78%, and 95%, respectively. No complications followed the procedure. CONCLUSIONS: Both transabdominal percutaneous imaging-guided and intraoperative FNA cytology of pancreatic lesions are simple, safe, and highly accurate methods in differentiation of benign from malignant pancreatic lesions.

Adult↗

PubMed1990

[Fine needle aspiration cytology for orbital lesions].

Cytological examination of fine needle aspiration (FNA) material from orbital lesions is a simple but reliable procedure. FNA establishes preoperative diagnosis essential for planning of treatment. A 58-year-old woman is presented in whom CT demonstrated a space-occupying lesion of the orbit, diagnosed cytologically as metastatic breast cancer. Based on this cytological diagnosis, hormonal treatment was administered and unnecessary surgical intervention was avoided.

Biopsy, Needle↗

PubMed1990

Umbilical metastasis diagnosed by fine needle aspiration.

Fine needle aspiration (FNA) is emerging as a useful diagnostic tool in the evaluation of tumor masses, providing high diagnostic yield. Fine needle aspiration for cytologic evaluation was performed on 14 patients suspected of having umbilical metastasis. The site of the primary tumor was known in 12 patients. In nine patients with previously documented malignancy, FNA of the umbilical nodule demonstrated malignant cells compatible with the histologic diagnosis of the primary cancer. In five other patients metastatic umbilical nodule was the first or the only sign for the presence of primary cancer elsewhere and in four of them FNA revealed malignant cells prior to the diagnosis of internal carcinoma. In one case, FNA demonstrated only inflammatory cells while surgery revealed adenocarcinoma associated with inflammation. The sensitivity of FNA in diagnosing malignant umbilical nodule, and the accuracy of FNA findings were 98.2%, while the predictive value of a FNA cytologic finding of malignancy was 100%. It is recommended that an umbilical nodule should alert the clinician to the possibility of malignancy and FNA should be performed as the first diagnostic procedure. This safe, rapid, reliable, and inexpensive method may diagnose malignancy and preclude the need for umbilical biopsy or more complicated diagnostic intervention.

Abdominal Neoplasms↗