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J R Goellner

Publications and source records attributed to J R Goellner.

138 records · Page 8Linked to original sources
PubMedDate not supplied

Fine-needle aspiration biopsy of thyroid nodules.

Nodular thyroid disease is a common problem, particularly in women and the elderly population. Furthermore, 5% of thyroid nodules are likely to be malignant. Therefore, assessment for malignant potential is important, and fine-needle aspiration (FNA) biopsy is the most accurate technique. For each nodule, two to four aspirations should be attempted from different areas of the nodule. Although major complications of FNA biopsy are rare, proper cytologic interpretation necessitates special expertise. Cytologic diagnoses are usually categorized as diagnostic or nondiagnostic, and the diagnostic specimens are classified as benign, "suspicious," or malignant. Rebiopsy is indicated for enlarging nodules, recurrent cysts, and nondiagnostic cytologic findings. Because FNA biopsy is a safe, reliable, and rapid means of evaluating thyroid nodules, we recommend its routine use for diagnosis and treatment of thyroid nodular disease.

Journal Article↗
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Has fine-needle aspiration biopsy changed thyroid practice?

OBJECTIVE: To assess the influence of fine-needle aspiration (FNA) biopsy on the management of nodular thyroid disease. METHODS: We retrospectively evaluated the effect of the availability of FNA biopsy on thyroid surgical practice at our institution by comparing the data for two study periods--1975-1976 (before the introduction of FNA) and 1985-1986 (5 years after its introduction). RESULTS: The study inclusion criteria were fulfilled by 1,451 patients. In 1975-1976, 938 patients had thyroid operations at our institution. FNA biopsy was introduced into our practice in 1980. In 1985-1986, 513 patients underwent a thyroid surgical procedure. Before the FNA era, the frequency of carcinoma in patients selected for thyroidectomy was 18%, whereas after FNA became available, it increased to 25% (P< 0.0001). When patients were selected for surgical treatment because of either "suspicious" or malignant cytologic results, the yield of carcinoma increased to 40%. CONCLUSION: These data suggest that FNA biopsy has improved selectivity for operation in patients with nodular thyroid disease and has reduced the number of patients who undergo thyroidectomy for benign disease. The result is an increasing yield of malignant lesions found at surgical intervention. FNA biopsy has had a substantial cost-saving effect on thyroid practice.

Journal Article↗
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Direct extension of malignant lesions to the thyroid gland from adjacent organs: report of 17 cases.

OBJECTIVE: To characterize malignant tumors with direct extension to the thyroid gland from adjacent organs. METHODS: We retrospectively studied 17 patients with direct extension of malignant tumor to the thyroid from primary lesions in the head and neck who had been examined at Mayo Clinic Rochester between 1985 and 1994. The origin of the primary tumor was identified in all cases. Thyroid involvement was confirmed histologically. Data were analyzed for the frequency and types of malignant lesions, the clinical course, and the follow-up after thyroid involvement. RESULTS: All 17 study patients had a diagnosis of a primary malignant tumor before detection of thyroid involvement. Of the 17 patients, 12 had squamous cell carcinoma (SCC) of the larynx, 2 had SCC of the tongue base, 2 had SCC of the proximal and the cervical esophagus, respectively, and 1 had synovial cell sarcoma of the proximal esophagus. The time between diagnosis of the primary tumor and detection of thyroid invasion in the patients with SCC of the larynx or tongue base ranged from 1 to 196 months (mean, 38). Only 1 of these 14 patients had thyroid gland involvement clinically evident before surgical exploration. Thyroid invasion was diagnosed after surgical intervention. All three patients with esophageal malignant tumors had thyroid involvement clinically. CONCLUSION: SCC of the larynx, tongue base, or proximal esophagus may invade the thyroid gland directly. SCC of the larynx may have the greatest tendency to extend to the thyroid. In patients with SCC, extension of the primary malignant tumor to the thyroid gland should be considered despite lack of clinical evidence.

Journal Article↗
PubMedDate not supplied

Detection of Chlamydia trachomatis in Papanicolaou-stained cervical smears by an indirect immunoperoxidase method.

A two-step (indirect) immunoperoxidase method directed against Chlamydia trachomatis was developed. The method was then used to evaluate the specificity of cytologic changes suggestive of C. trachomatis in Papanicolaou smears of cervical specimens from women who were culture-negative for the organism. Positive immunoperoxidase staining was detected in 9 of 21 cases (43%) tested. Technical problems, especially background staining, precluded interpretation in the remainder of the cases. Cervical cytology, as demonstrated by immunoperoxidase staining, may, in some instances, be more sensitive than the culture. However, because the etiology of cytologic changes not specifically identified by immunoperoxidase staining may be due to other organisms or factors, immunoperoxidase procedures, as described, should not replace culture for confirmation of cytologic findings suggestive of C. trachomatis.

Cervix Uteri↗
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Intranuclear inclusions in urinary cytology.

Twenty-one urinary cytology specimens from 16 patients showed red intranuclear inclusion bodies. The literature pertinent to these inclusions mainly suggests that lead poisoning is a cause for such inclusions. Histories were reviewed for possible causes, particularly lead poisoning, associated medications, associated illness or relationship to neoplasia. The only consistent associations found were that all the patients were women over the age of 50 and that all inclusions were found in voided urine specimens. Four slides containing inclusions were stained by acid-fast methods, with negative results. The origin of these inclusions remains unknown.

Aged↗
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Utility of bronchoalveolar lavage in the diagnosis of drug-induced pulmonary toxicity.

Two hundred consecutive bronchoalveolar lavages (BALs) performed at Mayo Clinic were retrospectively reviewed. The BAL specimens were evaluated for nuclear enlargement, hyperchromasia and increased cytoplasmic staining density as possible cytologic markers of cytotoxic drug effects. Of the 200 patients whose lavages were examined, 178 had sufficient clinical data for study. Thirty-six BAL specimens had cytologic changes consistent with drug-induced pulmonary toxic effects. Twenty-three of the 36 patients had concurrent or subsequent lung tissue available for evaluation; 10 of the 23 showed histologic evidence of cytotoxic effects. The results indicate that BAL is a safe and useful procedure, not only for the assessment of suspected pulmonary infection in immunocompromised patients, but also for the investigation of drug-induced pulmonary disease.

Biopsy↗
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Transthoracic needle aspiration biopsy. Review of 233 cases.

In 233 cases in which transthoracic needle aspiration was done at the Mayo Clinic from 1980 through 1983, the cytology slides, tissue fragments and patient histories were reviewed; the original and review diagnoses were compared and correlated with the subsequent clinical course. In most cases, the procedure was performed with an 18-gauge needle under fluoroscopic guidance, primarily in cases with suspected malignant masses that were considered to be not surgically resectable. In 70% of the cases, there was a history of malignancy, and 82% of the malignant lesions were of extrapulmonary origin. Correlation of the original diagnosis with the clinical course yielded 70% (164 cases) true positives, 6% (14 cases) true negatives, 16% (37 cases) false negatives, 0% false positives and 8% (18 cases) indeterminants. In none of the false-negative cases was the slide subsequently read as positive in a blind review. Of the true-positive cases, 12% had positive tissue fragments only, 37% had positive cytology smears only, and 51% had both positive smears and fragments. In 32% of the cases, there were radiologically demonstrable pneumothoraces, and in 12%, placement of a chest tube was required. Hemoptysis occurred in less than 5% of the cases. In summary, transthoracic needle biopsy provides an efficient way to accurately obtain diagnostic tissue, with acceptable minor complications.

Adult↗
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Fine needle aspiration cytology of the thyroid, 1980 to 1986.

An experience with approximately 6,300 fine needle aspirations of the thyroid was reviewed. The cytologic results were negative in 65% of the aspirates, suspicious for malignancy in 11%, positive for malignancy in 4% and nondiagnostic in 20%. Sensitivity in 382 cases of known malignancy was 98%, and the specificity of a positive cytologic report for malignancy was 99%. Repeat aspiration on initially nondiagnostic cases produced diagnostic results in more than half of the cases. The major limitation of the technique seems to be the lack of specificity in the group whose results are suspicious for malignancy, in large part due to an inability to separate cellular follicular or Hürthle-cell adenomas from follicular or Hürthle-cell carcinomas. The protocols for obtaining and processing the aspirates are briefly summarized.

Biopsy, Needle↗
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False-negative results in cervical cytologic studies.

The appropriate interval between cervical cytologic screening studies is a matter of considerable controversy, with a major consideration being the problem of false-negative results. To determine the rate of false-negative cervical cytologic results in our laboratory and to determine how these failures occur, tissue-proven cases of carcinoma in situ, invasive squamous-cell carcinoma, endocervical adenocarcinoma and lymphoid malignancy involving the cervix with negative Papanicolaou smears obtained within one year prior to the tissue diagnosis were reviewed. Over the four-year period from 1980 through 1983, 339 patients had tissue-proven cervical malignancies. Of these, 66 had false-negative Papanicolaou smears, representing a 20% overall false-negative rate. These false-negative smears were rescreened. For all types of cervical malignancy, the majority of errors were due to sampling. No malignancy was missed disproportionately by either cytotechnologists or cytopathologists. We plan to utilize these data for quality control purposes and for continued review of future performance.

Cervix Uteri↗
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Cytology of cystic papillary carcinoma of the thyroid.

Cytologic features in nine cases of cystic papillary carcinoma of the thyroid are described. These cases were from a group of 66 consecutive patients who had papillary carcinomas examined cytologically. The most prominent cytologic findings were clusters and sheets of epithelial cells, enlarged and pale nuclei, intranuclear inclusions and psammoma bodies. Multinucleated giant cells and viscous colloid were not seen in these cystic cases. In eight specimens of resected tissue, the primary lesion was cystic; four cases showed multicentric primary carcinoma, and one showed cystic degeneration in metastases. An evaluation of the cytologic features when cystic degeneration is present may be difficult because papillary cell groups may not be obvious, cell details may be obscured, and intranuclear inclusions and psammoma bodies may be rare or absent.

Adult↗
PubMedDate not supplied

Detection of p53 antigen expression in cytologic preparations of ovarian carcinomas.

We explored the value of p53 immunostaining in detection of malignant cells in cytologic analyses in ovarian cancer patients. Ninety-six percent of 23 tumor touch preparations had nuclear staining with PAb240: 44% had nuclear only, 26% had both nuclear and cytoplasmic staining, and 26% had cytoplasmic staining alone. Eight of 20 cytospins of peritoneal washings from ovarian cancer patients were PAb240 positive, 6 had cytoplasmic, and two had nuclear staining. Cytospins of fluid from 3/15 patients with no malignancy revealed cytoplasmic staining of mesothelial cells. The lack of concordance between staining of primary tumors and cytospins of peritoneal washings and the apparent reactivity in some benign samples may limit the utility of immunohistochemical detection of malignant cells in the peritoneal fluid of ovarian cancer patients.

Adolescent↗