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N Sneige

Publications and source records attributed to N Sneige.

At least 73 records · Page 4Linked to original sources
PubMed1995

Image analysis--derived morphometric differences in fine needle aspirates of ductal and lobular breast carcinoma.

The differentiation of ductal and lobular carcinoma (including lobular carcinoma in situ) of the breast has important prognostic implications; thus, preoperative differentiation of these entities via fine needle aspiration could have a substantial impact on the therapeutic options offered to patients. However, well-defined, reliable light microscopic criteria do not currently exist for their distinction in cytologic preparations, particularly when the differential diagnosis of lobular versus low nuclear grade ductal carcinoma is considered. In this study we utilized a morphometric image analysis system to identify distinct nuclear features useful in the differentiation of these two entities and found that a number of significant differences do exist. Although some features (i.e., nuclear size) may be detected in traditional cytologic preparations, others may not be detected by the human observer, supporting a role for automated morphometric analysis as a useful adjunct in the distinction of lobular and low nuclear grade ductal carcinoma in fine needle aspirates of the breast.

Biopsy, Needle↗
PubMed1994

Quantitative analysis of chromosome in situ hybridization signal in paraffin-embedded tissue sections.

Interphase cytogenetic analysis using chromosome-specific probes is increasingly being used to detect chromosomal aberrations on paraffin-embedded tissue sections. However, quantitative analysis of the hybridization signal is confounded by the nuclear slicing that occurs during sectioning. To determine the sensitivity and accuracy of chromosome in situ hybridization for detecting numerical chromosomal aberrations on paraffin-embedded sections, in situ hybridization was performed on sections derived from mixtures of cell populations with known frequencies of numerical chromosomal aberrations and the Chromosome Index (CI) was calculated (i.e., total number of signal spots/number of nuclei counted) as a quantitative measure of chromosome copy number. The presence of 25% or more monosomic or tetrasomic cells in a given population was easily detected as a change in CI (P < 0.05). Lower degrees of polysomy could be detected as a small percentage of nuclear fragments with > 2 signal spots. The CI was not significantly influenced by a change in section thickness from 4 to 8 microM, by an increase in cell size from 478 to 986 microM3, or by the choice of detection method (fluorescence vs. conventional bright-field microscopy). Comparative analysis of touch preparations and tissue sections from the corresponding breast tumors showed that CI accurately reflects the average copy number of chromosomes in intact nuclei and may actually be superior to in situ hybridization on whole nuclei for the detection of numerical chromosomal changes in defined histologic areas. This method is thus a sensitive and accurate means of studying genetic changes in premalignant and malignant tissue, and of assessing the genetic changes associated with specific phenotypes.

Aneuploidy↗
PubMed1994

Correlation of two AgNOR counts with Ki-67 labeling index: a study in fine-needle aspirates of lymphoproliferative disorders and breast carcinoma.

The Ki-67 antibody binds to nonresting cells where Ki-67 labeling index (KLI) reflects proliferative activity (PA). The argyrophilic nucleolar organizer regions (AgNOR) counts have been correlated to ploidy and/or PA. Two AgNOR counting methods distinguish ploidy from PA. The first count is the mean AgNOR count (mAg-NOR) which correlates with ploidy. The second is the percentage of nuclei with > or = 5 AgNORs/nucleus (pAgNOR) which reflects PA. To explore this relationship, we separately stained smears of 20 fine-needle aspirates (FNAs) of lymphoproliferative disorders (n = 12) and breast carcinomas (n = 8) for AgNOR and Ki-67. We also double-stained 10 of the smears for both AgNOR and Ki-67. The correlation of pAgNOR counts and KLI was statistically significant (P < 0.0001) whereas it was not between mAgNOR and KLI (P = 0.13). Additionally, using the double stain, the Ki-67 negative cells had an AgNOR granule range of 1-3/nucleus with a mean of 1.33 (+1.86 SD). The Ki-67 positive cells showed an AgNOR granule range of 2-12/nucleus with a mean of 4.15 (+/- 1.02 SD) (P < 0.0002). We thus conclude that pAgNOR is a more reliable indicator of PA than mAgNOR and that four AgNORs/nucleus is an acceptable number differentiating proliferating from resting cells.

Biopsy, Needle↗
PubMed1994

Tubular carcinoma of the breast: cytologic features in fine-needle aspirations and application of monoclonal anti-alpha-smooth muscle actin in diagnosis.

Twenty fine-needle aspirations (FNAs) of histologically proven tubular carcinoma of the breast (TCB) were reviewed, and the staining distribution of alpha-smooth muscle actin (SMA) was evaluated to see if this improved FNA sensitivity. In 18 cases, the aspirates were cellular, consisting predominantly of epithelial cells arranged in cohesive tubular structures that appeared angular or twisted. Single epithelial cells were present in varying numbers in 14 cases (70%). Cribriform fragments corresponding to in situ ductal carcinoma were noted in 9 cases (45%). Individual, bare nuclei were present in seven cases (35%). The initial cytologic diagnoses were 10 carcinomas, eight suspicious for carcinoma, and two cases were misinterpreted as fibroadenoma. In 8 of 14 cases, the epithelial fragments stained negatively for SMA, whereas in six cases some fragments (< 10%) stained positively. These findings were in contrast to a reticulated staining pattern noted in almost all of the epithelial fragments in nine fibroadenomas and three fibrocystic changes. Eighteen well-differentiated invasive ductal carcinomas stained negatively, whereas four had occasional positively staining fragments. We conclude that TCB displays distinct cytomorphologic features that can be recognized or at least suggested by FNA. Awareness of the cytologic characteristics--angulated tubular structures with or without single epithelial cells--coupled with mammographic/ultrasound findings, is necessary to avoid a misdiagnosis. Alpha-smooth muscle actin staining may help in selected cases.

Actins↗
PubMed1994

Fine-needle aspiration cytology of recurrent and metastatic mixed mesodermal tumors.

We report the cytological and clinical findings of 16 fine-needle aspirates (FNAs) performed on recurrent (n = 6) and metastatic (n = 10) mixed mesodermal tumors (MMMTs). The median interval between the primary diagnosis and FNA was 16 mo. Primary sites were the endometrium (n = 11), the ovary (n = 3), the cervix (n = 1), and pelvic soft tissue (n = 1). Primary tumors showed carcinoma with homologous mesenchymal components in 13 cases and focal heterologous elements in three (two chondrosarcomas and one rhabdomyosarcoma). The FNAs showed carcinoma in all 16 cases, with adenocarcinoma differentiation in three. Mesenchymal elements were identified in aspirates of three recurrent and two metastatic lesions. They were all homologous. aspirates. We conclude that mesenchymal components in FNAs of MMMTs are less likely to be seen in metastatic lesions, and that heterologous mesenchymal components are rarely seen in these aspirates even in recurrent disease. These findings confirm that the epithelial component is responsible for the malignant behaviour of MMMTs, and suggest that these lesions may need to be classified as sarcomatoid carcinomas rather than true carcinosarcomas.

Adenocarcinoma↗
PubMed1994

Fine-needle aspiration cytology of ductal hyperplasia with and without atypia and ductal carcinoma in situ.

To determine cytomorphological characteristics of proliferative lesions of breast duct epithelium, we reviewed fine-needle aspiration (FNA) smears of 11 cribriform and micropapillary, low nuclear grade, ductal carcinomas in situ (DCIS), nine atypical ductal hyperplasias (ADH), and 10 florid or moderate ductal hyperplasias (DH) without atypia. These breast lesions presented as a palpable mass in 16 patients or were detected by diagnostic imaging in 14 patients. Cytological findings evaluated were cellularity, cell composition, architectural pattern (including presence and shape of intercellular spacing and cell characteristics of epithelial cell groups), nuclear diameter and pleomorphism, chromatin pattern, and number of single epithelial cells. Smears also were evaluated by cytological criteria only, using the scoring system of Masood et al. Based on our study's use of cytological and architectural features combined, the FNA diagnoses were as follows: of the 11 DCIS cases eight were carcinoma and three were inconclusive: proliferative epithelium (ADH v DCIS); of the nine ADH cases two were carcinoma and seven were inconclusive: proliferative epithelium (ADH v DCIS); and of the 10 DH cases four were DH, two were suspicious for carcinoma, and four were inconclusive: proliferative epithelium (DH v ADH). Using the cytological scoring system alone, of the 11 DCIS cases one was classified as carcinoma, five as ADH, and five as DH; of the nine ADH cases one was classified as carcinoma, three as ADH, and five as DH; and of the 10 DH cases four were classified as ADH and six as DH. This study shows that the application of both cytological and architectural criteria to the interpretation of FNA smears is more reliable than cytology alone in the identification of proliferative breast lesions and low-grade carcinoma. However, overlapping features between DH and ADH as well as ADH and low-grade carcinoma exist making separation of some of these lesions difficult. Aspirates of DH and ADH may display many single epithelial cells, mimicking low-grade carcinoma. However, a diagnosis of low-grade carcinoma can be made with confidence if the aspirates are cellular with many single atypical epithelial cells and lack an admixture of benign cellular elements. Architectural and cytological characteristics of proliferative duct epithelium, as evaluated in histological sections, are well represented in aspiration smears and should aid in the identification of these lesions.

Adult↗
PubMed1994

Ultrasound-guided fine-needle aspiration of nonpalpable breast lesions. Cytologic and histologic findings.

Between 1989 and 1992, 651 nonpalpable breast lesions in 586 patients were aspirated using the ultrasound-guided technique at M.D. Anderson Cancer Center. Cytologic diagnoses were as follows: malignant, 167; suspicious, 30; benign, 211; cysts, 168; atypical ductal hyperplasia, 4; and insufficient for diagnosis, 71. In all cystic and most benign lesions, fine-needle aspiration (FNA) confirmed the benign clinical findings, and surgery was not performed. Of the 483 solid lesions, 254 were subsequently treated surgically, either because of suspicious mammographic or sonographic findings or because of positive or suspicious cytologic findings. The cytologic diagnoses in these cases were as follows: 132 (52%) malignant, 65 (25%) benign, 26 (10%) suspicious, 4 (2%) atypical, and 27 (11%) insufficient for diagnosis. The sensitivity of ultrasound-guided FNA for the diagnosis of malignant lesions was 91%, specificity 77%, and overall accuracy 84%. There were four (2%) false-negative results. Diagnostic failures were attributed to the small size of the lesions, histologic type, and inexperience in localization and cytologic interpretation of tubular carcinoma. One (1%) false-positive diagnosis was made (atypical ductal hyperplasia misdiagnosed as carcinoma). The authors' findings indicate that ultrasound-guided FNA offers a reliable and simple alternative to open biopsy of nonpalpable breast lesions. The efficacy of this technique depends primarily on accurate localization of the biopsy needle and on skillful cytologic interpretation of certain breast lesions.

Biopsy, Needle↗
PubMed1994

Pleural effusion in patients with differentiated papillary thyroid cancer.

Among 1,772 patients who registered at the MD Anderson Cancer Center between 1944 and 1991 with papillary thyroid cancer, 10 had malignant pleural effusion that developed during the course of the disease. At primary surgery, all 10 were found to have metastases to cervical lymph nodes. Seven of these patients also had invasion into adjacent soft tissues, 4 had lung metastases, and 1 had pleural effusion. All patients had radiologically apparent lung metastases at the time pleural effusion was found. Malignant effusion appeared 0 to 60 months after abnormal chest radiographs in 9 patients and 61 to 132 months after the initial diagnosis of thyroid cancer in 4 patients. Pleural effusions were treated with local radioisotopes or sclerosing agents, systemic radioiodine or chemotherapy, or both. All 10 patients died of thyroid cancer; overall survival time was 7 to 170 months (median, 27 months); however, appearance of pleural effusion preceded death by 1 to 20 months (median, 11 months). Malignant pleural effusion complicates the clinical course in 0.6% of adult patients with papillary thyroid cancer. It may develop many years after the initial diagnosis but is associated with greatly shortened survival time in all cases.

Adult↗
PubMed1994

Masses in breasts with implants: diagnosis with US-guided fine-needle aspiration biopsy.

PURPOSE: To evaluate retrospectively the findings at ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of masses in breasts that contain a prosthesis. MATERIALS AND METHODS: Real-time US-guided FNAB was performed in 22 lesions in 17 patients with breast implants. Pneumocystography was performed in seven of eight cysts. The final diagnosis was based on either histologic findings after surgical excision or a combination of cytologic, imaging, and clinical findings. RESULTS: The lesions had a mean diameter of 15 mm +/- 9 (standard deviation). Fifteen lesions (68%) were not identified on mammograms. In all cases, FNAB was completed without complication. Pneumocystography was successful in seven of seven cysts. Cytologic diagnosis was correct in 21 of 22 lesions (95%). There was one case of inadequate specimen (5%). In 16 cases (73%), the diagnosis was established with a single pass. CONCLUSION: Real-time US allowed continuous visualization of the needle during insertion and sampling, which resulted in pinpoint accuracy and safety. US-guided FNAB is recommended for needle biopsy in breasts with implants.

Adult↗
PubMed1993

Flow cytometric (DNA content and S-phase fraction) analysis of breast cancer.

The advent of therapeutic alternatives for patients with breast cancer has altered their clinical management profoundly. Because of this, the need for reliable prognostic indicators with definable clinical utility has spawned a number of objective evaluations of the neoplasm itself. Flow cytometric analysis of DNA and the cell cycle (S-phase fraction) are two of the objective measurements. Their current status in breast cancer is unclear. In the important category of carcinomas with negative axillary lymph nodes, DNA content (ploidy) information does not add important, independent, or prognostic information. S-phase fraction, in addition to correlating with DNA content and histologic grade, may be an independent factor, but methodologic variables have hampered definite conclusions about its utility. Currently, given the rather consistent absence of correlation between DNA ploidy, S-phase fractions, and nodal metastases, the independent prognostic utility of the two flow cytometric parameters can be questioned. A resolution of their final status in the prognostic hierarchy depends on rigorous adherence to the variables affecting them, i.e., preanalytic, analytic, and postanalytic factors.

Breast Neoplasms↗
PubMed1993

Objective comparison of cellular yield in fine-needle biopsy of lymph nodes with and without aspiration.

Recent reports have indicated that needle biopsy without aspiration obtained adequate material for diagnosis. To determine objectively the adequacy of cell yield both for diagnosis and for special studies (e.g., flow cytometry, markers), we prospectively studied 20 superficial lymph nodes in 20 patients with a history of lymphoma. In each case, the cytology materials were obtained by fine-needle biopsy techniques with (FNAB) and without (FNB) aspiration. Two needle passes for each method were placed in separate tubes of RPMI medium. With FNAB, the cell counts (determined by a Coulter counter) ranged from 1.55 to 70 million (M) per tube, mean = 19.12 M, whereas with FNB, the cell counts ranged from 1.58 M to 40 M, mean = 15.48 M (P = 0.4555). Although FNAB provided more cells in 12 cases (60%), FNB provided more cells in the remaining 8 cases (40%) (P = 0.9392). Both techniques provided adequate numbers of cells for special studies in all cases. We conclude that FNB can provide an adequate number of cells both for diagnosis and for special studies.

Biopsy, Needle↗
PubMed1993

Fine-needle aspiration of the breast: a review of 1,995 cases with emphasis on diagnostic pitfalls.

Between 1985 to 1989, 1,995 fine-needle aspirations of palpable breast lesions were performed at our institution. In all cases, the aspirates were procured by cytopathologists using 22- or 23-gauge needles. Direct smears were immediately stained with Diff-Quik and Papanicolaou and assessed for specimen adequacy (criteria as followed in this institution). Tissue follow-up was available in 1,117 cases. The cytologic diagnoses rendered in these cases were: malignant, 690 cases (60.2%); suspicious for carcinoma, 49 cases (4.3%); benign, 343 cases (29.9%), and insufficient specimen, 35 cases (3.1%). There were 28 false-negative and 2 false-positive results. Considering only cases definitively diagnosed as benign or malignant, the sensitivity was 96%, specificity 99%, positive predictive value 99%, negative predictive value 94%, and overall efficiency 97%. Of these specimens considered suspicious, only 11 cases (22%) were proved not to be malignant after excisional biopsy. These were three fibroadenomas, three ductal hyperplasias, two adenosis tumors, two mucocele-like lesions, and one nipple adenoma. The two lesions that resulted in true false-positive diagnoses were an apocrine cyst with atypia and sclerosing adenosis with radial scar. The clinical and cytologic features of the benign conditions that resulted in false suspicious and positive diagnoses and those features that distinguish them from carcinoma are presented.

Biopsy, Needle↗
PubMed1993

Quality-assurance study of simultaneously sampled, non-correlating cervical cytology and biopsies.

As part of a quality assurance study, we reviewed 223 cases of simultaneously sampled cervical smears and biopsies that showed a significant lack of correlation for squamous dysplasia or carcinoma. In 153 of the 223 cases (68.6%), the cytology was negative and the biopsy positive. After review of the specimens, errors in this group were found to be of the following types: sampling 64%, interpretive 29%, and combined sampling and interpretive 7%. In the remaining 70 cases (31.4%), the biopsy was negative and the Papanicolaou smear positive. In these cases, the following types of errors occurred: sampling 54%, interpretive 33%, and combination 13%. Twenty-nine of these 70 patients showed dysplasia on follow-up material. These findings indicate there are a significant number of false-negative Papanicolaou smears, mostly because of sampling problems. There are few false-positives. In cases of positive Papanicolaou and negative biopsy, dysplasia is likely to be present in subsequent samples.

Biopsy↗
PubMed1993

Spindling artifact of urothelial cells in post-laser treatment urinary cytology.

We reviewed 22 post-laser (Nd:YAG laser) coagulation bladder washes collected immediately after treatment. All washes demonstrated a striking artifact of cellular spindling. These spindled cells occurred singly, in loose clusters, and in lamellar stacks and had elongated nuclei with dense chromatin and bipolar cytoplasm that was fused in the stacks. Concurrent biopsies demonstrated similar cytologic changes. The spindling is a nonspecific epithelial response to heat. Conventionally electrocauterized epithelia show this artifact in biopsies, but since only the base of the lesion and surrounding urothelium are subjected to heat with electrocautery, the relatively few spindled epithelial cells created presumably go undetected in cytology specimens. With laser treatment, however, the whole urothelial surface of the lesion is coagulated, producing a much greater number of spindled cells. It is important to avoid misinterpreting the spindled cells as cells from a mesenchymal neoplasm or a sarcomatoid carcinoma, mistakes that were made in some of our initial cases. Malignancy cannot be evaluated when cells exhibit spindling artifact; this judgement should be made on undistorted cells. Thus, pre-laser and post-laser washes should be submitted for evaluation of malignancy.

Artifacts↗
PubMed1993

Fine-needle aspiration cytology of sclerosing hemangioma of the lung: case report with immunohistochemical study.

Sclerosing hemangioma of the lung (SHL) is a rare benign neoplasm, usually found incidentally on a routine chest X-ray. We present a case of SHL initially diagnosed by fine-needle aspiration cytology. Cytomorphologic characteristics were confirmed by a cell block examination and immunohistochemical findings. The differential diagnoses of the fine-needle aspiration are discussed.

Aged↗
PubMed1993

Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases.

To determine the diagnostic pitfalls of thyroid fine-needle aspiration (FNA), we reviewed 394 thyroid aspirates obtained between January 1986 and December 1990. Surgical follow-up was available for 150 aspirations. The cytologic diagnoses were categorized into four groups: benign, 57; indeterminate, 51; malignant, 33; and nondiagnostic specimen, nine. There were three false negative diagnoses (3%), which upon review were judged to be inadequate specimens. Three false positive diagnoses (7%) were identified: in the first two cases, follicular adenomas were mistaken for papillary carcinoma; in the third case, atypical Hürthle cells were mistaken for a Hürthle cell carcinoma. Our results showed a sensitivity of 93% and a specificity of 91% for the detection of malignancy. If indeterminate cases were considered positive, the specificity decreased to 50%, while the sensitivity increased to 97%. We conclude that: 1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma; 2) as in follicular neoplasms, aspirates of Hürthle cell adenomas cannot be differentiated from Hürthle cell carcinomas; 3) with adequate sampling, false negative results can be markedly reduced.

Adolescent↗
PubMed1993

Fine-needle aspiration cytology of silicone granulomas in the augmented breast.

We studied 12 aspirates from 10 patients who underwent diagnostic fine-needle aspiration cytology (FNAC) of an augmented or reconstructed breast. Six patients were augmented with silicone gel-filled implants and four patients had silicone liquid injections. FNAC indications included a painful or suspicious mass. Excisional biopsy was performed in six cases after FNAC. The findings of eight cases included modestly cellular smears composed of loosely cohesive histiocytes containing vacuoles of various sizes. Multinucleated foreign body giant cells, fragments of dense, amorphous fibrous tissue, and fibroblast nuclei stripped of cytoplasm were also present. Two patients showed a mixture of inflammatory cells characteristic of intramammary lymph nodes or lymphoid aggregates. We conclude that silicone granulomas of the breast show a characteristic set of findings on FNAC which enable a cytopathologist to render a specific diagnosis given an appropriate history of breast augmentation.

Adult↗