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W J Frable

Publications and source records attributed to W J Frable.

At least 91 records · Page 5Linked to original sources
PubMed1989

Needle aspiration biopsy: past, present, and future.

Since its inception more than 50 years ago at Memorial Hospital for Cancer (New York), needle aspiration biopsy has traveled to its present popularity over a torturous road. The early influence of Stewart on the interpretation of aspiration smears and the use of this biopsy method is still worthy of review, particularly the importance of close cooperation between clinician and pathologist. While cytology has been profoundly influenced by individual cell interpretation as practiced by Papanicolaou, it is really pattern recognition that dominates successful diagnosis by the aspiration biopsy smear method. Present concerns over technical variation in procurement of the biopsy and staining methods should be of less importance than identification of the aspiration methodology that produces the best-quality microscopic image. Reliability of diagnosis by aspiration smear must also be judged by a suitable and reproducible standard, something that is not necessarily fulfilled by tissue pathology, although many would believe otherwise. The author proposes that aspiration may also now be judged, like tissue pathology, by clinical outcome. The application and ease of procuring cell samples from tumors for cell image analysis, for flow cytometry and ploidy studies, and for gene rearrangement place this biopsy method in the forefront of the integration of biologic research and clinical medicine. Aspiration biopsy has caused us to explore how the human eye and brain analyze microscopic images and may even assist in the design of useful artificial intelligence diagnostic systems in the future.

Biopsy, Needle↗
PubMed1989

Sternomastoid tumor of infancy (fibromatosis colli): diagnosis by aspiration cytology.

Sternomastoid tumor (SMT), as part of the spectrum of muscular torticollis, presents in infants as a discrete mass lesion in the neck, typically unassociated with neck torsion. We describe two patients who underwent fine needle aspiration (FNA) of their neck mass. The cytopathology of these aspirates was composed solely of a mixture of benign-appearing spindle cells and degenerating myofibers. Both infants showed a gradual disappearance of the mass without surgical intervention. We believe that FNA cytology is a diagnostic tool applicable to neonates. Additionally, in the proper clinical setting, aspiration cytology can be diagnostic of the clinicopathologic entity of SMT.

Biopsy, Needle↗
PubMed1989

Primary lymphangioma of the thyroid gland.

A 21-year-old woman presented with a solitary, hypofunctioning right thyroid nodule. Findings of fine-needle aspiration biopsy were consistent with a thyroid cyst, but a subsequent biopsy demonstrated changes suggestive of a papillary neoplasm. Surgery was performed and a well-circumscribed 12-mm nodule was identified within the thyroid parenchyma. Microscopic examination confirmed the presence of a thyroid lymphangioma. To our knowledge, this is the first case of a primary thyroid lymphangioma reported in the English literature.

Adult↗
PubMed1988

Fine-needle aspiration cytology of mesenchymal tumors of the breast.

This report describes the fine-needle aspiration (FNA) cytologic findings of 15 cases of sarcomas involving the breast out of a combined series of 2,064 breast FNA biopsies, including 580 malignancies, thereby accounting for 2.6% of all the malignant breast tumors. The series consisted of 14 women and one man with a mean age of 48.4 yr (range, 29-63). There were eight cases of cystosarcoma phyllodes, including one malignant cystosarcoma phyllodes. Three benign cystosarcoma phyllodes had a significant concomitant atypical epithelial hyperplasia, which lead to a misdiagnosis of carcinoma in two of the cases. The third case was correctly identified as recurrent cystosarcoma phyllodes. In retrospect, features suggestive for cystosarcoma phyllodes and unusual for breast carcinoma include increased numbers of naked nuclei and hypercellular stromal fragments. Sarcomatous patterns in our four metaplastic carcinomas included chondrosarcoma (two cases), malignant fibrous histiocytoma (MFH) (one case), and fibrosarcoma (one case). Two additional pure primary MFHs (both of which had electron microscopic confirmation) and one metastatic fibrosarcoma to the breast were encountered. Recognition of unusual cytologic patterns for breast carcinoma should suggest the possibility of a primary or metastatic sarcoma to the breast. Potential pitfalls for misdiagnosis include the presence of atypical epithelial hyperplasia in some cases of cystosarcoma phyllodes, along with occasional cases having patterns indistinguishable from a fibroadenoma. The pleomorphic and bizarre cellular features can suggest the diagnosis of metaplastic and pure sarcomas of the breast, although the potential exists for confusion with very poorly differentiated carcinoma. FNA diagnosis of sarcomatous lesions of the breast is essential in order to insure proper surgical treatment.

Adult↗
PubMed1988

Application of fine needle aspiration biopsy to pediatrics.

Fine needle aspiration (FNA) biopsy cytology is a technique rarely used in children, although it is increasingly used in a routine fashion for the evaluation of masses in adults. We reviewed our experience with FNA in patients 16 years of age and younger from the period 1973 to 1987. FNA diagnoses were confirmed either by subsequent surgical biopsy, autopsy, or clinical follow-up for a minimum period of 1 year. One-hundred twelve FNA procedures were performed in 107 patients. Patient age distribution was as follows: newborn to 5 years of age, 37 aspirates; 6 to 11 years of age, 39 aspirates; and 12 to 16 years of age, 36 aspirates. Fifty-five patients were female. Of the 112 aspirates, 70 were diagnosed as benign disorders, 39 were diagnosed as malignant, one was diagnosed as unsatisfactory, and two were considered suspicious for malignancy. The most common sites of involvement for benign lesions were lymph node (31 sites), soft tissue (13 sites), and thyroid (12 sites). The most common sites for malignancies were lymph node (12 sites), bone (eight sites), and soft tissue (eight sites). Of the malignant aspirates, 20 were from primary neoplasms, three were from locally recurrent neoplasms, and 16 were from metastatic neoplasms. Two false-positive and one false-negative diagnoses yielded sensitivity and specificity rates of 97%, and a predictive value of a positive FNA of 95%. Our experience indicates that selective application of FNA is a useful and important step in the evaluation and management of mass lesions throughout the entire age range of infancy and childhood.

Adolescent↗
PubMed1988

Endometrial carcinoma arising in a large polypoid adenomyoma of the uterus.

A case of endometrial carcinoma arising in a large adenomyomatous polyp is described in a 75-year-old woman. The malignant element appeared to be a mixed adenosquamous carcinoma that was embedded in diffuse adenomyomatous infiltration. The lesion was entirely intramural, and the surface endometrium was atrophic and not neoplastic. The absence of endometrial involvement led to a 6-year delay before hysterectomy was carried out. Pathologic study of the radically excised uterus showed evidence of metastasis to one paraaortic lymph node. Since this appears to be the first example of such an event, the English literature was reviewed for the associated findings of adenomyosis and carcinoma in an intramural setting with noninvolvement of the surface endometrium.

Adenocarcinoma↗
PubMed1988

Fine needle aspiration biopsy. Applications in the diagnosis of lymphoproliferative diseases.

A review of fine needle aspiration biopsies of lymph nodes was performed to determine accuracy and reproducibility among observers for the diagnosis of malignant lymphomas and lymphoproliferative diseases and to identify problem areas in the diagnosis of lymphomas and lymphoproliferative diseases by this biopsy method. Not including cases of carcinoma, 85% of the lymphomas and lymphoproliferative processes were correctly identified by seven of eight observations from a blind review without clinical information. Four problem areas in diagnosis from aspirates were identified: (a) distinction of lymphoid hyperplasia from non-Hodgkin's lymphoma by relying significantly on polymorphism versus monomorphism of the smear pattern; (b) separating undifferentiated carcinoma from large cell lymphoma; (c) overinterpreting extensive lymphoid polymorphism as Hodgkin's disease; and (d) diagnosing some aspirates of granulomatous lymphadenopathy, viral infection, or nodes with extensive necrosis as Hodgkin's disease. From the analysis of this series, a programmed approach was developed for diagnosing lymph node aspirates. History, physical examination, correct performance of the aspiration biopsy, and proper handling of the specimen are the four basic elements. Microscopic evaluation includes assessment of overall cellularity, pattern of cell arrangement, identification of predominant cell type, and background elements.

Adult↗
PubMed1987

Fine-needle aspiration biopsy of lymphoblastic lymphoma and leukemia. A clinical, cytologic, and immunologic study.

Six cases of lymphoblastic lymphoma or leukemia are reviewed in which fine needle aspiration (FNA) biopsy was used to either initially diagnose or to document relapse of the condition. Accuracy of diagnosis was confirmed by surgical or autopsy material or by subsequent clinical course. Cytologically, aspirates were characterized by numerous blast cells with frequent mitoses. Immunologic confirmation utilizing aspirate material was obtained in all cases. Adequate material for extensive immunologic studies was obtained in five of six cases. The impact of FNA on patient management included; primary diagnosis in three cases; documentation of recurrence in two cases; avoidance of surgical biopsy in a patient considered a poor surgical candidate in three cases; correct subtyping of a lymphoma in which material obtained by surgical biopsy was unclassifiable in one case; and correct subtyping of a lymphoma inaccurately subtyped by surgical biopsy in one case.

Adult↗
PubMed1986

The treatment of thyroid cancer. The role of fine-needle aspiration cytology.

A series of 960 fine-needle aspiration biopsies of thyroid lesions are reported. The primary indication is the presence of a solitary thyroid mass. Aspiration biopsy is accomplished using a 23-gauge needle and a commercially available syringe pistol equipped with a 20.0-mL syringe. Sensitivity for the presence of a thyroid neoplasm, specificity for the absence of a thyroid neoplasm, predictive value of a positive diagnosis for a thyroid neoplasm, and diagnostic efficiency are all over 90% in this series. Eight percent of the aspirates were unsatisfactory. Use of fine-needle aspiration biopsy for the diagnosis of thyroid conditions reduces thyroid surgery significantly for nonneoplastic disease. It is cost-effective and essentially free of complications.

Biopsy, Needle↗
PubMed1986

Chordoma: diagnosis by fine-needle aspiration biopsy with histologic, immunocytochemical, and ultrastructural confirmation.

Five cases of chordoma, diagnosed by fine-needle aspiration (FNA) biopsy, are presented. Four cases were histologically confirmed, and in one, immunocytochemical and ultrastructural studies were performed on both the aspirate and tissue specimen. Four cases presented as sacral masses, while in the fifth case, a destructive lesion of the clivus extended into the soft tissues of the lateral neck. A spectrum of cytomorphologic features was encountered including the presence of abundant microtissue fragments and cells in a dissociate pattern, often with abundant metachromatic extracellular matrix. Stellate and cuboidal cells often contained intracytoplasmic vacuoles of varying sizes. Intranuclear inclusions, mitotic figures, and anisonucleosis were prominent features of several cases. Immunoperoxidase studies on a single case demonstrated cytoplasmic staining for low- and high-molecular-weight cytokeratins, vimentin, and epithelial membrane antigen, while glial fibrillary acidic protein and carcinoembryonic antigen were negative. Ultrastructural features included the presence of mitochondrial endoplasmic reticulum complexes, occasional desmosome-like junctions, and abundant extracellular matrix adherent to the tumor cells. We believe the cytomorphologic findings are characteristic and, when taken in concert with immunocytochemical and ultrastructural studies, allow differentiation of chordoma from other primary or metastatic neoplasms occurring in bone. As demonstrated in our series, chordoma is often an unsuspected diagnosis. We believe that FNA biopsy of these lesions can lead to a correct preoperative diagnosis and may also be utilized to document recurrence and thus facilitate the evaluation and management of patients with these lesions.

Aged↗
PubMed1986

Hodgkin's disease: diagnosis by fine-needle aspiration biopsy. Analysis of cytologic criteria from a selected series.

Two hundred thirteen cases in which a lymph node aspirate and subsequent surgical biopsy had been performed were studied independently by four observers. Each observer attempted to discriminate involvement by Hodgkin's disease from involvement by other processes. The material included 18 cases of histologically confirmed Hodgkin's disease. The remaining 195 cases included a wide range of pathologic processes. All four observers were able to distinguish Hodgkin's disease from other processes in the great majority of cases. Two observers reviewed the aspirate material from the 18 cases of Hodgkin's disease to determine the presence and significance of elements known to characterize this disease, i.e., multinuclear and mononuclear Reed-Sternberg cells, polyploidal cells, granulomatous elements, metachromatic material, necrosis, eosinophils, neutrophils, and plasma cells. Reed-Sternberg cells were present in most but not all cases. Reed-Sternberg-like cells also were occasionally encountered in other processes. Polyploidal cells were invariably present and were useful in recognizing the disease. Granulomatous elements, metachromatic material, necrosis, eosinophils, and neutrophils were frequently present and, while not specific for the process, helped to draw attention to or substantiate the diagnosis of Hodgkin's disease.

Biopsy, Needle↗
PubMed1984

Needle aspiration of the breast.

Using a 20- or 22-gauge needle and a 20.0 ml syringe attached to a commercially available syringe pistol, the author performed 853 aspiration biopsies of palpable breast masses during the 9-year period 1974 through 1982. There were 269 diagnoses of breast cancer, 42 suspected cases of cancer, and 496 aspirates reported as benign tumor, inflammation, or another non-neoplastic diagnosis. Twenty-seven cases of carcinoma were not diagnosed from the aspiration biopsy sample. There was one false-positive diagnosis of carcinoma in a patient whose tumor was a cystosarcoma phylloides, benign variant. Forty-six aspirates were considered unsatisfactory, usually because of an insufficient cellular sample. Sensitivity for the diagnosis of breast cancer was 89.0%, while specificity for the absence of breast cancer was 97.0%. Only 13 cases in the group reported as suspicious for carcinoma were proven not to be breast cancer after excisional biopsy and histologic study. The procedure is free of complications, convenient, and cost effective. It provides for evaluation of the patient who has breast cancer on an outpatient basis as well as a full discussion of treatment options prior to intervention.

Biopsy, Needle↗
PubMed1984

Breast carcinoma with osseous metaplasia: an electron microscopic study.

A breast carcinoma containing osseous metaplasia was examined with electron microscopy. The heterologous components were intermingled closely with the usual infiltrating ductal type of a breast carcinoma. Ultrastructurally, carcinoma cells were distinguished clearly from the various mesenchymal cells composed of active fibroblasts, osteoblasts, and osteoclasts. No intermediate cells were present between the two distinct cell populations. Our findings are consistent with the stromal cell origin of the heterologous components and are discussed with relation to their histogenesis in breast carcinoma.

Aged↗
PubMed1984

Fine-needle aspiration effects on benign lymph node histology.

The histology of 28 lymph nodes with benign hyperplasia were assessed for evidence of the effects of fine-needle aspiration prior to biopsy. Only 43% of the lymph nodes showed evidence of prior aspiration. This consisted of needle tracts occupying less than 5% of any one section in ten cases, and 10% in two cases. In none of the 28 lymph nodes did prior fine-needle aspiration interfere with the histologic evaluation. The authors conclude that fine-needle aspiration does not interfere with subsequent histologic evaluation of lymph-adenopathy.

Biopsy, Needle↗
PubMed1984

Isolated noninfectious granulomas of the ovary.

Four examples of noninfectious granulomas of the ovary were studied. All four occurred in premenopausal women. One patient had a salpingo-oophorectomy for a symptomatic ovarian mass; the other three examples were incidental findings in hysterectomy and salpingo-oophorectomy specimens. None of the patients had a history of systemic granulomatous disease, nor have any of the patients developed any symptoms on follow-up, which varies from 2 to 7 years.

Adolescent↗
PubMed1984

Fine-needle aspiration biopsy: efficacy in the diagnosis of head and neck sarcoidosis.

The authors report the usefulness of fine-needle aspiration biopsy to establish the diagnosis of sarcoidosis in patients with palpable disease in the head and neck areas. Aspiration biopsy proved to be a simple and quick method for establishing this diagnosis in the eight cases reported in this series. Interpretation of cytologic smears with identification of typical sarcoid-like granulomas proved to be quite easy. No complications occurred secondary to use of this technique.

Adult↗