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PubMedDate not supplied

CT-guided fine needle aspiration and needle core biopsy of skeletal lesions. Complementary diagnostic techniques.

OBJECTIVE: To compare the diagnostic sensitivity and specificity of fine needle aspiration (FNA) to those of needle core biopsy (NCB) and to attempt to determine if a complementary role exists for the two modalities. STUDY DESIGN: Skeletal lesions in 144 patients were evaluated with concomitant FNA and NCB over a 21-year period. FNAs and NCBs were divided as diagnostic of neoplasm, normal or inflammatory (i.e., osteomyelitis), or unsatisfactory. The results of each modality were then reviewed and compared. RESULTS: In the 144 total cases, a diagnosis was possible in 79% (114) cases. FNA and NCB concurred in 73% (83) of diagnostic cases. Concurrence was 87% between diagnostic FNA (83) and NCB (95). The two modalities agreed in 78% of cases diagnosed as metastatic carcinoma and in 59% of primary malignant tumors of bone (17) (excluding Ewing's sarcoma). FNA alone was diagnostic in 8% (9) of cases, including 5 metastatic carcinomas, 2 chondrosarcomas, 1 Ewing's sarcoma and 1 case of osteomyelitis. This represented 24% of the 38 cases in which NCB was unsatisfactory (11) or normal (27). NCB alone was diagnostic in 19% (22) of cases, including 11 metastatic carcinomas, 3 osteosarcomas, 1 chondrosarcoma, 1 spindle cell sarcoma (not otherwise specified), 1 Ewing's sarcoma, 2 capillary hemangiomas and 3 cases of osteomyelitis. This represented 43% of the 51 cases in which FNA was misinterpreted (2), unsatisfactory (33) or normal (16). NCB more specifically typed a metastatic lesion or suggested a primary focus in 21% (12) of the 58 cases in agreement. It also more specifically subtyped 50% (5) of the 10 primary malignant tumors of bone. CONCLUSION: Given these findings, NCB is more specific in the evaluation, grading and typing of skeletal lesions in particular malignant primary bone tumors. Overall, there is excellent agreement between FNA and NCB, especially in the evaluation of benign primary bone tumors. Most important, FNA improved the diagnostic yield in 24% of cases when NCB was normal or unsatisfactory, obviating the need for rebiopsy. FNA should be performed concurrently with NCB in the evaluation of skeletal lesions since the two modalities are complementary.

Adolescent↗
PubMed2000

Large-needle aspiration biopsy for the preoperative selection of palpable thyroid nodules diagnosed by fine-needle aspiration as a microfollicular nodule or suspected cancer.

The palpable thyroid nodules with a fine-needle aspiration (FNA) diagnosis of microfollicular nodule or suspected cancer usually are excised; however, most of them are proved benign by postoperative histologic examination. We reviewed the clinical and pathologic data for patients with thyroid nodules with an FNA diagnosis of microfollicular nodule or suspected cancer; nodules also were examined by large-needle aspiration biopsy (LNAB) to assess whether the distinction achieved by LNAB into pure microfollicular or mixed microfollicular-macrofollicular nodules could be used preoperatively to better predict malignancy. One hundred fourteen nodules of this type were excised. The prevalence of cancer was 22% (14/63) among the microfollicular and 4% (2/51) among the microfollicular-macrofollicular nodules at LNAB. These data indicate that histologic examination of the LNAB specimen can be used for preoperative selection of thyroid nodules diagnosed by FNA as a microfollicular nodule or suspected cancer.

Adenocarcinoma, Follicular↗
PubMed1998

Additional information from percutaneous cutting needle biopsy following fine-needle aspiration in the diagnosis of chest lesions.

OBJECTIVE: To determine the contribution of percutaneous cutting needle biopsy (PNB) subsequent to fine-needle aspiration (FNA) in the diagnosis of chest lesions. DESIGN: A retrospective review of 220 patients who underwent CT-guided FNA followed immediately by PNB performed at our center between 1988 and 1995 was undertaken. Thirty-eight patients were excluded because FNA and/or PNB specimens were nondiagnostic, yielding a study group of 182 patients. RESULTS: A diagnosis of malignancy was made in 141 (77.5%) and nonmalignancy in 41 (22.5%) cases. The yield of histospecific diagnosis due to FNA was marginally higher than PNB in malignant lesions (86.5% vs 78%, respectively). In contrast, PNB was superior to FNA for the histospecific diagnosis of benign lesions (87.8% for PNB vs 31.7% for FNA, p<0.00001) and lymphomas (88% for PNB vs 56% for FNA, p<0.05). In 58.8% of the patients with benign lesions and in 37.5% of the patients with lymphoma, PNB performances altered clinical management, either by avoiding further surgery or allowing specific medical treatment. Pneumothorax occurred in 24.7% of the cases but only five patients (2.7%) required hospitalization. CONCLUSION: PNB is extremely effective for making a specific diagnosis in benign lesions compared with FNA. PNB does not increase the yield of histospecific diagnosis for malignant lesions except for the subset of lymphoma, where it seems to provide important additional information in many instances. We recommend that FNA be performed as the initial procedure, followed by PNB in cases of equivocal diagnosis of carcinoma, for lymphoma and for suspected benign lesions.

Adolescent↗
PubMed2003

Comparison of fine-needle-nonaspiration with fine-needle-aspiration technique in the cytologic studies of thyroid nodules.

INTRODUCTION: Fine needle aspiration (FNA) has been adopted as a simple and cost effective technique for cytologic studies of thyroid nodules. The recently introduced fine needle nonaspiration (FNNA) technique, however, is claimed to be superior because it provides specimens with larger number of cells and better preserved cytomorphology and architecture of thyroid papillae and follicles. In this study, we compare the efficacy of the two methods. MATERIALS AND METHODS: Two hundred patients with thyroid nodules, 1-4 cm in size, were recruited. FNA and FNNA techniques were applied to each patient. In a single-blind setting, all specimens were examined by a single cytopathologist. The specimens were scored (0, 1, or 2) on the basis of background blood or clot, number of obtained cells, preserved architecture of papillae and follicles, and cellular degeneration. Nonparametric methods were then used to compare the scores of the two techniques. RESULTS: Two hundred patients (162 female, 38 male) were entered into the study. Specimens from 43 patients were inadequate. In the remaining 157 patients, no statistically significant difference was seen between FNNA and FNA average scores in each parameter (p > 0.05). CONCLUSION: We concluded that FNNA is not superior to FNA in the cytopathologic studies of thyroid nodules.

Biopsy, Fine-Needle↗
PubMed1995

Cytopathologic touch preparations (imprints) from core needle biopsies: accuracy compared with that of fine-needle aspirates.

OBJECTIVE: The aim of this study was to evaluate the touch preparation (imprint) cytology method for obtaining rapid interpretations from core material obtained during abdominal percutaneous biopsy. SUBJECTS AND METHODS: For 28 patients undergoing biopsy of abdominal masses, paired slides were prepared for rapid staining by use of smears of standard fine-needle aspirates and by use of a touch preparation of the core material obtained with a semiautomated biopsy gun. The slides were scored in comparison with the final cytopathologic and histopathologic diagnosis. RESULTS: Touch preparation slides were equivalent in diagnostic yield to fine-needle aspirate smears, demonstrating similar cellular features. Touch preparation slides revealed features of tumor architecture not present on smears. CONCLUSION: Touch preparation cytology offers rapid diagnosis from a single core biopsy sample. Carefully performed, the touch preparation method preserves the core material for subsequent permanent fixation and sectioning.

Abdominal Neoplasms↗
PubMed1999

A prospective comparison of stereotaxic fine-needle aspiration versus stereotaxic core needle biopsy for the diagnosis of mammographic abnormalities.

BACKGROUND: Confidence in a negative stereotaxic breast biopsy result allows for safe clinical and mammographic follow-up, whereas a positive or equivocal diagnosis leads to excision. Direct comparison of stereotaxic core needle biopsy (SCBX) and fine-needle aspiration (SFNA) is needed, and should be based on the use of appropriate current methods of practice, and address the indication of each for different types of mammographic lesions. METHODS: The diagnostic accuracy of SFNA, SCBX, and combined SFNA with SCBX performed at a community radiology practice were assessed for different mammographic lesions and levels of radiologic suspicion. Negative predictive values (NPVs) measured the confidence that a negative diagnosis (failure to identify atypia or malignancy) was benign and therefore suitable for follow-up. A benign outcome was accepted only after surgical excision or > or =24 months' follow-up of the lesion. Positive predictive values (PPVs) [final diagnoses at least atypical (A) or carcinoma (CA)] also were calculated. RESULTS: SFNA was performed for 495 lesions and was combined with SCBX for 252 of these. Nondiagnostic (SFNA, 2%; SCBX, 8%) and atypical (SFNA, 7%; SCBX, 3%) rates were low. The authors obtained 94% follow-up (81% > or = 24 months). NPVs were all SFNAs, 99%; SCBXs, 95% (corresponding SFNAs, 98%); and SFNA with SCBX, 99%. NPVs were 100% for masses, ill-defined densities, and architectural distortions. NPVs for microcalcifications (for low, moderate, and high suspicion) were all SFNAs, 97% (100, 95, and 75); SCBXs, 93% (94, 93, and 67), corresponding SFNAs, 96% (100, 94, 75); and SFNA with SCBX, 98% (100, 97, 75). All false-negative lesions were microcalcifications. Calcium was recognized in 98% of SFNA specimens and in 89% of SCBX specimens from microcalcifications. No calcium was identified in the histologic sections in 63% (5 of 8) SCBX false-negative specimens. PPVs(A) were atypical (SFNA, 46%; SCBX, 88%) and suspicious (SFNA, 93%). PPVs(CA) were SFNA carcinoma, 100%; SCBX in situ, 89%; and SCBX invasive, 100%. CONCLUSIONS: SFNA identified benign lesions more reliably for follow-up, particularly microcalcifications. Based on these results, the authors suggest 1) added SCBX if on-site SFNA assessment is nondiagnostic, atypical, or positive (and needs preoperative confirmation of invasion); 2) either SCBX or SFNA for masses, architectural distortions, and ill-defined densities; 3) SFNA for microcalcifications, with SCBX added for moderately and highly suspicious lesions; and 4) surgical excision for all highly suspicious microcalcifications.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration and core needle biopsy techniques in the diagnosis of nodular thyroid pathologies.

It is widly accepted that Fine Needle Aspiration Biopsy (FNAB) is the main test to distinguish benign from malignant thyroid lesions. Nevertheless, this technique presents some limits such as the possibility of false-negative or inadequate samples and it is unable to cytologically discriminate among adenomathosus goiter, follicular adenoma and well-differentiated follicular carcinoma. The aim of this study was to evaluate the possibility of restricting these limitations using Core Needle biopsy (CN) technique. Therefore we selected for CN, 40 out of 136 patients who underwent FNAB during a one year period; among these patients only 32 agreed a to this technique. Forty-two out of 136 patients underwent surgery; 29 of them were subjected to both biopsies. Sixteen of the diagnostic microbiopsies have been histologically confirmed. We had no discordant cases between cytological and microhistological diagnosis, except for one case which appeared cytologically colloid goiter, microhistologically follicular neoplasm and histologically follicular adenoma. In this case it was not possible to microhistologically discriminate benign from malign follicular lesion. In our experience not all patients accepted CN biopsy as well as FNAB and, moreover, this technique showed no advantage over FNAB diagnosis. On this base we think that actually FNAB should be the main procedure in the diagnosis of the thyroid lesions. It is easily performed, accepted by the patients and has a low cost-benefit ratio. If the sample is not diagnostic it can be easily repeated and false-negative cases could be discovered thanks to an adequate clinical and ultrasonographical follow-up of the patients.

Adenocarcinoma, Follicular↗
PubMed2004

[Clinical evaluation of three methods of fine-needle aspiration, large-core needle biopsy and frozen section biopsy with focus staining for non-palpable breast disease].

BACKGROUND & OBJECTIVE: Early detection of breast cancer is crucial to improve the therapeutic effect and to increase the survival rate. However, it is difficult because breast cancer in early stage was usually occult, impalpable, and could not be detected by laboratory test. This study was designed to compare the effectiveness of three methods for diagnosis of non-palpable breast cancer. METHODS: Twenty-four patients with impalpable breast mass suggested by computer-aided stereotactic mammography were performed with three kinds of methods, including fine-needle aspiration cytology (FNAC), large-core needle biopsy (LCNB), and frozen section biopsy (FSB) with focus staining. The results were compared with postoperative pathology. RESULTS: Compared with postoperative pathology results, the diagnostic consistent rates of FNAC, LCNB and FSB with staining focus were 75%, 92%, and 100%, respectively (P< 0.05). CONCLUSION: Frozen section with focus staining guided by computer-aided stereotactic mammography was the effective diagnostic technique for non-palpable breast cancer.

Adult↗
PubMed2006

Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy.

To assess the value and limitations of fine-needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of intrathoracic lesions, we retrospectively compared the diagnostic accuracy of 362 FNA and concurrent CNB procedures performed on 350 patients. Based on the final diagnoses that were determined based on combined information from biopsy, resection, clinical, radiologic, and microbiologic findings, the study cases were grouped into 188 malignant, 161 benign, and 13 inconclusive lesions. FNA and CNB yielded similar diagnostic accuracy for malignant tumors (85.1% vs 86.7%) and epithelial malignant neoplasms (86.4% vs 85.2%), whereas CNB yielded better diagnostic accuracy (96%) than FNA (77%) for nonepithelial malignant neoplasms. Combined FNA and CNB substantially improved the rate of malignancy diagnosis (95.2%). Of 161 benign cases, 50 were proven to be benign-specific lesions; FNA provided specific diagnosis in 20 (40%) and CNB in 46 (92%). The remaining 111 benign lesions yielded benign-nonspecific findings on both specimens. These results indicate that CNB should be obtained when clinical or radiologic findings do not match the cytologic findings or nonepithelial lesions and benign lesions are considered likely.

Adolescent↗
PubMed2006

[Epidural infusion of low dose bupivacaine after combined spinal-epidural anesthesia using needle through needle method provided no analgesic effect on postoperative pain after caesarian section].

BACKGROUND: In order to evaluate the analgesic efficacy of low dose epidural bupivacaine infusion with and without morphine after caesarean section we performed combined spinal-epidural anesthesia (CSEA) using needle through needle method. Three different epidural analgesic regimens were compared retrospectively. METHODS: The number of analgesic use during 24 hours after operation was compared. Patients were categorized into three groups; group N : intraoperative bolus epidural morphine (2.5 mg) alone, group L : bolus morphine (2.5 mg) plus epidural bupivacaine infusion (32 ml of 0.2% bupivacaine) at a rate of 2.1 ml x hr(-1), group M : bolus morphine (2.4 mg) plus epidural bupivacaine-morphine (33 ml of 0.2% bupivacaine containing morphine 2.3 mg) infusion at a rate of 2.1 ml x hr(-1). Used analgesics included pentazocine 15 mg i.m., diclofenac 25 mg suppo. and loxoprofen 60 mg p.o.. RESULTS: The mean number of analgesic use during the first 24 hours in group M (0.29 +/- 0.46) was significantly smaller than those of group N (0.97 +/- 0.91) and group L (0.84 +/- 0.95). Percentage of patients requiring no analgesic during the first 24 hours was significantly less in group M (70.8%) than in group N (33.4%) and group L (42.1%). CONCLUSIONS: A 2.1 ml x hr(-1) infusion of epidural bupivacaine has no analgesic effect after caesarean section under CSEA using NTN method.

Anesthesia, Epidural↗
PubMed1989

Transrectal fine-needle aspiration and truecut needle biopsy of the prostate: a blinded comparison of accuracy.

Transrectal needle aspiration biopsy and core biopsy of the prostate were performed simultaneously on 88 men with prostatic nodules. Cytologic and histologic assessments were made in a blinded, independent fashion, and the results were compared. All patients with positive findings on aspiration also had positive findings on core biopsy, for a positive predictive value for aspiration of 100%. However, five negative and six "insufficient" results obtained by aspiration were positive on core biopsy, for a negative predictive value for aspiration of 88%. This experience support the use of needle aspiration as an initial diagnostic maneuver in the assessment of prostatic nodules.

Biopsy, Needle↗
PubMed1982

Comparison of fine-needle and coarse-needle biopsies in evaluating thyroid nodules.

The purpose of this study was to compare the results of fine-needle biopsy (FNB) and coarse-needle biopsy (CNB) in evaluating patients with dominant thyroid nodules. Five hundred twenty-six patients were seen because of solitary thyroid nodules. Three hundred of these underwent satisfactory CNB and FNB. Using the incidence of cancer found at operation as a guide to the specificity of the biopsy, CNB was better than FNB in determining underlying pathologic condition. The main difference between the two techniques was the inability of FNB to distinguish adenomatous hyperplasia from true adenoma. FNB, however, was as good as most older techniques in selecting patients for surgery. The main limitation of CNB was that it could only be applied on 69% of solid lesions.

Biopsy, Needle↗
PubMed1995

Yield and complications in ultrasound-guided biopsy of abdominal lesions. Comparison of fine-needle aspiration biopsy and 1.2-mm needle core biopsy using an automated biopsy gun.

A series of 458 consecutive ultrasound-guided biopsies in 347 patients-171 fine-needle aspiration biopsies (FNABs) and 287 1.2-mm needle core biopsies (NCBs)-was analysed for diagnostic yield and complications. FNAB was diagnostic in 107 (64%) biopsies of focal lesions with a correct diagnosis of malignancy in 86 of 125 biopsies (69%) and of benign disease in 21 of 43 (49%) biopsies. NCB provided a correct diagnosis in 189 (90%) biopsies for focal lesions, divided into 140 of 159 (88%) correct for malignancy and 49 of 50 (98%) correct for benign disease. In 69 patients examined with both FNAB and NCB on the same occasion, 50 out of 55 malignant lesions were identified with NCB but only 34 with FNAB; all 14 benign lesions were correctly identified by NCB, and only 6 by FNAB. Clinical relevant bleeding complications occurred in 6 out of 458 biopsies (1.3%)-3 out of 287 following NCB (1.0%) and 3 out of 171 following FNAB (1.8%). It is concluded that if FNAB is replaced with 1.2-mm NCB using an automated biopsy gun, the diagnostic accuracy for abdominal lesions increases significantly (p < 0.001), while the complication rate remains the same.

Abdominal Neoplasms↗
PubMed1995

Core needle biopsy and fine-needle aspiration in the diagnosis of bone and soft-tissue lesions.

Although core needle biopsy (CNB) and fine needle aspiration (FNA) procedures are widely used for the diagnosis of epithelial neoplasms, these procedures have not gained popularity on patients suspected of having bone or soft-tissue neoplasms. This article describes the University of Texas, M.D. Anderson Cancer Center experience with CNB and FNA procedures in bone and soft tissue performed in over 800 patients.

Biopsy, Needle↗
PubMed1995

Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules.

To evaluate the efficacy of simultaneous fine-needle aspiration (FNA) and core-needle (CN) biopsies of thyroid nodules, the clinical course and operative findings in 100 patients having both tests were reviewed. Each patient had a diagnosis made with this approach. Both specimens were adequate for diagnosis in 95 patients. In the remaining 5 patients, a diagnosis was provided by FNA in four and CN biopsy in one. FNA and CN biopsies gave the same diagnosis of either a benign nodule in 53 patients or neoplasia in 30 patients. When both FNA and CN biopsies showed a benign nodule, a nonoperative approach was taken in 43 of the 53 patients. Forty-two patients were operated on either because of biopsy findings (32) or clinical indications (10). The surgical specimens were used to determine the false positive and false negative rates, the sensitivity, specificity, and accuracy for the diagnosis of neoplasia. The false (+) and false (-) rates in diagnosing neoplasia were 33 per cent and 7 per cent for FNA, 20 per cent and 4 per cent for CN biopsy, and 20 per cent and 0 per cent for both. The sensitivity, specificity, and accuracy for FNA were 93 per cent, 67 per cent, and 83 per cent, for CN biopsy 96 per cent, 80 per cent, and 90 per cent, and 100 per cent, 80 per cent, and 93 per cent for both FNA and CN. All neoplasms were detected, and no thyroid carcinomas were missed by this combination. There was only one complication: bleeding after a CN biopsy. Combined FNA and CN biopsies allow most patients with thyroid nodules to avoid an unnecessary operation and accurately diagnose those with thyroid carcinoma. These two procedures are safe and complementary.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Fine needle aspiration cytology vs. needle core biopsy of soft tissue tumors. A comparison.

Fine needle aspiration (FNA) cytology is an effective modality in the diagnosis of soft tissue lesions. Previous studies compared FNA with surgical biopsies and reported high sensitivity and specificity rates. No study has evaluated the diagnostic yield of FNA to that of needle core biopsies (NCBs). One hundred seventeen FNAs were performed by our clinical staff for soft tissue lesions (1980-1992). The FNAs were divided into three categories: diagnostic 53 (37 sarcoma, 16 benign); unsatisfactory, 44; normal/inflammatory cells present, 20. Of these, 59 had concomitant NCBs: 37 on patients with sarcoma on FNA, 22 on unsatisfactory FNA and none on those with normal/inflammatory cells (followed clinically). There was 100% correlation between FNA and NCB when sarcoma was diagnosed. In 7 of these cases, the NCB further specified the type of sarcoma. No NCBs were employed to confirm the diagnosis of benign tumor on FNA; excisional biopsies showed a total correlation. The 22 NCBs for unsatisfactory FNA yielded 15 sarcomas, 2 fibromatosis and 5 benign lesions. Seventeen patients with unsatisfactory FNA had surgical biopsies (3 sarcoma, 14 benign), and 5 were lost to follow-up. In our experience, diagnostic FNA gave a yield identical to that of NCB, and the latter did not contribute to patient management. Core biopsies may have the advantage of subtyping selected sarcomas diagnosed by FNA. Unsatisfactory FNA should be evaluated further by a repeat aspirate or NCB. Performance of FNA by cytopathologists can reduce the number of unsatisfactory specimens and allow repeat aspiration. In our study most of the unsatisfactory FNAs were from retroperitoneal and pelvic lesions, were performed under radiographic guidance and could have been minimized by immediate cytologic assessment. Many of these lesions, however, may be as readily accessible via NCB as they are via FNA. Utilization of each of these modalities and of their full benefits ultimately depends on the proper clinical setting and the experience of the clinician and pathologist.

Adolescent↗
PubMed1993

Percutaneous ultrasound-guided biopsy. Fine needle biopsy, cutting needle biopsy, or both?

The results of 155 US-guided cutting needle biopsies, mainly of abdominal and transthoracic lesions, were reviewed to assess the diagnostic accuracy of the method. A fine needle biopsy (FNB) was additionally performed in 99 of the patients. Sufficient material for histologic and cytologic analysis was obtained in 88% (137/155) and 98% (97/99), and a correct benign or malignant diagnosis was made in 87% and 88%, respectively. Among the 99 combined biopsies the corresponding figures were 100% and 97%, respectively. The proportions of inconclusive and false-negative results among histologic samples were 0% and 4% (2/57), in FNBs 7% (7/99) and 5% (3/56), and in combined examinations 3% (3/99) and 0%. One major complication, Streptococcus faecalis sepsis, occurred. The combined use of FNB and histologic biopsy increases the proportion of correct diagnoses about 10% without increasing the complications.

Abdominal Neoplasms↗
PubMed1996

[Value of fine-needle aspiration and extemporaneous examination in thyroid surgery. A prospective study of 1235 fine-needle aspirations and extemporaneous examinations in 846 patients].

We report a prospective study conducted from 1993 through 1995 in 846 patients (mainly women) consulting for a thyroid nodule. There were 465 multinodular goiters and 373 single nodules. The clinical diagnosis was obvious in 8 patients who were excluded. Pre-operative fine-needle aspiration was performed in 1235 patients and per-operative extemporaneous examinations in 569. These two simple reliable examinations, with few significant complications in skillful hands, are complementary. Fine-needle aspiration gives reliable histology data for thyroid nodules and should always be included in the pre-operative workup. Extemporaneous pathology examination of the surgical specimen provides information for adapted surgery and avoids morbidity due to reoperation.

Adolescent↗