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PubMed1991

Clear ovarian cyst aspiration guided by vaginal ultrasonography.

Thirty patients with clear ovarian cysts underwent aspiration guided by vaginal ultrasound. In 23 cases a complete aspiration was accomplished. In 4 only partial aspiration was possible, and in the remaining 3 failed aspiration led to surgery. Histological findings correspond to retroperitoneal lipoma and mucinous cystadenoma (2 cases). Malignant cells were not detected in the fluid of any of the 27 aspirates. Eight of the ten patients presenting with abdominal pain experienced a relief following aspiration. Recurrence of the cyst occurred in 12 cases (40%) with significantly smaller dimensions (P less than 0.01). Vaginal ultrasound aspiration of clear cyst is easy and safe and can be considered as an outpatient procedure.

Adult↗
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↗
PubMed1994

Silent aspiration prominent in children with dysphagia.

Children with neurologically-based dysphagia are at high risk for silent aspiration. Aspiration can lead to complications such as acute pneumonia and chronic lung disease. Thorough evaluation of the oral, pharyngeal, and esophageal phases of swallowing is crucial for patients with dysphagia. The videofluoroscopic modified barium swallow study (MBS) is the procedure of choice for children to delineate the pharyngeal and upper esophageal phases of the swallow that can only be inferred by bedside clinical assessment. This study describes attributes of aspiration and pharyngeal motility in a large sample of infants and children assessed with MBS. Aspiration was observed in 48 (26%) of 186 children, primarily on liquid before or during swallows. Aspiration was trace (less than 10% of a bolus) and silent in 94%. Relationships to clinical history and implications for management are discussed. Given the lack of objective clinical information to identify children at risk for aspiration, MBS should be considered in all children with severe dysphagia to rule out or confirm aspiration.

Adolescent↗
PubMed1988

Repeated fine needle aspirations in the diagnosis of soft tissue metastases in breast cancer.

In 36 patients, treated for breast cancer and with a suspected metastasis in the subcutis, the diagnostic efficacy of repeated fine needle aspiration (FNA) has been evaluated in 39 tumours. By increasing FNA from one to three, the diagnostic sensitivity was increased from 0.59 (95% C.L. 0.33-0.82) to 0.83 (95% C.L. 0.52-0.98). Diagnostic specificity for one aspiration was 0.95 (0.77-1.00), and for two and three aspirates it was 0.96 (0.80-1.00) if suspicious aspirates were considered as positive, and 1.00 for one, two and three aspirations when only aspirates with tumour cells were considered positive. Statistically, three aspirates were significantly better than one in establishing the diagnosis of a soft tissue tumour in patients with breast cancer.

Biopsy, Needle↗
PubMed1993

Aspiration and acute lung injury.

Aspiration is a common clinical entity whose consequences range from the relatively benign to fulminant acute respiratory failure and death. Clinical situations in which airway protection is lost or compromised predispose patients to aspiration. Treatment of aspiration, while generally supportive, depends in part upon the material aspirated and the resulting clinical syndrome. When mechanical ventilatory support is required, the avoidance of iatrogenic complications, including worsening lung injury, becomes especially important. Preventative measures, either to minimize the chances of aspiration, or to reduce the potential for injury consequent to aspiration may be highly effective in reducing the incidence of aspiration syndromes.

Journal Article↗
PubMed2004

The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery.

The exclusion of infection is the most important factor in determining treatment options in a failed hip arthroplasty. Preoperative biopsy in the form of aspiration or tissue biopsy can be used to diagnose infection. Preoperative aspiration and tissue drill biopsy were performed in 273 consecutive patients under general anesthesia 3 months before exchange arthroplasty surgery. The results of the preoperative aspiration and tissue biopsy cultures were compared with the definitive intraoperative tissue cultures obtained at surgery. Seventy-one of 273 (26%) hips were infected. Overall accuracy of aspiration was 90.1% and tissue biopsy 87.9%. The sensitivity and specificity was 80% and 94% for aspiration and 83% and 90% for tissue biopsy. Positive predictive value and negative predictive values were 81.4% and 93.1% for aspiration and 73.8% and 93.8% for tissue biopsy. The more invasive tissue drill biopsy offers no advantage over aspiration in terms of bacterial accuracy and results in more false positives.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Gestational sac aspiration: a novel alternative to dilation and evacuation for management of early pregnancy failure.

STUDY OBJECTIVE: To explore the effectiveness (success, safety, and complications) of a novel technique of gestational sac aspiration in the management of early pregnancy failure as an alternative to dilation and evacuation (D&E) and conservative management. DESIGN: Prospective historical cohort study comparing effectiveness of gestational sac aspiration (study group) to conservative management (control group) with follow-up until negative quantitative beta human chorionic gonadotropin testing is achieved (Canadian Task Force classification II-1). SETTING: An infertility treatment center. PATIENTS: Among 60 women with failed early pregnancies that were achieved by in vitro fertilization or intrauterine insemination, 20 underwent gestational sac aspiration, whereas 40 chose conservative management. INTERVENTIONS: Gestational sac aspiration was done by transvaginal ultrasound-guided needle aspiration under conscious sedation. Aspirated tissue was sent for karyotyping. Both study and control (conservative management) groups received close follow-up with ultrasound and serial beta human chorionic gonadotropin measurements. MEASUREMENTS AND MAIN RESULTS: There was no significant difference in age, infertility factor, or treatment between study and control groups. Mean gestational age was 8 versus 6 weeks in study and control groups, respectively (p < .05). One and 11 patients required D&E in the study and control groups, respectively (p < .05). Karyotyping was successful in all except one patient in the study group. Chromosomal abnormalities were found in 36% of products of conception. No significant complications occurred CONCLUSION: Gestational sac aspiration is a simple and safe outpatient technique that is more effective than conservative management of early pregnancy failure and less invasive than D&E. Moreover, the technique provides a high probability of obtaining a noncontaminated adequate gestation tissue sample for chromosomal study.

Abortion, Incomplete↗
PubMed1997

Accuracy of mammographic appearances after breast fine-needle aspiration.

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic. STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of "suspicious" lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks). RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had "suspicious" mammograms and 19 had "nonsuspicious" mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had "suspicious" mammograms and 864 had "nonsuspicious" mammograms. CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained.

Adolescent↗
PubMed1991

Transvaginal ultrasound-guided follicular aspiration in the management of anovulatory infertility associated with polycystic ovaries.

STUDY OBJECTIVE: To investigate whether or not transvaginal ultrasound (US)-guided follicular aspiration can effectively induce ovulation and facilitate pregnancy in anovulatory patients with polycystic ovaries (PCO). DESIGN: Eight patients with polycystic ovarian disease (PCOD) and 10 patients with PCO were participants who failed to ovulate by the medical therapies. Most of persistent follicles were punctured, and their contents were thoroughly aspirated during the midluteal phase. The same ovarian stimulation regimen as used in the previous cycles were administered in the cycles after the aspiration. MAIN OUTCOME MEASURES: Evidence of ovulation and a subsequent pregnancy was ultrasonically monitored after the aspiration, and the responsiveness of pituitary gonadotropins to gonadotropin-releasing hormone was tested in these patients. RESULTS: The ovulation rates were 87.5% per patient, 52.6% per cycle monitored in PCOD patients and 100% per patient, 63.3% per cycle monitored in PCO patients, respectively. Half of the patients both with PCOD and PCO achieved pregnancy after the aspiration. A significant decrease (P less than 0.05) of the basal and peak levels of serum luteinizing hormone was observed after the aspiration. CONCLUSIONS: The US-guided follicular aspiration seems to be a new surgical method for treating anovulatory patients with PCO.

Anovulation↗
PubMed1995

Percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in the management of infertility due to obstructive azoospermia.

OBJECTIVE: To evaluate the recovery rate of spermatozoa from the epididymis using a percutaneous aspiration technique and to examine the fertilization rate after intracytoplasmic sperm injection. DESIGN: Prospective observational study. SETTING: Private infertility clinic, London. SUBJECTS: Twenty patients with obstructive azoospermia who each had an attempt at IVF. The sperm used for intracytoplasmic sperm injection was retrieved by percutaneous epididymal sperm aspiration in 16 patients. In one patient, microepididymal sperm aspiration was performed in addition because the quality of the sperm obtained by percutaneous epididymal sperm aspiration was not considered suitable for microinjection. In the remaining three patients, neither percutaneous epididymal sperm aspiration nor microepididymal sperm aspiration resulted in the recovery of sperm, which was obtained by testicular biopsy in one of them. INTERVENTION: Assisted fertilization with intracytoplasmic sperm injection. MAIN OUTCOME MEASURES: Normal fertilization and pregnancy rates. RESULTS: A total of 179 eggs were collected and 157 subsequently were microinjected. Normal fertilization occurred in 22 oocytes (14%) and the total number of embryos cleaved was 30. Twelve patients underwent ET in which three conceived (pregnancy rate 25% per transfer). The implantation rate was 10% and failed fertilization occurred in four cycles. CONCLUSION: Percutaneous epididymal sperm aspiration can be used successfully to recover sperm in men with obstructive azoospermia for use in assisted fertilization IVF cycles. The technique is simple, effective, and less traumatic compared with an open microsurgical operation.

Adult↗
PubMed1995

Ultrasound-guided aspiration of endometriomas: possible applications and limitations.

OBJECTIVES: To evaluate the role of needle aspiration in the management of endometriomas. DESIGN: Retrospective evaluation of the activity of the section of interventional ultrasound in a single tertiary care institution. SETTING: Department of Obstetrics and Gynecology, Ospedale S. Gerardo, Monza, University of Milan, Italy. PATIENTS: Two hundred nine premenopausal patients underwent aspiration for diagnostic purpose (n = 166), for relief of symptoms (n = 25), or with therapeutic intent (n = 18). RESULTS: Adequate material was obtained by all punctures. Early complications (self-limiting vagal symptoms or pain) occurred in eight cases. Short-term complications consisted of acute abdominal pain in three cases and infection in one. Three women required surgical treatment of the complication. At first examination after aspiration, persistence of the cyst was observed in all but four cases, including all cases who had undergone therapeutic aspiration. Nine patients reported relief of symptoms but six other patients referred onset or worsening of pelvic discomfort after aspiration. CONCLUSIONS: Ultrasound-guided aspiration of endometriomas is feasible. The transvaginal route reduces early complication but implies a risk of infection of 1.3%. However, drainage alone is ineffective as a therapeutic procedure and the applications of aspiration of endometriomas appear limited to some cases with diagnostic intent.

Adult↗
PubMed1999

A multicenter U.S. experience with EUS-guided fine-needle aspiration using the Olympus GF-UM30P echoendoscope: safety and effectiveness.

BACKGROUND: The aim of this study was to determine the safety, efficacy, and accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration using the GF-UM30P echoendoscope. METHODS: GF-UM30P-guided EUS-guided fine-needle aspiration results from 3 EUS referral centers were prospectively recorded. Successful sampling required that the needle tip be seen within the lesion on at least 1 pass. Aspirates were considered adequate if they were diagnostic for cancer, contained suspicious or atypical cells, or were adequately cellular for interpretation but nondiagnostic. RESULTS: EUS-guided fine-needle aspiration was attempted on 162 lesions in 152 patients with no complications. Sampling was successful in 150 of 162 (93%) attempts (mean lesion size 2.5 +/- 1.2 cm (range 0.7 to 6.0 cm). Aspirates were adequately cellular in 138 of 162 (85%) attempts (43% diagnostic, 15% suspicious and/or atypical cells, 27% adequate cellularity but nondiagnostic). Sampling failed in 12 of 162 (7%) attempts. Ten of 12 (83%) failures and 11 of 12 (92%) inadequate aspirates occurred when lesions measured less than 2 cm. The sensitivity for malignancy was 93% if only successfully sampled lesions with surgically confirmed negative results were included. However, it was 68% if all attempts were included and when unconfirmed high/moderate suspicion negative results were counted as false negatives and low suspicion negative results as true negatives. CONCLUSIONS: The GF-UM30P may be clinically useful for EUS-guided fine-needle aspiration if a curved linear array instrument is unavailable.

Biopsy, Needle↗
PubMed2000

Steroid concentrations in follicular fluid aspirated repeatedly from transitional and cyclic mares.

The objectives of the present study were to determine follicular progesterone (P4) and estradiol-17beta (E2) in transitional mares and to compare follicular steroid concentrations between transitional and cyclic mares. Follicles > 8 mm were aspirated under transvaginal ultrasound-guidance 4 times at 3 to 4 day intervals (T1-T4) in Norwegian pony mares during vernal transition. During the breeding season, follicular aspirations were conducted in each mare on Day 6, Day 14 and Day 18 after ovulation of 3 separate estrous cycles (Day of ovulation = Day 0). Plasma and follicular fluids were analyzed for P4 and E2 with ELISA and RIA, respectively. Plasma P4 concentrations remained below 1 ng/mL throughout T1-T4, while the follicular P4 concentrations increased significantly to cyclic levels after the first transitional aspiration. Plasma E2 concentrations similarly remained at low levels during the course of the transitional aspirations, while the follicular E2 concentrations increased gradually over the 4 aspirations to cyclic concentrations. The mares ovulated on average 9.8 +/- 1.6 (mean +/- SEM) days after the last transitional aspiration, and 16.6 +/- 0.2, 11.3 +/- 1.5 and 23.2 +/- 4.4 days after aspirations conducted on Day 6, 14 and 18, respectively. The present study demonstrates that in the transitional mare newly developing follicles exhibit biosynthesis of P4 and E2. Furthermore, an increase in follicular steroid concentrations is not necessarily reflected in the peripheral steroid concentrations.

Animals↗
PubMed2003

Efficacy of linear and convex transducers for ultrasound-guided transvaginal follicle aspiration.

A new device was developed to hold linear transducers for transvaginal follicle aspiration. Efficacy of follicle aspiration was compared using a linear 6 MHz and a convex 5 MHz transducer. Fifty-five cows were submitted to follicle aspiration at random days of the estrous cycle. Aspirations were conducted with linear (n=28) and convex (n=38) transducers with 18 G needles at a negative pressure corresponding to 13 ml H(2)O/min. A greater number of follicles were aspirated using convex than to linear probe (12.4 versus 7.8, respectively, P<0.05). Mean number of oocytes and recovery rates were similar for convex (5.4 and 48.6%) and linear (4.6 and 59.3%) transducers. Limited space between the linear transducer and needle guide restricted access to some portions of the ovary, reducing the number of follicles aspirated using a linear transducer. The newly developed adaptor allowed greater stability, holding the ovaries firmly against the linear transducer. This diminished mobility permitted a similar number of oocytes to be recovered with both transducers. In conclusion, this new adaptor provided a low cost alternative for routine follicle aspiration and oocyte recovery in cattle.

Animals↗
PubMed1988

Diagnosis of cystic hydatid disease: role of aspiration cytology.

Fine needle aspiration of mass lesions is reported in eleven patients in whom cystic hydatid disease (CHD) was not a differential diagnosis or whose serological results were negative. Aspiration was continued until no more fluid could be obtained. In five patients aspiration was done under ultrasound guidance. No sequelae were observed that could be attributed to aspiration per se. Aspirated fluid was stained with haematoxylin and eosin and giemsa or was passed through 5 micron polycarbonate filters which were then stained in the same way. The aspirated material and polycarbonate filters were also stained with trichrome which proved the best stain to demonstrate the acid-fast hooklets. Such filtration of the total volume of the aspirated material or that evacuated at operation is simple, quick, and accurate.

Adult↗
PubMedDate not supplied

Diagnosis of bone marrow metastases in children with solid tumors and lymphomas. Aspiration, or unilateral or bilateral biopsy?

BACKGROUND: Malignancies are among the most common causes of death in children. The present study was undertaken to evaluate and compare bone marrow aspiration and unilateral biopsy to detect bone marrow metastases in pediatric patients, using bilateral biopsy as the gold standard. METHODS: During a 6-month period, 63 consecutive newly diagnosed children with confirmed malignant diseases other than leukemia were evaluated for bone marrow metastases or infiltration. Biopsies were obtained from both right and left posterior iliac crests whereas aspiration was performed only at the right crest. Interpretation to the right-side biopsy was considered as the unilateral biopsy result, whereas the bilateral biopsy result was as follows: positively was accepted if one or both of the two-side samples were qualified as positive, while a negative result was considered only if both sides were negative. The bilateral biopsy was considered the gold standard, and sensitivity, specificity, positive and negative predictive value, and false positive and negative rates were computed for the unilateral biopsy and aspiration procedure. RESULTS: We identified bone marrow metastases in 11 (17.5%) patients. The sensitivity was the only significant difference (p <0.05) observed between unilateral biopsy and aspiration. Finally, of the 63 patients, unilateral biopsy was reported as inadequate in one patient (1.6%), while aspiration was inadequate in two (3.2%). CONCLUSION: Unilateral biopsy was better than bone marrow aspiration. However, because bilateral biopsy is the gold standard, we recommend using this and bone marrow aspiration simultaneously to evaluate a pediatric patient with any malignancy potentially infiltrating bone marrow.

Adolescent↗
PubMed1990

Intravenous catheter aspiration for obtaining basic analytes during intravenous infusion.

The aspiration of blood through a functioning IV line to obtain samples for laboratory analysis was evaluated. Thirty-eight emergency department patients were studied. Each had an 18-gauge IV catheter placed and then received a 100-mL bolus of either normal saline, lactated Ringer's, or 5% dextrose in water. Two samples of blood ("first aspirate" and "second aspirate") were then aspirated from the IV catheter while one sample was obtained by venipuncture from the opposite arm (control). All three samples were then analyzed for CBC, electrolytes, BUN, creatinine, and glucose. Catheter aspiration succeeded in 30 of 38 attempts (79%). Three samples were hemolyzed, and five samples were unable to be fully aspirated. Results of paired t testing showed only occasional statistical significance and except for bicarbonate were not of clinical significance. This study suggests that catheter aspiration is a useful method of obtaining blood for certain laboratory tests in patients receiving IV infusions.

Blood Specimen Collection↗
PubMed1981

Fine-needle aspiration cytology in thyroid disease.

Fine-needle aspiration biopsy of palpable lesions of the thyroid is a diagnostic method routinely used in several medical centres, but still relatively new in others. Experience has shown that the technical steps involved in this biopsy procedure, that is, palpation, aspiration, smear making, fixation and staining, are critical for good results, and they are therefore reviewed and illustrated. Another prerequisite for the use of aspiration biopsy cytology is a specially interested cytopathologist who is familiar with the methodological aspects, as well as the interpretation of cells in aspirates. A description is given of the different cytological patterns in smears of fine-needle aspirates for clinical thyroid diseases, such as simple and toxic goitre, different types of thyroiditis (acute, subacute and chronic) as well as the various differentiated thyroid neoplasms (follicular, papillary, medullary), anaplastic carcinomas and lymphomas. The limits of cytological diagnosis are indicated and differential diagnostic aspects are discussed. diagnostic accuracy of aspiration biopsy cytology, with particular reference to tumour diagnosis, is high: no false positive diagnoses are made by experienced cytopathologists, whereas false negative tumour diagnosis can occur in about 10 per cent of cases. Such results are the reason for the special position of fine-needle aspiration biopsy among other methods in the diagnostic work-up of patients with thyroid disease.

Adenoma↗