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PubMed2002

Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia.

OBJECTIVE: To measure the inter- and intra-rater reliability of cervical auscultation used alone to detect aspiration in dysphagic patients. SETTING: A university teaching hospital. DESIGN: Comparison of the detection of aspiration in 16 recorded swallow sounds by five speech and language therapists on two occasions. Swallow sounds were recorded simultaneously with videofluoroscopy. SUBJECTS: Sixteen patients referred for assessment of dysphagia with videofluoroscopy. RESULTS: The kappa statistic for multiple raters showed fair agreement between raters (kappa = 0.28). There was high agreement when aspiration occurred but in non-aspirating swallows there was significant overdetection of aspiration (p < 0.001 McNemar's test). The intra-rater reliability within different individuals was widely variable (kappa = 0.55 (range 0.31-0.85)). CONCLUSIONS: Presented with the swallowing sounds in isolation speech and language therapists cannot reliably classify swallows into those with accompanying aspiration and those without. There appears to be a problem of over detection of aspiration. Even in this small study, however, some individual therapists achieve such high reliability (kappa = 0.85) that they must be using successful internal criteria to interpret the swallow sounds correctly and further qualitative research may identify these.

Adult↗
PubMed1983

The influence of percutaneous fine needle aspiration on serum thyroglobulin.

To determine whether percutaneous needle aspiration of the thyroid affects tests of thyroid function, in particular thyroglobulin (TG), serum TG, T4, free T4 index, T3, and TSH were measured before and after percutaneous needle aspiration biopsy of the thyroid in 25 subjects. Seven control subjects were tested before and after vigorous external manual palpation of the thyroid. Serial measurements were made additionally in 3 subjects undergoing thyroid surgery to assess how quickly serum TG increases after injury. The results were analyzed, and statistically significant differences between paired results were defined if the differences were greater than the maximum interassay variation in 11 consecutive assays. Eleven out of 25 patients had statistically significant elevations of serum TG after aspiration. None of the seven who underwent external manual palpation of the thyroid gland had elevation of serum TG. With three exceptions, there were no significant changes in serum T4, free T4 index, T3, and TSH in either group. Marked elevations in serum TG occurred within 2 min after open manual palpation, diathermy, and excision. The results were analyzed and correlated with factors that might lead to release of TG from the thyroid during needle aspiration. No positive correlation was observed with the apparent degree of trauma, the size of nodule, the TG content, volume or character of aspirate, or the time elapsed from aspiration to withdrawal of the blood sample. Correlation of serum TG elevation with final diagnosis did not show a significant trend; however, the existence of a possible relationship needs further studies. We conclude that serum for TG measurement should be obtained before percutaneous thyroid aspiration biopsy.

Adolescent↗
PubMed2001

Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches.

In childhood the traditional diagnostic approach to thyroid nodules consists of clinical, laboratory, and imaging evaluations. A safe and accurate procedure is needed to promptly identify patients who require surgery. In regard to the usefulness of fine needle aspiration biopsy, the data in the literature concerning children and adolescents are scanty. The aim of this study was to evaluate and compare the diagnostic accuracies of clinical, laboratory, and imaging data collected retrospectively in a group of pediatric patients with thyroid nodules submitted to fine needle aspiration biopsy. Forty-two patients who underwent surgery for thyroid nodules, recruited in 9 Italian pediatric endocrine units, were retrospectively studied. According to histological diagnosis, they were divided into 2 groups, 22 patients with benign lesions and 20 patients with malignant lesions. From clinical records we obtained data about 1) symptoms of neck compression; 2) cervical adenopathy; 3) thyroid function, calcitonin level, and antithyroid antibody titers; 4) ultrasonography; 5) (99m)Tc scintiscanning; and 6) cytology obtained with fine needle aspiration biopsy. Patients and nodule characteristics were analyzed statistically for associations with the presence of thyroid cancer. Among clinical findings, only adenopathy was significantly higher in the group with cancer (8 of 22 benign lesions vs. 16 of 20 malignant lesions; P = 0.006). Thyroid function and antibody titers were similar in the 2 groups, whereas the serum calcitonin level was elevated only in 1 patient with malignant lesions. Among ultrasonography findings, no significant statistical difference was found between the 2 groups with regard to number, dimensions, growth progression, or hypoechogenic pattern of the nodules. Regarding scintigraphic findings, no significant difference was found between the 2 groups. However, a positive correlation (r = 0.90; P < 0.0001) was found between fine needle aspiration biopsy cytological findings and histological diagnoses. The sensitivity, specificity, and accuracy of fine needle aspiration biopsy were 95%, 86.3%, and 90.4%, respectively. A multiple regression analysis showed that only fine needle aspiration biopsy (beta coefficient = 0.963; P < 0.0001) significantly contributed to detecting malignancy (multiple r = 0.973; P < 0.0001). This study provides strong evidence that fine needle aspiration biopsy is a safe technique even in childhood and adolescence, offering the best sensitivity, specificity, and accuracy in detecting malignancy compared with conventional approaches.

Adolescent↗
PubMed1997

Ultrasound-guided follicle aspiration and IVF in dairy cows treated with FSH after removal of the dominant follicle at different stages of the estrous cycle [corrected].

Recently, transvaginal ultrasound-guided follicle aspiration technology has been found to be of great value for in vitro fertilization (IVF) programs, even though the oocyte recovery rate and cleavage rate of transferrable embryos were low. In this study, we investigated the effect of the removal of the dominant follicle at different stages of the estrous cycle on the ovarian response of donor cows. Four experiments (EXPs) were devised. In EXP 1, 3 cows received 20 mg FSH on Day 1, ovulation occurred on Day 0, and on Day 3 follicles were aspirated. In EXP 2, the dominant follicle of the first wave was removed on Day 6 from 3 cows which received 20 mg FSH on Day 7 and on Day 9 follicles were aspirated. In EXP 3, 2 pregnant cows received 20 mg FSH on 70 d of pregnancy and 48 hr later follicles were aspirated a total of 5 times at 5-day intervals. In EXP 4, after ovulation on Day 0, 9 cows received 20 mg FSH on Days 8 to 14 of the estrous cycle and 48 hr after the last injection, follicles were aspirated once. The respective mean +/- SD numbers of aspirated follicles and recovered oocytes were higher (p < 0.01) in EXP 1 (13.4 +/- 1.7 and 8.7 +/- 2.3), EXP 2 (12.1 +/- 1.4 and 7.7 +/- 1.7) and EXP 3 (10.7 +/- 2.1 and 7.0 +/- 2.2) than in EXP 4 (5.8 +/- 2.3 and 3.1 +/- 1.6). The oocyte recovery rates were higher (p < 0.05) in EXP 1, EXP 2 and EXP 3 than in EXP 4. Similarly, the respective numbers of viable oocytes and cleavage rates were higher in EXP 1, EXP 2 and EXP 3 (6.0 +/- 1.3, 5.0 +/- 1.1 and 4.6 +/- 1.5 viable oocytes (p < 0.01); 66, 73 and 65% cleavage rates (p < 0.05)) than in EXP 4 (2.4 +/- 1.1; 46%). The numbers of morulae and blastocysts were higher (p < 0.05) in EXP 1, EXP 2 and EXP 3 than in EXP 4. In conclusion 1) removal of the dominant follicles from lactating and pregnant cows enabled viable oocytes to be recovered constantly and repeatedly by aspiration at different reproductive stages, and that viable blastocysts can be produced after IVF. 2) The presence or absence of a dominant follicle significantly affects the ovarian responses to FSH treatment. 3) This ultrasound-guided procedure proved to be an effective, repeatable and safe method for viable oocyte recovery from valuable pregnant donors.

Animals↗
PubMed2005

Transbronchial needle aspirates: comparison of two preparation methods.

STUDY OBJECTIVES: Transbronchial needle aspiration has evolved as a key bronchoscopic sampling method. Specimen handling and preparation are underrated yet crucial aspects of the technique. This study was designed to identify which of two widely practiced sample preparation methods has a higher yield. DESIGN: Prospective comparison of two diagnostic methods. SETTING: Tertiary academic hospital. PATIENTS: Consecutive patients undergoing transbronchial needle aspiration. INTERVENTIONS: Transbronchial aspirates were obtained pairwise. One specimen was placed directly onto a slide and smears were prepared on site (ie, the direct technique), and the other specimen was deposited into a vial containing 95% alcohol and further prepared in the laboratory (ie, the fluid technique). In total, 282 pairs of samples were aspirated from 145 target sites (paratracheal, 10 sites; tracheobronchial, 101 sites; hilar, 17 sites; endobronchial or peripheral, 17 sites). MEASUREMENTS AND RESULTS: The measured outcome was the presence of diagnostic material at the final laboratory assessment. At least one diagnostic aspirate was obtained in 66% of 86 investigated patients (small cell lung cancer, 18 patients; non-small cell lung cancer, 47 patients; other diagnoses, 21 patients). The direct technique had a better yield overall than the fluid technique (positive aspirates, 36.2% vs 12.4%, respectively; p < 0.01), as well as after stratification for tumor type and for anatomic site. CONCLUSION: The direct technique is superior to the fluid technique for the preparation of transbronchial needle aspirates.

Adolescent↗
PubMed1984

The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma.

Transcarinal needle aspiration for staging subcarinal nodes was performed in 134 consecutive patients with suspected bronchogenic carcinoma at the time of diagnostic fiberoptic bronchoscopy using a prototype 20-gauge by 1-cm needle. The aspiration was performed before examination of the lower airways to avoid cellular contamination. Twenty-four patients had benign primary disease and negative needle aspirates. The transcarinal needle aspirate was positive in 15 percent of the 110 patients with bronchogenic carcinoma. There were no false-positives, and the transcarinal needle aspirate was the only evidence of unresectability in 69 percent (11/16) of those in whom it was positive. In addition, two subgroups of patients were identified in whom the aspirate is most likely to be positive--patients with endobronchial tumors (24 percent; 15/63) and those with an abnormal carina at bronchoscopy (38 percent; 8/21). No complication occurred. We conclude that transcarinal needle aspiration is a low-risk procedure that can save a significant number of patients the morbidity and cost of surgical staging and that it should be performed at the time of diagnostic bronchoscopy in all patients with an endobronchial lesion or a visually abnormal carina.

Adult↗
PubMed1987

Eleven cases of nonfunctioning parathyroid cyst--significance of needle aspiration in diagnosis and management.

Eleven cases of nonfunctioning parathyroid cyst are reported. Ultrasonography revealed the cystic nature of the asymptomatic lump in the neck. Clear watery fluid obtained by needle aspiration and the increased parathyroid hormone concentration in the fluid established the diagnosis. Five patients, in four of whom the cysts reappeared after one (3 cases) or seven (1 case) needle aspirations, underwent surgical resection of the cysts. Six other patients were followed conservatively after the aspiration maneuver. In four patients with enough follow-up time for evaluation, the cyst fluid has not reaccumulated 5, 2 and 2 years after only one aspiration, and 1 year after two aspirations. In one patient, the cyst reappeared 9 months after the initial aspiration. Simple percutaneous aspiration may be curative in some cases of nonfunctioning parathyroid cysts.

Adult↗
PubMed1987

The role of phosphatidylglycerol in phospholipid analysis of tracheal and gastric aspirate in premature infants.

Tracheal and gastric aspirates from premature infants simultaneously sampled shortly after birth were analyzed for their phospholipid composition using 2-dimensional thin layer chromatography. The results were related to clinical outcome. The L/S ratio was higher in infants without than in infants with hyaline membrane disease (HMD). The L/S values and the concentrations of phosphatidylglycerol (PG) were higher in tracheal compared with gastric aspirates (table I). This resulted in different L/S cutoff points with respect to lung maturity. In both aspirates, the predictive value of a "mature" (but not of an "immature") L/S ratio was improved by PG determination (table II). Only one out of 22 infants with HMD had a completely "mature" phospholipid profile in its tracheal aspirate. Two vaginally delivered premature infants without HMD had an "immature" phospholipid pattern in their gastric aspirates, but a "mature" one in their tracheal aspirates. The results indicate that phospholipid analysis of tracheal and gastric aspirates shortly after birth is useful in the biochemical diagnosis of HMD if proper cutoff points for the L/S ratio are used and the determination of PG is included. It may prove to be important in establishing criteria for a therapeutic trial of surfactant substitution.

Chromatography, Thin Layer↗
PubMed2002

Comparison of bone marrow cells harvested from various bones of cynomolgus monkeys at various ages by perfusion or aspiration methods: a preclinical study for human BMT.

Using cynomolgus monkeys, we have previously established a new method for harvesting bone marrow cells (BMCs) with minimal contamination of the BMCs with T cells from the peripheral blood. We originally conducted this new "perfusion method" in the long bones (the humerus, femur, and tibia) of cynomolgus monkeys. Here, we apply the perfusion method to obtain BMCs from the ilium of cynomolgus monkeys, since BMCs are usually collected from the ilium by the conventional aspiration method in humans. The perfusion method consists of two approaches: transverse iliac perfusion and longitudinal iliac perfusion. BMCs harvested by the perfusion method from the long bones and ilium were compared with those collected from the ilium by the aspiration method. The contamination of BMCs with peripheral blood, determined by the frequencies of CD4+ and CD8+ T cells, was significantly lower in BMCs obtained from the ilium or long bones by the perfusion method (CD4+ plus CD8+ T cells <4%) than in those obtained by the iliac aspiration method (CD4+ plus CD8+ T cells >20%). However, the numbers of immature myeloid cells, such as myeloblasts, promyelocytes, myelocytes, and metamyelocytes, were higher in BMCs obtained by the iliac perfusion method than in those obtained by the iliac aspiration method. The assays for in vitro colony-forming unit in culture revealed that progenitor activity was significantly higher in BMCs obtained by the perfusion method than in those obtained by the aspiration method. These findings suggest that the contamination of BMCs with peripheral blood is much less when using the perfusion method than when using the aspiration method. To determine the best site for harvesting BMCs by the perfusion method, age-dependent changes in BMCs harvested by the perfusion method from the long bones and ilium were examined. The numbers of BMCs varied in the long bones (humerus > femur > tibia) and showed age-dependent decreases, whereas they remained similar in the ilium of cynomolgus monkeys from 3 years to 6 years of age. However, in cynomolgus monkeys, BMC harvesting by the perfusion method from the ilium (but not from the long bones) is found to involve the risk of fat emboli, particularly when the BMCs are quickly perfused under high pressure. These findings suggest, even in humans, that the perfusion method is better than the aspiration method, and that the best site for collection of BMCs is the humerus.

Aging↗
PubMed1998

One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses.

OBJECTIVE: This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. MATERIALS AND METHODS: Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. RESULTS: Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. CONCLUSION: Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.

Abdominal Abscess↗
PubMed2003

Treatment of breast abscesses with sonographically guided aspiration, irrigation, and instillation of antibiotics.

OBJECTIVE: We studied the feasibility of treating breast abscesses with sonographically guided aspiration, irrigation, and local instillation of antibiotics without placing indwelling catheters. MATERIALS AND METHODS: Seventy-three patients with breast abscesses were seen from 1995 to 2001. Aspiration and irrigation were performed under sonographic guidance. Repeated aspiration was performed when deemed necessary. One gram of cephradine was injected into 29 abscesses measuring more than 25 mm. RESULTS: Six patients refused further treatment after failure of the first aspiration and elected surgical drainage. Of the remaining 67 patients who completed treatment, 38 required one aspiration for cure, 18 required two aspirations, and eight required more than two aspirations. The treatment failed and surgical drainage was required in only three of the 67 patients completing treatment. CONCLUSION: Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.

Abscess↗
PubMed2007

Comparison of core needle biopsy and fine-needle aspiration of enlarged peripheral lymph nodes for antemortem diagnosis of enzootic bovine lymphosarcoma in cattle.

OBJECTIVE: To determine whether antemortem core needle biopsy and fine-needle aspiration of enlarged peripheral lymph nodes could be used to distinguish between inflammation and lymphosarcoma in cattle. DESIGN: Prospective study. ANIMALS: 25 cattle with enlarged peripheral lymph nodes. PROCEDURES: Antemortem biopsies of the selected lymph nodes were performed with an 18-gauge, 12-cm core needle biopsy instrument. Fine-needle aspirates were performed with a 20-gauge, 4-cm needle. Specimens were analyzed by pathologists who were unaware of clinical findings and final necropsy findings, and specimens were categorized as reactive, neoplastic, or nondiagnostic for comparison with necropsy results. RESULTS: Sensitivity and specificity of core needle biopsy ranged from 38% to 67% and from 80% to 25%, respectively. Sensitivity of fine-needle aspiration ranged from 41% to 53%, and specificity was 100%. Predictive values for positive test results ranged from 77% to 89% for core needle biopsy and were 100% for fine-needle aspiration. Predictive values for negative test results were low for both core needle biopsy and fine-needle aspiration. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that core needle biopsy and fine-needle aspiration can aid in the antemortem diagnosis of bovine enzootic lymphosarcoma. Results of fine-needle aspiration of enlarged peripheral lymph nodes were more specific and more predictive for a positive test result than were results of core needle biopsy.

Animals↗
PubMed2006

Open epididymal sperm aspiration (OESA): minimally invasive surgical technique for sperm retrieval.

OBJECTIVES: Male infertility caused by irreparable obstructive azoospermia is widely treated with MESA (Microsurgical Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) or PESA (Percutaneous Epididymal Sperm Aspiration) followed by an Intracytoplasmatic Spermatozoa Injection (ICSI). For each procedures are claimed advantages and disadvantages. Aim of this work is to describe our technique (OESA) for sperm retrieval reporting the results. METHODS: From 1998 to 2003 153 sperm retrieval procedures in azoospermic patients were performed. The technique consists in a small (1 cm.) surgical incision of scrotal wall under local or spinal anaesthesia. After inspecting the intrascrotal component to record the status of the epididymis and of the testicle, epididymal sperm aspiration was performed in the most appropriate site with 18 gauge needle. The aspirated spermatozoa were used immediately after aspiration not being permitted in our Institute cryopreservation. When no sperms were found TESE was performed. RESULTS: In 78 cases aspiration from epididymis was successful (OESA). In the other patients (75) TESE was performed. Higher count of spermatozoa were retrieved in all cases of OESA. Pregnancy rate was 26.6% for OESA and 6.4% for TESE. No complications occurred. CONCLUSIONS: This technique is very simple and easy allowing to obtain the advantages of microsurgical techniques (mainly choice of the most appropriate site of aspiration and immediate haemostasis if needed) with minimal invasivity (avoiding epididymal surgical incision). Moreover if OESA does not allow sperm extraction is possible to perform immediately TESE.

Epididymis↗
PubMedDate not supplied

Comparison of specimen adequacy in fine-needle aspiration biopsies performed by surgeons and pathologists.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) may yield different results depending on its operator. We compared the proportions of unsatisfactory aspirates obtained by pathologists vs. surgeons. METHODS: In a retrospective review, all FNAB reports and slides performed between March 2002 and February 2003 were grouped by organ/site and according to whether they were done by a pathologist or a surgeon. The proportions of unsatisfactory aspirates for pathologists and surgeons were compared. RESULTS: Of 692 FNABs, 390 were performed by pathologists at the FNAC clinic and the remainder by surgeons. Overall, 15.5% of aspirates obtained were unsatisfactory (n=107). Of aspirates obtained by surgeons, 29.5% were unsatisfactory, compared to 4.6 % of those obtained by pathologists (P<0.001). Pathologists had significantly lower proportions of unsatisfactory aspirates in all sites. A 33% reduction in the number of lymph node excisional biopsies has been reported subsequent to establishment of the FNAC clinic. CONCLUSIONS: The advantages of a pathologist performing FNAB are that a rapid evaluation can be rendered regarding specimen adequacy and the need for repeating the procedure. In addition, pathologists can direct the distribution of aspirated material for other tests such as culture study, flow cytometry and electron microscopy, as indicated by preliminary evaluation of the smears. These factors significantly lower the proportions of unsatisfactory specimens and improve the diagnostic accuracy of FNAB technique.

Biopsy, Fine-Needle↗
PubMed1995

[Usefulness of fine needle aspiration cytology in the diagnosis of prostate cancer].

The efficacy of aspiration cytology, using Franzen method and echo-guided aspiration for prostate cancer was examined to 102 patients under saddle-block anesthesia in urological clinic of Chiba University Hospital. Between 1990 and 1993, 77 cases out of 102 patients were diagnosed histologically as prostate cancer by needle biopsy and 90% of them were coincidental with findings of aspiration cytology. Looking at histological grades, well differenciated cancer was shown to yield low positivity compared with moderately and poorly differentiated cancer. Positive rate showed similar when grade of specimens from needle biopsy was classified with Gleason pattern. Neither T category nor method of aspiration between Franzen and echo-guided methods influenced positive rate of aspiration cytology. On aspiration cytology, its grading revealed 60% of coincidence with that obtained by histological method. When counting more than 300 scattered cells, 90% of coincidence was achieved with histological grading. It is concluded that aspiration cytology is efficient for diagnosis of prostate cancer.

Biopsy, Needle↗
PubMed1997

Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: a comparison study.

BACKGROUND: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. OBJECTIVE: To assess the utility of endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography for the detection of metastases to the posterior mediastinal lymph nodes in non-small-cell lung cancer. DESIGN: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. SETTING: Referral-based academic medical center. PATIENTS: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. INTERVENTIONS: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. RESULTS: 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography without aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P < 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients, the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography-guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. CONCLUSIONS: Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung-cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or "bulky" subcarinal nodes.

Biopsy, Needle↗
PubMed1993

The role of sonographically guided aspiration in the clinical management of ovarian cysts.

This study was undertaken to verify the role of fine-needle aspiration (FNA) followed by cytologic examination as a possible alternative to surgery in case of cystic pelvic masses. From January 1988 to March 1989, 204 patients with a proven cystic pelvic mass underwent FNA under sonographic guidance. In 20 cases the aspiration was performed transvaginally. Thirty-six patients were postmenopausal. In all cases the aspirated fluid was collected for cytologic evaluation. Other than one case of persistent hematuria, no complications occurred. The overall recurrence rate, verified 3 months from FNA, was 65%. Fifty-two per cent of patients developed a new cyst after a complete aspiration. Fifty-three patients underwent a laparotomy, allowing a comparison between cytologic and histologic patterns. The sensitivity of cytologic examination of aspirated fluids was 40% (3 of 5 malignancies were missed) and the specificity was 100% (no false positives were observed). We conclude that FNA might be proposed in young women with a unilocular ovarian cyst to avoid a surgical procedure. In postmenopausal women with a unilocular cystic mass 5 cm or less, FNA may be considered as an important step in the diagnosis. In all instances the ultrasonographic appearance of the cyst (echo texture and regularity of wall) and the characteristics of aspirated fluid are the most important findings. When the aspirated fluid contains mucus or blood, or when a complex mass is present, exploratory laparotomy or a laparoscopy is recommended.

Adolescent↗
PubMed2000

Small cell carcinoma versus other lung malignancies: diagnosis by fine-needle aspiration cytology.

BACKGROUND: When a diagnosis of small cell carcinoma is reached in a patient with a lung mass, a surgical treatment approach is no longer considered and chemotherapy becomes the treatment of choice. The aim of this study is to compare the diagnostic accuracy of fine-needle aspiration cytology in the diagnosis of small cell carcinoma with the diagnoses of other lung malignancies. The capacity of this technique to distinguish between these two categories is assessed. METHODS: Two hundred fifty-nine consecutive transthoracic fine needle aspirations of lung tissue from 235 patients with histologic diagnosis of malignancy were reviewed. The aspirates were performed over a 10-year period at the University of Miami/Jackson Memorial Medical Center, Miami, Florida. Two hundred and forty-two fine-needle aspirations from 221 patients yielded satisfactory smears and were included in the study. Fourteen patients were excluded. The cytologic diagnoses were classified into 5 categories: 1) small cell carcinoma (18 smears, 7%); 2) other lung malignancies (158 smears, 65%); 3) suspicious for malignancy (19 smears, 8%); 4) inflammatory process (7 smears, 3%); and 5) negative for malignancy (40 smears, 17%). RESULTS: The histologic diagnoses were divided into two groups: small cell carcinomas (29 smears, 12%), and other lung malignancies (213 smears, 88%). The efficiency of fine-needle aspiration cytology in the diagnosis of these two groups was 96% versus 88%, respectively, with an equal specificity of 100%, and a sensitivity of 67% versus 81%. Once the diagnosis of malignancy was established, fine-needle aspiration cytology was found to be highly accurate in distinguishing small cell carcinoma from other neoplasms. CONCLUSION: We conclude that fine-needle aspiration cytology of the lung is an accurate diagnostic tool for the diagnosis of lung malignancies and is an excellent technique for distinguishing small cell carcinoma from other malignant neoplasms. It can be used with confidence to select treatment modalities and to avoid unnecessary surgeries in patients with lung malignancies.

Adult↗