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PubMed1983

Sonographic depiction of changes in ventricular size associated with repeated ventricular aspirations.

Serial real-time cranial sonography was performed on 11 preterm neonates who had demonstrated progressive posthemorrhagic ventricular dilatation and were subjected to repeated ventricular aspirations. Changes in ventricular size were correlated with gestational age, birth weight, and extent and location of the intracranial hemorrhage, as well as the timing, frequency, and location of the ventricular aspirations and the average amount of cerebrospinal fluid removed. The sizes of both lateral ventricles of each neonate were measured and the occurrence of sequelae related to repeated ventricular aspiration was examined. Eleven ventricles diminished in size, eight increased, and there was no change in three. Two neonates had bleeding near the aspiration sites. It is concluded that repeated aspiration can be associated with a diminution in ventricular size in some neonates. It is recommended that alternative methods of treatment, such as serial lumbar puncture or external ventriculostomy, be attempted prior to initiating repeated ventricular aspirations.

Birth Weight↗
PubMed1999

Alternative and effective treatment of shoulder ganglion cyst: ultrasonographically guided aspiration.

The therapeutic effect of ultrasonographically guided aspiration of a ganglion cyst of the shoulder is evaluated. Fifteen patients (nine male, six female) with chronic shoulder pain were enrolled in this study. Each patient was referred to rule out rotator cuff lesion. The ultrasonographic examination showed an anechoic cystic lesion in the shoulder region in every patient and abnormality of the rotator cuff in only four patients. Under ultrasonographic guidance, an 18 gauge needle was inserted into the cyst to aspirate the fluid. Initial sonographic imaging showed the cyst, which appeared as a localized fluid accumulation and was located between the deltoid muscle and the subscapularis tendon in seven patients, between the deltoid muscle and the biceps tendon in one patient, below the coracoacromial ligament in five patients, and over suprascapular notch area in one patient. The ganglion cysts ranged in size from 3.5 to 30 mm. The amount of aspirated fluid in each cyst varied from 0.4 to 12 ml (mean, 2.6 ml +/- 3.1) with a clear or light yellowish color and a jelly-like appearance. No major complications occurred during or after this procedure. The symptom (pain) was improved after sonographically guided aspiration in each patient. Follow-up study showed complete relief of pain in four patients, marked improvement in nine patients, and mild improvement but still persistent shoulder pain in two patients. Duration of follow-up study ranged from 2 to 24 months (mean, 6.4 months +/- 6.9). The success rate for sonographically guided aspiration was 86% on the basis of marked symptom improvement or relief. Ultrasonographically guided aspiration of shoulder ganglion cysts is an effective procedure in the management of shoulder pain caused by ganglion cysts.

Adult↗
PubMed2000

Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration.

The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided needle aspiration in the treatment of prostatic abscess. Fourteen patients with prostatic abscess were evaluated with this technique and treated with sonographically guided needle aspiration. Using this technique, all cases (100%) had one or more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients (71.0%), the lesion showed internal septa or solid portion. The margins of the hypoechoic area were well defined and thick in 11 patients (79.0%) and poorly defined in 3 patients (21.0%). The estimated volume of the prostatic abscess ranged between 2 and 28 ml (mean, 12.0 ml). The presence of a pus collection within the prostate was confirmed by transrectal ultrasonographically guided aspiration in all patients. However, successful treatment of prostatic abscess with transrectal needle aspiration was done in 12 (86.0%) of 14 patients; the treatment failed in 2 (14.0%) of 14 patients. One patient was treated with perineal incision and drainage and the other with transurethral resection. The amount of pus drained ranged between 1 and 39 ml (mean, 12.0 ml). On follow-up transrectal ultrasonographic examination, no remaining abscess pocket was found within the prostate in any of the cases. One year later, the prostatic abscess recurred in one case. In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an effective method for treating prostatic abscess.

Abscess↗
PubMed2002

Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy.

OBJECTIVE: For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method. The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. METHODS: We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000. RESULTS: Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. CONCLUSIONS: Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy.

Abscess↗
PubMedDate not supplied

Needle aspiration and biopsy in the diagnosis and monitoring of bone marrow diseases.

OBJECTIVE: To review the procedures required to perform and evaluate needle aspiration and biopsy of bone marrow. DATA SOURCES: Journal articles, monographs and authors' experience. DATA SYNTHESIS: The performance of bone marrow needle aspiration and biopsy requires close cooperation between the physician and the clinical laboratory scientist (CLS). Several tests require special handling when obtaining and processing bone marrow samples. Serial bone marrow aspiration and biopsy studies can help in the management of some bone marrow diseases. This article reviews the procedures required to obtain and to process bone marrow aspirates and biopsies. It also reviews the interpretation of light microscopic studies of bone marrow samples. CONCLUSION: Current procedures for obtaining and procuring bone marrow needle aspirates and biopsies require close interaction between the CLS and the physician. Multiple specialized assays require special handling at the time marrow samples are obtained. Serial bone marrow needle aspirates and biopsies can be very useful in guiding the clinical care of certain patients.

Biopsy, Needle↗
PubMed1998

Microbiological profile of anterior chamber aspirates following uncomplicated cataract surgery.

Anterior chamber aspirate cultures were done for 66 patients who underwent either an uncomplicated intracapsular cataract extraction, extracapsular cataract extraction with posterior-chamber intraocular lens implantation, or phacoemulsification with posterior-chamber intraocular lens implantation. The aspirate was obtained at the time of wound closure. The aspirates were immediately transferred to the microbiology laboratory where one drop of the aspirate was placed on a glass slide for gram stain, and the remainder was unequally divided and inoculated into blood agar, chocolate agar and thioglycolate broth. The cultures were incubated at 37 degrees C with 5% CO2 and held for 5 days. Of 66 patients 4 (6%), had smear-positive anterior chamber aspirates. None of the aspirates showed any growth on any of the 3 culture media used. None of the eyes in the study developed endophthalmitis. This study concludes that there is no contamination of the anterior chamber by viable bacteria after cataract surgery, irrespective of the mode of intervention.

Aged↗
PubMed1976

Interpretation of aspiration tests in local anesthetic injections.

Three young adult laboratory rabbits were anesthetized with a barbiturate and their abdominal cavities were surgically opened to expose a variety of blood vessels. A number of veins and arteries were penetrated with 25- and 27-gauge needles attached to standard dental aspirating cartridge-type syringes. Aspiration tests were performed and the results were recorded. No differences in the performance of aspiration were detected with the two gauges of needles. Where the aperture of the needle lay unobstructed and wholly within a vein greater than 1.5 mm in diameter or within any artery, it was impossible not to aspirate blood even with a peer technique. In certain circumstances, false-negative and misleading positive readings are possible. Recommendations for a clinically reliable aspirating technique have been given and four grades of positive result described. Absolutely infallible interpretation of results is impossible but, provided the aspirating technique itself is sound, intelligent evaluation of observed effects should result in very few errors of interpretation.

Anesthesia, Local↗
PubMed2000

Use of the ultrasound surgical aspirator in ovarian cancer: a case-control study.

BACKGROUND: This study was undertaken to evaluate the use of the ultrasound surgical aspirator in ovarian cancer and to determine if cytoreduction was improved with its use. METHODS: The study is a retrospective case control trial. Twenty-six consecutive ovarian cancer patients who had the ultrasound surgical aspirator used during their surgery were retrospectively compared to 25 consecutive ovarian cancer patients who did not have the ultrasound surgical aspirator used during their surgeries. The latter group had their surgeries immediately before the ultrasound surgical aspirator was introduced into the hospital. Both groups were similar in age, stage, histology type, grade, and median number of chemotherapy cycles. RESULTS: Patients that had the ultrasound surgical aspirator used had a 69% optimal cytoreduction rate compared to 16% in the control group (p = .001). This was statistically significant (p = 0.001). Survival time was equal in both groups. CONCLUSIONS: Results of the study showed that use of the ultrasound surgical aspirator may permit more patients to be optimally cytoreduced.

Case-Control Studies↗
PubMed2000

Thyroid aspiration cytology in Newcastle: a six year cytology/histology correlation study.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a well-established technique for pre-operative investigation of thyroid nodule(s). Thyroid FNAC was introduced in the teaching hospitals of Newcastle upon Tyne in 1981, initially with a small group of clinicians as aspirators. Audit results for 1981-1986 inclusive showed an unsatisfactory rate of 25.3% and prediction of malignancy with a sensitivity of 93.5%. FNAC has become more popular locally for the investigation of thyroid disease and the number of clinicians performing aspirates has increased. The results for recent years have, therefore, been audited. METHODS: Medical records were reviewed for 239 patients with a dominant thyroid nodule who had FNAC carried out in the 6 year period 1990-1995 and subsequent partial or complete thyroidectomy. RESULTS: Histology of thyroid specimens showed 60 follicular adenomas and 34 malignant lesions (including 19 papillary, 10 follicular and 3 medullary carcinomas, one lymphoma and one follicular neoplasm with indeterminate malignant potential). A total of 302 FNAC had been carried out on these 239 patients. On cytological grounds the unsatisfactory sample (AC0 and AC1) rate was 43.1% on initial aspiration which was reduced to 32.2% on repeated aspiration. FNAC predicted neoplasia (AC3, AC4 and AC5) with a sensitivity of 86.8%, a specificity of 67.0%, a negative predictive value of 87.5% and a positive predictive value of 65.5%. Malignancy was predicted by FNAC (AC3, AC4 and AC5) with a sensitivity of 88.9%. A FNAC report of AC5 had a positive predictive value for malignancy of 100%. CONCLUSIONS: FNAC is an invaluable and minimally invasive procedure for the pre-operative assessment of patients with a dominant thyroid nodule. It is, however, important that the number of aspirators and cytopathologists be kept small to maintain expertise and also that the results of FNAC be subjected to ongoing audit.

Adolescent↗
PubMed2001

Soft tissue aspiration cytopathology of malignant lymphoma and leukemia.

BACKGROUND: Malignant lymphoma (ML) and leukemia infrequently involve soft tissue and, to the authors' knowledge few reports exist regarding the role of fine-needle aspiration biopsy (FNAB) in their diagnosis. In the current study, the authors report their experience with FNAB in patients with soft tissue ML and leukemia. METHODS: All cases of ML, leukemia, or atypical lymphoid cells from soft tissue aspirates were reviewed. Masses from lymph node-rich sites, those adjacent to enlarged lymph nodes, or those associated with cutaneous lesions were excluded. RESULTS: Twenty-one patients (male:female ratio of 1:1) who ranged in age from 10 months to 87 years (mean age, 51 years) were studied. Seven patients had superficial masses and 14 patients had deep soft tissue masses. Sites included the extremities (10 patients), trunk (8 patients), and head (3 patients). Cytologic diagnoses were ML (large cell [11 patients] and Hodgkin [1 patient]), acute leukemia (lymphoblastic [3 patients] and myelogenous [2 patients]), and atypical lymphoid cells (4 patients). Eight aspirates represented the initial diagnosis of ML, three were recurrent ML, four were recurrent leukemia, one was initial leukemia, and one ML aspirate was obtained concurrently with core needle biopsy. Four aspirates were diagnosed as atypical lymphoid cells. Three subsequently were diagnosed as ML and one aspirate was diagnosed as acute leukemia. All ML were of large B-cell type. One case of atypical lymphoid cells was found to be a mantle cell lymphoma. The leukemia cases were T-cell (two cases), pre-B-cell (two cases), and myelogenous (two cases). Immunophenotyping confirmed the cytology by flow cytometry (five cases), cytospin (three cases), and cell block (four cases). Immunophenotyping of eight cases was performed on tissue samples. In one case a cytopathologic diagnosis of ML reversed a prior tissue core biopsy diagnosis of liposarcoma. The specificity and sensitivity rates for a definitive diagnosis of ML or leukemia were 100% and 82%, respectively. CONCLUSIONS: In the majority of cases, it is possible to determine a specific diagnosis and subtype of soft tissue ML or leukemia using FNAB. Cancer (Cancer Cytopathol)

Adolescent↗
PubMed2000

[Fine-needle aspiration biopsy and cytologic diagnosis in thyroid disease-a 3-year experience].

Fine needle aspiration biopsy (FNA) is a morphological method, which may bridge the diagnostic gap between initial clinical and sonographic examination and histological diagnosis in thyroid disease. Our study was aimed at a review of 3-year aspiration cytology of the thyroid gland in clinical practice. 175 FNA were assessed (165 in females and 10 in males). Aspiration biopsy was performed using 20 to 23 G needles and aspirates were stained after Pappenheim. The highest number of performed FNA was between 40 and 60 yrs of age. The most commonly observed clinical diagnosis requiring FNA included multinodular goiter, Hashimoto thyroiditis and thyroid adenoma. These were also the most common cytological findings. Unsatisfactory specimens were found in 21% of aspirates. Most pitfalls were found in cases of multinodular goiter and Hashimoto thyroiditis. Our results are comparable to those of other clinical centers. They reflect the age-adjusted incidence of thyroid disease. We conclude that combination of ultrasound tomography, aspiration puncture, and cytological evaluation improves the diagnosis of thyroid disease and reduces the duration of the examination.

Adult↗
PubMed1999

The diagnostic value of fine-needle aspiration cytology in the assessment of thyroid nodules: a retrospective 5-year analysis.

OBJECTIVE: To audit the diagnostic accuracy and value of fine-needle aspiration cytology in the assessment of thyroid nodules over a 5-year period. DESIGN: Retrospective study. SETTING: Private practice, Hong Kong. PATEINTS: The computerised records from cytological and histological examinations of all thyroid specimens submitted from 1993 through 1997 were studied; the 1236 aspirates came from 1033 women and 175 men (gender was not specified in 28 cases). MAIN OUTCOME MEASURES: Cytological reports were classified diagnostically, and histological and cytological correlations were determined. RESULTS: Of the 1236 aspirates, 113 (9.1%) were unsatisfactory; 1013 (82.0%), including cysts, were benign; and 110 (9.0%) were neoplastic or malignant. Histological follow-up was available for 149 cases; 13 were unsatisfactory for cytological diagnosis. Statistical analysis of the remaining 136 cases yielded the following results: sensitivity of fine-needle aspiration cytology, 56%; specificity, 90%; positive predictive value, 74%; negative predictive value, 80%; accuracy, 79%. These results were within the range of previously published values. The sensitivity was improved by combining clinical information: if nodules larger than 3-cm diameter were excised (despite a non-neoplastic aspiration cytology report), the sensitivity increased to 71% and the accuracy to 84%. CONCLUSION: Fine-needle aspiration cytology is an effective screening test to help evaluate whether surgery is required in the management of thyroid nodules. False-positive and false-negative rates can be minimised by taking clinical and imaging data into consideration.

Journal Article↗
PubMed2002

Fine needle aspiration cytology of hepatobiliary cystadenoma with mesenchymal stroma.

BACKGROUND: Hepatobiliary cystadenomas (HBCs) with mesenchymal stroma (MS) are rare cystic neoplasms occurring exclusively in women. Hepatobiliary cystadenoma consists of a mucin-producing cyst lining epithelium underlined by a dense MS cell layer. In the current study, the authors review the fine needle aspiration cytology of HBC with MS and identify characteristic cytologic features that suggest such an uncommon neoplasm on aspirates. METHODS: A search of the histopathology files at the University of Texas Medical Branch at Galveston for the interval of January 1992 through December 2000 yielded four cases of HBC having both cytologic and histologic specimens. The cytologic features of the aspirates were reviewed and correlated with the clinical history, radiologic findings, and the histopathology of the excised specimens. RESULTS: All four patients were middle-aged women (mean age, 48.5 years) who presented with epigastric pain radiating to the back, due to large cystic lesions in the right liver lobe (three patients) or the left liver lobe (one patient). Aspiration cytology revealed chronic inflammatory exudate in all cases, along with occasional aggregates of bland, cuboidal-columnar epithelial cells (in three cases), which rarely arranged in papillary clusters. No significant atypia, evidence of malignancy, or MS cells were identified on the aspirates. HBC with MS was confirmed histologically on the excised specimens in all cases. CONCLUSIONS: By ensuring adequate sampling and correlating with consistent clinical and radiologic findings, a diagnosis of HBC or cystic hepatobiliary neoplasm can be suggested on the basis of aspiration cytology.

Biliary Tract Neoplasms↗
PubMedDate not supplied

Amoebic liver abscess: a comparative study of needle aspiration versus conservative treatment.

BACKGROUND: Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs. METHODS: This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess < 300 cm3 were treated with drugs alone. Group B patients with abscess > 300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications. RESULTS: There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group. CONCLUSIONS: Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

Adolescent↗
PubMedDate not supplied

Combined cytologic and histologic diagnosis of liver tumors via one-shot aspiration.

BACKGROUND/AIMS: Ultrasound-guided fine needle aspiration is considered to be a safe alternative in diagnosing liver tumors. Combined cytologic and histologic preparation via one-shot fine needle aspiration was evaluated, especially in outpatients. METHODOLOGY: During a 1-year period, 95 patients (including 57 outpatients and 38 inpatients) who had received 97 sessions of fine needle aspiration and had final diagnosis were enrolled. Using a 22-gauge needle, the aspirate from liver tumor was processed for cytology and cell block histology simultaneously in patients without ascites and/or bleeding tendency. RESULTS: From 94 malignant and 3 benign tumors, the accuracy of cytology was 88.7%; while, the difference between outpatients and inpatients was not significant (91.2% vs. 85%). No complication after fine needle aspiration was elicited in both groups. The rates of inadequate specimen preparation for cytology and histology were 0% and 13.4%, the false-negative rates of malignancy were 11.7% for cytology and 16% for histology. The inadequate and false-negative rates of histology were not associated with gender, underlying liver cirrhosis, or tumor size, type, and location. CONCLUSIONS: Ultrasound-guided 22-gauge one-shot fine needle aspiration is safe, convenient and reliable in diagnosing liver tumor, and can be performed in outpatients meticulously.

Adenocarcinoma↗
PubMedDate not supplied

Modification of endoscopic aspiration mucosectomy (EAM) for early gastric cancer: EAM with pre-cutting.

BACKGROUND/AIMS: We have performed endoscopic aspiration mucosectomy for early gastric cancer since June 1993. In order to increase the complete resection rate, it is necessary to place the cancer in the center of the resection field. To facilitate complete resection, a circular incision to guide aspiration mucosectomy was made with a cutting knife (pre-cutting) before endoscopic aspiration mucosectomy, a procedure that we call endoscopic aspiration mucosectomy, with pre-cutting. METHODOLOGY: Eleven patients who had undergone endoscopic aspiration mucosectomy with pre-cutting for early gastric cancer at our department were included in this study. All resected specimens were examined macroscopically and histopathologically to assess the curative potential of this modified method of mucosectomy. RESULTS: The resected specimens ranged from 22 to 28 mm (mean: 25 mm) in maximum diameter, while the tumors ranged from 10 to 18 mm (mean: 12 mm) in size. Each resected specimen had the tumor at its center. The resection rating was EA in 10 (90.9%) of the 11 lesions and EC in 1 lesion (9.1%). CONCLUSIONS: For curative endoscopic surgery, there is no dispute that complete resection is essential. Thus, endoscopic aspiration mucosectomy with pre-cutting should contribute to the cure of early gastric cancer.

Aged↗
PubMed2000

[Detection of hyperdiploid in malignant cells in fine-needle aspirates from lung cancer by fluorescence in situ hybridization].

OBJECTIVE: To study the numerical abnormality of chromosomes in malignant cells in fine-needle aspirates from lung cancer by fluorescence in situ hybridization (FISH). METHODS: 30 fine-needle aspirates from lung cancer (4 from lung tissues, 26 from lymph nodes) were detected by FISH with the centromere DNA probes for chromosome 7, 11, 17 and X. RESULTS: In 27 positive fine-needle aspirates the rates of hyperdiploid in chromosome 7, X, 17, and 11 were 81.5% (22/27), 77.8% (21/27), 70.4% (19/27) and 63.0% (17/27), respectively. In 3 negative fine-needle aspirates, the number of chromosomes was normal. CONCLUSIONS: (1) Interphase cytogenetic cells analysis of fine-needle aspirates by FISH is feasible and simple; (2) Hyperdiploid in malignant cells in fine-needle aspirates from lung cancer can be used as a biomarker for benign and malignant cells.

Biopsy, Needle↗
PubMed1992

[A comparison of transrectal fine needle aspiration and biopsy of prostatic lesion].

Transrectal fine needle aspiration and biopsy were performed on 100 patients with suspicious prostatic lesions using 22 gauge aspiration needles and 18 gauge biopsy needles. These collections were made from January 1990 to June 1991. Sufficient prostate tissue for cytological and histological diagnosis were obtained in 97% (97/100) and 99% (99/100), respectively. Thirty-nine patients (39%) were diagnosed having cancer with an accuracy rate of 89.7% (35/39) by histology and 69.2% (27/39) by cytology. One patient with a normal cytological aspiration was found to have an atypical biopsy, therefore, the biopsy was repeated and the prostate showed adenocarcinoma. Our results indicate that the needle aspiration cytology has a less accurate diagnosis rate than the needle biopsy histology. Fine needle aspiration is a safe and effective outpatient procedure but there is a definite learning curve before its use can be fully exploited. It is important to have experienced urologists and pathologists to perform these aspirations until sufficient experience is accumulated.

Aged↗