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PubMed1985

Fine-needle aspiration of lymphadenopathy of suspected infectious etiology.

We present a protocol for culture of lymph node find-needle aspirations in a series of 44 patients. Clinical indications for inclusion in the protocol included fever, localized erythema, pain or heat, an independent clinical diagnosis of infection by the referring physician, or a grossly purulent appearance of the initial aspirate material. Organisms (fungi, bacteria, or mycobacteria) were isolated in 13 (30%) of the aspirates. The probable contamination rate was 9%. These figures approached the culture yields obtained from open biopsy specimens as reported in the literature. A notable discrepancy existed between the cytologic appearance of the aspirates and culture results in three cases of mycobacteria. Six unsuspected malignancies were diagnosed. There were no complications from the procedure in this series. Based on this study, we present recommendations for culture of fine-needle aspirates from lymph nodes.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology of benign lymph node hyperplasias. Diagnostic significance of lymphohistiocytic aggregates.

The fine needle aspiration cytomorphology and the number of lymphohistiocytic aggregates were correlated with five categories of benign lymph node histologies. Of 187 patients who had benign lymph node aspiration diagnoses made from 1975 to 1982 at the Medical College of Virginia, 26 had a subsequent lymph node biopsy. Excluded from the study were four cases with the biopsy site different from the aspiration site, three cases with evidence of metastatic carcinoma and one case of fistula at the site of biopsy. Of the remaining 18 cases, 13 (72%) had lymphohistiocytic aggregates on the aspiration slides. The mean number of lymphohistiocytic aggregates on the aspiration slides was greater in cases with histologic evidence of follicular hyperplasia (6.1) than in those with some other predominating benign histology (1.6).

Biopsy, Needle↗
PubMed1986

Fragment filtration: a method for the accurate determination of flow cytometric kinetic data from bone marrow aspirates.

The extent to which bone marrow obtained by conventional aspiration is contaminated by peripheral blood has been confirmed and quantitated. In marrow aspirates from normal subjects the median percentage of nucleated cells that had originated from the peripheral blood was 32% (range 2.5%-64%), in patients with acute leukemia 23% (range 0.5%-96.5%), in patients with chronic leukemia 59% (range 17%-76%), and in patients with lymphoma 31% (range 0.5%-74%). Flow cytometric (FCM) DNA analysis of conventional marrow aspirates from a range of subjects significantly underestimated the proportions of S-phase cells present, when compared with results from trephines obtained at the same time. Having shown, using 51Cr-labeled red cells in mice, that circulating red cells do not reenter the marrow parenchyma, a mathematical correction for contaminating blood similar to that described by Holdrinet et al. was devised. This correction improved the S-phase cell estimate from aspirated marrows, and the corrected values were not significantly different from values from paired trephine samples. A previously described technique for collecting fragments by filtration of aspirated marrow has been adapted for FCM analysis as a more direct way of overcoming problems due to blood contamination. This method was shown to yield estimates of S-phase cells not significantly different from those in paired marrow trephines and offers an alternative to routine trephine biopsies for FCM analysis of marrow cell kinetics.

Animals↗
PubMed1985

Fine-needle aspiration in gynecology: evaluation of extrapelvic lesions in patients with gynecologic malignancy.

Fine-needle aspiration for suspicious extrapelvic lesions is documented in 82 specimens from patients with known pelvic malignancy. Specimens were obtained from lung (39%), supraclavicular lymph nodes (24%), paraaortic lymph nodes (11%), liver (7%), and other sites. Three of 32 (9.4%) patients with transthoracic aspirates experienced pneumothoraces requiring chest tube placement, and three others had smaller pneumothoraces that resolved spontaneously. Fifty-nine (72%) specimens were positive for malignancy. There were no known false positives. Of six negative aspirates that had follow-up histology, there were two false negatives. When the subsequent course was used as an indication of accuracy, specificity was 100%, and sensitivity was 91%. Fifty-eight (71%) patients had therapeutic alterations as a direct result of aspiration diagnosis. Thirty-nine major operative procedures and 28 open biopsies were spared. Fine-needle aspiration is a reliable and cost-effective diagnostic method that should become an increasingly routine component of the diagnostic armamentarium and may have broader roles defined through continuing study.

Adenocarcinoma↗
PubMed1979

Comparison of acid secretion rates measured by gastric aspiration and by in vivo intragastric titration in healthy human subjects.

In nine healthy subjects acid secretion rates, measured first by gastric aspiration and then by in vivo intragastric titration to pH 5, were compared. In vivo intragastric titration was initiated by instilling 50, 100, or 700 ml saline (pH 5) into the stomach, followed by a continuous intragastric saline infusion at 3.3 ml/min. Irrespective of the volume of saline used to initiate in vivo intragastric titration, acid secretion rates during titration were two to three times greater than secretion rates during gastric aspiration (P less than 0.005). This difference was not due to transpyloric acid losses during aspiration, since such losses were corrected for by nonabsorbable marker recovery; nor was the difference due to a higher intragastric pH during in vivo titration, since significant differences in acid secretion rates between aspiration and titration persisted when in vivo titration was performed at an acid pH. These findings suggest that in vivo intragastric titration leads to higher measured acid secretory rates than gastric aspiration because the titration method is associated with gastric distention and even small degrees of gastric distention stimulate gastric acid secretion.

Adult↗
PubMed1979

Percutaneous pulmonary aspiration biopsy using the Chiba needle.

The Chiba needle was used for percutaneous needle aspiration of lung lesions in 35 patients. Two separate needles were used for each patient at the same sitting. The aspirate was true positive for malignancy in 23 patients and true negative for malignancy in eight patients. Two aspirates were false negative for malignancy and two aspirates, negative for malignancy, were classified as inconclusive due to inadequate patient follow-up. The overall accuracy rate was 94%. Six patients had small pneumothoraces but only one required a chest tube. Appreciable hemoptysis did not occur. The Chiba needle provided an adequate aspirate for cytologic diagnosis. The complication rate using two needles appears to be entirely acceptable.

Adult↗
PubMedDate not supplied

Fine needle aspiration biopsy of the liver. A study of 102 consecutive cases.

One hundred five CT-guided or ultrasound-guided fine needle aspirations of liver in 102 consecutive patients were reviewed. Adequate histologic confirmation or clinical follow-up of the final diagnosis was available for 86 of the 105 aspirations. A definite diagnosis of malignancy was made in 53 of the 61 aspirations performed on patients with malignant hepatic disease (86.9%). There were no false positives. The most common tumors detected were metastatic adenocarcinomas from an unknown primary or from the colon and rectum. The tumors were typed correctly in nearly all cases. Benign lesions encountered included cysts, abscesses, hemangiomas, cirrhosis and fatty metamorphosis. No serious complications were encountered as a result of aspiration. Guided fine needle aspiration biopsy of focal liver lesions appears to be an accurate, safe and relatively inexpensive method of diagnosis.

Adenoma, Bile Duct↗
PubMed1983

Splenic aspiration; experience in Kenya.

We describe the technique of splenic aspiration in 113 patients presenting with splenomegaly. It was used initially to establish a diagnosis, and in those patients with kala azar, to follow the response of the parasites to therapy until 'parasitological cure'. In all 671 aspirations were performed. No complications occurred in the 69 patients with active kala azar, who collectively had more than 600 aspirations. One patient in a moribund condition had a fatal haemorrhage. The aspirate suggested a lymphoma, confirmed at autopsy. In 68 of the 69 patients with active kala azar, the diagnosis was established at the first aspiration. The essentials of the technique are the use of a small calibre needle (21 G), and speed, the needle being in the spleen for less than a second, with the consequent procurement of a few drops of material only.

Biopsy, Needle↗
PubMed1983

Prediction of respiratory distress syndrome by the fetal lung maturity analyzer microviscosimeter on newborn gastric aspirate.

To predict the development of respiratory distress syndrome (RDS), the authors determined the fluorescent polarization values on gastric aspirates obtained from 67 premature infants within 30 minutes of birth. In 29 cases these results were also compared with the fluorescent polarization values measured on the corresponding amniotic fluid samples. Measurements for microviscosity were made by fetal lung maturity analyzer. Among 15 of 67 premature infants who developed RDS, the fluorescent value measured on gastric aspirates in all 15 infants was greater than 0.320. The fluorescent polarization values were less than 0.320 in all 52 infants in whom RDS did not develop, a predictability of 100%. Direct comparison found fluorescent polarization values measured on gastric aspirates to be somewhat lower than the corresponding amniotic fluid fluorescent polarization values. The results indicate that gastric aspirate obtained within 30 minutes of birth contains swallowed amniotic fluid. In cases where amniotic fluid samples were not available for surfactant evaluation prenatally, the determination of fluorescent polarization values on the newborn's gastric aspirate may accurately predict the development of RDS. The use of the fetal lung maturity analyzer microviscosimeter provides a simple, reliable, and rapid (45 minutes) method for assessment of surfactant in premature infants.

Amniotic Fluid↗
PubMed1983

Intraoperative cytodiagnosis of lung tumors by needle aspiration.

Rapid-stain cytologic evaluation of needle aspirates are a recent adjunct to diagnosis and staging of lung neoplasms. The benefits of this approach include ease of sampling from deep and remote lesions and the fact that the results are generally available within 10 minutes. In the past 2 years, we did 187 needle aspirations for cytopathological evaluation in 70 patients at 51 thoracotomies and 21 mediastinoscopies. The cytologic findings from aspirates of lymph nodes, mediastinal masses, and intrapulmonary lesions were compared with diagnosis obtained by histopathological techniques. Quick-stain cytopathological evaluation discriminated cancer among all 55 lung masses from which aspirates were taken; specific diagnosis as to the type of neoplasm, lymphoproliferative disorder, or infection was achieved in 60 of 70 patients (85%). We conclude that intraoperative needle aspirations for cytologic evaluation facilitates the practice of modern general thoracic surgery.

Adult↗
PubMed1983

[Meconium aspiration syndrome. 1. Perinatal problems; etiology and types].

Obstetric literature deals with meconium stained amniotic fluid (AF) in various ways when judging it as an indicator of fetal distress. This evidently reflects the difficulty of finding overt relations between measurable alterations in the condition of the fetus or of the newborn infant and the amount of meconium passed into the AF. Nor is the moment predictable by means of fetal monitoring when meconium is passed. Discussing these problems in the light of the consecutive course of events resulting finally in meconium aspiration some of the discrepancies can be explained without difficulty. Considering also the kinetics of formation and excretion of AF the distinction of 3 variants of meconium aspiration syndrome is possible: 1. late meconium aspiration syndrome in non-asphyctic infants, 2. late meconium aspiration syndrome in asphyctic infants, 3. "connatal" meconium aspiration syndrome.

Amniotic Fluid↗
PubMed1978

Cytological survey of bronchial brushings and aspirations performed during fiberoptic bronchoscopy.

In this series of 342 cases of bronchial carcinoma diagnosed by fiberoptic cytology (brushing and aspiration), comparison with the endoscopic findings gave the following results:--As regards primary carcinomas, 91 per cent of the cases in which the tumour was visible had a positive cytology when brushing was used and 84 per cent with aspiration. 79 per cent of the cases with no visible tumour but with suspicious changes of the bronchial wall had a positive cytology with brushing and 71 per cent with aspiration. When no abnormality could be seen by fiberoptics, positive cytologies dropped to 47 per cent and 50 per cent respectively.--In case of metastatic carcinoma the results are not as good. However, brushings gave 87 per cent positivity when the tumour was visible with the fibroscope and aspiration 75 per cent. Such cases are rather unfrequent unfortunately. Suspicious lesions at the fibroscope examination yielded respectively 68 and 64 per cent positivity. While in cases with no abnormality seen with the fibroscope brushings gave a 29 per cent positivity and aspirations a 25 per cent. No false positives were made. Correlation with histology and comparison with sputum cytology will be commented upon.

Bronchoscopy↗
PubMedDate not supplied

The decisive role of fine needle aspiration cytology in the preoperative work-up of breast cancer.

During an 18-mo period, 760 palpable mammary lesions were examined and aspirated. When indicated, mammography was performed in addition. Three separate aspirations were performed in each lesion utilizing 23 gauge (0.6 mm) needles. Biopsies were performed following aspiration in 206 lesions; and 470 of the cases in whom biopsies were not performed were followed up clinically for periods of 10 to 26 mo (mean period 15 mo). Accuracy and sensitivity of the cytological examination were found to be far higher than that of clinical evaluation or mammography. Aspiration cytology resulted in only 1.5% false negative, no false positive, and only 1.65% inconclusive reports. On the other hand, clinical evaluation and mammography yielded 35 and 29% false negative, 0.3 and 0.8% false positive, and 6.75 and 8.8% inconclusive findings, respectively. Eleven malignant cases that were considered to be benign both clinically and mammographically, were correctly diagnosed cytologically. Aspiration cytology was found to be the most accurate of the preoperative diagnostic methods.

Biopsy, Needle↗
PubMed1980

Intrauterine meconium aspiration syndrome.

A case of presumptive intrauterine meconium aspiration is reported in which the diagnosis was made on the basis of an unexplained intrauterine fetal tachycardia and the presence of severely meconium-stained amniotic fluid. The possible pathophysiology of intrauterine meconium aspiration is discussed with special attention to animal experimentation. The importance of an early diagnosis of this condition is stressed. The clinical management of such cases may change once the antenatal diagnosis of intrauterine meconium aspiration can be made with more certainty. In addition, the legal implications of a confirmed diagnosis of intrauterine meconium aspiration are discussed as meconium aspiration is considered presently to represent a largely preventable neonatal event.

Adolescent↗
PubMed1995

[Trabecular aspiration. A new surgical method for improving chamber angle facility in pseudoexfoliation glaucoma].

BACKGROUND: The main reason for elevation of intraocular pressure (IOP) in glaucoma capsulare is secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The goal of this study was to evaluate the clinical results of trabecular aspiration, a new surgical concept to improve trabecular facility in glaucoma capsulare. METHODS: Trabecular aspiration was performed under the operating microscope prior to extracapsular cataract extraction (ECCE) in half of the chamber angle circumference, using a specially designed irrigation-aspiration device in 27 glaucomatous eyes. The hand-held instrument has three outlets, one for aspiration (400 microns wide and 45 degrees horizontally angulated to meet the slope of the meshwork) and two (650 microns) for irrigation to maintain a deep anterior chamber and to keep the iris away from suction. Trabecular debris and pigment was cleared with a suction force of 100-200 mmHg. RESULTS: The mean preoperative IOP (with and without glaucoma therapy) was 31.6 +/- 7.2 mmHg; At different times after operation, IOP values were: day 5, 15.1 +/- 4.2 mmHg. 1 month, 17.5 +/- 3.2 mmHg; 3 months, 17.2 +/- 2.5 mmHg; 6 months, 17.5 +/- 2.6 mmHg; 12 months, 21 +/- 4.5 mmHg. The mean antiglaucomatous medication score decreased from 3.81 medications/day preoperatively to 0.52 medications/day 12 months postoperatively. CONCLUSIONS: In a limited number of patients suffering from pseudoexfoliative glaucoma and cataract, the IOP-lowering effect of trabecular aspiration in combination with ECCE could be substantiated. Removal of inter- and pretrabecular debris prior to ECCE decreased IOP by 44% from baseline (12-month results), which indicates clinical relevance.

Aged↗
PubMed1995

Trabecular aspiration. A new mode to treat pseudoexfoliation glaucoma.

PURPOSE: The primary cause of intraocular pressure (IOP) elevation in pseudoexfoliation glaucoma is obstruction of the intertrabecular spaces by exfoliation material. The aim of the current study was to evaluate the efficacy of a novel surgical approach--trabecular aspiration--for the management of pseudoexfoliation glaucoma. METHODS: Twelve patients characterized by medically uncontrolled IOP level in pseudoexfoliation glaucoma underwent trabecular aspiration as a primary antiglaucomatous procedure. Aspiration treatment of the meshwork was performed in the inferior circumference of the chamber angle using a specially designed irrigation-aspiration device to fit the chamber angle. Trabecular debris and pigment were cleared with a suction force of 100 to 200 mm Hg. RESULTS: Before surgery, IOP ranged from 24 mm Hg to 52 mm Hg (mean, 37.4 mm Hg). Fifteen months after surgery, IOP ranged from 15 mm Hg to 23 mm Hg (mean, 18.3 mm Hg), which is equivalent to an absolute decrease of 18.7 mm Hg (50%). After surgery, the IOP of 10 eyes was less than 21 mm Hg, although 6 of these eyes still required topical medication. Two eyes attained a final IOP of 24 mm Hg. All treated eyes were aspirated once. Mean antiglaucomatous medication decreased from 4.3 medications daily before surgery to 1.39 medications daily at 15 months after surgery. CONCLUSIONS: This new surgical modality, removing intertrabecular and pretrabecular debris of the trabecular meshwork, can be effective in the management of pseudoexfoliation glaucoma. However, long-term follow-up and extended sample size must be prospected for further clinical evaluation.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology of extramedullary chronic myelogenous leukemia.

Chronic myelogenous leukemia (CML) shows extramedullary involvement in 10% of cases. We report the cytologic findings of fine needle aspiration (FNA) of recurrent CML in extramedullary sites in 11 patients with CML. The patients' ages ranged from 24 to 62 years (median, 38 years). There were seven male and four female patients. The aspiration sites were mostly lymph nodes (cervical in 7, retroperitoneal in 2, axillary in 1) and abdominal wall soft tissue (1). The numbers of blasts in the aspirates ranged from 27% to over 90%. Confirmation of the myeloid nature of the blasts was done using naphthol AS-D chloroacetate esterase in one case. Cytologic and flow cytometric immunotyping was done in eight cases. Two cases were based on cytomorphologic features only. Two of the eight immunophenotyped aspirates showed evidence of T-lymphoblastic differentiation. Another showed a mixed myeloid and T-cell phenotype. Blasts were seen in the peripheral blood and bone marrow in 4 of the 11 patients. We thus conclude that extramedullary involvement by CML in our series was associated with younger age, high incidence of cervical lymphadenopathy, increased blasts and frequent lack of bone marrow and peripheral blood involvement. T-cell phenotypes appeared to be higher in our series than reported in the literature. This suggests that there is a need for phenotyping some aspirates of recurrent extramedullary CML, mainly to evaluate the possibility of dedifferentiation and its possible impact on the behavior of the neoplasm.

Adult↗
PubMed1995

[Ultrasound guided fine-needle aspiration biopsy in the diagnosis of hepatocellular carcinoma].

This retrospective study was undertaken to evaluate the diagnostic usefulness of 244 sonographically guided fine- needle aspiration biopsy in 226 patients with ultrasonographically suspected hepatic malignant lesions. A final diagnosis of malignancy was established in 166 cases (73%) (145 hepatocellular carcinoma, 21 metastasis); benign lesions were aspirated in 60 cases (27%). The diagnostic sensitivity of this technique was 93%, with 100% specificity. When both cytology and microhistology were obtained, the positive correlation of the two techniques was 80% In the series of 244 fine-needle aspiration biopsy the authors had only one acute complication. They report one case of needle tract tumor seeding after biopsy. These results confirm the usefulness of sonographically guided fine-needle aspiration biopsy in diagnosing malignant hepatic tumors. The procedure is simple, safe, free of important side effects. The authors believe that ultrasound guided fine-needle aspiration biopsy represents the first choice of invasive technique in the assessment of hepatic focal benign lesions and malignant tumours.

Adult↗