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PubMed1995

Virchow's node revisited. Analysis with clinicopathologic correlation of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes.

OBJECTIVE: The left supraclavicular lymph node (Virchow's node) may be involved by metastatic malignancies, including those of abdominal or pelvic origin. Almost all previous studies have been based on examination of surgically sampled tissue or postmortem examination. To our knowledge, there has not been a study for nearly 40 years addressing the metastatic pattern to the left supraclavicular lymph node. Furthermore, there has been no study comparing left with right supraclavicular lymph node metastasis or the utilization of fine-needle aspiration biopsy to samples these sites. DESIGN: A retrospective review of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes was performed, and the neoplasms were grouped into six diagnostic categories from five primary regions. RESULTS: The patients ranged in age from 2 years to 94 years (average, 55 years) and consisted of 66 males and 83 females. Three patients were biopsied twice. Of the 152 fine-needle aspirations, 87 (57.2%) were of the left supraclavicular lymph node and 65 (42.8%) of the right supraclavicular lymph node. Of the 96 biopsies positive for malignancy, 58 (60.4%) were biopsies of the left and 38 (39.6%) were of the right supraclavicular lymph nodes. Sixteen of 19 pelvic tumors and all six primary abdominal malignancies metastasized to the left supraclavicular lymph node. Thorax, breast, and head and neck malignancies showed no differences in metastatic patterns to the right and left supraclavicular lymph nodes. Ten patients (10.4% of positive nodes) had a diagnosis of non-Hodgkin's lymphoma, leukemia, or Hodgkin's disease. Six patients (7.1% of positive nodes) had a metastasis of unknown primary site, and 19 cases (19.8%) had acute or chronic inflammation; seven of the latter cases demonstrated acid-fast bacilli in the aspirated smears. CONCLUSIONS: Fine-needle aspiration biopsy is an excellent initial procedure in the workup of an enlarged supraclavicular lymph node. Our study confirmed that malignancies originating in the pelvis or abdomen were significantly more likely to metastasize to the left supraclavicular lymph node and that the primary site and types of malignancies that involved the left supraclavicular lymph node were different from those involving the right supraclavicular lymph node.

Abdominal Neoplasms↗
PubMed1995

Hold that x-ray: aspirate pH and auscultation prove enteral tube placement.

We report here a prospective study evaluating an alternative to the roentgenographic confirmation of "fine-bore" nasoenteral feeding tubes. Of 78 nasoenteral intubations in 46 patients using a Dobbhoff (Biosearch Medical Products) weighted enteral feeding tube, gastric aspirates were evaluated in 28. Auscultation was performed in all 78. Data was collected at initial placement prior to x-ray confirmation. Observers used color-coded pH paper to analyze gastric aspirate (pH < or = 4) and/or auscultation of the epigastrium to determine feeding tube position prior to x-rays. Auscultation alone was ineffective as a confirmatory test with only 6.3% specificity (p = 0.31). Aspiration to ascertain tube position was very accurate when pH < or = 4.0 (p = 0.0005) and when it was performed. A pH value of > 4 was not very helpful in predicting malposition (37%) especially when pH altering medications were used. Aspiration of contents was successful in 85% of patients. We conclude that when the pH of the nasogastric tube aspirate is < 4.0, x-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is indicated since auscultation is inaccurate.

Adult↗
PubMed1995

Preventing severe ovarian hyperstimulation syndrome in an in vitro fertilization/embryo transfer program. Use of follicular aspiration after human chorionic gonadotropin administration.

In 3,972 human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG)-stimulated menstrual cycles, severe ovarian hyperstimulation syndrome (SOHSS) developed in 10 patients (0.25%), while in 627 hMG-, hCG- and gonadotropin releasing hormone analog (GnRH-a)-stimulated cycles, 6 patients (0.95%) developed SOHSS. In cases of threatening SOHSS in the follicular phase (excessive estradiol values, multiple follicles), a preventive method was applied: follicular aspiration 12 hours after hCG administration and regular oocyte retrieval 36 hours after hCG (17 patients). The method of post-hCG aspiration in one ovary was effective, leading to the withdrawal of all signs of SOHSS within six days after the second aspiration. In hMG-stimulated, pretreated patients there were four deliveries of seven healthy infants (two singleton, one twin and one triplet), while one pregnancy in seven GnRH-a-stimulated and pretreated patients ended in a spontaneous abortion. Post-hCG aspiration is a quick, simple and effective method that prevents the development of SOHSS and permits pregnancy in the treated cycle. Although the pregnancy rate in patients who developed SOHSS was higher (100% per embryo transfer), one should also consider the high spontaneous abortion rate (33.3% for the hMG- and 50% for the GnRH-a/hMG-treated groups) and the fact that SOHSS is a life-threatening condition, demanding expensive, intensive care. According to our experience, post-hCG follicular aspiration is the treatment of choice in patients with signs of SOHSS.

Chorionic Gonadotropin↗
PubMedDate not supplied

Effect of suppressive therapy on thyroid fine needle aspiration cytology.

The effect of suppressive therapy on the cytology of thyroid nodules and its usefulness in classifying lesions with indeterminate fine needle aspiration (FNA) results were evaluated. The study group consisted of 19 thyroid nodules (6 adenomatoid nodules and 13 neoplasms) aspirated before and while the patients were on suppressive therapy. The control group consisted of nine nonsuppressed nodules (four adenomatoid nodules and five neoplasms) aspirated twice. Both aspirates of each nodule were compared for differences in cytologic features. Differences between aspirates were detected in three suppressed and one nonsuppressed adenomatoid nodule. Suppression revealed no effect on the cytology of thyroid neoplasms and on 50% of adenomatoid nodules. Repeat FNAs allowed correct classification of 3/14 suppressed and 2/2 nonsuppressed nodules with indeterminate diagnoses on initial FNA. Our results indicate that lack of a cytologic response to suppressive therapy does not confirm a neoplastic diagnosis since it can be observed in both neoplastic and nonneoplastic nodules. However, repeat FNA, with or without suppressive therapy, may help to establish the correct diagnosis in difficult cases.

Adenocarcinoma, Follicular↗
PubMed1995

Transvaginal ultrasound-guided aspiration and surgical starch sclerosis therapy in recurrent pelvic inclusion cysts--report of two cases.

Pelvic inclusion cyst is one of the complications of major abdominal surgery. Treatment of the symptomatic mass is either surgical or needle aspiration. However, recurrence of the condition is still not uncommon. Repeated surgery or aspiration could result in serious morbidity. We report two cases of recurrent pelvic inclusion cyst which were successfully treated with transvaginal aspiration and sclerosing therapy with starch powder from surgical gloves and normal saline solution. The aspirations were guided by transvaginal ultrasound and on local paracervical anesthesia. Starch and normal saline solution were injected through the aspiration needle for irrigation three times. One patient with a large cyst needed two treatment courses, the other only one. Both patients had no discomfort both intra- and postoperatively. A Follow-up ultrasonography proved no recurrence to date.

Adult↗
PubMedDate not supplied

[Lymph node biopsy using fine-needle aspiration. Clinical and cytohistological correlation in 179 cases].

We reviewed the institutional experience with fine needle aspiration biopsy (FNAB) of peripheral lymph nodes in the Instituto Nacional de la Nutrición Salvador Zubiran from January 1988 to December 1992. A total of 298 FNAB had been performed in 288 patients. Aspirates with just blood, few stromal cells or with desiccation changes were excluded (63 cases), as well as those in whom it was not possible to establish a clinical or morphologic correlation (56 cases). In the 179 cases included, the FNAB diagnosis was histologically confirmed in 137 and in 42 cases the correlation was established by clinical follow-up and response to treatment. According to the diagnosis, aspirates were divided in benign and malignant in the analysis. We observed 70 aspirates (39%) with benign lesions and 109 (61%) with primary or metastatic neoplastic cells. The most frequent benign diagnosis was hyperplasia followed by epithelial metastatic neoplasms. In 25 aspirates there was a discrepant cyto-histologic diagnosis but only six were false negatives. No false positive or complications were identified. The FNAB in our cases showed: sensitivity 95%, specificity 100%, positive predictive value 100% and negative predictive value 91.4%. Our data support the value of FNAB as a reliable, safe, inexpensive and easy to perform method in the diagnosis of lymph node enlargements. Thus, we believe this method should be recommended as the initial approach in the study of lymphadenopathies.

Biopsy, Needle↗
PubMed1994

Transrectal fine needle aspiration cytology of granulomatous prostatitis.

Transrectal fine needle aspiration cytology by Franzen technique was carried out from January, 1985 till January, 1992 on 567 patients having prostatomegaly which were suspicious of malignancy by clinical per rectal examination. Granulomatous prostatitis was diagnosed in 56 cases. Analysis showed 34 cases were tuberculous prostatitis and 22 cases were nonspecific granulomatous prostatitis. Comparison of aspiration cytology with bacteriological study of the aspirated material and histopathology showed correct diagnosis of granulomatous prostatitis by fine needle aspiration. The findings indicate that transrectal fine needle aspiration cytology is a reliable procedure for diagnosis of granulomatous prostatitis which can clinically mimic prostatic malignancy when it presents as a diffuse or nodular enlargement with firm to hard consistency.

Adult↗
PubMedDate not supplied

[Diagnostic limitations of the isolation of trophozoites of Giardia lamblia in duodenal aspirates].

Examination of fecal specimens for detection of Giardia lamblia cysts is known to produce a high percentage of false negative results while it is generally believed that duodenal juice often contains trophozoites even when the stool examination is negative. The aim of this study was to compare the detection of trophozoites in duodenal aspirate with the findings of cysts in stool samples for the diagnosis of asymptomatic giardiasis. Forty five children with iron deficiency anemia (one to six years of age) were studied, 21 with giardiasis and 24 without giardiasis. For each subject, one to five stool samples were examined for cysts of Giardia lamblia employing the formol-ether concentration method. Duodenal juice from all children were examined for the presence of trophozoites of Giardia lamblia. Fecal excretion of cysts was demonstrated in 20 (95%) of the 21 patients with giardiasis; however, only nine (43%) exhibited the presence of trophozoites in their duodenal aspirates. In one child trophozoites were observed in the duodenal aspirate; but the parasitologic investigation was negative for cysts in the feces. All the children without giardiasis had at least three stool samples and duodenal aspirate negative for Giardia lamblia. In conclusion, fecal examination by formol ether concentration method exhibited a greater number of positive results than did the duodenal aspirate microscopy method in the diagnosis of giardiasis.

Animals↗
PubMed1994

Indeterminate fine-needle aspiration biopsy of the thyroid: identification of subgroups at high risk for invasive carcinoma.

BACKGROUND: We examined the various cytologic features of indeterminate thyroid fine-needle aspirates along with known clinical and radiologic risk factors to determine whether any parameters were predictive of malignancy. METHODS: Indeterminate fine-needle aspirates were prospectively categorized into four subgroups: (1) suspicious for papillary carcinoma, (2) follicular neoplasm, (3) Hürthle cell neoplasm, and (4) hypercellular follicular aspirates with colloid. Several clinical risk factors were examined, and subgroup comparisons were performed with Fisher's exact test. RESULTS: Of 571 fine-needle aspirate cytologic findings 104 were interpreted as indeterminate for malignancy, and 81 patients underwent thyroidectomy. Invasive cancer was diagnosed in 9 of 10 lesions cytologically suspicious for papillary carcinoma, 8 of 43 follicular neoplasms, 5 of 18 Hürthle cell neoplasms, and 0 of 10 hypercellular aspirates. Cytologic subgroup (p < 0.0001) and age of 50 years or older (p = 0.008) were the only significant predictors of malignancy. When used together, age of 50 years or older and a cytologic diagnosis of follicular or Hürthle cell neoplasm also identified a subgroup of patients at high risk (9 of 20) of invasive malignancy (p = 0.01). CONCLUSIONS: The majority of invasive cancers (18 of 22, 82%) were found in patients whose lesions were suspicious for papillary carcinoma or in patients 50 years or older with follicular or Hürthle cell neoplasms. The risk of carcinoma in these combined subgroups (18 of 30, 60%) warrants early surgical intervention.

Adult↗
PubMed1994

Fluorescent in situ hybridization in routinely processed bone marrow aspirate clot and core biopsy sections.

Fluorescent in situ hybridization (FISH) is a technique which complements conventional cytogenetic banding analysis by allowing the evaluation of cells in interphase as well as metaphase. This technique has been used to study air-dried peripheral blood and bone marrow aspirate smears. We have applied the FISH technique to study routinely processed sections of bone marrow aspirate clot and decalcified core biopsy specimens, fixed in either formalin or B5 and embedded in paraffin. We evaluated 28 specimens (8 aspirate clot and 20 core biopsy sections) for chromosome 8 copy number, studied previously by conventional cytogenetics, and found the following distribution: 15 with disomy, 11 with trisomy, and 2 with tetrasomy. Using a chromosome 8 alpha-satellite probe, we detected fluorescent hybridization signals in 18 of 28 specimens (64%); 6 of 8 (75%) aspirate clot sections, and 12 of 20 (60%) core biopsy sections. Ten of 13 (77%) B5-fixed and 8 of 15 (53%) formalin-fixed specimens had hybridizing signals. Specimen age was a significant factor; 10 of 11 (91%) specimens processed within the last 6 months showed signals, in contrast with 8 of 17 (47%) specimens older than 6 months. In the positive specimens, 200 cells were analyzed in areas where individual cells could be identified. In the disomic specimens, two signals per cell were seen in 34 to 66% of the cells. Rare cells (0-2%) with three signals were detected. In the trisomic specimens, three signals per cell were seen in 19 to 46% of the cells. In the tetrasomic specimens, four signals per cell were seen in 15 to 25% of the cells. We conclude that the FISH technique may be useful in the detection of numerical chromosomal abnormalities such as trisomy and tetrasomy 8 in routinely processed bone marrow aspirate clot and decalcified core biopsy sections.

Biopsy, Needle↗
PubMedDate not supplied

Association of abnormal nipple aspirate cytology and mammographic pattern and density.

The pattern and density of mammograms have been shown to be associated with proliferative histopathology and an increased risk of breast cancer. We recently found that epithelial atypia in nipple aspirate fluid obtained 10-18 years earlier was associated with an increased risk of breast cancer. In the present study we examined the association between the cytology of nipple aspirate fluid and mammographic patterns in 588 volunteers recruited from the mammography clinic at the University of California. Nipple aspirate fluid cytology was classified according to the most severe epithelial change present and mammograms were classified by the Wolfe method and the percentage area of density. A direct relationship was found between mammographic density and cytological abnormality. When controlled for age, body mass index, previous biopsy, and calcification, the odds ratios of high density mammograms (over 50%) with nipple aspirate fluid cytological atypia was 4.4 (95% confidence interval, 0.9-21.5; P = 0.08) when normal cytology was the referent. These preliminary findings indicate that highly dense mammograms are associated with cytological atypia and are consistent with studies reporting an association of histological hyperplasia and atypical hyperplasia with severe mammographic findings. If confirmed by further studies, nipple aspirate cytology may be a useful adjunct to mammographic patterns in the prediction of breast cancer risk, especially among premenopausal women.

Adult↗
PubMed1993

Correlation of histologic grade of breast carcinoma with cytologic features on fine-needle aspiration of the breast.

Histologic grade is an important prognostic factor for breast carcinoma. To determine whether histologic grade could be reproduced on fine-needle aspiration of the breast, we analyzed 50 cases of histologically proven infiltrating ductal carcinomas that had a preoperative fine-needle aspiration. The histologic grade was based on tubule formation, nuclear pleomorphism, and mitotic frequency [a modified Bloom-Richardson (BR) grading system]. Fine-needle aspirations were analyzed for cellularity, cellular arrangements, percentage of single cells, nuclear pleomorphism, mitoses, hyperchromasia, chromatin pattern, nucleoli, and background. The cases in BR Grades 1 and 2 (n = 28) were combined into one category for comparison with those in BR 3 (n = 22). BR 3 was more likely than BR 1 and 2 to be associated with marked nuclear pleomorphism (59 versus 18%, P < 0.05) and vesicular or coarse chromatin (77 versus 43%, P < 0.05). Of the 18 cases that showed both marked nuclear pleomorphism and either coarsely granular or vesicular chromatin on fine-needle aspiration, 13 (72%) were BR Grade 3 on histology. These 13 cases represent 59% of the 22 cases of BR Grade 3 on histology. Aspiration cytology is of some, but limited, use in predicting BR grade. As expected, nuclear features are most easily translated from histology to cytology.

Biopsy, Needle↗
PubMed1994

Fine needle tissue aspiration biopsy of the testis.

OBJECTIVE: To develop a fine needle tissue aspiration biopsy technique that provides sufficient tissue for accurate histological assessment and research purposes. DESIGN: After assessing different needles and developing a method for handling small amounts of tissue, 87 patients underwent fine needle tissue aspiration biopsy. The quantity, quality, and appearance of the tissue was examined and adverse effects of the procedure were noted. Fine needle tissue aspiration and open biopsy samples were compared in 26 patients. Suitability of the tissue for flow cytometry and electron microscopy was also assessed. RESULTS: The 20-gauge, 5-cm Menghini and Turner biopsy needles penetrated the testis more readily and recovered larger quantities of tissue. Adequate samples were recovered from 83% of cases (average of 21.8 tubule sections per testis) with the frequency of recovery and the amount of tissue obtained increasing through-out the study. Some distortions of the tissue were seen but these rarely interfered with the diagnosis. Although many patients suffered slight discomfort during the injection of the anesthetic, no serious complications were encountered during or after the procedure. Comparison of fine needle tissue aspiration and open biopsy diagnoses found either full agreement (56%) or slight differences (38%) in the degree of hypospermatogenesis. CONCLUSIONS: Fine needle tissue aspiration biopsy was found to be a quick, easy, repeatable, and reproducible method of obtaining testicular tissue. No serious adverse effects of the procedure were detected and the diagnoses were found to be comparable to those obtained by open biopsy.

Adult↗
PubMed1993

[Pregnancy via spermatozoa aspirated from the ductus deferens and fertilization in vitro].

The possibility of aspirating sperm from the first segments of the seminal tract by microsurgical techniques has permitted in vitro fertilization of the oocytes of the partners of men with obstructive azoospermia and ejaculation disorders. Sperm can be aspirated from the epididymis by microsurgical techniques in those cases with deferent duct agenesis or other obstructive pathologies, or from the deferent duct if spermatogenesis is unimpaired and there is no epididymal obstruction, but spermatozoa do not reach the ejaculate. We previously reported a pregnancy achieved by in vitro fertilization using sperm aspirated from the epididymis and the present article reports the first pregnancy achieved in our country using sperm aspirated from the deferent duct of the spouse with aspermia of psychogenic origin. A micropipette was utilized to obtain the sample, which was prepared using the mini-Percoll method. A total of 10 million motile spermatozoa were obtained and 6 of the 15 oocytes aspirated from the spouse were fertilized. The 3 embryos transferred to the fallopian tube resulted in a twin pregnancy that was carried to term.

Adult↗
PubMed1993

[Aspiration of ganglia in the wrist].

Because of recently published good results we wished to evaluate the therapeutic effect among our own patients of simple aspiration of ganglia near the wrist. We entered 24 consecutive patients referred for operation of wrist ganglia into the study and administered a regimen of up to three aspirations at intervals of four to six weeks. There were five deviants from the protocol. Among the remaining 19 patients the ganglion had disappeared in 13 by the end of the aspiration regimen. However, one year after the first aspiration there had been seven recurrences. Only eight of the original 24 patients underwent surgery. The remainder felt that this was no longer necessary. In our material simple aspiration had little therapeutic effect, but markedly reduced the number of patients operated on for ganglia of the wrist.

Adolescent↗
PubMed1993

Morphometric analysis of neoplastic renal aspirates and benign renal tissue.

This study was designed to develop a practical morphometric procedure for the diagnosis of carcinoma in renal aspirates. We studied aspirates from renal cell carcinomas (grades 1-2) and normal kidneys. Video images of nuclei were traced on a high-resolution, touch-sensitive screen connected to an image analysis system. From each tracing the computer calculated nuclear perimeter length, nuclear profile area, maximal chord length, and the means and standard deviation for all measurements. Size distribution of nuclear profile areas and perimeter length in discrete bins ranged, respectively, from 30 to 80 at 10 microns2 intervals for areas and from 1 to 12 microns at 1-micron intervals for the maximum chords. The size distribution plots for the maximal chord of individual nuclei demonstrated an early narrow peak at low values for normal renal aspirates (peak located in the class ranging from 7 to 8 microns), while a broader, flatter peak with a shift to the right and a malignant tail was seen in renal cell carcinoma aspirates (peak located at 9-10 microns). These data were used for multivariate analysis to form two categories to establish a data base against which unknown cases could be tested. Multivariate analysis using a total of 14 variables yielded a value of 169.1 for the euclidean distances between the center of clusters of the neoplastic and normal renal aspirates and confirmed the classification with posterior probabilities of 1.0. From these data, automated classificatory analysis of 10 unknown cases was performed by means of the k-nearest neighbor procedure, with correct classification established in each case.

Biopsy, Needle↗
PubMed1996

[Ultrasound-guided aspiration of pleural fluid].

We review the outcome of guided, percutaneous, catheter drainage of pleural collections in 102 patients over a 2-year period. In 87% diagnostic aspiration of small or loculated collections was performed. Drainage of malignant and nonmalignant effusions in high-risk patients, or after failure of drainage without imaging guidance, was performed in 13%. All aspirations were successful and the only complication was a small pneumothorax in a single patient. If the collection was a small pneumothorax in a single patient. If the collections were large and easy to aspirate, we marked the best location for aspiration on the skin and sent the patient back to the ward for aspiration. We conclude that the use of sonography increases the proportion of successful drainage of small pleural collections and results in few complications.

Catheterization↗
PubMed1996

Successful intracytoplasmic sperm injection without performing cytoplasmic aspiration.

OBJECTIVE: To compare the effect of cytoplasmic aspiration versus no aspiration before intracytoplasmic sperm injection (ICSI) on the rate of oocyte damage, fertilization rate, and embryo quality. DESIGN: A randomized prospective study on sibling oocytes. SETTING: The Egyptian IVF-ET Center, Cairo, Egypt. PARTICIPANTS: Fifty-eight patients who were infertile due to male factor who underwent 60 ICSI cycles. INTERVENTION: Intracytoplasmic sperm injection was performed on randomly allocated metaphase II oocytes with cytoplasmic aspiration in group I and without cytoplasmic aspiration in group II before sperm injection. MAIN OUTCOME MEASURE: Fertilization rate, oocyte damage rate, and embryo quality. RESULTS: Normal fertilization rate per injected oocyte was 61.4% in group I compared with 62.5% in group II. The damage rate per injected oocyte was 16.8% in group I compared with 4.6% in group II. Grade I embryos were 24.5% in group I compared with 48.5% in group II. CONCLUSION: Cytoplasmic aspiration before sperm injection in ICSI is not essential for oocyte activation. It did not improve the rate of normal fertilization. On the other hand, it increased the damaged oocyte rate and the rate of cytoplasmic fragments.

Adult↗