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PubMed1999

Cytodiagnostic patterns of metaplastic breast carcinoma in aspiration samples: a study of 14 cases.

Metaplastic breast carcinomas (MBCs) are not only uncommon neoplasms but also show a myriad of cytomorphologic patterns in aspiration samples. These tumors comprise less than 5% of breast malignancies and have an uncertain prognosis. In this study, the fine-needle aspiration cytologic features of 14 MBCs with the identification of two distinct malignant cell populations are presented, based on which a definitive diagnosis was possible in 12 of the 14 cases. In the remaining 2 cases the diagnosis of MBC was substantiated after study of cell blocks from the aspirate, which were made in all the cases. Furthermore, the diagnosis of MBC was also confirmed subsequently on tissue examination. The various combinations of patterns included malignant ductal, squamous, and sarcomatous (including heterologous) elements and multinucleated osteoclastic giant cells. As a result of this study, it was felt that if malignant breast aspirates on careful examination show two or more distinct neoplastic elements, the diagnosis of MBC may be possible.

Adult↗
PubMed1999

Microcystic adenoma of the pancreas: cytologic appearance on percutaneous and endoscopic ultrasound-guided fine-needle aspiration: report of a case.

Microcystic adenoma is an uncommon neoplasm of the pancreas usually affecting older people. Its histologic features have been well characterized. The cytologic appearance of this tumor has been described only rarely, however, Microcystic adenomas may enlarge considerably and often produce symptoms related to their compression to adjacent anatomic structures. The fact that this neoplasm is almost always benign indicates the need for accurate preoperative diagnosis to differentiate it from other, more common, malignant or potentially malignant tumors of the pancreas. We present a case of pancreatic microcystic adenoma initially diagnosed by percutaneous image-guided fine-needle aspiration cytologic examination and core biopsy and further evaluated by endoscopic ultrasound-guided fine-needle aspiration on follow-up. This case report illustrates that microcystic adenoma of the pancreas can be accurately diagnosed by aspiration cytology. Fine-needle aspiration--percutaneous, guided by computerized tomography, or endoscopically guided by ultrasonography--constitutes a reliable and cost-efficient diagnostic tool associated with minimal trauma to the patient.

Adenoma↗
PubMed1976

Prostatic biopsy. A morphologic correlation of aspiration cytology with needle biopsy histology.

One hundred and eighteen aspiration biopsies of the prostate are correlated with needle biopsies. The overall accuracy of the needle biospy is 85.6% and that of the aspirates is 86.6%. The author recommends that both techniques should be used simultaneously in the diagnosis of carcinoma of the prostate. Descriptions are given of benign and malignant cell types in prostatic aspirates, with special emphasis on the features differentiating benign atypia of prostatic cells from well-differentiated adenocarcinoma, as this is potentially an important source of false-positive reports in aspiration smears.

Aged↗
PubMed1979

Fine-needle aspiration of the breast: diagnoses and pitfalls. A review of 3545 cases.

Fine-needle aspiration is now a recognized diagnostic tool. In the past eight years we have studied 3545 aspirates from the breast, including both cystic and solid masses. All were prepared according to the method of Papanicalaou. The cellular findings are described and discussed. Abnormal cells were found in the aspirates from 90% of the 368 malignancies. Reliable criteria for diagnosis are emphasized and diagnostic pitfalls discussed. Aspiration biopsy was helpful in the management of all patients with breast lesions. The method is rapid, accurate, and essentially complication-free. It should be used with the idea of complementing, not competing with, routine histologic biopsy.

Adenofibroma↗
PubMed1980

Percutaneous fine-needle aspiration biopsy. I. Its value to clinical practice.

From the experiences in dealing with 2591 cases of transthoracic and transabdominal fine-needle aspiration biopsies (1967-1978), we present our views on the value of this relatively new diagnostic method to clinical practice. Virtually any accessible localized lesion in any organ of the body can be investigated by fine-needle aspiration biopsy, which is considered most useful in patients with suspected malignant disease. Transthoracic and transabdominal fine-needle aspiration biopsy may provide information otherwise obtainable only by thoracotomy or laparotomy. It is an inexpensive and safe method with high accuracy for obtaining a pathologic diagnosis, and can impart some practical significance to clinical practice, especially in clinical management. The pitfalls in cytomorphologic interpretation, which often cause unsuccessful attempts, can be readily avoided with increased practical experience, as indicated by the increase in detection rate of lung cancer by fine-needle aspiration method from 82.8% in 1967-1968 to 93.4% in 1976 at the Toronto General Hospital. The accuracy of cytologic diagnosis plays a major role in spreading this still relatively unfamiliar but excellent diagnostic method. We believe that the method deserves widespread clinical application and when this happens, it will bring about great savings in health care resources.

Abdomen↗
PubMed1981

Guided percutaneous fine-needle aspiration biopsy of the liver.

Forty patients with suspected malignant disease of the liver underwent percutaneous fine-needle aspiration biopsy with radioisotope scintigraphic and fluoroscopic guidance. The needle was aimed at focal defects identified on the liver scan and several passes were made. When the scan was diffusely abnormal, the liver was widely sampled with multiple passes. Thirty patients were eventually considered to have malignant disease and aspiration biopsy was positive in 28 (93%) of these patients, including 25 of 26 with liver metastases (96%). There were two false-positive results and one minor complication. In 24 patients, conventional wide-bore needle biopsy was also performed. In this group, 16 patients had a final diagnosis of hepatic malignancy. Aspiration biopsies were positive in 14 of these (87%) and conventional needle biopsies were positive in four (25%). Guided percutaneous fine-needle aspiration biopsy is recommended for pathologic diagnosis of hepatic malignancy because of its simplicity, high yield, and reasonable safety.

Biopsy, Needle↗
PubMed1983

Role of aspiration cytology in the diagnosis and management of mammary lesions in office practice.

Sixteen hundred and eighty breast aspiration specimens obtained from 1410 patients seen in office practice were reviewed. The cytologic diagnosis was unsatisfactory in 230 cases, benign in 1019 cases, atypical in 198 cases, suspicious for malignancy in 102 cases, and malignant in 131 cases. All cases diagnosed as cytologically malignant had a subsequent tissue diagnosis of malignant neoplasm. Four percent of the cytologically benign cases and 17% of the cytologically atypical cases had malignant neoplasms. Clinical and cytologic examination detected more cancers (87%) than did clinical and mammographic examination (79%). Ninety-three percent of malignant neoplasms were detected by the combination of clinical, cytologic, and mammographic examination. Aspiration cytology significantly contributes to the clinical evaluation of mammary lesions in office practice, but it does not replace tissue biopsy or careful follow-up of mammary lesions of clinical concern. Proof of the presence of breast cancer by aspiration in the office may obviate the need for a two-stage procedure in the surgical management of breast cancer. Aspiration of minimally suspicious lesions often is helpful in initiating excisional biopsy in some occult, clinically unrecognized breast cancers.

Adult↗
PubMed1984

Needle aspiration of the breast.

Using a 20- or 22-gauge needle and a 20.0 ml syringe attached to a commercially available syringe pistol, the author performed 853 aspiration biopsies of palpable breast masses during the 9-year period 1974 through 1982. There were 269 diagnoses of breast cancer, 42 suspected cases of cancer, and 496 aspirates reported as benign tumor, inflammation, or another non-neoplastic diagnosis. Twenty-seven cases of carcinoma were not diagnosed from the aspiration biopsy sample. There was one false-positive diagnosis of carcinoma in a patient whose tumor was a cystosarcoma phylloides, benign variant. Forty-six aspirates were considered unsatisfactory, usually because of an insufficient cellular sample. Sensitivity for the diagnosis of breast cancer was 89.0%, while specificity for the absence of breast cancer was 97.0%. Only 13 cases in the group reported as suspicious for carcinoma were proven not to be breast cancer after excisional biopsy and histologic study. The procedure is free of complications, convenient, and cost effective. It provides for evaluation of the patient who has breast cancer on an outpatient basis as well as a full discussion of treatment options prior to intervention.

Biopsy, Needle↗
PubMed1985

Aspiration biopsy of the kidney. Simultaneous collection of cytologic and histologic specimens.

Aspiration biopsy of mass lesions of the kidney is a diagnostic procedure whose potential benefit to patients with equivocal radiologic findings, suspected metastases, palpable flank masses, nonfunctioning kidneys and even cortical cysts has not been fully explored. Over the past 7 years 163 renal aspiration specimens from 152 patients have been examined. Diagnostic yield was enhanced by use of modified "fine" needles with notched tips so that tissue fragments for histology as well as smears for cytology were obtained in 89% of solid tumors. The availability of aspirated tissue contributed significantly to pathologic classification and often spared patients additional surgery for confirmation of the cytologic diagnosis. Among the 152 cases, there were 35 with renal cell carcinomas, a sufficient number for detailed semiquantitative evaluation of their cytologic features. The remaining cases comprised metastatic carcinomas, lymphomas, transitional cell carcinomas, oncocytomas, cortical cysts, and miscellaneous conditions, e.g., abscesses, nonfunctioning kidneys, and hematomas. Overall, the aspiration biopsy determined the nature of the renal mass in 141 cases (93%). False-negative interpretations were due to insufficient diagnostic material in all but one instance. There was one false-positive result.

Adenoma↗
PubMed1985

Values of CA 19-9 in the serum, pure pancreatic juice, and aspirated pancreatic material in the diagnosis of malignant pancreatic tumor.

The diagnostic accuracy of the measurement of CA 19-9 in the serum, pure pancreatic juice, and aspirated pancreatic fluid in the diagnosis of pancreatic tumors was assessed in 32 patients with malignant pancreatic tumors and 19 patients with pancreatitis. Pure pancreatic juice was collected from the pancreatic duct by endoscopic cannulation with a duodenofiberscope after intravenous administration of secretin. Pancreatic material was obtained by percutaneous fine-needle aspiration biopsy under ultrasonic guidance. Abnormally high CA 19-9 levels in the serum were significantly more frequent in patients with malignant pancreatic tumors than in those with pancreatitis: they were elevated in 71.9% of the patients with pancreatic tumors. High CA 19-9 levels were found primarily in patients with a tumor of the head of the pancreas, in those with a tumor greater than 3 cm in its greatest diameter, and in those with an unresectable cancer. Only 57.1% of seven patients with a tumor of less than 3 cm in its greatest diameter showed an increase in CA 19-9 level. The CA 19-9 levels in pure pancreatic juice were significantly higher in patients with pancreatic tumors than in patients with pancreatitis without pancreatic stone. However, it was not useful for differentiating pancreatic tumors from pancreatitis with pancreatolithiasis. The CA 19-9 level in pancreatic materials obtained by aspiration biopsy was significantly higher in patients with malignant pancreatic tumors than in those with pancreatitis. Eight patients (80%) with pancreatic tumors had values above 1000 U/ml, whereas all five patients with pancreatitis had values of less than 30 U/ml. Although CA 19-9 levels in pancreatic materials was useful only when cytologic examination did not provide any evidence of malignancy, the combination of the CA 19-9 assay and the cytologic study of specimens obtained by percutaneous fine-needle aspiration biopsy of the pancreas increased the diagnostic rate to 100%.

Adult↗
PubMed1986

Cytologic diagnosis of bronchioloalveolar carcinoma by fine-needle aspiration biopsy.

From 1970 to June 1984, 275 patients with bronchioloalveolar carcinoma were admitted to the Toronto General Hospital. Of these, 181 (190 aspiration biopsies, including nine repeat samples) had this diagnosis made following the use of transthoracic fine-needle aspiration biopsy. Based on the cytomorphologic features observed in the aspiration preparations, the tumor was subclassified into three types: nonsecretory, secretory, and poorly differentiated. The cytologic features of these three types of bronchioloalveolar carcinoma are presented and illustrated. Cytomorphologically, the three types of this tumor are distinctly different and their features are sufficiently distinctive from those of bronchogenic adenocarcinoma and metastatic adenocarcinomas to be of diagnostic value. Transthoracic fine-needle aspiration biopsy appears to be a definitive minimally invasive means of establishing the diagnosis of bronchioloalveolar carcinoma preoperatively and especially to be of value for those small peripheral cancers which are relatively inaccessible to direct method of study and are potentially surgically curable.

Adenocarcinoma↗
PubMed1986

Values of carcinoembryonic antigen, elastase 1, and carbohydrate antigen determinant in aspirated pancreatic cystic fluid in the diagnosis of cysts of the pancreas.

The levels of carcinoembryonic antigen (CEA), elastase 1, and carbohydrate antigen determinant (CA 19-9) in the pancreatic cystic fluid and the serum from five patients with cystadenocarcinoma of the pancreas, one patient with retention cyst due to pancreatic carcinoma, three patients with cystadenoma, and eight patients with benign pseudocyst accompanying or following pancreatitis, were determined by immunoassay technique. Fluid from pancreatic cysts was obtained by ultrasonically-guided percutaneous fine-needle aspiration biopsy. The specimens were centrifuged and the supernatant was used for the measurement of CEA, elastase 1, and CA 19-9, while the cell pellet was examined cytologically. The levels of CEA in the aspirated fluid were significantly higher in patients with malignant cysts of the pancreas than in those with benign cystadenomas and pseudocysts. In contrast, the levels of elastase 1 were significantly lower in patients with malignant cysts than in those with benign pancreatic cysts. Although the levels of CA 19-9 were significantly higher in patients with malignant cysts than in those with pseudocysts, the overlap between the values of patients with malignant and benign pancreatic cysts is too great. The serum CA 19-9 was most useful, however, to distinguish an individual patient with malignant cysts of the pancreas from those with benign pancreatic cyst, since there were no significant differences between the levels of serum CEA and elastase 1 in patients with malignant and benign pancreatic cysts. Correct diagnoses were made cytologically in 4 (66.7%) of 6 patients with malignant cysts. In two patients with malignant cyst, in whom no cancer cells were detectable in the aspirated materials, levels of CEA were abnormally high, but high levels of elastase 1 did not occur. Therefore, the combined measurement of CEA and elastase 1 in the aspirated cystic fluid of the pancreas could be used as an aid in diagnosis of malignant cysts of the pancreas.

Antigens, Neoplasm↗
PubMed1988

Fine-needle aspiration biopsy of cold thyroid nodules.

This study analyzes the results of fine-needle aspiration biopsy (FNAB) of hypofunctioning thyroid nodules performed by one physician. There were 68 patients (age range, 20 to 73 years) with 83 aspirations; 30 were interpreted as positive for neoplasm (adenoma or carcinoma), 43 were negative, and ten (12%) were technically unsatisfactory. Thyroidectomy was performed on 25 patients who had positive aspirates. Subsequent morphologic study showed that 13 patients had carcinomas, ten had adenomas, and two had adenomatoid nodules (false-positive rate of FNAB for neoplasms was 8%). One of three thyroidectomy patients with negative preoperative aspirates had a carcinoma and two had adenomas (estimated minimal false-negative rate of FNAB was 9%). Nineteen patients who underwent thyroidectomies had dynamic radioisotopic thyroid angiography. There was no correlation between the pattern of vascularity and the type of neoplasm. Ultrasound (US) study was performed on 17 patients. Both adenoma and carcinoma can be solid or partially cystic. Although approximately 33% of the nodules initially diagnosed by FNAB as follicular or papillary neoplasms had different interpretations on subsequent examination of thyroidectomy specimens, 93% of the patients selected to be operated on had either adenoma or carcinoma. Thus, in this series, FNAB of cold thyroid nodules gave more useful diagnostic information than nodule size, dynamic radioisotopic scan, or US studies.

Adenoma↗
PubMed1988

Flow cytometric analysis of breast needle aspirates.

This study investigated two hypotheses: (1) sufficient cells may be obtained by needle aspiration of breast nodules to produce good flow cytometric DNA profiles; and (2) benign breast lesions do not produce aneuploid G0G1 peaks, and therefore a distinct aneuploid peak is sufficient for a diagnosis of malignancy. Breast specimens received in Surgical Pathology between December 1985 and February 1987 were aspirated, and the cells stained with propidium iodide for flow cytometric DNA analysis. A total of 344 specimens were aspirated, of which 204 (59%) were malignant and 140 (41%) benign. One hundred fifty-three malignant and 111 benign specimens contained sufficient cells for analysis. Cytologic smears were available for 177 malignant and 123 benign specimens. DNA histograms were considered diagnostic of malignancy if an aneuploid peak was present which contained at least 20% of the cells in the distribution, and had a DNA index greater than or equal to 1.2. Using these criteria, 73 of 153 (48%) carcinomas could be identified. None of the benign lesions satisfied these criteria. One fibroadenoma with atypical hyperplasia produced a distinct peak which contained less than 5% of the cells in the histogram, and had a DNA index of 1.25. Flow cytometric analysis provides objective data that complement the subjective cytologic interpretation of fine needle aspirates.

Aneuploidy↗
PubMed1989

Fine-needle core and aspiration biopsy. A new method for diagnosis of prostatic carcinoma.

Fine-needle aspiration of the prostate has failed to gain widespread acceptance among pathologists more familiar with histologic sections. The authors aspirated 27 freshly excised radical prostatectomy specimens with needles of varying caliber and type and found a 22-gauge Turner needle (Cook Incorporated, Bloomington, IN) which obtained large tissue fragments suitable for cell block preparation as well as high quality cytologic specimens. Thirty men with prostate nodules each had 14-gauge transperineal core biopsy and fine-needle aspiration. In 20 cases, cytologic smears and cell blocks and core biopsies agreed on a diagnosis: 12 benign and eight carcinoma. Of seven cases that were atypical by cytologic smears, five were benign on cell block and core; one was benign on cell block and carcinoma on core; and one was carcinoma on cell block and core. Three cases with scant specimens and diagnoses of carcinoma by cytologic smears were benign on cell blocks and cores: one contained seminal vesicle on review; one had repeat benign biopsies; and one had three microscopic foci of low-grade carcinoma in his radical prostatectomy specimen. This fine-needle aspiration technique provides histologic sections which are especially useful to those gaining experience with cytologic specimens of the prostate. Cases with discordant diagnoses on cell block and cytologic preparations warrant further evaluation.

Biopsy, Needle↗
PubMed1991

Percutaneous fine-needle aspiration cytologic study of main pancreatic duct stenosis under pancreatographic guidance.

When pancreatography shows a stenosis of the main pancreatic duct in patients with normal or inconclusive ultrasound and computed tomography, the exact nature of such stenosis is sometimes difficult to precise before surgical exploration. In such cases, the authors systematically performed a percutaneous fine-needle aspiration cytologic study of the stenosis under pancreatographic guidance. Fifteen patients were referred because of suspected pancreatic malignancy. The tumor markers, carcinoembryonic antigen (CEA) and CA 19-9 were normal in 11 patients and elevated in one patient, whereas only CA 19-9 was elevated in three others. In 14 cases, both the ultrasound and computed tomography did not show any obvious pancreatic mass. The pancreatography was done through endoscopic retrograde cholangiopancreatography (ERCP) (12 patients) or percutaneously in case of failure at ERCP3 and showed a main pancreatic duct stenosis that underwent aspiration by percutaneous fine needle precisely positioned using biplane fluoroscopy. The aspirated material was then smeared on glass slides, air-dried, and stained by Giemsa. In nine of the 15 patients, cytologic study revealed adenocarcinoma. This was confirmed by surgery in five and by progressive deterioration followed by death in four. In six patients, cytologic study gave a nonmalignant result. Chronic pancreatitis was found in five of them, confirmed at surgery in three and based on uneventful follow-up of at least 12 months in two others. In one case, a pancreatic adenocarcinoma not detected by cytologic study was found at surgery. Thus, the sensitivity and specificity of this diagnostic approach were 90% and 100%, respectively. No serious complication was noticed. The authors conclude that when ultrasound and computed tomography are inconclusive, percutaneous fine-needle aspiration cytologic study of main pancreatic duct stenosis under pancreatographic guidance is a safe, simple, and helpful procedure in the investigation of patients with suspected pancreatic malignancy.

Adenocarcinoma↗
PubMed1992

Significance of proliferative epithelial changes in breast fine-needle aspiration.

The authors analyzed 6439 fine-needle aspirations (FNA). The total number of FNA performed per year at the authors' institution was found to be increasing. The authors analyzed the numbers of carcinomas and proliferative breast alterations separately. A statistically significant increase was recorded in the group of aspirate specimens that had epithelial proliferation; the increase was greater than that seen in aspirate specimens with normal epithelium (P less than 0.001). Biopsy was recommended in 151 of 6439 (2.3%) FNA and performed for 67 of the 151 (1.0%) recommendations. Cytologic findings were compared with pathohistologic findings. A histologic carcinoma was found in 14 of 67 (20.8%) patients who had biopsy performed. The authors concluded that clinicians should give particular attention to atypia in cytologic aspirate specimens.

Biopsy, Needle↗
PubMed1993

Fine-needle aspiration of parotid masses.

BACKGROUND: There is controversy concerning the utility of fine-needle aspiration in diagnosing parotid masses. Even studies on large series of patients have compared aspiration findings with the histology in much fewer cases. METHODS: Preoperative fine-needle aspiration findings were compared with the histopathologic diagnoses from surgically resected specimens in 246 patients presenting with and treated for parotid mass from 1980-1990. RESULTS: Of 173 benign tumors, 159 (91.9%) were diagnosed correctly and 110 of 144 (> 60%) were typed. Of 36 malignant tumors, malignancy was recognized in 22 cases (61.1%). There were nine false-negatives, and in five cases, the specimen was unsatisfactory. The four cases of metastatic disease were correctly typed. Only two of seven lymphomas (28.6%) were identified. The cytologic and histologic diagnoses were concordant in all cases of nonneoplastic disease. Overall accuracy was 87%. CONCLUSIONS: Fine-needle aspiration speeds up the diagnostic process and, with close cooperation between clinician and pathologist, the technique is a valuable adjunct to preoperative assessment in patients with parotid masses.

Adolescent↗