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PubMed2004

A pathologist's perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination.

The bone marrow aspirate and biopsy is an important medical procedure for the diagnosis of hematologic malignancies and other diseases, and for the follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of medical therapy. During the procedure, liquid bone marrow is aspirated from the posterior iliac crest or sternum with a special needle, smeared on glass microscope slides by one of several techniques, and stained by the Wright-Giemsa or other techniques for micro-scopic examination. The bone marrow core biopsy is obtained from the posterior iliac crest with a Jamshidi or similar needle and processed in the same manner as other surgical specimens. Flow cytometric examination, cytochemical stains, cytogenetic and molecular analysis, and other diagnostic procedures can be performed on bone marrow aspirate material, while sections prepared from the bone marrow biopsy can be stained by the immunoperoxidase or other techniques. The bone marrow procedure can be performed with a minimum of discomfort to the patient if adequate local anesthesia is utilized. Pain, bleeding, and infection are rare complications of the bone marrow procedure performed at the posterior iliac crest, while death from cardiac tamponade has rarely occurred from the sternal bone marrow aspiration. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimens obtained.

Adult↗

PubMedDate not supplied

Ultrasound-guided testicular sperm aspiration in azoospermic patients: a new sperm retrieval method for intracytoplasmic sperm injection.

PURPOSE: We investigated the technique of ultrasound-guided testicular sperm aspiration (USTSA) and compared it with "blind" testicular sperm aspiration (TSA) in patients with nonobstructive azoospermia. METHODS: Thirty-nine consecutive azoospermic men underwent TSA, 16 under sonographic guidance (USTSA group) and 23 with no imaging guidance (TSA group). Clinical and hormonal evaluation and sonography of the scrotum and testes were performed 1-2 days before the procedure. The aspiration was done using short-term general anesthesia. Follow-up consisted of sonographic reexamination of the scrotum and testes immediately and 1 month after the procedure. RESULTS: Intraoperative sonography with power Doppler imaging enabled good visualization of the testicular parenchyma, easy sampling, and avoidance of prominent vessels. Sufficient material was retrieved in 15 USTSA patients (94%) and 19 TSA patients (83%). No patients needed more than 4 hours' ambulatory hospitalization after the procedure. In the remaining 5 patients, aspiration failed to yield sperm, so open biopsy was performed. In those patients, postaspiration surgical exploration revealed subtunical bleeding in 3 patients after TSA but none after USTSA. Late minor complications occurred in 2 patients (13%) in the USTSA group and 7 (30%) in the TSA group. No difference was found between the 2 groups in pregnancy rate in the patients' female partners. CONCLUSIONS: USTSA is a safe and accurate method for sperm retrieval in azoospermic patients.

Adult↗

PubMed1981

Ultrasound gray-scale pattern and guided aspiration puncture of abdominal abscesses.

Various ultrasound gray-scale patterns of 45 consecutive abscesses were studied in 43 surgical and medical patients. Eleven abscess formations were unsuspected clinically, 27 had developed as a postoperative complication; 25 collections (55.6%) presented with an anechoic appearance, and 15 (33.3%) showed a mainly fluid pattern but contained a few nonreverberatory echoes. Five abscesses (11.1%) appeared with a complex solid-like pattern with large amounts of internal echoes. A total of 28 ultrasound guided diagnostic fine-needle aspirations of abscesses were performed on 26 patients without serious complications. All the aspirated samples yielded material sufficient for cytological or bacteriological examinations. Percutaneous fine-needle aspiration guided by sonography is recommended as a safe and useful diagnostic measure to confirm the nature of an ultrasonically displayed abdominal lesion suspected to be an abscess. Results from both sonography and confirmatory aspiration provide detailed topographic and diagnostic information for the choice of surgical or nonoperative management of abdominal abscess.

Abdomen↗

PubMedDate not supplied

Value of parathyroid hormone assay for preoperative sonographically guided parathyroid aspirates for minimally invasive parathyroidectomy.

PURPOSE: The key to successful parathyroid surgery is accurate preoperative tumor localization. This study investigates the use of ultrasound (US)-guided parathyroid fine needle aspiration (FNA) as a confirmatory diagnostic method in patients with hyperparathyroidism undergoing minimally invasive parathyroidectomy. METHODS: Patients were selected for minimally invasive parathyroidectomy based on the finding of a single parathyroid adenoma identified with US and/or sestamibi scans and confirmation of the suspected parathyroid lesion via FNA and parathyroid hormone (PTH) assay. The value of aspirate obtained from the thyroid gland intraoperatively served as the negative control. RESULTS: A total of 56 tissue FNAs were performed in 27 patients. US detected masses suggestive of parathyroid lesion in all 27 patients, and 31 US-guided FNAs were performed. No complications related to the procedure were noted. Intraoperatively, FNA was performed in the thyroids of 25 patients undergoing minimally invasive parathyroidectomy. Aspirates from lesions subsequently confirmed as having developed from the parathyroid gland had a mean PTH level of 4,677 +/- 123 pg/ml (range, 3,600-5,000 pg/ml), which was significantly higher than thyroid aspirates, which yielded a mean PTH level of 48 +/- 7 pg/ml (range, 5-57 pg/ml). The sensitivity of US and sestamibi scans in the detection of abnormal parathyroid glands was 88% and 77%, respectively. The sensitivity of US-guided FNA in confirming the parathyroid origin of a lesion was 100%. CONCLUSION: US-guided FNA for PTH assay can be performed safely for the confirmation of lesions identified with preoperative US for the selection of patients eligible for minimally invasive parathyroidectomy.

Adenoma↗

PubMed2002

Aspiration: a factor in rapidly deteriorating bronchiolitis in previously healthy infants?

The objective of this study was to evaluate the presence of indicators of aspiration in previously healthy infants with respiratory syncytial viral (RSV) bronchiolitis who experienced rapid deterioration in their respiratory status. Lipid-laden macrophage index (LLMI) was assessed in 6 previously healthy infants with RSV bronchiolitis and no prior history of aspiration, who had a rapid deterioration of their respiratory status requiring mechanical ventilation. Five of 6 infants had a LLMI of more than 100, a level that is very suggestive of aspiration. We conclude that aspiration is likely to play a role when rapid deterioration occurs in infants with RSV bronchiolitis.

Biomarkers↗

PubMedDate not supplied

The value and safety of percutaneous lung aspiration for children with serious pulmonary infections.

It is often difficult to establish the etiology of pulmonary infections in children. The diagnostic value and safety of percutaneous needle aspiration of the lung were investigated in 98 children who were suspected of having a bacterial pulmonary infection and who were seriously ill or had failed to respond to apparently adequate empiric antimicrobial therapy. The etiology of the pulmonary infection was established in 60 patients (61%); in the remaining 38 cases (39%) no bacterial microorganisms were recovered from the lung aspirate. Twenty-four (40%) patients in whom the pathogen(s) were identified were already receiving empiric antimicrobial therapy, and in 18 (66%) the original therapeutic regimen had to be changed to optimally treat the isolated microorganism(s). A total of 11 complications occurred in 10 children (10%): 9 pneumothoraces and two instances of mild, self-limited hemoptysis. Six of the pneumothoraces (66%) required treatment by either a thoracostomy and chest-tube or simple percutaneous aspiration. There were no deaths related to the procedures. It was concluded that percutaneous needle aspiration of the lung in children is a potentially useful and reasonably safe technique for the diagnosis of pulmonary infection in carefully selected cases when an exact etiologic diagnosis is needed.

Bacterial Infections↗

PubMed1981

Transrectal fine-needle aspiration biopsy for cytologic diagnosis and grading of prostatic carcinoma.

In this article, the Karolinska experience of transrectal fine-needle aspiration biopsy of prostatic carcinoma, which now extends over more than twenty years, is evaluated. The cytologic criteria for diagnosing prostatic carcinoma in aspirates are well defined. While accuracy for cytodiagnosis is similar to that of histopathologic diagnosis, fine-needle aspiration is a less traumatic, cheaper procedure compared with histologic biopsy methods. Accuracy depends very much upon the skill of the examiner taking the cell samples and on the alertness of the cytopathologist for possible diagnostic pitfalls. Cytologic grading of prostatic carcinoma into well, moderately, and poorly differentiated types has been shown to be correlated significantly not only to histopathologic grading, but also to clinical stage, response to hormonal therapy and survival. The degree of tumor differentiation is well reproduced by independent observers. Cytochemical parameters, such as DNA measurement, constitute a potential refinement of cytologic grading, especially in moderately differentiated carcinomas. In medical centers with long experience of fine-needle aspiration biopsy, the method has a central role in diagnosis and management of prostatic carcinoma, including posttherapy follow-up.

Adenocarcinoma↗

PubMed2000

Lymphoscintigraphy and ultrasound-guided fine needle aspiration cytology of sentinel lymph nodes in head and neck cancer patients.

Accurate staging of the regional lymph nodes is crucial for the appropriate management of patients with squamous cell carcinoma of the head and neck (HNSCC). However, the current diagnostic modalities have low accuracy for N0 neck, and even the most optimal procedure, ultrasound-guided fine needle aspiration cytology (USgFNAC), still has a sensitivity of only 42%-73%. In this study we evaluated whether the identification of the sentinel node might improve the selection of lymph nodes for USgFNAC. Twelve HNSCC patients received 3-4 peritumoral injections of 10-30 MBq 99mTc-labeled colloidal albumin, and the sentinel node was identified by dynamic scintigraphy and marked on the skin using a handheld probe, and/or by scintillation counting of the aspirates. After sentinel node identification USgFNAC was performed. Correct aspiration of the identified sentinel node(s) was confirmed by scintillation counting. In 11 out of 12 cases the sentinel node(s) could be visualized by dynamic planar imaging. In one case the sentinel node(s) were identified by scintillation counting only. In a number of patients different or supplementary lymph nodes were aspirated on the basis of sentinel node identification. These initial data strongly suggest that sentinel node identification might improve the staging of the neck by USgFNAC.

Biopsy, Needle↗

PubMed1994

Stereotactic techniques for colloid cysts: roles of aspiration, endoscopy, and microsurgery.

Stereotactic surgical techniques were used to manage 25 consecutive patients with colloid cysts of the third ventricle. All patients had stereotactic aspiration as the initial procedure; it was successful in 13 (52%). In patients in whom aspiration failed, endoscopic visualization of the cyst and attempted removal, or microsurgical cyst resection via a transcortical approach was performed. Three elderly patients did not have a second procedure and were shunted. The computed tomographic appearance of a hypodense or isodense cyst indicates low-viscosity contents and predicts successful stereotactic aspiration. Stereotactic microsurgery is used in hyperdense cysts, or in those which cannot be aspirated.

Adult↗

PubMed1986

Tracheobronchial foreign body aspiration in childhood. A report on 224 cases.

In 224 patients aged 7 months to 14 years aspirated foreign bodies (FB) were extracted from the tracheobronchial system. Eighty-one percent of the children were younger than 3 years, 50% were in the second year of life. There were twice as many boys as girls. Sixty-seven percent of the FB were nuts, of these more than half were peanuts. Fifty-six percent of aspirated FB were localized in the right bronchial system, 39% in the left and 5% subglottic or tracheal. All FB could be removed by endoscopy under general anaesthesia with muscle relaxation. The development of an extraction technique without forceps ("encasing") led to an easier way of removing crumbling FB, like nuts. Complications were rare, no postoperative tracheotomy was necessary, no cardiac arrest and no death occurred. The interval between aspiration and intervention was longer than 3 weeks in one-third of the cases; in some cases it was months or years with the consequence of chronic damage of the bronchial system or the lung. The possibilities of prevention appear to be limited; thus it is necessary to diminish the frequency of prolonged lodging of FB in the respiratory tract by considering aspiration early in the differential diagnosis of airway symptoms.

Adolescent↗

PubMed1994

Fine-needle aspiration technique for the concurrent immunocytochemical evaluation of multiple biologic parameters in primary breast carcinoma.

Fine-needle aspiration cytology has been already established as a reliable method for the diagnosis of breast cancer. Its application has been recently extended to immunocytochemical analysis of biological parameters. In the current study estrogen and progesterone receptors, Ki67 growth fraction, and p53 protein expression were immunocytochemically evaluated on the cellular material sampled by the same fine-needle aspirate used for the conventional cytologic diagnosis of malignancy. Fine-needle aspiration specimens from 100 patients with primary breast carcinoma were submitted to the immunocytochemical analysis. Twenty-eight percent were in premenopause; 23% had tumors with a diameter less than 2 cm, 59% from 2 to 5 cm, and 18% more than 5 cm; 60% had axillary nodal status negative, 34% positive, and 6% unknown. The concomitant immunocytochemical evaluation of all parameters was possible in 70% of the patients. A significant association was found between p53 overexpression and Ki67 values (p = 0.004), and between Ki67 values and progesterone receptor status (p = 0.003). No correlation was found between any parameter and clinical tumor size. Estrogen (p = 0.02) and progesterone (p = 0.04) receptor negativity and high Ki67 growth fraction (p = 0.005) were significantly associated with the clinical evidence of axillary node involvement. This study suggests that fine-needle aspiration cytology represents an effective practice for a simultaneous evaluation of multiple biologic indicators and could be useful as a preoperative procedure in patients who are candidates for neoadjuvant chemotherapy and/or endocrine therapy.

Adult↗

PubMed1995

Renal transplant fine needle aspiration and cytokine gene expression.

Fine needle aspiration of renal transplants is a safe effective means of obtaining intragraft material for diagnostic evaluation of transplant dysfunction in the first 3-6 months post engraftment. Aspiration can be performed daily as an outpatient to assess causes of renal insufficiency and response to therapeutic intervention. Aspiration also provides a unique tool for the investigation of pathogenetic mechanisms in acute rejection; samples can be subjected to reverse transcriptase-polymerase chain reaction with quantitation of cytokine gene expression. We have utilized this technique to demonstrate the strong, likely causal, relationship between gamma-interferon and acute rejection. The ability to perform aspirates frequently affords an opportunity to map the cytokine cascade prior to and during episodes of acute rejection. This may identify new areas for therapeutic intervention during the process of rejection.

Biopsy, Needle↗

PubMed1988

Ovarian cyst aspiration during in vitro fertilization/embryo transfer (IVF/ET) cycles.

Fifteen patients treated in an IVF program with ovarian cysts were retrospectively evaluated. Ten women with ovarian cysts formed during induction of ovulation were treated by puncture and aspiration and compared to a control group of five patients in whom the ovarian cysts could not be punctured. Induction protocols in both groups were based on hMG/hCG or pFSH/hCG administration. In patients in the study group the mean volume aspirated from cysts was 7.4 +/- 2.1 ml. Mean estrogene (E2) levels on the day of hCG were 1411 +/- 213 and 1036 +/- 177 pg/ml in the hMG and pFSH groups, respectively. Mean progesterone (p) levels were 1.6 +/- 0.4 and 1.9 +/- 0.3 ng/ml, respectively. Oocyte collection was done with the aid of a vaginal ultrasound transducer. A mean of 6.2 and 5 oocytes was picked up respectively, with a fertilization rate of 74.3 and 69.1%. In all cases embryo transfer was performed. Two clinical pregnancies were achieved, one in each of the induction protocol groups. In the control group, patients underwent early luteinization, i.e., requiring cancelation of the cycle, after the ovarian cysts had not been aspirated. It is suggested that puncture and aspiration of ovarian cysts occurring during induction of ovulation may be an efficient method to avoid early luteinization. It should be evaluated further.

Adult↗

PubMed1989

Comparison between laparoscopically and ultrasonographically guided transvaginal follicular aspiration methods in an in vitro fertilization program in the same patients using the same stimulation protocol.

Oocyte recovery from 43 patients undergoing ultrasound-guided transvaginal oocyte retrieval was compared to a previous laparoscopic oocyte retrieval cycle from the same patient. Gonadotropin stimulation in both cycles was performed using the same protocol. There were no statistically significant differences in the mean day of oocyte retrieval or the mean daily estradiol level up to the day of oocyte retrieval between laparoscopic and transvaginal cycles. The total number of follicles aspirated per cycle, preovulatory oocytes aspirated per cycle, and number of concepti of preovulatory origin transferred per cycle were not statistically different. The number of immature oocytes aspirated per cycle was statistically decreased in transvaginal retrieval cycles, which resulted in an increased total number of concepti transferred per transfer in laparoscopic retrieval cycles. Twelve pregnancies resulted from the transvaginal retrieval cycles (27.9%), seven of which are ongoing or delivered. Ultrasound-guided transvaginal follicular aspiration yields results comparable to laparoscopic retrieval in the same patients and should be the method of choice for oocyte pickup because of its many advantages.

Female↗

PubMed1990

Is analgesia required for transvaginal single-follicle aspiration in in vitro fertilization? A double-blind study.

High oocyte retrieval rates using transvaginal follicular aspiration for single follicles and improved laboratory techniques have engendered renewed interest in natural-cycle in vitro fertilization (IVF). To assess analgesia requirements during single-follicle aspiration, a double-blind study was set up in 30 patients comparing intraprocedure intravenous fentanyl with normal saline as a placebo. Analysis of pain perception using visual analogue scoring showed a similar pain tolerance in both groups for the procedures of vaginal ultrasound scanning, needle insertion, and follicular aspiration. A correlation between each patient's tolerance of common pain-producing experiences with that for the procedure was not well defined (r = 0.5). We conclude that one of the benefits of natural-cycle IVF using transvaginal single-follicle aspiration is that it can be performed without analgesia.

Analgesia↗

PubMed1992

Follicular aspiration does not protect against the development of ovarian hyperstimulation syndrome.

OBJECTIVE: The purpose of this study was to determine the effect of follicular aspiration on the incidence of ovarian hyperstimulation syndrome (OHSS). DESIGN: A retrospective study was done on 219 IVF cycles that proceeded to follicular aspiration (group A) and they were compared with 189 cycles of ovulation induction for non-IVF cycles (group B). We compared the incidence of OHSS in regularly ovulating patients (subgroups A1 and B1) and anovulatory patients (subgroups A2 and B2) in both groups. SETTINGS: The study took place at The Egyptian IVF-ET Center. PARTICIPANTS: Participants were 319 infertility patients. INTERVENTION: Ovulation was induced and follicles were aspirated. MAIN OUTCOME MEASURES: The incidences of moderate and severe OHSS were the main outcome measures. RESULTS: The incidence of OHSS in group B was significantly higher than that in group A (P = 0.016). There was no significant difference in the incidence of OHSS between subgroup A1 and subgroup B1 or between subgroup A2 and subgroup B2. CONCLUSIONS: Follicular aspiration had no effect on the incidence of OHSS. In contrast, the higher incidence of OHSS in group B was related to the higher incidence of anovulatory infertility.

Adult↗

PubMed1979

Differential diagnosis of pancreatic mass lesion with percutaneous fine-needle aspiration biopsy under ultrasonic guidance.

Ultrasonically guided percutaneous fine-needle aspiration biopsy for cytological diagnosis was performed on 28 patients with ultrasonically scanned solid mass lesions of the pancreas in an attempt to make a differential diagnosis between pancreatic cancer and chronic pancreatitis. In 25 of the 28 patients, enough cells were aspirated to enable a cytological diagnosis to be made. In 19 of these 25 patients, malignant cells were obtained, while the aspirates from 6 patients contained only normal pancreatic cells. In 3 of the 28 patients, insufficient numbers of cells were obtained to allow the establishment of a cytological diagnosis. Pancreatic cancers were present in 22 of the 28 patients, and among these a positive diagnosis of cancer was made by aspiration biopsy in 86.4% (19/22). The technique resulted in no false positive diagnoses of cancer among 6 patients with chronic pancreatitis. No complications, such as bleeding, fistula formation, and elevation of the serum amylase, followed the procedure. This new method appears to be extremely useful in the diagnosis of pancreatic mass lesions.

Adult↗

PubMed1987

Treatment by aspiration of brain abscesses.

Sixteen patients, with a total of 18 abscesses, were treated by aspiration and systemic antibiotic therapy, to which antiepileptic prophylaxis and corticosteroids were added. Diagnosis of the abscesses and monitoring of their evolution relied principally upon computed tomography; this technique was also used per-operatively when aspirating small abscesses. Bacteriological examinations were positive in all our cases and a polymicrobial flora was found in half of these. One or, eventually, two aspirations within the same week were sufficient, in most cases, to promote healing. Nevertheless, in three patients, the abscesses, however sterilized, did not show any volume reduction, probably because of adhesions to the dura mater, of a large part of the abscess surface area. One patient died from concomitant cardiac disease and one patient remained seriously disabled. Epilepsy was observed as a sequela, in six patients. This study emphasizes the role of neuroradiological and bacteriological examinations, whilst surgery may be restricted, in most cases, to a simple aspiration.

Adolescent↗