Comparative study of lymphography and aspiration cytology in the staging of prostatic carcinoma. Report of 35 cases with histological control and review of the literature

Diagnostic value of lymph node fine needle aspiration cytology: an institutional experience of 387 cases observed over a 5-year period

Lymph node fine needle aspiration (LNFNA) cytology is valuable in solving the diagnostic problems of clinical adenopathy. The usefulness of the procedure in the staging and diagnosis of various malignant and lymphoproliferative tumours, as well as its role in distinguishing reactive hyperplastic lymph nodes from lymphoma, has been documented in the literature generally on an individual basis. We report our cumulative 5 year experience of LNFNA representing 387 cases. Approximately half (n = 182) were diagnosed as either metastatic carcinoma or melanoma; in 54 cases (30%) excisional biopsy or tissue study was performed to confirm the diagnosis; there was only one false-positive diagnosis of a metastatic squamous carcinoma rendered on a submandibular lymph node. Sixty-one lymphoma cases were successfully diagnosed via LNFNA with no false positives; concurrent flow cytometry was utilized in 51% (n = 31) of the 61 cases and supported the cytologic diagnosis of lymphoma in 27 of the 31 cases (87%). A benign or reactive lymph node process was also diagnosed via LNFNA alone or in combination with flow cytometry in 48 cases with only five false negatives, which included four cases of mantle cell lymphoma and one case of melanoma. Unsatisfactory cases accounted for 12%, and represented specimens obtained by 'Wang needle' or other emerging techniques. Our study demonstrates that LNFNA can be an accurate, economical and rapid diagnostic procedure.

Urologic cancer

Cancer prevention and risk reduction in patients with carcinomas of the urinary tract are most easily identified by smoking cessation. Recent assessments of patients with bladder carcinomas show a high percentage of active smokers. Urologic surgeons and those dealing with cancers of the genitourinary tract should recognize such an important factor. In other lifestyle guidelines, the American Cancer Society suggests that those who significantly reduce the fat content of their diet with weight reduction will generally reduce risk factors in a number of cancers, including prostate cancer. Many new diagnostic tests have been introduced since the 1980 conference. Transrectal ultrasonography as a preoperative staging technique has been received with some enthusiasm. Currently, a national program for the testing of the detection of prostate cancer by ultrasound compared with other physical examinations and marker antigens, such as prostate antigen, is underway. The evaluation of renal masses continues to be improved by the use of ultrasonography and computed tomography (CT) scanning. Currently, magnetic resonance imaging (MRI) techniques are believed to have added some improved assessment for particularly large tumors and the question of their vascular extension. Occasionally observed lesions of the adrenal gland without hormonal expression in patients continue to be noticed during evaluations for frequently unrelated diagnoses. The management of such lesions less than 3.5 cm in diameter is believed to be conservative based on their size. Preoperative staging of the bladder has improved with transurethral ultrasonography use and the follow-up with patients has developed more frequently with the widely available urinary cytology. Fine needle aspiration of the prostate gland, lymph nodes, and other urinary tumor masses is increasing in diagnostic use. Flow cytometry has been applied to all lesions of the urinary tract and continues to be a field of clinical investigation. The field of biologic markers in diagnosis, detection, and follow-up evaluation of patients with carcinomas of the urinary tract is a most interesting and progressive one. Currently, the most widely accepted new innovation is the prostate antigen, which was developed by members of the National Prostatic Cancer Project between 1975 and 1986. Other markers offer potential added value in more accurate and earlier diagnosis and detection and correlation with prognostic factors concerning individual groups of patients. Progress in the detection, diagnosis, and management of genitourinary cancer is being achieved, and prevention, although perhaps simplistic in design, can be more readily applied.