Current concepts in fine needle aspiration biopsy cytology

Prospective randomized clinical trial of the effect of needle size on pain, sample adequacy and accuracy in head and neck fine-needle aspiration cytology

BACKGROUND

Fine-needle aspiration cytology (FNAC) is useful in the diagnosis of many conditions of the head and neck. No reported studies have investigated the optimal needle gauge in the head and neck region.

METHODS

This was a prospective randomized trial of 100 patients who required FNAC performed with either a 21G or 23G needle. Discomfort was scored by patients using a visual analogue scale. Sample accuracy was assessed in patients who subsequently had excision biopsy.

RESULTS

FNAC performed with a 23G needle was less painful (mean +/- SE, 1.6 +/- 1.01) than FNAC with a 21G needle (3.3 +/- 1.94; p < .001). There was no difference in sample adequacy between the 2 needle sizes (p = .59). The sensitivities and specificities of both needles were similar.

CONCLUSION

Head and neck FNAC should routinely be performed with a 23G needle, resulting in less patient discomfort, and giving sample adequacy comparable to a conventional 21G needle.

Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. I. Percutaneous transthoracic needle biopsy

PTNB is a well-established technique for the diagnosis of lung cancer. In recent years, CT guidance has become the primary imaging modality, replacing fluoroscopy guided biopsies in many institutions. CT fluoroscopy, which is currently not universally available, offers promising advantages and may permit accurate and rapid procedures. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy, particularly in benign lesions. PTNB is one of several methods available for tissue diagnosis of suspected lung cancer. The decision as to which method to use should be tailored to each patient, and is preferably reached by a team consisting of pulmonary physicians, chest surgeons, oncologists, cytologists, and radiologists.

Aspiration and tetracycline sclerotherapy for management of simple ovarian cysts

OBJECTIVE

To evaluate the procedure of aspiration and tetracycline sclerotherapy in the management of simple ovarian cysts.

METHODS

Twenty-five cases of simple ovarian cysts were subjected to cyst fluid aspiration and 5% tetracycline injection under ultrasound guidance. Cytological examination of the aspirated fluid was carried out in 24 cases and the patients were followed for 6-36 months.

RESULTS

Cytology revealed a cellular sediment in 18 cases (simple cysts), follicular cells in four cases (follicular cysts), and blood and hemosiderin-laden macrophages in two cases (endometriosis); subsequent surgery was required in only one case (endometriosis).

CONCLUSIONS

The procedure of aspiration and tetracycline sclerotherapy was easy, safe and acceptable, with no recurrences. It appears to be a valid alternative to cyst aspiration in the management of simple ovarian cysts.

Transthoracic needle biopsy

Percutaneous fine-needle aspiration biopsy is a relatively simple invasive procedure with good patient acceptance, low morbidity, and almost negligible mortality. It provides a diagnosis of pulmonary, hilar, and mediastinal masses quickly and accurately, thus eliminating many laboratory tests, saving hospital days, and thereby saving time and money. Percutaneous fine-needle aspiration biopsy should be performed early in the investigation of many types of intrathoracic lesions.

Ultrasound guided fine needle aspiration of ovarian cysts: diagnosis and treatment in pregnant and non-pregnant women

Ovarian cysts are conventionally managed by laparoscopy or laparotomy. Twenty-two patients underwent fine needle aspiration of ovarian cysts under ultrasound control. Four patients were pregnant, and in two of these, aspiration of the cyst was performed transvaginally. The aspirate was examined cytologically and correlated with histology where available. The technique and results are discussed. No complications occurred. It is concluded that fine needle aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. It is of particular use in pregnancy, and in patients unsuitable for laparoscopy or surgery. Surgery can be reserved for cysts which recur after aspiration, cysts with a haemorrhagic aspirate, cysts in post-menopausal women and those with ultrasonic criteria of malignancy.

Value of sonographically guided fine needle aspiration biopsy in evaluating the liver with sonographic abnormalities

This retrospective study was undertaken to evaluate the diagnostic usefulness of 97 sonographically guided fine needle aspiration biopsy cytologies in 92 patients with one or more hepatic lesions suspicious of malignancy. Results of the fine needle aspiration biopsy were then compared with the definitive results obtained by histologic examination, or with the subsequent course of the patient. A final diagnosis of malignancy was established in 65 cases, of which fine needle aspiration biopsy cytology revealed a concordant diagnosis in 54 cases. The diagnostic sensitivity of this technique was 83% for malignant lesions with 93% specificity. Of the 54 cases with malignant cytology, it was possible to distinguish between a primary or secondary lesion in 31 cases (57%). Benign lesions were aspirated in 32 cases, of which 30 cases concorded with the final diagnosis. This study confirms the usefulness of sonographically guided fine needle aspiration biopsy cytology in diagnosing malignant hepatic tumors.

Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens

Five years experience in the application of electron microscopy to fine needle aspiration biopsy specimens is reviewed. In an initial evaluation, 200 consecutive unselected specimens were examined; 89 proved diagnostic and, in a third of these, electron microscopy gave additional information that was often essential to diagnosis. Negative specimens resulted almost entirely from failure to obtain an adequate amount of material. Results were improved by the adoption of a preparation technique involving concentration of the cells in bovine serum albumin and by the inspection of a rapidly stained smear at the time of the aspiration procedure, with a further needle pass for electron microscopy being performed if necessary. Despite the small size of specimens, adequate examination was usually possible and electron microscopy has proved of value in the diagnosis of tumor samples acquired by fine needle aspiration in the same way as has been established with the larger sized specimens obtained by conventional biopsy and surgical resection.

Cytologic diagnosis of hepatocellular carcinoma by fine-needle aspiration biopsy

From 1976 to June 1982, 237 patients with clinical suspicion of hepatic malignant disease underwent guided percutaneous fine-needle aspiration biopsy of the liver. Of these, 12 were diagnosed cytologically as "hepatocellular carcinoma" and this diagnosis was confirmed in the follow-up of all cases. On the basis of the cytomorphologic features observed in the aspirates, the tumor was subclassified into three types; well differentiated, pleomorphic large cell; and poorly differentiated. The various cytologic appearances of different types of hepatocellular carcinoma are presented and illustrated. Cytomorphologically, these three types of hepatocellular carcinoma were distinctly different and their cytomorphologic features were also sufficiently distinctive from those of secondary hepatic cancer to be diagnostic. Guided percutaneous fine-needle aspiration biopsy of the liver appears to be a definitive minimally invasive means of establishing the diagnosis of hepatocellular carcinoma, and promises to be a valuable diagnostic procedure for potentially resectable localized hepatocellular carcinoma.

Electron microscopy applied to fine-needle aspiration. A report of six cases from various sites

The authors report the results obtained from the application of electron microscopy techniques to the cytology of fine-needle-aspirated samples of neoplastic lesions from various body sites. These results show that the tissue structure, which is usually lost during the squashing necessary for light microscopy cytology, is preserved when the samples are processed for ultrastructural analysis. Electron microscopy also allows a highly detailed study of the cell's inner structures. Thus, when this technique is applied, fine needle-aspirated samples can be regarded as actual microbiopsies. However, because of the high cost of ultrastructural techniques, we suggest that actual analysis be performed only in selected cases, whereas fixation and inclusion for electron microscopy could be done routinely.

Intracellular acidic mucins and their identification in diagnostic cytology

Exfoliative, abrasive and aspiration cytology were increasingly relied upon for tissue diagnosis of tumours. The established histological stains for the differentiation of mucin and non-mucin-secreting tumours are not ideal for alcohol-fixed cytology smears and a more reliable cytological technique for the preservation and staining of intra-cellular acidic mucins using Alcohol Alcian Blue 8GX is presented.