Percutaneous core needle biopsy vs. fine needle aspiration in diagnosing benign lung lesions.

OBJECTIVE: To determine the diagnostic value of percutaneous core needle biopsy (PCNB) in comparison with fine needle aspiration (FNA) in patients with benign pulmonary lesions. STUDY DESIGN: A retrospective review was undertaken of computed tomography-guided PCNBs and FNAs performed between 1988 and 1997. Both FNA and PCNB biopsies were carried out sequentially at the same visit in every patient. RESULTS: A specific benign diagnosis was made in 10/60 cases (16.7%) by FNA and in 49/60 (81.7%) by PCNB. PCNB findings resulted in significant modification of the diagnosis established by FNA. The only significant complication encountered was pneumothorax, at a rate of 11.7%, which is compatible with that reported in the literature for complications induced by FNA alone. CONCLUSION: Radiologically guided PCNB is a safe procedure, can provide sufficient histologic material for a specific diagnosis of peripheral lung disease and can avoid more-invasive surgical procedures in many cases. Our experience demonstrated that the histologic analysis provided by PCNB can greatly increase the diagnostic accuracy in benign pulmonary diseases as compared with the yield of FNA.     

Fine needle aspiration biopsy of myxoid metastasis of malignant melanoma

The cytopathologic features of the fine needle aspiration biopsy of a myxoid metastasis of a cutaneous malignant melanoma are documented. The cytologic findings included fusiform-to-round cells with elongated cytoplasmic processes, fibroblastlike cells and inflammatory cells in a characteristic amorphous background substance. Immunocytochemical staining for S-100 protein was positive. The cytologic findings correlated well the histologic, histochemical, immunohistochemical and ultrastructural studies of the neoplasm. The cytologic differential diagnosis between metastases of malignant melanoma and other myxoid tumors of soft tissues is discussed.     

Fine needle aspiration biopsy of primary malignant fibrous histiocytoma of the lung

Malignant cells were found on the fine needle aspiration (FNA) biopsy smears from a primary tumor of the lung. The cytologic specimen contained a mixture of fibroblastlike cells, histiocytelike cells, giant cells and undifferentiated cells; mitotic figures were also found. Histologic, histochemical and electron microscopic studies confirmed the FNA cytologic suggestion of a primary malignant fibrous histiocytoma of the lung.     

Metaplastic breast carcinoma. A diagnostic problem in fine needle aspiration biopsy.

Fine needle aspiration (FNA) was used to evaluate a breast lump and enlarged lymph nodes in a woman with a prior history of lumpectomy on the contralateral breast and a recent negative mammogram. The FNA cytologic findings included markedly atypical fibroblast-like cells lying singly and in groups in a myxoid background, highly atypical multinucleated cells and numerous mitoses, features that were interpreted as a high-grade malignant mesenchymal tumor. The carcinomatous cells in the aspirates were only fully appreciated after histologic examination of the mastectomy specimen and the axillary lymph node metastases showed a dual differentiation consisting of both epithelial and mesenchymal components, leading to a final diagnosis of metaplastic carcinoma. Electron microscopic study of histologic samples confirmed the dual differentiation, and both keratin and vimentin intermediate filaments were recognized by immunohistochemical staining. The regional lymph node metastases were predominantly sarcomatous, which apparently is a rare event. The entity of metaplastic carcinoma is discussed in relation to other mixed epithelial-mesenchymal lesions of the breast, and the previous literature on this entity is briefly reviewed.     

Fine needle aspiration cytology of malignant schwannoma metastatic to the breast

A case of malignant schwannoma metastatic to the breast is reported. The tumor was found as a solitary breast lump in a 43-year-old woman and was clinically considered to be a primary tumor. Fine needle aspiration (FNA) smears of the mass were interpreted cytologically as a malignant neurogenic tumor, compatible with a malignant schwannoma. The patient did not have multiple neurofibromatoses. Eight months previously, an excision of a solitary nodule located in the left axilla had been performed in another hospital. Comparison of the histologic section from that excision with the FNA confirmed that the breast tumor was a metastatic malignant schwannoma, and the patient was treated accordingly.     

Cytology of fine needle aspiration biopsy of primary breast rhabdomyosarcoma in an adolescent girl

A bilateral breast tumor in an 11-year-old girl was diagnosed as a malignant mesenchymal neoplasm by fine needle aspiration biopsy, and its muscular origin was suggested. An immunoperoxidase stain for the demonstration of intracellular myoglobin in destained cytologic aspirates exhibited a positive reaction of variable intensity in some of the undifferentiated round cells and in the more mature bipolar sarcomatous elements. These findings were confirmed in the histologic sections of the excised tissue. Needle aspiration is helpful in these rare cases of primary breast rhabdomyosarcoma, which often present with a solid, undifferentiated histologic pattern in this age group. In addition to the cytologic characteristics, the possibility of detecting muscle antigens as markers for these embryonal small cells, even in previously stained slides, provides a successful method for defining the specific type of sarcoma.     

Fine needle aspiration biopsy of myxoid variant of malignant leiomyoblastoma metastatic to the liver

The cytologic features seen in a fine needle aspiration biopsy specimen of a liver metastasis from a myxoid variant of a malignant leiomyoblastoma (epithelioid leiomyosarcoma) of the stomach are presented. The abundant mucus production and rich vascularity evident in the aspiration smears corresponded to the histologic findings in the original tumor, which had been excised two years previously. Histochemical and immunochemical staining were used to substantiate the smooth-muscle origin of the tumor.     

Adoptive T-cell therapy for malignant melanoma patients with TILs obtained by ultrasound-guided needle biopsy

Adoptive cell therapy with tumor-infiltrating lymphocytes (TIL) can mediate objective responses in up to 50% of malignant melanoma patients with a good performance status refractory to standard treatments. Current protocols for generation of TILs rely on open surgery for access to tumor tissue. We obtained tumor material by ultrasound-guided core needle biopsy or surgery from melanoma patients with progressive disease and were able to isolate >5 × 10⁶ TILs from 23 of 24 patients who were subsequently treated with these cells. One-third of the individual TIL-positive cultures displayed interferon gamma activity after stimulation with relevant melanoma cell lines. When expanded TILs were used for treatment in combination with daily low dose s.c. IL-2 after prior lymphodepleting chemotherapy, we observed objective clinical responses in one patient treated with TILs obtained from surgery and 4 patients treated with TILs from core biopsies. The results of this study demonstrate for the first time the potential of core biopsies for generation of relevant numbers of TILs that can mediate objective responses in patients with metastatic malignant melanoma. Ultrasound-guided core needle biopsy is a robust, safe and inexpensive approach to obtain tumor tissue for TIL generation, and is especially valuable in instances where surgery is contraindicated.     

An HR-MAS MR metabolomics study on breast tissues obtained with core needle biopsy

Background

Much research has been devoted to the development of new breast cancer diagnostic measures, including those involving high-resolution magic angle spinning (HR-MAS) magnetic resonance (MR) spectroscopic techniques. Previous HR-MAS MR results have been obtained from post-surgery samples, which limits their direct clinical applicability.

Methodology/Principal Findings

In the present study, we performed HR-MAS MR spectroscopic studies on 31 breast tissue samples (13 cancer and 18 non-cancer) obtained by percutaneous core needle biopsy. We showed that cancer and non-cancer samples can be discriminated very well with Orthogonal Projections to Latent Structure-Discriminant Analysis (OPLS-DA) multivariate model on the MR spectra. A subsequent blind test showed 69% sensitivity and 94% specificity in the prediction of the cancer status. A spectral analysis showed that in cancer cells, taurine- and choline-containing compounds are elevated. Our approach, additionally, could predict the progesterone receptor statuses of the cancer patients.

Conclusions/Significance

HR-MAS MR metabolomics on intact breast tissues obtained by core needle biopsy may have a potential to be used as a complement to the current diagnostic and prognostic measures for breast cancers.     

Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions

Background

To assess the accuracy of ultrasound-guided 16G or 18G core needle biopsy (CNB) for ultrasound-visible breast lesions, and to analyze the effects of lesion features.

Methods

Between July 2005 and July 2012, 4,453 ultrasound-detected breast lesions underwent ultrasound-guided CNB and were retrospectively reviewed. Surgical excision was performed for 955 lesions (566 with 16G CNB and 389 with 18G CNB) which constitute the basis of the study. Histological findings were compared between the ultrasound-guided CNB and the surgical excision to determine sensitivity, false-negative rate, agreement rate, and underestimation rate, according to different lesion features.

Results

Final pathological results were malignant in 84.1% (invasive carcinoma, ductal carcinoma in situ, lymphoma, and metastases), high-risk in 8.4% (atypical lesions, papillary lesions, and phyllodes tumors), and benign in 7.5%. False-negative rates were 1.4% for 16G and 18G CNB. Agreement rates between histological findings of CNB and surgery were 92.4% for 16G and 92.8% for 18G CNB. Overall underestimate rates (high-risk CNB becoming malignant on surgery and ductal carcinoma in situ becoming invasive carcinoma) were 47.4% for 16G and 48.9% for 18G CNB. Agreements were better for mass lesions (16G: 92.7%; 18G: 93.7%) than for non-mass lesions (16G, 85.7%; 18G, 78.3%) (P <0.01). For mass lesions with a diameter ≤10 mm, the agreement rates (16G, 83.3%; 18G, 86.7%) were lower (P <0.01).

Conclusions

Ultrasound-guided 16G and 18G CNB are accurate for evaluating ultrasound-visible breast mass lesions with a diameter >10 mm.     

Fine needle aspiration cytology of rare malignant tumors of the breast.

This report describes the fine needle aspiration (FNA) cytologic findings in 17 rare malignant breast tumors. The series consisted of invasive cribriform carcinoma, papillary carcinoma, apocrine carcinoma, carcinoma with pseudosarcomatous metaplasia, carcinosarcoma, fibrosarcoma, malignant phyllodes tumors, primary malignant lymphomas, plasmocytoma, metastatic melanoma and metastatic renal clear cell carcinoma. Besides cytomorphology, the results of immunostaining in eight cases are presented, as is a review of the literature. It is important for rare primary malignancies, as well as for metastatic tumors, to be diagnosed, or at least have the diagnosis suggested, preoperatively by FNA and immunocytochemistry, permitting better therapy planning.     

Endoscopic fine needle aspiration biopsy

A catheter assembly that can be passed through the biopsy channel of a standard fiberoptic gastroduodenoscope was devised to permit fine needle aspiration biopsy of gastrointestinal neoplasms under direct vision of the endoscope. This technique for endoscopic aspiration biopsy was performed in ten consecutive patients with esophageal and gastric carcinomas, along with the conventional endoscopic brushing and biopsy. Endoscopic aspiration biopsy gave a positive diagnosis in all ten cases while the other two techniques gave inconclusive results in one patient with an ulcerative growth. We feel that endoscopic aspiration biopsy can be used to obtain representative samples from gastrointestinal neoplasms, and it may add to the diagnostic accuracy of endoscopic biopsy and brushing cytology.     

Percutaneous needle aspiration biopsy.

This paper reviews the history, technique, applications, advantages, disadvantages and complications of percutaneous needle aspiration biopsy. This technique, particularly when performed with a time needle (21-gauge or less), is a relatively painless, inexpensive and safe method of obtaining a pathologic diagnosis, and it can often be carried out at the bedside or in the outpatient department. It complements other methods and may obviate, but never precludes, subsequent excisional biopsy. Its advantages are insufficiently recognized. Considerable expertise of the cytopathologist and close cooperation with the clinician are necessary for consistent results.     

Fine needle aspiration biopsy of a granulocytic sarcoma (chloroma) of the breast

A case of granulocytic sarcoma (chloroma) presenting as an isolated left breast mass in a 56-year-old woman is described. The diagnosis was initially considered from the examination of a fine needle aspiration (FNA) biopsy specimen because of the recognition of granulocytic differentiation in the cytologic material. The patients showed no peripheral blood or bone marrow evidence of leukemia. A biopsy revealed a green neoplastic tissue infiltrating the breast. Immunohistochemical study showed intracytoplasmic lysozyme, a marker for myeloid precursors, and ultrastructural examination revealed primary myeloid granulation. These findings confirmed the FNA cytologic diagnosis of granulocytic sarcoma, which should be considered when eosinophilic myelocytes are observed in aspirated material.     

Fine needle aspiration biopsy in uveal melanoma

Fine needle aspiration (FNA) biopsies were performed in a series of patients with uveal tumors. Cytopathologic examination established the correct diagnosis in 26 of 29 uveal melanomas. FNA biopsy was able to exclude the diagnosis of a malignant neoplasm in five nonmelanoma tumefactions. Histologic and FNA cytologic typing of melanomas as epithelioid or predominantly spindle cell showed good agreement, with the same classifications made in 14 of 18 cases. FNA biopsy specimens also proved to be adequate for DNA-content and cell-cycling studies. The cessation of cell cycling in successfully irradiated melanomas may be useful in establishing the postradiation status of tumors that have questionable growths after therapy, as was shown using FNA samples in three such cases in this study. The results of this study show that FNA biopsy is a useful diagnostic adjunct in patients with atypical lesions that require therapy.     

Fine needle aspiration of benign and malignant breast masses associated with pregnancy.

Of 1,612 fine needle aspirates (FNA) of breast lesions performed over a seven-year period, 25 cases (1.5%) were identified as breast masses associated with pregnancy. Patients ranged in age from 16 to 46 years, with a mean of 27. Gestational age at the time of FNA ranged from three months to three months postpartum or following breast-feeding. Cytologic diagnoses of these pregnancy-associated breast masses were: galactocele (5 cases, 20%), lactating adenoma (9 cases, 36%), fibroadenoma with lactational change (7 cases, 28%), juvenile fibroadenoma with lactational change (1 case, 4%), atypical reactive duct cells with lactational change (1 case, 4%) and infiltrating duct carcinoma (2 cases, 8%). The degree of lactational change varied proportionately with gestational age. None of the 22 patients with benign cytologic diagnoses of galactocele, lactating adenoma or fibroadenoma subsequently developed carcinoma. The mean clinical follow-up for these 22 patients was 27 months. Three cases of fibroadenoma and the case of juvenile fibroadenoma were confirmed by surgical excision. Biopsy of the lesion cytologically diagnosed as atypical reactive duct cells with lactational change revealed infiltrating duct carcinoma (IDC). All three patients with IDC had involvement of multiple axillary lymph nodes, and 1 patient had widely metastatic disease. In two cases of IDC the background lactational breast epithelium exhibited marked cytologic atypia that closely resembled the IDC. Pregnancy-related cellular atypia potentially results in a false-positive diagnosis of breast carcinoma on FNA. FNA is useful in distinguishing benign breast masses of pregnancy from those with marked cytologic atypia requiring surgical biopsy and may minimize the delayed diagnosis of carcinoma associated with pregnancy.     

Stereotaxic fine needle aspiration cytology of clinically occult malignant and premalignant breast lesions

Stereotaxic fine needle aspiration (FNA) cytology was used to study clinically occult (nonpalpable) breast lesions in 114 consecutive patients with mammographically suspicious findings prior to excisional biopsy. The aspirate contained insufficient material for cytologic evaluation in 15 cases (13.2%), which were histologically diagnosed as benign (7 cases), atypical hyperplasia (7 cases) or carcinoma in situ (1 case). The cytologic findings indicated a benign lesion in 77 cases (67.5%), which were histologically diagnosed as benign (71 cases) or atypical ductal hyperplasia (6 cases). The cytologic sample showed atypia in eight cases (7.0%), which were histologically diagnosed as severe atypical ductal hyperplasia (three cases), carcinoma in situ (one case) or proliferative fibrocystic disease (four cases). In the eight cases (7.0%) cytologically interpreted as probably malignant, histology confirmed six invasive carcinomas, one carcinoma in situ and one fibrocystic disease. Of six cases (4.4%) cytologically reported as malignant, five were histologically diagnosed as invasive carcinoma and one as carcinoma in situ. Overall, stereotaxic FNA cytology reported as malignant or probably malignant 14 of the 15 cases with a histologic confirmation of malignancy, for a sensitivity of 93.3%. Cytology correctly identified 78 of the 83 histologically negative cases, for a specificity of 94.0%. The 16 cases histologically diagnosed as ductal hyperplasia, which carries a high risk for subsequent malignancy, were studied in detail in an effort to define histologic and cytologic criteria for this entity. Using selected histologic criteria, 11 of these cases were graded as showing mild-to-moderate atypical hyperplasia and 5 as showing severe atypical hyperplasia. Three of the latter cases were similarly identified by an analogous cytologic grading; the other two cases had insufficient cytologic samples. The total results in this series of 114 cases support the use of stereotaxic FNA cytology in the diagnosis of these nonpalpable breast lesions, examples of which are illustrated. In particular, it may help to raise the low specificity yielded by mammography alone, which would represent a significant advance for the patient in terms of the accuracy, expediency and reduced cost of diagnosing these lesions.