Comparison of Fine Needle Sampling By Capillary Action and Fine Needle Aspiration

Fine needle aspiration (FNA) and non-suction fine needle sampling (FNS) were performed consecutively in 107 lesions from 100 patients. the quality of diagnostic material was assessed using a scoring system based on the cellularity and amount of blood in the smear. the total score in the FNS group was significantly higher (P < 0.05) than that of FNA technique. the FNS procedure is less traumatic and equally cost effective and can be safely undertaken in liver, orbital and thyroid lesions. In lymph nodes, especially in children, FNS gives an excellent cellular yield. However, this procedure can not be advocated in cystic, bony and fibrous lesions.     

Fine Needle Aspiration Cytology of Myxoid Liposarcoma; A Study of 18 Tumours

The cytological features of 18 myxoid liposarcomas from 12 patients were analysed. the most consistent cytological features were: abundant myxoid matrix, several small tissue fragments with uniform small, round or stellate cells and a network of branching thin-walled capillaries. the presence of univacuolated or multivacuolated lipoblasts was noted frequently, but not in all aspirates. the diagnostic importance of vacuolated lipoblasts and the main problems of differential cytodiagnosis are discussed. Une série de 18 cytoponctions provenant de 12 patients chez qui un diagnostic de liposarcome myxoïde a été porté cytologiquement et histologiquement est analysée. Les caractéristiques cytologiques les plus constantes sont la présence d'une matrice myxoïde abondante, de petits fragments tissulaires constitués de cellules rondes ou étoilées assez monomorphes et d'un réseau branché de capillaires à paroi fine. La présence de lipoblastes mono ou pluri-vacuolisés est fréquente mais non constante. L'importance diagnostique de ces lipoblastes vacuolisés et les problèmes majeurs de cytodiagnostic différentiel sont discutés. Feinnadelpunktate wurden von 18 histologisch gesicherten myxoiden Liposarkomen von 12 Patienten hergestellt. Die zuverlässigsten zytologischen Kriterien waren: reichlich myxoide Grundsubstanz, kleinere Gewebsfragemente einheitlicher, runder oder sternförmiger Zellen und Bruchstücke dünnwandiger Kapillaren. Lipoblasten mit einer oder mehreren Vakuolen wurden häufig, jedoch nicht in allen Punktaten gefunden. Ihre diagnostische Bedeutung für die Differentialdiagnose wird diskutiert.     

Fine Needle Aspiration For the Diagnosis and Management of Granulomatous Disease

Fine needle aspiration is a quick, minimally invasive and cost-effective technique for the diagnosis of granulomatous disease. Cytological diagnosis can often be specific, with the help of special stains and microbiological culture of aspirated material, particularly in the case of tuberculosis, the most common infective granulomatous disease in this country. At a fine needle aspiration clinic many cases of granulomatous disease, some from unusual sites, have been diagnosed and the use of more invasive investigations has been avoided. The problems involved in cytological diagnosis are discussed using seven cases as examples.     

Fine Needle Aspiration of Adrenal Myelolipoma: A Case Report

A case of an adrenal myelolipoma in a 50-year-old woman with endometrial carcinoma is described. The diagnosis was established by computed tomography-guided fine needle aspiration, which is particularly useful for the pre-operative evaluation of adrenal tumours in asymptomatic, high-risk or cancer patients. The criteria used to distinguish extra-adrenal myelolipomas from mass-forming extramedullary haematopoiesis are discussed.     

Reliability of Fine Needle Aspiration Cytology For Distinguishing Between Carcinoma,Lymphoma and Sarcoma; the Influence of Clinical Information

To investigate interobserver variation of fine needle aspiration (FNA) cytological diagnosis with respect to distinguishing between carcinoma, sarcoma and lymphoma, a set of 80 randomly sampled slides was randomized twice and read ‘blindly’by five cytopathologists. In the first round the slides were read without any information, and in the second round clinical information was provided. Histology was used as a reference standard. In the first round, the positive predictive values for the cytological diagnosis of carcinoma, sarcoma and lymphoma were 93%, 94% and 86% respectively. In the second round the positive predictive values for the cytological diagnoses of carcinoma, sarcoma and lymphoma were 95%, 99% and 99%, respectively. Interobserver variability, tested with weighted kappa scores (range 0.73–0.92) between histological and cytological diagnosis, was low. the most accurate FNA cytologic classification was obtained when the clinical context was known. L'étude de la variabilité interobservateur du diagnostic différentiel entre carcinome, sarcome et lymphome par cytoponction à l'aiguille fine a été conduite sur 80 cas pris au hasard. Deux lectures successives ont été faites ‘en aveugle’par 5 cytopathologistes. Les renseignements cliniques n'one été fournis que lors de la deuxième lecture. L'histopathologie est le standard de référence. Après la première lecture, la valeur prédictive positive moyenne du diagnostic de carcinome, de sarcome et de lymphome est respectivement de 93%, 94% et 86%. Après la seconde lecture, ces valeurs sont respectivement de 95%, 99% et 99%. La variabilité interobservateur, testée par le score kappa pondéré (intervalle de 0.73 à 0.92) entre les diagnostics histologiquest et cytologiques est faible. Le meilleur résultat est obtenu lorsque le contexte clinique est connu. Zur Überprüfung der Übereinstimmung zwischen verschiedenen Zytopathologen wurden 80 Präparate von Karzinomen, Sarkomen und Lymphomen zweimal randomisiert und von 5 Zytopathologen blind ausgewertet. In der 1. Runde erfolgte dies ohne Zusatzinformation, in der 2. mit klinischen Informationen. Bezugsstandard war die Histologie. In der 1. Runde waren die positiven praediktiven Werte für Karzinom, Sarkom und Lymphom 93%, 94% bzw. 86%. In der 2. Runde betrugen die Werte 95%, 99% und 99%. Testet man die Variabilität zwischen den Auswertern mit Kappawerten (0.73–0.92), so ergeben sich nur geringe Unterschiede in der Zuverlässigkeit zwischen histologischer und zytologischer Diagnose. Die besten zytologischen Ergebnisse werden erreicht, wenn die klinischen Daten bekannt sind.     

Fine Needle Aspiration Cytology of High Grade T-Cell Lymphomas In Human T-Lymphotropic Virus Type 1 Carriers

We studied the fine needle aspiration (FNA) cytology of high grade peripheral T-cell lymphomas from eight human T-lymphotropic virus-1 (HTLV-1) positive patients. FNA smears from seven lymphomas showed a distinctive cytologic pattern with a dominance of rounded cells with irregular nuclei and a moderately basophilic cytoplasm. Irregular cells with a pale abundant cytoplasm were present in varying amounts. Some smears contained a few giant cells with cerebriform nuclei. In addition, plasma cells and eosinophils were found. Epithelioid cells were an inconstant finding. On histology these seven lymphomas were assigned to the pleomorphic medium-large cell subtype and all but one were of T-helper phenotype with rearrangements of the T-cell receptor. FNA smears from a lymph node in a patient with a previous histological diagnosis of lymphomatoid papulosis of the gingiva showed a monotonous pattern of large immunoblastic cells with some binucleated variants consistent with a diagnosis of high grade immunoblastic lymphoma, which was confirmed histologically. Our results show that peripheral T-cell lymphomas from HTLV-1 positive patients have cytological patterns which are distinctive enough to allow a conclusive diagnosis of high grade T-cell lymphoma. However, we do not think that the cytology of HTLV-1 positive lymphomas can be differentiated from that of virus-unrelated high grade T-cell lymphomas.     

Cost Effectiveness of A Fine Needle Aspiration Clinic

The resource implications of a Fine Needle Aspiration (FNA) Clinic at Northampton General Hospital have been evaluated over a 12 month period using a patient management questionnaire. A total of 490 cases from which fine needle aspirates were taken from superficial sites have been assessed (breast 381, thyroid 46, lymph node 44, salivary gland 9, soft tissue 10). Total resource savings (135,544 pounds) exceeded the expenses of the FNA clinic (27,290 pounds). Potential cost savings per case were the greatest for thyroid aspirates. The FNA clinic where the pathologist takes, stains and reports optimally prepared specimens, provides a high quality and accurate service on which clinicians can confidently base clinical management decisions. Unnecessary investigations and operations are avoided, allowing scant resources to be released for other procedures.     

Fine Needle Aspiration of Palpable Breast Lumps: A 1-Year Audit Using the Cytospin Method

A fine-needle aspiration (FNA) service for the diagnosis of palpable breast lumps was started at the Royal Preston Hospital, Preston, UK, in November 1989. Over the subsequent year, 407 FNAs were taken from 393 women. A simple technique was used which involved the surgeon flushing the aspirate into 10 ml of Cytospin collection fluid; cytocentrifuge preparations were then safely and conveniently prepared in the laboratory. Slides were stained with Papanicolaou and H&E. The method detected 112 out of a total of 121 cancers (92.6%); of the nine that were undetected, five aspirates were inadequate and four were falsely reported as negative. There were no false positives. The overall inadequate rate was 11.0%. Excluding inadequate samples, the absolute sensitivity was 89.7% and complete sensitivity 96.6% with 94.4% specificity. This 1-year audit has shown the Cytospin method of FNA in palpable breast disease to have a favourable sensitivity and specificity, and therefore to be an alternative to conventional FNA using direct smears.     

Fine Needle Aspiration Cytology of the Breast: Factors Affecting Sensitivity

At Northampton General Hospital a pathologist takes, stains and immediately reports aspirates at a fine needle aspiration clinic which is run in conjunction with a busy surgical breast clinic. the effect of various factors on the sensitivity of the technique have been quantified. Small tumour size, certain types of tumour and lesions difficult to palpate are causes of reduced sensitivity. Acellular samples had little effect on sensitivity. In this clinic trainee aspirators achieved good results early in their experience. After one year each had improved to the level of an experienced aspirator.     

Fine Needle Aspiration Cytodiagnosis of Apocrine Carcinoma of the Breast

The cytopathological appearances of 14 cases of apocrine breast carcinoma diagnosed by fine needle aspiration cytology are described and the features compared to those seen in apocrine cells aspirated from benign cystic and solid lesions. Significant atypia must be observed before a diagnosis of apocrine carcinoma can be entertained.     

Fine Needle Aspiration Cytodiagnosis of A Carcinoid Tumour of the Male Breast

The diagnosis of a primary carcinoid tumour of the breast in a 38-year-old male was initially made from a fine needle aspiration sample. The cytodiagnosis was supported by the histochemical demonstration of Grimelius-positive granules in tumour cells which were also found in tissue removed in a subsequent biopsy. An immunocytochemical study using markers for neuron-specific enolase and chromagranin in the aspirated sample and tissue was found to be negative. A total mastectomy with axillary node dissection was performed which showed no residual or metastatic tumour. No primary tumour was found elsewhere.     

Metastatic Renal Clear Cell Carcinoma In the Thyroid Gland Diagnosed By Fine Needle Aspiration Cytology

An 81-year-old woman presented with a mass in the right lobe of the thyroid. Fine needle aspiration of this lesion showed metastatic clear cell carcinoma. This was subsequently confirmed histologically. In patients with metastatic carcinoma, tumour deposits are frequently found in the thyroid. The most common metastatic tumour to masquerade as a primary thyroid tumour is a renal cell carcinoma. In patients with this tumour the possibility that a thyroid mass may be a metastatic deposit should always be considered.     

Fine Needle Aspiration of Sister Mary Joseph''s Nodule

A case of Sister Mary Joseph's nodule (umbilical metastasis) is described from a primary adenocarcinoma of the transverse colon. Needle aspiration cytology made the diagnosis which was confirmed by immunocytochemical localization of CEA, B72.3, EMA, and cytokeratin in the tumour cells. Extensive mucus production in the tumour cells was demonstrated by alcian blue and mucicarmine stains.     

Fine Needle Aspiration Cytology of Collagenous Spherulosis of the Breast

We present a case of a 45-year-old woman with a benign breast lump in which collagenous spherulosis was an incidental finding. Since collagenous spherulosis has a similar appearance to adenoid cystic carcinoma of breast on fine needle aspiration cytology, the two conditions can easily be confused. The problem of making this important distinction is discussed.     

Fine Needle Aspiration Cytodiagnosis As A Pre-Requisite For Primary Medical Treatment of Breast Cancer

The accurate non-surgical diagnosis of breast lumps allows assessment of breast cancer patients for conservation or neoadjuvant primary treatment before surgical intervention. We have analysed the accuracy of clinical assessment, fine needle aspiration cytology (FNAC), and mammography in over 868 women seen in a symptomatic breast clinic. Clinical examination by an experienced breast physician, together with FNAC, detected over 99% of the cancers with a 12% false positive rate. A cytological diagnosis of definite carcinoma was obtained in 69% of women with breast cancer with no false positive result from the women with benign conditions producing a 100% positive predictive value. These results indicate that it would be acceptable to give pre-surgical systemic endocrine or chemotherapy to women with positive cytology which is therefore a prerequisite for a neoadjuvant therapy programme.     

C-Erbb-2 Expression and Dna Ploidy Status In Breast Cancer Cells Obtained By Fine Needle Aspiration (Fna)

The aim of this study was to determine the relative rate of c-erbB-2 oncoprotein immuno-detection on matched fine needle aspiration (FNA) smears and surgical specimens of breast cancer, and to correlate the c-erbB-2 expression with the assessment of the DNA ploidy status. the expression of c-erbB-2 oncoprotein was evaluated using an immunoalkaline phosphatase technique in 49 breast aspirates (four benign and 45 malignant lesions) and 21 matched surgical specimens. the DNA ploidy status was assessed by densitometric techniques on Feulgen-stained smears. Fifty-eight per cent of the smears obtained from 45 malignant lesions and 43% of the 21 corresponding paraffin sections contained cells that were stained by the antibody. the higher incidence of c-erbB-2 expression on smears seems to be due mainly to the better antigen preservation in the fresh cytological preparations. the correlation between c-erbB-2 oncogene expression and DNA ploidy assessment showed an increased incidence of oncogene expression in aneuploid tumours (71% vs 29%; P > 0.05).     

Fine needle aspiration cytology of palatine tonsils: a study of 112 consecutive adult tonsillectomies

M. J. Ashraf, N. Azarpira, B. Nowroozizadeh, M. Shishegar, B. Khademi, A. Faramarzi, S. B. Hashemi, A. Hakimzadeh and E. Abedi
Fine needle aspiration cytology of palatine tonsils: a study of 112 consecutive adult tonsillectomies Objective: To study fine needle aspiration cytology (FNAC) findings of tonsillar lesions with histological controls and to assess its role in the diagnostic evaluation of tonsillectomy specimens. Methods: This study consisted of 112 cases that required tonsillectomy, comprising 55 (49.1%) men and 57 (50.9%) women. The ages ranged between 20 and 62 years. The clinical diagnosis in 101 cases was chronic tonsillitis, whereas 11 were suspected of neoplasia. FNAC was performed before tonsillectomy under general or local anaesthesia or on fresh specimens using a 21‐G needle. The smears were stained using Wright–Giemsa and Papanicolaou methods. Histological examination was carried out on surgical specimens of all cases and, when required, immunohistochemistry was performed on histological sections. The diagnostic outcomes between FNAC and surgical biopsy were compared. Results: In this study, 106 cases were diagnosed as chronic tonsillitis/follicular hyperplasia, four cases as non‐Hodgkin’s lymphoma, one as Hodgkin’s lymphoma and one as monophasic synovial sarcoma. All malignant cases were diagnosed by FNAC, but synovial sarcoma was incorrectly diagnosed as squamous cell carcinoma. Five cases clinically suspected of neoplasia were correctly diagnosed as chronic tonsillitis on cytology. Conclusion: Tonsillar aspiration is a safe procedure and is useful in the evaluation of tonsillectomy specimens. However, ancillary tests on cytological material are often needed when neoplasia is suspected and would help clinical management and allow histological examination of cases diagnosed cytologically as lymphoma.     

Fine Needle Aspiration Cytology of Cutaneous Vascular Tumours

We have studied 12 cutaneous vascular tumours by means of fine-needle aspiration cytology (FNAC): six capillary haemangiomas, one cavernous haemangioma, one Masson's pseudo-angiosarcoma, two angiosarcomas, one benign haemangioendothelioma and one glomus tumour. We describe the main cytopathological findings and we discuss the differential diagnosis in each case. We consider that the cytopathological findings of the above lesions, evaluated in the context of the clinical findings, are sufficiently characteristic for us to be able to make a definitive diagnosis. We believe that FNAC can play an important part in the diagnosis and therapeutic planning of these tumours.     

Evaluation of the Cost Effectiveness of Establishing A Fine Needle Aspiration Cytology Clinic In A Hospital Out-Patient Department

In an attempt to reduce the number of inadequate smears processed by our laboratory and the false negative rate of fine needle aspiration cytodiagnosis, we have introduced a fine needle aspiration cytology service where aspirates are taken by the cytopathologist in a clinic. In the 12 month period since the introduction of this service, the number of inadequate smears fell sharply. Nine per cent of the specimens were inadequate compared with 43% of specimens from other sources. The establishment of the clinic resulted in a threefold reduction in the cost of diagnosing breast lesions.     

Fine Needle Aspiration Cytology of Breast In Invasive Carcinoma of Tubular Type and In Radial Scar/Complex Sclerosing Lesions

Fine needle aspirates (FNA) from 31 invasive carcinomas of tubular type and 22 radial scar/complex sclerosing lesions (RS/CSL), diagnosed in Edinburgh between 1986 and 1991, were reviewed. the lesions in this study varied in size and palpability at presentation, but are of increasing interest in the differential diagnosis of non-palpable areas of increased mammographic density. In agreement with previously published information^1'5'8, it was found that the tubular cancers were usually selected for biopsy following aspiration, but less often definitively diagnosed as malignant. Nearly 50% of the RS/CSL group were correctly reported benign on cytology, but in 40%, biopsy was recommended to exclude malignancy. In addition, cytological features helpful in suggesting malignancy in aspirates from tubular cancers, also raised suspicion in aspirates from the RS/CSL group, with a risk of overdiagnosis of cancer.