Histocytological correlation in fine needle aspiration biopsy of the thyroid gland]

Monoclonal antibodies are useful probes for analyzing cells at the molecular level at various developmental stages. Although identification of the genes encoding tissue- and stage-specific antigens could be informative for further molecular analysis, gene cloning is usually a time-consuming step, particularly when a monoclonal antibody is the only probe available. We describe here an immunocytochemical method for preliminary and immediate analysis of the regulation of antigen-coding genes. mRNAs purified from stage 27 and 38 Xenopus tadpoles were fractionated by size and injected into newt oocytes, from which frozen sections were prepared for immunostaining with tissue-specific monoclonal antibodies. Both of the antigens we tested, which are early markers for differentiating epidermal cells of Xenopus tadpoles, were detected in mRNA injected oocytes, but not in control oocytes. Immunostaining for each of the antigens showed that their relative levels in stage 27 and 38 tadpole tissue were reflected in those oocytes injected with mRNA purified from tadpoles of the respective stages. We suggest that this oocyte translation system combined with immunostaining provides for rapid analysis of changes in levels of antigen coding mRNAs throughout development.     

The use of fine needle aspiration biopsy in the management of thyroid disease

Fine needle aspiration biopsy is now a first line investigation in thyroid disease. The purpose of this study was to evaluate the results of this technique in comparison with routine histopathology. A total of 593 aspirations over a four year period were included. There were 390 (65.7%) solitary nodules, 124 (20.9%) multinodular goiters, 66 (11.1%) diffuse goitres and 13 (2.2%) recurrent post thyroidectomy nodules. Radioisotope scanning in 386 cases showed 325 (84.2%) cold nodules, 54 (14.0%) warm nodules and 7 (1.8%) hot nodules. There were 458 (77.2%) colloid goitres and cysts, 14 cases of thyroiditis (2.2%) and 30 malignancies diagnosed on fine needle aspiration biopsy. In 19 cases (3.2%) a diagnosis of follicular neoplasm and in 29 cases (4.9%) a diagnosis of suspicious aspirate was made. Histological results were available in 176 cases. In 108 cases findings of histology and FNAB were compared with radioisotope scanning. A sensitivity of 92.8% and 42.8%, a specificity of 90.1% and 98.7% and accuracy index of 90.3% and 94.3% was found, when considering suspicious cases alternatively as positives and negatives. Surgery was recommended in all suspicious cases to prevent reduction in sensitivity of the technique. Fine needle aspiration biopsy was found to be a highly effective procedure which can obviate a lot of unnecessary surgery in thyroid lesions.     

CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration

AIMS: We retrospectively investigated the diagnostic accuracy and complication rate of transthoracic core biopsy using an automated biopsy gun and compared the findings with those of aspiration needle biopsy. PATIENTS AND METHODS: Seventy-three patients underwent 74 core biopsy procedures and 50 patients underwent 52 aspiration biopsy procedures. Of these, a final diagnosis was obtained in 107 lesions with surgery or clinical course. Fifteen patients in which a final diagnosis was not obtained were excluded from the study on diagnostic accuracy. Thus, in the study of diagnostic accuracy, 63 core biopsy procedures for 62 lesions are included. Core biopsy was performed with an 18 G cutting needle using an automated biopsy gun. Aspiration biopsy was performed with a 20 G aspiration needle. RESULTS: Core biopsy yielded sufficient material in 57/63 procedures (90.5%). A correct diagnosis was obtained in 36 procedures (85.7%) for malignant leisons and a specific benign diagnosis was obtained in 11 procedures (52.4%). Aspiration biopsy yielded a correct diagnosis in 26 procedures (81.3%) for malignant leisons and in seven (46.7%) for benign lesions. The overall correct diagnosis were 75.8% and 71.7% with core biopsy and aspiration biopsy, respectively. Core biopsy gave a higher predictive rate than that of aspiration biopsy for both benign and malignant lessons (P < 0.02). Pneumothorax occurred in 18/74 (24.3%) patients with core biopsy and in 18/45 (40.0%) patients with aspiration biopsy. Of these, three with core biopsy and two with aspiration biopsy needed tube drainage. The other complication was haemoptysis, which occurred in six patients following core biopsy and in three after aspiration biopsy. All nine cases subsided spontaneously. There were no fatal complications. CONCLUSIONS: Core biopsy with a biopsy gun increase the diagnostic accuracy with a higher histologic predictive rate and no obvious additional risk of complications.     

Macrofollicular variant of papillary thyroid carcinoma diagnosed by fine needle aspiration biopsy: a case report

BACKGROUND: Macrofollicular variant of papillary thyroid carcinoma (PTC) is an uncommon, recently described thyroid tumor. By frozen section it can be confused easily with goiter or macrofollicular adenoma. CASE: A 41-year-old female presented with a huge mass in the right thyroid lobe, cold on scintigraphy. By fine needle aspiration fluid was obtained. Smears of the sediment of the fluid showed epithelial cells with morphologic features diagnostic of PTC. Frozen section diagnosis was benign. CONCLUSION: This is the first reported case of macrofollicular variant of PTC diagnosed preoperatively by cytology. In our case the cytology was similar to that of cystic PTC.     

Preparation of fine needle aspiration biopsy samples for flow cytometric analysis

In order to improve the quality of flow cytometric (FCM) DNA histograms, a new preparatory method was tested on samples obtained by fine needle aspiration biopsy (FNAB) of breast tumors. Twenty-four samples were obtained in vivo (group 1), and 20 were obtained from surgically resected specimens (group 2). Tumors from both groups were aspirated twice each. The first sample was injected directly into 70% ethanol, whereas the second sample was pretreated with a mixture of Tween-20 and citric acid solution (Tween-20 CA) before ethanol fixation. The coefficient of variation (CV) of G0-G1 peaks of Tween 20 CA-pretreated samples varied from 1.85 to 5.10 (mean, 3.3) in group 1 and from 1.87 to 3.72 (mean, 2.77) in group 2. The CV of G0-G1 peaks of ethanol-preserved samples ranged from 2.28 to 7.22 (mean, 5.23) in group 1 and from 1.78 to 4.04 (mean, 3.48) in group 2. The CV values of histograms obtained by the new protocol were significantly lower (group 1, P < .05; group 2, P < .01).     

Pediatric thyroid nodules: management in the era of fine needle aspiration

BACKGROUND/PURPOSE: Thyroid nodules are rare in children. The need to uncover malignancy is the most challenging dilemma in management. The aim of this report was to determine whether management of pediatric thyroid nodules has changed in the era of fine-needle aspiration (FNA) cytology. METHODS: Twenty-four children with thyroid nodules comprised the study group. Demographic characteristics, clinical manifestations, imaging results, FNA cytology results, surgical therapy, complications, and pathological reports were reviewed retrospectively. FNA cytology results were categorized as either benign, malignant, suspicious, or insufficient. RESULTS: Girls outnumbered boys (five to one) with a mean age of 14.9 years. Nineteen nodules were benign and five malignant. Malignancy was characterized by localized tenderness, multiglandular appearance, and fixation to adjacent tissues. Ultrasound scans and nuclear scans gave no clue toward management because cystic, hot, and warm nodules figured among malignant cases. FNA in 18 children achieved 80% accuracy, 60% sensitivity, 90% specificity, 75% positive, and 81% negative predictive value. Physical examination findings, persistence of the nodule, and progressive growth decided for surgery in most children. CONCLUSIONS: FNA is a safe adjunctive test that plays a minor role in the decision to withhold surgery. Its greatest strength is to resolve, in case of suspicious or malignant cytology, that a more radical procedure will be needed. Clinical judgement as determined by serial physical findings continues to be the most important factor in the management of thyroid nodules in children.     

Diagnosis of occult thyroid carcinoma by thyroid ultrasonography with fine needle aspiration cytology

OBJECTIVE: To assess the role of ultrasonography and fine needle aspiration cytology (FNAC) in preoperative diagnosis of patients with occult thyroid carcinoma (OTC). STUDY DESIGN: Data on 768 thyroid carcinoma patients receiving primary treatment at Chang Gung Medical Center were retrospectively reviewed. Of these patients, 97 had OTC. To detect small thyroid nodules early and define the characteristics of clinically palpable nodules, thyroid ultrasonography with FNAC were performed on 67 histopathologically proven OTC patients. Analysis for diagnostic value was done for ultrasonography and FNAC. RESULTS: In the 67 patients receiving ultrasonography with FNAC, 23 were preoperatively diagnosed as having papillary thyroid carcinoma and 1 as having follicular carcinoma. The tumor size of these 24 preoperative FNAC-proven OTC was 0.81 +/- 0.23 cm (mean +/- SD). In the remaining patients, 10 presented pictures suspicious for malignancy, with a mean tumor size 0.63 +/- 0.24 cm, and 33 (49.3%) were diagnosed as having benign thyroid lesions in preoperative FNAC. The tumor size in these 33 lesions was 0.58 +/- 0.24 cm. Fifty-seven of the 67 OTC patients received frozen sections. Thirty-eight papillary thyroid carcinomas and four follicular carcinomas were correctly diagnosed on frozen sections. CONCLUSION: Although the rate is not high, high-resolution ultrasonography and FNAC is the best approach to preoperative diagnosis for OTC patients today.     

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy

PURPOSE: To define the accuracy and clinical impact of fine needle aspiration biopsy (FNAB) in diagnosing recurrent breast cancer after mastectomy. MATERIAL AND METHODS: The results of ultrasonography (US) and US-guided FNAB of 175 lesions located at the mastectomy site or in the ipsilateral axilla were reviewed. The final diagnosis was recurrent cancer in 77 cases and benign lesion in 98 cases, as verified by histological examination (n = 77) or follow-up (n = 98). RESULTS: FNAB yielded a representative aspirate in 92.6% of cases. The sensitivity, specificity and overall accuracy of FNAB cytology were 96.1%, 89.8% and 92.6% respectively. US and FNAB cytology were complementary methods in recurrent cancer diagnosis. The cytologic examination increased the specificity of US. The only recurrent tumor which appeared benign both sonographically and cytologically was removed because of a suspicious finding at palpation. FNAB cytologic diagnosis was found to have a clinical impact in 92.2% of the recurrent cases. CONCLUSION: US-guided FNAB provided an accurate adjunct to clinical examination and mammography for diagnosing and excluding breast cancer recurrence after mastectomy.     

Preliminary results of fine needle aspiration biopsy histology in upper gastrointestinal submucosal tumors

To elucidate the characteristics of lung cancer complicated by pneumoconiosis, we compared the clinical features of complicated and uncomplicated lung cancer cases. The average age at onset was higher for patients with pneumoconiosis than for those without. Because pneumoconiosis presents various respiratory symptoms, subjective symptoms were less important than objective symptoms in detecting lung cancer complicated by pneumoconiosis. Although fiberoptic bronchoscopy was the predominant diagnostic method, it could not be used with the pneumoconiosis patients. Diagnoses of lung cancer complicated by pneumoconiosis were made more after by percutaneous needle aspiration cytology. Squamous cell carcinoma is the most frequent form of cancer in patients with pneumoconiosis, which suggests that the inhalation of carcinogens may play a role in the pathogenesis of lung cancer. With respect to the smoking index (SI), histological specimens indicated that the incidence of squamous cell carcinoma in patients with pneumoconiosis was significantly higher in heavy smokers (SI > or = 600) than in light smokers (SI < 600) or nonsmokers. It is suspected that smoking affects carcinogenesis of pneumoconiosis. No differences in the distribution of lung cancer (right-left, hilar-peripheral) distinguished the 2 groups. Many of the patients with peripheral-type lung cancer and pneumoconiosis had tumors in the lower lung lobes. These findings underline the importance of encouraging pneumoconiosis patients to avoid lung cancer by not smoking, and to have lung cancer detected in its early stages by undergoing regular medical exams.     

Outpatient needle aspiration biopsy of the prostate

The use of aspiration needle biopsy and needle biopsy of the prostate is described in 38 cases. Aspiration needle biopsy is a fast, safe and reliable procedure that requires no special equipment. It can be used as a preliminary office screening procedure in the diagnosis of carcinoma of the prostate.     

Fine needle aspiration biopsy of the pancreas

This article covers basic topics such as indications, contraindications, techniques and complications. Individual sections focus on the differential diagnosis between adenocarcinoma and benign or reactive processes, diagnosis of pancreatic endocrine tumors, and the diagnosis of cystic lesions using pancreatic cyst fluid analysis including cytopathology.     

Thymic carcinoid. Report of a case with diagnosis by fine needle aspiration biopsy

BACKGROUND: Fine needle aspiration biopsy (FNAB) affords a less expensive, less morbid approach to masses within the complex anatomy of the mediastinum as opposed to surgical biopsy. Given the current state of computed tomography guidance and the available cell block preparations and ancillary studies, definitive diagnosis of mediastinal tumors is possible. CASE: A 19-year-old male presented with weight loss and muscle weakness. Computed tomography revealed an anterior superior mediastinal mass with attachment to the posterior sternum and anterior aorta. FNAB yielded hyperchromatic cells with densely clumped chromatin and prominent nucleoli. These were present as single cells and clusters. Cell block preparations were studied with immunoperoxidase methods and were strongly positive for chromogranin and glucagon, supporting the diagnosis of carcinoid tumor. Surgical excision yielded a 7-cm, unencapsulated, red-brown tumor with medium-sized cells with oval to round nuclei, scant and granular cytoplasm and coarse "salt and pepper" chromatin with prominent nucleoli. The cells were arranged in islands and bands and were associated with prominent capillaries and dense, collagenous septae. Immunoperoxidase and electron microscopy demonstrated numerous intracytoplasmic, nonspecific neurosecretory granules and positivity for somatostatin, synaptophysin, cytokeratin and chromogranin. CONCLUSION: FNAB affords an accurate and timely diagnosis of an anterior mediastinal tumor without the necessity for open biopsy and also offers accurate surgical planning and decreased morbidity.     

Value of immunoperoxidase staining of thyroglobulin in fine needle aspiration cytology of thyroid diseases

To elucidate the value of thyroglobulin staining by the immunoperoxidase method in fine needle aspiration cytology of thyroid diseases, it was performed on fine needle aspiration smears of 57 cases of various thyroid diseases. Thirteen of 22 cases (59%) with benign nodular goiter were positive. Eight of 14 cases (57%) with papillary thyroid carcinoma were positive. Among these eight cases with positive staining, seven were at clinical stage II or less. Among the other six cases with negative staining, five cases were in clinical stage III or more. There was a significant relationship between clinical stage and thyroglobulin staining (P < .05). One of 10 cases with thyroid cysts was positive. One of four cases with anaplastic carcinoma was positive. One of two cases with follicular thyroid carcinoma was positive. Two cases of subacute thyroiditis were positive. One case of Hashimoto's thyroiditis was positive. Two cases of metastatic thyroid cancer from the ovary were negative. These results reveal that positive thyroglobulin staining was helpful in defining the source of tissue from the thyroid. However, negative staining could not definitively exclude a thyroid origin. Positive thyroglobulin staining in papillary thyroid carcinoma correlated with less advanced clinical stages.     

Comparative evaluation of fine needle aspiration cytology and biopsy of testis in diagnosis of male infertility

Infertility has a fair degree of male factor contribution in its aetiology, hence needs complete evaluation of male partner especially the status of spermatogenesis. In the present study comparative evaluation of fine needle aspiration cytology (FNAC) and biopsy of testis showed 90% accuracy of FNAC in respect of histopathological diagnosis of spermatogenesis. FNAC is a safe, fairly accurate, outdoor investigation in infertile man and it is devoid of the complications of haematoma formation, suppression of spermatogenesis and antigenic stimulation as seen with testicular biopsy.