Fine needle aspiration biopsy of extramedullary leukemia

OBJECTIVE: To study the cytologic features and role of fine needle aspiration biopsy (FNAB) in the diagnosis of extramedullary leukemia. STUDY DESIGN: Forty-one cases of extramedullary leukemia diagnosed by FNAB were analyzed along with their detailed clinical and hematologic features. RESULTS: Common sites of leukemic involvement were lymph nodes (34), skin (4), orbit (1), eyelid (1) and breast (1). The most common variety of leukemia was chronic myeloid in the chronic phase (17). Twenty-six patients were referred to the cytology clinic for FNAB as the initial screening test. In the majority of fresh cases, leukemia was not the first possibility considered, and FNAB played an important diagnostic role. No gross discrepancy was noted in any of the cases. CONCLUSION: FNAB is helpful in the diagnosis of extramedullary involvement by leukemia because of the good morphologic detail of blasts and other granulocytic cells. However, for more accurate subclassification of a hematologic disorder, other hematologic investigations are mandatory.     

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.     

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.     

Transbronchial needle aspiration and percutaneous needle aspiration for staging and diagnosis of lung cancer

In summary, knowledge of the exact location of lymph nodes in mediastinum and hilar areas and their relationship to the puncture site of TBNA is the first step to a successful TBNA. The necessity to determine the N3 status and multistation status of patients with bronchogenic carcinoma being evaluated for surgery and the current financial restraint of the medical care system further highlight the potential of this simple, effective, and safe procedure. TBNA can markedly enhance the diagnostic yield of flexible bronchoscopy. TBNA and PCNA are complimentary procedures.     

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.     

Implantation metastasis after percutaneous transthoracic needle aspiration biopsy

The risk of tumour spread at aspiration biopsy of pulmonary tumours through the needle track has been analyzed by reviewing the case histories of 1 264 patients with a malignant tumour demonstrated by needle biopsy. Only in one case did metastatic tumour growth develop at the site of the biopsy. The history of this case is presented and the available literature on the subject discussed.     

Fine needle aspiration biopsy in hepatic Echinococcus multilocularis

OBJECTIVE: To determine the fine needle aspiration biopsy (FNAB) findings in hepatic Echinococcus multilocularis. STUDY DESIGN: FNAB and tru-cut liver needle biopsy were applied in 14 hepatic E multilocularis cases. Cytologic smears were stained with May-Grünwald-Giemsa and periodic acid-Schiff (PAS) stain. Tissue sections were stained with hematoxylin-eosin (HE) and PAS stain. RESULTS: In tissue sections, homogeneous, thin, cystic structures of various dimensions strongly stained with PAS. Mucoid material was stained with PAS in the cystic structures. Wide, coagulative necrosis was observed in all cases. In some cases there were foreign body-type giant cells at the periphery of the lesion. In all the cytologic smears there were an intense necrotic ground, PAS-positive hyaline cuticular structures and mucoid globules; in some cases there were foreign body-type giant cells. CONCLUSION: The above cytologic characteristics are basic diagnostic criteria for FNAB of E multilocularis.     

Transcutaneous needle biopsy of the lung

Spinal muscular atrophy (SMA) is a frequent autosomal recessive neurodegenerative disorder leading to weakness and atrophy of voluntary muscles. The survival motor neuron gene (SMN) is a strong candidate for SMA and present in two highly homologous copies (telSMN and cenSMN) within the SMA region (5q11.2-q13.3). More than 90% of SMA patients show homozygous deletions of at least exon 7 of telSMN, whereas absence of cenSMN seems to have no clinical consequences. In 23 non-deleted SMA patients, we searched for intragenic mutations of the SMN genes in exons 1-7 and the promotor region by single strand conformation analysis. We identified two different missense mutations, S2621 and T2741, in exon 6 of telSMN in three independent SMA families, providing further evidence for the telSMN gene as a SMA determining gene. Both mutations, as well as two previously described mutations (Y272C and G279V) are located within a highly conserved interval from codon 258 to codon 279 which seems to be an important functional domain of the telSMN protein. Recently, this region has been shown to contain a tyrosine/glycine-rich motif, which is also present in various RNA binding proteins, suggesting a potential role of SMN in RNA metabolism. Missense mutations might be useful for in vivo and transgenic experiments and further investigations on understanding the function of the telSMN protein.     

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).     

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.     

Apoptosis and cytologic differentiation in hepatocellular carcinoma on fine needle aspiration samples

OBJECTIVE: To evaluate possible alterations of the mechanisms leading to apoptosis in hepatocellular carcinoma by studying bcl-2 expression on fine needle aspiration biopsy (FNAB) samples using immunocytochemistry. STUDY DESIGN: The study was performed on a series of 84 hepatocarcinomas aspirated under ultrasound guidance. A Papanicolaou-stained smear for each case was destained and restained for bcl-2 by using the immunoperoxidase technique. bcl-2 Expression was then correlated with cytologic grading and the size of the tumor. RESULTS: In 16 cases (19%), bcl-2 immunostaining gave a specific cytoplasmic signal. Fourteen of these positive cases were well differentiated, and two were pleomorphic tumors. Six positive cases were smaller than 5 cm, 3 were larger than 5 cm, and 7 were diffuse. CONCLUSION: A significant percentage of hepatocellular carcinomas produce and accumulate bcl-2 protein in cell cytoplasm. bcl-2 Expression can be detected on destained cytologic smears. bcl-2 Expression seems to correlate with the cytologic degree of differentiation but not with the size of the tumor.     

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.     

Fine needle aspiration biopsy of the liver. Principal diagnostic challenges

Fine needle aspiration biopsy (FNAB) is the diagnostic procedure of choice for evaluation of liver lesions. Although primarily applied to malignant disease, it is also used in the evaluation of benign conditions. Improvements in imaging techniques and advances in cytologic interpretations, as well as production of new biopsy needles, have all contributed to the rapid increase in radiologically guided liver FNAB.     

Fine needle aspiration biopsy of breast carcinoma in pregnancy and lactation

OBJECTIVE: To delineate the cytomorphologic features seen in cancer of the breast during pregnancy and lactation, to compare them to the cytomorphologic parameters in benign conditions and to determine the feasibility of differentiating features of malignant breast carcinoma from those of benign breast lesions during pregnancy. STUDY DESIGN: The study group consisted of pregnant or lactating women with breast carcinoma and with benign breast lesions who underwent fine needle aspiration (FNA) of the breast lesions. The findings of FNA were reviewed, analyzed, tabulated and correlated with the pathologic diagnosis of the breast biopsies. RESULTS: Eleven patients had malignant cytomorphologic changes, including increased cellularity, multilayering, enlarged and pleomorphic nuclei, single or multiple nucleoli, mitosis and numerous isolated tumor cells. Secretory changes were scanty. The background was foamy and necrotic. FNA of the benign lesions showed a biphasic cell pattern with cohesion; minimal nuclear pleomorphism; single, regular nucleoli; and naked nuclei in a granular background with foamy macrophages. Increased cellularity with nuclear atypia, single cells and a dirty background was seen in benign and malignant conditions. CONCLUSION: The main cytologic features that differentiate breast carcinoma from benign conditions during pregnancy and lactation are crowding and overlapping of nuclei, dyscohesion and enlarged, pleomorphic nuclei with irregular nuclear membranes, coarse nuclear chromatin and mitoses. Pregnancy-related hyperplastic changes with atypia can potentially result in a false positive diagnosis of carcinoma.     

Fine needle aspiration biopsy of salivary gland, 1985-1995

Cellular insulin resistance in polycystic ovary syndrome (PCOS) has been shown to involve a novel postbinding defect in insulin signal transduction. To find possible mechanisms for this defect, adipocytes were isolated from age- and weight-matched obese normal cycling (NC) and PCOS subjects. Insulin sensitivity for glucose transport stimulation was impaired in PCOS adipocytes (EC50 = 290 +/- 42 pmol/L) compared to that in NC cells (93 +/- 14; P < 0.005). The lipolytic responses to isoproterenol as well as maximal suppression by insulin were similar in NC and PCOS adipocytes. However, PCOS cells were less sensitive to the antilipolytic effect of insulin (EC50 = 115 +/- 33 pmol/L) compared to NC cells (42 +/- 8; P < 0.01). Treatment of adipocytes from NC subjects with the adenosine receptor agonist N6-phenylisopropyl adenosine had no effect on either insulin responsiveness or sensitivity for glucose transport stimulation. However, N6-phenylisopropyl adenosine treatment was able to normalize insulin sensitivity in PCOS cells (EC50 = 285 +/- 47 vs. 70 +/- 15 pmol/L, before and after treatment; P < 0.05). In conclusion, our results suggest that insulin resistance in PCOS, as accessed in the adipocyte, occurs at an early step in insulin signaling that is common for glucose transport and lipolysis. In addition, this insulin resistance involves an impairment of the system by which adenosine acts to modulate insulin signal transduction.     

Immediate assessment of fine needle aspiration cytology of lung

BACKGROUND AND OBJECTIVE: To report five cases of vitreous opacification in phacolytic glaucoma (PG). PATIENTS AND METHODS: The records of patients with PG were retrospectively reviewed. A total of 135 eyes with PG were studied to determine the presence of vitreous opacification. RESULTS: Five eyes with PG demonstrated opacification of the vitreous, which was first noted at surgery and confirmed postoperatively. All patients had had symptoms of PG for 7 days or more (mean +/- SD, 10.6 +/- 2.4 days) before they sought medical attention. Three eyes had a hypopyon on preoperative examination; two of these eyes showed refractile crystals in the anterior chamber. The opacities resolved spontaneously in all five eyes over a period of 12 weeks and interfered with visual activity only in the immediate postoperative period. CONCLUSION: Vitreous opacification in PG is a self-limited process that may not require surgical intervention unless more rapid visual rehabilitation is desired. The vitreous opacification probably results from an exaggeration of the process causing the anterior chamber reaction.     

Fine needle aspiration biopsy of metastatic malignant melanoma with "rhabdoid" features. Frequency, cytologic features, pitfalls and ancillary studies

OBJECTIVE: To characterize the cytopathology of metastatic malignant melanoma (MM) with "rhabdoid" features, a recently described, rare morphologic variant of MM that can be incorrectly diagnosed in fine needle aspiration (FNA) biopsy. STUDY DESIGN: A retrospective review of all FNA biopsy material with the diagnosis of metastatic MM was performed at two institutions. Only cases with a predominant composition of cells that met criteria defined as "rhabdoid" morphology were selected for study. The cytomorphologic features, immunocytochemistry and clinical features of these cases were reviewed. RESULTS: Of 88 FNA cases previously diagnosed as metastatic MM, 4 (4.6%) had a predominance of cells with rhabdoid features. These cases consisted of scattered atypical cells having enlarged, eccentrically placed nuclei; prominent nucleoli; and a moderate amount of cytoplasm possessing round, globular inclusions in Papanicolaou- and Diff-Quik-stained smears. Immunochemistry showed strong S-100, HMB-45 and vimentin staining in two of four cases. CONCLUSIONS: Metastatic MM may present in FNA biopsy as a poorly differentiated malignancy with rhabdoid features, potentially leading to an incorrect cytologic diagnosis. MM must be considered when evaluating neoplasms with a rhabdoid phenotype. Correlation of the cytologic finding with the clinical history and immunohistochemical studies can help in diagnosing this morphologic variant.