PubMed Health⌕ Search

Biomedical subjects

L J Layfield

Publications and source records attributed to L J Layfield.

At least 91 records · Page 5Linked to original sources
PubMed1995

Benign, dysplastic, or malignant--making sense of endoscopic bile duct brush cytology: results in 149 consecutive patients.

OBJECTIVES: To determine the efficacy of endoscopic bile duct brush cytology for diagnosis of pancreaticobiliary malignancies and to provide guidelines for interpretation of dysplastic cytology. METHODS: Consecutive endoscopic bile duct brush cytology specimens were classified by an independent cytopathologist as benign, low- or high-grade dysplasia, or cancer. A final diagnosis was established in a blinded fashion by histopathology, radiographic evidence of metastatic disease, or independent clinical follow-up. Sensitivity and specificity were adjusted for dysplastic cytology, and likelihood ratios were determined for each diagnosis and used for calculation of posttest probability of malignancy. RESULTS: Dysplasia was found in 23% of 168 consecutive bile duct brushings performed in 149 patients. Sensitivity of brush cytology was 37% and specificity 100%; its likelihood ratio for malignancy ranged from 3.4 for high-grade dysplasia, to 1.1 for low-grade dysplasia, to 0.6 for benign. For a patient with a 50% pretest probability of malignancy, finding of high-grade dysplasia changed the posttest probability to 77%, low-grade dysplasia to 52%, and benign to 38%. CONCLUSION: Cytological dysplasia occurs frequently, with high-grade dysplasia being strongly suggestive of malignancy. Presented likelihood ratios can be used to calculate the posttest probability of malignancy for any diagnosis.

Aged↗
PubMed1994

Cytomegalovirus sialadenitis in patients with the acquired immunodeficiency syndrome: a potential diagnostic pitfall with fine-needle aspiration cytology.

We report three cases of cytomegalovirus (CMV) sialadenitis which presented as parotid gland nodules in patients infected with the human immunodeficiency virus. While CMV is known to widely infect patients with the acquired immunodeficiency syndrome (AIDS), we are aware of only a single report of CMV sialadenitis in a patient with AIDS (Pialoux et al.: Rev Infect Dis 1991;13:338). Utilizing fine-needle aspiration (FNA) cytology as the initial investigative modality, two cases were correctly diagnosed preoperatively while the third case displayed atypical features and was interpreted erroneously as carcinoma leading to surgical intervention. Upon review of these cases of CMV sialadenitis, the characteristic intranuclear inclusions are best identified with Papanicolaou (Pap) staining. CMV sialadenitis should be considered in the differential diagnosis of painless salivary gland enlargement in patients with AIDS. We believe this lesion can be diagnosed preoperatively with FNA and the interpretation is aided by evaluating both Pap- and Giemsa-stained material.

AIDS-Related Opportunistic Infections↗
PubMed1994

Paranuclear blue inclusions in small cell undifferentiated carcinoma: a diagnostically useful finding demonstrated in fine-needle aspiration biopsy smears.

In a study of bone marrow aspiration smears, Wittchow et al. (Mod Pathol 1992;5:555-558) described a highly characteristic finding, paranuclear blue inclusions (PBIs), found almost exclusively in cases of metastatic small cell undifferentiated carcinoma (SCUC). PBIs are 1-4 microns, light blue, cytoplasmic inclusions best visualized with Romanowsky-type stains. These inclusions are most easily found indenting the nuclei within clusters of closely opposed tumor cells. In the current study air-dried fine-needle aspiration biopsy (FNAB) smears from 146 primary and metastatic small cell and non-small cell adult and childhood malignancies were reviewed. PBIs were found in 28/32 (88%) of SCUC but were observed in only 4/44 (9%) non-small cell carcinomas, 2/21 (9.5%) lymphomas, 1/8 (12.5%) melanomas, 0/14 sarcomas, and 6/27 (22%) small round cell neoplasms. These results suggest that the presence of PBIs in air-dried FNAB smears of adult neoplasms, while not pathognamonic of SCUC, are a diagnostically useful finding. PBIs may be seen in a variety of different childhood small round cell neoplasms which limits their utility in this setting. The recognition of PBIs is most important to the cytologist who may not have access to ancillary studies, such as immunohistochemistry and electron microscopy.

Biopsy, Needle↗
PubMed1994

Fine-needle aspiration biopsy of renal collecting duct carcinoma.

The fine-needle aspiration biopsy (FNA) findings in a case of collecting duct (ducts of Bellini) carcinoma of the kidney are described. The cytologic smears were modestly cellular and contained individual and small clusters of round to oval cells with small to moderate amounts of well-defined cytoplasm. The nuclei were large and hyperchromatic with prominent single nucleoli and focal chromatin clearing. The findings were distinct from those of the usual clear or granular cell renal-cell carcinomas and were more similar to adenocarcinomas arising in the breast, ovary, or pancreas. Because collecting duct carcinomas need to be distinguished from metastatic deposits and are believed to have a poorer prognosis than the majority of renal-cell carcinomas, preoperative diagnosis may have important therapeutic implications. The distinction of collecting duct carcinoma from the more common variants of renal-cell carcinoma and transitional-cell carcinoma is discussed.

Aged↗
PubMed1994

Laboratory compliance with federal government and professional society recommendations.

Quality assurance issues have assumed growing importance in the cytology laboratory. The 1988 Clinical Laboratories Improvement Amendment (CLIA '88) (United States Department of Health and Human Services, Federal Register: U.S. Government Printing Office 1990;55:9495) regulates the patient identifiers and clinical data on the requisition form but does not mandate physician compliance to provide the information. We investigated the use of patient identifiers and clinical data by laboratories as specimen acceptance/rejection criteria. We surveyed 81 board certified cytopathologists and 235 randomly selected cytology laboratories for acceptance criteria of cytology specimens and received responses from 104. Approximately two thirds of all responding laboratories had specific criteria for rejecting specimens on the basis of inadequate identification or clinical data. While the vast majority required the specimens to be identified with patient name, collection date, and specimen source, a minority of laboratories required clinical information such as LMP, prior atypical cytologic/histologic specimens, and history of previous therapy. Little correlation was found between practice setting and the use of rejection criteria.

Laboratories↗
PubMed1994

Focal fatty change of the liver: cytologic findings in a radiographic mimic of metastases.

Fine-needle aspiration (FNA) is being increasingly utilized for the workup of patients with suspected metastatic disease. In the course of these biopsies, cytologists are being confronted by a variety of nonneoplastic lesions which radiographically simulate metastatic deposits. Some of these lesions will predominately reveal hepatocytes. One of these cytologically poorly characterized lesions is focal fatty change. Aspirates show a population of benign hepatocytes with single or multiple clear cytoplasmic vacuoles. Recognition of the entity along with accurate needle placement in the nodule can establish the diagnosis of focal fatty infiltration and negate the need for further biopsies.

Adult↗
PubMed1994

Fine-needle aspiration cytology in the management of gynecologic oncology patients.

Fine-needle aspiration cytology has received little attention by physicians involved in the care of gynecologic oncology patients. Concerns over diagnostic accuracy and complications such as rupture of cystic ovarian tumors with resultant tumor dissemination have limited the technique's utilization. Recent studies have shown the method to have a diagnostic accuracy (percent of neoplasms correctly categorized as benign or malignant) of approximately 95% for ovarian tumors [2-8]. The method is generally free of major complication when patients are properly selected, but severe pelvic infections have followed transvaginal or transrectal puncture of cystic ovarian neoplasms, resulting in a complication rate of about 1.6% [28]. Presently, FNA of ovarian tumors has a role in the workup of cystic lesions in young women where epithelial malignancies are unlikely and preservation of ovarian function is highly desirable. In peri- or postmenopausal women with adnexal masses, operative intervention is appropriate in most cases. Sevin and colleagues defined four clinical situations where FNA is useful [16]. These are 1) workup of primary neoplasms, 2) biopsy of superficial masses in patients with known prior disease, 3) follow-up of irradiated patients, and 4) follow-up of patients undergoing chemotherapy. From the available data, FNA has an accuracy of approximately 90% [10,18] and a low complication rate. The technique is an excellent method for the detection of recurrent or metastatic disease in patients being followed for gynecologic malignancies. When FNA is used for the investigation of newly discovered adnexal masses, patient selection is critical. FNA is helpful in carefully selected young women with cystic ovarian masses. However, its utility is limited in peri- or postmenopausal women with solid and solid-cystic adnexal masses, because these should be investigated by operative intervention.

Biopsy, Needle↗
PubMed1994

Determination of proliferation index with MIB-1 in advanced ovarian cancer using quantitative image analysis.

A new monoclonal antibody, MIB-1, reacts with the same epitope recognized by Ki-67. The authors investigated the feasibility of using image analysis to quantitate the MIB-1 staining (proliferation index [PI]) of epithelial ovarian cancers. The PI was determined in 50 advanced-stage primary ovarian cancers. Paraffin sections were immunostained with the MIB-1 monoclonal antibody, and the PI was calculated using a CAS 200 image analyzer. Among 36 stage III ovarian carcinomas, the median PI was 15.1%, compared with 18.9% in 14 stage IV cancers (P = .47). Based on exploratory methods, a cutoff point of 7% best dichotomized these patients into two prognostic groups. Of 39 patients whose cancers had a high MIB-1 expression (> or = 7%), the median survival was 16.5 months, which differed significantly (P = .01) from the median survival of 33.2 months observed in the 11 patients whose tumors demonstrated low MIB-1 expression (< 7%). Using MIB-1 as a binary variable, a strong correlation was found between overexpression of c-erbB-2 (2+ and 3+) and MIB-1 > or = 7% (P = .001). No relationship was found between PI and histologic grade. Further studies are warranted to investigate the relationship between MIB-1, PI expression, and other known clinicopathologic and genetic features of early- and late-stage ovarian cancer.

Antibodies, Monoclonal↗
PubMed1993

The palpable breast nodule. A cost-effectiveness analysis of alternate diagnostic approaches.

BACKGROUND: Traditionally, open biopsy has been considered the optimal procedure for the diagnosis of breast nodules. Fine-needle aspiration biopsy (FNAB) has been proposed as an alternate method for the diagnosis of many palpable breast lesions. METHODS: The authors compared the diagnostic utility of open biopsy and FNAB using decision tree and cost-effectiveness analyses. RESULTS: When compared with two-step excisional biopsy, FNAB achieved a savings of over $700 at the cost of 0.1% decrease in 10-year overall survival. CONCLUSIONS: These data indicate FNAB to be a reasonable alternative to open biopsy for the diagnosis of palpable breast lesions in many patients.

Adult↗
PubMed1993

Diagnostic accuracy and clinical utility of fine-needle aspiration cytology in the diagnosis of clinically primary bone lesions.

Optimal treatment of primary bone sarcomas requires minimal disturbance of the tumor prior to preoperative radiation and chemotherapy. Currently, carefully planned incisional or cutting needle biopsies are the favored methods for procurement of specimens. Recently, fine-needle aspiration has gained favor as the initial diagnostic procedure at some centers. We investigated the diagnostic accuracy and the effects of errors in diagnosis and of complications on the patient's course in a series of 101 patients presenting with lesions clinically believed to have arisen in bone. We found that 29% of aspirates were insufficient for the diagnosis; 41% of aspirates yielded a correct diagnosis that had a significant favorable impact on the patient's course, while 20% of aspirates gave a correct diagnosis that did not significantly influence therapy. In 7% of cases, the aspirates were associated with an incorrect diagnosis that negatively influenced therapy, and in an additional 3% of cases an incorrect diagnosis was obtained that had no impact on patient outcome. No complications were encountered in this series of patients.

Biopsy, Needle↗
PubMed1993

Aspiration cytology of clear-cell lesions of the parotid gland: morphologic features and differential diagnosis.

Clear-cell lesions of the parotid gland are uncommon but when studied by fine-needle aspiration may result in a clinically important but cytologically difficult differential diagnosis. Clear-cell lesions involving the parotid include acinic cell neoplasm, clear cell oncocytoma, mucoepidermoid carcinoma, primary clear-cell carcinoma, epithelial-myoepithelial carcinoma, and metastatic renal cell carcinoma. Accurate diagnosis is achieved by assessment of nuclear features, other cell populations present, and clinical data including radiographic studies.

Adenocarcinoma, Clear Cell↗
PubMed1992

Clinical determinants for the management of thyroid nodules by fine-needle aspiration cytology.

To evaluate the utility of clinical features for the selection of patients with thyroid lesions suitable for diagnosis by fine-needle aspiration cytologic study, we reviewed 149 cases with complete clinical histories, laboratory evaluations, fine-needle aspirates, and histologic study of the index lesion. Review of these data demonstrated that only the presence of lymphadenopathy was of statistical value in the distinction of benign from malignant nodules. Moreover, once an aspiration diagnosis of "follicular neoplasm" had been made, no clinical, radiologic, or laboratory test aided in the distinction of follicular adenoma from follicular carcinoma.

Analysis of Variance↗
PubMed1992

Metastatic head and neck malignancy treated using MRI guided interstitial laser phototherapy: an initial case report.

Interstitial laser phototherapy (ILP) guided by magnetic resonance imaging (MRI) may become an attractive adjunctive modality for the treatment of deep and surgically inaccessible tumors of the head and neck when accurate methods of laser dosimetry and "real-time" monitoring techniques with the MRI are introduced. We recently demonstrated in ex vivo and in vivo models, a linear relationship between levels of laser energies, thermal profiles, MR signal intensity changes, and histopathological tissue damage. Results of treatment in a patient with an unresectable large right jugulodigastric metastatic squamous carcinoma using new approach of MRI guided ILP are now reported. The patient complained of significant right-sided neck pain and headaches secondary to a rapidly growing metastatic lymphadenopathy which recurred after previous surgery, radiation, and chemotherapy. Two treatment sessions were used at an interval of 2 weeks. Each treatment was performed in the MRI suite under heavy sedation. Using a 600-microns bare fiber of the Nd:YAG laser implanted interstitially under MR guidance, the metastatic node was treated at three sites. T1- and T2-weighted images were performed prior to, immediately after, 24 and 48 hours, and 4, 5, 7, 9, 16, and 25 days post-treatment. Successful relief of pain and growth arrest of this node was observed after the second treatment and at the 3-month follow-up. These results demonstrate that this technique of ILP guided by MRI may be feasible in humans, and will become clinically practical when appropriate methods of dosimetry and instrumentation are developed.

Aluminum Silicates↗
PubMed1991

Mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions. Can it replace open biopsy?

The authors report the accuracy of mammographically guided fine-needle aspiration (FNA) for the diagnosis of nonpalpable breast lesions in a series of 71 patients. Each mammographically guided FNA was immediately followed by hookwire localization and open biopsy. Seven malignancies were identified cytologically, but three cancers were not detected in aspirates judged to be sufficient for diagnosis. In addition, 19 aspirates were reported to be insufficient, and 4 of these were obtained from lesions histologically proven to be adenocarcinoma. Although no false-positive diagnoses were encountered, the technique demonstrated a sensitivity of 78% and a diagnostic accuracy of 94% for adequate specimens. In this study, mammographically guided FNA was insufficiently sensitive to replace open biopsy for the diagnosis of nonpalpable breast lesions.

Biopsy↗
PubMed1991

Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules.

Between January 1980 and December 1988, 161 patients underwent thyroidectomy with intraoperative frozen section consultation after fine-needle aspiration (FNA) of a thyroid nodule. The FNA were insufficient in 15 instances (9%) and in error in 39 (24%). In 15 cases, the incorrect aspiration diagnosis could have led to excessive surgery and in ten cases to delayed therapy if it had been the only guide for therapy. The diagnosis was deferred to permanent section analysis in 30 (19%) frozen sections. Twenty-two errors (14% of cases) were made in the interpretation of frozen section material, and in an additional 15 patients (9%), the diagnosis suggested (but deferred at frozen section) was in error. In one patient, this error could have led to more extensive surgery than necessary; in 21 patients, the frozen section error could have led to undertreatment. When frozen section results were combined with those of FNA, no therapeutically important false-positive diagnoses were made. In five patients, the combination of both FNA and frozen section results would not have identified a carcinoma which, in three cases, was a small occult papillary carcinoma not found in the index nodule.

Adenoma↗
PubMed1991

Fine-needle aspiration biopsy of orbital and periorbital masses.

We present the cytologic findings of 18 fine-needle aspirates performed on orbital and periorbital masses. An accurate specific diagnosis was confirmed by histology in ten cases. In eight cases the diagnostic evaluation and/or therapeutic regimen was significantly altered by the results of the fine-needle biopsy. In three cases the cytologic diagnoses obviated the need for open biopsy. Two specimens were insufficient for diagnosis. No false positive diagnosis of malignancy occurred. Electron microscopy was useful in three cases to confirm the correct cytologic diagnosis. Immunocytochemistry helped to define a lymphoid proliferation as monoclonal. The cytologic findings from an unusual case of sebaceous carcinoma are presented.

Adenocarcinoma↗
PubMed1991

Rhabdomyosarcomatous differentiation in a neuroblastoma: a potential pitfall in the cytologic diagnosis of small round-cell tumors of childhood.

Rhabdomyoblasts demonstrating immunoreactivity for muscle-specific actin, desmin, and myoglobin were identified in smears obtained by aspiration from a large retroperitoneal mass in a 14-mo-old girl. Following a tentative diagnosis of a rhabdomyogenous neoplasm, retroperitoneal exploration and adrenalectomy demonstrated a stromal poor neuroblastoma with extensive rhabdomyogenous differentiation. The presence of a subpopulation of rhabdomyoblasts was not diagnostic of rhabdomyosarcoma when obtained by fine-needle aspiration from a retroperitoneal tumor composed predominantly of primitive small round cells.

Adrenal Gland Neoplasms↗