PubMed · 8029438
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R M Steiner, B B Goldberg, J B Liu. 1994. US-assisted bronchoscopy.. https://doi.org/10.1148/radiology.192.2.581-c
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BACKGROUND: Over the last decade, the specimen types used to diagnose primary pulmonary malignancies at the authors' institution have changed in terms of their frequency of submission. METHODS: The authors reviewed pathologic findings in 216 cases of primary lung carcinoma diagnosed during the years 1983-1984 (earlier period) and compared these with the findings in 299 cases diagnosed during the years 1993-1994 (later period). RESULTS: The total number of transbronchial fine-needle aspirates (TBNA) increased from 13 to 206 (P < 0.0001), the total number of sputum (SP) samples declined from 236 to 36 (P < 0.0001), and the total number of forceps endobronchial biopsy (FBX) specimens increased from 61 to 119 (P = 0.0023) between the earlier period and the later period. The positivity rate of some specimen types was similar for these two periods (transthoracic percutaneous fine-needle aspirate [PFNA], 95% and 97%; bronchial washings, 61% and 60%), but the positivity of others improved by a statistically nonsignificant degree (bronchial brushings, 61-71%; FBX, 59-69%). The positivity of TBNA was 57% in 1993-1994. The collective positivity of bronchoscopic cytology specimens was significantly higher than simultaneous FBX during both periods (P = 0.0032), but bronchoscopic histology and cytology were complementary. The positivity of fiberoptic bronchoscopy (FOB) improved significantly, from 72% in 1983-1984 to 85% in 1993-1994 (P = 0.0059). During both periods, an equivalent proportion of patients were subjected to each of 3 major invasive sampling procedures (FOB, 70%; PFNA, 20%; open surgical biopsy, 10%). Fifteen patients were diagnosed by SP cytology without an invasive procedure in 1983-1984, but none were diagnosed by SP cytology in 1993-1994. CONCLUSIONS: TBNA and increased utilization of FBX have displaced postbronchoscopy SP examination, generating higher positivity for FOB. Bronchoscopic cytology and histology were complementary, but radiologically guided fine-needle aspiration was the procedure with the highest positivity.
BACKGROUND: The false-negative diagnosis is a major clinical concern and a significant cause of litigation in fine-needle aspiration cytology of breast lesions. A significant number of false-negative diagnoses may be due to inadequate sampling of these lesions. Little information is available in the literature about what constitutes an adequate specimen, and the few publications that address this issue propose criteria based on anecdotal information. Recommendations vary widely and may or may not take clinical findings into account. METHODS: The authors studied a subgroup of 183 cases with known outcome, drawn from a series of 1779 cases, to determine the minimum number of cell clusters necessary to ensure that adequate cellular material was present for accurate diagnosis. The series included 21 cases cytologically diagnosed as false-negative, 75 cases that had been correctly identified as benign, 47 cases cytologically designated as atypical, and 40 cases that on initial review had been correctly identified as malignant. In semiblind fashion, the smears from each case were assigned to low, medium, and high cellularity categories. Low cellularity was defined as 10 or fewer cell clusters, moderate cellularity was defined as 11-30 clusters, and high cellularity was defined as more than 30 clusters. A cell cluster was defined as five or more cells. Within the low cellularity group, exact numbers of cell clusters and the presence of individual cells were recorded. The presence of bipolar cells was used as an adjunct criterion for specimen adequacy, and the bipolar cells in each of 10 x 200 fields were counted. Cellularity was then correlated with diagnostic accuracy. RESULTS: Using a cutpoint of a cumulative score of 6 or more cell clusters or the prominence of bipolar cells (> or = 10 in each of 10 medium-power, x200 fields) for assessment of specimen adequacy, a false-negative rate of 1.5%, associated with an unsatisfactory rate of 20.2%, was obtained. CONCLUSIONS: Based on the data gathered in this study, the authors believe that the sampling false-negative and unsatisfactory rates can be minimized by selecting a cutpoint for satisfactory smears at a level of 6 or more cell clusters (cumulative total) or the presence > or = 10 intact bipolar cells per 10 medium-power fields (x200). Use of these criteria will decrease the false-negative rate of sampling in epithelial lesions of the breast. A false-negative rate of approximately 1.5% was obtained in association with an unsatisfactory rate of 20.2%. Using a cutpoint of 1 or more cell clusters, a false-negative rate of 2.1%, associated with an unsatisfactory rate of 13.7%, was obtained.
BACKGROUND: Cytologic criteria reported to be helpful in the distinction of proliferative breast disease without atypia (PBD) from nonproliferative breast disease (NPBD) have not been rigorously tested. METHODS: Fifty-one air-dried, Diff-Quik-stained fine-needle aspirates (FNA) of palpable breast lesions with biopsy-proven diagnoses of NPBD (34 cases) or PBD (17 cases) were reviewed. The smears were evaluated for the cellularity, size, and architectural arrangement of the epithelial groups; the presence of single epithelial cells and myoepithelial cells; and nuclear characteristics. RESULTS: The only cytologic feature found to be significantly different between PBD and NPBD was a swirling pattern of epithelial cells. A swirling pattern was noted in 13 of 17 PBD cases (76%) and 12 of 34 NPBD cases (35%) (P = 0.008). CONCLUSIONS: Because there is significant overlap in cytologic features between NPBD and PBD, the distinction between the two entities is difficult in cytologic sampling.