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PubMed1991

Fine-needle cytology of the breast: a controlled study of aspiration versus nonaspiration.

We report on 534 breast masses examined by fine-needle aspiration cytology. Two samples were obtained from each mass, one with aspiration and the other without. Aspiration, equivalent to that obtained by a 20-ml syringe on full aspiration, was obtained by an automatic aspirator. The two sampling modalities did not differ apart from aspiration and were compared in terms of inadequate sampling rates. The inadequacy rate was the same in 166 cancers (6.6%), whereas a significant difference was recorded in favor of aspiration (13.6 versus 24.4%) in 368 benign masses. When inadequate results were excluded, the accuracy of the two modalities was almost the same. Sensitivity was 97.4% and 96.7% and specificity was 99.4% and 99.3% for sampling with and without aspiration, respectively. Reducing the rate of inadequate sampling from benign masses seems to be the major advantage of aspiration. Double sampling, independent of the specific techniques, reduced inadequacy rates to very low levels (1.2% for cancers; 5.9% for benign masses) and may be useful as a routine policy.

Biopsy, Needle↗

PubMed1989

Measuring gastric contents during general anaesthesia: evaluation of blind gastric aspiration.

Various medications have been reported to decrease gastric content volume and thus risk for pulmonary aspiration. The majority of studies have used blind gastric tube aspiration of stomach contents as the method of measuring the volume of gastric contents. This study evaluated the accuracy of this method by first measuring gastric content volume using blind gastric aspiration and then aspirating residual content in the stomach, using a visually guided flexible fiberoptic gastroscope. Ten obese patients undergoing elective surgery were studied. Gastric contents were collected using a multi-orificed gastric tube and blind aspiration. Immediately after this was completed, residual gastric volume was collected using a visually guided gastroscope. The sum of these two aspirate volumes (true total gastric volume) was statistically compared with the blind aspirate volume. The blind aspirate volume underestimated true total gastric volume by an average of 14.7 ml and was significantly different from true total gastric volume (p less than 0.05). Blind gastric aspiration was thus demonstrated only to approximate true gastric volume. Its use to measure precisely gastric volume cannot, therefore, be recommended.

Adult↗

PubMedDate not supplied

Usefulness and limitation of manual aspiration immediately after pneumothorax complicating interventional radiological procedures with the transthoracic approach.

The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement, but chest tube placement was required in 15 patients. Requirement of chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 670 mL. Percutaneous manual aspiration of the pneumothorax performed immediately after the procedure might prevent progressive pneumothorax and eliminate the need for chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL), chest tube placement should be considered.

Adult↗

PubMed2000

The risk profile of trabecular aspiration versus trabeculectomy in glaucoma triple procedure.

OBJECTIVE: This study was set up to establish the relative safety and effectiveness of trabecular aspiration in combination with phacoemulsification and intraocular lens (IOL) implantation (phacoaspiration) for decreasing intraocular pressure (IOP), and to compare the outcome of this method of treatment with that of standard filtering glaucoma triple procedure (phaco-trab). STUDY DESIGN: Prospective, randomized study. PARTICIPANTS: The study consisted of 40 eyes of 40 patients with uncontrolled exfoliation glaucoma without a history of previous intra- or extraocular surgery and in need of cataract surgery. INTERVENTION: Temporal clear corneal phacoemulsification and foldable IOL implantation was performed in all eyes. In the phaco-aspiration group, trabecular aspiration was performed with a suction force of 100-200 mmHg under light tissue-instrument contact using a modified intraocular aspiration probe. A modified Cairns-type trabeculectomy without adjunctive antimetabolites was performed superiorly in the phaco-trab eyes after IOL implantation. MAIN OUTCOME MEASURES: The surgical outcome was assessed in terms of IOP change, need for adjunctive glaucoma medication, visual acuity outcome, and incidence of complications. RESULTS: At 1 year after combined surgery, mean (+/-SD) IOP and number of glaucoma medi- cation were 19.5+/-2.7 mmHg and 0.6+/-0.5 in the phaco-aspiration group, compared with 17.5+/-2.4 mmHg and 0.3+/-0.4 in the phaco-trab group. Hyphema (38%) and ocular hypotony (14%) were observed in the phaco-trab group only, whereas blood reflux (52%) and descemetolyses (23%) were seen exclusively in the phaco-aspiration group. CONCLUSION: In exfoliative eyes, trabecular aspiration in combination with phacoemulsification and IOL implantation is less effective in reducing postoperative IOP and number of glaucoma medications than the standard filtering glaucoma triple procedure. The risk profile, however, appears to be more favorable in the phaco-aspiration-treated eyes than in the phaco-trab group. Trabecular aspiration in glaucoma triple procedure could serve as a possible treatment of choice for exfoliative eyes with coexisting cataract and glaucoma.

Aged↗

PubMed2000

Use of arterial oxygen saturation, heart rate, and blood pressure as indirect objective physiologic markers to predict aspiration.

If an indirect bedside variable can reliably predict whether an objective instrumental dysphagia evaluation is needed, time and money can be saved without compromising patient care. To date, the search for a reliable indirect subjective marker of aspiration has not been successful. However, research on indirect objective markers of aspiration is alluring. The purpose of the present study was to investigate changes, if any, in the physiologic parameters of arterial oxygen saturation (SpO(2)), heart rate, and blood pressure during simultaneous objective confirmation of aspiration status with Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Sixty adult subjects were divided into 4 groups of 15. Group 1 did not require supplemental oxygen and did not aspirate. Group 2 did not require supplemental oxygen and exhibited aspiration. Group 3 required supplemental oxygen and did not aspirate. Group 4 required supplemental oxygen and exhibited aspiration. Simultaneous SpO(2), heart rate, and blood pressure measurements were collected at 1-min intervals, i.e., pre-FEES baseline for 5 min; during FEES; and post-FEES for 5 min. Results indicated no significant differences in SpO(2) levels based on aspiration status or oxygen requirements for any of the 4 groups. A consistent pattern of higher heart rate values during FEES and continuing for 5 min post-FEES was observed for all 4 groups. A consistent pattern of higher blood pressure values during FEES and then lower blood pressure values post-FEES was observed for all 4 groups. It was concluded that the use of changes in SpO(2), heart rate, or blood pressure values as indirect objective markers of aspiration was not supported.

Adult↗

PubMed1995

In vitro embryo production after microinjection and ovarian dynamics following transvaginal follicular oocyte aspiration.

Ultrasound-guided transvaginal follicular aspiration of oocytes from live cows combined with IVM, IVF and in vitro culture (IVC) is a procedure for producing preimplantation-stage bovine embryos and a source of oocytes for pronuclear microinjection of DNA for producing transgenic cattle. This experiment was designed to compare in vitro embryo development rates between oocytes derived from transvaginal follicular aspiration and those obtained from cows at slaughter. Nine cows were subject to a twice-weekly aspiration. Oocytes were aspirated with a 5 MHz ultrasound transducer packaged in a vaginal probe equipped with a dorsal-mounted needle guide (16-ga). All visible follicles (>2 mm) were punctured with a 17-ga, 55-cm needle at each aspiration session and the contents removed under vacuum suction. Oocytes underwent IVM/IVF/IVC. Microinjection of DNA was performed during the pronuclear stage of development, and the zygotes were co-cultured on Buffalo Rat Liver (BRL) cells in modified M199 at 39 degrees C in 5% CO2 and air. After 7 d in culture, embryos were removed and scored for development. A Chi-square analysis was used to compare transvaginal follicular-derived oocytes (microinjected and not) and slaughterhouse-derived, matured in transit oocytes (SHDMT; microinjected and not). Nonmicroinjected embryos resulting from IVF of transvaginal aspiration-derived oocytes developed to blastocysts at a higher rate than SHDMT oocytes (40.0 vs 30.8%; P < 0.05). There was no difference in development rates between the microinjected groups (aspiration = 15.9% vs SHDMT = 12.8%). Higher proportions of the embryos generated from the aspirated oocytes were of excellent or good quality following culture (P < 0.05). In the present experiments the effects of microinjection may overshadow some effects of ova source, but transvaginal follicular aspiration may provide a more consistent, synchronous population of oocytes than those derived from commercial slaughter house sources for use with in vitro systems.

Journal Article↗

PubMed1996

Effects of aspiration vacuum and needle diameter on cumulus oocyte complex morphology and developmental capacity of bovine oocytes.

The effects of aspiration vacuum and needle diameter on the morphology of the cumulusoocyte-complex (COC) and developmental capacity of the oocyte after IVF was studied in 2 experiments using a disposable ovum pick-up needle guidance system whose construction permits its use in vitro. In Experiment 1, the relationship was determined between the aspiration vacuum, expressed in millimetre of mercury, and the actual amount of water aspirated by the system, expressed in millilitre per minute. In Experiment 2, five different levels of aspiration vacuum for 3 different needle diameters (18g, 19g and 21g) were tested in slaughterhouse ovaries. The cumulus-oocyte complexes (COCs) were divided into 3 categories: 1) oocytes with a compact cumulus, 2) oocytes with an expanded cumulus and 3) naked oocytes. The results show that a change of needle diameter can triple the amount of fluid actually aspirated. The highest oocyte recovery rates are obtained when using the thickest needle (18-g), regardless of the aspiration vacuum. On the average, for all needle types, more oocytes are recovered at the highest aspiration vacuum. For all needle diameters, the proportion of oocytes surrounded by a compact cumulus decreases progressively as the vacuum increases. Regardless of the vacuum applied, thinner needles result in a higher proportion of recovered COCs with a compact cumulus. At a high aspiration vacuum, naked oocytes become predominant regardless of the needle diameter. The prevalence of blastocysts, expressed in proportion to the recovered COCs, decreases as the aspiration vacuum increases, being especially noticeable between 70 and 130 mm Hg.

Journal Article↗

PubMed2004

The risk of aspiration of pureed food as determined by flexible endoscopic evaluation of swallowing with sensory testing.

OBJECTIVE: This study evaluates the risk of aspiration of pureed foods in patients with dysphagia with increasing sensory deficits of the hypopharynx with intact versus impaired pharyngeal muscular tone (pharyngeal squeeze). STUDY DESIGN: Two hundred four dysphagic patients underwent flexible endoscopic evaluation of swallowing with sensory testing and were prospectively divided into 3 groups, with normal, moderate, and severe sensory deficits. Each group was divided into those with normal and those with impaired pharyngeal squeeze. Subjects were given pureed food boluses and were evaluated for aspiration. RESULTS: There was a significant difference in the incidence of aspiration of pureed foods for normal and moderate sensory loss when comparing normal and impaired pharyngeal squeeze (P < 0.001, Fisher exact test). There was no significant difference in the severe sensory loss group. In both the normal and impaired pharyngeal squeeze groups, there was no significant difference in aspiration as the sensory deficit increases. CONCLUSIONS: Patients with impaired pharyngeal squeeze at different levels of sensory deficits are at significantly greater risk for aspiration of pureed foods compared with those with normal squeeze. However, as sensory deficits increased, the patients did not show a significant increase in aspiration. The aspiration of pureed foods may depend more on muscle tone of the hypopharynx than on sensation. Dysphagic patients who are given a pureed diet to prevent aspiration may still be at risk for aspiration. This may be easily predicted by the use of flexible endoscopic evaluation of swallowing with sensory testing in conjunction with evaluation of pharyngeal muscle tone.

Adolescent↗

PubMed2001

Needle aspiration of breast abscesses.

BACKGROUND: Traditional treatment of breast abscesses involves incision and drainage, with and without ultrasound guidance. These procedures cause considerable discomfort and morbidity for the patient. This study was conducted to determine whether needle aspiration of breast abscesses without ultrasound guidance was an effective treatment modality. METHOD: In our prospective study, 30 patients with 33 breast abscesses were treated by needle aspiration of pus, oral antibiotics, and repeat aspiration, if necessary. All were outpatients, and ultrasonography was not used. Twenty-five of the 30 patients were lactating. RESULTS: Eighteen patients required only a single aspiration, 9 patients required multiple aspirations, and 6 patients required incision and drainage (overall cure rate, 82%). Those patients in whom needle aspiration was successful had a significantly smaller volume of pus on initial aspiration (4.0 mL versus 21.5 mL, P = 0.002) and were more likely to have presented earlier than those not cured by aspiration (5.0 days versus 8.5 days, P = 0.006). CONCLUSION: Needle aspiration without ultrasound guidance is an effective treatment for breast abscesses.

Abscess↗

PubMed2001

Aspiration of human neutrophils: effects of shear thinning and cortical dissipation.

It is generally accepted that the human neutrophil can be mechanically represented as a droplet of polymeric fluid enclosed by some sort of thin slippery viscoelastic cortex. Many questions remain however about the detailed rheology and chemistry of the interior fluid and the cortex. To address these quantitative issues, we have used a finite element method to simulate the dynamics of neutrophils during micropipet aspiration using various plausible assumptions. The results were then systematically compared with aspiration experiments conducted at eight different combinations of pipet size and pressure. Models in which the cytoplasm was represented by a simple Newtonian fluid (i.e., models without shear thinning) were grossly incapable of accounting for the effects of pressure on the general time scale of neutrophil aspiration. Likewise, models in which the cortex was purely elastic (i.e., models without surface viscosity) were unable to explain the effects of pipet size on the general aspiration rate. Such models also failed to explain the rapid acceleration of the aspiration rate during the final phase of aspiration nor could they account for the geometry of the neutrophil during various phases of aspiration. Thus, our results indicate that a minimal mechanical model of the neutrophil needs to incorporate both shear thinning and surface viscosity to remain valid over a reasonable range of conditions. At low shear rates, the surface dilatation viscosity of the neutrophil was found to be on the order of 100 poise-cm, whereas the viscosity of the interior cytoplasm was on the order of 1000 poise. Both the surface viscosity and the interior viscosity seem to decrease in a similar fashion when the shear rate exceeds approximately 0.05 s(-1). Unfortunately, even models with both surface viscosity and shear thinning studied are still not sufficient to fully explain all the features of neutrophil aspiration. In particular, the very high rate of aspiration during the initial moments after ramping of pressure remains mysterious.

Cytoplasm↗

PubMed1996

Randomized comparison of ultrasonic aspiration versus conventional electrocautery for dissection of the human internal thoracic artery.

The most common technique currently employed to harvest the internal thoracic artery for coronary artery bypass grafting is conventional electrocautery. This study compared an alternative method, electrocautery with an ultrasonic aspirator, for harvesting the internal thoracic artery. Patients were randomly assigned to one of six experimental groups (conventional electrocautery, ultrasonic aspirator at settings of 60%, 80%, and 100% power output, and ultrasonic aspirator in 100% CAVI-Pulse modes 1 and 3). Ring segments of internal thoracic artery were studied in an organ bath. Contraction responses were elicited with 123 mmol/L potassium physiologic salt solution, KPSS, KPSS solution containing noradrenaline, and a cumulative noradrenaline dose-contraction curve. Relaxation studies were performed with the vasodilators acetylcholine, bradykinin, and sodium nitroprusside. Forty percent of the electrocauterized vessels were traumatized or damaged and failed to respond to contractile stimuli, whereas only 10% of the vessels in ultrasonic aspirator groups 60%, 80%, and 100% failed to respond. All vessels in the group harvested by ultrasonic aspirator in 100% CAVI-Pulse mode 1 responded, whereas 20% of the vessels in the group harvested by ultrasonic aspirator in 100% CAVI-Pulse mode 3 failed to respond. All settings of electrocautery with an ultrasonic aspirator produced a greater contractile response to KPSS and noradrenaline. Acetylcholine and sodium nitroprusside produced similar relaxations in all groups, but the bradykinin responses were significantly improved in all groups undergoing 100% electrocautery with an ultrasonic aspirator. These results suggest that 100% electrocautery with an ultrasonic aspirator, particularly in 100% CAVI-Pulse mode 1, resulted in less damage and trauma than conventional electrocautery during harvesting of the internal thoracic artery.

Adult↗

PubMed1998

Successful sperm retrieval by percutaneous epididymal and testicular sperm aspiration.

PURPOSE: We evaluated the safety and efficacy of percutaneous sperm aspiration from the epididymis or testicle as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperm for use in intracytoplasmic sperm injection. MATERIALS AND METHODS: We present our experience with 69 sperm aspiration procedures in men considered to have nonreconstructible obstructive azoospermia. This short outpatient procedure was performed using a butterfly needle with the patient under intravenous sedation and local anesthesia. RESULTS: Of the 32 diagnostic aspirations 20 demonstrated mature and motile sperm, 9 maturation arrest and 3 germ cell aplasia. In 35 of 37 therapeutic sperm aspirations (95%) adequate samples of sperm after processing (mean of 5.4 million) were obtained. Of 24 epididymal aspirations 13 (54%) had sufficient residual sperm for cryopreservation of 1 to 5 vials (mean 2.5) containing an average of 170,000 sperm per vial. In the 32 intracytoplasmic sperm injection cycles 221 of 392 eggs (56.3%) fertilized (2PN) and 6 resulted in ongoing pregnancies (21.4% per transfer). There have been no acute or chronic complications in this patient population. Ten men underwent a second successful aspiration procedure for intracytoplasmic sperm injection and 3 underwent a third aspiration without added difficulty. CONCLUSIONS: Percutaneous epididymal or testis sperm aspiration is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive, costly and technically difficult.

Adult↗

PubMed1989

A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer.

Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.

Biopsy↗

PubMed2003

Testicular and epididymal percutaneous sperm aspiration in men with either obstructive or nonobstructive azoospermia.

OBJECTIVES: To investigate our experience with epididymal and testicular sperm obtained by percutaneous aspiration to determine the effectiveness of these procedures in patients with obstructive or nonobstructive azoospermia. We also report on the pooled outcome of intracytoplasmic sperm injection, performed at six in vitro fertilization centers, using sperm from these two patient populations. METHODS: A method of percutaneous aspiration of sperm was developed to facilitate diagnostic biopsy and therapeutic aspiration. A total of 265 aspirations were performed for diagnostic and therapeutic purposes from August 1995 through July 2001. RESULTS: Mature sperm were found in 34 (47%) of 73 men with nonobstructive azoospermia, who underwent testicular sperm aspiration for diagnostic purposes. In 56 procedures for men with nonobstructive azoospermia who underwent testicular sperm aspiration for intracytoplasmic sperm injection, an adequate number of viable sperm was obtained from 46 (82%), with an oocyte fertilization and clinical pregnancy rate of 55% and 44%, respectively. In men with obstructive azoospermia who underwent percutaneous epididymal sperm aspiration, viable sperm were found in 91 (97%) of 94 procedures, with an oocyte fertilization and clinical pregnancy rate of 58% and 39%, respectively. Sperm were obtained in 18 (100%) of 18 procedures in men with obstructive azoospermia who underwent testicular sperm aspiration, with a corresponding fertilization and clinical pregnancy rate of 51% and 38%, respectively. A small (less than 1 cm in diameter) subcapsular hematoma was the only complication. CONCLUSIONS: Percutaneous aspiration of sperm is an effective, safe, and reproducible means of obtaining adequate sperm for diagnosis or intracytoplasmic sperm injection in patients with obstructive or nonobstructive azoospermia. Our experience indicates that similar results can be obtained in both patient groups.

Adult↗

PubMed2003

Rapid recurrence of endometrioma after transvaginal ultrasound-guided aspiration.

OBJECTIVE: Ultrasound-guided aspiration is a less invasive management option for recurrent endometrioma. We postulated that the endometriotic tissue in the epithelial lining of endometrioma had undergone pressure atrophy after a period of observation, and resolution of the endometrioma can be achieved by aspiration of its content. STUDY DESIGN: A prospective study was carried out in which patients with recurrent endometrioma that remain stationary in size for a period of at least 6 months were included. Ultrasound-guided aspiration of endometrioma was performed transvaginally under conscious sedation. Ultrasound scan examination was performed at 1, 3, 6, and 12 months after aspiration to detect recurrence. RESULTS: Eight endometriomas were aspirated in six patients. The mean diameter and volume of endometrioma at aspiration were 31.0 mm (range, 18.0-46.3 mm) and 21.9 ml (range, 3.16-52.0 ml), respectively. There were no major complications. Cytological examination revealed hemosiderin-laden macrophages; neither malignant cells nor endometrial cells were detected in all cases. Six ovarian cysts recurred in five women (83.3%), all recurrence were detected within 3 months after aspiration. CONCLUSION: We concluded that although transvaginal ultrasound-guided aspiration is a safe procedure, but the recurrence rate after aspiration is unacceptably high, and hence cannot be recommended as a treatment option for recurrent endometrioma.

Endometriosis↗

PubMed2002

EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication.

BACKGROUND: EUS-guided fine-needle aspiration is rapidly becoming the procedure of choice for the diagnostic evaluation of pancreatic masses. Acute pancreatitis has been reported after EUS-guided fine-needle aspiration of the pancreas. This study evaluated the effect of EUS-guided fine-needle aspiration on the pancreas by serial measurement of amylase and lipase levels and determining the frequency of acute pancreatitis after EUS-guided fine-needle aspiration of pancreatic masses. METHODS: In 100 consecutive patients referred for EUS-guided fine-needle aspiration of a pancreatic mass, amylase and lipase levels were determined immediately before and within 2 hours after the procedure. Additionally, patients were questioned as to the occurrence of symptoms of acute pancreatitis within 48 hours after EUS-guided fine-needle aspiration. RESULTS: For 2 of 100 patients (2%) there was clinical and biochemical evidence of acute pancreatitis after EUS-guided fine-needle aspiration. Both patients had a history of recent pancreatitis. In addition, there was a significant increase in postprocedure lipase levels (p = 0.40) compared with amylase levels in this patient subset. CONCLUSION: The frequency of acute pancreatitis after EUS-guided fine-needle aspiration of the pancreas was 2% in this study. A history of recent pancreatitis appears to be a potential risk factor. Amylase and lipase levels can be elevated after EUS-guided fine-needle aspiration and in most cases have no clinical significance.

Aged↗

PubMed1989

Transbronchial fine-needle aspiration. Reliability and limitations.

Transbronchial needle aspiration is a new method of sampling pulmonary, paratracheal, and mediastinal masses. A total of 116 aspirations of the lung performed during a two-and-a-half-year period were reviewed. The results were compared with those of bronchial wash, bronchial brush, sputum, transbronchial forceps biopsy, and histologic material subsequently obtained during surgery or at autopsy. Clinical information was also reviewed. Transbronchial needle aspiration was performed on 104 patients, yielding 116 specimens. With the use of a combination of aspiration, wash, brush, sputum, and forceps biopsy, malignancy was detected in 48 patients. Open biopsy, mediastinoscopy, and transcutaneous needle aspiration increased the number of malignant neoplasms detected to 72. The tumors were detected in 67% of these 72 cases by a combination of all bronchoscopic methods. Transbronchial aspiration correctly identified 36% of malignant cases compared with 35% identified by wash, 39% by brush, 25% by sputum, and 59% by forceps biopsy. The overall accuracy of the techniques was 56% for aspiration, 48% for wash, 56% for brush, 35% for sputum, and 71% for forceps biopsy. Malignant cases were associated with cellular transbronchial aspirates, good preservation of cell detail, and a high degree of cytologic/histologic correlation regarding cell type. Transbronchial fine-needle aspiration has the potential for improving the diagnostic ability of bronchoscopy. However, the high incidence of false negative diagnoses is the main limitation for the technique, and the responsible factors are discussed.

Adult↗

PubMed1996

Aspiration cytology of neoplastic and non-neoplastic ovarian cysts: is it accurate?

To evaluate the role of aspiration cytology in the distinction between neoplastic and non-neoplastic ovarian cysts, we examined the cytology of 81 aspirates from 80 women 14-67 years of age. We then correlated results with subsequent histology or the clinical follow-up. Aspiration were performed during laparoscopy (32 cases) or immediately after surgical removal of the tumors (49 cases). The cysts ranged in size from 1.0 to 43.0 cm. Papanicolaou-stained cytospin preparations of samples were evaluated, and the lesions were classified into non-neoplastic (68 cases), benign neoplasms (four cases), and malignant neoplasms (nine cases). Cytologic impressions were correlated with histologic findings in 74 cases and with the clinical follow-up in the remaining seven. Nine of the 12 (75%) cystadenocarcinomas, including two serous neoplasms of low malignant potential (LMP), were correctly diagnosed as malignant by cytology. There were no false-positive results. On the other hand, of the 26 benign neoplasms (19 cystadenomas and seven mature cystic teratomas), only four teratomas (15%) could be subclassified specifically. The remaining 68 aspirates were classified as non-neoplastic. Seventy-seven percent of all proven non-neoplastic cysts measured < 8.0 cm, whereas 77% of all benign and malignant neoplastic cysts were > 8.0 cm. The overall diagnostic accuracy was improved from 63% to 69% when cyst size was taken into consideration. In malignant cysts the diagnostic sensitivity was 75%, specificity 100%, and overall accuracy 96%. We arrived at the following conclusions: Aspiration cytology is an accurate predictor of malignancy in ovarian cystic lesions, but because the sensitivity of the technique is not high enough, one should not rely on aspiration cytology alone; The differential diagnosis between cystadenocarcinomas and tumors of low malignant potential cannot be made by cytology; Although it is difficult to distinguish between benign neoplasms and non-neoplastic benign cysts, diagnostic accuracy will improve when the size of the lesion is considered; Aspiration cytology can provide particularly useful information in young women with functional cysts of the ovary to avoid an unnecessary operation; Acellular cyst fluids should not be considered nondiagnostic because they represent benign cysts in the majority of cases; false-negative results of fine-needle aspiration of cystic ovarian lesions is usually due to low cellularity of the sample and secondary degenerative changes; negative fine-needle aspiration results should be followed clinically.

Adolescent↗