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PubMed1991

Fine-needle aspiration evaluation of lymphoproliferative lesions in human immunodeficiency virus-positive patients. A multiparameter approach.

Forty-six fine-needle aspirates of lymphoproliferative lesions from 31 human immunodeficiency virus (HIV)-positive patients were reviewed using cytomorphologic, immunocytochemical, flow cytometric (FCM), cytogenetic, and molecular studies. There were 29 lymphomas (15 small non-cleaved cell [SNCL], 11 large cell [LCL], one small lymphocytic, and two Hodgkin's), 14 reactive hyperplasias, and three "atypical lymphoid proliferations." The reactive hyperplasias were characteristically polymorphic and polyclonal lymphoid populations; six of seven were diploid on FCM, the seventh was hypodiploid. Higher proliferative indices (mean, 11.6%) and higher RNA indices (mean, 1.2) characterized this subgroup compared with published reactive lymphoid hyperplasias from patients without HIV positivity. Aspirates of SNCL showed monotonous populations of intermediate-sized cells except in one patient where a giant cell syncytial variant occurred. Nine of 13 SNCL aspirates showed light chain restriction. JH rearrangement revealed B-cell lineage in one aspirate in which immunocytochemical study was negative for Kappa, lambda, B1, and Leu-4. Nine of 12 SNCL were diploid; the mean proliferative index was 25.6% and the mean RNA index 2.3. Chromosomal translocations involving the c-myc locus were demonstrated in five of seven SNCL aspirates karyotyped. Five of eight LCL showed light chain restriction the remaining three showed null cell phenotype. Large cell lymphomas were diploid on tetraploid with the mean proliferative index of 22.0% and mean RNA index of 2.2. One of two LCL aspirates karyotyped demonstrated c-myc translocation. Despite the multiparameter approach, a definitive diagnosis could not be reached in three aspirates.

Adult↗

PubMed1995

Percutaneous fine-needle aspiration of portal vein thrombi as a staging technique for hepatocellular carcinoma. Cytologic findings of 46 patients.

BACKGROUND: Detection of portal vein tumor invasion in patients with hepatocellular carcinoma (HCC) is important in determining therapy and prognosis. Fine-needle aspiration (FNA) of a portal vein thrombus under ultrasound guidance facilitates the distinction of malignant from benign thrombus without resorting to laparotomy. In this study, the FNA findings of 46 patients who underwent this procedure are described. METHODS: Cytologic findings of 48 aspirations from 46 patients who underwent percutaneous ultrasound-guided portal vein FNA were reviewed. RESULTS: Twenty-nine of the 46 patients had a prior or concurrent biopsy-confirmed diagnosis of HCC at the time of portal vein FNA. On cytologic review, 39 of the aspirates were positive for malignancy, 6 were negative, and 3 were suspicious. Histologic follow-up of three of the six patients with negative aspirates confirmed bland thrombi in their portal veins. No complications resulted from the FNA procedure. Of the 39 aspirates positive for HCC, 22 were well differentiated, 5 were well to moderately differentiated, 9 were moderately differentiated, and 3 were poorly differentiated. In all except the poorly differentiated tumors, a trabecular cellular arrangement was detected in either smears or cell blocks. The cytologic findings in these aspirates, in general, mirror those found in aspirates of HCC in the liver proper. CONCLUSIONS: Portal vein FNA is an effective, well tolerated method for disease staging of patients with HCC. When used as the initial diagnostic procedure, in selected patients, it can provide the diagnosis and staging information simultaneously.

Adolescent↗

PubMed2000

Fine-needle aspiration of scalp lesions.

A variety of inflammatory and neoplastic scalp lesions are encountered in surgical pathology. However, the literature on fine-needle aspirations (FNAs) of the scalp is exceedingly rare. We report on a series of 70 FNAs involving cutaneous and subcutaneous lesions on the scalp. A total of 70 fine-needle aspirations of cutaneous and subcutaneous scalp lesions was reviewed to identify patterns of metastasis to the scalp and to demonstrate the effectiveness of FNA in diagnosing these lesions. There were 42 male and 28 female patients, ranging in age from 29-91 yr (mean, approximately 61 yr). Sixty-one patients had a previous history of malignancy. Of these aspirates, 59 were neoplastic, consistent with the patient's known primary. One case was an abscess, and the remaining case was unsatisfactorvy for cytologic evaluation. Follow-up biopsy revealed granulomatous inflammation. The most common primary tumor to metastasize to the scalp was lung carcinoma, which was seen in 18 cases, followed by hematopoietic malignancies in 14 cases. Melanoma was identified in 6 cases, head and neck tumors in 5 cases, renal malignancies in 4 cases, gastrointestinal tumors in 3 cases, sarcoma in 3 cases, breast and prostate malignancy in 2 cases each, and an olfactory neuroblastoma and meningioma in 1 case each. The remaining 9 aspirates were from patients who did not have a previous history of malignancy. These included 6 benign aspirates consisting of 3 epidermal inclusion cysts, 2 lipomas, and 1 neurofibroma. Two aspirates were malignant and included 1 primary squamous-cell carcinoma and 1 metastatic adenocarcinoma of unknown origin. The remaining case was unsatisfactory for cytologic evaluation. Follow-up biopsy of this lesion showed noncaseating granulomas. Of the aspirates from patients with a previous history of malignancy, 97% were neoplastic. Lung carcinoma and hematopoietic malignancies were the most common neoplasms that metastasized to the scalp. Since the scalp is a common site for metastasis, awareness of this fact is useful to both oncologists and dermatologists. It must be understood that FNA can provide a rapid and accurate diagnosis in the evaluation of scalp masses.

Adult↗

PubMed2004

Thrombus aspiration prior to primary angioplasty in acute myocardial infarction: estimation of rescued myocardial tissue by return of ST-segment elevation.

BACKGROUND: The goal of the study was to validate the clinical benefit of adjunctive thrombus aspiration prior to balloon or stent angioplasty in patients with acute myocardial infarction. HYPOTHESIS: Adjunctive thrombus aspiration reduces no-reflow by eliminating peripheral thromboembolism. METHODS: In all, 143 consecutive patients underwent primary angioplasty for acute myocardial infarction in our institution. We excluded patients with subacute stent thrombosis or bundle-branch pattern of the electrocardiogram (ECG) and divided the remaining 131 into two groups: 62 patients who underwent intervention without a thrombus aspiration device (Group 1) and 69 patients who were treated as soon as a specifically designed thrombus aspiration catheter became available at our institution (Group 2). The intention was to use thrombus aspiration in every suitable case with proximal occlusion of a major vessel. The reduction of the sum of ST-segment elevation following angioplasty as a marker of rescued myocardial tissue was compared between the two groups. RESULTS: Thrombus aspiration was technically feasible in 23 of 25 attempted cases. The reduction of the sum of ST-segment elevation following intervention was 0.41 +/- 0.39 mV in Group 1 and 0.37 +/- 0.42 mV in Group 2 (p > 0.05). CONCLUSIONS: Thrombus aspiration may be helpful during primary angioplasty in selected cases but does not improve the general outcome. Other reasons for "no-reflow," apart from peripheral thromboembolism, seem to be responsible for the lack of clinical benefit.

Aged↗

PubMed2002

"Histiocytoid" cells in fine-needle aspirations of papillary carcinoma of the thyroid: frequency and significance of an under-recognized cytologic pattern.

BACKGROUND: Although the classic cytologic features of papillary carcinoma of the thyroid in fine-needle aspirates have been well described, one uncommon feature, a vacuolated, histocyte-like cell without classic nuclear changes of papillary carcinoma, has been less well characterized. METHODS: The author reviewed a large series of thyroid aspirates for specimens with these cytologic features. RESULTS: Seven specimens were identified, representing approximately 6% of all aspirates with the features of papillary carcinoma and less than 0.5% of all aspirates. The cells resembled histiocytes but were larger, more atypical, and keratin positive in the one specimen that was tested. The cells had enlarged nuclei with abundant cytoplasm that often was vacuolated. The nuclei had grainy chromatin, occasional nucleoli, and lacked grooves and prominent pseudoinclusions. The background showed numerous, hemosiderin-laden macrophages typical of cyst contents in only three specimens. Calcifications were present in six specimens and resembled psammoma bodies in two specimens. Three specimens showed papillary carcinoma at resection, two specimens had other passes from the same nodule that were diagnostic of papillary carcinoma, and two specimens were from recent patients without follow-up. Only one of the three resected tumors showed prominent cystic change. None of 50 aspirates that were diagnosed as benign cyst contents had similar atypical cells, nor did resections of six predominantly cystic, benign lesions. CONCLUSIONS: Histiocytoid cells are present in as many as 6% of all aspirates in which some features of papillary carcinoma are present. Increased awareness of these cells may help improve the sensitivity of fine-needle aspiration for the diagnosis of papillary carcinoma of the thyroid.

Biopsy, Needle↗

PubMed2004

Automation of bone marrow aspirate examination using the XE-2100 automated hematology analyzer.

BACKGROUND: Attempts to analyze bone marrow aspirates have been reported with the use of several automated blood cell counters, but sufficient accuracy in examination is not acquired yet. Major problems have included difficulties in correctly differentiating various immature cells and interference by lipid in bone marrow aspirates. The goal of this study was to solve these problems to attain more accurate assessment of bone marrow aspirates with automated blood cell counters. METHODS: We modified the XE-2100 Automated Hematology Analyzer (Sysmex Corporation, Kobe, Japan) to fit it for bone marrow aspirate measurement and evaluated its performance. Measurements were performed with the modified XE-2100 on 81 patient samples of bone marrow aspirates; as a reference, the manual visual method was used and flow cytometric analysis were carried out. RESULTS: Good correlations between results with the modified XE-2100 and the manual visual method were obtained for total nucleated cell count (TNCC; r = 0.99), erythroblast/TNCC ratio (r = 0.93), and myeloid cell/TNCC ratio (r = 0.75). CONCLUSIONS: When this device is used, bone marrow aspirate differentials can be determined quickly and easily. This device will be useful for preliminary examination to obtain a summary of various blood cell ratios in bone marrow aspirates before performance of microscopic examination.

Automation↗

PubMed2002

Cystic change in metastatic lymph nodes: a common diagnostic pitfall in fine-needle aspiration cytology.

Fine-needle aspiration cytology (FNAC) of cystic metastases is a challenging diagnostic category and has been investigated in a limited number of malignancies and sites. The present study retrospectively reviewed 1,211 FNAC of superficial masses, including lymph nodes (1,102 aspirates), benign cystic lesions (64 aspirates), and lymphocysts (45 aspirates) with the aim of determining the tumors that cause cystic change in metastases. Cytology results from 1,102 lymph node aspirations were suspicious or positive for malignancy in 541 specimens (49.1%), benign in 230 (20.9%), and unsatisfactory in 331 (30%). There were 28 malignant aspirates demonstrating cystic change (5.2%). The tumor type that most frequently caused cystic change was thyroid papillary carcinoma (42.8% of cases), followed by squamous cell carcinoma (primary in the head and neck region 30.8% and in the skin 24%), tumors of unknown origin (6.3%), serous papillary carcinoma of the ovary or endometrium (4.8%), and malignant melanoma (2.1%). Cystic change was observed most commonly in the head and neck region lymph nodes (60%). The most challenging lesions to assess using FNAC were metastatic lymph nodes showing cystic change, accounting for six of the 16 false-negative diagnoses and one false-positive diagnosis. The results of this study suggest that cystic change in metastatic lymph nodes occurs in certain types of tumors and is an important cause of diagnostic error. FNAC should be repeated in case of suspicious hypocellular cystic aspirations, especially in patients with known malignancy.

Adult↗

PubMed2006

Fine-needle aspiration of chondrosarcoma.

Fine-needle aspiration (FNA) is a reliable, safe and cost-effective procedure with an established role in the diagnosis of various solid tissue neoplasms. However, the role of FNA in the diagnosis of primary bone tumors, including chondrosarcoma (CS) is controversial. To determine the accuracy of FNA as a diagnostic procedure, the author reviewed the institutional experience of a series of patients with CS who underwent FNA for diagnosis. The author's objectives were to determine the accuracy of the technique as well as possible limitations to sensitivity and specificity, and perhaps to suggest the most appropriate use for this procedure. Computer records and then subsequently archives of the department were searched for patients diagnosed and treated for CS between 1993 and 2003. Patients without adequate clinical follow-up, missing materials or records otherwise unavailable for review were eliminated from study. All patients who underwent FNA for a diagnosis had to have a subsequent histological confirmation to be included in the study. FNAs were largely performed with image-guided assistance. In those that were palpable, the aspiration was performed by the aspiration cytologist using standard methods. Histologic materials were processed according to standard methods. All cytological and histologic materials were reviewed for accuracy and appropriateness of diagnosis by the author. There were 34 aspirates from 32 patients with CS (2 patients with 2 aspirates each). Attempts at diagnoses were made from 27 primary lesions, 6 recurrent lesions, and one metastatic lesion. There were an additional two patients who were assigned a diagnosis of CS on FNA who ultimately were proven to have chondroblastic osteosarcoma. Of the primary CS, 18 were definitively diagnosed as CS or "malignant chondroid neoplasm," 8 of the aspirates were considered equivocal in that an additional diagnostic procedure was required to clarify or confirm the diagnosis. Two aspirates were diagnosed as negative. Both of the false negatives were due to inadequate sampling of the lesion on FNA. Diagnostic accuracy of FNA for primary CS in this series was 67% (18/27). Accuracy for recurrent or metastatic lesions was higher at 86% (6/7). FNA appears to be a reliable means of diagnosis of recurrent and/or metastatic CS in patients with a documented history. In primary lesions, however, the accuracy of the technique is lower. In addition, there are problems of sampling chondroid components of non-CS lesions such as this study's experience with chondroblastic osteosarcoma.

Adult↗

PubMed1998

Motor and somatosensory deficits following uni- and bilateral lesions of the cortex induced by aspiration or thermocoagulation in the adult rat.

We have previously shown that lesions of the sensorimotor cortex induced by either thermocoagulation or aspiration produce different effects on axonal plasticity. We have now investigated whether these methods of lesion also influence the behavioral outcome. The behavioral effects of unilateral and bilateral lesions of the sensorimotor cortex induced by either aspiration or by thermocoagulation of pial blood vessels were examined in adult Sprague-Dawley rats. Rats were tested to determine limb use asymmetry by analyzing (1) coordinated forelimb placement and (2) paw use preference when rearing. Their responsiveness to somatosensory stimulation was tested by analyzing (1) the latency to remove sticky tape on the ventral surface of the paw, and (2) vibrissae-stimulated forelimb placing. Behavioral tests were performed prior to surgery and on day 4, 8, 12, 16, and 20 after surgery. Both unilateral lesions resulted in an over-reliance on the nonimpaired forelimb as early as 4 days after the surgery; functional recovery occurred after 16 days. Animals with bilateral lesions did not use either forelimb for support in postural support behaviors. However, this effect was more apparent in the animals with a thermocoagulatory lesion and, in contrast to the animals with an aspiration lesion, these animals did not show functional recovery. Animals with a unilateral aspiration, but not a thermocoagulatory lesion, showed a slowed response to tactile stimulation applied to the contralateral forelimb. After bilateral lesions, animals showed a slowed response to tactile stimulation applied to either forelimb at early time points after the lesion and recovery of function at later time points. These data indicate that, for the most part, lesions of the sensorimotor cortex by aspiration or thermocoagulation produce very similar effects on the behaviors examined in this study. However, unexpectedly, thermocoagulatory lesions induced a more severe (unilateral lesion) or prolonged (bilateral lesion) deficit in forelimb use than aspiration lesions. Conversely, the effect on tactile stimulation is more prominent after unilateral aspiration than thermocoagulatory lesions.

Animals↗

PubMed1994

Prevalence and recovery of aspiration poststroke: a retrospective analysis.

This retrospective study was undertaken to review aspiration documented by videofluoroscopic modified barium swallow (VMBS) examination in a group of patients admitted to a stroke rehabilitation unit. Forty-two of 54 patients tested demonstrated evidence of aspiration of thin liquids on VMBS performed an average of over 5 weeks following the onset of stroke. However, only patients in whom there was clinical concern of aspiration (54 of 255 stroke patients admitted to the rehab unit) were tested with VMBS evaluation. With this limitation in mind, aspiration was demonstrated in at least 9.9% of all unilateral right hemispheric patients, 12.1% of unilateral left hemispheric, 24% of bilateral hemispheric, and 39.5% of brainstem stroke patients. Of the 42 patients in whom aspiration of thin liquids was demonstrated, 31 underwent repeat VMBS studies an average of 6 weeks after the initial VMBS. 7 of these 31 (22.6%) no longer showed aspiration on VMBS. Eighteen of the 42 patients (43%) clinically stopped aspirating over this 6-week period.

Aged↗

PubMed1995

Comparison of nasopharyngeal aspirates and throat swab specimens in a polymerase chain reaction-based test for Mycoplasma pneumoniae.

Nasopharyngeal aspirates and throat swab specimens were compared in a polymerase chain reaction (PCR)-based test for Mycoplasma pneumoniae. The pathogen was detected in 50% and 45% of throat swab specimens and aspirates, respectively. However, in specimens negative for Mycoplasma pneumoniae by PCR, amplification inhibitors were detected in 0% and 36% of throat specimens and aspirates, respectively. Further investigations confirmed that no throat specimens, but one-quarter of aspirates, are likely to be rejected for containing inadequate respiratory material or excess amplification inhibitors. Because rejection of most of the unsuitable specimens is possible only after PCR, the use of aspirates is less cost-effective. This, and the reluctance to subject patients to aspiration, make the aspirate an inferior specimen for detection of Mycoplasma pneumoniae by PCR.

Adult↗

PubMed1999

Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: An evaluation of blue dye visualization in cases of known aspiration.

The reliability of the modified Evans blue dye (MEBD) test for the detection of aspirated materials in patients with tracheostomy has been questioned. The videofluoroscopic swallow study (VFSS) has been the standard procedure used to detect aspiration, but there are known risks and the VFSS is not always an available evaluation option for aspiration detection. The purpose of the present study was to investigate the visualization of blue tracheal secretions in cases of known aspiration as documented by the VFSS. Twenty consecutive simultaneous MEBD study and VFSS were completed on patients with tracheostomies at an acute rehabilitation hospital. Overall, the MEBD showed a 50% false-negative error rate. The MEBD identified aspiration in 100% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%).

Adolescent↗

PubMedDate not supplied

Pancreatic cystic neoplasms: the role and sensitivity of needle aspiration and biopsy.

BACKGROUND: The proper evaluation of patients with pancreatic cystic neoplasms remains controversial. Although computed tomography (CT) and sonography can differentiate the majority of these tumors, needle aspiration and biopsy can be helpful in selected patients. The purpose of this study was to (1) determine the sensitivity of needle aspiration and biopsy of cystic pancreatic neoplasms, (2) assess the complications after needle aspiration and biopsy, and (3) assess the indications for needle aspiration and biopsy by using the radiographic appearance as a guide. METHODS: The histories, imaging studies, and pathologic specimens of 18 patients with serous cystadenoma (10 patients) or mucinous cystic tumor (eight patients) of the pancreas who also underwent CT-guided (n = 16), sonographically guided (n = 3), or intraoperative (n = 4) needle biopsy (n = 23 total biopsies) between 1976 and 1996 were retrospectively reviewed. RESULTS: The histologic diagnosis of the serous subtype was made with needle aspiration and biopsy in five of 10 patients with serous cystadenoma. The histologic diagnosis of the mucinous subtype was made with needle aspiration and biopsy in six of eight patients with mucinous cystic neoplasms. Of the 23 biopsies performed, one patient experienced significant intraperitoneal hemorrhage. Indications for needle biopsy include an atypical cystic mass on diagnostic imaging studies, confirmation of a serous cystadenoma before observation, and confirmation of mucinous cystadenocarcinoma in patients with nonresectable disease. CONCLUSION: Needle biopsy and aspiration is a helpful and safe procedure to aid in the diagnosis of cystic pancreatic neoplasms before surgery.

Aged↗

PubMed2000

Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification.

Most people would agree that successful parathyroidectomy depends on two important variables: the surgeon's recognition and excision of the abnormal parathyroid gland(s) and the pathologist's confirmation that the removed tissue is parathyroid tissue. Frozen section is usually employed to confirm the identity of parathyroid tissue, but occasionally confirmation cannot be made without a permanent section, as with intrathyroidal glands. This study proposes a new method of expeditious and easy confirmation of parathyroid tissue utilizing the immunoassay for quick measurement of intraoperative parathyroid hormone (IOPTH). By directly aspirating the suspected adenoma, the assay becomes a rapid diagnostic tool that can be used as an alternative to frozen section. In cases where the surgeon is already planning to employ the assay, the elimination of frozen section is cost-effective. Intraoperative aspiration of histologically confirmed parathyroid adenomas was performed on 12 consecutive patients undergoing parathyroid surgery. Parathyroid glands were aspirated with a 22-gauge syringe after gland excision. Aspirates were placed in 1 to 3 ml of buffered saline. A similar process was performed on 12 thyroid controls. Specimens were centrifuged, aliquotted, and stored at -70 degrees C. The parathyroid hormone value was analyzed electively by rapid assay and the values recorded. For all parathyroid aspirates, the rapid assay value was > 1500 pg/ml, exceeding the uppermost limit of the diagnostic chart. Values for thyroid aspirates ranged from 58 to 85 pg/ml (mean 75.7 pg/ml). In all cases tissue confirmation was achieved with permanent section. Values were 100% sensitive and specific. Measurement of PTH from intraoperative aspiration of suspected parathyroid adenomas is clinically useful in patients for whom frozen section would routinely be employed. Values > 1500 pg/ml secure the tissue diagnosis. There is no additional cost in cases where IOPTH monitoring is already being utilized to confirm cure. The elimination of frozen section could be cost-effective and, for some institutions, actually decrease the operating time as the IOPTH assay takes only 15 minutes. PTH assay is an accurate diagnostic technique and to date is 100% sensitive and specific for differentiating between parathyroid tumors and thyroid nodules.

Biopsy, Needle↗

PubMedDate not supplied

Sterile fluid collections in acute pancreatitis: catheter drainage versus simple aspiration.

PURPOSE: To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in patients with acute pancreatitis. METHODS: We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages or needle aspirations were included in the study. Fifteen patients had aspiration of 10-20 ml fluid only (group A) and 22 patients had catheter placement for chronic evacuation of fluid (group C). We excluded patients with grossly purulent collections and chronic pseudocysts. We also recorded the number of sinograms and catheter changes and duration of catheter drainage. The CT severity index, Ranson scores, and maximum diameter of abdominal fluid collections were calculated for all patients at presentation. The total length of hospital stay (LOS), length of hospital stay after the drainage or aspiration procedure (LOS-P), and conversions to percutaneous and/or surgical drainage were recorded as well as survival. RESULTS: The CT severity index and acute Ransom scores were not different between the two groups (p = 0.15 and p = 0.6, respectively). When 3 crossover patients from group A to group C were accounted for, the duration of hospitalization did not differ significantly, with a mean LOS and LOS-P of 33.8 days and 27.9 days in group A and 41.5 days and 27.6 days in group C, respectively (p = 0.57 and 0.98, respectively). The 60-day mortality was 2 of 15 (13%) in group A and 2 of 22 (9.1%) in group C. Kaplan-Meier survival curves for the two groups were not significantly different (p = 0.3). Surgical or percutaneous conversions occurred significantly more often in group A (7/15, 47%) than surgical conversions in group C (4/22, 18%) (p = 0.03). Patients undergoing catheter drainage required an average of 2.2 sinograms/tube changes and kept catheters in for an average of 52 days. Aspirates turned culture-positive in 13 of 22 patients (59%) who had chronic catheterization. In group A, 3 of the 7 patients converted to percutaneous or surgical drainage had infected fluid at the time of conversion (total positive culture rate in group A 3/15 or 20%). CONCLUSIONS: There is no apparent clinical benefit for catheter drainage of sterile fluid collections arising in acute pancreatitis as the length of hospital stay and mortality were similar between patients undergoing aspiration versus catheter drainage. However, almost half of patients treated with simple aspiration will require surgical or percutaneous drainage at some point. Disadvantages of chronic catheter drainage include a greater than 50% rate of bacterial colonization and the need for multiple sinograms and tube changes over an average duration of about 2 months.

Adolescent↗

PubMed2001

The value of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: an assessment of its diagnostic potential and pitfalls.

This study was conducted to assess the diagnostic potential and pitfalls of performing fine-needle aspiration cytology (FNAC) for thyroid nodules. We retrospectively analyzed 1,012 aspirated samples obtained from 806 thyroid nodules by the ultrasound (US)-guided method. Of these 806 nodules, 226 (31%) had been surgically treated, 152 (67%) of which were histologically diagnosed as malignant. The rate of sufficient aspirate was 82%, being lower in nodules with a diameter of less than 5mm (73%, P = 0.10); either calcified (77%, P = 0.043) or benign (72%, P = 0.0002). The accuracy of FNAC was 75%, the rate of indeterminate diagnosis was 16%, the false negative rate was 13%, and the positive malignancy rate was 99%. The rate of indeterminate diagnosis was higher in adenomatous goiter, follicular carcinoma, and malignant lymphoma, at P = 0.015, P = 0.0008, and P = 0.035, respectively. The accuracy was lower in follicular carcinoma and malignant lymphoma (both at P = 0.013). Sufficient aspirate was finally obtained from 701 (87%) of the 806 nodules by repeated aspiration. Of 152 malignant nodules, 28 (18%) were diagnosed after two or more aspirations, and the accuracy was improved to 81% by repeating the procedure. These findings indicated that repeated aspiration may be a simple and effective method of improving the diagnostic potential of FNAC.

Adenocarcinoma, Follicular↗

PubMed1978

Pharyngeal aspiration in normal adults and patients with depressed consciousness.

A sensitive technic using indium111 chloride was devised to investigate the occurrence of pharyngeal aspiration. Twenty normal subjects and 10 patients with depressed consciousness were studied. Forty-five per cent of the normal subjects aspirated during deep sleep. Normal subjects who did not aspirate were noted to sleep poorly. Seventy per cent of the patients with depressed consciousness aspirated. Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium and also in normal adults during deep sleep. Bacterial pneumonia may result when aspirated bacteria are not effectively cleared. This may result when clearance mechanisms are impaired or when they are overwhelmed by large volumes of aspirated secretions.

Adult↗

PubMed1989

Fine-needle aspiration biopsy in the diagnosis of recurrent and metastatic intraabdominal malignancies.

To evaluate the efficacy of directed percutaneous fine-needle aspiration (FNA) biopsy in the diagnosis of recurrent and metastatic intraabdominal malignancies, we reviewed our experience from 1981 to 1988. Seventy-three aspirations were performed in 73 patients. Forty-six patients with a previously treated malignancy had aspiration to diagnose either locally recurrent or metastatic disease. The remaining 27 patients had liver aspiration to rule out metastases from suspected or unknown primary sites. Computed tomography and ultrasonography were equally effective in providing diagnostic material, which was obtained from 68 of 73 aspirates. No serious morbidity occurred. Fifty-seven patients had a metastatic or recurrent malignancy, and 3 had primary hepatocellular carcinoma. Fine-needle aspiration biopsy correctly identified 51 (85 percent) of these 60 cases. There were no false-positive results and five false-negative results. Aspiration results obviated the need for a diagnostic laparotomy in 49 of the 60 patients with malignancy (82 percent). We conclude that directed percutaneous FNA biopsy is a safe and accurate method of diagnosing recurrent and metastatic intraabdominal malignancies.

Abdominal Neoplasms↗