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PubMed2000

Percutaneous epididymal sperm aspiration versus microsurgical epididymal sperm aspiration for irreparable obstructive azoospermia--experience with 100 cases.

PURPOSE: This study investigated the sperm retrieval success rates, fertilization rates, pregnancy rates, and complications of percutaneous epididymal sperm aspiration (PESA) and microsurgical epididymal sperm aspiration (MESA) in cases of irreparable obstructive azoospermia. METHODS: During a period of 36 months, 100 men with irreparable obstructive azoospermia underwent 109 cycles of sperm retrieval procedures and intracytoplasmic sperm injection (ICSI). We routinely performed PESA first in each retrieval cycle; MESA and/or testicular sperm extraction (TESE) were performed if PESA failed. The sperm retrieval success rates, mean fertilization rates, and pregnancy rates of PESA and MESA were evaluated. RESULTS: PESA was performed in all 109 retrieval cycles with a successful sperm retrieval rate of 61%. When PESA failed to retrieve a sufficient number of viable sperm, MESA was subsequently performed with a sperm retrieval rate of 93%. Three cases, which had failed retrieval with both the PESA and MESA procedures, received TESE successfully. The rates of fertilization and pregnancy were 56% and 39% in the 66 PESA-ICSI cycles, respectively, and 47% and 45% in the 40 MESA-ICSI cycles. No significant differences were found in fertilization rates or pregnancy rates among the various sperm retrieval methods and obstruction etiologies. The overall mean fertilization rate and pregnancy rate were 51% and 41%, respectively. CONCLUSION: Both PESA and MESA can be used successfully to obtain sufficient sperm for ICSI. PESA cannot replace MESA in some cases as some epididymal pathologies prevent its success. The results of this study indicate that PESA should be the treatment of choice for patients with ductal obstruction distal to the epididymis, owing to its higher initial success rate. In contrast, patients with irreparable epididymal obstruction might achieve better success rates with MESA.

Epididymis↗

PubMed2001

Comparing the acceptability of manual vacuum aspiration and electric vacuum aspiration as methods of early abortion.

OBJECTIVE: to compare the acceptability of manual vacuum aspiration (MVA) and electric vacuum aspiration (EVA) as methods of early (< or = 77 days' gestation) abortion. METHODS: We interviewed 42 women who had been randomly assigned to either MVA or EVA and compared their perceptions of the two procedures. RESULTS: The experiences and perceptions of women in the two groups were similar in many ways. The majority of women in both procedure groups were very satisfied with the method used, and most indicated that they would prefer the same method if they were to have another abortion. CONCLUSION: This study found no major differences in the acceptability of MVA and EVA among women undergoing early abortions.

Abortion, Induced↗

PubMed2004

Diagnostic utility of fine needle non-aspiration cytology versus fine needle aspiration cytology in breast masses.

Fine needle aspiration cytology (FNAC) and fine needle non-aspiration cytology (FNNAC) techniques were studied in 145 cases of breast masses. All the needle-sampling procedures were done by single operator. The samples were assessed cytologically and evaluated using five parameters i.e. background blood or clot, amount of cellular material, degree of cellular degeneration, degree of cellular trauma and retention of appropriate architecture. Differences between all the individual parameters as observed in FNAC and FNNAC smears were insignificant. After evaluation of FNNAC and FNAC on the basis of these scores, greater number of diagnostically superior samples were obtained by FNNAC; however by FNAC more number of diagnostically adequate smears were observed. This difference was statistically significant. The number of unsuitable smears were also more by FNNAC technique.

Biopsy, Fine-Needle↗

PubMed1989

Immunocytochemical analysis of cytocentrifuged fine needle aspirates. A study based on lung tumors aspirated in vitro.

The value of Cytospin preparations of fine needle aspiration (FNA) biopsy material for immunocytochemical analysis was investigated using aspirates obtained from 23 resected human lung tumors. The results were compared with those on cryostat sections from the same tumors. The Cytospin preparations of the FNA biopsies gave the best immunostaining reactions and enabled a comprehensive range of monoclonal antibodies (MAbs) to be utilized. The quality of the Cytospin immunostaining compared favorably with that on cryostat sections of the same tumors and generally yielded a similar immunophenotype. However, the Cytospin preparations were not suitable for staining with MAb Ki67, which detects an antigen associated with cellular proliferation. With Ki67, conventionally prepared smears were much superior and enabled an assessment of tumor growth fraction that concurred with the growth fraction calculated from cryostat sections in most cases.

Antibodies, Monoclonal↗

PubMed1978

Transthoracic aspiration biopsy. The distribution of the non-neoplastic cells in aspiration biopsies from different types of malignant lung tumours.

In an earlier paper concerning classification of aspirated May-Grünwald-Giemsa stained malignant tumour cells from lung lesions, we found the sensitivity to be 80--95 per cent for adenocarcinomas, undifferentiated carcinomas and small cell carcinomas. For epidermoid carcinomas the sensitivity was only 64 per cent. It was therefore found of interest to see if a registration of the non-neoplastic cells could be an aid in the cytological tumour cell classification. An analysis has been performed of the distribution of the non-neoplastic cells in 71 aspiration biopsies from six different types of malignant lung tumours. A variegated population of many and different types of infalmmatory cells, mast cells and alveolar epithelial cells was a characteristic finding in biopsies from neoplasms with an epidermoid differentiation.

Biopsy, Needle↗

PubMed1996

[Value of fine-needle aspiration and extemporaneous examination in thyroid surgery. A prospective study of 1235 fine-needle aspirations and extemporaneous examinations in 846 patients].

We report a prospective study conducted from 1993 through 1995 in 846 patients (mainly women) consulting for a thyroid nodule. There were 465 multinodular goiters and 373 single nodules. The clinical diagnosis was obvious in 8 patients who were excluded. Pre-operative fine-needle aspiration was performed in 1235 patients and per-operative extemporaneous examinations in 569. These two simple reliable examinations, with few significant complications in skillful hands, are complementary. Fine-needle aspiration gives reliable histology data for thyroid nodules and should always be included in the pre-operative workup. Extemporaneous pathology examination of the surgical specimen provides information for adapted surgery and avoids morbidity due to reoperation.

Adolescent↗

PubMed1989

Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate.

This placebo-controlled trial compared the effects of preoperative, intravenous cimetidine (300 mg) or ranitidine (50 mg) on gastric pH and gastric volume in 31 adult patients requiring general anesthesia. The elapsed time from drug administration to initial gastric sampling did not differ significantly between ranitidine (45 minutes), cimetidine (48 minutes), or placebo (52 minutes) treated patients. Ranitidine, but not cimetidine, significantly (P = 0.02) increased gastric pH when compared with placebo. Gastric pH correlated (r = 0.7, P = 0.01) with cimetidine concentration in gastric fluid at induction. Gastric pH was directly proportional to ranitidine concentration in gastric fluid at induction, but the correlation was weak (r = 0.54, P = 0.1). The H2 blockers did not significantly alter gastric volume when compared with placebo. The number of patients with gastric pH less than = 2.5 and gastric volume = greater than 25 ml did not differ significantly between cimetidine (8%), ranitidine (10%), and placebo (22%). No clinical evidence of aspiration pneumonitis was found in our study patients.

Adult↗

PubMed2006

The reliability of fine-needle aspiration biopsy as the initial diagnostic procedure for palpable masses: a 4-year experience of 730 patients from a community hospital-based outpatient aspiration biopsy clinic.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is a reliable, rapid, minimally invasive alternative to surgical biopsy when it is performed by physician specialists for the diagnosis of palpable masses. FNAB may be under-utilized in community hospitals in the U.S. because physicians without specialty training commonly provide the service, resulting in less reliable results. METHODS: Records were reviewed retrospectively from 730 consecutive FNAB cases that were performed and interpreted by expert cytopathologists practicing in an outpatient community hospital setting between 2000 and 2004. Data concerning patient demographics, referring physician specialty type, body sites, diagnoses, specimen adequacy, accuracy of diagnosis, and follow-up were examined and analyzed. RESULTS: FNAB was diagnostic in 93% of patients and was 95% accurate. There were 5 false-negative results and no false-positive results for the diagnosis of malignancy. The overall sensitivity of FNAB was 93%, and the specificity was 100%. Using either histology or clinical follow-up, the positive predictive value was 100%, and the negative predictive value was 99%. CONCLUSIONS: Highly reliable results can be obtained when patients are referred to specialty-trained cytopathologists practicing in the community for FNAB of palpable mass lesions. Clinicians are encouraged to seek out and support specialized FNAB services in their own communities.

Adult↗

PubMed1989

Determination of false negative rate in fine-needle aspiration of prostate. Study of sequential aspirations in 30 untreated carcinoma patients.

Despite several studies comparing the diagnostic accuracy of core needle biopsy and fine-needle aspiration (FNA) in the diagnosis of prostatic adenocarcinoma, no clear picture of the false negative rate for FNA is available. We studied 101 follow-up FNA evaluations in 30 patients with untreated well-differentiated carcinoma. The patients were followed for a median of two years and seven months and had from two to seven FNA follow-up evaluations (median = 2.5 evaluations per patient). If three inadequate evaluations are omitted, the combined rate of positive plus suspicious FNA biopsies was 92.9 percent (88.8% plus 4.1%, respectively). The residual false negative rate was 7.1 percent. The clinical features and follow-up data are described. A semiquantitative definition of "suspicious for malignancy" is suggested. We conclude that in experienced hands. FNA is a highly efficacious method for the diagnosis of prostatic adenocarcinoma.

Adenocarcinoma↗

PubMed2002

Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy.

The objective of the present study is to compare the cytologic features of islet cell tumor (ICT) of pancreas obtained by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and computed tomography guided FNA (CT-FNA). We also describe the cytologic features associated with malignant ICT. Eleven cytology samples from 121 CT- FNA and 30 EUS- FNA of the pancreas were obtained from nine patients with ICT. Diff-Quik, Papanicolaou, and immunohistochemical stains to determine neuroendocrine differentiation and the hormonal status were evaluated. Cytologic features and specimen adequacy were compared between the two techniques. Cytologic features noted in both benign and malignant ICT were also compared. Nine patients (5 men, 4 women) ranging in age from 29 to 84 years (mean age, 53.8 years). Diagnoses consisted of benign (4) and malignant (5) ICT. EUS-FNA was superior to CT-FNA in obtaining adequate cells (2/2 v 7/9) for the diagnosis and increased cellularity to perform additional immunohistochemical stains (2/2 v 4/7). Single, plasmacytoid cells with finely granular chromatin distribution characterized ICT on cytology. Mitoses (3/5) and necrosis (1/5) were noted in malignant ICT but not in benign ICT. EUS-FNA is superior to CT- FNA for obtaining cells for the diagnosis of ICT. Detection of mitoses and or necrosis from patients with ICT should initiate a search for metastasis.

Adenoma, Islet Cell↗

PubMed1998

CT-guided transthoracic fine-needle aspiration versus transbronchial fluoroscopy-guided needle aspiration in pulmonary nodules.

PURPOSE: To evaluate the diagnostic yield of CT-guided (CTNAB) and fluoroscopy-guided transbronchial (TBNA) fine-needle aspiration cytology in pulmonary nodules and to compare their complications. MATERIAL AND METHODS: Thirty patients with pulmonary nodules not abutting upon the chest wall and inaccessible to bronchoscopy were randomised for CTNAB or TBNA. Eighteen patients underwent CTNAB and 16 TBNA. Four patients underwent both procedures. RESULTS: In the CTNAB group, a definitive diagnosis could be made in 14 (78%) out of 18 patients whereas in the TBNA group, a definitive diagnosis was made in 11 (69%) out of 16 patients. This difference was not statistically significant (p > 0.05). The final diagnosis in 29 out of 30 patients comprised primary bronchogenic carcinoma in 14 patients, metastases in 5 patients, and benign lesions in 10 patients (34%) of which 3 lesions (30%) were of tuberculous aetiology. There were 2 asymptomatic pneumothoraces in the CTNAB group and no complication was observed in the TBNA group. CONCLUSION: Both techniques were safe and effective in the diagnosis of peripheral pulmonary lesions. TBNA was best suited for lesions larger than 3 cm and located in the middle and lower lobes while CTNAB could be used for any lesions.

Adult↗

PubMed2002

Comparing suprapubic urine aspiration under real-time ultrasound guidance with conventional blind aspiration.

UNLABELLED: To determine the optimal method of suprapubic aspiration (SPA), the success rates of real-time ultrasound-guided SPA were compared with those of conventional SPA, and factors associated with success were studied. Thirty infants were randomly allocated to group A (for real-time ultrasound-guided SPA) and 30 infants to group B (for blind SPA with a prehydration protocol). The results showed that the overall success rates for all attempts were similar (26/30 or 87% in group A vs 24/30 or 80% in group B, p > 0.05). The first attempts in both groups were equally successful (both 18/30 or 60%). In comparison with failed attempts, successful ultrasound SPA attempts were associated with a greater bladder depth (mean +/- SD: 28 +/- 11 vs 21 +/- 5 mm, p < 0.01), length (32 +/- 12 vs 23 +/- 9 mm, p < 0.05) and volume (17 +/- 13 vs 8 +/- 6 ml, p < 0.01), but similar width (33 +/- 9 vs 29 +/- 5 mm, p > 0.05). In blind SPA, successful attempts were associated with the presence of bladder dullness on percussion (odds ratio 29). CONCLUSION: This study confirms that ultrasound-guided SPA has a high success rate. Blind SPA could also be equally successful with appropriate preparation. Ultrasound-guided SPA is recommended when the bladder depth exceeds 3 cm, or the bladder length exceeds 3.7 cm. If an ultrasound machine is not available, blind SPA may be an alternative, with attention being paid to prehydration and the demonstration of bladder dullness by percussion.

Computer Systems↗

PubMed2006

Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules.

OBJECTIVE: Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this prospective study, we compared palpation-guided FNAB (PGFNAB) with ultrasound-guided FNAB (UGFNAB) to establish the rates of inadequate material and cost-effectiveness. DESIGN: A total of 285 thyroid nodules in 215 patients were included in the study. Palpable nodules with the greatest diameter between 1 and 2.5 cm were included in the study. PGFNAB and UGFNAB techniques were applied to the same nodule by the same operator. Cytologic evaluations were performed by the same cytologist in a blinded fashion. To provide cost analysis, the prices obtained from different hospitals were evaluated. MAIN OUTCOME: The rates of inadequate material for PGFNAB and UGFNAB were significantly different as 32.3% and 21.4%, respectively (p = 0.004). There was significantly higher inadequate material rate in PGFNAB group for small-sized nodules (greatest nodule diameter between 10 and 15 mm) (p = 0.009), despite inadequate material rate was not significant for both procedures for larger sized nodules. False-negative results were 15.8% for PGFNAB and 5.6% for UGFNAB. Regarding cost analysis, the difference between the two methods was 20 dollars on average for each patient. CONCLUSIONS: We consider UGFNAB to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation. Indeed, the difference between the costs of two procedures might be acceptable.

Adolescent↗

PubMed1988

Fine-needle aspiration biopsy in the monitoring of liver allografts. I. Correlation between aspiration biopsy and core biopsy in experimental pig liver allografts.

We have used allogeneic pig liver transplants to investigate the structure of inflammation in acute liver allograft rejection. An inflammatory episode of acute cellular rejection was observed in 9/10 allografts in nonimmunosuppressed recipients, when monitored with simultaneous fine-needle aspiration biopsies (FNAB) and core needle biopsies (NB). The intensity of inflammation in FNAB was quantitated using the corrected increment method and correlated with NB findings. In FNAB, all inflammatory episodes were detected on the 4th day after transplantation with lymphoid blast and lymphocyte infiltration, later accompanied by monocytes and macrophages. Maximal intensity of inflammation was recorded in FNAB on day 14. In NB, histology demonstrated distinct inflammation in the portal area on day 4. The predominantly lymphocytic infiltration, also containing varying numbers of plasma cells, eosinophils, neutrophils and macrophages, reached its maximum 7-14 days after transplantation. With the indirect immunoperoxidase technique, lymphoid cell subpopulation analysis of FNAB demonstrated an increase of both T4 and T8 cells during rejection. The T4/T8 ratio was first low, and increased at the beginning of the episode, on day 4, but decreased again on days 7 and 14. The number of B cells in the graft was also elevated during rejection. The cellular changes in the corresponding blood specimens followed approximately the same lines, although the changes were less prominent. NB immunohistology, using immunoperoxidase and frozen sections, correlated well with FNAB results, and demonstrated a T4 predominance in the portal area on day 4 but a T8 predominance on days 7 and 14. In addition to lymphoid cells, macrophages/granulocytes were also frequent in the portal area and scattered in the parenchyma on days 7 and 14. An additional inflammatory cell component in liver allograft rejection, detectable only in the NB, was eosinophils in the portal area, recorded in maximum on day 14. Taken together, the inflammatory changes in the FNAB and NB were similar, and time-related changes of cellular infiltrate in FNAB and NB correlated closely.

Animals↗

PubMedDate not supplied

Diagnostic accuracy of fine needle aspiration cytology of the thyroid: impact of ultrasonography and ultrasonographically guided aspiration.

OBJECTIVE: To determine the impact of ultrasonography on the diagnostic accuracy of fine needle aspiration cytology (FNAC) of the thyroid. STUDY DESIGN: We compared two FNAC series. In period 1 we used neither ultrasonograph nor ultrasonographically-guided FNAC in the evaluation of thyroid nodules, while both tools were routinely applied in period 2. Moreover, in the former period all cellular follicular lesions were encountered among suspicious findings, while in period 2 we advised regular follow-up examinations instead of immediate surgery for patients with no significant atypia. The basis of follow-up examinations was ultrasonographic volumetry of the nodule and repeat FNAC on growing nodules. RESULTS: The number of FNAC, positive predictive value of FNAC, number of malignancies, sensitivity, the specificity and diagnostic accuracy were higher in period 2 as compared with period 1: 3,446 vs. 1,448; 45% vs. 16%, 39 vs. 29, 92% vs. 76%, 65% vs. 87% and 66% vs. 87%, respectively. CONCLUSION: The introduction of ultrasonography permits higher diagnostic accuracy of the evaluation process. This is achieved not only by lessening false negative reports but, more important, by decreasing false positive results.

Biopsy, Needle↗

PubMedDate not supplied

Fine needle aspiration of basal cell adenocarcinoma of the parotid gland. Report of a case with assessment of DNA ploidy in aspirates and tissue sections by image analysis.

BACKGROUND: Basal cell adenocarcinoma of the parotid gland is a low grade malignant neoplasm. It has cytologic features of basal cell adenoma and a histologically infiltrative growth pattern of malignant tumors with perineural and vascular invasion. CASE: Fine needle aspiration biopsy findings of basal cell adenocarcinoma of the parotid gland in a 77-year-old male were supplemented by DNA ploidy analysis. CONCLUSION: No single cytologic feature was found to unequivocally distinguish this lesion from basal cell adenoma and/or solid variant of adenoid cystic carcinoma. Therefore, for diagnostic purposes, we grouped all three lesions under the term basal cell tumor. Evaluation of DNA content of tumor cells revealed diploid histograms in both cytologic material and paraffin-embedded tissue. Infiltrative tumor nests, the histologic basis for differentiating basal cell adenocarcinoma from adenoma, showed the same diploid pattern. Though DNA quantitation may not discriminate basal cell adenoma from basal cell adenocarcinoma, it may prove useful in separating them from adenoid cystic carcinoma, which is considered to be a tumor with high malignant potential.

Adenocarcinoma↗

PubMedDate not supplied

Performance of fine-needle aspiration cytology of the breast-multicenter study of 23,063 aspirates in ten Italian laboratories.

AIMS AND BACKGROUND: The aim of this study was to assess the performance of routine breast cytology in a group of Italian laboratories, as a basis for interlaboratory quality control. METHODS: A multicenter retrospective consecutive series of 23,063 aspirates from breast lesions (5,130 invasive carcinoma, 247 intraductal carcinoma, 2,386 benign lesions [histological], 13,144 benign lesions [follow-up], 2,156 other [no follow-up]) was reviewed. Standard accuracy measurements (inadequacy rate, sensitivity, specificity, predictive value) were determined, as well as the contribution of diagnostic tests such as physical examination and instrumental diagnostic procedures (mammography, sonography). RESULTS: Overall, inadequacy rate was 6.5% for malignant and 23.2% for benign lesions. Sensitivity was 92.2%, specificity was 95.3%, and the positive predictive value of an equivocal or malignant report was 53.4% or 96.9%, respectively. Sensitivity was associated with histological type (intraductal vs invasive: 77.0% vs 92.9%, p < 0.000001; lobular vs other invasive: 85.5% vs 94%, p = 0.0025) as well as with tumor size (pT1 = 91.6%, pT2 = 94.3%, pT3-4 = 96.0%, p < 0.000001). Observed differences in performance indicators between centers may be explained by variability in sampling or reading accuracy, and warrant the need for some adjustment in single centers, especially, as far as the criteria to report an equivocal smear are concerned. Cytology contributed to detect otherwise unsuspected carcinomas, although in some centers this benefit was poor and not cost-effective because a large number of unnecessary biopsies were caused by false equivocal/positive reports. CONCLUSIONS: Although centers scored, on average, well within standards recommended by national authorities, this study suggests the opportunity of interlaboratory quality control to achieve more homogeneous criteria.

Biopsy, Needle↗

PubMedDate not supplied

[Comparison of the usefulness of intraoperative examination and fine needle aspiration biopsy in thyroid lesions. Analysis of discordant cases in aspiration biopsy].

INTRODUCTION: Fine-needle aspiration biopsy (FNAB) is currently considered the most reliable and cost effective examination for diagnosis of solitary thyroid nodules prior to surgery. Because of its great utility the indication of intraoperative examination (IOE) (macroscopic examination, cytology and frozen section), has recently been questioned. OBJECTIVE: To compare the accuracy of the FNAB and IOE, in those patients with nodular thyroid disease who undergo thyroidectomy. As well as to analyse the, discrepant cases by FNAB. MATERIAL AND METHODS: The results of IOE and FNAB were compared in a period of two years (1997-98) at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). In all cases the diagnosis established from paraffin embedded tissue sections was considered to be the gold standard. The cytologyc smears and the histologic sections of the discrepant cases were reviewed. RESULTS: One thousand and fourteen IOE were done during two consecutive years; from these cases, 136 (13.4%) were thyroid lesions. Half of the thyroid lesions (69 cases) corresponded to carcinomas, the others were follicular adenomas (13 cases) and non-neoplasic lesions (54 cases). The analysis of the copacity to discriminate between malignant and benign diseases with IOE and FNAB demonstrated sensitivity of 89% (CI: 78.2-95.1) and 97.7% (CI: 86.8-99.9), specificity of 100% (CI: 93.1-100) and 90% (CI: 90.4-96.7). The positive predictive value of 100% and 91.6%, negative predictive value of 90.4% and 97.3%, and equal accuracy (94.6% and 94.1% respectively). When the analysis of capacity to stratify diseases was performed, IOE and FNAB showed similar percentages in all the cases, including the follicular adenomas and carcinomas. The causes of false positive and false negative cases by FNAB, reproduce what has been written in the literature. CONCLUSIONS: FNAB preoperative examination is adequate for the selection of patients that undergo thyroidectomy. Nevertheless, IOE should be done in most of the cases, and routinely in those cases with inconclusive FNAB results and in cases of follicular tumor.

Biopsy, Needle↗