[Cytodiagnosis from the surgical viewpoint. C. Technical problems of cytodiagnosis in breast aspiration biopsies].
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CT guided percutaneous fine needle aspiration cytodiagnosis was performed on 30 patients with pancreatic and periampullary tumors in China-Japan Friendship Hospital from November 1984 to January 1986. In our series, 9 pancreatic head cancers, 4 pancreatic body and tail cancers, 5 ampullary cancers had positive cytodiagnosis (100%-18/18). 2 of 3 (67%) duodenal cancers and 6 of 7 (86%) the distal common bile duct cancers were positive by cytodiagnosis. 2 pancreatitis were negative (100%). The positive rate by CT guided diagnosis was 93.3% (28/30). In the same period, ultrasonically guided percutaneous fine needle aspiration cytodiagnosis was performed on 30 patients with pancreatic and periampullary tumors, a correction rate of diagnosis was 67%. CT guided procedure is more accurate than that ultrasonically guided.
Fine-needle aspiration cytology (FNAC) was performed on 195 cases of salivary gland lesions. The smears were technically adequate in 178 cases. Tissue examination was available for subsequent histocytologic correlation in 57 cases. The cytodiagnosis included inflammatory lesions (59) and benign (68) and malignant (51) tumors (total, 119). The accuracy of cytodiagnosis was 87.7% with a sensitivity of 80.9% and a specificity of 94.3%. Exact histologic typing was possible in 61.9% of the malignant tumors. Mucoepidermoid tumors and cellular-atypical pleomorphic adenoma posed difficulties in cytodiagnosis.
It has been recommended that before retrograde brushing of upper urinary tract lesions to diagnose malignancy the contrast medium should be washed away with saline because of possible cellular distortion. There were 21 paired specimens from 19 patients submitted for urinary cytodiagnosis. One specimen was a contrast medium wash, similar in pH and osmolality to urine, and the other a saline wash. Cellular detail was adequate for cytodiagnosis in 20 of the 21 contrast medium specimens. Of 7 specimens from patients with malignancy 3 were diagnosed correctly as malignant, 1 was classified as suspicious and 3 were falsely negative in the contrast wash group. Of the 3 falsely negative diagnoses 2 were changed to malignant when the paired saline wash specimens were examined. Urologists should not discard the contrast medium specimen prior to retrograde brushing but should send it along with a saline wash specimen for cytodiagnosis because the discarded contrast material and irrigant may have diagnostic cells.
The aim of quality control of a laboratory investigation is to ensure that similar results are obtained on the same material at different centres. To investigate its practicability in cytodiagnosis, the same cytological material was examined independently at six centres. Each centre supplied material from 20 cases, providing a total of 120 cases, ie, 100 cases excluding the donor centre's own material. The degree of agreement between the centres was studied using (a) the standard National Health Service cytology report terminology, (b) the centre's own terminology, and (c) the recommended recall time. The results revealed close agreement between five out of six centres in the reports obtained in relation to dysplasia and malignancy, namely, less than 3% false negative results and not more than 1.7% false positive results. The recommended recall time provided a similar order of agreement after discrepancies due to the management of inflammatory conditions had been eliminated. There was marked disagreement in the diagnosis of both presence and type of infection. The results indicate that improvement in the quality of cytological material would increase the consistency of cytodiagnosis. Cytodiagnosis itself, being an expression of opinion, does not appear to be an appropriate field for quality control.
The cytodiagnosis is a simple noninvasive procedure which requires close cooperation between the clinician and an experienced cytologist. It enables important diagnostic and therapeutic recommendations on the basis of morphological findings. A total of 1000 smears of the larynx obtained from 430 patients with chronic laryngitis were examined. In a case- controlled study of 143 patients with chronic hyperplastic laryngitis, smokers and/or laryngeal dysplasia patients with a 9.6% risk for malignant transformation, were identified as risk groups needing cytological screening at intervals of 6 months to a year. In the cytodiagnostic evaluations the main emphasis should be placed on dysplasias and metaplasias. Performed systematically, cytologically assisted early examination of the larynx expands the diagnostic possibilities, and is a useful supplement to biopsy. In the risk group chronic hyperplastic laryngitis, cytodiagnosis can be used to screen suspicious lesions for tumors. Although it cannot replace histological examination, it is highly suitable for the early diagnosis and effective follow-up of precancerous epithelial changes of the larynx.
Preoperative fine-needle aspirates of 25 soft tissue tumors and four bone tumors were used for cytodiagnosis and flow cytometric DNA ploidy analysis. The results were compared with the histopathologic diagnosis and flow cytometric DNA ploidy analysis on tissue samples after surgery. There was good agreement between the cytodiagnoses and histopathologic diagnoses with regard to benign tumor or sarcoma. There was good agreement between the ploidy determinations in aspirates and tissue samples in 20 out of the 26 tumors that could be analyzed. Aneuploid cell populations were found in 13 tumors cytologically classified as sarcoma and in one tumor classified as unspecified malignant tumor. These 14 tumors also showed aneuploid cell populations in the tissue samples and were histologically diagnosed as high-grade malignant sarcomas. The combined evaluation of preoperative cytodiagnosis and DNA ploidy on aspirates may give valuable prognostic information.
A 25 yr old married woman with complaints of lower abdominal pain for 2 months, was found to have a irregular nontender mass in pelvis, adherent to uterus. Her Papanicolaou smear was inflammatory. To confirm the diagnosis of either ovarian malignancy or pelvic tuberculosis made on the basis of observations during exploratory laparotomy, ovarian biopsy was taken. The imprint cytodiagnosis was tuberculosis. The patient was then managed surgically and the previous diagnosis was reconfirmed by histopathology. Imprint cytodiagnosis appears to be a valuable technique whenever facilities for frozen section are not available.
We have done endoscopic retrograde pancreatography-aspiration cytology for 81 consecutive patients in whom there had been neither pancreatic mass nor duct stenosis; cancer cells were detected in four cases (5%). This report reviews a new method of intraoperative cytodiagnosis, which was done for these four cases, to locate the original lesion of the cancer cells. This method involved dividing the pancreatic neck at a right angle to the main pancreatic duct. A catheter was then inserted in both the caudal and cranial ducts of Wirsung. With the aid of an intravenous injection of secretin, pure pancreatic secretions were collected separately and used for intraoperative cytodiagnosis. With this method, all four occult neoplasms of the pancreas were correctly identified as to whether they were located in the cranial, caudal, or both portions. In one case in which carcinoma in situ extended throughout the entire pancreas, total pancreatectomy had been indicated by the positive results obtained from both portions. Likewise, in the other three cases in which, the occult neoplasms were limited to the cranial or caudal pancreas, either a Whipple procedure (one case) or a caudal pancreatectomy (two cases) had been quite correctly indicated. Since this method is simple, safe, and reliable, it is beneficial to the patient with occult neoplasm, because it prevents blind resection of the entire pancreas without any fear of leaving the neoplastic lesion behind.
The paper underlines the importance of early diagnosis in the treatment of breast tumours and emphasises the value of cytodiagnosis as a very sensitive and specific predictive method for detecting impalpable lesions. In conclusion, the Authors affirm that cytodiagnosis, together with the introduction of new diagnostic instruments such as the TRC Mammotest, allows the diagnostic and therapeutical approach to impalpable breast tumours to be improved. It adds to the already high sensitivity of mammography and to the high predictive specificity of cytology, thus contributing to the reduction of the so-called "bioptic cost".
A retrospective study of the use of fine needle aspiration (FNA) cytology to confirm a clinical suspicion of tuberculosis in tissue enlargements was performed, using 70 cases. The criteria required to make an FNA cytodiagnosis of tuberculosis were reassessed, and the sensitivity and predictive value of cytology for diagnosing such aspirates was determined. All but 2 of the 70 aspirates contained adequate cellularity. The adequate samples were diagnosed as 40 cases of caseating tuberculosis, 11 cases of noncaseating tuberculosis and 17 cases of acute necrotizing granulomatous inflammation suspicious for tuberculosis. Subsequent histologic study verified the cytologic diagnosis in 27 of 27 biopsied caseating lesions, 4 of 7 biopsied noncaseating cases and 5 of 8 necrotizing cases. The six cases with a false-positive cytodiagnosis of tuberculosis were histologically diagnosed as one Lennert's lymphoma, two reactive lymph nodes and three necrotizing metastatic carcinomas. The sensitivity of FNA cytology for the diagnosis of tuberculosis was 100%, with the predictive value of a positive result being 88%. The findings in this study emphasize that all criteria for the diagnosis of tuberculosis in FNA samples must be utilized and that particular caution should be exercised in making a diagnosis of acute necrotizing tuberculosis.
The reliability and efficiency of the cytodiagnosis of fibrogastroendoscopic biopsy samples obtained under direct vision in 676 cases during a five-year period were reviewed. The critical evaluation showed a cytodiagnostic sensitivity of 93.54%, a specificity of 98.79%, a false-negative rate of 6.46%, a false-positive rate of 1.21%, a predictive value of a positive result of 98.01%, a predictive value of a negative result of 96.00%, a prevalence rate of 38.91%, an overall diagnostic accuracy of 96.75% and a chi-square value of 5.50 (P less than .05). These results were comparable to those obtained by histologic study in the same cases; the combined use of both cytology and histology to analyze the samples obtained gave the best results. These findings reemphasize the important role of fibrogastroendoscopic cytodiagnosis in establishing the existence of gastric cancer and shows that the technique is accurate and efficient. The types of statistics useful for assessing such data are discussed.
This report analyses the results obtained using endoscopic cytodiagnosis in upper gastrointestinal lesions. Cytological and bioptic samples were taken from 435 lesions, in 435 patients. Specificity was 0.99% and sensitivity 0.9%. The accuracy of the endoscopic sampling and in preparing the cytological slides had a decisive influence on the obtaining of these results. The time required for a good cytological sample is the same as required for a biopsy. As employed the cytodiagnosis of esophago-gastric lesions was really useful, and indeed essential in diffuse mucosal lesions.