The diagnoses of 1,000 pairs of conventional Papanicolaou (Pap) smears and ThinPrep preparations were compared. Cervical cells were collected using an Ayre spatula and endocervical brush. The conventional smear was made first, the collection devices were rinsed into PreservCyt solution, and the slides were prepared using the ThinPrep Processor. The diagnoses of the paired smears agreed in 988 of the 1,000 cases (98.8%), including 949 negatives, 28 atypicals, 9 low grade squamous intraepithelial lesions (LGSIL), and 2 high grade squamous intraepithelial lesions (HGSIL). Five cases where LGSIL or HGSIL was found on the ThinPrep slide were negative or atypical on the conventional smear. No conventional smear abnormalities were missed on the ThinPrep slide. Although not statistically significant, this difference indicates that the ThinPrep method gives a better diagnosis of abnormalities than the conventional method. The ThinPrep method was acceptable to participating physicians and ThinPreps were easier and faster to screen than conventional smears.
Fine needle aspiration (FNA) has proven to be an effective tool in management of patients with thyroid nodules. However, the diagnosis of follicular patterned lesions can be challenging. The surgical and cytopathology computer database at a large referral medical center was searched for cases that had both cytologic and histologic thyroid accessions from January 2004 to November 2008. A total of 1,255 histologic thyroid specimens and 2,776 thyroid FNA biopsies were retrieved for review. Histologically, 272 overt malignancies were identified; 20 (7.4%) were follicular carcinomas. Cytologically, 1,348 cases were follicular-patterned lesions, comprising 1,044 cases of "benign follicular nodules" (BFN), 137 cases of "follicular lesions of undetermined significance" (FLUS), and 167 cases of "suspicious for follicular neoplasm" (SFN). Seventy-nine (7.5%) of BFN, 23 (16.8%) of FLUS, and 65 (38.9%) of SFN cases had histologic follow-up. Overt malignancy, a cystic papillary carcinoma, was identified histologically in only one case of BFN, for a negative predictive value of 98.7%. Overt malignancy was identified histologically in two cases of FLUS, both follicular variant of papillary carcinoma, for a positive predictive value of 8.7%. Overt malignancy was identified histologically in 14 cases of SFN, for a positive predictive value of 21.5%. Five follicular carcinomas were identified histologically in the SFN category, all minimally invasive. Incidental ("occult") papillary microcarcinoma were identified histologically in all three categories. In this study, the risk of overt malignancy increases from 1.3%, to 8.7%, to 21.5% for BFN, FLUS, and SFN, respectively. All follicular carcinomas identified histologically occurred in the SFN category and all were minimally invasive. Papillary microcarcinomas can occur in any of the three diagnostic categories.
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided a set of uniform diagnostic terminology including benign (B), atypia of undetermined significance (AUS), follicular neoplasm (FN), suspicious for malignancy (SM), malignancy (M), and nondiagnostic (ND) for the interpretation of thyroid fine-needle aspiration (FNA). We applied this terminology on our 1,382 thyroid aspirates in a community practice setting, which included 539 cases of B (39%), 376 cases of AUS (27.2%), 116 cases of FN (8.4%), 37 cases of malignant (2.7%), 36 cases of SM (2.6%), and 278 cases of ND (20.1%). Two hundred twenty-one cases (16%) of thyroid FNA had corresponding follow-up thyroidectomies. Each diagnostic category represented a unique association with risk of malignancy and risk of neoplasm. Based on histologic follow-up, the risk of neoplasm (including benign and malignant neoplasm) was B 14%, AUS 44%, FN 67%, SM 77%, and M 100% and the risk of malignancy was B 3%, AUS 6%, FN 22%, SM 56%, and M 100%. The classification and follow-up recommendation of TBSRTC are appropriate for each category. Both B and AUS are low-risk lesions with low probability of malignancy. FN predicts a higher rate for neoplasm but an intermediate rate for malignancy while SM carries a high risk for malignancy.
A retrospective study of 1,855 fine-needle aspirations of the lymph node (LN) from 1,484 Chinese patients in Queen Mary Hospital over a period of 11.5 yr (January 1, 1976, to June 30, 1987) was reviewed and analyzed. Positive cytologic results diagnosed malignancies in 49.3%. Sensitivity and specificity of cytology reached 95% and 96.5%, respectively. The order of frequency of the metastatic tumors according to primary sites was analyzed. The most common metastatic carcinomas in various groups of LNs were nasopharyngeal carcinoma in the cervical LN, breast carcinoma in the axillary LN, and cervical carcinoma in both the groin and pelvic LNs. Tuberculosis (TB) is an important differential diagnosis; FNAC showed a sensitivity of 76.9% in the detection of TB lymphadenopathy.
This retrospective study was designed to evaluate the accuracy of cytopathologic diagnosis and of correct classification of benign breast diseases. A total of 1,598 FNABs were identified to have met the study criteria; of these, 1,258 (78.7%) cases were cytologically benign, 88 (5.5%) suspicious, 3 (0.18%) false-positive, and in 249 (15.6%) cases an inadequate sample was obtained. A specific diagnosis was made in 847/1,258 (67.3%) cases; the other 411 were diagnosed as benign NOS. Out of 847 specific FNABs diagnoses, 451 were fibroadenomas, 27 phyllodes tumors, 289 fibrocystic diseases, 4 proliferative fibrocystic diseases, 38 papillomas, 22 fat necrosis, 9 mastitis, 1 pseudolymphoma, 2 lipomas, 2 duct ecstasies, and 2 atheromas. In our study group the cytopathologic diagnosis of benign breast diseases excluding unsatisfactory aspirates was correct in 93%. Specific diagnosis was correct on average in 50% of cases, only in FA was its accuracy over 60%; in adequately sampled tumor, the predictive value of FA was 86.2%.
Fine-needle aspirates and tissue sections from 120 surgically treated parathyroid (PT) lesions and histologic archive material from PT lesions in 1,500 additional cases of hyperparathyroidism were reviewed to assess the importance of various features in distinguishing PT disease from other types of lesions by aspiration cytology. We conclude that the morphologic variation shown by PT lesions is so many-sided that this distinction cannot be based on the presence or absence of a single feature only. Instead the cytologic picture as a whole must be taken into account and evaluated with full knowledge of the anatomical conditions pertaining to the lesion examined. If still in doubt, the diagnosis can be substantiated by supplementary immunocytochemical examinations.
Between 1985 to 1989, 1,995 fine-needle aspirations of palpable breast lesions were performed at our institution. In all cases, the aspirates were procured by cytopathologists using 22- or 23-gauge needles. Direct smears were immediately stained with Diff-Quik and Papanicolaou and assessed for specimen adequacy (criteria as followed in this institution). Tissue follow-up was available in 1,117 cases. The cytologic diagnoses rendered in these cases were: malignant, 690 cases (60.2%); suspicious for carcinoma, 49 cases (4.3%); benign, 343 cases (29.9%), and insufficient specimen, 35 cases (3.1%). There were 28 false-negative and 2 false-positive results. Considering only cases definitively diagnosed as benign or malignant, the sensitivity was 96%, specificity 99%, positive predictive value 99%, negative predictive value 94%, and overall efficiency 97%. Of these specimens considered suspicious, only 11 cases (22%) were proved not to be malignant after excisional biopsy. These were three fibroadenomas, three ductal hyperplasias, two adenosis tumors, two mucocele-like lesions, and one nipple adenoma. The two lesions that resulted in true false-positive diagnoses were an apocrine cyst with atypia and sclerosing adenosis with radial scar. The clinical and cytologic features of the benign conditions that resulted in false suspicious and positive diagnoses and those features that distinguish them from carcinoma are presented.
The simplicity and safety of the fine-needle aspiration (FNA) make it a useful procedure for the initial evaluation of supraclavicular lymphadenopathy. We analyzed data (106 patients) in combination with the data of three recently published studies (total 301 patients) to make the observations more meaningful. The usefulness of various ancillary techniques such as special histochemical stains (SHC), immunohistochemistry (IHC), and flow cytometry (FCM) in establishing specific diagnoses was also examined. Analysis of the combined data from 407 patients helps to reinforce certain trends observed by previous investigators such as the marked predominance of metastatic carcinoma (63%) over lymphoid malignancies (9%), reactive (19%) and infectious processes (2%), and the tendency of abdominal and pelvic primary carcinomas to metastasize to the left supraclavicular lymph node (SCLN) (88%). In addition, the current study confirms utility of performing IHC, FCM, and SHC on the aspirate material obtained from supraclavicular lymph nodes, because in 19 of the 22 cases (86%), these ancillary techniques provided supplemental diagnostic information critical to patient management.
Fine-needle aspiration (FNA) biopsy of the kidney has a traditionally well-defined role in the diagnosis and treatment of renal lesions. Recent improvements in renal imaging techniques have also brought renal FNA to the forefront, since small and asymptomatic renal masses are increasingly being detected. Before the physician institutes a treatment plan, such lesions usually require a definitive diagnosis that is best provided by FNA. To assess various aspects of renal FNA, including specimen adequacy, questionable cytologic patterns, and diagnostic pitfalls, we retrospectively evaluate our experience with 108 FNA biopsies performed for the evaluation of renal masses in adults. For each case, the smears were reviewed and correlated with tissue sections from cell blocks, surgical specimens, or autopsy material, when available. The cytologic diagnoses were confirmed by cell block (59 cases), nephrectomy or autopsy (35 cases), or clinical follow-up. Of the 108 FNA biopsy samples, 17 showed evidence of blood, soft tissue, necrotic material, glomeruli, or tubular cells and were classified as unsatisfactory. The following diagnostic categories were noted in the 91 satisfactory aspirates: renal abscess (four cases), benign cyst (30 cases), suspicious lesions (11 cases), and malignant lesions (46 cases). In four cases of renal abscess, FNA found abundant clusters of neutrophils. For the 30 cases interpreted on cytologic evidence as benign cysts, the diagnosis was confirmed in 28 cases; the two remaining cases were acquired cystic kidney and cystic renal-cell carcinoma, respectively. Among the 11 suspicious lesions, the final diagnoses were one benign simple cyst, one angiomyolipoma, two multilocular cystic nephromas, two adult polycystic kidneys, one acquired cystic kidney, three cystic papillary renal-cell carcinomas, and one solid renal-cell carcinoma. Cases classified as suspicious shared characteristic cytologic patterns that distinguished them from simple benign cysts and from classic renal-cell carcinoma. Among the 46 malignant lesions, as evidenced on cytologic examination, 27 were renal-cell carcinomas, five were transitional-cell carcinomas, four were lymphomas, one was a small-cell undifferentiated carcinoma, and nine were metastatic carcinomas. False-positive or false-negative cases were not encountered in this category. In conclusion, FNA is an excellent method to diagnose space-occupying lesions of the kidney. For cystic lesions, cytologic-radiographic correlation is needed to avoid misinterpretation. Our study defines a spectrum of suspicious patterns characteristic of a group of renal lesions that are distinct from both benign simple cyst and straightforward renal malignancy.
We describe an unusual case of chondroblastic osteosarcoma of the skull in an 11-yr-old girl in whom a preoperative diagnosis was made by fine-needle aspiration (FNA) biopsy, followed by histologic confirmation of tissue biopsy and the surgically resected specimen. FNA cytology revealed pleomorphic oval cells with prominent nucleoli along with spindle cells, tumor giant cells, and a chondromyxoid background. The cell block of the aspirated material showed osteoid associated with the malignant cells. Immunocytochemical stains revealed S-100 and vimentin positivity; actin, myoglobin, and cytokeratin stains were negative. Electron microscopy revealed neoplastic cells with chondrocytic differentiation. This case demonstrates the value of FNA biopsy combined with immunocytochemical and ultrastructural studies performed on the aspirated material in diagnosing osteosarcoma from an unusual location such as the base of the skull.
To determine the effect of stereotactic core-needle biopsy (SCNB) on the utilization of breast fine-needle aspirate (FNA) biopsy, we retrospectively reviewed 1,568 cases of breast FNAs that were obtained from 1,188 patients between the years 1990 and 2000. There were 378 positive and atypical cases and 497 negative and unsatisfactory cases in the pre-SCNB group (between 1990 and 1996; 7 years); and 225 positive and atypical cases and 468 negative and unsatisfactory cases in the post-SCNB group (between 1997 and 2000; 4 years). The average number of cases per year in the pre- and post-SCNB groups was 125 and 173, respectively. While the average positive/atypical cases per year in both groups remained relatively constant, the average negative/unsatisfactory cases per year were significantly increased in the post-SCNB group (117 in the post-SCNB vs. 71 in the pre-SCNB). The increase in this group was due to a true increase in the negative diagnoses, since unsatisfactory rate decreased in the post-SCNB group (12.6% in the post-SCNB vs. 9.3% in the pre-SCNB). The sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 79%, 92%, and 82% in the pre-SCNB group and 93%, 86%, 91%, and 90% for the post-SCNB group, respectively. In conclusion, the implementation of SCNB did not result in a decrease in the total number of breast FNAs; however, the distribution of cases changed. FNA is increasingly used to complete the triple test in clinically and radiographically negative cases.
Only a few cases of retinoblastomas in older children have been reported and the clinical diagnosis may be difficult. In case, fine-needle aspiration from an atypical retinal mass of an 11-yr-old boy was performed. The vitreous fluid was stained with Diff-Quik for an immediate cytological examination and the diagnosis of retinoblastoma was suggested. The rest of the specimen was separated into two parts. One was stained with May-Grünwald-Giemsa and the other was centrifuged, embedded in paraffin, and finally stained with hematoxylin-eosin-safran. The undifferentiated blue cells were associated with abundant necrotic debris and portions of capillaries with perivascular tumor cells around. The cytoplasm of the tumor cells was strongly stained with neuron-specific enolase antibody. The diagnosis of retinoblastoma was confirmed. The specimen of enucleation confirmed the diagnosis. In conclusion, cytological aspiration can categorically diagnose suspected intraocular tumors of older children in whom clinical and noninvasive investigations have failed to establish the diagnosis.
We report on our experience in fine-needle aspiration (FNA) biopsy of the retroperitoneum: 111 FNA biopsies performed on 99 patients. Cytologic diagnoses were divided into four groups: nondiagnostic (unsatisfactory samples because of a low cellularity and/or improperly prepared smears) aspirates (20%), benign (16%), suspicious for malignancy (13%), and malignant (50%). There were no known false-positive samples. We had two false-negative diagnoses due to sampling errors. Among diagnostic smears, the procedure showed a sensitivity of 97% and a specificity of 100%. The predictive value of a positive result was 100% and the predictive value of a negative result was 90%. The overall accuracy was 98%. Metastatic carcinomas accounted for the largest number of lesions in the group of malignant tumors. A primary tumor site was known for the majority of the cases before the aspiration was performed. In the remaining cases we were unable to suggest an origin. It is therefore important to emphasize the role of ancillary studies in patients that are at the first assessment of the disease or when a second intercurrent malignancy is suspected. In our limited experience, a suggestion of the correct subtype of retroperitoneal sarcoma was not possible. As in the rest of cytopathology, a multidisciplinary approach is mandatory in this setting to improve patient management.
The authors studied 112 patients who received definitive radiotherapy/chemotherapy solely on the basis of positive cytologic findings in the appropriate clinical context. Eighty patients (71.4%) were treated on the basis of one or more positive sputum studies, while the remainder had at least one positive bronchial cytologic preparation. Eighty-six patients (76.3%) received radiotherapy alone; 19 received both radiotherapy and chemotherapy; only 7 were exclusively given chemotherapy. The utilization of stringent verification criteria revealed that none of our patients was falsely positive for malignancy. For those patients categorized as having malignant disease by verification criteria I-IV, there were no significant disparities between histologic and cytologic diagnoses. This study demonstrated, in a systematic fashion, that patients can be reliably and definitively treated for lung cancer on the basis of positive respiratory cytology findings without tissue corroboration.
The preoperative fine-needle aspiration cytology (FNAC) diagnoses in 116 surgically excised neurilemomas were reviewed and compared with the corresponding histopathologic diagnoses made on surgical specimens and with clinical data. In addition, the utility of adjunctive techniques was analyzed and other spindle-cell lesions in the differential diagnoses were discussed. An unequivocal, benign diagnosis was rendered by FNAC in 80 cases, 67 of which were correctly labelled as neurilemoma in a review of the original cytology reports. There were 6 false-positive malignant diagnoses while 23 smears were considered insufficient and 7 inconclusive as to whether benign or malignant. On reevaluation, the diagnostic smears in most cases contained spindle cells with wavy nuclei embedded in a fibrillar, occasionally collagenous, and/or myxoid matrix and Antoni A/Antoni B tissue fragments. A moderate to abundant admixture of round to oval cells was also frequent. Nuclear palisading was seen in 41 smears with distinctive Verocay bodies in 10. Markedly pleomorphic nuclei were seen in smears from 8 ancient and 6 conventional neurilemomas, and slight to moderate nuclear pleomorphism was observed in 38 additional cases. Thus most neurilemomas have distinct cytomorphologic features that allow correct diagnosis. The major problem in FNAC of neurilemoma is to obtain sufficient material. Furthermore aspirates showing predominantly Antoni A features, nuclear pleomorphism, and/or myxoid changes can easily be confused with other types of benign or malignant soft-tissue tumors.
We reviewed 119 percutaneous, radiologically guided fine-needle aspirations (FNA) from 114 patients with liver masses to evaluate diagnostic effectiveness and complications of this procedure. Satisfactory material was obtained in 118 cases (99%), of which 78 were diagnosed as positive (66%), three suspicious (2%), five atypical (4%), and 32 (27%) as negative for malignancy. Compared to surgical biopsy (48 cases) and clinical data, the sensitivity and specificity of FNA for malignancy was 95.1% and 100%, respectively, yielding a positive predictive value of 100% and a negative predictive value of 88.8%. Four cytology cases (3.4%) were false-negatives (FN); all were interpretive errors. Four FN surgical biopsies (8.3%) were sampling errors. Minor complications occurred in three cases (2.5%). We conclude that FNA is safe and effective for determining the malignant potential of liver masses and should be the procedure of choice. Our experience suggests that having a pathologist present in the radiology suite provides optimal patient care.
One hundred and twenty-two fine needle aspirates (FNA) from female patients were studied to determine whether CA-125 assay contributed to cytologic diagnosis and CEA assay. Cytologic examination was done on Papanicolaou-stained smears and cell blocks, CEA by EIA (Abbott Laboratory, > 5 ng/ml cutoff) and CA-125 by RIA (Abbott Laboratory, North Chicago, IL, > 66 mu/ml cutoff). Final diagnosis were correlated with histologic diagnosis when available, clinical, radiologic studies, and follow-up.
29 benign, 93 malignant. Sensitivities and specificities: cytology, 91%, 100%; CEA: 59%, 86%; CA-125, 50%, 55%. CEA plus cytology sensitivity, 97%. CA-125 content was highest in endometrial/ovarian carcinoma (39,899 mu/ml) and < 5,000 mu/ml in other tumors and benign FNA in contrast to CEA which showed highest levels in carcinomas of colon, pancreas, and lung (> 280 ng/ml). While elevated CEA enhances the sensitivity of cytologic diagnosis of carcinomas of the colon, pancreas, and lung, low CEA and high CA-125 content supports an ovarian/endometrial primary.
Fine-needle aspiration (FNA) cytology of ovarian cysts, especially in in vitro fertilization (IVF) patients, has been only rarely reported. The aim of this study was to describe the spectrum of cytological findings seen in FNA specimens of 125 ovarian cysts obtained from 84 IVF patients at our institution from 1989-1993. The Papanicolaou-stained slides made following cytocentrifuge or membrane-filter preparation were reviewed blindly by two independent pathologists, and the consensus diagnoses were compiled and correlated with clinical and radiological findings as well as surgical pathology when available. Eight aspirates derived from 4 different patients contained neoplastic cells and, of these, one patient was later found to have a serous cystadenocarcinoma of low malignant potential, while another had a serous cystadenoma. The other 2 patients with neoplastic cells in their ovarian aspirates have persistent ovarian cysts that are being followed clinically for preservation of fertility. The breakdown of the cytological diagnoses of the other aspirates is as follows: 30 follicular cysts, 5 corpus luteum cysts, and 16 endometriotic cysts. The exact underlying nature of 66 cysts could not be determined as the aspirates consisted of foamy macrophages only. This study demonstrates that the nature of ovarian cysts in IVF patients can be determined in many cases by their cytological features, information that may help in defining an unsuspected cause for infertility (such as endometriosis), and in choosing the most appropriate therapy. This study also illustrates that FNA cytology of ovarian cysts can play a role in the detection of occult ovarian neoplasms in the IVF patients population.
Although fine-needle aspiration (FNA) is accepted as the method of choice for the initial evaluation of lymph nodes for metastatic carcinomas, its utility as the initial diagnostic procedure for hematopoietic processes is less established. We review our experience over a 3-year period with 127 FNA cases accompanied by flow cytometric (FC) analysis from 117 patients. Fifty cases had subsequent histologic examination. A hematopoietic process was identified in 85 cases, a reactive process in 27 cases, and a nonhematopoietic process in 15 cases. All non-Hodgkin lymphomas (NHL) were B-cell processes except for one T-cell lymphoma. By FNA/FC, 44 NHL had sufficient findings to be subtyped; of these, 27 had subsequent histologic examination. The correlation between the FNA/FC and histologic classification in these cases of NHL was 100%. One case was insufficient for diagnosis by FNA and six cases were inadequate for FC. We conclude that FNA in conjunction with FC can be used as the initial diagnostic approach for both primary and recurrent hematopoietic processes.
In order to assess the utility of amniotic fluid cytology in the diagnosis of neural tube defects (NTDs), we performed a prospective study of 129 pregnancies selected for maternal age or history of prior congenital defects or multiple stillbirths. Amniotic fluid obtained between the 16th and 22nd weeks of gestation was cytocentrifuged and stained with hematoxylineosin (H&E), Papanicolaou, and Diff-Quik. Chromosomal analysis, amniotic fluid alpha fetoprotein (AFP) level, and eventual pregnancy outcome were recorded for each case. The AFP levels were normal in 128 cases, including two closed NTDs (meningomyelocele and encephalocele). Three patients had abnormal chromosomal studies: two with 47,XXX and one with trisomy 21. Of these 128 cases, 16 had inadequate cytologic preparations; the remainder, including the five aforementioned patients, showed predominantly squamous cells, amnion cells, and minicells. Other cell types, including genito-urinary cells, umbilical cord cells, respiratory cells, and macrophages, were also present in smaller numbers. One case exhibited a large population of small, darkly staining neural cells and large macrophages. The AFP in this case was markedly elevated, and the fetus was noted to be anencephalic. We found the H&E to be the preferred stain for both cytologic detail and minicell preservation; however papanicolaou was better for bloody specimens. Amniotic fluid cytology may provide a rapid and inexpensive method of confirming the diagnosis of open NTDs.
Radical trachelectomy is a fertility preserving alternative for early cervical cancer patients. This audit assesses the role of isthmic-vaginal smear in postoperative follow-up. A total of 94 patients were identified generating 913 smears. The final surgical margin was at the lower uterine segment in 37 cases (39.4%) and significantly correlated with the presence of lower uterine segment endometrial cells (LUSEC) in smears (P = 0.035). The most common abnormal diagnoses in the presence of LUSEC were ASC-US and AGUS seen in 14.2% and 11.9% of positive smears, respectively. The most common follow-up pattern was initial positive smears, which converted to negative (45.7% of patients), showing that reactive changes are another potential overcall pitfall. The only 2 central recurrences were successfully diagnosed by smears. This study summarizes our experience, emphasizing the role of isthmic-vaginal smears for early detection of central recurrence and highlighting the role of LUSEC and reactive changes as potential overcall pitfalls.
Adolescent patients with breast lesions represent a unique population of patients whose differential diagnoses differ from adults. We report a clinically unsuspected case of alveolar soft part sarcoma (ASPS) presenting in the breast of a 13-year-old female. ASPS is a rare neoplasm that is usually present in the head, neck, or lower extremities. This rare case presentation gives us the opportunity to review the differential diagnosis of adolescent breast lesions. We also will review diagnostic features of ASPS on fine-needle aspiration. These are relatively rare disease processes about which many cytopathology professionals may be unfamiliar.
Subacute thyroiditis (SAT) is usually diagnosed clinically without the need for fine-needle aspiration. The cytologic literature on this condition is therefore rare. We report on 14 cases of SAT presenting with thyroid nodules. The majority of patients were women with a mean age of 46 yr. All had pain/tenderness in the thyroid area accompanied by fever or an elevated ESR. The salient cytologic features included cellular smears; multinucleated giant cells in 100% of cases, some ingesting colloid or neutrophils; fibrous fragments with enmeshed inflammatory cells were a constant feature; follicular cells were scant to absent in most cases. Granulomas were rare. Colloid, when present was thick, with central cracks and frayed edges. One case was suspicious for malignancy. We conclude that the cytologic features of SAT are predictable, particularly, in the appropriate clinical setting. FNA is also helpful in ruling out concomitant neoplastic conditions.
Metaplastic breast carcinomas (MBCs) are not only uncommon neoplasms but also show a myriad of cytomorphologic patterns in aspiration samples. These tumors comprise less than 5% of breast malignancies and have an uncertain prognosis. In this study, the fine-needle aspiration cytologic features of 14 MBCs with the identification of two distinct malignant cell populations are presented, based on which a definitive diagnosis was possible in 12 of the 14 cases. In the remaining 2 cases the diagnosis of MBC was substantiated after study of cell blocks from the aspirate, which were made in all the cases. Furthermore, the diagnosis of MBC was also confirmed subsequently on tissue examination. The various combinations of patterns included malignant ductal, squamous, and sarcomatous (including heterologous) elements and multinucleated osteoclastic giant cells. As a result of this study, it was felt that if malignant breast aspirates on careful examination show two or more distinct neoplastic elements, the diagnosis of MBC may be possible.
Portal vein tumor thrombosis is an important and consistent prognostic indicator in hepatocellular carcinoma. We reviewed 14 cases of ultrasonically guided fine-needle aspiration biopsy (FNAB) of the portal vein. All the patients had clinical evidence of portal vein thrombosis (PVT). Twelve of these patients had a preliminary diagnosis of hepatocellular carcinoma while the remaining two, initially, had a clinical diagnosis of end-stage liver disease. The mean age of the patients was 60 years. An average of 1.7 passes per case was made. No clinical complications were encountered. The cytomorphologic features of the aspirated materials were reviewed. Twelve of the 14 cases (85.7%) were judged neoplastic or thought to have probable neoplastic involvement of the portal vein while two were clearly benign. The cell block was found to be the most useful in diagnosis. We conclude that FNAB of the portal vein is a feasible method in evaluating PVT, especially in patients already known to have hepatocellular carcinoma.
Filariasis is a major health problem in tropical countries like India. Detection of microfilariae or adult worm or egg in FNAC is very unusual despite the high incidence of this parasite in endemic zone. The aim of this study was to document the value of fine-needle aspiration cytology (FNAC) in diagnosis of filaria at all possible sites presenting as mass or swelling.
Fourteen patients (nine males and five females) in the age range of 14–61 years were subjected to FNAC. FNA from swellings was done using 22-gauge needles fitted with 10 or 20 ml disposable plastic syringes. The slides were stained with May–Grunwald–Giemsa stain, Haematoxylin and Eosin (H&E) stain, and Papanicolaou (Pap) stain.
In total, 14 cases of filariasis were detected, which included subcutaneous swellings (six cases), epididymis/spermatic cord nodules (four cases), breast lumps (two cases), lymph nodes (one case), and thyroid swelling (one case). Larvae (microfilariae), eggs, and adult worms were detected in cytological smears. Microfilaria was present in all 14 cases whereas adult worm was found in three cases only. In four cases, eggs were seen in the smears. None of the patients was microfilariaemic and significant eosinophilia (>10%) was seen seen in two patients.
Filarisis should be considered as one of the differential diagnosis of swelling in endemic area. Identification of the parasite, Wuchereria bancrofti, in FNA smears and accurate diagnosis of filaria is important to employ proper treatment. Early diagnosis and treatment prevents the more severe manifestation of the disease, lymphatic filariasis. Diagn. Cytopathol. 2010.
The aim of this study was to evaluate the cytospin technique as an alternative method to prepare fine-needle aspiration (FNA) specimens of the breast. To do so, the cytology of 148 breast FNAs that had been prepared by the cytospin technique and that had histologic correlation, was reviewed. All the cases that were diagnosed as malignant by cytology were proved malignant after surgical excision, and there were no false-positive results. All but two cases diagnosed as benign by cytology proved to be benign on excision. The two false-negative cases were missed due to sampling error. The cytological features seen on cytospins were similar to those seen on conventional direct smears. The major advantage of this method is that no aspirate is unsatisfactory due to unskilled direct smear technique. This, along with its good correlation with histology, proves that the cytospin method is an effective alternative to conventional direct smears for breast FNA.
Fine-needle aspiration cytology (FNAC) is a well-established technique for diagnosis of malignant lymphoma (ML). Generally, Giemsa but not Pap stain is used in FNAC. However, cytologic features obtained from Pap stain are also valuable. Very few studies on the cytologic characteristics of ML, as determined by Pap stain, are available. It is easier to observe nuclear irregularity and to identify nucleoli in ML cells by Pap stain than by Giemsa stain. Here, we applied Pap stain for cytomorphologic differential diagnosis of follicular lymphoma (FL) from reactive follicular hyperplasia (RFH).
The aim of the study was to assess the relationship between fallopian tube lavage cytology and recognized microscopic prognostic features in cancer of the uterine corpus. Tubal (TW) and peritoneal washing cytology (PW), endometrial tumor grade, and tumor involvement of the cervix, myometrium, myometrial vessels, and peritoneum were assessed in 150 patients. Endometrioid adenocarcinoma grade I was considered a low-grade tumor, while endometrioid carcinoma grades 2/3, serous/clear cell carcinoma, carcinosarcoma, and high-grade stromal sarcoma were considered high grade. The overall concordance rate for paired TWs and PWs was 72% (108/150). Forward stepwise logistic regression analysis of the 150 tumors revealed that only PWs and cervical involvement were independently predictive of TWs. No relationship was evident between TWs and depth of myometrial invasion, myometrial vascular involvement, or peritoneal metastases. It is concluded that retrograde transtubal spread by malignant endometrial cells occurs independently of myometrial histoprognostic features. TWs provide supporting evidence for diagnostically difficult PWs, and malignant TWs may be detected in the presence of minimally invasive serous/clear cell carcinoma and carcinosarcoma of the endometrium.
To avoid contamination of equipment and reduce risks of infection, intraoperative cytology (IOC) is a useful substitute to conventional frozen section in the diagnosis of infectious diseases. One of the various histomorphologic patterns of infections is the granuloma, which sometimes may be difficult to diagnose cytologically. In an attempt to assess accuracy and pitfalls of IOC in the diagnosis of granuloma, cases diagnosed as granuloma on IOC or on permanent sections (PS) at George Washington University Medical Center were collected for the period of September 1990 to March 1996. Cyto-histologic correlation was performed.
During that time, a diagnosis of granuloma in either the IOC or PS was rendered in 156 of 5,901 IOC cases. IOC showed definite granuloma (87), suspicious for granuloma (23), and neither definite nor suspicious for granuloma in 46 cases. The latter group corresponded to neoplasms (5) and benign conditions (41).
Eighty-five cases were accurately diagnosed as definite granuloma by both IOC and PS. Fifty-seven cases diagnosed as granuloma by PS corresponded on IOC to suspicious for granuloma (11), benign smear (41), and neoplasms (5). Only two cases were incorrectly diagnosed as granuloma on IOC: a neoplasm and a case of fibrosis.
Overall, four cases of neoplasms were interpreted as suspicious for granuloma (3) or definite granuloma (1) on IOC, and five cases of granulomas were misdiagnosed as neoplasms on IOC. Four of these nine case were deferred for a PS diagnosis.
IOC is a useful tool in the diagnosis of granulomas with a sensitivity of 60% and specificity of 99% and positive and negative predictive values of 98% and 99%, respectively. Rarely, neoplasms may be misdiagnosed as granulomas and vice versa. Diagn. Cytopathol. 1998;18:62–66.
Between January 1, 1992 and December 31, 1997, a cytopathological diagnosis of follicular variant of papillary thyroid carcinoma (FVPC) was made on a series of 16 out of 18 patients with palpable nodules who underwent fine-needle aspiration biopsy (FNAB) in our Department. The results of aspiration biopsy were followed by histopathological examination of the surgically excised tissues. There were three false-negative aspirations (16.6%), of which two were probably bound to fine-needle sampling and one due to a mixture of benign and malignant cells which had originally gone unrecognized. The accuracy of the cytopathologic diagnosis in this variant was 88.8%.
Adolescents may be more susceptible to cervical human papillomavirus (HPV) infections and may have more rapid progression of cervical intraepithelial neoplastic (CIN) lesions than adults. We evaluated Papanicolaou (Pap) smears and cervical tissue specimens from a consecutive series of 25 adolescent (age 15-20 yr) and 17 adult (age 35-40 yr) patients with a histologic diagnosis of CIN III. The study patients were all Detroit residents enrolled in a health maintenance organization (HMO) affiliated with Henry Ford Hospital. The cervical tissue specimens were evaluated for HPV 6b/11, HPV 16, and HPV 18 using agarose gel electrophoresis and Southern hybridization following polymerase chain reaction (PCR) DNA amplification. While the small sample size precluded testing for statistical significance, HPV 16 and/or HPV 18 DNA was detected in specimens from 21/25 (84%) adolescents compared to 12/17 (71%) adults (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 0.49-9.74). The relationship between adolescence and HPV infections appears to be stronger for HPV 18 and mixed HPV 16/18 infections (OR = 5.6; 95% CI = 0.7-42.4) than for HPV 16 infections (OR = 1.93; 95% CI = 0.4-8.8). None of the cervical specimens contained HPV 6b/11 DNA. Oral contraceptive (OC) use was associated with HPV infection in patients with CIN III, but there was no association between cigarette smoking and HPV infection. The effect of OC use on the relationship of age and HPV could not be evaluated due to small sample size. The effects of previous sexually transmitted disease (STD) on the relationship of age and HPV were assessed.(ABSTRACT TRUNCATED AT 250 WORDS)
Nocardia is an infrequent but significant cause of infections in the immunocompromised host. Clinical syndromes are varied and ranges from pulmonary, disseminated, cutaneous, and CNS involvement. Here we describe a case of disseminated subcutaneous nodules in a patient with multiple myeloma caused by Nocardia farcinica. The diagnosis was made by FNA biopsy which revealed gram positive filamentous bacilli in background of acute inflammation on smears. This was confirmed by 16S ribosomal gene sequencing. Prompt identification of N. farcinica is important because of its intrinsic resistance to broad spectrum cephalosporins and high risk of dissemination.
In this article we report on our diagnostic experience of fine-needle aspiration biopsies (FNAB) performed on 17 patients with testicular lesions in the period from 1994-1998. The cytological diagnosis was consistent with seminoma in 7 cases, sex cord-stromal tumors in 3 cases (2 Sertoli cell tumors, 1 Leydig cell tumor), embryonal carcinoma in 3 cases, and yolk-sac tumor in 1 case; the other 3 patients were suffering from flogistic pathology. The cytological diagnosis was confirmed in all cases after surgery. According to our experience, ultrasound FNAB of testicular lesions proved to be a very reliable technique in predicting malignancy with high sensitivity and specificity. None of the patients developed local recurrences or inguinal lymph-node metastasis due to FNAB. Therefore, tumor stage classification (TNM) was not modified in any patient.
We describe a method of in situ hybridization (ISH) to assess numerical chromosome abnormalities on alcohol-fixed smears obtained by fine-needle aspiration from breast cancer patients, using a commercially available amplification kit to demonstrate numerical chromosome alterations of chromosome 17. In this staining procedure after detection of the biotin-labeled alpha-satellite probe for chromosome 17 with avidin-biotin-peroxidase, we incorporated a signal amplification based on the peroxidase-catalyzed deposition of a biotinylated phenolic compound followed by a secondary reaction with peroxidase. The reactions are revealed by deposition of diaminobenzidine and can be analyzed in an optical microscope, with total preservation of the morphology, allowing a direct morphologic-cytogenetic correlation. A series of 25 cases of aspirates from breast cancer were analyzed with this methodology. Aneusomy was found in 14 cases (56%), whereas 11 (44%) had a normal number of chromosome 17 copies. Polysomy occurred in all aneusome cases except one. We did not find concordance between numerical chromosome abnormalities of chromosome 17 and nuclear grading as well as with the immunoexpression of p53 and c-erbB2 studied in the smears. We conclude that the application of the ISH signal amplification method on alcohol-fixed smears will eliminate the need for fresh material and will provide several advantages, such as improvement of morphological concomitant analysis without the need for a fluorescence microscope; utilization, whenever malignancy is found, without necessity to reaspirate the patient; and adequacy of archival material.
Primary sclerosing cholangitis (PSC) is uncommon in the younger age range and bile duct brushing cytology can present unique challenges. We describe the case of a 17-year-old boy with a new diagnosis of PSC who presented with cholangiocarcinoma. The clinical history, endoscopic features, cytomorphologic findings, and results of UroVysion™ fluorescent in situ hybridization (FISH) on the bile duct brush are described. UroVysion FISH on bile duct brushings is an ancillary study that can improve the diagnostic sensitivity for malignancy, specially in challenging cases where the cytomorphologic or clinical characteristics of the case are not typical. The occurrence of cholangiocarcinoma in young age group with PSC is uncommon, and the utilization of UroVysion FISH has been rarely described.
One hundred thirty-two cases diagnosed as non-Hodgkin's lymphoma (NHL) by fine-needle aspiration cytology (FNAC) and histology, and 43 cases in which there were minor or major discrepancies between cytology and histology for diagnosis of NHL, were reviewed. The diagnostic accuracy of FNAC for NHL was 86.3% at the initial diagnosis. Following review, all the 132 cases initially diagnosed as NHL by cytology and histology remained so with minor changes in subtypes in a few cases. Of the 43 discrepant cases, 28 turned out to be NHL and 6 as Hodgkin's disease (HD); 3 were anaplastic carcinoma; and in 6 cases the discrepancy still persisted. Diagnostic accuracy of FNA for NHL improved to 98.0% following review. Categorization of histologically diagnosed NHL cases under working formulation showed that 10.4%, 21.5%, and 57.7%, respectively, were low, intermediate, and high-grade lymphomas. The corresponding figures were 16.6%, 18.4%, and 60.1%, respectively, in cytology. The diagnostic accuracy of cytology for subtyping was found to be 67.5%.
The cytologic features of 18 fine-needle aspirates (FNAs) of metastatic nasopharyngeal carcinoma from 17 patients were examined. The 12 males and 5 females had a median age of 45 years (range 17-75 years). Six were white, five Oriental, four Hispanic, and two black. All patients had mid- or upper-cervical lymphadenopathy (14 bilateral, 3 unilateral). Seven developed widespread metastasis (bone, 5; lung, 2; liver 1; adrenal, 1; soft tissue, 1). The FNAs were from cervical lymph nodes (15), liver (1), adrenal (1), and soft tissue (1). Most aspirates showed similar cytologic features. Tumor cells were present singly and in syncytial groups with overlapping moderately pleomorphic oval to spindle-shaped nuclei with thin, slightly irregular nuclear contours, moderately hyperchromatic chromatin, and usually one or two prominent nucleoli. The cytoplasm was scant and pale with ill-defined borders. Mitoses were frequent. Mature lymphocytes were common in the background of lymph node aspirates. Electron microscopy and immunocytochemistry confirmed the epithelial nature of the tumor in four cases. Although the cytologic features of metastatic nasopharyngeal carcinoma (NPC) are characteristic, other poorly differentiated neoplasms need to be considered. Clinical and radiologic data are helpful in supporting the cytologic diagnosis.
Imaging studies using the fluoride-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan have recently become available for patient neoplasia evaluation. Fine-needle aspiration (FNA) biopsy is a well-described diagnostic method for hepatic lesion evaluation. Correlation of these testing modalities in hepatic abnormalities has not been previously reported. Pathology files of Saint Louis University Hospital were retrospectively searched for patients with FNA biopsy of the liver. Thirty-one patients with a total of 32 FNA biopsies of the liver with corresponding FDG-PET scans were identified. Twenty-five patients had 25 cases of metastatic malignant neoplasia diagnosed by FNA biopsy. Of these cases, all but one had an FDG-PET scan positive for malignancy, yielding a sensitivity of 96% (24/25) for the FDG-PET scan. Combined positivity of the two testing modalities yielded a sensitivity of 100% (24/24). Seven patients did not demonstrate neoplasia by FNA biopsy, and the FDG-PET scan was negative in 6 of these 7 cases. The FDG-PET scan is an important imaging technique and, combined with FNA biopsy, can provide reliable diagnostic results and assist in the guidance of oncologic patient management.
During the Montebello Conference on malignant serosal tumours at Lillehammer, Norway, in June 2004, a group of 30 international experts addressed the biologic and genetic aspects of malignant tumours affecting serosal cavities in the human body. Three neoplasms were mainly dealt with: mesotheliomas arising locally, ovarian carcinomas developing in close proximity to the serosa, and breast tumours in which the spread came from some distance. New, important data on the tumour microenvironment and the process of carcinogenesis with progression and acquisition of invasive properties shed new lights on the mechanisms, including proliferative properties, alterations of signal transduction pathways, and tissue remodelling by proteolytic enzymes in the metastasizing cells. Several of these markers have considerable diagnostic and clinical interest. In addition, new aspects of morphologic and immunocytochemical characteristics of the cells as well as genetic markers may soon become powerful tools for practical use. The molecular fingerprint of the individual tumours may also give guidelines for chemotherapy as well as biologic therapies, including induction of apoptosis. The easy accessibility of tumours from serosal fluids and possibilities for specific discrimination of the neoplastic cells from admixed leukocytes and other cells are promising avenues for cytodiagnostics.
Vaginal lactobacilli assessed by PCR-based microarray and PCR-based genotyping of HPV in South African women at risk for HIV and BV.
Vaginal lactobacilli can be defined by microarray techniques in fixed cervical samples of South African women. Cervical brush samples suspended in the coagulant fixative BoonFix of one hundred women attending a health centre for HIV testing in South Africa were available for this study. In the Ndlovu Medical Centre in Elandsdoorn, South Africa, identification of 18 hr-HPV genotypes was done using the INNO-LiPA method. An inventory of lactobacilli organisms was performed using microarray technology.
On the basis of the Lactobacillus and Lactobacillus biofilm scoring, the cases were identified as Leiden bacterial vaginosis (BV) negative (BV-; n = 41), Leiden BV intermediate (BV±; n = 25), and Leiden BV positive (BV+; n = 34).
Fifty-one women were HIV positive and 49 HIV negative. Out of the 51 HIV positive women, 35 were HPV infected. These 51 HIV positive women were frequently infected with HPV16 and HPV18. In addition, HPV35, HPV52, HPV33, and HPV66 were often detected in these samples. Lactobacillus salivarius and Lactobacillus iners were the most prevalent lactobacilli as established by the microarray technique. In women with HPV infection, the prevalence of Lactobacillus crispatus was significantly reduced. In both HIV and HPV infection, a similar (but not identical) shift in the composition of the lactobacillus flora was observed. We conclude that there is a shift in the composition of vaginal lactobacilli in HIV-infected women. Because of the prominence of HPV35, HPV52, HPV33, and HPV66, vaccination for exclusively HPV16 and HPV18 might be insufficient in South African HIV+ women. Diagn. Cytopathol. 2012;40:472–477.
The paper traces the history of cytopathology in the U.K. from the time of the pioneers in the last century to the 1930s and continues with the development of cervical and breast screening, with reference to training and quality control, to the present time. Diagn. Cytopathol. 2000;22:203-206.