Showing papers in "Acta Cytologica in 1995"

Fine needle aspiration biopsy in the diagnosis of lymphadenopathy in 1,103 patients. Role, limitations and analysis of diagnostic pitfalls.

Abstract: Fine needle aspiration biopsy (FNAB) is widely used for the assessment of various lesions. The results of FNABs of lymph nodes on 1,103 patients, performed over a 14-year period, from 1978 to 1992, are presented. The patients ranged in age from 1 to 90 years. Cervical nodes were the site sampled most frequently (47%). Of all the aspirates, 593 were diagnosed cytologically as malignant, 61 as suspicious for malignancy and 329 as benign. The material was classified as unsatisfactory in 120 cases. Aspirates from supraclavicular nodes were most likely to be malignant (85%), followed by those from deep nodes (67%). The most challenging lesions to assess using FNAB were lymphomas, accounting for 15 of the 23 false negatives. Most of these were related to difficulty in the interpretation of well-differentiated neoplasms in the early years of this study, prior to the use of immunocytochemistry. Sampling errors accounted for eight false-negative diagnoses; they included all the cases of metastatic carcinomas that had been missed. There were only three false-positive diagnoses; two of these involved the misinterpretation of lipid-rich lesions as metastatic clear cell carcinomas. The results of this study support the accuracy of FNAB and its value in investigating lymphadenopathies. FNAB of nodes provides a high level of diagnostic accuracy, as shown by the 3.4% false-negative and 0.9% false-positive rates. Lymphoid marker studies of cytologic material greatly enhance our ability to diagnose and properly classify lymphomas and reduce the false-negative rate.

Ultrafast Papanicolaou stain. An alternative preparation for fine needle aspiration cytology.

Abstract: The objective of this study was to develop a Papanicolaou stain as fast as Diff-Quik yet with cytomorphology as exquisite as that processed by ThinPrep for the optimal evaluation of fine needle aspirates. Satisfactory results were obtained after three modifications were made: (1) rehydration of air-dried smears with normal saline, (2) use of a 4% formaldehyde/65% ethanol fixative, (3) and use of Richard-Allan Hematoxylin 2 and Cyto-stain. The first modification restored the transparency of the cells and hemolysed red blood cells, the second modification reduced the time needed for proper fixation and staining from minutes to seconds, and the third modification simplified the procedure. This 90-second protocol yields a transparent, polychromatic stain with crisp nuclear and cytoplasmic features. The cytomorphology processed by this protocol is at least equal to, if not better than, the quality of specimens prepared by ThinPrep and superior to those processed by the standard Papanicolaou procedure.

Accuracy and morphologic aspects of pancreatic and biliary duct brushings.

Abstract: One hundred eight brushing cytology specimens with adequate follow-up were obtained from strictures of the biliary and pancreatic ducts. The material was classified as benign, reactive, low grade dysplasia, high grade dysplasia or adenocarcinoma. A diagnosis of carcinoma was made in 18 patients, high grade dysplasia in 12, low grade dysplasia in 6 and benign, nonneoplastic in the remaining cases. The diagnostic sensitivity for carcinoma was 44%, with a specificity of 98%. Ten of 12 patients with high grade dysplasia demonstrated other evidence of carcinoma. No complications were encountered. Brushing cytodiagnosis of extrahepatic biliary and pancreatic duct strictures appears to be a safe procedure, with high specificity but only modest sensitivity.

Fine needle aspiration of the pancreas. In quest of accuracy.

Abstract: Percutaneous fine needle aspiration (FNA) is the diagnostic method of choice for patients with a pancreatic mass. A positive cytologic diagnosis allows administration of neoadjuvant therapy in patients with resectable disease and avoids laparotomy in patients with locally advanced or metastatic disease. Ninety patients underwent computed tomographically guided FNA of the pancreas, and the results were compared to the final histologic diagnosis. The initial sensitivity for diagnosis of pancreatic adenocarcinoma was 70%. To improve our diagnostic accuracy, 19 independent cytologic criteria were evaluated for each case. Multivariate logistic-regression analysis identified three major criteria (nuclear crowding and overlapping, nuclear contour irregularity, irregular chromatin distribution) and four minor criteria (nuclear enlargement, single epithelial cells, necrosis, mitoses) as the most important predictors of malignancy. In the presence of two or more major or one major and three minor criteria, the sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma were 100%. Objective application of these criteria improved our diagnostic sensitivity to 90%.

Cytologic versus histologic evaluation of needle biopsy of the lung, hilum and mediastinum. Sensitivity, specificity and typing accuracy.

Abstract: Fine needle aspiration biopsy (FNAB) and punch biopsy (PB) are reliable methods of establishing a morphologic diagnosis in thoracic lesions. However, some reservations exist concerning the diagnostic accuracy of and indications for both methods. Therefore, we evaluated the sensitivity, specificity, typing accuracy and complication rates of both methods. We present a six-year experience with 501 thoracic FNABs and PBs in 482 patients. To examine site-specific differences, we evaluated three different compartments: lung, mediastinum and hilum. In 457 cases the final outcome was known for evaluating the accuracy of the cytologic or histologic diagnoses. FNAB was used most often in lung (81.8%) and hilar lesions (87.3%), whereas PB was used mostly in mediastinal (67.9%) and pleural lesions or if a mesenchymal lesion was suggested radiologically but never in foci below 20 mm in diameter. Our complication rate was 21.3% for FNAB and 4.6% for PB. The most frequent complications were pneumothorax, one hematothorax and intercostal neuralgia. The overall sensitivities of the biopsy methods were equal (FNAB, 98.4%; PB, 98%), but the typing accuracy was better for PB than FNAB (87.2% vs. 83.5%). In the hilum the sensitivities of FNAB and PB were 94.6% and 85.7%, respectively, and for the lungs, 99% and 98.2%. In the mediastinum the sensitivity was 100% for both methods. There were false-positive diagnoses in 5% with FNAB of the lung due to misinterpretation of regenerating epithelium and hamartochondroma and a 0.1% rate of false-negative diagnoses as a result of misplacement of the cannula, leading to inflammation, infarction or scarring. Our data indicate that FNAB is the method of choice in pulmonary and hilar lesions because of the similar diagnostic accuracy. Mediastinal and pleural lesions and presumed mesenchymal tumors should be sampled with PB because the typing accuracy of FNAB is insufficient in these cases.

Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid lesions.

Abstract: OBJECTIVE : To study the utility of fine needle aspiration (FNA) cytology as the initial modality in the investigation of thyroid lesions. STUDY DESIGN : Fine needle aspiration biopsies performed on patients presenting with diffuse or nodular thyroid enlargement and solitary thyroid nodules at the Goa Medical College Hospitals, Bambolim Goa, India, from January 1986 to June 1993, were reviewed. Two thousand four biopsies were performed on 1,992 patients, with 12 patients undergoing repeat FNA biopsy at different tmes due to an inconclusive primary result.Thes repeat biosies were also inconclusive and were excluded from the series, leaving 1 992 cases.Two hundred thirty-eight of these 1 992 cases undrewent surgery, either excision of the nodule or some form of thyroidectomy for a cytologically suspicious diagnosis, compression symptoms or cosmetic reasons, and a cytohistopathologic correlation was established in these cases. Twenty-five of the 238 cases that had inadequate cytologic findings were excluded, and the accuracy was studied in the remaining 213 cases. RESULTS : The results of FNA classified 1,557 (78.16%) of these cases as benign, 151 (7.58%) as suspicious, 30 (1.51%) as malignant and 254 (12.75%) as unsatisfactory. Cytohistopathologic correlation was established in 238 cases, which were operated on. Nine (5.5%) of 163 cases with an FNA diagnosis of benign, 10 (26.3%) of 38 cases with an FNA diagnosis of suspicious and 11 (91.67%) of 12 cases with an FNA diagnosis of malignant were histologically malignant. CONCLUSION : FNA biopsy of the thyroid can be used effectively as the initial modality in the evaluation of thyroid lesions, both nodular and diffuse. It is very useful in detecting neoplastic foci in multinodular goiter and also in evaluating solitary thyroid nodules. (Acta Cytol 1995 ;39 :898-904)

Analysis of false results in a series of 835 fine needle aspirates of breast lesions

Abstract: OBJECTIVE : To analyze cases of false diagnoses from a large series to help increase the accuracy of fine needle aspiration of palpable breast lesions. STUDY DESIGN : The results of FNA of 835 palpable breast lesions were analyzed to determine the reasons for false positive, false negative and false suspicious diagnoses. RESULTS : Of the 835 aspirates, 174 were reported as positive, 549 as negative and 66 as suspicious or atypical but not diagnostic of malignancy. Forty-six cases were considered unsatisfactory. Tissue was available for comparison in 286 cases. The cytologic diagnoses in these cases were reported as follows: positive, 125 (43.7%) ; suspicious, 33 (11.5%) ; atypical, 18 (6.2%) ; negative, 92 (32%) ; and unsatisfactory, 18 (6.2%). There was one false positive diagnosis, yielding a false positive rate of 0.8%. This lesion was a case of fibrocystic change with hyperplasia, focal fat necrosis and reparative atypia. There were 14 false negative cases, resulting in a false negative rate of 13.2%. Nearly all these cases were sampling errors and included infiltrating ductal carcinomas (9), ductal carcinomas in situ (2), infiltrating lobular carcinomas (2) and tubular carcinoma (1). Most of the suspicious and atypical lesions proved to be carcinomas (35/50). The remainder were fibroadenomas (6), fibrocystic change (4), gynecomastia (2), adenosis (2) and granulomatous mastitis (1). CONCLUSION : A positive diagnosis of malignancy by FNA is reliable in establishing the diagnosis and planning the treatment of breast cancer. The false-positive rate is very low, with only a single case reported in 835 aspirates. Most false negatives are due to sampling and not to interpretive difficulties. The category suspicious but not diagnostic of malignancy serves a useful purpose in management of patients with breast lumps. (Acta Cytol 1995;39:858-864)

Fine needle aspiration cytology of primary and metastatic lesions of the adrenal gland. A series of 188 biopsies with radiologic correlation.

Abstract: OBJECTIVE : To determine the efficacy of fine needle aspiration (FNA) in the diagnosis of primary and metastatic lesions of the adrenal gland in conjunction with the radiologic size of the lesion. STUDY DESIGN : One hundred eighty-eight FNA biopsies performed between 1988 and 1992 with a diagnostic rate of 86% (161 cases) were reviewed and correlated with the radiologically (computed tomography, ultrasound) measured size of the lesion and follow-up. RESULTS : Eighty-one cases (43%) were primary adrenal lesions, and 80 (43%) were metastatic tumors. Three large cell lymphomas and two adrenal histoplasmoses were also noted. The most common primary site of metastatic tumors was the lung ; these 55 cases (29%) included 47 adenocarcinomas and 3 small cell, 2 large cell and 3 squamous cell carcinomas. The other metastatic tumors were 5 melanomas, 7 renal cell carcinomas and 1 mixed mullerian tumor. The size of the metastatic tumors averaged 5.1 ± 2.5 cm (± SD) and ranged from 1.5 to 10 cm in greatest diameter. Benign cortical nodules (61 cases, 32%) were the most common primary adrenal lesion, followed, in decreasing frequency, by 11 cortical neoplasms/carcinomas, 5 pheochromocytomas and 1 myelolipoma. The benign cortical nodules/adenomas measured an average of 2.4 ± 0.8 cm in greatest diameter and ranged from 1 to 4 cm. The cortical neoplasm/carcinoma sizes ranged from 4 to 12 cm. CONCLUSION : These data suggest that FNA in conjunction with the radiologically measured size of adrenal lesions is a specific and sensitive method of evaluating primary and metastatic lesions of the adrenal gland. It is also an important diagnostic tool in cancer staging, obviating open surgical procedures for many patients. (Acta Cytol 1995 ;39 :843-851)

Assessment of fine needle aspiration cytology and histopathology for diagnosing male breast masses

Abstract: OBJECTIVE : To investigate the diagnostic accuracy of fine needle aspiration cytology (FNAC) from breast lesions in males and to determine the frequency of benign versus malignant histopathologic diagnoses in surgical biopsies from male breast lesions. STUDY DESIGN : FNAC specimens from breast lesions taken from 241 males over 8.5 years were divided into four subgroups according to the original cytologic diagnoses. Diagnostic accuracy was verified with the Norwegian Cancer Registry. Ten years' worth of material from 809 surgical biopsies from male breast lesions was subgrouped according to the original histopathologic diagnoses. RESULTS : Of the 809 surgical biopsies, 779 (96.3%) were benign lesions. Of the 241 fine needle aspirates, 27 (11.2%) were unsatisfactory for cytologic diagnosis. Of the remaining 214 cases, 200 benign cytologic diagnoses were confirmed at follow-up. Thus, there were no false negative cytologic diagnoses ; eight malignant diagnoses were confirmed by later histopathologic examination of the surgical biopsy. CONCLUSION : To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions. (Acta Cytol 1995 ; 39 :877-881)

Comparison of ThinPrep preparations with conventional cervicovaginal smears. Practical considerations.

Abstract: This study compared cytologic quality, diagnostic accuracy, detection of endocervical and endometrial cells and yeast, screening times and costs for 128 ThinPrep preparations (TP) to the corresponding conventional cervicovaginal cytologic smears (CCVS). Final diagnoses agreed in 114 (89%) cases. There were four discrepancies between atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesion. The number of abnormal cells was lower in TP than in CCVS. Endocervical and endometrial cells were detected less frequently in TP than in CCVS. Yeast forms were seen rarely but were identified in both CCVS and TP. Inflammation and blood were less prominent on TP. While some CCVS showed artifacts related to fixation, cell preservation was optimal in all TP. Screening times were significantly shorter for TP than for CCVS. The combined cost of reagents, preparation and screening for an average TP was $1.78 higher than for a CCVS. We conclude that the use of TP for cervicovaginal smears reduces screening time and produces better cytologic preparations. However, cost-benefit analyses, readjustments in criteria for diagnosis of dysplasia and improvements in the recovery of glandular cells may be necessary before this method is used instead of CCVS.

Fine needle aspiration of medullary carcinoma of the thyroid. Cytomorphology, immunocytochemistry and electron microscopy.

Abstract: OBJECTIVE : To analyze of medullary carcinoma of the thyroid (MCT) diagnosed by fine needle aspiration (FNA) utilizing cytomorphologic features and ancillary studies. STUDY DESIGN : Nine cases of MCT were collected, and the cytomorphologic findings were reviewed. Additionally, immunocytochemistry, immunoelectron microscopy and ultrastructural examination results were reviewed for selected cases. RESULTS : In five cases, loose groups predominated over single cells, whereas single cells predominated in three cases. One case showed only highly cohesive groups of cells. Most cells were round to oval, and every case had some degree of plasmacytoid morphology. Spindle-shaped cells were predominant in one case and were occasionally noted as a subpopulation in the other cases. Binucleation was noted in seven cases, and scattered, abnormally large nuclei were identified in five cases. The cytoplasm was moderate to abundant and delicate in all cases. Routine immunocytochemical staining for calcitonin and chromogranin was positive in three of four cases, and staining positive for the markers was detected by immunoelectron microscopy in two cases. In four cases, electron microscopy revealed neurosecretory granules. CONCLUSION : The cytomorphologic appearance of medullary thyroid carcinoma is highly distinctive, and the diagnosis can be corroborated by appropriate ancillary studies. (Acta Cytol 1995 ;39 :920-930)

A modified cell block technique for fine needle aspiration cytology.

Abstract: A modification of the cell block technique, useful in processing material obtained by fine needle aspiration (FNA), is described. Four hundred six aspirates, obtained from 333 consecutive patients, were studied after immediate fixation in 4% buffered paraformaldehyde. Conventional histochemical and immunohistochemical staining methods were used. Histologic verification of the cytologic diagnoses made by FNA was possible in 67 cases. The overall accuracy was 97%, with a sensitivity of 95% and specificity of 100%. A major disadvantage of the cell block technique is time. Therefore, even if this technique increases the accuracy of cytologic diagnosis, its routine use is impractical because the delay in diagnosis when compared with smears may be considerable. The cell block technique is a valuable method, particularly when immunohistochemical staining for a battery of markers is required.

Fine needle aspiration cytology of non-Hodgkin's lymphomas. A morphologic and immunophenotypic study.

Abstract: To assess the value of fine needle aspiration cytology (FLAC) in the diagnosis of non-Hodgkin's lymphomas (NHL), we retrospectively studied all the cases diagnosed cytologically as NHL in our laboratory during a five-year period (1987-1991). We also traced cases in which FLAC failed to diagnose NHL and where the diagnosis was made subsequently by histopathology. Fine needle aspiration (FLA) was performed on both peripheral/palpable and deeply situated lesions. A total of 164 specimens were studied cytologically, and for 130 of them a histologic report was available. In 83 of the cases, FNA was carried out as part of the initial evaluation, and in 81 the diagnosis of NHL was known and FNA was performed to confirm or exclude a relapse. In 76 cases for which morphology was inconclusive the immunophenotype was assessed by immunocytochemistry. There were three false-negative and one false-positive result; in none of them was immunophenotyping performed. No discrepancy was observed in the distinction between low and high grade lymphomas, but this was feasible in only 115 of the 164 specimens studied. We conclude that the method is a feasible, rapid and inexpensive first approach in the evaluation of patients with NHL. FNAC may be substituted for histology in the occasional patient for whom the surgical risk outweighs the inaccuracies of the procedure

Cystic change in lymph nodes with metastatic squamous cell carcinoma

Abstract: A retrospective analysis was performed of the gross characteristics of aspirated material in 335 consecutive cases of metastatic squamous cell carcinoma in cervical/supraclavicular lymph nodes seen during a three-year period. In 57 cases (17.01%), 1-2 mL of fluid was obtained. Microscopic examination of cytocentrifuge smears in all cases showed malignant squamous cells. Cystic change in lymph nodes harboring metastatic squamous cell carcinoma was frequently associated with a tongue primary (21/58 cases, 36.2%) followed by an esophageal primary (4/16 cases, 25%). The frequency of cystic change varied from 9.1% to 21.5% with primaries in the oral cavity, nasopharynx, lung, uterine cervix and unknown sites.

Fine needle aspiration cytology diagnosis of male breast lesions. A study of 185 cases

Abstract: OBJECTIVE : To study the fine needle aspiration (FNA) cytologic features of male breast lesions and to determine the efficacy of FNA cytology in the diagnosis of these lesions. STUDY DESIGN : During a five-year period (July 1988-June 1993), 188 males with breast lesions were investigated by fine needle aspiration cytology (FNAC). Slides were available for review in 185 of these cases. RESULTS : Gynecomastia was the most common lesion (132 cases). followed by benign tumors and cysts (16 cases), carcinoma (6 cases) and inflammatory lesions (5 cases). In 26 cases the smears were considered inadequate. The cytologic features of gynecomastia included cohesive sheets of bland cells (100.0% of cases), bipolar bare nuclei (76.5%) and columnar cells (38.6%). Mild nuclear atypia was observed in seven cases. The cytologic features of gynecomastia included cohesive sheets of bland cells (100% od cases), bipolar bare nuclei (76,5% ) and columnar cells (38,6%). Mild nuclear atypia was observed in seven cases.The cytologic features consisted of dyshesive groups of ductular cells with moderate to severe nuclear atypia and absence of bare nuclei as well as columnar cells.The benign tumors and cysts included lipomatous lesions (10 cases), spindle cell tumors (3 cases) and epidermal inclusion/pilar cysts (3 cases). Histology was done in 25 cases. Diagnostic accuracy of FNAC for gynecomastia, begnin tumors and malignancy was 100%, 100%,and 66,7%, respectively. The only discrepant case was a carcinoma diagnosed as highly suspicious on the cytlogic specimen. CONCLUSION : FNAC was very useful for investigating male breast masses. (Acta Cytol 1995 ;39 :870-876)

A clinical trial of the AutoPap 300 QC system for quality control of cervicovaginal cytology in the clinical laboratory.

Abstract: Objective False-negative reports of cervicovaginal (CV) smears (FNs) due to interpretive errors pose a significant and persistent problem in cytology. Using routinely prepared CV smears, the AutoPap 300 QC System, an automated cytology screening device, can provide an enriched population of slides for manual rescreening. In this clinical trial, the performance of the AutoPap System was assessed and compared to current random quality control (QC) selection techniques. Study design A total of 3,487 "within normal limits" cases were rescreened, both manually and by the AutoPap 300 QC System. Detected FNs were classified by three different methods: cytotechnologist rescreen, internal discrepancy panel and external discrepancy panel. The sensitivity of the AutoPap System to these FNs was established at five QC score thresholds. Results By cytotechnologist rescreening, 106 FNs were identified. Subsequent internal and external discrepancy panel reviews confirmed the FNs in 80 cases and 86 cases, respectively. At a 10% review rate, the AutoPap System identified approximately 50% of the squamous intraepithelial lesion FNs. Conclusion The AutoPap 300 QC System is a sensitive automated cytology system that has the potential of yielding five times as many FNs as a 10% random rescreen.

Spectrum of Cytologic Changes in Pregnancy. A Review of 100 Abnormal Cervicovaginal Smears, With Emphasis on Diagnostic Pitfalls

Abstract: OBJECTIVE : To review pregnancy-related changes in cervicovaginal smears and to distinguish them from neoplasia and dysplasia. STUDY DESIGN : One hundred consecutive abnormal cervicovaginal smears from pregnant women obtained during 1992-1993 were reviewed. Corresponding biopsies that were available were also reviewed for cytologic correlation. RESULTS : Sixty-one percent of cases showed inflammation changes, 21% contained low grade squamous intraepithelial lesion, and 9% had high grade squamous intraepithelial lesion. Diagnostic problems were encountered with decidual cells, Arias-Stella reaction and trophoblastic cells. CONCLUSION : Both the clinician and pathologist must be aware of diagnostic pitfalls and false positive diagnoses in pregnancy. Hence, it is extremely important that the clinician notify the pathologist about the pregnancy status of the patient. (Acta Cytol 1995 ;39 : 905-908)

Cytologic diagnosis in the management of gallbladder carcinoma.

Abstract: Cytologic investigations of 16 proven cases of gallbladder carcinomas were analyzed in order to establish the usefulness of cytological methods, including exfoliative bile cytology, fine needle aspiration and endoscopic brushing, in the preoperative and intraoperative diagnosis and management of gallbladder carcinoma. Fine needle aspiration cytology had a sensitivity of 88% and exfoliative cytology of bile a sensitivity of 50%, but both brushings performed yielded false negatives. A preoperative diagnosis was made in 69% (9/13) of cases, and cytologic diagnosis was helpful in planning surgical management. We recommend its wider application in the preoperative diagnosis of gallbladder carcinoma.

Fine needle aspiration cytology of renal and retroperitoneal angiomyolipoma : report of two cases with cytologic findings and clinicopathologic pitfalls in diagnosis

Abstract: BACKGROUND : Angiomyolipoma is a benign soft tissue neoplasm that usually arises in the kidney, although rare extrarenal examples have been documented. CASES : Two cases of the neoplasms occurred in which fine needle aspiration (FNA) biopsies were performed. The first patient was a 73-year-old female with a history of breast carcinoma who presented with a large retroperitoneal mass. Transabdominal FNA biopsy revealed multiple fragments of spindle-shaped mesenchymal cells, a few of which showed marked cellular atypia with occasional cells containing fat vacuoles, producing a lipoblastlike appearance. However, the atypical spindle cells were immunohistochemically reactive for actin, raising the possibility of a smooth muscle tumor rather than a liposarcoma. The surgically resected specimen revealed an extrarenal, retroperitoneal angiomyolipoma. The second patient was a 71-year-old female who presented with a right renal mass and hepatomegaly. Computed tomography showed a mass in the upper pole of the kidney and multiple enhancing lesions in the liver. FNA biopsy was diagnostic of angiomyolipoma, which was confirmed histologically. CONCLUSION : Angiomyolipoma should be considered in aspirates of both renal and extrarenal masses when an admixture of blood vessels, fat and smooth muscle cells is encountered. Pitfalls leading to an incorrect diagnosis include aspiration at unusual sites for angiomyolipoma and/or the presence of atypical spindle cells and lipoblastlike cells, which can be mistaken for leiomyosarcoma or liposarcoma cells. Ancillary studies, such as immunocytochemistry for smooth muscle markers, may be helpful in making the correct diagnosis. (Acta Cytol 1995 ;39 :945-950)

Solid and papillary epithelial neoplasm of the pancreas. Diagnosis by fine needle aspiration cytology in four cases.

Abstract: The cytologic features of four cases of solid and papillary epithelial neoplasm of the pancreas that were diagnosed on fine needle aspiration cytology are described. Papillary structures with delicate vascular cores covered with several layers of bland tumor cells were a distinctive feature. The papillae in two of the cases showed mucoid material in their cores. The cytologic features of solid and papillary epithelial neoplasm of the pancreas are distinct from those of other cystic pancreatic tumors.

Intraoral and transoral fine needle aspiration. A review of 25 cases.

Abstract: During a four year period, 25 intraoral and transoral fine needle aspirations were performed. The sites aspirated were the parapharyngeal space (7), palate (4), floor of mouth (3), tongue (3) and a variety of other intraoral sites (8). Squamous cell carcinoma, the most common malignancy encountered, was correctly diagnosed in six cases. Other malignancies correctly diagnosed were 2 malignant lymphomas, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma. One malignant case called "carcinoma, probably adenoid cystic carcinoma" proved to be a mucoepidermoid carcinoma. One case called "suspicious for squamous carcinoma" was found to be a branchial cleft cyst. In another case a diagnosis of carcinoma in situ of the tongue was suggested and confirmed by subsequent biopsy, but the underlying adenoid cystic carcinoma was missed. Of seven benign entities, five were correctly diagnosed by fine needle aspiration (FNA), and in three cases the FNA diagnosis was equivocal. Unsatisfactory aspirates were obtained in four cases. Despite some obvious problems, we consider FNA to be especially useful for the evaluation of parapharyngeal masses, which are usually not accessible to routine surgical biopsy, and for palatal masses, which are usually submucosal and therefore often difficult to biopsy.

Cervical smears prepared by an automated device versus the conventional method: a comparative analysis

Abstract: An automated, fluid-based method for the preparation of cervical Papanicolaou smears/slides was compared to the conventional Papanicolaou smear (CPS) method used for the screening of neoplasia. We determined diagnostic agreement and sources of error for diagnostic disagreement. For 665 patients, one cervical sample was collected to make one CPS. The collection devices, a wooden Ayre spatula and endocervical brush, were rinsed into a vial with fluid medium to be processed in the automated device. All slides were distributed among five cytotechnologists in a blind fashion. Exact diagnostic agreement was 94.6%. The results were not statistically significant (P > or = .70, McNemar's test) but were clinically important, as evidenced by the detection of low grade lesions (LGL), during initial screening, on three slides prepared by the automated device but not on their matched-pair CPSs (0.5% of all specimens). After reevaluation, the three matched CPSs demonstrated LGL. Sources of diagnostic error on the CPSs were: air-drying artifact, obscuring blood/inflammation, crowding/overlapping of cells and/or absence of diagnostic cells. The only source of error in the automated-method smears was absence of diagnostic cells.

Intraoperative fine needle aspiration cytology of pancreatic lesions. A study of 90 cases.

Abstract: Undiagnosed masses in the pancreas represent a problem at laparotomy. Intraoperative biopsy of pancreatic lesions frequently fails to detect carcinoma and may cause severe complications. The aim of the present study was to determine the diagnostic accuracy of intraoperative fine needle aspiration cytology (FNAC) of pancreatic lesions. Ninety patients were studied from January 1988 to June 1992. The cytologic diagnoses were correlated with histology, autopsy results or clinical follow-up. Aspirates were reported as benign, suspicious, malignant or unsatisfactory. Final diagnosis of malignant pancreatic disease (MPD) was established in 60 patients and of benign pancreatic disease in 30. Among the 60 cases with MPD, the cytologic diagnosis was concordant in 42 and interpreted as suspicious in 4. Seven patients with benign cytology and 7 with unsatisfactory cytology later proved to have malignant disease. A total of 30 patients had benign disease; 26 of them had benign cytology. The remaining four had "unsatisfactory" cytologic reports. No false positives were reported. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for intraoperative FNAC results were 80%, 100%, 100%, 70% and 91%, respectively. No complications followed the procedure. Intraoperative FNA of the pancreas is a safe and highly accurate diagnostic method for pancreatic lesions at laparotomy.

Role of nuclear grooves in the diagnosis of papillary thyroid carcinoma. A quantitative assessment on fine needle aspiration smears.

Abstract: Thirty-four cases of papillary thyroid carcinoma and 69 control cases consisting of 17 follicular neoplasms, 5 Hurthle cell neoplasms, 7 medullary carcinomas, 6 thyrotoxic goiters, 19 chronic lymphocytic thyroiditis cases, 3 subacute thyroiditis cases and 12 colloid goiter cases were studied for nuclear grooves. Such grooves were seen in 100% of papillary carcinoma and in 75-100% of other thyroid disorders, but their number was strikingly higher in papillary carcinoma. A quantitative assessment for nuclear grooves was made based on counting 500 follicular cells in hematoxylin and eosin (H&E)-stained and May-Grunwald-Giemsa (MGG)-stained smears. In H&E-stained smears of papillary carcinoma the number of cells with nuclear grooves (227.3 +/- 99.96 SD) was significantly higher as compared to other thyroid disorders (P or = 20% tumor cells, whereas none of the other thyroid diseases exceeded this level. In MGG-stained smears the number of cells with nuclear grooves (40.7 +/- 32.83 SD) was also significantly higher as compared to other thyroid disorders (P or = 4% cells with nuclear grooves, whereas 0-40% of other thyroid diseases exceeded this level. Nuclear grooves were significantly higher in H&E-stained smears of papillary carcinoma as compared to MGG-stained smears (P < .001). Based on this objective assessment, nuclear grooves were a useful criterion in the diagnosis of papillary thyroid carcinoma in H&E-stained smears but were not as reliable in MGG-stained smears.

Bronchoalveolar lavage in the diagnosis of disseminated lung tumors.

Abstract: We report our experience with bronchoalveolar lavage (BAL) and its value in the diagnosis of malignant lung infiltrates. A total of 162 patients with biopsy- or autopsy-proven cancer had an analysis of BAL fluid performed. Cytologic examination showed malignant cells in 123 (76%) patients. The diagnostic accuracy varied depending on the neoplastic nature and growth pattern of the disease. BAL disclosed cancer cells in 93% of 44 bronchioloalveolar carcinomas. Carcinomatous lymphangitis due to metastatic cancer was diagnosed in 83% of 69 cases. Hematogenous metastases (with sharply circumscribed nodules on chest radiography) were diagnosed in 45% of 22 such cases. We recognized 67% of 15 non-Hodgkin's lymphomas and 3 of 9 cases of Hodgkin's disease with pulmonary involvement. Immunocytochemistry using monoclonal and/or polyclonal antibodies was of value in the identification and classification of cells in non-Hodgkin's lymphoma.

Fine needle aspiration cytology of primary mediastinal germ cell tumors

Abstract: Fine needle aspiration cytology was performed on six patients with malignant mediastinal germ cell tumor: 1 pure seminoma, 1 pure embryonal carcinoma, 1 pure yolk sac tumor and 3 mixed germ cell tumors containing teratoma. Their cytologic features were compared with each other and with the cytologic features of thymoma, which arises commonly in the anterior mediastinum. A definitive cytologic diagnosis could be made only in the cases of seminoma because of its characteristic cytologic features. Cytochemical staining for germ cell alkaline phosphatase was helpful in diagnosing seminoma in the cytologic examination, while the presence of hyaline globule or alpha-fetoprotein immunostaining as the cytologic diagnostic feature of yolk sac tumor were not necessarily found in fine needle aspiration cytology. All epithelial, lymphocytic and mixed type thymomas were easily differentiated from the four types of germ cell tumor examined.

Cytomorphology of subcutaneous cysticercosis. A report of 10 cases.

Abstract: The findings of fine needle aspiration cytology (FNAC) of subcutaneous cysticercosis are described Nine patients had a single subcutaneous nodule One patient had multiple skin and cerebral nodules that were clinically suspected due to cysticercus Patients with a single nodule in the extremities and trunk were clinically diagnosed as having lipoma (1), fibroma (3) and neurofibroma (3) Tuberculous lymphadenitis was suspected in two cases with a single cervical nodule The characteristic cytomorphology of parasitic tegument and parenchyma helped identify the larvae in the cytological smears, as did a polymorphous inflammatory reaction Biopsy was done in four cases Six patients were lost to follow-up Histopathology of the nonaspirated nodule from the case with multiple skin nodules showed cysticercus The other three biopsies showed a parasitic granuloma only Of the four biopsied cases, only two underwent computed tomographic scans, which showed cerebral involvement In a developing country like India, a rapid, safe and reliable cytologic diagnosis of subcutaneous cysticercus by FNAC on an outpatient basis proves to be a cost-effective procedure since it obviates the need for open biopsy

Transformation of follicular lymphoma. Expression of p53 and bcl-2 oncoprotein, apoptosis and cell proliferation.

Abstract: Transformation in follicular lymphoma represents an abrupt transition in tumor biology. The protein product of the bcl-2 oncogene is overexpressed in most follicular lymphomas and inhibits apoptosis. The protein product of the p53 oncogene prevents cell proliferation and induces apoptosis and is overexpressed in the dysfunctional (mutated) form. We studied 15 transformed lymphomas (large cell type), 7 follicular lymphomas before transformation and 2 control groups of follicular center cell lymphomas with no evidence of transformation (9 small cleaved cell and 10 de novo large cell lymphomas). High p53 expression (> or = 45% cells) was detected by immunostaining in 9/15 transformed lymphomas as compared with 0/10 de novo large cell lymphomas and 1/7 follicular lymphomas. Overexpression of bcl-2 (> or = 50% cells) was similar in transformed (11/15) and de novo large cell lymphomas (6/10). The apoptotic index was high (> or = 2%) in all transformed and large cell lymphomas and low in all follicular lymphomas and in the control group of small cleaved cell lymphomas. The apoptotic index in the transformed lymphomas appeared to be independent of bcl-2 expression and was sometimes paradoxically high in the presence of both p53 and bcl-2 overexpression. The apoptotic index was weakly associated with bcl-2 expression in de novo large cell lymphomas. Expression of p53 did not correlate with proliferation index. Our results indicate that p53 overexpression is a specific step associated with transformation and may occur shortly before it. This is not seen in de novo large cell lymphoma. Furthermore, the high apoptotic index in transformed lymphomas often occurs despite overexpression of bcl-2 and p53, implying that other factors may induce apoptosis in these tumors.

Diagnosis of Pneumocystis carinii pneumonia by bronchoalveolar lavage in AIDS patients. Comparison of Diff-Quik, fungifluor stain, direct immunofluorescence test and polymerase chain reaction.

Abstract: OBJECTIVE : To assess the sensitivity, specificity and accuracy of Diff-Quik, fungifluor stain, the direct immunofluorescence test (DIFT) and the polymerase chain reaction (PCR) in the diagnosis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. STUDY DESIGN : From December 1992 through November 1993, 112 bronchoalveolar lavage fluid (BALF) samples were obtained from 80 HIV-infected patients. BALF samples were processed for cytologic and microbiologic analysis and for PCR. Cytologic examination was carried out on Diff-Quik-stained cytocentrifuge preparations and with May-Grunwald-Giemsa staining and fungifluor staining. For diagnosis of PC infection, DIFT and PCR were used. RESULTS : Thirty-two of 112 acute episodes were caused by P carinii. Diff-Quik had the highest sensitivity (84.8%) as compared to fungifluor stain (60.0%), DIFT (59.4%) and PCR (65.6%). The specificity was 98.7% with Diff-Quik, 100% with fungifluor stain, and 98.6% and 97.3% with DIFT and PCR, respectively. Accuracy was high with every method (94.4% with Diff-Quik, 88.3% with fungifluor stain, 86.7% with DIFT and 87.6% with PCR). CONCLUSION : Diff-Quik is a good diagnostic tool in the diagnosis of PCP. The combination of Diff-Quik and fungifluor stain is recommended because of its cost-effectiveness and because of its rapid diagnosis of severe PCP. PCR and DIFT should be used only on patients judged clinically to have PCP with discrepant results in Diff-Quik and fungifluor stain in BALF samples.

Evaluation of large-needle biopsy for the diagnosis of cancer.

Abstract: The arguments for a choice between a large or fine needle in the diagnosis of tumors are still unclear. This paper reviews the advantages and disadvantages of large-needle biopsy and fine needle aspiration. Reports indicate that although the procedures have the same diagnostic efficacy, the risk of tumor seeding is far higher following large-needle biopsy. For this reason it should be avoided for the diagnosis of cancer. The risk of tumor seeding after fine needle aspiration may be reduced by performance through a cover of normal parenchyma, by maintaining suction during withdrawal of the needle and by examining samples for quality during the procedure.