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Malignant Diagnosis (malignant + diagnosis)
Selected AbstractsSolid renal masses in adults: Image-guided fine-needle aspiration cytology and imaging techniques,"Two Heads Better Than One?"DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2008José García-Solano M.D. Abstract We have compared the diagnostic accuracy of image-guided 25G-FNA (fine-needle aspiration) and imaging modalities in a group of 31 patients with solid space-occupying renal lesions. All patients had undergone total nephrectomy and histologic sections were available for review. By FNA there were 24 malignant diagnoses, I benign diagnosis, and 6 cases with yield inadequate for diagnosis. The FNA accuracy for malignancy was 100% with no false positive cases; cancer typing by FNA matched the final histologic diagnoses in 91.6% of cases. Sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 14%, 80%, and 14%, respectively. Radiologically there were 26 diagnoses of malignancy, I of benignity, and 4 indeterminate lesions (IL). Accuracy for malignancy was 100%, with one false positive case; cancer typing matched the final histologic diagnoses in 84%. Sensitivity of imaging modalities was 86%, specificity 17%, positive predictive value 83%, and negative predictive value 20%. Four IL corresponded to renal cell carcinoma in the final histologic report: two IL had a previous diagnosis of malignancy by FNA, and the yield of two was inadequate for cytologic diagnosis. Both techniques have 100% accuracy for the diagnosis of malignancy. The sensitivity, specificity, positive predictive value, and negative predictive value of imaging techniques are slightly higher than those obtained by FNA. Imaging techniques and FNA of solid renal masses complement each other in IL and in nondiagnostic FNAs. Diagn. Cytopathol. 2008;36:8,12. © 2007 Wiley-Liss, Inc. [source] Fine-needle aspiration of neurilemoma (schwannoma).DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2006A clinicocytopathologic study of 116 patients Abstract 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. Diagn. Cytopathol. 2006;34:403,412. © 2006 Wiley-Liss, Inc. [source] Results of laparoscopic splenectomy for treatment of malignant conditionsHPB, Issue 4 2001E M Targarona Background Laparoscopic splenectomy (LS) is widely accepted for treatment of benign diseases, but there are few reports of its use in cases of haematological malignancy. In addition, comparative studies with open operation are lacking. Malignant haematological diseases have specific clinical features - notably splenomegaly and impaired general health - which can impact on the immediate outcome after LS. The immediate outcome of LS comparing benign with malignant diagnoses has been analysed in a prospective series of 137 operations. Patients and methods Between February 1993 and April 2000, 137 patients with a wide range of splenic disorders received LS. Clinical data and immediate outcome were prospectively recorded, and age, diagnosis, operation time, perioperative transfusion requirement, spleen weight, conversion rate, accessory incision, hospital stay and complications were analysed. Results The series included 100 benign cases and 37 suspected malignancies. In patients with malignant diseases the mean age was greater (37 years [3,85] vs 60 years [27,82], p <0.01), LS took longer (138 min [60,400] vs 161 min [75,300], p <0.05) and an accessory incision for spleen retrieval was required more frequently (18% vs 93%, p <0.01) because the spleen was larger (279 g [60,1640] vs 1210 g [248,3100], p <0.01). However, the rate of conversion to open operation (5% vs 14%), postoperative morbidity rate (13% vs 22%) and transfusion requirement (15% vs 26%) did not differ between benign and malignant cases. Hospital stay was longer in malignant cases (3.7 days [2,14] vs 5 days [2,14], p <0.05). Conclusion LS is a safe procedure in patients with malignant disease requiring splenectomy in spite of the longer operative time and the higher conversion rate. [source] Stereotactic biopsy and cytological diagnosis of solid and cystic intracranial lesionsCYTOPATHOLOGY, Issue 3 2003L. M. Collaço Cytological smears from 115 consecutive cases of stereotactic biopsies of intracranial lesions were reviewed. Ninety-five lesions were solid and 20 cystic. Material from 90 solid and 13 cystic lesions was sent both for cytological and histological examination. In 66 of the solid lesions, the cytological diagnosis was confirmed by histology (five were benign lesions and 61 malignant tumours: 56 primary brain tumours, three metastases and two lymphomas). In 24 cases with discrepant cytology and histology, the histology was inconclusive or insufficient in 14 cases, while cytology established the diagnosis of astrocytoma grade II (seven cases), metastases (two cases), gliosis (one case) and benign (four cases). Necrosis of tumour type was observed cytologically in six patients representing glioblastoma (two cases), anaplastic astrocytoma (one case), lymphoma (one case) and normal brain (two cases) histologically. Three cases reported cytologically as benign were primary brain tumour (two cases) and gliosis (one case). One smear of a glioblastoma was insufficient for cytological diagnosis. Cystic lesions were cytologically benign in 17 cases and malignant in three cases. Histology from the cyst wall confirmed the malignant diagnosis in three cases and showed tumour in six more cases, a benign process (two cases), changes induced by radiotherapy for arteriovenous malformation (one case) and insufficient material (one case). In conclusion, cytology from solid brain lesion allows an accurate diagnosis and subtyping of tumours in a majority of cases, and can thus be used to choose type of therapy. In cystic brain tumours, however, examination of the cystic fluid, is often inconclusive and a biopsy from the cyst wall should be performed if there is clinical or radiological suspicion of tumour. [source] A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 11 2007Shailja Garg M.B.B.S. Abstract The present study was undertaken to compare the efficacy of needle core biopsy (NCB) of the breast with fine-needle aspiration cytology (FNAC) in breast lesions (palpable and non-palpable) in the Indian set-up, along with the assessment of tumor grading with both the techniques. Fifty patients with suspicious breast lesions were subjected to simultaneous FNAC and ultrasound-guided NCB following an initial mammographic evaluation. Cases were categorized into benign, benign with atypia, suspicious and malignant groups. In cases of infiltrating duct carcinomas, grading was performed on cytological smears as well as on NCB specimens. Both the techniques were compared, and findings were correlated with radiological and excision findings. Out of 50 cases, 18 were found to be benign and 32 malignant on final pathological diagnosis. Maximum number of patients with benign diagnosis was in the fourth decade (42.11%) and malignant diagnosis in the fourth as well as fifth decade (35.48% each). Sensitivity and specificity of mammography for the diagnosis of malignancy was 84.37% and 83.33%, respectively. Sensitivity and specificity of FNAC for malignant diagnosis was 78.15% and 94.44%, respectively, and of NCB was 96.5% and 100%, respectively. But NCB had a slightly higher specimen inadequacy rate (8%). NCB improved diagnostic categorization over FNAC by 18%. Tumor grading in cases of IDC showed high concordance rate between NCB and subsequent excision biopsy (94.44%) but low concordance rate between NCB and FNAC (59.1%). NCB is superior to FNAC in the diagnosis of breast lesions in terms of sensitivity, specificity, correct histological categorization of the lesions as well as tumor grading. Diagn. Cytopathol. 2007;35:681,689. © 2007 Wiley-Liss, Inc. [source] Fine-needle aspiration of soft tissue leiomyosarcoma: An analysis of the most common cytologic findings and the value of ancillary techniquesDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2006Henryk A. Domanski M.D., Ph.D. Abstract This study aims to determine the diagnostic accuracy of fine-needle aspiration cytology (FNAC) of primary leiomyosarcoma (LMS) of soft tissue and to review diagnostic criteria and adjunctive methods, which can contribute to a confident diagnosis. We evaluated the preoperative FNAC in 89 patients with primary LMS for the following: cytomorphology and correspondence of FNA to histological features of excised tumors and clinical data. In addition, the utility of adjunctive techniques was analyzed and other spindle-cell lesions in the differential diagnoses were discussed. An unequivocal, malignant diagnosis was rendered by FNAC in 78 cases; 74 tumors were diagnosed as sarcoma, of which 31 as LMS or suspicion of LMS. In addition, three smears were labeled as malignant tumor, one as carcinoma metastasis, and three as neurilemmoma. Seven aspirates were inconclusive and one insufficient. On reevaluation, the diagnostic smears in most cases contained tumor cell fascicles with an admixture of dispersed cells or stripped nuclei. The most common cells were spindle cells with elongated, blunt-ended, segmented or fusiform nuclei, and round/polygonal cells, often with rounded or indented nuclei. In addition, 51 cases showed pleomorphic, often multinucleated cells. Osteoclasts, intranuclear vacuoles, and mitoses occurred in 14, 47, and 27 cases, respectively. Thus, most high-grade LMSs have cytologic features that allow diagnosis of sarcoma. Ancillary studies can confirm the diagnosis of LMS and help in the correct interpretation of predominant spindle-cell or epitheloid-cell smears resembling neurilemoma or carcinoma, respectively. Diagn. Cytopathol. 2006;34:597,604. © 2006 Wiley,Liss, Inc. [source] Fine-needle aspiration cytology of salivary glands: Diagnostic pitfalls,revisitedDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2006Arvind Rajwanshi M.D., F.R.C.Path. Abstract Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management. Diagn. Cytopathol. 2006;34:580,584. © 2006 Wiley-Liss, Inc. [source] Medical thoracoscopy in an Australian regional hospitalINTERNAL MEDICINE JOURNAL, Issue 4 2007G Simpson Abstract Medical thoracoscopy is not widely available in Australia. A medical thoracoscopy service has been set up in a regional hospital using no specialized equipment and at minimal cost. Of the first 100 procedures carried out, 89 were for investigation of pleural effusion, 6 for pneumothorax and 6 for empyema. Of the 89 pleural effusions, 73 were diagnosed as malignant (43 carcinoma, 24 mesothelioma, 3 lymphoma, 2 melanoma and 1 sarcoma). The sensitivity for a malignant diagnosis was 94.5%, with 100% specificity. Four patients had unsuspected tuberculous effusions. Pleurodesis was carried out with instillation of dry sterile talc in 67 cases. In 92.5% of these, no further drainage procedure was needed. There was one fatality caused by pre-existing sepsis in a debilitated patient with disseminated carcinoma. Medical thoracoscopy is a simple, safe and cost-effective technique for diagnosing and treating pleural effusions and provides a useful service in the setting of a regional hospital. [source] Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2008Lakshmana Ayaru Abstract Background:, Self-expanding metal bile duct stents provide good palliation for inoperable malignant disease. However, problems may arise if metal stents are inserted before definitive histological diagnosis. The aim of this study was to evaluate the outcome of such patients. Methods:, A retrospective case note review was conducted of patients referred to a tertiary pancreaticobiliary center between 1992 and 2004 in whom a metal bile duct stent was inserted for presumed unresectable malignant disease before definitive histological diagnosis. Results:, There were 21 patients identified. Final diagnoses were: group 1, benign disease (n = 3); group 2, resectable malignancy (n = 2); group 3, unresectable malignancy (n = 12); and group 4, diagnosis remains uncertain (n = 4). During a follow-up of 22, 38 and 111 months, the patients in group 1 had one, eight and five episodes of stent occlusion. In group 2, both patients underwent pancreaticoduodenectomy for ampullary carcinoma, 2 and 6 months after presentation. In group 3, the median time to a confirmed malignant diagnosis was 2 months (range 1,27 months). In group 4, a median of two biopsies (range 1,4) were negative for malignancy, during a median follow up of 13 months (range 3,46). Overall in eight patients, the metal stents caused artifacts on computed tomography and/or were associated with tissue in-growth making the differentiation between benign and malignant disease difficult. Conclusion:, These cases indicate that metal bile duct stent insertion before definitive histological diagnosis can be problematic. A proportion of cases will have benign strictures and in others the confirmation of malignancy may be made more difficult. [source] The Use of Stereotaxic Core Biopsy and Stereotaxic Aspiration Biopsy as Diagnostic Tools in the Evaluation of Mammary CalcificationTHE BREAST JOURNAL, Issue 6 2000Joan F. Cangiarella MD Abstract: We compared stereotaxic fine needle aspiration biopsy (SFNA) with stereotaxic core needle biopsy (SCB) in the evaluation of radiographically clustered mammary microcalcification, a common finding at screening mammography. Over a 4-year period, 181 specimens were obtained from 175 patients who underwent both SFNA and SCB of clustered microcalcification. Aspiration and core biopsies were performed by radiologists at a community-based diagnostic radiology facility. All aspiration smears were air dried, stained on site, and assessed for adequacy by the radiologists, then sent to the cytopathologists at New York University for interpretation. Core biopsy specimens were formalin fixed, paraffin embedded, hematoxylin and eosin stained, and interpreted by surgical pathologists at a community hospital. Of 181 SFNA specimens, 133 (74%) were benign, 18 (10%) were atypical, 13 (7%) were suspicious, and 16 (9%) were malignant. One (0.5%) aspiration biopsy was nondiagnostic. Excisional biopsies were performed after 12 benign SFNAs and in 46 of the 47 cases with an atypical, suspicious, or malignant diagnosis on SFNA. Mammographic follow-up in 111 of the 133 cases (92%) diagnosed as benign showed no radiologic change (mean 29.2 months, range 6,60 months). The false-negative rate for cancer was 4% (6 cases) for SFNA alone. There were no false-positive diagnoses for SFNA. There was one false-positive diagnosis on core biopsy [focal cribriform ductal carcinoma in situ (DCIS)], which at excisional biopsy and correlation with the core biopsy was diagnosed as ductal hyperplasia; the false-negative rate for cancer was 8% (13 cases) for SCB alone. Aspiration biopsy identified calcification in 180 procedures, core needle biopsy revealed calcification in 170. SFNA was superior to SCB for the confirmation of clustered mammary microcalcification (99% versus 94%) and in the identification of cancer associated with microcalcification (false negative rate of 4% versus 8%). Patients with benign findings on stereotaxic aspiration and core biopsy can reasonably be followed mammographically. [source] | ||||||||||