Fine needle aspiration cytology in the diagnosis of superficial lymphadenopathy in children and adolescents: an analysis of 869 cases

Fine needle aspiration cytology [FNAC] in children has gained acceptance gradually and is currently used extensively as an initial diagnostic tool. This study was undertaken to determine the value of FANC in peripheral lymphadenopathy in pediatric and adolescent patients in Kuwait. Retrospective. Mubarak Al-Kabeer Hospital, Kuwait. Eight hundred and sixty-nine children and adolescents [ranging from five months to 20 years] from January 2000 to September 2009. FNAC. The spectrum of disease of lymph nodes in pediatric and adolescent age groups, using FNAC. Out of the 4116 lymph node aspirates performed, the cytology reports of 869 [21.1%] pediatric aspirates were reviewed. There were 409 [51.3%] male and 388 [48.7%] female patients. Seventy-two [8.3%] were considered unsatisfactory. Out of the 797 [91.7%] satisfactory aspirates, reactive lymphoid tissue was reported in 616 cases [77.3%], lymphadenitis in 115 [14.4%], atypical cytology in 18 [2.3%], lymphoreticular malignancy in 46 [5.7%] and metastatic tumor in 2 [0.3%]. The lymphadenitis included 8, 66, 23 and 18 cases of necrosis only, granulomatous lymphadenitis, necrotizing granulomatous lymphadenitis and tuberculous lymphadenitis [where acid fast bacilli were detected respectively. FNAC of lymph nodes in children and adolescents is feasible and reliable. Majority of the nodes revealed reactive lymphoid tissue and helped allay the fears of parents thereby preventing unnecessary surgery

Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Role of fine needle aspiration cytology in the diagnosis of swelings in the salivary gland regions: a study of 712 cases

A mass in the salivary gland region often presents a diagnostic challenge with regard to its site of origin [salivary versus nonsalivary], benign or malignant nature, and tissue-specific diagnosis. The present study describes the utility of fine-needle aspiration [FNA] cytology in the diagnosis of these lesions. Subjects and Over a 6-year period [January 1994 to December 1999], 712 patients aged between 6 months and 91 years [median, 37 years] were subjected to FNA of swellings in their salivary gland regions. Male:female ratio was 1.28:1. The swellings were mostly located in the parotid [323 cases], submandibular [343 cases], and upper cervical region [27 cases]. Swellings of oral [5 cases] and sublingual [2 cases] sites were rare. The lesions diagnosed by FNA cytology were compared among the major salivary glands. Cytologic diagnoses were correlated with histology in 45 cases. Benign nonneoplastic lesions were the most common [73%], followed by neoplasms [20%], and those with atypical cytology [1%]. Cytologic material was inadequate in 6% cases. Parotid gland region was involved more frequently by neoplasms [27.1%] than the submandibular gland region [13.7%, p < 0.0001]. Inflammatory processes affected the submandibular gland region more commonly [42.0%] than the parotid [32.6%, p = 0.0164]. Pleomorphic adenoma was the most common neoplasm [61.5%], followed by Warthin's tumor [12.6%]. Malignancies accounted for 10.5% of neoplasms. Frequency of involvement of parotid by Warthin's tumor [16.7%] was significantly higher than that of submandibular gland [2.3%, p = 0.0191]. However, the submandibular gland was more commonly affected by malignancy than the parotid gland [p = 0.0003]. Sensitivity, specificity, and diagnostic accuracy of FNA cytology for all neoplastic lesions of the salivary gland were 94.6, 75.0, and 91.1%, respectively. The corresponding figures for malignancies were 60.0, 95.0, and 91.1%, respectively. FNA cytology is very useful for the diagnosis of salivary gland lesions. However, sampling and interpretation errors may occur. The low specificity for the diagnosis of neoplasms as a whole and the poor sensitivity for malignancies found in our study can be attributed to the relatively small number of benign nonneoplastic and malignancy cases with available histopathologic diagnoses

Solitary nodular goiter: Role of ultrasonography in fine-needle aspiration cytology diagnosis

Purpose: To assess the contribution of ultrasonography to the fine-needle aspiration cytology diagnosis of solitary nodular goiters [SNG]. 759 cases of SNG detected by ultrasonography were subjected to fine-needle aspiration. The age of the patients ranged from 9 to 92 years with a median of 35 years. Male:female ratio was 135:624. May-Gr'nwald-Giemsa-stained smears were reviewed and the cytodiagnosis was correlated with clinical and ultrasonographic findings. The right lobe of the thyroid was more frequently involved [52.3% cases] by solitary nodules compared to the left lobe [33.9% cases] and isthmus [13.8% cases]. 27% of SNG cases missed at clinical examination could be detected because of ultrasonography. The frequency of solid echotexture in colloid goiter without cytologic evidence of cystic degeneration [60.3%] was significantly higher than that observed in colloid goiter with cystic degeneration [32.6%, p < 0.001]. The difference of solid echotexture between hyperplastic nodules [55.4%] and colloid goiter [38.5%] was also statistically significant [p < 0.02]. The frequency of solid echotexture and homogeneous hypoechoic pattern in neoplastic goiter [65.4 and 21.2%, respectively] was significantly higher than that in nonneoplastic lesions [43.3 and 8.6%, respectively, p < 0.01]. Ultrasonography, besides its use in the detection of solitary nodules and selection of appropriate areas for aspiration, correlated with cytological interpretation in the majority of cases. However, ultrasonography cannot replace cytologic diagnosis as the specificity and positive predictive values are not sufficiently accurate

Role of fine needle aspiration, intraoperative imprint cytology and frozen section the diagnosis of breast lumps and thyroid lesions

Background and Lesions of the thyroid and breast represent the two commonest sources of frozen section in Kuwait. This study investigates the value of intraoperative cytology [IC], preoperative fine needle aspiration cytology [FNAC] and intraoperative frozen section [FS], in improving the diagnostic accuracy of such lesions. Material: Thirty-one breast masses and 45 thyroid lesions were included. In each case, diagnosis was established by [1] preoperative FNAC, [2] intraoperative IC and [3] FS. Their accuracy was compared to paraffin section diagnosis. Sensitivity of FNAC, IC and FS for breast malignancy was 82.6, 95.8 and 91.7%, respectively, while for thyroid malignancy sensitivity was 68.4, 85.0 and 65%, respectively. All three had 100% specificity and 0% false-positive rates. A 100% diagnostic accuracy was achieved by combined FNAC and IC in breast, and 93.3% with combined IC and FS in thyroid lesions. Intraoperative IC improves the diagnostic accuracy of FNAC and FS in breast and thyroid lesions