Fine needle aspiration cytology: accurate and reliable tool for primary diagnosis of salivary gland lesions.

Background: Management of salivary gland lesions is greatly influenced by preoperative or intraoperative diagnosis of malignancy. Fine needle aspiration cytology (FNAC) is used as a primary diagnostic tool since long. Objective: The objective of study was to evaluate usefulness and diagnostic accuracy of FNAC in primary diagnosis of salivary gland lesions. Methods: Study includes 75 cases suspected of salivary gland lesions evaluated by FNAC from January 2010 to August 2012. Whenever possible follow up histopathology also studied. Results: Out of total of 75 cases of salivary gland lesions 30 cases (40%) were nonneoplastic, 30 cases (40%) were benign and 15 cases (20 %) were malignant. FNAC showed satisfactory sensitivity and specificity with about 91% diagnostic accuracy for benign lesions and for malignant lesions. Conclusions: Study concludes that FNAC has proven to be simple, easy, minimally invasive method with satisfactory accuracy for initial diagnosis of Salivary gland lesions especially benign and malignant neoplasms. It almost accurately type benign tumors like pleomorphic adenoma and showed fair accuracy and reliability. FNAC is vital for management primarily to exclude need of surgery as nonneoplastic lesions are managed conservatively and planning preoperative chemoradiation like in cases of Mucoepidermoid carcinoma arising in odd locations like palate.

Adjunctive role of immunohistochemistry to traditional histomorphology in diagnosis and accurate typing of soft tissue sarcoma.

Background: Soft tissue sarcomas, compared with carcinomas and other neoplasms, are relatively rare and constitute less than 1% of all cancers. Immunohistochemistry (IHC) especially a panel approach is an important adjunct to histopathological morphology and plays an important role in Soft tissue sarcoma diagnosis and accurate typing. Aims & Objective: Current study is to evaluate the utility of histopathology and immunohistochemistry in soft tissue sarcoma diagnosis and accurate typing. Material and Methods: Total of 50 cases of soft tissue sarcoma studied from January 2010 to October 2012. All cases were reported using routine (H&E) Hematoxylin- eosin stain and other ancillary techniques including panel approach of immunohistochemistry. Results: Histomorphology confirmed diagnosis in 22 % cases. In 78 % cases it was contributory to IHC. IHC provide confirmative diagnosis (Single diagnosis) in 45 cases (90%), definitive diagnosis (with two possibilities) in 4 cases (8%) and noncontributory in 1case (2%). Conclusion: Despite the rapid development of molecular genetic techniques, IHC still remains the most important diagnostic tool in the diagnosis of soft tissue tumours aside from recognition of morphologic features and clinical correlation. One of its major utilities is to correctly identify a tumour as mesenchymal or nonmesenchymal origin and then accurate typing done according to specific cell lineage. IHC is specifically useful in tumours of uncertain cell lineage and primitive round cell tumours. Indeed IHC has brought Brown revolution in sarcoma diagnosis and accurate typing. But important not to forget histopathology which provide the basic platform for the panel approach of IHC.

Selection of mode of biopsy in histopathological diagnosis of Soft tissue sarcoma depending on diagnostic accuracy and feasibility: Debatable issue in modern era.

Background: Biopsy method of choice is a controversy issue for diagnosis of soft tissue sarcoma which are traditionally been managed by wide excision surgery and radiotherapy. Chemotherapy is reserved for advanced cases. Aims & Objective: The objective of study was to evaluate diagnostic accuracy of various modes of biopsy focusing on image guided core needle biopsy (CNB). Material and Methods: Current study includes 50 cases of soft tissue sarcoma from January 2010 to October 2012. The Mode of biopsies included image guided CNB, open and excision biopsy. Effective accuracy of each was determined by accuracy of biopsy to provide adequate tissue for histopathological and other special examinations like immunohistochemistry to reach final diagnosis. Results: Out of total 50 cases CNB was done in 13 cases, open biopsy in 2 cases and in 35 cases excision biopsy was done. CNB was adequate in 92.31 % cases and 7.69 % cases it was inadequate. Open and excision biopsy were 100 % adequate. Conclusion: Image guided CNB is very helpful in early diagnosis and shows high accuracy especially for high-grade sarcoma. It is less invasive compared to others and differentiate benign from malignant. It is handful when preoperative diagnosis is essential for planning pre-operative chemotherapy especially in patients with primarily inoperable, advanced tumour with compromised performance status or recurrent tumour. But it should be properly directed and representative of whole tumour and require full radiological correlation by experienced hands. Tumours with myxoid pattern, lipomatous tumours and low grade sarcomas encounters lower diagnostic accuracy on CNB.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method.

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Study of metastasis in lymph node by fine needle aspiration cytology: our institutional experience.

Background: Fine needle aspiration cytology (FNAC) is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor, prognosis as well in the management of patient for staging purposes. The aim of the study was to detect and diagnose metastasis in lymph nodes. Methods: A study was done of all metastatic lymph node lesions reported in Department of Pathology, Govt. Medical College, Surat from May 2011 to April 2012. Results: A total of 2355 cases of fine needle aspiration cytology were carried out of which 580 cases were of lymph node. Cytology results were positive for metastasis in 157 specimens (27.06%). The most common site was cervical lymph nodes. Maximum numbers of cases of metastatic tumors were in 41-50 yrs age group. There were 115 males and 42 females with a male predominance (Male:Female= 2.8:1). The most common malignancy was squamous cells carcinoma, seen in 118 cases (75.15%), followed by metastatic mammary carcinoma (13 cases, 8.29%). In 26 cases out of 580 cases, histopathological confirmation was done and diagnostic accuracy of FNAC was 100%. Conclusions: Fine needle aspiration cytology of lymphadenopathy is a useful tool in diagnosing metastatic lesions with good certainty.

Diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors: our institutional experience.

Background: Diagnosis of Soft tissue tumors by FNAC (Fine needle aspiration cytology) is one of the diagnostic modality of choice in pathological evaluation of soft tissue neoplasms especially to differentiate from the non-neoplastic soft tissue lesions. It is challenging and controversial. Very few centers rely on simple FNAC for diagnosis which is largely due to a lack of experience, familiarity, confidence and tricky cytological features. Methods: We have studied 140 cases of soft-tissue tumors by simple FNAC procedure done by cytopathologist from 01/01/2012 to 31/12/2012. After considering thorough history, clinical, radiology and other findings all cases were reported by the experienced faculty in cytopathology section of our institute. Results: Out of total 140 cases of soft tissue tumors 131 (93.58%) were benign and 9 (6.42%) were malignant. In benign category maximum numbers were lipoma 105 cases (80.15%) followed by benign neural tumors 5 cases (3.82%), ganglion 4 cases (3.05%), benign fibrohistiocytic lesions 2 cases (1.53%) and others. Conclusions: Current study demonstrates that FNAC is valuable as a primary tool in diagnosing soft tissue tumors specifically benign lesions like lipomatous tumors, high grade malignant sarcoma and recurrent lesions. Findings are well supported by histopathological correlation.