Treatment of bengin thyroid nodules with perculaneous ethanol injection

Aim: Percutaneous ethanol injection for treatment of solitary benign thyroid nodules has been introduced since more than a decade. In the present work, we aimed to apply percutaneous ethanol injection [PEI] guided by ultrasound, for a group of patients with solitary benign thyroid nodules to study its efficacy, acceptance by patients, and assessment of clinical, laboratory and ultrasonographic outcomes. Subjects and Twenty-two cases were recruited. They were classified according to thyroid scintiscan and hormonal profile into 3 groups: group I comprised 8 euthyroid patients with toxic nodule, group II which comprised 8 euthyroid patients with cold nodule, and group III included 6 thyrotoxic patients with toxic nodule. All patients were subjected to fine needle aspiration cytology, assessment of serum T3, T4 and sTSH, 99Tc pertechnetate thyroid scanning in addition to clinical and ultrasonographic evaluation. Patients were subjected to injection of sterile 95% ethanol alcohol, under ultrasound guidance without anaesthesia or sedation with a 22-gauge needle using sterile disposable plastic syringes. Dose per injection was calculated to be 20-30% of the nodule volume to achieve a total amount of 1.5 times the nodule volume. Injection was done once per week, and one injection was done in one session. Patients were followed up for 6 months. There was a significant reduction in nodule volume in the three studied groups without any difference between them. For group I, the initial nodule volume was 15.8 +/- 3.1 ml. It became 9.0 +/- 2.39 ml. after 3 months [P 0.000] and at the end of 6 months it became 6.8 +/- 1.3 ml with a net reduction of 59% of the initial nodule volume. For group II the initial nodule volume was 12.5 +/- 1.7 ml. It became 6.8 +/- 1.3 ml after 3 months [P 0.000] and at the end of 6 months it became 5 +/- 0.6 with a net reduction of 60% of the initial nodule volume. For group III, the initial nodule volume was 11.7 +/- 2.4 ml. It became 6.67 +/- 1.6 ml after 3 months [P < 0.005] and at the end of 6 months it became 5.0 +/- 0.9 ml with a net reduction of 54% of the initial nodule volume. For the three groups, there was positive significant correlation between the initial nodule volume and the amount of reduction in size of the nodule [for group I: r 0.99 and P 0.000, for group II: r 0.87 and P < 0.005, while for group III: r 0.9 and P < 0.01]. Comparing the reduction in nodule volume after 6 months follow up in the three studied groups it was not significantly different [F 2.16, P > 0.05]. In the group of toxic patients [group III], thyroid hormone levels at the end of 6 months were all normalized, while for the other patients the thyroid hormone profile was kept within normal without a significant change through the period of follow up. The technique was well accepted by the patients, and the side effect profile was limited to local pain.with variable radiations. Short-term fever was recorded in 4 cases and transient dysphonia was recorded in 3 cases. All reported complications disappeared from a few hours to 3 days. Conclusions: It was concluded that PEI is cheap, convenient, well accepted by patients, effective in inducing nodule shrinkage and in controlling the thyrotoxic state, without inducing hypothyroidism, and free of the known risks of radioiodine or surgery. With all these advantages, PEI is recommended to have its place in the management options of solitary benign thyroid nodules

Evaluation of BCL-2 expression in prostatic carcinoma. A fine-needle aspiration study

Bcl-2 expression was evaluated in a series of twenty cytologically positive prostatic carcinoma and was correlated with the cytologic grade of the tumor. In aspirated cells, the intensity of immunostaining was more frequent in high grade tumors [5 cases, 25%] than in intermediate grade [6 cases, 30%] or low grade tumors [9 cases, 45%]. There was a significant correlation [p = 0.027] between Bcl-2 expression and cytologic tumor grade. One patient was misdiagnosed as benign prostatic hyperplasia on histopathology but the diagnosis was proven to be well differentiated low grade prostatic carcinoma on application of Bcl-2 immunostaining. Bcl-2 immunostaining of specimens taken by FNAs of prostatic carcinoma is a potential tool to confirm or correct conflicting diagnosis. Bcl-2 is beneficial for diagnosis and grading of prostatic carcinoma. In addition, Bcl-2 can be used as a diagnostic marker of hormone refractory prostatic carcinoma and can be a very beneficial prognostic factor in metastatic prostate carcinoma

Evaluation of diagnostic accuracy of fine needle aspiration cytology in different masses

Pre-operative fine needle aspiration is a reliable widely used method for obtaining a rapid diagnosis which can direct further planning of therapy. The procedure enables the clinician to obtain a definitive diagnosis in a high percentage of patients with minimal cost or expenditure of time -and is useful in delineating patients with metastatic disease or primary bone neoplasm such as multiple myeloma or lymphoma to avoid unnecessary surgery. In the present work, a comparative study was carried out on 137 patients with superficially accessible masses to access the accuracy of cytodiagnosis. Fine needle aspiration proved to have a valuable role even in undiagnosed cases as it could differentiate between benign and malignant tumors. Cytologically undiagnosed breast cases were attributed to the presence of dense sclerotic stroma which yielded unsatisfactory smears, the same explanation for one of the cases of thyroid swelling was suspected, while the other case which was suspicious is explained by the similar features of benign and malignant well differentiated follicular tumors. 2 out of 11 cases of salivary glands were misclassified with regard to the type of malignancy. The accuracy rate was 100% in cases with osseous tumors, lymphadenopathy, subcutaneous soft tissue masses as well as liver nodules

Fine needle aspiration cytology in the diagnosis of palpable thyroid lesions

Fine needle aspiration cytology [FNAC] has gained acceptance and is being widely used in the diagnosis of palpable thyroid lesions. At our institution we regularly started this procedure in June, 1992. Till May 1995, 312 patients of palpable thyroid lesions were subjected to FNAC. On cytological evaluation there were 234 [75%] cases diagnosed as non neoplastic including 6[1.92%] cases of thyroiditis. Twenty eight [8.97%] were positive for malignancy, 24 [7.69%] labelled as suspect neoplastic, and for 26 [8.33%] cases the aspirates were unsatisfactory. Surgical specimens were available in 95 cases for histological examination and comparison with cytological diagnosis. The statistical analysis revealed sensitivity of 95%, a specificity of 100% and an accuracy of 98.57%. We consider FNAC of palpable thyroid lesions, as a simple safe, well tolerated, useful and a rapid diagnostic procedure

Visceral pleural biopsy with fenestrated cup biopsy forceps versus parietal pleural biopsy with abram's needle and fluid cytology in the diagnosis of pleural effusion

A study on 30 patients with pleural effusion had been carried out to evaluate the usefulness of visceral pleural biopsy using fenestrated cup biopsy forceps in comparison with parietal pleural biopsy using the Abrams, needle and fluid cytology with its complications. Cytological examination of the pleural fluid revealed the diagnosis in 6 cases [20%]. Parietal pleural biopsy by the Abram needle estalished the diagnosis in 13 cases [43.3%] whether the visceral pleural biopsy using fenestrated cup biopsy forceps established the diagnosis in 11 cases [36.6%]. Final-diagnosis was achieved in 18 cases [60%] and 12 cases [40%] remained undiagnosed fourteen cases of them were malignant conditions [3 cases of mesothelioma and 11 cases of metastatic malignant conditions] and 4 cases of tuberculosis. Complications were observed in 7 cases [23.3%]. Six cases developed a small bronchopleural fistula [20%] which was absorbed spontaneously requiring no further management and one case [3.33%] developed a large bronchopleural fistula that required intercostal tube drainage followed by pleurodesis by autologous blood

Fine needle aspiration cytology in toxoplasmic lymphadenitis

During the period from October 1991 to February 1993, 120 patients with undiagnosed lymphadenopathy were subjected to FNA at Cytodiagnostic unit Ain Shams University Hospital. Cytologic examination was suggestive to toxoplasmosis in 21 cases. These cases were subjected to full history and clinical examination, complete blood picture, serologic examination and surgical biopsy in two. Toxoplasmosis was confirmed by serology in 10 and srology and biopsy in 2. These 12 patients were all of middle age except one. 9 were males and 3 were females. 7 had history of animal contact. Eosinophilia was present in 5. These results show that FNA of peripheral lymph nodes can avoid patients with toxoplasmosis unnecessary hospitalization for surgical biopsy

Evaluation of aspiration biopsy cytology in the diagnosis of solitary thyroid nodule

Thirty nine patients [35 femals and 4 males] presenting with solitary non toxic thyroid nodule were admitted to El Hussein University Hospital on the period between September 89 to May 1991. They were subjected to full history and, clinical examination, serum T3 and T4 levels, ultrasonic and isotope scanning. Fine needle aspiration biopsy [Aspiration Biobsy Cytology, ABC] was done for every patient and the results obtained were compared with the results obtained by excisional biopsy. In our study the sensitivety for the presence of the tumour was 75% and when we added follicular adenoma as a positive for the tumour the sensitivity increased to become 86%. The specificity for the abscence of the tumour was 100% [there is no false positive cases] the false negative rate was 3.2% the positive predicitive value was 100%, the negative predictive value was 97%. The over all accuracy of ABC was 92.3%

Comparative study of clinical examination, mammography and fine needle aspiration cytology in the diagnosis of breast tumours

The diagnostic acuracy of clinical examination, mammography and fine needle aspiration cytology was compared with definitive histological findings in 125 breast lumps. When suitable aspirates were obtained for cytological examination, the diagnostic acuracy of aspiration cytology was higher than clinical examination or mammography. A diagnostic acuracy of 100% was achieved when all three screening tests were in agreement. Cytology is useful in identifying malignancy when clinical findings suggest that the tumour is benign. The availability of acurati cytology has affected patient management in many ways. Mammography did not enhance the diagnostic acuracy of clinical examination and aspiration cytology in patients presenting with a breast lump and as a procedure with potential hazard, the benifit of routine mammography is questionable when an efficient cytological service is available