ABSTRACT
Forty fine needle aspiration (FNA) biopsies of the pancreas were performed on 37 patients with a radiologic suspicion of malignancy; 32 aspirations were guided by ultrasound, 2 were guided by CT, and 6 were obtained intraoperatively. A pathologist read a rapid-stained smear of the initial aspirate as the procedure was performed and triaged specimens for routine cytologic, cell block and ultrastructural study in solid lesions plus carcinoembryonic antigen (CEA) assay and amylase study in cystic lesions. Purulent material was studied by gram staining and culture. The overall sensitivity in the series was 81%, with a specificity of 100%. No complications were noted. Ultrastructural examination improved the diagnostic accuracy in two cases. Assays for CEA and amylase in "cyst fluids" differentiated true cysts and cystadenocarcinoma from pseudocysts. Maximum utilization of the material aspirated was useful in diagnosing the etiology of solid and cystic pancreatic masses.
Subject(s)
Pancreatic Diseases/pathology , Pancreatic Neoplasms/pathology , Adult , Aged , Biopsy, Needle/methods , Humans , Middle Aged , Pancreatic Diseases/diagnosis , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/ultrastructure , RadiographyABSTRACT
A total of 81 transhepatic fine needle aspiration (FNA) biopsies were performed on 78 patients to rule out focal or diffuse neoplastic disease; 87.6% were performed with ultrasound guidance, 6.1% with CT guidance, 3.7% intraoperatively and 1 using fluoroscopy during percutaneous transhepatic cholangiography. Smears of the aspirated samples were cytologically evaluated with clinical and radiologic correlation; in addition, histologic examination of cell blocks was performed in 46% of the cases, ultrastructural examination in 34% of the cases and peroxidase-antiperoxidase staining in 3 cases. Ultrastructural definition of the type of malignancy was possible in 24 cases (29%). Minor complications in two patients were pain and tenderness at the puncture site. The sensitivity for malignancy was 91%, the specificity was 100%, the predictive value of positive results was 100%, and the predictive value of negative results was 73%. This series demonstrates that FNA biopsy with ultrasound guidance can provide an accurate diagnosis of malignancy and may preempt a lengthy workup in the search for a primary tumor.
Subject(s)
Liver Neoplasms/pathology , Liver/pathology , Adenocarcinoma/pathology , Aged , Biopsy, Needle/methods , Carcinoma, Hepatocellular/pathology , Diagnostic Errors , False Negative Reactions , Female , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Male , Middle AgedABSTRACT
A total of 189 effusion specimens (100 benign and 89 malignant) submitted for cytologic examination were assayed for carcinoembryonic antigen (CEA) by an enzyme immunoassay to determine whether the addition of CEA evaluation to cytologic study would improve the diagnostic accuracy for the detection of malignancy. The sensitivity and specificity were 78% and 90%, respectively, for a cytologic diagnosis of malignancy and 68% and 99%, respectively, for a positive CEA (greater than 5 ng/mL). CEA assay was negative in the most common epithelial malignancies of the female genital tract (15 of 17 cases), mesotheliomas (5), lymphomas (7) and alveolar-cell carcinoma of lung (1). CEA assay was positive in 55 of 89 cases of malignancy, including 14 cases with cytologically negative malignant effusions. The CEA assay sensitivity for lung carcinoma (95% for adenocarcinoma, 100% for oat-cell carcinoma and 100% for carcinosarcoma), breast carcinoma (95%), and gastrointestinal carcinoma (100%) were all over 90%. No significant difference in the levels of CEA was noted between gastrointestinal and lung adenocarcinomas. Oat-cell carcinomas and squamous-cell carcinomas had lower values. In cases of an effusion with an unknown primary, an elevated CEA in the fluid is diagnostic of metastatic carcinoma arising from the breast, lung or gastrointestinal tract.
