David C. Chhieng

Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy in Patients with Suspected Pancreatic Carcinoma Emphasis on Atypical, Suspicious, and False-Negative Aspirates

Although atypical or suspicious cytology may support a clinical diagnosis of a malignancy, it is often not sufficient for the implementation of therapy in patients with pancreatic carcinoma. Endoscopic ultrasound–guided fine‐needle aspiration biopsy (EUS‐FNAB) is a relatively new method for obtaining cytology samples, and one that may decrease the number of atypical/suspicious diagnoses. The goals of the current study were to prospectively evaluate the yield of EUS‐FNAB in the diagnosis of patients presenting with solid pancreatic lesions and to evaluate the significance of atypical, suspicious, and false‐negative aspirates.

Endoscopic ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases.

Endoscopic ultrasound (EUS) provides detailed imaging of both intramural and extramural structures within the abdomen and mediastinum. However, EUS is limited in its ability to differentiate an inflammatory/reactive process from a malignancy. Fine‐needle aspiration biopsy (FNAB), coupled with EUS, allows for the sampling of the target lesion under ultrasound guidance in real time. To better evaluate the clinical utility and efficiency of EUS‐FNAB, a retrospective analysis of the first 103 EUS‐FNABs performed at our institute was undertaken.

Use of thyroid transcription factor 1, PE‐10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine‐needle aspiration biopsy specimens

The distinction of a primary lung carcinoma from a metastatic lesion is important, because the treatment and prognosis differ for patients with these malignancies. Such a distinction can be difficult because of overlapping cytologic features. It has been shown that antibodies to thyroid transcription factor 1 (TTF‐1) and PE‐10 are fairly specific markers for primary lung tumors in histologic specimens. TTF‐1 regulates the expression of surfactant protein production, and PE‐10 is a monoclonal antibody against components of human surfactant proteins. The combination of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) immunoprofiling has been helpful in the identification of the primary site of origin of lung tumors.

Endoscopic ultrasound‐guided fine‐needle aspiration biopsy: A powerful tool to obtain samples from small lesions

Endoscopic ultrasound (EUS) is a powerful imaging modality to identify and determine the extent of a lesion. In addition, EUS is superior to a computed tomography scan in detecting lesions < 3 cm. The objective of the current study was to determine whether small lesions (≤ 25 mm) affected the specimen adequacy and the diagnostic accuracy for lesions aspirated under EUS guidance.

Fine-needle aspiration cytology of hodgkin disease: A study of 89 cases with emphasis on the false-negative cases

INTRODUCTION.

MUC1 and MUC2 expression in pancreatic ductal carcinoma obtained by fine‐needle aspiration

Mucins are high molecular weight glycoproteins that are produced by various epithelial cells including those found in the pancreas. MUC1 and MUC2 are two well characterized mucin antigens. The objective of the current study was to examine the pattern of phenotypic expression of MUC1 and MUC2 in pancreatic lesions obtained by fine‐needle aspiration biopsy (FNA) and to determine the utility of MUC1 and MUC2 as markers for pancreatic ductal carcinoma.

Cytology of myoepithelial carcinoma of the salivary gland.

Myoepithelial carcinoma, also know as malignant myoepithelioma, is rare in the salivary gland, and its cytologic features have rarely been reported.

Microphthalmia transcription factor: a sensitive and specific marker for malignant melanoma in cytologic specimens.

The diagnosis of melanoma can be difficult because of shared cytomorphology with other malignant neoplasms. The most commonly used melanocytic markers, anti‐S‐100 protein and HMB‐45 antigen, have limited specificity and sensitivity, respectively. Microphthalmia transcription factor (Mitf) is a nuclear transcription factor critical for the development and survival of melanocytes and has been shown as a sensitive and specific marker for melanoma in histologic specimens.

Endoscopic ultrasound‐guided fine‐needle aspiration in the diagnosis of foregut duplication cysts: The value of demonstrating detached ciliary tufts in cyst fluid

The management of foregut duplication cysts is controversial, especially in asymptomatic patients. The safety and accuracy of endoscopic ultrasound (EUS) and EUS‐fine‐needle aspiration EUS‐FNA) in confirming the nature of cysts by using electron microscopy (EM) has not been reported. In this study, the authors describe the utility of demonstrating detached ciliary tufts (DCTs) in the diagnosis of foregut duplication cysts with EUS‐FNA.

Cytology and immunophenotyping of low- and intermediate-grade B-cell non-Hodgkin's lymphomas with a predominant small-cell component: a study of 56 cases.

Diagnosis of non‐Hodgkins lymphomas based on cytologic evaluation of fine‐needle aspirates and body cavity fluids has gained increasing acceptance. However, the accurate diagnosis and classification of low‐ and intermediate‐grade B‐cell lymphomas with a predominant small‐cell population still present a diagnostic challenge. In this study, we reviewed the cytology and immunophenotype of 56 cases of low‐ and intermediate‐grade non‐Hodgkins B‐cell lymphomas composed of predominantly small cells, with histologic correlation in all cases. These cases consisted of 23 small lymphocytic lymphomas (SLL), 15 follicular center lymphomas (FCL), grade I (small cell predominant), 8 lymphoplasmacytoid lymphomas (LPL), 6 mantle‐cell lymphomas (MCL), and 4 marginal zone lymphomas (MZL) including mucosa‐associated lymphoid tissue (MALT) lymphoma. Histologic comparison was available in all cases. A cytologic diagnosis of malignant lymphoma was made in 46 (82%) cases. Based on cytomorphology and immunophenotyping of cytologic material, 39 (85%) cases were correctly classified using the Revised European and American Lymphoma classification. In 7 (11%) cases, which included 3 FCLs, 2 MALT lymphomas, and 2 SLLs, the findings were atypical but not diagnostic of lymphoma. There were 3 (5%) false‐negative cases. They were 2 SLLs and a FCL. Immunophenotyping done in 4 “atypical” cases was noncontributory. No marker studies were done in the remaining “atypical” case and all false‐negative cases. We conclude that cytology, when used in conjunction with immunophenotyping, can accurately diagnose and in most instances subclassify low‐ and intermediate‐grade B‐cell non‐Hodgkins lymphoma with a predominant small‐cell population. Diagn. Cytopathol. 24:90–97, 2001.