Ehud Malberger

Symptomatic pericardial effusion in breast cancer patients: The role of fluid cytology

Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1–219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis.

Cytologic Analysis of Pericardial Effusion Complicating Extracardiac Malignancy

The ratio of the motion due to atria1 systole to the total diastolic AV plane displacement can therefore be considered to represent the contribution of atria1 systole to left ventricular filling. In our study, all but 3 control subjects had an atria1 contribution of 150%. According to Starling’s law of the hearC the ventricular contraction is dependent on the end-diastolic fiber length and pressure. The atrium, by virtue of its active contraction, can modify ventricular end-diastolic pressure and end-diastolic fiber length, and thereby is capable of modifying the performance of the ventricle. In this study, younger subjects showed a relatively mild atria1 systole, compared with older groups, as judged from the decreased ratio between atria1 AV and total AV plane displacement. These findings reflect the phenomenon of decreased left ventricular compliance with advancing age with a concomitant compensatory augmentation of active atria1 emptying as reflected by an increase in atria1 AV plane displacement in older age groups. This was further supported by the finding of a good linear correlation of age with the atria1 contribution to AV plane displacement. Using different techniques, others have also demonstrated a decrease in diastolic function with advanced age.lOyl l The ratio of the height of the “A” wave to the “E” wave in the Doppler velocity curve across the mitral valve is frequently used to express the contribution of atria1 systole to left ventricular filling. With increasing age, this ratio also increases because of a larger contribution of atria1 systole to overall left ventricular filling.rO In this study there was a good linear correlation between A/E waves and the contribution of atria1 AV plane displacement, which further supports the usefulness of the new echocardiographic parameter for the assessment of diastolic function. Right ventricular systolic descent of the AV plane is related to systolic function in a way similar to that of the left ventricle. However, the displacement was significantly greater than left ventricular AV plane displacement. This is in agreement with Rushmer et al** and reflects the predominance of longitudinal shortening of the right ventricular free wall with little shortening of its width. This is probably due to different patterns of muscle structure in the right ventricle. Although the right atria1 AV plane displacement was significantly increased compared with the left atria1 AV plane displacement, the percentage of atria1 contribution to right ventricular filling was quite similar to that of the left ventricle. However, in calculating AV plane displacement of the right ventricular free wall, we probably underestimated the absolute excursion because of a slightly arc-like movement of the recording site, causing a narrow angle with the ultrasound beam. In conclusion, this study provides a simple echocardiographic means of assessing left ventricular diastolic function in a series of healthy subjects. The method is highly reproducible with low inter- and intraobserver variabilities. Normal values of atria1 AV plane displacement in relation to total AV plane displacement for different age groups of healthy subjects provide further information regarding the age-related changes in diastolic function. Further studies, however, are needed to assess its significance, especially in patients with pathologic impairment in diastolic function.

Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses

PURPOSE Fine needle aspirative cytology is a well-established diagnostic tool for evaluating tumor masses. The goal of the current study was to determine the diagnostic accuracy of direct (nonimaging-guided) fine needle aspiration of palpable abdominal masses excluding the liver. PATIENTS AND METHODS Direct aspiration of a palpable abdominal mass was performed in 190 patients in order to confirm or to rule out malignancy. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 165 patients, of whom 130 had a malignant abdominal mass and 35 a benign abdominal mass. The cytologic findings were verified by correlation with histologic, cytologic, and clinical findings. RESULTS Among the 130 patients with a malignant abdominal mass, the cytologic findings failed to reveal malignancy in 12 patients (9.2%), but did reveal suspected malignancy in five (3.8%) and malignancy in 113 patients (86.9%). Among all 35 patients with a benign abdominal mass, the cytologic findings were reported as nonmalignant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of cytologic findings were 90.8%, 100%, 100%, 74.5%, and 92.7%, respectively. A nonfatal case of bile peritonitis and a case of localized peritonitis that, in retrospective, could have been avoided were the only major complications that followed the fine needle aspirative procedure. CONCLUSION With careful patient selection and meticulous attention to the proper procedure, direct fine needle cytology is a simple, safe, and highly accurate method for diagnosing palpable abdominal masses.

Fine‐needle aspiration and cytologic findings of surgical scar lesions in women with breast cancer

Benign and/or malignant lesions may occur in surgical scars after mastectomy or lumpectomy (SML) in patients with breast cancer (BC). Early diagnosis of these lesions is essential for both therapeutic and prognostic evaluation. The diagnostic value of fine‐needle aspiration (FNA) was determined for these scar lesions. The findings of cytologic and histologic specimens obtained from the same lesion of SML in 83 women with BC were correlated. Twenty‐five FNA yielded only acellular specimens. Of the FNA done by the cytopathologist, only 6.2% were not representative. However, 45% of those done by less experienced clinicians were not representative. Representative FNA were obtained from 58 of the women who took part in the study. Based on the histologic diagnosis, 38 patients had malignant scar lesions (MSL), and 20 had benign scar lesions (BSL). In one patient of the 38 with MSL, cytologic examination did not show the malignant lesion; in four women, the tumor was suspected cytologically; and in the remaining 33, the cytologic findings were consistent with malignancy. In 18 of the 20 patients with BSL, cytologic findings were reported as benign and in the other two, as inconclusive. The sensitivity, specificity, and positive and negative predictive values for the cytologic findings were 97.4%, 100%, 100%, and 94.7%, respectively. The diagnostic accuracy of FNA cytology was 98.2%. No complications followed the procedure. It was concluded that FNA cytologic examination of lesions in SML is a simple, safe, highly accurate, and cost‐effective method to distinguish malignant from benign lesions in women with BC. Lesions in SML should be explored routinely by FNA, rather than by the traditional biopsy, provided the FNA is done by an experienced operator.