Franco Fulciniti

Accuracy of fine needle aspiration biopsy in head and neck tumors

PURPOSE Fine-needle aspiration biopsy (FNAB) is frequently used in the diagnosis of lesions occurring in the head and neck region. This study evaluated the correlation between the findings on FNAB and the histological findings observed after surgery. MATERIALS AND METHODS A review of 218 patients who underwent FNAB of a head or neck tumor was performed. Cytological reports were classified into the following diagnostic categories: negative or positive for malignant cells and unsatisfactory. False-positive, false-negative, true-positive (sensitivity), and true-negative (specificity) rates were calculated. RESULTS Twelve specimens did not allow an adequate diagnosis (5.5%). Among benign tumors, 96.2% of the cases were correctly diagnosed, and 3.8% were nondiagnostic specimens. Among malignant tumors, 86.4% of cases were correctly identified. There were two (3.4%) false-negatives and six (10.2%) nondiagnostic specimens, with a total false-negative rate of 13.6%. CONCLUSIONS Sampling errors present a minor problem with FNAB. Most nondiagnostic or incorrect specimens were caused by nonhomogenous lesions, with poor placement of the needle and an insufficient amount of aspirated material. FNAB is a useful modality for the diagnosis of head and neck masses.

Fine needle aspiration (FNA) biopsy of orbital masses: a critical review of 51 cases

Fine needle aspiration (FNA) biopsy of orbital masses: a critical review of 51 cases

Fine needle aspiration cytology of medullary thyroid carcinoma: a review of 18 cases

A series of 18 consecutive medullary thyroid carcinomas (MTC) diagnosed by fine needle aspiration cytology (FNAC) is described. The most important diagnostic cytologic criteria were the dispersed cell pattern, the polygonal appearance of the cells, binucleated cells and the presence of amyloid. Other less common cytologic features are reported and the variable microscopic appearance of MTC is pointed out. The possibility that this cytologic variability of MTC may be by itself an important diagnostic feature is proposed.

Hodgkin's disease: diagnostic accuracy of fine needle aspiration; a report based on 62 consecutive cases

We report on our series of 62 cases occurring between January 1977 and December 1990, which were diagnosed as Hodgkins disease by fine needle aspiration (FNA) samples. the overall accuracy of the cytological diagnosis was high, with only four incorrect diagnoses and a positive predictive value of 93.5%. the value of FNA as a first level diagnostic technique in the screening of lymphadenopathies is discussed, as well as the limitations and pitfalls of the cytological diagnosis.

Fine-needle aspiration biopsies of breast masses. An additional experience with 1153 cases (1985 to 1988) and a meta-analysis

A series of 1153 fine‐needle aspiration biopsies (FNAB) of breast masses obtained during the period 1985 to 1988 in one institution was examined. The following diagnostic accuracy values were found: sensitivity, 93.0%; specificity, 92.4%; predictive positive value, 93.7%; and efficiency, 92.8%. These results were compared with a previously published series for the period 1976 to 1984. The diagnostic accuracy values did not differ significantly between the two series.

Sclerosing polycystic adenosis of the parotid gland: Report of one case diagnosed by fine-needle cytology with in situ malignant transformation

Sclerosing polycystic adenosis (SPA) is a rare pathological condition affecting the salivary glands, first described by Smith etal. in 1996. Even though this lesion is being increasingly diagnosed, less than 50 cases have been published in the world literature to date. In line with numerous other pathological analogies between breast and salivary gland lesions, SPA shares with fibrocystic disease of the breast many histopathological features, i.e., fibrosis, oncocytic (apocrine) changes, hyperplasia of ductal and acinar epithelium, cystic dilation of ducts, and, often, atypical epithelial changes. Most of the described cases have followed a benign clinical course, despite the frequent possibility of atypical hyperplasia in more than 50% of the cases and of the more than occasional in situ malignant transformation. In this article, we introduce a new case occurring in the parotid gland of a 57‐year‐old male showing atypical epithelial hyperplasia and low‐grade in situ mucoepidermoid carcinoma. Fine‐needle cytology (FNC) was performed on the lesion and, when a diagnosis of SPA was prospected, the variegated cytological features of the obtained sample posed several differential diagnostic problems. The spectrum of pathological lesions entering differential diagnosis comprised sebaceous adenoma, Warthins tumors with presence of sebaceous remnants, and low‐grade mucoepidermoid carcinoma. Histopathological examination disclosed SCA with intraductal neoplastic transformation resembling noninvasive low‐grade mucoepidermoid carcinoma. The cytological diagnosis of SPA should be entertained whenever a polymorphous picture is found on FNC samples comprising oncocytic/apocrine changes, sebaceous cells, cystic background, and epithelial hyperplasia with low‐grade cytological atypias. Diagn. Cytopathol. 2010.

Fine needle cytology of endometriosis: experience with 10 cases.

OBJECTIVE To evaluate whether commonly used cytologic criteria for the diagnosis of endometriosis are sufficiently specific, to assess the possible role of special methods in the differential diagnosis and to assess the clinical meaning and drawbacks of a cytopathologic diagnosis of endometriosis by fine needle aspiration. STUDY DESIGN We retrieved 10 cases of endometriosis from our files that had been diagnosed primarily by fine needle cytology (FNC) with subsequent tissue study. In some cases additional cytospin preparations and/or smears had been used for cytochemistry (periodic acid-Schiff stain, mucicarmine) or immunocytochemistry (pan-cytokeratin, cytokeratin 7, vimentin, CD10) using a 3-step streptavidin-biotin-immunoperoxidase reaction. RESULTS The cell pattern and immunocytochemical profile of the cases suggested a diagnosis of endometriosis. All cases were histologically confirmed. CONCLUSION With optimal preparations a confident cytologic diagnosis of endometriosis may be made with ease, permitting correct treatment of the disease and, in selected cases, planning of preoperative pharmacologic therapy.

Cyclin-dependent kinase inhibitor p27Kip1 expression in thyroid cells obtained by fine-needle aspiration biopsy : A preliminary report

Recent studies on paraffin‐embedded tissue have shown that the cyclin‐dependent kinase inhibitor p27Kip1 is expressed in normal thyroid cells, whereas it is downregulated in neoplastic cells. This prospective study was undertaken to assess whether p27Kip1 staining may also be applied to fine‐needle aspiration biopsy (FNAB) samples of the thyroid. We present here our preliminary results on 100 FNABs examined for p27Kip1 expression. p27Kip1 expression was assessed by immunocytochemistry; the technique was optimized on smears prepared from a normal thyreocyte cell line (TL5), which conspicuously expresses p27Kip1, and then applied to FNAB samples prospectively collected from 80 cases of nodular goiter and 20 cases of thyroid neoplasms (10 papillary carcinomas and 10 follicular neoplasms). The TL5 cell culture smears showed that methanol fixation, followed by heat‐induced antigen retrieval, is the most suitable technique for p27Kip1 staining on cytological samples. The FNAB smears similarly treated showed high p27Kip1 expression (75%) in goiter and a significantly lower expression (35%) in neoplasms (P < 0.0001). Our preliminary results show that: 1) p27Kip1 protein expression can be reliably assessed on cytological samples; and 2) p27Kip1 stains nonneoplastic and neoplastic samples in a different fashion, and thus is a useful tool in thyroid cytology. Diagn. Cytopathol. 23:77–81, 2000.

Comparative morphometric analysis of aggressive and ordinary basal cell carcinoma of the skin

A morphometric analysis was performed on histologic sections of 11 cases of aggressive basal cell carcinoma that recurred and/or metastasized after the first diagnosis (BCC2) and on 11 ordinary basal cell carcinomas (BCC1). The considered parameters were as follows: nuclear area, perimeter, maximum diameter, feret x, feret y, form perimeter, and form area. The results show numeric differences between the two groups for the first five parameters. A statistical analysis was performed between BCC1 and BCC2 for all the considered parameters using a two‐sided t test for independent samples. The test showed significant differences between the first five parameters except for the two form factors. A multivariate analysis was performed using area and perimeter values of the compared groups that amplified the discrimination threshold between the two groups. The authors conclude that a morphometric assessment may bring significant contribution in the knowledge and in the outcome prediction of basal cell carcinoma.

c-erbB-2 expression in FNAB smears and matched surgical specimens of breast cancer

Most of the data regarding the significance of c‐erbB‐2 oncogene expression as a prognostic marker in breast cancer have been generated in many large retrospective studies by retrieving the corresponding oncoprotein in archival paraffin embedded sections. Recently, employing fresh breast cancer cells obtained by means of fine‐needle aspiration biopsy, we found a rate of c‐erbB‐2 positive breast tumors (58%) higher than that reported in paraffin‐embedded tissue sections by others studies. The present analysis was undertaken to investigate the impact of routine tissue processing on the preservation of the c‐erbB‐2 immunoreactivity. This issue was addressed by assessing the relative rate of c‐erbB‐2 oncoprotein immunodetection on FNAB smears and matched surgical specimens of breast cancer. The expression of c‐erbB‐2 oncoprotein was evaluated using the alkaline phosphate‐anti‐alkaline phosphatase (APAAP) technique in 54 breast aspirates and corresponding surgical specimens of primary breast cancer. Twenty‐six (48%) smears and 23 (43%) matched paraffin sections gave specific signal for c‐erbB‐2 oncoprotein. The slightly higher incidence of c‐erbB‐2 expression found on smears seems to be mainly due to the better antigen preservation in the fresh cytological preparations. We conclude that routine histological processing may affect c‐erbB‐2 immunoreactivity; therefore, in mounting prospective studies, it is advisable to assess c‐erbB‐2 status in fresh tissue. Moreover, the assessment of c‐erbB‐2 expression on aspirate samples may yield additional information to the pre‐surgical prognostic evaluation of breast cancer diagnosed by FNAB. Diagn Cytopathol 1996;14:135–139.