Lester J. Layfield

The palpable breast nodule. A cost-effectiveness analysis of alternate diagnostic approaches

Background. Traditionally, open biopsy has been considered the optimal procedure for the diagnosis of breast nodules. Fine‐needle aspiration biopsy (FNAB) has been proposed as an alternate method for the diagnosis of many palpable breast lesions.

What constitutes an adequate smear in fine‐needle aspiration cytology of the breast?

The false‐negative diagnosis is a major clinical concern and a significant cause of litigation in fine‐needle aspiration cytology of breast lesions. A significant number of false‐negative diagnoses may be due to inadequate sampling of these lesions. Little information is available in the literature about what constitutes an adequate specimen, and the few publications that address this issue propose criteria based on anecdotal information. Recommendations vary widely and may or may not take clinical findings into account.

Fine-needle aspiration : Comparison of smear, cytospin, and cell block preparations in diagnostic and cost effectiveness

We compared the results of smears to those of cytospin and cell block preparations from fine‐needle aspirations to determine the cost effectiveness of each and to determine which should be routinely obtained. We reviewed 844 cases, 361 of which had both smears and cytospins, and 483 of which had both smears and cell blocks. Smears alone were diagnostic in 94% of cases (796/844 cases), cytospins alone diagnostic in 43% of cases (154/361 cases), and cell blocks alone diagnostic in 57% of cases (277/483 cases). Cytospins contributed additional information beyond that obtained from smears in 2% (7/361) and cell blocks in 12% (57/483) of cases. When smears were nondiagnostic, cytospins contributed additional information in 10% (2/21) of cases and cell blocks contributed additional information in 44% (12/27) of cases. The cost of providing a diagnosis from smear alone is

Fine-needle aspiration biopsy of salivary duct carcinoma: Report of five cases

212, from cytospin alone is

Salivary gland lesions with a prominent lymphoid component : Cytologic findings and differential diagnosis by fine-needle aspiration biopsy

352, and from cell block alone is

Fine-needle aspiration of epithelioid malignant peripheral nerve sheath tumor (epithelioid malignant schwannoma).

392. The cost for additional information established by cytospin is

Fine‐needle aspiration cytology of ganglion cysts

7,736 and by cell block the cost is

Aspiration cytology of clear-cell lesions of the parotid gland: morphologic features and differential diagnosis

1,906. Smears are superior to either cytospins or cell blocks in providing a diagnosis. It is not cost‐effective to obtain either cytospins or cell blocks in addition to smears on all cases. However, it is cost‐effective to obtain cell blocks when the immediate smear evaluation is nondiagnostic. Diagn. Cytopathol. 1998;19:70–74.

Fine‐needle aspiration biopsy of renal collecting duct carcinoma

Salivary duct carcinoma is a high grade malignancy which histologically strongly resembles ductal carcinoma of the breast. The findings from five cases of histologically proven salivary duct carcinoma sampled by preoperative fine‐needle aspiration (FNA) cytology are presented. Characteristic cytomorphologic features include cohesive clusters and flat sheets of epithelial cells which display a cribriform pattern with eccentrically located, hyperchromatic nuclei, abundant finely granular cytoplasm, and necrosis in the smear background. Diagn. Cytopathol. 16:526–530, 1997.

Focal fatty change of the liver: Cytologic findings in a radiographic mimic of metastases

Fine‐needle aspiration (FNA) is an accepted technique for the preoperative diagnosis of salivary gland nodules. The majority of salivary gland nodules are pleomorphic adenomas and offer little difficulty in diagnosis. Most diagnostically difficult lesions fall into one of four morphologic categories represented by squamous‐cell‐containing lesions, clear cell neoplasms, neoplasms with a prominence of stromal material, and lymphocyte‐containing lesions. Herein, we describe our experience with a series of 61 histologically confirmed cases in which the smears contained a prominent or predominant number of lymphocytes. The differential diagnosis is discussed and points of diagnostic aid enumerated. Diagn. Cytopathol. 1997;17:183–190.