No abstract

The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.

The aim of this study was to compare clinical evaluation of the site of hindfoot synovitis with contrast-enhanced magnetic resonance imaging (MRI) findings in children with juvenile chronic arthritis (JCA), and to evaluate the efficacy of selective guided intra-articular steroid injections. Thirteen symptomatic ankles of 11 consecutive JCA patients were examined clinically and with contrast-enhanced MRI. Pannus was demonstrated on MRI in both tibio-talar and sub-talar joints in 10 ankles, in the tibio-talar joint only in one ankle and in neither joint in two ankles. Correlation of clinical and MRI findings was good for the tibio-talar joint with concordance in 11/13 cases. Correlation was poor for the sub-talar joints. Of the 10 sub-talar joints shown to have pannus on MRI, only two were thought to have had definite clinical evidence of synovitis. Guided intra-articular steroid injection resulted in at least 6 months remission in 6/9 ankles compared with 1/10 ankles which had had previous unguided injections. We therefore recommend the use of image guidance for intra-articular triamcinolone hexacetonide injection in children with hindfoot synovitis.

We have reviewed 13 operations on 11 patients using curettage and polymethylmethacrylate cement for giant-cell tumour of bone (GCT) to assess the value of radiology in the early detection of recurrence. There were four recurrences, the most specific radiological sign on plain radiography was lysis of 5 mm or more at the cement-bone interface. This preceded clinical signs by a mean of four months and was identified at a mean of 3.75 months after operation. There was not always a complete sclerotic margin around the cement, but when it was present, there was never evidence of recurrence. MRI was helpful in assessing cases with evidence of recurrence.Frequent surveillance with plain radiography should continue for one year after operation irrespective of clinical signs of recurrence. When the appearance of the plain radiographs suggests recurrence, MRI should be performed and followed by image-guided needle biopsy. PATIENTS AND METHODSBetween 1983 and 1995, we treated a total of 49 patients with GCT, 14 of whom had previously been operated on elsewhere. Of these, 16 patients were treated by curettage and cementing, two of them twice. We reviewed the radiological records and the notes of clinical follow-up after 13 such procedures in 11 of these patients. The other five patients were excluded since their records were incomplete; two lived overseas and three had been treated more than ten years ago. There were six men and five women with a mean age at operation of 36.8 years (24 to 62). Details of the patients are given in Table I. The patients had usually been reviewed at two weeks, six weeks, three months, four months after operation and at six months thereafter. Follow-up was for a mean of two years (6 months to 4 years). Radiographs of the cement mass were taken at each attendance. The maximum width of lysis around the 'cementoma' was measured and the presence and completeness of a sclerotic rim assessed. The case notes were reviewed for indications of recurrence such as pain, swelling and limitation of movement. MRI had been performed in some cases of suspected recurrence and all recurrences had been confirmed histologically by needle biopsy 6 or at operation. RESULTSMost of the patients in our series had had previous operations elsewhere and only five of our procedures were on primary tumours. There were four recurrences in three patients, all on the diaphyseal side of the cementoma. The mean interval between cementing and a clinical diagnosis of recurrence was 7.75 months (7 to 12). In retrospect, recurrence could have been suspected radiologically when the lucent rim around the cementoma was 5 mm or more at any point on either of the two standard projections (Figs 1 and 2). In all such cases later films