Background. There is controversy concerning the utility of fine‐needle aspiration in diagnosing parotid masses. Even studies on large series of patients have compared aspiration findings with the histology in much fewer cases. Methods. Preoperative fine‐needle aspiration findings were compared with the histopathologic diagnoses from surgically resected specimens in 246 patients presenting with and treated for parotid mass from 1980–1990. Results. Of 173 benign tumors, 159 (91.9%) were diagnosed correctly and 110 of 144 (> 60%) were typed. Of 36 malignant tumors, malignancy was recognized in 22 cases (61.1%). There were nine false‐negatives, and in five cases, the specimen was unsatisfactory. The four cases of metastatic disease were correctly typed. Only two of seven lymphomas (28.6%) were identified. The cytologic and histologic diagnoses were concordant in all cases of nonneoplastic disease. Overall accuracy was 87%. Conclusions. Fine‐needle aspiration speeds up the diagnostic process and, with close cooperation between clinician and pathologist, the technique is a valuable adjunct to preoperative assessment in patients with parotid masses.

We describe the FNA features of five cases of malignant parotid myoepithelioma, the majority of which were thought clinically to be recurrent pleomorphic adenomas. A major finding was cell shape variation: round-oval, polygonal or spindle-shaped, with basophilic cytoplasm. Many were epithelial and plasmacytoid-like and had nuclear grooves, pseudoinclusions, and multinucleation. The true myoepithelial nature of the neoplastic cells was identified in all cases, but only two showed obvious cytological malignant features, both initially and on re-examination. FNA of malignant myoepithelioma may thus show overt features of malignancy, or may lack atypia and malignancy can only be identified on histology. The correct diagnosis can be predicted in FNA samples in certain cases, both in terms of typing and malignancy, whilst sometimes only the myoepithelial nature of the lesion can be assessed.

Fine-needle aspiration (FNA) is a well-established method for diagnosing breast cancer which has recently been successfully combined with molecular and cytogenetic analysis (Ljung et al, 1994). c-erbB2/neu overexpression is usually detected by the immunocytochemical (ICC) technique, although the methodological and specimen variability, and differences in antibody sensitivity, make this technique not entirely reproducible and, therefore, not highly reliable (Troncone et al, 1993;Corkill et al, 1994;Press et al, 1994;Midulla et al, 1995). On the other hand, the quantification of c-erbB2/neu copy number with semi-quantitative polymerase chain reaction (PCR) (Lonn et al., 1996) does not allow the performance of a 'cell by cell' analysis and the evaluation of gene distribution. The feasibility of dual-colour fluorescence in situ hybridization (FISH) on cytological material from FNA (performed on thawed tissue samples using a 24-gauge needle) has already been described (Sauter et al, 1996). Similarly, one-colour FISH on archival cytological samples up to 94 days old has been successfully performed (Cajulis et al, 1996). We have recently started to perform FNA for TP53 molecular analysis in a number of patients candidate to primary chemotherapy for breast cancer (Lavarino et al, 1998). In this paper, we further developed a cytogenetic approach applying dual-colour FISH analysis of c-erbB2/neu (Kallionemi et al, 1992) to material obtained from the same pass from the same patient series and to a new series.c-erbB2/neu, which is located on chromosome 17q11.2-q12 and chromosome 17 pericentromeric probes, were co-hybridized on fresh cytological smears and, when the latter were not available, on destained smears. A number of cases, of which fresh frozen material was available, were also analysed for c-erbB2/neu overexpression by means of conventional ICC technique. The purposes of this analysis were as follows: (i) to verify the feasibility of a molecular-cytogenetic analysis for c-erbB2/neu gene amplification on FNA material, (ii) to verify the possibility of using frozen and/or destained smears, and (iii) to compare molecular-cytogenetic and ICC results. The results show that dual-colour FISH may be successfully performed on each type of smear. The quantification and evaluation of spatial distribution and the heterogeneity level of c-erbB2/neu amplification among the nuclei represent an obvious advantage of FISH over ICC. Moreover, the higher sensitivity and reproducibility, as well as the evaluation of the chromosome copy number, make FISH unique for the assessment of c-erbB2/neu gene amplification on FNA material. MATERIALS AND METHODS Patients and tumoursFifty-eight consecutive female patients (age range 25-71 years; mean 53 years) with primary breast carcinoma ascertained by FNA, who had entered a primary chemotherapy protocol with doxorubicin and paclitaxel, were selected for the present study. According to the tumour node and metastasis classification (TNM; UICC, 1992), one case was T4bN2M1, one case T4bN2M0, three c...

In order to improve the cytomorphologic diagnosis of malignant lymphoma on lymph node fine-needle aspiration (FNA), and to make a confident discrimination between low-grade follicular non-Hodgkin's lymphoma (NHL) and lymphoid hyperplasia, polymerase chain reaction (PCR) analysis was performed of the Ig CDR3 region and BCL2 breakpoint region in 25 nonselected cases of malignant lymphoma (17 NHL and 8 Hodgkin's disease [HD]) with histologic control, and 22 cases of lymph nodal hyperplasia with histologic and/or clinical control. Among lymphomas, IgH monoclonality was detected in 7 (77%) of 9 NHLs and BCL2 rearrangement in 3 (17.6%) of 17 NHLs, all of which were follicular centroblastic-centrocytic (FCBCC). Three BCL2/JH negative FCBCC cases were monoclonal for CDR3. Neither IgH monoclonality nor BCL2 rearrangement were found in HD. Among cytologically diagnosed lymphoid hyperplasias, one IgH polyclonal case was considered false-negative, being histologically diagnosed as lymphoplasmacytic NHL on the subsequent excisional biopsy. Another 4 cases (2 BCL2 rearranged and 2 monoclonal for IgH) were considered false-positive on the basis of histologic features or clinical control. These data indicate that the combined PCR analysis of IgH and BCL2 rearrangements can confirm a cytologic diagnosis of lymphoma in FNAs while, due to the occurrence of both false-positive and false-negative results, it is of limited value in the distinction between follicular lymphoma and lymphoid hyperplasia without morphologic or clinical support.

HER-2/neu protein expression and gene amplification were analyzed in a series of 85 consecutive breast carcinoma patients entered into an adriamicin/taxol primary chemotherapy trial followed by surgery, 45 of whom underwent pre-treatment fine needle aspirate (FNA). Dual color FISH (fluorescent in situ hybridization) assay revealed high-level HER-2/neu gene amplification in the immunocytochemistry (ICC) indicated 3+ cases and no, low or moderate amplification in the ICC 2+ group, consistent with previous findings in untreated patients series. Results obtained with the ICC assay CB 11 showed higher overall concordance with FISH than did the Herceptest ICC assay, but CB 11 was less accurate than Herceptest in terms of selecting patients suitable for Herceptin treatment, which is currently restricted to ICC 3+/FISH amplified patients. The only ICC 3+ low-level amplified case (non-amplified according the two more stringent criteria applied) was found with the CB 11 assay. Comparison between pre-treatment smears and post-treatment sections by FISH revealed no significant changes in the HER-2/neu gene profile. In the clinical setting these findings point to the usefulness of HER-2/neu assessment in chemotherapy-treated patients, when pre-treatment material is unavailable.