Diagnostic pitfalls in fine needle aspiration biopsy of the spleen

Friedlander, M.; Wei, Xiaorong; Iyengar, Pratibha; Moreira, André L.

doi:10.1002/dc.20749

Cited by 24 publications

(24 citation statements)

References 18 publications

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“…Several more recent publications have reported much lower complication rates with smaller needle diameters (18 gauge or smaller) ( 5,6,16 ). Diseases that commonly affect the spleen can pose a diagnostic challenge to the clinician, radiologist, and pathologist, and the reported diagnostic accuracy of splenic biopsy varies, ranging between 84% and 90% ( 5,14,(16)(17)(18)(19)(20)(21).…”

Section: Search Strategymentioning

confidence: 99%

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

McInnes

Kielar²,

Macdonald³

2011

Radiology

111

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Purpose:To use meta-analysis to determine the complication rate and diagnostic accuracy of image-guided percutaneous needle biopsy of the spleen. Materials and Methods:Several electronic databases were searched through July 2010 without language restrictions. Two reviewers independently selected studies that met the inclusion criteria for the diagnostic accuracy and complication rate arms of the study. Study data were independently extracted by the two reviewers. The primary 2 3 2 data were investigated with a random-effects meta-analysis of sensitivity and specifi city. The complication rate data were investigated with a random-effects meta-analysis; sensitivity analysis of complication rate, excluding needles larger than 18 gauge, was performed. Results:Four studies met the inclusion criteria for the diagnostic accuracy arm (639 patients), and nine met the inclusion criteria for the complication rate arm (741 patients). The meta-analysis showed a pooled sensitivity of 87.0% (95% confi dence interval [CI]: 80.7%, 91.4%) and specifi city of 96.4% (95% CI: 81.4%, 99.4%). The pooled major complication rate was 2.2% (95% CI: 0.8%, 5.6%). Sensitivity analysis with the removal of biopsies performed with needles larger than 18 gauge showed a major complication rate of 1.3% (95% CI: 0.6%, 2.5%). The most commonly encountered complications were hemorrhage followed by pain. Conclusion:Image-guided percutaneous biopsy of the spleen demonstrates high diagnostic accuracy and a major complication rate, for needles 18 gauge or smaller, that is similar to that reported for the liver and kidney. This technique should be considered a favorable alternative to splenectomy.q RSNA, 2011

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Section: Search Strategymentioning

confidence: 99%

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

McInnes

Kielar²,

Macdonald³

2011

Radiology

111

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“…It has the reputation of being a dangerous intervention and the specimen obtained is usually thought to be unduly difficult to assess, but these prejudicial ideas are fundamentally wrong. [2][3][4][5][6][7][8] FNAC is a safe, easy, simple, reproducible and rapid diagnostic procedure and has distinct advantage over open true cut or core biopsy. As it requires no special instrument and incur no significant trauma and cost to the patient Although radiological modalities like ultrasound, CT scan, or MRI usually narrow down the differential diagnosis but rarely provide a definitive picture and tissue sample in form of an aspirate or a biopsy is required to clinch a specific diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Splenic pathology can be localised or secondary to systemic involvement in various diseases. The indications of splenic FNAC [3][4][5]8,16 are non-neoplastic diseases like infectious diseases, storage disorder, sarcoidosis, amyloidosis, hemophagocytic syndrome and neoplastic conditions like different haematological and metastatic epithelial tumours. In this present retrospective study, we have explored the role of FNAC in splenic lesion in a multidisciplinary tertiary health care centre.…”

Section: Introductionmentioning

confidence: 99%

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Role of aspiration cytology in splenic lesions

2016

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INTRODUCTIONThe FNAC has become quite popular diagnostic modality now days. Splenic fine needle aspiration cytology (FNAC) as a diagnostic procedure has been used since beginning of last century and was first reported in 1916. 1 Although many authors from different centers have highlighted its utility for diagnosing splenic pathology, it is used routinely in very few cases. It has the reputation of being a dangerous intervention and the specimen obtained is usually thought to be unduly difficult to assess, but these prejudicial ideas are fundamentally wrong.2-8 FNAC is a safe, easy, simple, reproducible and rapid diagnostic procedure and has distinct advantage over open true cut or core biopsy. As it requires no special instrument and incur no significant trauma and cost to the patient Although radiological modalities like ultrasound, CT scan, or MRI usually narrow down the differential diagnosis but rarely provide a definitive picture and tissue sample in form of an aspirate or a biopsy is required to clinch a specific diagnosis.9-15 In these circumstances, FNAC remains the first mainstay diagnostic investigation. Splenic pathology can be localised or secondary to systemic involvement in various diseases. The indications of splenic FNAC [3][4][5]8,16 are non- ABSTRACTBackground: Splenic fine needle aspiration cytology (FNAC) as a diagnostic procedure has been used since beginning of last century and was first reported in 1916. The objective of the study was to evaluate the diagnostic role of aspiration cytology in splenic lesions. Methods: In our retrospective study Fine needle aspiration cytology (FNAC) of spleen was done in a total 34 cases, out of which 28 cases were aspirated under ultrasonological guidance and 6 cases were aspirated blindly. There were 23 male and 11 female patients and the age range of the patients was from 2 to 69 years with 8 patients from paediatric group. Before commencing the procedure all the necessary precautions and investigations including coagulation profile were done. Results: Out of 34 FNAC cases, 5 were bloody aspirate while 2 cases showed normal splenic aspirate. In 27 cases definite diagnostic opinion was possible. Amongst non-neoplastic group maximum patients (8 cases) were showing features of extra medullary hematopoeisis followed by 4 cases of tuberculosis, then 3 cases each of kala azar and storage disorder and 2 cases showed granulomas. In the neoplastic group, we had 2 cases of non-Hodgkins lymphoma, one case of Hodgkin lympoma with 2 cases of hairy cell leukemia and one case of histiocytosis. No major difference in the cellularity noticed when the aspiration done blindly or under ultrasound guidance No procedural complications were seen in our study. Conclusion:Hence when done with full precautions FNAC spleen is a safe, cheap, rapid and highly diagnostic procedure as a primary investigation.

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“…Percutaneous US-guided FNA has been considered an effective and less invasive alternative to surgical splenectomy for the diagnosis of lymphoma [66,67,68]. However, the use of this diagnostic technique remains controversial.…”

Section: Fna Diagnosis Of Specific Organ-based Primary Deep-seated Lymentioning

confidence: 99%

Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas

Jin

Wakely²

2016

Acta Cytologica

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Evaluation of deep-seated lymphomas by fine-needle aspiration (FNA) can be challenging due to their reduced accessibility. Controversy remains as to whether FNA and ancillary techniques can be used to diagnose deep-seated lymphomas reliably and sufficiently for clinical management. Most published studies are favorable that endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS)-FNA plays an important role in the diagnosis of deep-seated lymphomas. The addition of ancillary techniques, particularly flow cytometry, increases diagnostic yield. While subclassification is possible in a reasonable proportion of cases, the reported rates of successful subclassification are lower than those for lymphoma detection/diagnosis. The diagnostic limitation exists for Hodgkin's lymphoma, grading of follicular lymphoma, and some T-cell lymphomas. The role of FNA in deep-seated lymphomas is much better established for recurrent than primary disease. It remains unclear whether the use of large-sized-needle FNA or a combination of core needle biopsy and FNA improves subclassification. It is important for cytopathologists to have considerable understanding of the WHO lymphoma classification and develop a collaborative working relationship with hematopathologists and oncologists. As EUS/EBUS-FNA techniques advance and sophisticated molecular techniques such as next- generation sequencing become possible, the role of FNA in the diagnosis of deep-seated lymphomas will possibly increase.

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Diagnostic pitfalls in fine needle aspiration biopsy of the spleen

Cited by 24 publications

References 18 publications

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

Role of aspiration cytology in splenic lesions

Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas

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