Fine-needle aspiration cytopathology in the diagnosis of Wilms tumor

Abstract

BACKGROUND/PURPOSE The International Society of Paediatric Oncology (SIOP) protocol for Wilms tumor (WT) includes preoperative chemotherapy as the initial approach. However, an inadequate treatment may be performed in case of histological misdiagnosis. We evaluated the impact of fine-needle aspiration cytopathology (FNAC) in the diagnosis of unilateral WT in our group of patients. MATERIALS AND METHODS A retrospective descriptive study of patients with diagnosis of unilateral WT who underwent FNAC prior to neoadjuvant chemotherapy between 1993 and 2009 was performed. We reviewed the cytological diagnosis obtained by ultrasound-guided FNAC and the histological correlation with the resected specimens. RESULTS FNAC was performed in 66 patients with unilateral WT. In 57 of the 58 patients with positive FNAC for WT, the final diagnosis was correct (PPV: 98.2%). In 8 cases with negative FNAC for WT, the final diagnosis was positive for WT in 3 patients (NPV: 62.5%). Sensitivity was 95% and specificity was 83.3%. No complications were found associated with the procedure, except for an episode of haematuria, which resolved spontaneously. CONCLUSIONS FNAC is a useful and feasible technique in children that may confirm the suspected diagnosis of unilateral WT, avoiding inadequate preoperative chemotherapy in case of a non-Wilms renal tumor.

Indications and results of diagnostic biopsy in pediatric renal tumors: A retrospective analysis of 317 patients with critical review of SIOP guidelines

“…When required, both FNA and CNB techniques provide adequate samples. The cellularity was judged satisfactory in 82% to 85% of our cases, in agreement with the literature (i.e., 76% to 93% for FNA and 80% to 95% for CNB) . However, our data confirm a significantly higher diagnostic accuracy of CNB, as previously reported .…”

“…The cellularity was judged satisfactory in 82% to 85% of our cases, in agreement with the literature (i.e., 76% to 93% for FNA and 80% to 95% for CNB). [13][14][15]17,[45][46][47][48][49][50][51] However, our data confirm a significantly higher diagnostic accuracy of CNB, as previously reported. 13,[15][16][17][18]52,53 Nevertheless, in our experience, FNA remains useful in several settings: it allows extemporaneous examinations during the procedure, helping physicians performing biopsies to adjust the amount of tissue to be obtained.…”

Diagnostic accuracy and cytomorphological spectrum of Wilms tumour in fine needle aspiration biopsy cytology samples supplemented with cell blocks

“…Thus, cell blocks often showed additional epithelial or mesenchymal This is concordant with a previous study by Alam et al and higher than the reported sensitivity of 95% by Fernández-Pineda et al 8,14 In comparison, a recent trial in UK by Jackson et al showed 86% sensitivity for CNB requiring repeat biopsies. 15 Furthermore, there is a theoretical possibility and one case report in the literature regarding needle tract seeding after CNB.…”

“…In the 2001 SIOP WT protocol, FNABC for providing a cellular diagnosis prior to chemotherapy was allowed with no risk of upstaging. 8 In majority of these cases, FNABC is amenable without any anaesthesia and has an advantage of low cost, early diagnoses, minimal invasiveness and lesser contraindications. Previous studies have documented the cytomorphology of WT on FNABC samples, [9][10][11][12] including the distinction of WT from other uncommon paediatric renal neoplasms.…”

Diagnostic accuracy of fine needle aspiration biopsy in pediatric small round cell tumors

“…A study by Fernandez-Pineda et al found FNAB to be a very valuable technique to confirm the diagnosis of Wilms tumor. The sensitivity and specificity of FNAB was found to be 95% and 83.3% respectively [ 10 ].…”