Fine‐needle aspiration of fibrous dysplasia of bone: A worthwhile endeavor or not?

Abstract

Fine-needle aspiration (FNA) is a minimally invasive technique which is enjoying ever-increasing popularity in the initial diagnosis of many pathologic processes. However, FNA diagnosis of neoplasms occurring within bones is less commonly employed and is not the preferred method in some types of bony lesions. Fibrous dysplasia is a primary neoplasm of bone for which it is not yet clear whether FNA can reliably yield adequate diagnostic material. Review of data from 82 cases of fibrous dysplasia diagnosed between 1990 and 2006 yielded six cases, in which diagnosis was initially attempted by FNA prior to open biopsy and surgical resection. Corresponding cytologic, histologic, and imaging characteristics of the cases were reviewed. Of the six cases in which initial diagnosis was attempted by FNA, only two of six (33%) yielded adequate diagnostic material. Smears of aspirated material in all cases contained nonspecific elements, including fragments of benign host bone and cartilage, bland stromal cells, adipocytes, blood, and debris. Importantly, the two positive FNA cases were dependent on the concurrent core needle biopsy (all smears of aspirate material were nondiagnostic). Even with image guidance, FNA is insufficient to obtain diagnostic material for cases of suspected fibrous dysplasia of bone. Core needle biopsy at least is recommended to obtain adequate material, and to reduce the risk of misdiagnosis due to sampling error.

Fine needle aspiration cytology in a case of fibrous dysplasia of jaw

“…6 This is so because the material aspirated/area sampled may or may not be sufficient for accurate diagnosis. Yet, it is frequently carried out to distinguish between benign and malignant lesions of the jaw.…”

O papel da citologia no diagnóstico das neoplasias músculo-esqueléticas: revisão sistemática

“…The various reasons mentioned for the above phenomenon are: inability to evaluate tissue architecture; 8,16 difficulty obtaining an appropriate sample, 2-4,6,9,17,18 difficulty recognizing the extracellular matrix, especially osteoid; 9,19 considerable variability in histological patterns 6 with similar aspects both among different malignant lesions and among benign, malignant and non-neoplastic lesions, 2,4,7,9, 16,19,20 difficulty in the histologic subtyping and grading of lesions. 7,8,12,13,19,21 It could be noted that few authors base the definitive treatment exclusively on cytopathological results 5,7-10 , which demonstrates that despite the degree of precision referred to by the authors, there is limited confidence in the method.…”

“…Several factors appear to influence the precision of the exam, while the diagnosis is noticeably more difficult in neoplasms of the soft tissues, fusocellular lesions (a very frequent histological pattern among both benign and malignant lesions), 4,8,17,19,21,23 as well as in primary lesions (when compared to recurrences and metastases). 1,7,8,16 …”

Cementoid bodies on fine‐needle aspiration of a skull lesion

“…[1][2][3] We describe an FNA of a posterior parietal skull lesion in which the finding of cementoid bodies was sufficient for a diagnosis of fibrous dysplasia for clinical purposes.…”

“…7 Although there are rare reports of successful diagnosis of fibrous dysplasia on cytology, 1,2 FNA cannot be considered a reliable diagnostic method. 3 Efforts might fail if the aspiration needle does not penetrate cortical bone or if the fibro-osseous tissue itself is too dense for aspiration. Additionally, fibrous dysplasia can show degenerative changes (myxoid stroma, foamy histiocytes, multinucleate giant cells, and cyst contents) and might contain cartilage, obscuring the diagnosis.…”