Fine‐needle trucut biopsy versus fine‐needle aspiration cytology with ultrasound guidance in the abdomen

Abstract

Historically, fine-needle aspiration cytology (FNAC) has varying sensitivity, specificity and accuracy in the diagnosis of abdominal lesions with a high insufficient sampling rate. We compared 20-G fine-needle trucut biopsy (FNTB) with FNAC results in the biopsy of solid abdominal tumours. A retrospective review of 171 (128x 20-G FNTB and 43x FNAC) ultrasound-guided biopsies of abdominal tumours on 157 patients (male : female 85:72, mean age 61.25 years) were carried out. One hundred and seventy-one biopsies were carried out: liver 109, pancreas 19, lymph node 10, omentum 5, right iliac fossa mass 6, adrenal 6 and others 16. An average of 2.06 and 1.97 passes (range 1-4) were carried out per FNTB and FNAC, respectively. A definitive diagnosis was made in 122/128 biopsies (95.3%) and 32/43 biopsies (74.4%) for FNTB and FNAC, respectively. Diagnoses consisted of metastatic liver disease (74/171), pancreatic adenocarcinoma (10/171), lymphoma (8/171) and others (33/171) and benign (29/171). No significant complications occurred in either group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87, 100, 100, 50, 84.4 and 93.1, 100, 100, 60, 71.4 for FNTB and FNAC, respectively. A greater and more consistent positive diagnosis rate is yielded by 20-G FNTB (95.3%) than FNAC (74.4%). The diagnostic accuracy of FNTB is 84.4% compared with 69.8% for FNAC. A greater insufficient sampling rate occurs with FNAC (25.6%) than with FNTB (4.7%). For abdominal biopsy, 20-G FNTB needles have a much higher yield than FNAC with no increase in complications. FNTB is the preferred choice, particularly where cytological assistance at the time of biopsy is unavailable.

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions

“…One of the most relevant ones is the possibility to use larger core needles to obtain biopsies instead of cytologies. In a report by O’Connell et al [12], the use of larger needles was not associated with more complications and reduced the number of insufficient samples from 25.6 to 4.7% with a parallel increase in accuracy (from 69.8 to 84.4%). However, the authors recognized that this improvement was mainly seen when no control of the quality samples was employed at the time of FNAC collection.…”

“…It seems clear this lack of homogeneity can at least partially explain the large variability in the diagnostic yield of FNAC of pancreatic lesions reported in the literature, which tends to be lower than the usually accepted 80%. It also seems clear that the use of large needles (19 G) that render larger tissue samples [12] and ROSE of material by expert cytopathologists significantly increases the diagnostic yield of FNAC [13], but experience with FNAC is still frustrating in clinical everyday practice in many centers.…”

Perkutan Biyopsi: Igne Secimi ve Goruntuleme Kilavuzlari

“…Perkütan biyopsi sürecinde renkli doppler iğne yolunu belirlerken vasküler yapılara zarar verme olasılığını en aza indirir. Ayrıca renkli doppler işleme bağlı gelişebi-lecek komplikasyonlardan aktif kanama ve arterio-venöz fistül taramasında kullanılabi-lir [19][20][21][22].…”

Fine Needle Aspiration Cytopathology of Liver Masses: 101 Cases with Cyto-/Histopathological Analysis

“…With regard to the differentiation between malignant and benign lesions, specificity of FNA of the liver approaches 100% and sensitivity ranges from 67 to 100%, averaging at about 85% [3,4,5] . In the present study, including 101 controlled cases, sensitivity was 96.3%, specificity 90.0%, and overall accuracy was 95.6%.…”

“…Therefore, these two techniques should be considered complementary in the investigation of liver lesions [1,6] . Although biopsies are more accurate in subtyping some tumors than FNAC, NCB has an increased incidence of complications, such as hemorrhage, tumor seeding, infection, fistula formation and pain by using the larger bore needles [4] . In our opinion, FNAC and NCB should be considered complementary diagnostic techniques and used in combination depending on clinical conditions.…”