Role of fine needle aspiration cytology as a diagnostic tool in orbital and adnexal lesions

Abstract

Purpose:To evaluate the role of fine needle aspiration (FNAC) as a diagnostic tool in cases of orbital and ocular adnexal masses. Cytological findings were correlated with histopathological diagnosis wherever possible.Methods:FNAC was performed in 29 patients of different age groups presenting with orbital and ocular adnexal masses. Patients were evaluated clinically and investigated by non-invasive techniques before fine needle aspiration of the masses. Smears were analyzed by a cytologist in all cases. Further, results of cytology were compared with the histopathological diagnosis.Results:The age of patients ranged from 1 to 68 years (mean: 29.79±19.29). There were 14 males and 15 females with a male to female ratio of 0.93:1. Out of 29 cases, 26 aspirates were cellular. Cellularity was insufficient in three (10.34%) aspirates. Out of 26 cellular aspirates, 11 were non-neoplastic while 15 were neoplastic on cytology. Subsequent histopathologic examination was done in 21/26 cases. Concordance rate of FNAC in orbital and ocular adnexal mass lesions with respect to the precise histologic diagnosis was 90%.Conclusion:When properly used in well-indicated patients (in cases where a diagnosis cannot be made by clinical and imaging findings alone), FNAC of orbital and periorbital lesions is an invaluable and suitable adjunct diagnostic technique that necessitates close cooperation between the ophthalmologist and cytologist. However, nondiagnostic aspirates may sometimes be obtained, and an inconclusive FNAC should not always be ignored.

Fine needle aspiration cytology of orbital and ocular adnexal lesions

“…[21] In their series, it was not indicated whether the size, location, and the radiologic appearance of the lesions in terms of being focal or diffuse might have any effect on the rate of insufficient aspirates or the diagnostic accuracy of FNAC. Furthermore, similar to other FNAC-based studies, this study had limitations regarding being non-randomized and retrospective.…”

Evaluation of cytology and histopathology for the diagnosis of canine orbital neoplasia: 112 cases (2004‐2019) and review of the literature

“…For cases for which both cytology and histopathology results were available, the rate of disagreement between the two modalities was surprisingly high but similar to that reported in the physician‐based literature. In people, fine needle aspirate for cytology of orbital lesions is nondiagnostic in 10%‐30% of cases and discordant with later histopathology in 10%‐31% of cases, while in our patient population 15% of cytology samples were nondiagnostic and 17% were overturned by later histopathology . No specific causative factors could be identified for cases in which cytology samples were considered nondiagnostic or were initially characterized as representative of an inflammatory rather than neoplastic process.…”

“…In people, fine needle aspirate for cytology of orbital lesions is nondiagnostic in 10%-30% of cases and discordant with later histopathology in 10%-31% of cases, while in our patient population 15% of cytology samples were nondiagnostic and 17% were overturned by later histopathology. [22][23][24][25][26] No specific causative factors could be identified for cases in which cytology samples were considered nondiagnostic or were initially characterized as representative of an inflammatory rather than neoplastic process. Of the 11 samples in these categories, 10 came from dogs who had undergone a CT and eight were obtained using ultrasound guidance, suggesting that failure to sample the lesion of interest was unlikely to be the reason for discordance.…”

Isolated optic nerve leukemic relapse diagnosed via fine needle aspiration biopsy and transconjunctival biopsy

“…Other diagnoses sharing comparable clinical features include inflammation, infections, medication effects, autoimmune disorders, ischemia, and other neoplasms. 5,8,10 One reliable and relatively safe preliminary diagnostic tool before attempting any invasive procedure is FNAB of the optic nerve head, discussed by Khan et al 11 Although not reported for the diagnosis of leukemic infiltration, FNAB has been used to diagnose other ophthalmologic issues such as optic disk melanocytoma. 12 In our case, cytopathology following FNAB revealed rare atypical cells, further adding to the suspicion of ALL recurrence.…”

“…13 FNAB is known to give a cellular yield in 89% of patients and the technique is safe with respect to preserving vision; the most common complication is self-resolving intraocular hemorrhage. 11 The biopsy is performed with a 25 or 27 gauge needle and hence the diagnostic yield is often low with only a few cells obtained to diagnose the disease. In reported literature, the concordance rate between FNAB and subsequent histopathology in 90%.…”