Diagnostic accuracy and limitations of fine‐needle aspiration cytology of bone and soft tissue lesions

Abstract

BACKGROUND: Fine-needle aspiration (FNA) cytology is increasingly being used as a diagnostic modality for soft tissue and bone lesions. These diagnoses can be challenging because of a variety of factors, including interpretation and sampling issues. This study investigates the diagnostic utility of FNA biopsy, in addition to the diagnostic pitfalls, in soft tissue and bone cytopathology. METHODS: We retrospectively reviewed the soft tissue and bone FNAs over a 4-year period (2004)(2005)(2006)(2007)(2008), along with available ancillary studies, pathological follow-up, and clinical data. The cases with a cytologic-histologic discrepancy were then reviewed. RESULTS: A total of 1114 soft tissue and bone FNAs were identified. Of the 1114 aspirates, 525 (47%) were positive for malignant cells, 505 (45.5%) were benign aspirates (including 189 benign lesions/neoplasms), 37 (3.5%) were inadequate, 34 (3%) had atypical cells, and 13 (1%) were suspicious for malignancy. Of the 586 cases (53%) with follow-up, including 445 cases with histological follow-up and 141 with ancillary studies, the overall sensitivity was 96%, the specificity was 98%, the positive predictive value was 99%, and the negative predictive value was 92%. A total of 15 false negatives and 3 false positives were identified with errors because of sampling (9 cases), interpretation (7 cases), and screening (2 cases). CONCLUSIONS: This large series demonstrates that there can be a high sensitivity and specificity in diagnosing bone and soft tissue lesions by FNA. Our data supports prior studies in the literature in showing that FNA cytology can be a valuable method for diagnosing these lesions. Cancer (Cancer Cytopathol) 2010;118:24-32.

Fine-needle aspiration cytology in soft tissue tumors: How far did we go??

“…When compared with open biopsy, this procedure is well-tolerated by patients and risk of complications is minimal, in addition, the multiple passes of the needle make it possible to sample different parts of a tumor, opposed to a single small core biopsy or open biopsy. [1,2] An almost equal incidence of benign and malignant cases in our series was in contrasting to Rekhi et al, where sarcomas formed a greater proportion of referral cases at their center. [2] In terms of diagnostic efficacy, in malignant cases, we had a sensitivity of 84.61% and specificity of 85.71%.…”

“…Finding a threshold whereby sensitivity is maximized, and inadequacy rates are minimized is hard to define. [1] It has been seen that benign lesions are more difficult to subclassify than malignant lesions. 10 (71%) were subclassified as sarcoma while in contrast, only 7 (53%) could be subclassified as a specific benign lesion.…”

“…These findings were similar to that of Khalbuss et al who reported subclassification in 83% and 37% of malignant and benign cases. [1] Most of the smears, in a study of 5 cases of elastofibroma, were paucicellular, and the cellular component consisted of individual cells or clusters of spindled fibroblasts with bland nuclear features and rare mature adipocytes. The acellular matrix composed of elongated rod-like structures with serrated borders or braid-like or fern-like fibers and petaloid globules were the diagnostic component.…”

“…[4] Sampling errors can be attributed to low cellularity, inadequate sampling of the target and copious cystic/bloody/ necrotic material. [1] Obtaining adequate specimens from deeply seated lesions is a technical pitfall and misdiagnosis of cells from reactive zones around the tumor, correct evaluation of spindle cell lesions, rare soft tissue neoplasms, and "new entities" lacking reproducible cytological criteria are other important challenges. [5] Complex heterogeneity of STTs is known to be a limiting factor in their exact categorization.…”

Histopathological Evaluation of Neoplastic and Non-Neoplastic Bone Tumours in a Teaching Hospital

“…Krishnappa et al 2016 [16] reported two cases of chondroblastoma. Rajani et al 2014 [17] accounted for 2.3% and Khabuss et al 2010 [18] accounted for one case in their study. Osteosarcoma was the most common malignant lesion in our study.…”