Fine-Needle Aspiration Biopsy of the Distal Extremities

Abstract

We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.

Role of FNAC in diagnosing lesions of hand and wrist

“…Other lesions encountered for FNAC at these sites (but not seen in our study) reported by other studies include viral infections (herpes and molluscum contagiosum), angioma, glomus tumor, and skin carcinomas …”

“…Lesions in the hand and wrist are commonly encountered in clinical practice. Being exposed, these sites are prone to trauma, reactive, reparative and infectious processes which may form mass lesions mimicking neoplasia and prompting immediate work up . Most of these lesions are readily accessible to FNAC, which can be used as a primary diagnostic modality in most of them.…”

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

“…Sensitivity, that is, the ability to distinguish between benign and malignant lesions, among the authors who expressed these data from their populations, ranged from 65 3 to 100%, 10,11,22 which is close to those of the more invasive methods.…”

MRI for staging lymphoma: Whole‐body or less?

“…Unfortunately, in that paper, the analysis was limited to soft tissue metastases only, and the presence of lymph node and skeletal involvement outside the standard FOV was not assessed. Other case studies have reported that lymphomatous involvement can occur in popliteal lymph nodes (11, 12) and distal skeletal bones (13–16). Although these case studies only show selective clinical examples, they were also seen in the present, prospective study.…”