Fine-needle aspiration of renal masses in adults: Analysis of results and diagnostic problems in 108 cases

Truong, Luan D.; Todd, Teresa D.; Dhurandhar, Bakula; Ramzy, Ibrahim

doi:10.1002/(sici)1097-0339(199906)20:6<339::aid-dc4>3.0.co;2-7

Cited by 86 publications

(32 citation statements)

References 37 publications

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“…In experienced centers, both methods have been reported to have high sensitivity and specificity for small renal masses 2, 3 but these appear to be complimentary techniques as core samples seem to be superior in cystic lesions and FNA may be superior in high grade tumors. 4 Both US and CT guidance have advantages, but no high quality study has compared the two modalities head to head.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Biopsy of Primary Tumor in Metastatic Renal Cell Carcinoma to Predict High Risk Pathological Features: Comparison With Nephrectomy Assessment

et al. 2010

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PURPOSE As treatment options evolve in metastatic renal cell carcinoma (mRCC), there is need for predictive information to help guide therapy. The purpose of this study was to assess accuracy of percutaneous primary tumor biopsy in mRCC by comparing biopsy findings to final nephrectomy pathology in patients undergoing cytoreductive nephrectomy (CN). MATERIALS AND METHODS Using an institutional database, we reviewed records of patients who underwent percutaneous primary tumor biopsy prior to CN. For patients who underwent biopsy at an outside institution, pathology was re-reviewed at our institution. Differences in accuracy based on biopsy technique, imaging modality, and biopsy time period were determined using chi-square analysis. RESULTS We identified 166 patients who underwent percutaneous biopsy of the primary tumor prior to CN between 1991 and 2007 and had data available for review. Median pathologic tumor size was 9.1 cm (range 3–32). Median time from biopsy to surgery was 46 days (range 6–717). Of 104 patients whose biopsy was assigned a Fuhrman nuclear grade, 33 (31.7%) had the same grade in the nephrectomy specimen or 74 of 109 (67.9%) when only high or low grade was considered. Grade change by more than 2 points was seen in 18 of 104 (17.3%) patients. Sarcomatoid features were present in 34 of 166 (20.5%) nephrectomy specimens, however only 4 (11.8%) were identified pre-operatively. CONCLUSIONS In patients with mRCC, percutaneous renal biopsy has poor accuracy for assessment of Fuhrman nuclear grade or sarcomatoid features. Physicians should use caution when using biopsy data to guide therapy.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Biopsy of Primary Tumor in Metastatic Renal Cell Carcinoma to Predict High Risk Pathological Features: Comparison With Nephrectomy Assessment

et al. 2010

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“…15,16 The cytoplasm of these tumor cells can be wispy, granular, vacuolated, or a mixture thereof. 17 In high-grade tumors, the cytoplasm often takes a more coarsely granular appearance, which confers a more oncocytic appearance to the tumor. However, higher nuclear grade features typically accompany this change, which are not as commonly seen in other oncocytic renal neoplasms.…”

Section: Cytomorphologic Features Of Rcc Subtypesmentioning

confidence: 99%

Diagnosis of Metastatic Renal Cell Carcinoma on Fine-Needle Aspiration Cytology

Lew

Foo

Roh³

2014

Archives of Pathology &Amp; Laboratory Medicine

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Fine-needle aspiration has assumed an increasingly important role in the diagnosis and management of patients with advanced stage cancer. Given its predilection for metastases to distant sites and organs at the time of presentation, metastatic renal cell carcinoma (RCC) is not infrequently encountered in the setting of fine-needle aspiration for initial diagnosis. In some instances, fine-needle aspiration may be the only opportunity to obtain diagnostic tissue to diagnose and subclassify RCC. Therefore, cytopathologists and cytotechnologists should be familiar with and recognize the cytomorphology of RCC and the ancillary studies that can be used to confirm and subclassify RCC. Herein, we describe a case of metastatic RCC initially diagnosed on fine-needle aspiration, discuss the cytomorphologic features of RCC subtypes, and review pertinent ancillary immunohistochemical and cytogenetic adjuncts.

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“…[29] For this reason, in a subset of cases, adequate material for confirmatory immunohistochemical stains is crucial in order to reach a definitive diagnosis. [30] In one institution’s experience, it was reported that approximately 6% of cases had a discrepancy between the preliminary and final diagnosis, and this most commonly involved cases with a change from “nondiagnostic” or “benign” at ROSE to malignant at final diagnosis, which was partially attributed to the additional material available at the time of final diagnosis. [31] Given that cell block and immunohistochemical stains are not available at the time of ROSE, examination of the cytomorphologic features is crucial.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration

2010

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Background:One of the novel techniques utilizing fine needle aspiration (FNA) in the diagnosis of mediastinal and lung lesions is the endobronchial ultrasound (EBUS)-guided FNA. In this study, we describe five cases which had a discrepancy between on-site evaluation and final diagnosis, or a diagnostic dilemma when rendering the preliminary diagnosis, in order to illustrate some of the diagnostic difficulties and pitfalls that can occur in EBUS FNA.Methods:A total of five EBUS FNA cases from five patients were identified in our records with a discrepancy between the rapid on-site evaluation (ROSE) and final diagnosis, or that addressed a diagnostic dilemma. All of the cases had histological confirmation or follow-up. The cytomorphology in the direct smears, cell block, and immunohistochemical stains were reviewed, along with the clinical history and other available information.Results:Two cases were identified with a nondefinitive diagnosis at ROSE that were later diagnosed as malignant (metastatic signet-ring cell adenocarcinoma and metastatic renal cell carcinoma (RCC)) on the final cytological diagnosis. Three additional cases were identified with a ROSE and final diagnosis of malignant (large cell neuroendocrine carcinoma (LCNEC) and two squamous cell carcinomas), but raised important diagnostic dilemmas. These cases highlight the importance of recognizing discohesive malignant cells and bland neoplasms on EBUS FNA, which may lead to a negative or a nondefinitive preliminary diagnosis. Neuroendocrine tumors can also be difficult due to the wide range of entities in the differential diagnosis, including benign lymphocytes, lymphomas, small and nonsmall cell carcinomas, and the lack of immunohistochemical stains at the time of ROSE. Finally, the background material in EBUS FNAs may be misleading and unrelated to the cells of interest.Conclusions:This study illustrates the cytomorphology of five EBUS FNA cases that address some of the diagnostic challenges witnessed while examining these specimens during ROSE. Many of the difficulties faced can be attributed to the baseline cellularity of the aspirates, the bronchial contamination, the difficulty identifying neoplasms with bland cytology, the wide spectrum of diseases that can occur in the mediastinum with overlapping cytomorphologic features, the mismatch between the background material and the cell populations present, and the overall unfamiliarity with these types of specimens.

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Fine-needle aspiration of renal masses in adults: Analysis of results and diagnostic problems in 108 cases

Cited by 86 publications

References 37 publications

Percutaneous Biopsy of Primary Tumor in Metastatic Renal Cell Carcinoma to Predict High Risk Pathological Features: Comparison With Nephrectomy Assessment

Percutaneous Biopsy of Primary Tumor in Metastatic Renal Cell Carcinoma to Predict High Risk Pathological Features: Comparison With Nephrectomy Assessment

Diagnosis of Metastatic Renal Cell Carcinoma on Fine-Needle Aspiration Cytology

Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration

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