Grading of Spindle Cell Sarcomas in Fine-Needle Aspiration Biopsy Specimens

Abstract

A b s t r a c tWe studied whether histologie criteriafor grading sarcomas could be applied to fine-needle aspiration biopsy (FNAB) Fine-needle aspiration biopsy (FNAB) is an effective tool for the diagnosis of primary and metastatic soft tissue tumors with reported high sensitivity and specificity rates. 1_5Exact subclassification of sarcomas, especially spindle cell sarcomas, can be difficult on FNAB and histologie examination without the use of ancillary studies, such as immunohistochemistry and électron microscopy.6 ' 8 However, several studies report that among spindle cell sarcomas and sarcomas in gênerai, the most important prognostic factor, which influences survival and récurrence rates, is the grade of the sarcoma, rather than the histologie subtype. 6- 910 In addition, some current treatment protocols for adults include preoperative radiation, chemotherapy, or both, for intermediate-and high-grade sarcomas regardless of the histologie subtype. The grading schemes of sarcomas reported in the literature, however, were developed from histologie spécimens and not FNAB spécimens. 6 ' 11_l6 We studied whether the criteria used in histologie grading can be applied to FNAB spécimens of spindle cell sarcomas in adults, without knowledge of the sarcoma subtype. Materials and MethodsThe FNAB spécimens of 36 consécutive spindle cell sarcomas from adults, which had a corresponding histologie spécimen, were reviewed without knowledge of the grade or histologie subtype. The grading scheme was adapted to FNAB material from a modification of the grading scheme applied to histologie spécimens of sarcomas at our institution ITable 11. FNAB cell groups and single cells were assessed for nuclear atypia (mild, moderate, or marked), présence of necrosis, and number of mitotic figures per 10 high-power fields (HPFs). Cell groups also were evaluated for nuclear overlap (minimal, moderate, or marked). The number of cell groups on each FNAB slide was classified as low (<20 groups per slide, 8 4Am J Clin Pathol 1999; 112:784-790

Subgrouping and grading of soft‐tissue sarcomas by fine‐needle aspiration cytology: A histopathologic correlation study

“…Recent reports suggest that many sarcomas can be successfully subclassified and even graded by FNAB. 6,7 Therapeutic and prognostic considerations weigh heavily on the grade and stage of the tumor, and most sarcoma grading systems are in part dependent on histologic subtype. 8 In this report, we analyze the applicability and reproducibility of cytomorphologic subgrouping and grading of soft-tissue sarcomas in correlation with histopathologic subtype and grade.…”

Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas

“…To achieve this degree of accuracy, the system was modified to rely more heavily on nuclear atypia whenever mitotic activity and/or necrosis were lacking. 20 In our larger series of sarcomas, we were less successful in predicting final histopathologic grade by review of FNA specimens. The three observers in our study accurately predicted histopathologic grade in between 43% and 50% of cases.…”

“…The weakness of this system is that it is reliant on the cytopathologist's ability to subtype sarcomas, a process shown to be only 60 -70% accurate in most studies. The proposal by Weir et al 20 uses a three grade system based on assessment of nuclear atypia, nuclear overlap, mitotic figures, and necrosis. This scheme is less dependent on tumor subtype.…”

“…We studied the concordance of cytologic grade and histologic grade in a subset of 77 cases and investigated the interobserver reproducibility of cytologic grading in 107 cases. For the purposes of cytologic grading, we used a modified version of the scheme proposed by Weir et al 20 Although no universally accepted protocol exists for histologic grading, we followed the recommendations of Tsujimoto et al 21 In a study of 36 FNA specimens, Weir et al 20 accurately graded 92% of them using a 3-tier grading system. To achieve this degree of accuracy, the system was modified to rely more heavily on nuclear atypia whenever mitotic activity and/or necrosis were lacking.…”

Role of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumors

“…10 Standardized protocol for cytological grading of soft tissue sarcomas was used (Table 1). 11,12 For histological grading French federation of national cancer centre (FNCLCC) grading system was used which takes into account differentiation, mitosis and necrosis. 13 The cytological findings were correlated with the histopathological results, wherever available.…”