Image-guided fine-needle aspiration of retroperitoneal masses: The role of the cytopathologist

Abstract

Background:Retroperitoneal tumors constitute a difficult diagnostic category as they are not easily accessible. The advent of image-guided fine-needle aspiration (FNA) has resolved this problem significantly.Aims:We present a short study based on guided aspiration of retroperitoneal tumors, in which we have tried to assess the role of image-guided fine-needle aspiration cytology as a tool for pre-operative diagnosis.Materials and Methods:The study was conducted on patients diagnosed with retroperitoneal masses. FNA was performed under image guidance with the help of ultrasonography and/or computed tomography; smears were prepared and meticulously screened according to a fixed protocol. The results were analyzed to determine sensitivity, specificity, and diagnostic efficacy of cytopathological diagnosis using image-guided FNA techniques.Results:We assessed 38 patients with retroperitoneal masses. In all cases, adequate cellular material was obtained. No major complications were encountered. Statistical analysis was carried out in 35 cases; sensitivity, specificity, and diagnostic accuracy were 100% in these cases.Conclusion:FNA under image guidance should be considered a first-line diagnostic approach for retroperitoneal and other abdominal tumors, although caution should be exercised in case selection. In areas where advanced tests are not available, the cytotechnologist and cytopathologist have a very important role to play in ensuring accurate diagnoses.

Retroperitoneal Tumor: A Silent Trespasser – Role of Image-Guided Fine-Needle Aspiration Cytology with Histopathological Correlation in Early Diagnosis

“…In infancy and early childhood, Wilms’ tumor, neuroblastoma, and germ cell tumor were the most common, which is similar to the results reported by Mangal et al [1], Gangopadhyay et al [3], and Ahmad et al [5]. In middle age, renal cell carcinoma, followed by pancreatic adenocarcinoma was the most common, which is similar to findings of Mangal et al [1], Gangopadhyay et al [3], Das Gupta et al [11], Stelow et al [14], and Mehdi et al [4]; however, in elderly age, the most common retroperitoneal malignancy observed was metastatic carcinoma.…”

“…The most common malignancy was found to be renal cell carcinoma ( n = 58; 21.16%), which is similar to the findings of Mehdi et al [4] ( n = 8; 21.05%), Mangal et al [1] ( n = 12; 14.11%, i.e., 12 cases each of renal cell carcinoma and metastatic carcinoma), and Mehar et al [9] ( n = 7; 12.72%). However, Gangopadhyay et al [3] reported 11 cases (21.56%) of metastatic carcinoma in ­lymphnodes and Ahmad et al [5] reported 11 cases of Wilms’ tumor as the most common malignancy.…”

“…They noted 1 case of paraganglioma as the only benign lesion. Strauss et al [6] found benign neurogenic tumor (schwannoma, neurofibroma), followed by paraganglioma, whereas Mangal et al [1] found 7 cases of retroperitoneal lipoma, to be the most common benign lesion; these results are similar to those found by Mehdi et al [4], who reported 4 cases each of lipoma and benign adrenal cyst. However, recent studies by van der Byl et al [7] and Craig et al [8] clearly describe retroperitoneal lipomas as very rare lesions, contradicting the results of Mangal et al [1] and Mehdi et al [4].…”

“…Most retroperitoneal masses were of renal origin ( n = 106; 34.30%), which is similar to the findings of Mangal et al [1], Mehdi et al [4], and Ahmad et al [5]. However, Gangopadhyay et al [3] found a retroperitoneal lymph nodal origin to be the most common ( n = 20; 39.21%).…”

“…They reported 7 cases (13.72%) as benign and nonneoplastic and 44 cases (86.27%) as malignant lesions, and Mehdi et al [4] reported 11 cases (28.94%) as benign and nonneoplastic and 27 cases (71.05%) as malignant. Mangal et al [1] reported 38 cases (44.70%) as benign and nonneoplastic and 47 cases (55.29%) as malignant.…”