Limitations in Cytodiagnosis- An Institutional Study

Abstract

BACKGROUND Fine needle aspiration cytology has replaced open biopsy in majority of the palpable lesions. Differentiation between benign and malignant lesions is possible with this procedure with low cost, but has certain limitations. In the present study, the limitations of cytodiagnosis in various palpable lesions in the body is analysed.The aim of the study was to know the prevalence of various lesions which could be diagnosed on cytology, its limitations and need for histopathological examination. MATERIALS AND METHODSA prospective observational study was conducted in the Department of Pathology at tertiary care centre in rural area. 1200 cases attending for fine needle aspiration for a period of 2 years from January 2014 to December 2015 was taken up for the study. After obtaining informed consent from the patients, fine needle aspiration was performed using a 22 -24 gauge needle with 10 mL syringe and long lumbar puncture needle for guided aspirations. Smears were fixed in 95% isopropyl alcohol and stained with Haematoxylin and Eosin. Air dried smears were stained with May-Grunwald stain and special stains were done wherever necessary. The tissue was subjected for histopathological examination wherever indicated and results tabulated. Overall diagnostic accuracy, sensitivity and specificity of cytology as a diagnostic procedure was calculated. RESULTSThe overall accuracy of diagnosing granulomatous lymphadenitis and lymphoproliferative disorders on cytology was 65.71%. The overall accuracy of diagnosing fibrocystic disease of breast proliferative type was 80% and ductal carcinoma of breast was 100% on cytology. The overall accuracy of diagnosing follicular adenoma of thyroid was 36.20% and malignancy was 100% on cytology. The overall accuracy of diagnosing both benign and malignant lesions of salivary gland was 100% on cytology. The overall accuracy of diagnosing soft tissue tumours was 88.67% on cytology. In lesions of bone, skin and ultrasonographic-guided lesions of abdomen, the overall accuracy was 100%. On Pap smears, the overall accuracy was 84.48%. CONCLUSIONIn cases of granulomatous lymphadenitis without significant necrosis and negative AFB, fibrocystic disease of breast, follicular adenoma of thyroid, vascular tumours, soft tissue tumours with nuclear atypia and cases of atypical squamous cell of undetermined significance and high-grade intraepithelial lesions on Pap smears need histopathological examination for accurate diagnosis.