American Journal of Roentgenology, Vol 161, 629-631, Copyright © 1993 by American Roentgen Ray Society
Cytologic analysis in fine-needle aspiration biopsy: smears vs cell blocks
KT Brown, RK Fulbright, AM Avitabile and B Bashist
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10021.
OBJECTIVE. Imaging-directed fine-needle aspiration biopsy can be performed
with or without immediate cytologic assessment (smears). We compared the
results obtained immediately from cytologic smears with the results of
cell-block analysis. We wished to determine the frequency of false-negative
findings on cytologic smears in patients subsequently found to have
malignant tumors by cell-block analysis. MATERIALS AND METHODS. We
retrospectively reviewed the records for 100 consecutive biopsies performed
between January 1986 and August 1987. In each case, specimens were obtained
from both a 22-gauge and a 20-gauge notched needle placed in tandem. The
study group consisted of 84 patients who had results of analyses of both
cytologic smears and cell blocks available for review and who had clinical
or surgical correlation. RESULTS. Sixty-four (76%) of the 84 biopsies
yielded malignant tumor cells, 11 yielded evidence of a benign process, and
nine were not diagnostic. Malignant tumor cells were seen on the cytologic
smears in 55 (86%) of the 64 patients who had malignant tumors; in the
other nine patients, the malignant tumors were indicated by the cell-block
analysis only. Within the group of benign disorders, in only one case (9%)
was the cell block diagnostic when the cytologic smear was not. CONCLUSION.
Operators performing fine-needle aspiration biopsy should be aware of the
limitations of immediate cytologic evaluation. Cell-block analysis of the
aspirate remaining after the smears are made can be expected to increase
the diagnostic accuracy in up to 14% of patients.
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