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Fine Needle Aspiration for Clinical Triage of Extremity Soft Tissue Masses

Abstract

Background

Fine needle aspiration cytology (FNAC) is a rapid and low-morbid alternative to open biopsy or needle core biopsy for soft tissue masses. Numerous reports describe its use with metastatic or recurrent lesions, but FNAC is less accepted for primary lesions.

Questions/Purposes

We wished (1) to estimate the sensitivity, specificity, and positive and negative predictive values of FNAC for diagnosing malignancy; (2) to estimate the accuracy of subtyping and grading.

Methods

We retrospectively examined the diagnostic accuracy and clinical effectiveness of office-based FNAC performed by a trained pathologist on 213 females and 219 males (mean age, 51.8 years) who presented with a palpable soft tissue mass to one musculoskeletal oncology clinic between 2002 and 2008.

Results

The FNAC was reported as benign in 62.0%, indeterminate in 8.1%, and malignant in 29.9%. A second technique, such as needle core biopsy or open biopsy, was performed for 24.8% of lesions before a definitive treatment plan was rendered. Final tissue confirmation by open biopsy or resection was available for 52.2% of benign FNAC and 78.3% of malignant FNAC. Sensitivity, specificity, and positive and negative predictive values for detecting malignancy with either histopathologic confirmation or clinical followup were 89.2%, 89.8%, 96.1%, and 98.1%. There were seven sampling and nine interpretation FNAC errors in determining the nature of the lesion. Subtyping and grading for malignant lesions were 77.2% and 95.2% accurate, respectively.

Conclusions

FNAC is effective for initial triage and treatment selection at tertiary referral centers with close collaboration among the surgeon, pathologist, and radiologist.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Fig. 1

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Acknowledgments

We thank Benjamin Kaffenberger, BS, for assistance with data collection and analysis, Xueliang Jeff Pan, PhD, for statistical analysis, and Carl Morrison, MD, for interpretations of the biopsies.

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Corresponding author

Correspondence to Vincent Y. Ng MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Ng, V.Y., Thomas, K., Crist, M. et al. Fine Needle Aspiration for Clinical Triage of Extremity Soft Tissue Masses. Clin Orthop Relat Res 468, 1120–1128 (2010). https://doi.org/10.1007/s11999-009-1100-7

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  • DOI: https://doi.org/10.1007/s11999-009-1100-7

Keywords

  • Fine Needle Aspiration
  • Needle Core Biopsy
  • Fine Needle Aspiration Cytology
  • Open Biopsy
  • Histopathologic Confirmation