Advertisement

Image-Guided Fine-Needle Aspiration Cytology

  • Mats GeijerEmail author
  • Henryk A. Domanski
Chapter

Abstract

Several factors make image guidance necessary in fine-needle aspiration cytology (FNAC): A lesion is diffuse and difficult to palpate; the cytologist requires it for all deep-seated nonpalpable lesions; there may be sampling issues in a nonhomogeneous lesion with areas of different tissue characteristics (e.g., necrosis versus viable tumor or purely fatty areas versus contrast-enhancing areas in liposarcomas); and/or the lesion may be inaccessible behind bony structures or located inside the bone. In this chapter the different imaging modalities used for guidance will be discussed, as well as their use in different anatomic regions. Special techniques to approach lesions in hard-to-reach locations are described. Several illustrative cases are provided.

Keywords

Guided FNA Fluoroscopy CT Ultrasound MRI Stereotactic biopsy 

References

  1. 1.
    Åström KG, Ahlström KH, Magnusson A. CT-guided transsternal core biopsy of anterior mediastinal masses. Radiology. 1996;199(2):564–7.CrossRefGoogle Scholar
  2. 2.
    Åström KG, Ahlström KH, Hagberg HE. CT-guided transvertebral core biopsy of a retrocrural mass. AJR Am J Roentgenol. 1997;169(4):991–3.CrossRefGoogle Scholar
  3. 3.
    Ahlström KH, Åström KGO. CT-guided bone biopsy performed by means of a coaxial biopsy system with an eccentric drill. Radiology. 1993;188:549–52.CrossRefGoogle Scholar
  4. 4.
    White LM, Schweitzer ME, Deely DM. Coaxial percutaneous needle biopsy of osteolytic lesions with intact cortical bone. AJR Am J Roentgenol. 1996;166:143–4.CrossRefGoogle Scholar
  5. 5.
    Schweitzer ME, Gannon FH, Deely DM, O’Hara BJ, Juneja V. Percutaneous skeletal aspiration and core biopsy: complementary techniques. AJR Am J Roentgenol. 1996;166(2):415–8.CrossRefGoogle Scholar
  6. 6.
    Vandromme MJ, Umphrey H, Krontiras H. Image-guided methods for biopsy of suspicious breast lesions. J Surg Oncol. 2011;103(4):299–305.CrossRefGoogle Scholar
  7. 7.
    Levin DC, Rao VM, Frangos AJ, Parker L, Sunshine JH. Current practice patterns and recent trends in breast biopsy among radiologists and surgeons. J Am Coll Radiol. 2006;3(9):707–9.CrossRefGoogle Scholar
  8. 8.
    Parker SH, Burbank F, Jackman RJ. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology. 1994;193:359–64.CrossRefGoogle Scholar
  9. 9.
    Brenner RJ, Bassett LW, Fajardo LL, Dershaw DD, Evans WP 3rd, Hunt R, et al. Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology. 2001;218(3):866–72.CrossRefGoogle Scholar
  10. 10.
    Yu Y-H, Wei W, Liu J-L. Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis. BMC Cancer. 2012;12(1):41.CrossRefGoogle Scholar
  11. 11.
    Wang M, He X, Chang Y, Sun G, Thabane L. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: a systematic review and meta-analysis. Breast. 2017;31:157–66.CrossRefGoogle Scholar
  12. 12.
    Ojeda-Fournier H, Nguyen JQ. Ultrasound evaluation of regional breast lymph nodes. Semin Roentgenol. 2011;46(1):51–9.CrossRefGoogle Scholar
  13. 13.
    Gipponi M, Fregatti P, Garlaschi A, Murelli F, Margarino C, Depaoli F, et al. Axillary ultrasound and fine-needle aspiration cytology in the preoperative staging of axillary node metastasis in breast cancer patients. Breast. 2016;30:146–50.CrossRefGoogle Scholar
  14. 14.
    Kocjan G, Bourgain C, Fassina A, Hagmar B, Herbert A, Kapila K, et al. The role of breast FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology. 2008;19(5):271–8.CrossRefGoogle Scholar
  15. 15.
    Nassar A. Core needle biopsy versus fine needle aspiration biopsy in breast – a historical perspective and opportunities in the modern era. Diagn Cytopathol. 2011;39(5):380–8.CrossRefGoogle Scholar
  16. 16.
    Hazard HW, Hansen NM. Image-guided procedures for breast masses. Adv Surg. 2007;41:257–72.CrossRefGoogle Scholar
  17. 17.
    Cesur M, Corapcioglu D, Bulut S, Gursoy A, Yilmaz AE, Erdogan N, et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid. 2006;16(6):555–61.CrossRefGoogle Scholar
  18. 18.
    Hanbidge AE, Arenson AM, Shaw PA, Szalai JP, Hamilton PA, Leonhardt C. Needle size and sample adequacy in ultrasound-guided biopsy of thyroid nodules. Can Assoc Radiol J. 1995;46(3):199–201.PubMedGoogle Scholar
  19. 19.
    Court-Payen M, Nygaard B, Horn T, Krag Jacobsen G, Braendstrup O, Narvestad E, et al. US-guided fine-needle aspiration biopsy of thyroid nodules. Acta Radiol. 2002;43(2):131–40.CrossRefGoogle Scholar
  20. 20.
    Gu WX, Tan CS, Ho TWT. Surgeon-performed ultrasound-guided fine-needle aspiration cytology (SP-US-FNAC) shortens time for diagnosis of thyroid nodules. Ann Acad Med Singap. 2014;43(6):320–4.PubMedGoogle Scholar
  21. 21.
    Haldar S, Sinnott JD, Tekeli KM, Turner SS, Howlett DC. Biopsy of parotid masses: review of current techniques. World J Radiol. 2016;8(5):501–5.CrossRefGoogle Scholar
  22. 22.
    Haldar S, Mandalia U, Skelton E, Chow V, Turner SS, Ramesar K, et al. Diagnostic investigation of parotid neoplasms: a 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy. Int J Oral Maxillofac Surg. 2015;44(2):151–7.CrossRefGoogle Scholar
  23. 23.
    Howlett DC, Skelton E, Moody AB. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods – fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section. Br J Oral Maxillofac Surg. 2015;53(7):580–3.CrossRefGoogle Scholar
  24. 24.
    Shaffer K. Role of radiology for imaging and biopsy of solitary pulmonary nodules. Chest. 1999;116(6 Suppl):519S–22S.CrossRefGoogle Scholar
  25. 25.
    Boskovic T, Stanic J, Pena-Karan S, Zarogoulidis P, Drevelegas K, Katsikogiannis N, et al. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis. 2014;6(Suppl 1):S99–107.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Diacon AH, Schuurmans MM, Theron J, Schubert PT, Wright CA, Bolliger CT. Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists. Respiration. 2004;71(5):519–22.CrossRefGoogle Scholar
  27. 27.
    Tantawy WH, El-Gemeie EH, Ibrahim AS, Mohamed MA. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes. Eur J Radiol. 2012;81(10):2907–12.CrossRefGoogle Scholar
  28. 28.
    Koegelenberg CF, Bolliger CT, Irusen EM, Wright CA, Louw M, Schubert PT, et al. The diagnostic yield and safety of ultrasound-assisted transthoracic fine-needle aspiration of drowned lung. Respiration. 2011;81(1):26–31.CrossRefGoogle Scholar
  29. 29.
    Kalhan S, Sharma P, Sharma S, Dudani S, Ramakrishnan T, Chowdhry A. Evaluation of precision of guidance techniques in image guided fine needle aspiration cytology of thoracic mass lesions. J Cytol. 2012;29(1):6–10.CrossRefGoogle Scholar
  30. 30.
    Murphy JM, Gleeson FV, Flower CD. Percutaneous needle biopsy of the lung and its impact on patient management. World J Surg. 2001;25(3):373–80.CrossRefGoogle Scholar
  31. 31.
    Kaçar Özkara S, Ozöver Tuneli I. Fine needle aspiration cytopathology of liver masses: 101 cases with cyto-/histopathological analysis. Acta Cytol. 2013;57(4):332–6.CrossRefGoogle Scholar
  32. 32.
    Mehdi G, Maheshwari V, Afzal S, Ansari HA, Ansari M. Image-guided fine-needle aspiration cytology of ovarian tumors: an assessment of diagnostic efficacy. J Cytol. 2010;27(3):91–5.CrossRefGoogle Scholar
  33. 33.
    Ray S, Gangopadhyay M, Bandyopadhyay A, Majumdar K, Chaudhury N. USG guided FNAC of ovarian mass lesions: a cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines. J Turkish Ger Gynecol Assoc. 2014;15(1):6–12.CrossRefGoogle Scholar
  34. 34.
    Nahar Saikia U, Khirdwadkar N, Saikia B, Sood B, Goldsmith R, Dey P, et al. Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes. Acta Radiol. 2002;43(2):230–4.CrossRefGoogle Scholar
  35. 35.
    Veerapand P, Chotimanvijit R, Laohasrisakul N, Muennooch W. Percutaneous ultrasound-guided fine needle aspiration of abdominal lymphadenopathy in AIDS patients. J Med Assoc Thail. 2004;87(4):400–4.Google Scholar
  36. 36.
    Cavanna L, Lazzaro A, Vallisa D, Civardi G, Artioli F. Role of image-guided fine-needle aspiration biopsy in the management of patients with splenic metastasis. World J Surg Oncol. 2007;5:13.CrossRefGoogle Scholar
  37. 37.
    Ojalehto M, Tikkakoski T, Rissanen T, Apaja-Sarkkinen M. Ultrasound-guided percutaneous thoracoabdominal biopsy. Acta Radiol. 2002;43(2):152–8.PubMedGoogle Scholar
  38. 38.
    Arellano RS, Maher M, Gervais DA, Hahn PF, Mueller PR. The difficult biopsy: let’s make it easier. Curr Probl Diagn Radiol. 2003;32(5):218–26.CrossRefGoogle Scholar
  39. 39.
    Arellano RS, Harisinghani MG, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications. Curr Probl Diagn Radiol. 2003;32(1):3–10.CrossRefGoogle Scholar
  40. 40.
    Lieberman S, Libson E, Sella T, Lebensart P, Sosna J. Percutaneous image-guided splenic procedures: update on indications, technique, complications, and outcomes. Semin Ultrasound CT MR. 2007;28(1):57–63.CrossRefGoogle Scholar
  41. 41.
    Gupta S, Ahrar K, Morello FA Jr, Wallace MJ, Hicks ME. Masses in or around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach. Radiology. 2002;222(1):63–9.CrossRefGoogle Scholar
  42. 42.
    Fornari F, Civardi G, Cavanna L, Di Stasi M, Rossi S, Sbolli G, et al. Complications of ultrasonically guided fine-needle abdominal biopsy. Results of a multicenter Italian study and review of the literature. The cooperative Italian study group. Scand J Gastroenterol. 1989;24(8):949–55.CrossRefGoogle Scholar
  43. 43.
    Livraghi T, Damascelli B, Lombardi C, Spagnoli I. Risk in fine-needle abdominal biopsy. J Clin Ultrasound. 1983;11(2):77–81.CrossRefGoogle Scholar
  44. 44.
    Domanski HA, Carlen B, Sloth M, Rydholm A. Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations. Diagn Cytopathol. 2003;29(6):327–33.CrossRefGoogle Scholar
  45. 45.
    Leffler SG, Chew FS. CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy. AJR Am J Roentgenol. 1999;172:1389–92.CrossRefGoogle Scholar
  46. 46.
    Yang YJ, Damron TA. Comparison of needle core biopsy and fine-needle aspiration for diagnostic accuracy in musculoskeletal lesions. Arch Pathol Lab Med. 2004;128(7):759–64.PubMedGoogle Scholar
  47. 47.
    Mehrotra R, Singh M, Singh PA, Mannan R, Ojha VK, Singh P. Should fine needle aspiration biopsy be the first pathological investigation in the diagnosis of a bone lesion? An algorithmic approach with review of literature. Cytojournal. 2007;4:9.CrossRefGoogle Scholar
  48. 48.
    Chojniak R, Isberner RK, Viana LM, Yu LS, Aita AA, Soares FA. Computed tomography guided needle biopsy: experience from 1,300 procedures. Sao Paulo Med J. 2006;124(1):10–4.CrossRefGoogle Scholar
  49. 49.
    Hau A, Kim I, Kattapuram S, Hornicek FJ, Rosenberg AE, Gebhardt MC, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skelet Radiol. 2002;31(6):349–53.CrossRefGoogle Scholar
  50. 50.
    Sharma SD, Kumar G, Horsburgh A, Huq M, Alkilani R, Chawda S, et al. Do immediate cytology and specialist radiologists improve the adequacy of ultrasound-guided fine-needle aspiration cytology? Otolaryngol Head Neck Surg. 2015;152(2):292–6.CrossRefGoogle Scholar
  51. 51.
    Witt RL, Sukumar VR, Gerges F. Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy. Laryngoscope. 2015;125(7):1633–6.CrossRefGoogle Scholar
  52. 52.
    Domanski HA, Åkerman M, Carlén B, Engellau J, Gustafson P, Jonsson K, et al. Core-needle biopsy performed by the cytopathologist: a technique to complement fine-needle aspiration of soft tissue and bone lesions. Cancer. 2005;105(4):229–39.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Medical Imaging and PhysiologySkåne University HospitalLundSweden
  2. 2.Department of PathologySkåne University HospitalLundSweden

Personalised recommendations