Percutaneous image-guided fine-needle aspiration of peritoneal lesions

Our plain-English summary of Percutaneous image-guided fine-needle aspiration of peritoneal lesions, by L.J. Layfield, E.V. Gopez (Diagnostic Cytopathology, 2003).

The study

• Authors: L.J. Layfield, E.V. Gopez
• Journal: Diagnostic Cytopathology
• Published: 2003;28(1):6-12
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Fine-needle aspiration (FNA) is a widely accepted technique for the initial tissue diagnosis of a variety of lesions arising within retroperitoneal and intraabdominal viscera. Fear of complications secondary to perforation of the bowel wall has limited the use of FNA in the diagnosis of gastrointestinal and peritoneal masses. A variety of primary and secondary neoplasms involving the peritoneum may present as multiple nodules, as masses, or as diffuse involvement of the peritoneum. When these lesions are associated with mass lesions or areas of significant peritoneal thickening, they become amenable to percutaneous image-guided FNA. We report on our experience with a series of 23 peritoneal lesions investigated by FNA for which subsequent histologic confirmation was available in 19, along with an additional 4 cases without histologic confirmation. One to four passes were made into each lesion, and immediate assessment for adequacy was performed by a cytopathologist in all cases. All 17 cases with a specific cytologic diagnosis and histologic confirmation represented either primary or metastatic neoplasms (5 gastrointestinal stromal tumors, 4 metastatic melanomas, 2 mesotheliomas, 1 lymphoma, 1 example of Kaposi's sarcoma, 1 serous papillary carcinoma of ovarian origin, 1 mucinous adenocarcinoma of ovarian origin, 1 intraabdominal desmoplastic small-cell tumor, and 1 solitary fibrous tumor of the peritoneum). In an additional 4 cases, the aspirates were judged as insufficient for diagnosis, with the smears containing only blood and benign mesothelial cells and/or inflammatory cell elements. These four smears were associated with both neoplastic and nonneoplastic lesions. Surgical confirmation was obtained in only 2 of these cases (1 metastatic melanoma and 1 example of omental and peritoneal involvement by an ovarian adenocarcinoma). Two cases without histologic confirmation were associated with clinically confirmed metastases. In our series, no acute or chronic postprocedural complications were identified, indicating that FNA in this setting is a safe technique. Accurate cytologic diagnosis was achieved in 74% of cases. The overall insufficiency rate was 26%.

Copyright 2003 Wiley-Liss, Inc.

In plain English

This article from the University of Utah described a retrospective series of 23 patients who had fine-needle aspiration (FNA), a thin-needle sample guided by CT or ultrasound, of lesions mainly involving the peritoneum, the lining of the abdomen. The article did not discuss asbestos exposure. The authors reported that an accurate cytologic diagnosis was made in 74% of cases (17 of 23). The 17 cases with a specific diagnosis confirmed by tissue examination were all primary or metastatic tumors, including 5 gastrointestinal stromal tumors, 4 metastatic melanomas and 2 mesotheliomas. In the mesotheliomas, cell-block testing showed the tumor cells were positive for vimentin and calretinin. Overall, 26% of samples were insufficient for diagnosis. Among lesions found to be tumors, the figure was 20%. No false-positive diagnoses and no complications after the procedure were found. The authors concluded that FNA appeared to be an effective and safe technique for identifying tumors affecting the peritoneum. They noted that uniform criteria for an adequate sample had not been set before the study began.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective case series of fine-needle aspiration cytology
• Who was studied: 23 patients who had CT- or ultrasound-guided FNA of peritoneal-based lesions, identified from the files of the Department of Pathology at the University of Utah Medical Center and one author's personal files; the study period is not given
• Main results:
  • An accurate cytologic diagnosis was obtained in 74% of the 23 cases (17/23)
  • All 17 cases with a specific cytologic diagnosis and histologic confirmation were primary or metastatic neoplasms, including 5 gastrointestinal stromal tumors, 4 metastatic melanomas and 2 mesotheliomas
  • The overall insufficiency rate was 26%; for lesions that were clinically or histologically neoplastic it was 20%
  • No false-positive diagnoses were observed in the series
  • No acute or chronic complications after the procedure were identified
  • In the 2 mesotheliomas, immunohistochemistry on cell-block material showed the tumor cells were vimentin- and calretinin-positive and negative for thyroid transcription factor I
  • One gastrointestinal stromal tumor was diagnosed cytologically as a smooth-muscle tumor; this case predated the use of CD117 as a marker, so immunohistochemistry was not performed
• The authors' conclusion: The authors concluded that FNA appears to be an effective and safe technique for identifying primary and secondary tumors of the peritoneum. They reported a sufficiency rate of about 74% for all lesions and over 80% for neoplastic lesions, and stated that immunohistochemistry on cell-block material combined with careful morphologic analysis should allow subcategorization of most neoplasms when adequate material is obtained.
• Limitations the authors state:
  • Uniform criteria for specimen adequacy had not been established before the study began

Topics

Medical terms in this study, explained in our Lexicon: Fine-Needle Aspiration, Neoplasm, Peritoneum, Mesothelioma, Sarcoma, Serous Papillary Carcinoma, Adenocarcinoma, Desmoplastic Mesothelioma.

Related studies

• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens — E.J. Wills, S. Carr, et al. (1987)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma — B.T. Welch, P.W. Eiken, et al. (2017)
• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)

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