Interpretation of microbiopsies in cytological smears and Histopathological correlation.

Abstract

BACKGROUND: Fine needle aspiration cytology (FNAC) is the first line of investigation in diagnosis of neoplastic processes of the body.The scope for diagnosis is often not met due to absence of recognizable tissue architecture. Hence this study is done to overcome these shortcomings by focusing on well preserved tissue fragments (microbiopsies) in cytological smears. These microbiopsies can provide additional information in terms of tissue architecture; thus aiding in diagnosis, tumor typing and also in predicting possible primary sites in metastatic tumors. OBJECTIVES: To evaluate FNAC smears of malignant lesions for the presence of microbiopsies and theircyto-histopathological correlation. MATERIALS AND METHODS : The study was conducted on FNAC smears obtained from clinically suspicious malignant lesions. The lesions were aspirated using 22-23 gauge disposable needles and 10 ml syringes. Deep seated lesions were aspirated under computed tomography or ultrasonography guidance. These smears were examined microscopically for the presence of well preserved tissue fragments, disregarding the loose tumour cells in the background. Subsequent histopathological correlation was done wherever possible. RESULTS: A total of 80 FNA smears of clinically suspected malignant lesions were examined in the study from 1st December, 2014 to 30th July, 2016. Out of which 54 cases contained representative tissue fragments (microbiopsies) of the tumors. Majority of the cases were in the age group of 60 to 70 years accounting to 30% with slight female preponderance, male to female ratio being 1:1.16. Infiltrating ductal carcinoma (31.48%) was the most common malignancy in which the microbiopsies aided in the diagnosis. Other malignancies in which microbiopsies aided in diagnosiswere Squamous cell carcinoma (18.51%), Adeno carcinoma (11.11%), follicular neoplasm (9.25%), Hepatocellular carcinoma (7.4%), soft tissue sarcoma (7.4%), papillary carcinoma thyroid (5.56%) and others (9.25). In 37 casesHistopathological diagnosis wasavailable. In the present study, the cyto-hispathological concordance increased from 75% in absence of microbiopsies to 84% in their presence, thus an increase of 9% was noted. CONCLUSION:In the current era, where ''needle precedes the scalpel'' and the biopsy material is getting limited, it would be useful to carefully evaluate smears with tissue fragments/microbiopsies. Microbiopsies are of ample help in diagnosis , typing of the tumour and indentifying the primary site in the metastatic lesions. Thus, enhancing the diagnostic accuracy of FNAC especially in resource poor setups.