Role of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumors
DOI:
https://doi.org/10.18203/2320-6012.ijrms20174565Keywords:
FNAC, Soft tissue tumorsAbstract
Background: Soft tissue tumors constitute a large and heterogenous group of neoplasms. Benign tumors out number their malignant counterparts by a ratio of about 100:1 in hospital population. FNAC has emerged as a major outpatient procedure for the diagnosis of soft tissue tumors due to low cost of the procedure, less complications, feasibility, quick results and high therapeutic efficiency with specificity and sensitivity of approximately 95%. The diagnostic accuracy of FNAC of soft tissue tumors in distinguishing benign and malignant lesion is also very high. The objectives of this study were to study the role of FNAC in the diagnosis of soft tissue tumors and its correlation with histopathology. Also, this study aimed at studying various cytomorphological patterns of soft tissue tumors and correlating cytological grading with histopathological grading.
Methods: It was a hospital based study of 5 years which included 479 patients of all age groups, clinically presenting with soft tissue swellings. FNAC was performed. Smears were stained with Papanicolaou (PAP)/May Grunwald Geimsa (MGG). The cytological details of soft tissue tumors were studied and broadly classified into benign, malignant and indeterminate and suspicious. Cytomorphological subtyping and grading of tumors on FNAC was done. The cytological findings were correlated with the histopathological results, wherever available.
Results: Benign tumors comprised of 423 cases (88.3%) and malignant tumors comprised 56 cases (11.69%)only. Maximum number of cases were seen in well differentiated/lipomatous group (339 cases) followed by spindle cell category (88 cases). Histopathological correlation carried out in 136 out of 479 cases (benign:111 and malignant :25) revealed that out of 111 cases diagnosed as benign by cytology, one case was malignant (liposarcoma) and among 25 malignant cases diagnosed by cytology one case was benign (myofibroblastoma). Overall sensitivity and specificity of FNAC was 96% and 99% respectively. Comparison of cytological and histopathological grading of 24 sarcomas showed overall concordance of 75%.
Conclusions: FNAC is an excellent diagnostic modality in early diagnosis of soft tissue tumors. FNAC is highly reliable and obviates surgical procedures especially in high risk patients thus facilitating initiation of appropriate therapy and saving time and manpower. It is also highly sensitive in detecting benign soft tissue tumors and highly specific for malignant soft issue tumors.
References
Shidam VB, Frisch NK, Hassan O, Mahaseth H, Kim SH, Udager KG, et al. Benign and malignant soft tissue tumors. Drugs and Disease. 2015.
Gonzalez-campora R, Munoz-arias G, Otal-salaverri C. Fine needle aspiration cytology of primary soft tissue tumors. Morphological analysis of the most frequent types. Acta Cytol. 1992;36:905-17.
Bennert KW, Abdul Karim FW. Fine needle aspiration versus core needle biopsy of soft tissue tumors-a comparision. Acta Cytol. 1994;38:381-4.
Cutler SJ, Young JL. Third national cancer survey: incidence data. Natl Cancer Inst Monogr. 1975;41:1-454.
Ng VY, Thomas K, Crist M, Wakely PE, Mayerson J. FNAC for clinical triage of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468(4):1120-8.
Barth RJ, Merino MJ, Solomon D. A prospective study of the value of core needle biopsy and Fine needle aspiration in the diagnosis of soft tissue masses. Surg. 1992;112:536-43.
Rekhi B, Gorad BD, Kakade AC, Chinoy RF. Scope of FNAC in the diagnosis of soft tissue tumors- a study from tertiary cancer referral centre in India. J Cytol. 2007;31:4-20.
Roy S, Manna AK, Pathak S, Guha D. Evaluation of fine needle aspiration cytology and its correlation with histopathological findings in soft tissue tumors. J Cytol. 2007;24:37-40.
Weiss SW, Goldblum JP. Enzinger and Weiss soft tissue tumors, 4th edition, St. Louis, Missouri, 2001.
Gonzalez-compara R. Cytoarchitectural findings in the diagnosis of primary soft tissue tumors. Acta Cytol. 2001;45:115-46.
Weir MM, Rosenberg AE, Bell DA. Grading of spindle cell sarcomas in fine needle aspiration biopsy specimen. Am J Clin Pathol. 1999;112:784-90.
Jones C, Liu K, Hirschowitz S, Klipfel N, Layfield LJ. Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas: can grades obtained from analysis of the fine needle aspirates serve as the basis for therapeutic decisions. Cancer. 2002;96:8391.
Coindre JM. Grading of soft tissue sarcomas. Arch Pathol Lab Med. 2006;48(1):3-12.
Akhter M, Ali MA, Hug M. Fine needle aspiration biopsy diagnosis of rhabdomyosarcoma; cytologic, histologic and ultrastructural correlation. Diagn Cytopath. 1982;34:1737-43.
Rajvanshi A, Srinivas R, Upsana G. Malignant small round cell tumors. J Cytol. 2009;26(1):1-10.
Liu K, Dodge RK, Dodd LG, Layfield LJ. Logistic regression analysis of low grade spindle cell lesions: a cytologic study. Acta Cytol. 1999;43:143-52.
