Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) has been used with variable success as a diagnostic test for benign and malignant breast lesions. The goal of this study was to examine the effects of training physicians in the fine-needle aspiration sampling-technique on the diagnostic accuracy of FNAB of palpable breast masses. The settings for this study were private physicians' offices and university clinics of primary care physicians, surgeons, and cytopathologists. METHODS: We reviewed 1043 consecutive FNAB specimens of the breast obtained during 1 year (1992): 729 FNABs were performed by formally trained physicians (at least 150 FNABs performed previously under supervision during fellowship training or the equivalent) who had done at least 100 FNABs during the year; 314 FNABs were performed by physicians without formal training who had done a median of only 2 FNABs during the year (range, 1-43 FNABs). All FNAB specimens were reviewed microscopically and evaluated for cellularity and type of material present, for diagnostic accuracy, and for the rate of surgical intervention. A minimum of 2 years of follow-up was obtained by matching all cases to the population-based Northern California Cancer Registry. FNAB specimens were correlated with histologic specimens when they were available. RESULTS: Using FNAB, the formally trained physicians missed 2% of cancers, whereas the physicians without formal training missed 25%. Among the patients with benign lesions seen by the formally trained physicians, 8% went on to surgery, whereas 30% of those seen by physicians without formal training did so. Specimens obtained by the formally trained physicians were significantly more cellular and were significantly less likely to be nondiagnostic. CONCLUSIONS: FNAB, when performed by physicians who are well trained in the technique, is a highly accurate, cost-effective diagnostic method that carries minimal morbidity and could replace a large number of surgical biopsies. When performed by physicians without adequate training, FNAB is often misleading and potentially harmful.

Fine needle aspiration biopsy for diagnosis and follow-up of prostate cancer. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

Fine needle aspiration biopsy (FNAB) and ultrasound-guided core biopsy using biopty gun both have a high, and approximately equal, accuracy in diagnosing and grading prostate cancer. The TRUS-guided technique provides a better estimation of the tumor extent and to some degree even of capsular involvement. It is therefore a recommendable part of the preoperative evaluation when radical prostatectomy is contemplated. On the other hand, the aspiration technique usually provides more epithelial cells. It entails a significantly lower risk of septic complications and of seeding tumor cells. It has also a lower cost than the core biopsies. The aspiration biopsy can easily be performed repeatedly in the follow-up procedure, which is of particular importance in cases managed with watchful waiting. We recommend the aspiration biopsy for routine use in the diagnostic work-up and follow-up. It is essential that not only the cytologic evaluation but as well the sampling from the prostate is performed with adequate expertise.

Bromodeoxyuridine uptake in the assessment of hyperthermic therapy for intraocular tumor.

Assessment of uveal melanoma response after many nonenucleation therapies is difficult with current modalities, since tumor regression is usually delayed. The goal of most treatments, including ionizing radiation or radiation and adjunct hyperthermia, is to destroy the reproductive capacity of the tumor. Cell cycling analysis with bromodeoxyuridine, a thymidine analogue only incorporated during DNA synthesis, was a useful indication of tumor control after hyperthermia was used to treat a Greene intraocular melanoma model. Cell cycling decreased from a mean of 16% before therapy to less than 1% in all the successfully treated tumors. Cell cycling changes preceded histologic evidence of cell death. In contrast, tumors that grew after insufficient treatment had increased cell cycling to a mean of 25%. Cell cycling studies with bromodeoxyuridine represent a sensitive gauge of the reproductive integrity of the tumor.