Identification of oestrogen, progesterone receptor and human epidermal growth factor receptor 2 expression in mediastinal metastases of breast cancer obtained by endobronchial ultrasound-guided transbronchial needle aspiration.

BACKGROUND: In breast cancer patients, the expression statuses of oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are crucial in the choice of treatment. Receptor expression in metastatic lesions can differ from the primary tumour. The aim of our study was to analyse the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to obtain samples allowing the identification of ER, PR and HER2 expression in patients with mediastinal metastases of breast cancer. PATIENTS AND METHODS: The clinical files of all patients with a final diagnosis of breast cancer mediastinal metastases diagnosed by EBUS-TBNA in our institution were retrospectively analysed. The ability of EBUS-TBNA to obtain samples that allowed hormone receptor and HER2 expression analysis was calculated. RESULTS: Twenty-four patients were included. ER, PR and HER2 assessments could be performed in 22, 20 and 22 patients, respectively. In 20 of the 24 patients it was possible to investigate all three types of receptor expression. In the remaining four cases, where ER, PR or HER2 expression tests could not be performed, it was due to a lack of tissue. In cases with adequate results for EBUS-TBNA and the primary tumour agreement was greater for ER (16/19) and HER2 (12/14) than PR (8/17). Based on receptor status, there was a change in the choice of treatment for five patients. CONCLUSION: In patients with breast cancer mediastinal metastases, ER, PR and HER2 expression can be assessed in samples obtained by EBUS-TBNA whenever a sufficient tissue sample is collected.

Aberrant gene methylation and bronchial dysplasia in high risk lung cancer patients.

INTRODUCTION: The risk for lung cancer is incremented in high degree dysplasia (HGD) and in subjects with hypermethylation of multiple genes. We sought to establish the association between them, as well as to analyze the DNA aberrant methylation in sputum and in bronchial washings (BW). METHODS: Cross sectional study of high risk patients for lung cancer in whom induced sputum and autofluorescence bronchoscopy were performed. The molecular analysis was determined on DAPK1, RASSF1A and p16 genes using Methylation-specific PCR. RESULTS: A total of 128 patients were enrolled in the study. Dysplasia lesions were found in 79 patients (61.7%) and high grade dysplasia in 20 (15.6%). Ninety eight patients out of 128 underwent molecular analysis. Methylation was observed in bronchial secretions (sputum or BW) in 60 patients (61.2%), 51 of them (52%) for DAPK1, in 20 (20.4%) for p16 and in three (3.1%) for RASSF1A. Methylated genes only found in sputum accounted for 38.3% and only in BW in 41.7%, and in both 20.0%. In the 11.2% of the patients studied, HGD and a hypermethylated gene were present, while for the 55.1% of the sample only one of both was detected and for the rest of the subjects (33.6%), none of the risk factors were observed. CONCLUSIONS: Our data determines DNA aberrant methylation panel in bronchial secretions is present in a 61.2% and HGD is found in 15.6%. Although both parameters have previously been identified as risk factors for lung cancer, the current study does not find a significative association between them. The study also highlights the importance of BW as a complementary sample to induced sputum when analyzing gene aberrant methylation.

Condylomata, cytological abnormalities and human papillomavirus infection in the anal canal in HIV-infected men.

BACKGROUND: Genital infections with low-risk (LR) and high-risk (HR) human papillomavirus (HPV) genotypes are associated with ano-genital condylomata and anal squamous cell cancer. HPV-related pathologies in HIV-infected men are a serious concern. In this study, the prevalence of anal condylomata and their association with cytological abnormalities and HPV infection in the anal canal in HIV-infected men [men who have sex with men (MSM) and heterosexuals] were estimated. METHODS: This was a cross-sectional study based on the first visits of patients in the Can Ruti HIV-positive Men (CARH·MEN) cohort. Anal condylomata were assessed by clinical and proctological examination. Samples from the anal canal were collected for HPV genotyping and cytological diagnoses. RESULTS: A total of 640 HIV-infected men (473 MSM and 167 heterosexuals) were included in the study. The overall prevalence of anal condylomata was 25% [157 of 640; 95% confidence interval (CI) 21-28%]; in MSM it was 28% and in heterosexuals it was 15% [odds ratio (OR) 2.2; 95% CI 1.4-3.5]. In patients with anal condylomata, HPV infection in the anal canal was more prevalent (92% vs. 67% in those without anal condylomata; OR 8.5; 95% CI 3.2-22). This higher HPV prevalence involved at least two HPV genotypes (OR 4.0; 95% CI 2.2-7.1), mainly HR genotypes (OR 3.3; 95% CI 1.7-6.4). Similarly, the cumulative prevalence of HPV-6 and HPV-11 was higher in patients with anal condylomata (63% vs. 19% in those without anal condylomata). Having anal condylomata was associated with higher prevalences of cytological abnormalities (83% vs. 32% in those without anal condylomata; OR 6.9; 95% CI 3.8-12.7) and high-grade squamous intraepithelial lesions (HSILs) (9% vs. 3% in those without anal condylomata; OR 9.0; 95% CI 2.9-28.4) in the anal canal. CONCLUSIONS: HIV-infected men with anal condylomata were at risk of presenting HSILs and harbouring multiple HR HPV infections in the anal canal. Although MSM presented the highest prevalence of anal condylomata, heterosexual men also had a clinically important prevalence. Our findings emphasize the importance of screening and follow-up for condylomata in the anal canal in HIV-infected men.

Representativeness of nodal sampling with endobronchial ultrasonography in non-small-cell lung cancer staging.

The objective of our study was to determine the procedure-related requirements of mediastinal node sampling with endobronchial ultrasonography with real-time transbronchial needle aspiration (EBUS-TBNA) that would provide negative predictive value (NPV) for the identification of stage III disease in non-small-cell lung cancer (NSCLC) high enough to consider the technique equivalent to cervical mediastinoscopy. Representative EBUS-TBNA was defined as a sampling procedure obtaining satisfactory samples from normal nodes in regions 4R, 4L and 7 or diagnosing malignancy in mediastinal nodes. NPV was estimated using the results of postsurgical staging in patients who underwent surgery as a reference. Two-hundred ninety-six patients staged with EBUS-TBNA were included. Representative samples from regions 4R, 4L and 7 showing nonmalignant cytology were obtained from 98 patients (33.1%) and EBUS-TBNA detected N2/N3 disease in 150 (50.7%). Accordingly, an EBUS-TBNA procedure accomplishing the representativeness criteria required for sampling was attained in 248 of the participating patients (83.8%). The NPV of the procedure in this setting was 93.6%, with false-negative results only found in 5 patients, four of them with nodal metastasis out of the reach of EBUS-TBNA (regions 5, 8 and 9). In conclusion, representative sampling of regions 4R, 4L and 7 is achieved in more than 80% of patients staged using EBUS-TBNA, and in the procedures that attain this requirement a NPV >90% for mediastinal malignancy is reached, a figure equivalent to cervical mediastinoscopy.

Human papillomavirus HPV-16, 18, 52 and 58 integration in cervical cells of HIV-1-infected women.

BACKGROUND: Genomic integration of high-risk human papillomavirus into the cellular genome is considered an important event in the pathogenesis of cervical cancer related to the progression from premalignant cervical lesions to invasive cervical carcinoma. OBJECTIVE: This cross-sectional study was aimed to characterize the viral integration of HPV-16, HPV-18, HPV-52 and HPV-58 in cervical cells. STUDY DESIGN: HPV genotypes were determined by PCR and HPV integration by multiplex PCR in HIV-1-infected women without a background of HPV-related pathology. RESULTS: This study included 251 cervical cells samples of consecutive HIV-positive women who were visited between 1999 and 2003. The overall prevalence of HPV infection was 53% (133/251, 95%CI: 47-59%). The most prevalent genotypes were HPV-16 (27%), HPV-33 (15%), HPV-52 (8%) and HPV-58 (8%). The prevalence of abnormal cervical cytology was 33% (83/251, 95%CI: 27-39%). The overall prevalence of HPV integration was 11% (27/251, 95%CI: 7-15%), and the prevalence of HPV-16 integration was 33% (22/67, 95%CI: 22-45%), HPV-18 integration was 30% (3/10, 95%CI: 7-65%) and HPV-52 integration was 10% (2/19, 95%CI: 1-32%). No HPV-58 integration was detected. The percentage of HPV-16 and HPV-18 integration increased with the severity of the cervical lesions, HPV-16 integration was almost 70% and HPV-18 integration was 50% in high-grade squamous intraepithelial lesions. Integration was the most important risk factor associated with cervical dysplasia (OR=30.6, 95%CI: 3.5-270.6). CONCLUSION: HPV integration might represent a good biomarker of the evolution from HPV infection to cervical cancer. Further prospective studies are required to validate our findings.

Endobronchial ultrasound-guided transbronchial needle aspiration for identifying EGFR mutations.

The presence of somatic mutations of the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) gene in patients with advanced nonsmall cell lung cancer (NSCLC) correlates with a good response to tyrosine kinase inhibitors. The usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the detection of EGFR mutations in cells recovered from malignant mediastinal nodes in patients with NSCLC was assessed. All patients with lung adenocarcinoma or unspecified NSCLC referred for staging with EBUS-TBNA were included. Nodes with a short-axis diameter of >5 mm were sampled, and genomic DNA from metastatic tumour cells was obtained for analysis of exons 19 and 21. The impact of sampling on management was assessed. EGFR gene analysis of the EBUS-TBNA sample was feasible in 26 (72.2%) out of the 36 patients with lymph node metastasis. Somatic mutations of the EGFR gene were detected in tissue obtained through EBUS-TBNA in two (10%) out of 20 patients with metastasic lung adenocarcinoma. Malignant tissue samples obtained by EBUS-TBNA from patients with nodal metastasis of NSCLC are suitable for the detection of EGFR mutations in most cases, and this technique demonstrates mutated neoplastic cells in a tenth of patients with adenocarcinoma.

Ablación del cáncer de mama mediante técnica de radiofrecuencia. Experiencia inicial / No disponible

Objetivo: Valorar la efectividad de la ablación por radiofrecuencia(ARF) en el tratamiento local del cáncer de mama enestadios iniciales.Pacientes y métodos: La ARF guiada por imagen ecográficase practicó en 4 pacientes (de los 30 inicialmente previstoscomo objeto de reclutamiento) en quirófano bajo anestesia general.La resección del lecho tumoral se llevó a cabo 2-3 semanasdespués. La valoración pre- y post-ARF se efectuó medianteimagen ecográfica, mamográfica y resonanciamagnética (RM).Resultados: El análisis anatomo-patológico determinó presenciade tejido tumoral en todos los casos, mientras que laRM informó tejido viable en 1 de los 3 casos en que se efectuó.Estos resultados no permitieron continuar el reclutamientode pacientes.Discusión: La radiofrecuencia es la técnica actualmentemás atractiva para la realización de la ablación no quirúrgicaen el tratamiento primario del cáncer de mama. El presentetrabajo pretende aportar una visión real, basada tanto en laexperiencia propia como en la literatura publicada. Con estaspremisas discutimos nuestros resultados, desalentadores aunquepreliminares, así como la bondad de la técnica en cuantoa eficacia de ablación tumoral y la posibilidad futura de sustituirla exéresis quirúrgica de la tumoración, principal motivaciónde los estudios actuales(AU)

Objective: To evaluate the efficacy of radiofrequency ablation(RFA) therapy for breast cancer.Patients and methods: Only four of the 30 initially scheduledpatients underwent ultrasound-guided RFA under generalanesthesia. Lumpectomy was performed 2-3 weeks after theRFA procedure.Results: Post-RFA MRI scans revealed lesion enhancementin 1 of 3 patients, however residual tumor was confirmedhistopathologically in all four patients. Because of such discouragingresults we decided to stop patient enrollment.Discussion: Nowadays, RFA is the most promising ablationtechnique for primary breast cancer treatment. Based on publishedstudies and on our own experience, an overview ofbreast cancer RFA is presented. We discuss both technicalRFA issues and pros compared with standard surgical treatment(AU)

[Frequency and risk of bronchopulmonary neoplasia related to asbestos]. / Frecuencia y riesgo de neoplasia broncopulmonar relacionada con asbesto.

BACKGROUND: The goal of this study was to determine the prevalence of asbestos-related lung cancer and the importance of the occupational exposure to this inorganic fibre as a risk factor. PATIENTS AND METHODS: We performed a cross-sectional study of 82 patients with lung cancer (mean age 62 SD 9 years) and 53 patients without pleuropulmonary disease (63 SD 13 years). The occupational exposure to asbestos was determined by a questionnaire. We determined the concentration of asbestos bodies (AB) in bronchoalveolar lavage (BAL) (93 patients) or lung tissue (42 patients) after chemical digestion, with the results being expressed as AB/mL BAL or AB/g dry lung, respectively. A concentration higher than 1 AB/mL or 1,000 AB/g was considered as marker of high asbestos burden in lung tissue, which could be potentially responsible for pleuropulmonary disease. The importance of asbestos occupational exposure as a risk factor for lung cancer was determined using logistic regression models. RESULTS: 25 patients with lung cancer reported occupational exposure to asbestos (30%) and in 13 out of them AB were detected in BAL or lung tissue (24%), at high concentrations in 3 cases (4%). Six patients from the group without pleuropulmonary disease reported occupational exposure to asbestos (11%) and in 13 out of them AB were found in some samples (24%), with no case having high concentrations. In the univariate logistic regression analysis, diagnosis of bronchial neoplasia was associated with both smoking (OR 10.10, 95% CI 3.50-29.13) and occupational exposure to asbestos (OR 3.69, 95% CI 1.39-9.77). The association between asbestos exposure and lung cancer persisted statistically significant after adjustment for smoking (OR 2.80, 95% CI 1.00-7.84). CONCLUSION: In Spain, lung cancer was related to occupational exposure to asbestos in 4% of cases, and it appeared to exist a synergistic effect of smoking. Occupational exposure to this inorganic fibre doubles the risk of suffering from lung cancer.

Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity.

BACKGROUND: Sentinel node biopsy (SNB) has been proposed as an alternative to axillary lymph-node dissection (ALND) in breast cancer. Before implementing SNB in our practice, we wished to test its validity by comparing it to the standard ALND, both in our hands and with other reported series. PATIENTS AND METHODS: One hundred thirty-two patients were included prospectively. SNB and immediate ALND were performed. For SNB, a technetium-colloid was used to produce preoperative lymphoscintigraphy and intraoperative gamma-probe search for the SN. Serial sectioning and immunostains were used on the SN. A comprehensive review of the literature was done in order to run a meta-analysis of diagnostic tests using a summary receiver operating characteristic curve (SROC) to calculate the pooled parameters of sensitivity and associated 95% confidence interval (95% CI), including our own data. RESULTS: Our technical success rate was 96%. Local sensitivity was 96%, with a 95% CI from 85%-99%. Seven patients were upstaged by the SNB. A literature search identified 18 studies published from 1996-1999. Estimates of sensitivity ranged from 83%-100%. The pooled data meta-analysis gave a global sensitivity of 91%, with a 95% CI from 89%-93%. The area under the global SROC curve was 0.9967. CONCLUSIONS: The minimally invasive SNB was shown to be a practical alternative to ALND. We propose to use local as well as global sensitivity and associated 95% CI to test the validity of SNB in the clinical setting. Due to limitations of ALND as the golden standard, SNB can in fact be considered a more accurate method for nodal staging.

Resultados de la biopsia del ganglio centinela en 100 pacientes con cáncer de mama / Results of sentinel node biopsy in 100 patients with breast cancer

Comunicamos los resultados obtenidos con la biopsia del ganglio linfático (BGC) en 100 pacientes consecutivas con cáncer de mama en las que además se realizó vaciado axilar. Se utilizaron exclusivamente trazadores isotópicos y sonda gamma para la linfogammagrafía y el rastreo intraoperatorio. El análisis histopatológico incluyó cortes seriados e inmunohistoquímica para citoqueratinas en los GC. Los resultados mostraron una eficacia técnica del 97 por ciento. El número de GC por paciente fue de 2,0 ñ 1,2. En el 23 por ciento de las pacientes se encontraron GC fuera de la localización habitual (mamaria interna, intramamarios, etc.). En total, 37 pacientes mostraron metástasis ganglionares. La sensibilidad de la BGC fue del 94,6 por ciento, el valor predictivo del 96,8 por ciento y la tasa de falsos negativos del 5,4 por ciento. Se reestadiaron al alza seis pacientes (9,1 por ciento de las consideradas N0 por el vaciado axilar). Nuestros resultados confirman el valor de la BGC, que en el futuro tenderá a sustituir a la linfadenectomía axilar convencional. (AU)

[Identifying asbestos bodies in bronchoalveolar lavage fluid]. / Identificación de cuerpos de asbesto en el lavado broncoalveolar.

UNLABELLED: Asbestos bodies (AB) in respiratory secretions in bronchoalveolar lavage (BAL) identify subjects with lower airway AB content is a potential cause of pleural or pulmonary disease. The precision of this qualitative measure, however, has not been adequately analyzed. OBJECTIVE: To determine the sensitivity and specificity of finding AB in BAL fluid by conventional qualitative cytology in comparison with the quantification of AB in BAL fluid. METHOD: BAL samples from 40 subjects exposed to asbestos (mean age 59.2 years; men/women 36/4) were processed in the following ways: 1) qualitative cytology and 2) quantification of AB in BAL fluid expressed as AB/ml. The concentration of AB in BAL fluid was considered the gold standard (upper limit of normal 1 AB/ml) for determining the precision of qualitative cytology. RESULTS: In 9 of the 40 cases (22.5%) AB was found in BAL liquid cytology, but in only five of them were AB counts greater than 1 AB/ml. AB counts also showed concentrations greater than 1 AB/ml for four patients whose qualitative results were negative. The sensitivity of a qualitative AB-positive finding for identifying subjects with potentially disease-causing AB concentrations was 0.55, while specificity was 0.87. We conclude that a qualitative finding of AB in BAL fluid is adequately specific, but that sensitivity is very low, an indication that AB concentration in BAL should be determined to adequately screen for patients at high risk of developing disease.

Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer.

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.

Electron microscopic microanalysis of bronchoalveolar lavage: a way to identify exposure to silica and silicate dust.

OBJECTIVES: The diagnostic implications of finding non-fibrous inorganic particles in bronchoalveolar lavage (BAL) fluid has not been fully assessed. The aim of this study has been to measure the silica and non-fibrous silicates in BAL fluid from populations with different exposures to inorganic dust, and to find whether such measurement is useful for diagnostic purposes. MATERIALS AND METHODS: BAL samples from 19 subjects with only environmental exposure to inorganic dust (group A, mean (SD) age 50.7 (15.2)), 23 subjects with normal chest x ray films exposed to silica or silicates at work (group B, mean (SD) age 52.0 (12.4)), and 15 subjects with a previous diagnosis of silicosis (group C, mean (SD) age 68.0 (6.5)) were studied. Absolute and relative cell counts were found, and the samples were prepared for microanalysis by electron microscopy (EM). Firstly, semiquantitative x ray microanalysis was performed to find the level of silicon (Si) (peak/background Si) and this was followed by microanalysis of individual particles by EM. Variables related to the level of Si detected were assessed with multivariate analysis. RESULTS: Detected levels were higher in group B (2.09, 95% confidence interval (95% CI) 1.56 to 2.82) and C (1.50, 95% CI 1.07 to 2.12) than in group A (0.87, 95% CI 0.66 to 1.16) (P < 0.05, Dunett t test). A first multivariate analysis showed that exposure to silica or silicates was the only determinant of the level of Si expressed as log peak/background Si, when adjusted for age, sex, smoking habit, and cell count. A second multivariate analysis with microanalysis of individual particles as an independent variable showed the silica count to be the main predictor of detected concentration of Si. Silica and non-aluminium silicates together explain 55.5% (R2) of the variation in detected levels of Si. CONCLUSIONS: Detected levels of Si in BAL fluid depend on silica count and are higher in subjects with exposure to inorganic dust at work, but will not discriminate between exposed subjects with and without silicosis. Because semiquantitative x ray microanalysis does not accurately define exposure to non-silica inorganic particles, this measurement must be followed by EM microanalysis of individual particles in most cases, especially when exposure to silicates or metal dust is suspected.

p53 immunoreaction in hepatocellular carcinoma and its relationship to etiologic factors. A fine needle aspiration study.

OBJECTIVE: To determine immunohistochemically the expression of mutant p53 phosphoprotein in hepatocellular carcinoma (HCC) and its possible relationship to several etiologic factors. STUDY DESIGN: The study group consisted of 62 samples of HCC, grades 2, 3 and 4, obtained by fine needle aspiration cytology. The associated risk factors detected in these patients were as follows: ethanol abuse, ethanol abuse plus hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, HBV infection, HCV infection, non-A/ non-B hepatitis, hemochromatosis and obesity. RESULTS: Mutant p53 expression was identified in 22% of HCC and seemed to correlate with tumor grade. Positive immunostaining was frequently associated with a history of alcohol abuse (42%) and also with viral infection (HBV, 21%; HCV, 7%; non-A/non-B hepatitis, 7%). CONCLUSION: Mutant p53 seems to intervene in the progress of HCC through various grades of increasing malignancy. The association we found between alcohol intake and mutant p53 expression may deserve further investigation.

Fine-needle aspiration biopsy of metaplastic carcinoma of the breast: report of a case with abundant myxoid ground substance.

Metaplastic carcinoma (MC) is an uncommon neoplasm of the breast. There are several variants of MC depending on the dominant histologic pattern. The components include over infiltrating ductal carcinoma, extensive squamous differentiation and spindle cell proliferation with or without chondroid or asseous heterologous elements. In FNA smears, only 57% of cases show both ductal carcinoma and metaplastic component. Thus, in almost one half of the cases, the diagnosis is not possible by FNA. Often it is difficult to define the epithelial or sarcomatous character of malignant cells. We describe a case of metaplastic carcinoma of the breast studied by fine-needle aspiration cytology in which myxoid ground substance was the dominant feature in the cytology smears. The rest of the material was composed of scanty isolated atypical cells with large and irregular nuclei. It is important to bear in mind the diagnosis of MC and make a careful search for atypical cells when the cytological smears are mainly composed of myxoid ground substance.

Fine-needle aspiration cytology of benign nodular thyroid disease. Value of re-aspiration.

Fine-needle aspiration cytology (FNAC) has become a widespread procedure for the study of thyroid nodules (TN). Some authors recommend the practice of repeated punctures for their follow-up. This study was done to determine the usefulness of repeated FNAC in patients with benign nodular thyroid disease. We have studied 251 fine-needle re-aspirations performed on 116 females aged 45.6 +/- 14 years with benign nodular thyroid disease. The time elapsed between each consecutive FNAC was 1 year. No patients presented any changes in the size or consistency of their nodular goiters during this period; all FNACs were carried out by the same physician in the same thyroid area according to the Löwhagen technique, with a minimum of two or three aspirations of each nodule, and processed in the same way and valued by the same cytologist without any knowledge of previous cytological diagnoses. These were done using strictly classical criteria (Löwhagen). One hundred and five out of 116 patients (90.51%) with two consecutive FNACs (210) showed identical cytological diagnoses in the two specimens studied. The remaining 11 patients (9.48%) with two FNACs were diagnosed with colloid goiter and cyst alternately. Fifteen out of 19 patients (78.94%) with three FNACs showed identical cytological diagnoses in the three samples and the rest (21%) also demonstrated alternate diagnoses of colloid goiter and cyst. Our results show that the routine performance of repeated FNAC in the follow-up of females with benign nodular thyroid disease, without any clinical changes, is of limited usefulness.

A distinctive cytologic pattern for diagnosing tuberculous lymphadenitis in AIDS.

Tuberculous lymphadenitis (TL) is a very common infection in human immunodeficiency virus (HIV)-infected patients. We performed fine-needle aspiration biopsy (FNAB) of enlarged lymph nodes in 57 HIV-infected patients to evaluate its usefulness in this population. We observed three cytologic patterns in 21 patients diagnosed as having TL: granulomatous lymphadenitis (GL) in 4 FNABs, necrotizing granulomatous lymphadenitis (NGL) in 7 FNABs, and necrotizing lymphadenitis (NL) in 12 FNABs. GL and NGL are already well-known and considered to be highly suggestive of TL. Our results support the idea that NL should have the same diagnostic value as GL or NGL. In the group of 12 patients with NL, TL was confirmed in 11 by microbiologic methods (7 by a positive Ziehl-Neelsen stain and 4 by a positive Löwenstein culture) and in the remaining patient by a biopsy that showed NGL with acid-fast bacilli. We conclude that FNAB is a useful, inexpensive, and safe technique for diagnosing TL in HIV-infected patients. The finding of a NL pattern is suggestive enough of TL to start antituberculous treatment.