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COMPARISON OF SPECIMEN ADEQUACY IN FINE NEEDLE ASPIRATION CYTOLOGY PERFORMED WITH DIFFERENT GAUGE NEEDLES IN PALPABLE EXTERNAL SWELLINGS.

Byline: Tariq Sarfraz, Masood Fazil, Tariq Masood Malik, Saima Bashir and Humaira Tariq

Abstract

Background: Fine Needle Aspiration Cytology (FNAC) of external swellings may yield different specimen adequacy depending on different gauge needles used for aspiration.

Objective: To compare the specimen adequacy aspirated by various gauge (21 and 22) needles in external palpable swellings of lymph nodes, thyroid gland, salivary glands, breast and soft tissue.

Study Design: Comparative cross sectional study.

Duration: Six months (1st Jan 2012 to 30th June 2012).

Setting: Histopathology/Cytology department Combined Military Hospital Peshawar (Pakistan).

Methodology: This was a prospective study of 200 cases in which FNAC was performed with either 21 or 22 gauge needles (100 cases with 21 gauge and 100 with 22 gauge needles). Equal number of aspirations were done with 21 and 22 gauge needles from the swellings of thyroid gland, lymph nodes, salivary glands, breast and soft tissue. Results were analyzed for specimen adequacy by using SPSS 17.

Results: A total number of 200 cases were recruited in this study, out of which 100 were aspirated with 21 gauge needles and 100 with 22 gauge needles. Specimen adequacy in swellings of thyroid, lymph nodes and salivary glands was better with 22 gauge amounting 90%, 80% and 80% respectively, as compared to yield with 21 gauge needles which was 85%, 70% and 60% respectively. On the other hand in swellings of breast and soft tissue, the specimen adequacy was better with 21 gauge needles giving 98% and 90 % adequate yield respectively as compared to 22 gauge needles which was 70% and 40 % respectively.

Conclusion: Needles of smaller gauge (22 gauge) give a better yield in swellings of thyroid, lymph nodes and salivary gland while in swellings of breast and soft tissue sample adequacy is better with larger gauge needle (21 gauge).

Article

INTRODUCTION

Fine needle aspiration cytology (FNAC) is a simple and effective technique in investigation and evaluation of external swellings. It can also be used for internal organ swellings including thoracic, abdominal and pelvic organs, if assisted with image guidance. The external swellings in which FNAC is proved very useful and effective are lymph nodes, thyroid, salivary gland, breast and externally palpable soft tissue swellings1. The advantages of FNAC include cost effectiveness, quick reporting, bedside diagnosis, minimal physical and psychological trauma, one step procedure leaving a clean plan for surgeon to perform surgical procedures and participation of patients in management plan. The technique may also serve therapeutic role in cystic swellings by aspirating and draining them.2

FNAC is performed with different gauge needles ranging from 21 - 29 gauge. Routinely used needles are of 21, 22 and 23 gauges. Small gauge needles (22,23 gauge) cause less pain and discomfort as compared to the large gauge needles (21 gauge).3

There is a need to strike a balance between the discomfort caused to the patient and adequacy of specimen obtained for accurate diagnosis while using different gauge needles for aspiration. This study was carried out to compare the specimen adequacy with 21 and 22 gauge needles in externally palpable swellings of lymph node, thyroid, salivary gland, breast and soft tissue.

METHODOLOGY

After getting the informed consent, 200 patients with a palpable external swelling of thyroid gland, lymph nodes, salivary glands, breast or soft tissue were recruited during a period of 6 months (1st Jan 2012 to 30th June 2012), at Histopathology / Cytopathology department of Combined Military Hospital Peshawar (Pakistan). Children under 10 years of age and patients who refused to participate in the study were excluded. Patients were divided into two groups. Group 'A' comprised 100 cases in which FNAC was done with 21 gauge needles (larger gauge). Group 'B' also comprised 100 cases in which the procedure was done with 22 gauge needle (smaller gauge). Equal number of aspirations were done with 21 and 22 gauge needles from the swellings of thyroid gland, lymph nodes, salivary glands, breast and soft tissue. To eliminate the operator bias, all procedures were done by a single operator. In all cases 2 x air dried and 2 x wet fixed smears were made.

The air dried smears were stained with Haemacolour, while one wet fixed smear was stained with PAP stain and other wet fixed smear with H and E. All the smears were seen and reported by one consultant. Adequacy of specimen was checked in all externally palpable swellings of lymph nodes, thyroid, salivary gland, breast and soft tissue. The data was analyzed by using SPSS version 17.

RESULTS

A total number of 200 cases were recruited in this study, out of which 100 were aspirated with 21 gauge needle and 100 with 22 gauge needle. Overall cytological diagnosis was made in 80% cases with 21 gauge needle and in 78% cases with 22 gauge needles. Summary of cytological results of the study is given in table 1.

Table-1: Summary of fine needle aspiration cytology results from the study.

S.No###Site###Diagnosis###Number of cases

01###Thyroid (n = 80)###Adenornatous colliod nodule / Goiter

###Papillary Carcinoma###58

###Suspicious for follicular Neoplasm###04

###Thyroiditis###04

###Non diagnostic (with 21 guage needle)###06

###(with 22 guage needle)###04

02###Lymph node (n=80)###Reactive hyperplasia###16

###Chronic granulomatous inflammation###10

###Lymphoproliferative disorder###02

###Metastatic carcinoma###02

###Non diagnostic (with 21 gauge needle)###06

###(with 22 guage needle)###04

03###Breast (n=40)###Benign (C2)###16

###Malignant (C5)###10

###Suspicious for malignancy (C4)###04

###Atypia probably benign (C3)###02

###Non diagnostic (with 21 guage needle)###02

###(with 22 gurage needle)###16

04###Salivary gland

###(n = 20)###Pleomorphic adenoma###08

###Chronic sialadenitis###04

###Adenoid systic carcinoma###02

###Non diagnostic (with 21 guage needle)###04

###(with 22 guage needle)###02

05###Sof tissue

###swellings (n=20)###Lipoma###08

###Neurofibroma###02

###Haematoma###02

###Non diagnostic (with 21 guage needle)###02

###(with 22 guage needle)###06

Total###(n = 200)

Adequacy of the sample obtained with 21 and 22 gauge needles was different at different sites. Specimen adequacy in swellings of thyroid with 21 gauge needles was 85%, while with 22 gauge needle it was 90%. In lymph node swellings (most of the lymph nodes were cervical lymph nodes), the specimen adequacy with 21 gauge needle was 70% and with 22 gauge needle 80%, respectively. In salivary gland swellings adequate specimen was obtained in 60% cases with 21 gauge needle and 80% with 22 gauge. On the other hand, in swellings of breast and soft tissue the specimen adequacy was better with 21 gauge needle giving 98% and 90 % adequate yield respectively as compared to 22 gauge where adequate yield from breast and soft tissue was 70% and 40 % respectively (Table 2).

Table-2: Comparison of specimen adequacy with 21 and 22 guage needles.

S.No###Site###21 Gauge Needle (Group A)###22 Guage Needle (Group B)

###Adequate###Inadequate###Adequate###Inadequate

01###Thyroid###34 (85 %)###06 (15 %)###36 (90 %)###04 (10 %)

02###Lymph nodes###14 (70 %)###06 (30 %)###06 (80 %)###04 (20 %)

03###Salivary Gland###06 (60 %)###04 (40 %)###08 (80 %)###02 (02 %)

04###Breast###18 (90 %)###02 (10 %)###14 (70 %)###06 (30 %)

05###Soft tissue###08 (80 %)###02 (20 %)###04 (40 %)###06 (60 %)

###Total (n=200)###(n = 100)###(n = 100)

DISCUSSION

Fine Needle Aspiration Cytology has become a very popular and effective technique in diagnosis of external as well as internal organ swellings. The technique has become further effective with advent of ancillary studies made possible on aspirated material.4 There has always been an effort to maintain a quality control and strike a balance between the fineness of the needle used for aspiration causing least discomfort to the patient and adequacy of sample obtained.5 Different studies give different results with different gauge needles and a consensus needs to be achieved.6

In the present study, it was observed that adequacy of material aspirated with 21 and 22 gauge needles was different in swellings of thyroid gland, lymph nodes, salivary glands, breast and soft tissue.

The adequacy of material in swellings of head and neck regions including thyroid, cervical lymph nodes and salivary gland tissue was better with small gauge (22 gauge) needles as compared to large gauge (21 gauge) needles. These results are similar to the results shown by Jandu and Webster, indicating that smaller gauge needles are better for aspiration of head and neck swellings.7 Another study carried out by Anwar and Ambreen also indicated that small gauge needles are better for doing aspirations of head and neck and provide a better sample adequacy8. In their study they used even smaller gauge (23, 24 and 29 gauge) needles and recommended them for better yield in head and neck swellings, however our experience with very small gauge needles is not very satisfactory and we are using 22 gauge needles routinely for head a neck swellings.

A better yield in head and neck swellings with relatively small gauge needles may be due to delicate and vascular nature of swellings of head and neck like thyroid, salivary glands and cervical lymph nodes, which may reveal haemorrhagic aspirate with larger gauge needles making the aspirate non diagnostic9.

On the other hand our study indicated that aspiration of breast lumps and soft tissue swellings revealed more adequate specimen with larger gauge (21 gauge) needles as compared to the smaller gauge (22 gauge) needles. This result is different from that shown in study done by Malinae and David and Choukimth both of which revealed that even in breast and soft tissue swellings adequacy was better with small gauge needle (22, 23 gauges).10,11 However another study carried out by Yu showed that the specimen adequacy in breast swellings is better with larger gauge needles12. One possible explanation of inadequate yield in breast lumps and soft tissue swellings may be hard nature of these swellings due to more fibrous tissue or desmoplastic reaction making the small gauge needle difficult to cut through the tissue and get the adequate samples from this swellings.13

CONCLUSION

It is concluded from this study that needles of smaller gauge (22 gauge) give a better yield in swellings of thyroid, lymph nodes and salivary gland while in swellings of breast and soft tissue sample adequacy is better with larger gauge needle (21 gauge). In view of the results of present study, it can be recommended that for swellings of thyroid gland, lymph nodes and salivary glands it is preferable to use 22 gauge needles for better specimen adequacy. On the other hand, for swellings of breast and soft tissue, 21 gauge needles may be more effective and may yield a more adequate sample. Moreover, there is a need to compare 21 and 22 gauge needles with further smaller gauge needles regarding specimen adequacy, patient comfort and for health care quality improvement.

Reference

1. Frable WJ. Needle aspiration biopsy: past, present and future. Human Pathol. 1989; 20: 504-17.

2. Amedee RG, Dhurandhar NR. Fine-needle aspiration biopsy. Laryngoscope 2001; 111:1551-7.

3. Aslam, M. Comparison of the use of 21G needle with 23G needle for fine needle aspiration of palpable breast masses The Antiseptic. 2002; 99 (5): 171-2

4. Smith OD, Ellis PDM, Bearcroft PWP, Berman LH, Grant JW, Jani P. Management of neck lumps - a triage model. Ann R Coll Surg Engl 2000; 82: 223-6.

5. Thomas JO, Amanguno AU, Adeyi OA, Adesina AO. Fine needle aspiration in the management of palpable masses in Ibadan, impact on the cast of care. Cytopathology 1999; 10:206-10.

6. Peter A. Brennan, Neil Mackenzie, Rachel S. Oeppen, Kulamarva, Gareth J. Thomas, Anne V. Spedding. Prospective randomized clinical trial of the effect of needle size on pain, sample adequacy and accuracy in head and neck fine-needle aspiration cytology. Wiley Int Sci. 2007; 29(10): 919-22.

7. Jandu M, Webster K. The role of operator experience in fine needle aspiration cytology of head and neck masses. Int J Oral Maxillofac Surg 1999; 28:441-4.

8. Haq AU, Motassim A. A Comparative Study of Various Needle Gauges in Diagnostic Fine Needle Aspiration Cytology. Int J Pathology; 2005; 3(1): 2-5.

9. Daltrey IR, Kissin MW. Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology. Br J Surg. 2000;87(6): 777-9.

10. Harigopal M, Chhieng DC. Breast Cytology: current Issues and Future Directions. Open Breast Cancer J. 2010; 2 (1): 81-89.

11. Sharanabasav CM, Rangappa PK. Fine needle aspiration cytology of soft tissue tumors with special emphasis on grading of spindle cell sarcomas. Int J appl Biol Pharmacol Technol. 2012; 3 (2): 247-60.

12. Yu YH, Wei W, Jiu JL. Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis. BMC Cancer 2012; 12 (41): 3-14.

13. Cobb CJ, Raza AS. Obituary: Alas poor FNA of breast-we knew thee well!. Diagn Cytopathol 2005; 32(1): 1-4.

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Publication:Pakistan Armed Forces Medical Journal
Article Type:Clinical report
Geographic Code:9PAKI
Date:Mar 31, 2013
Words:2137
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