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Giant cell tumour showing mononuclear single cells and large multinucleated osteoclast type giant cells attached to the periphery of clusters of spindle cells.
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Due to difficulty in confirming clinical suspicions of malignancy in patients presenting with bone tumours, the cost of surgical biopsies where hospital charges are borne almost entirely by patients, competition with bone setters and healing homes with high rate of loss to follow up; we set out to find if sufficient material could be obtained to ar...
Citations
... In the present study, localized bone lesions were distributed among 54 males and 38 females, that is, they were more common in males as compared to females with male to female ratio of 1.4:1. In the study by Nnodu et al. [12], there were 57 males and 39 females with male to female ratio of 1.5:1. The male preponderance has been observed by other workers also such as Boomer et al. [13] (1.25:1). ...
Objectives: FNAC plays a pivotal role in any lesion for the ease of diagnosing and treatment of an ailment. The role of FNAC in bone lesions has not been studied in great vastness but it can definitely ease the time taken for diagnosing on histopathology. The aim of the study was to study the sensitivity, specificity, positive predictive value, and negative predictive value of FNAC in bone lesions, comparison of cytological findings to histopathological findings and to identify the accuracy of FNAC in bone lesions. Methods: The study was retrospective and observational study. All the FNAC samples were studied and correlated with the histopathology findings where available. Results: A total of 92 cases were studied. The accuracy of the study stands at 81.3% along with the sensitivity of 87.5% and specificity of 75% with a positive predictive value of 77.8%. Non-neoplastic lesions were 18, followed by primary benign bone tumors 29, Primary malignant bone tumors 28, secondary tumors of bone 6, and unsatisfactory smears 11 cases were identified. Conclusion: FNAC plays a very crucial role in diagnosing and early intervention and treating any ailment. Bone FNAC also is beneficial for identifying the treatment modality. It should be used on regular basis for bone lesions.
... 14,15,16 Cytologically, lesions are classified into benign, malignant and non-neoplastic, including infective and metabolic bone lesions. 2 Previous studies that have examined pre-biopsy imaging demonstrated a poor positive predictive value for malignancy (50% -75%). 17,18,19,20,21,22,23 On the contrary, other studies have shown higher sensitivities and specificities when including MRI and computer-aided detection. 24,25,26,27 Given the paucity of literature on this topic locally, this study was implemented to test a radiologist's interpretation of plain radiographs against a histopathological diagnosis. ...
... Nine percent of biopsies in this series had an inconclusive histology. 22 The higher incidence of infective lesions and relatively higher rate of osteogenic sarcoma compared with our study are explained by the fact that the mean age of their sample was 32 years and included a higher proportion of children. Our study did not include patients younger than 13 years as they are treated at an affiliated dedicated paediatric institution. ...
Background: The diagnosis of primary bone tumours is a three-fold approach based on a combination of clinical, radiological and histopathological findings. Radiographs form an integral part in the initial diagnosis, staging and treatment planning for the management of aggressive/malignant bone lesions. Few studies have been performed where the radiologist’s interpretation of radiographs is compared with the histopathological diagnosis.
Objectives: The study aimed to determine the frequency of bone tumours at a tertiary hospital in South Africa, and, using a systematic approach, to determine the sensitivity and specificity of radiograph interpretation in the diagnosis of aggressive bone lesions, correlating with histopathology. We also determined the inter-observer agreement in radiograph interpretation, calculated the positive and negative predictive values for aggressive/malignant bone tumours and computed the cumulative effect of multiple radiological signs to determine the yield for malignant bone tumours.
Method: A retrospective, descriptive and correlational study was performed, reviewing the histopathological reports of all biopsies performed on suspected aggressive bone lesions during a 3-year period from 2012 to 2014. The radiographs were interpreted by three radiologists using predetermined criteria. The sensitivity and specificity of the readers’ interpretation of the radiograph as ‘benign/non-aggressive’ or ‘aggressive/malignant’ were calculated against the histology, and the inter-rater agreement of the readers was computed using the Fleiss kappa values.
Results: Of the 88 suspected ‘aggressive or malignant’ bone tumours that fulfilled the inclusion criteria, 43 were infective or malignant and 45 were benign lesions at histology. Reader sensitivity in the diagnosis of malignancy/infective bone lesions ranged from 93% to 98% with a specificity of 53% – 73%. The average kappa value of 0.43 showed moderate agreement between radiological interpretation and final histology results. The four radiological signs with the highest positive predictive values were an ill-defined border, wide zone of transition, cortical destruction and malignant periosteal reaction. The presence of all four signs on radiography had a 100% yield for a malignant bone tumour or infective lesion.
Conclusion: The use of a systemic approach in the interpretation of bone lesions on radiographs yields high sensitivity but low specificity for malignancy and infection. The presence of benign bone lesions with an aggressive radiographic appearance necessitates continuation of the triple approach for the diagnosis of primary bone tumours.
... Accuracy of FNAC to diagnose true benign and malignant neoplastic lesion was found to be 84%. sensitivity and positive predictive value found to be 80% and 86.9% respectively which are (10) more than the study done by Ramana S.V et al , but lesser (9) than other studies like Obiageli E Nnodu O E et al and Jain (11) Vet al . (6) One more study done by Kujur P et al they found that male: female ratio was 1.9:1. ...
... Overall diagnostic accuracy was reported sensitivity, specificity, positive predictive value and diagnostic accuracy as 96.66%, 95.23%, 97.75% and 96.92% in this study. (9) The study done by Obiageli E Nnodu O E et al they found that adequacy of sample was 93.75%. Also having male preponderance, mostly involving lower limb. ...
INTRODUCTION :. Nowadays; fine needle aspiration cytology (FNAC) is gaining increasing popularity in the diagnosis of bony lesions (1).In the majority of patients,the combined evaluation of clinical and radiologic data together with the FNAC result has been sufficient for making treatment decisions. Only in a minority of patients, it has been necessary to perform biopsy before definitive treatment (2, 3). Many specific bone tumors either benign or malignant can be diagnosed correctly by FNAC alone (4). AIM : To determine the correlation between different FNAC and Radiological Imaging of Bony lesion. MATERIAL AND METHODS: We have selected fifty cases that suspected to be bony lesion either clinically or radiologically.Prior doing FNAC,radiologic imaging done on these patients.Then FNAC was done in the Cytopathology section of department of Pathology,RIMS,Ranchi. RESULTS: Out of 50 cases cytological diagnosis made possible in 47 cases.Maximum no of cases 20 (40%) were in the age group 11-20 years. Male: female ratio of 1.6:1. Most common bone involved was tibia followed by femur. Osteoclastoma (46%) was the most common benign bony whereas Osteosarcoma (43%) was most malignant bone tumor followed by Ewing's sarcoma (36%). Out of 50 cases radiological diagnosis was available only in 40 cases. In 40 cases,23 cases (57.50%) have similar Cytological diagnosis as that of radiological diagnosis.The sensitivity,specificity, positive predictive value and negative predictive value were 80%, 88%, 86.9% and 81.4% respectively. The accuracy was 84%.
... The overall accuracy rate of FNAC in this study was 81.08%, sensitivity was 84.6%, specificity was 79.17%, positive predictive value was 68.75% and negative predictive value was 90.47%. The parameters of evaluation correlated with several other published studies where overall accuracy rate of FNAC in bone lesions ranged 4,7,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] from 69% to 96.4%. ...
Introduction-Diagnosis of bone lesions is a multimodality approach. FNAC is simple cost effective outpatient procedure which can help in preliminary diagnosis of bone lesions. Objective-The aim of the study is to evaluate the role of FNAC in diagnosis of bone lesions and its diagnostic accuracy. Results-A prospective study of 44 cases of clinicoradiologically suspected bone lesions was done. Cytology revealed benign bone tumors in 19 patients (51.4%), malignant bone tumors in 13 patients (35.1%) and non neoplastic bone lesions 5 patients (13.5%). Among the malignant bone lesions primary bone lesions comprised 19% and metastatic bone lesions comprised 16%. The most common type of bone tumours encountered was giant cell tumours (29.73%) followed by metastatic tumours (16.22%) and osteosarcoma (10.81%). The overall accuracy rate of FNAC was 81.08%, sensitivity 84.6%, specificity 79.17%, positive predictive value 68.75% and negative predictive value 90.47%. Conclusion-FNAC along with clinical and radiological findings has a high diagnostic accuracy which can help the clinician in preoperative diagnosis.
... [19,20] Cytomorphological appearances in malignant bone tumors include pleomorphic sarcomatous cells in a conventional high-grade osteosarcoma [ Figure 3] and abundant chondroid matrix in a chondroid tumor, including a chondrosarcoma and round cells in Ewing sarcomas and non-Hodgkin's lymphomas, the latter invariably associated with several lymphoglandular bodies. [21][22][23][24] At all times, the findings need to be correlated with clinicoradiological findings. For example, in a case of multiple bone and soft tissue lesions in a pediatric patient, one should consider a possibility of a hematolyphoid neoplasm. ...
... For example, in a case of multiple bone and soft tissue lesions in a pediatric patient, one should consider a possibility of a hematolyphoid neoplasm. [23] There have been instances of identifying sarcomatous component on cytology specimens, in cases of a giant cell tumor of bone. [25] soft tIssue tuMors While evaluating smears in cases of soft tissue masses, it is necessary to have familiarity with normal structures, such as mesenchymal stroma (appears metachromatic on Romanowsky-stained smears), adipose tissue, neural tissue, and muscle fibers. ...
Fine needle aspiration cytology (FNAC) for diagnosis of musculoskeletal tumors is well discussed and debated. The current evidence restricts its application in recurrent and metastatic lesions, with core needle biopsy as the acceptable technique/gold standard for the primary diagnosis of these challenging tumors. However, there are several studies showing reasonable sensitivity and specificity in primary diagnosis of bone and soft tissue tumors, especially in differentiating benign from malignant tumors. There is an acceptable limitation in the exact subtyping of soft tissue tumors, based on cytology smear examination, in the absence of ancillary techniques. Nonetheless, cytology constitutes an optimal material for triaging cases for ancillary techniques, such as immunocytochemistry, immunohistochemistry, molecular cytogenetics, and molecular diagnosis, in the form of smears and cell block preparations. This review focuses on the strengths and limitations of cytology versus core needle biopsy in the diagnosis of bone and soft tissue tumors, with the current evidence in the form of published studies, including the authors' experience.
... Nnodu et al reported 95% sensitivity 94% specificity. 16 Out of 54 cases, two cases were diagnosed partially correct. One was a case of lymphoma bone which on histopathalogical examination and after PAS stain turned out to be a case of Ewing's sarcoma and the other diagnosed as osteomyelitis and a possibility of tubercular osteomyelitis was suggested on fine needle aspiration cytology later it was found to be a case of chronic nonspecific osteomyelitis. ...
p class="abstract"> Background: FNAC is considered an important procedure in the diagnosis of bone tumors because of its high accuracy. In our study FNA was performed in patients to study the role of FNAC in the diagnosis of bone tumors and to evaluate its usefulness as a diagnostic modality .
Methods: Fine needle aspiration was performed on 54 patients whose age ranged between 5 – 75 years with a male to female ratio 1.84 :1 presented with various bone lesions. The bone lesions included 42 (78%) primary lesions, 5 (9.3%) metastatic deposits and 7 (12. 7%) malignancy of related structures involving the bone.
Results: 47 biopsy specimens were available for cytohistological correlation and cytological findings of 45 cases correlated with histopathology. The overall diagnostic accuracy was 95.92%, with 100% sensitivity and specificity. The predictive values of positive as well as negative test were 100% .
Conclusions: Thus FNA was found to be a safe and an extremely useful, rapid method in the preliminary diagnosis of bone lesions . </p
... [6] Khan et al diagnosed GCT in 11 cases out of 13 cases with reported sensitivity of 92.4% and specificity of 88.4%, while Nnodu et al reported 19 cases of GCT in their aspiration cytological study of bone tumors. [10,11] Aly AM et al diagnosed 5 cases of GCT of bone with histological confirmation in 4 cases. [12] Jain M et al diagnosed 4 cases of GCT at unusual sites by cytology. ...
... Sherwani et al also reported 3 cases of Fibrous dysplasia, while Nnodu et al reported 2 cases of Fibrous dysplasia on cytology with histopathological confirmation in one case. [7,11] X-ray finding of expansile lytic lesion in the diaphysis of long bone with pathological fracture and cytological finding of scattered osteoclastic giant cells, small clusters of osteoblasts along with clusters of spindle cells, few inflammatory cells and bony matrix leads to diagnosis of fibrous dysplasia in our study, which later on confirmed by histopathology. 3 cases of chondromyxoid fibroma was diagnosed with mean age group of 14.3 years and M:F ratio of 1:2. ...
Introduction: Correct diagnosis is a matter of supreme importance because the treatment varies in different types of musculoskeletal tumors and in conditions simulating these tumors. Because of limited presence of literature for cytological diagnosis of giant cell lesions of the bone, we conducted this study to assess the reliability of Fine needle aspiration cytology in diagnosis of giant cell lesion of the bone and correlating our findings with final histopathological diagnosis.
Method: The superficial and deeply located bone lesions were localized with the help of radiographs. For aspiration of superficial lesions 22-23 gauge needles was used along with 10 ml disposable syringe, while for deeply located lesion 20 gauge needles was used. The cytological smears were then stained by May Grunwald Giemsa and Hematoxylin and eosin stain.
Result: During the period of one and half years, cytological diagnosis of giant cell lesions was made in 27 cases on FNAC. The mean age of the patient was 21.7 years with male to female ratio of 1.25:1. Maximum number of cases (18/27 cases) was encountered in 11-30 year age group. Tibia was the most common bone involved (12 cases) followed by femur and humerus (5 cases each). On final histopathological evaluation various giant cell lesions consist of 16 cases of Giant cell tumor, 5 cases of aneurysmal bone cyst and 3 cases each of Fibrous dysplasia and Chondromyxoid fibroma.
Conclusion: Despite limited literature we wish to recommend fine needle aspiration cytology as initial tool for differentiation of various giant cell lesions especially in conjunction with clinical and radiological findings.
... Open biopsy is considered the procedure of choice for diagnostic tissue sampling in musculoskeletal (MSK) tumors; however it requires hospitalization and sometimes surrounding tissue contamination, infection, hemorrhage or pathological fracture may occur (1). Percutaneous needle biopsy is also a major tool in the diagnosis of MSK lesions (2) but it also carries the risk of bleeding, infection, pneumothorax, spinal cord compression and neurologic injury. ...
... In many studies as those done by Nnodu et al., Layfield and Eyre et al., (1,15,18) and in our study, osteosarcoma was the commonest primary malignant tumor. The clinical presentation, the characteristic radiologic picture and the characteristic cytological features previously mentioned ( Fig. 1A and B), were mandatory and enough for reaching the diagnosis. ...
... The differential diagnosis between osteomyelitis and neoplasm may be difficult clinically and radiologically, therefore the results of bacterial culture and cytologic presence of inflammatory cells help to establish the diagnosis of osteomyelitis (1). ...
Aim
To evaluate the accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance.
Patients and methods
85 cases of FNAC of bone lesions were included. Sixty two procedures were performed by the radiologist and 23 procedures by the histopathologists. The aspirates were immediately fixed in 95% ethanol alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. Diagnosis was established in 81 cases (95.3%), classified into 3 categories: (1) positive for malignant cells (57.6%); (2) suspicious for malignant cells (10.6%); and (3) benign, borderline or inflammatory lesions (27.1%). Cytology findings were compared with subsequent available histology.
Results
The overall accuracy was 91%. The 49 cases diagnosed as malignant by cytology were all correct. FNAC could differentiate various giant cell rich lesions and round cell malignancies as Ewing’s sarcoma, myeloma and NHL. Uncommon bone lesions as chordoma and MFH were also correctly diagnosed. Cytological diagnosis of benign and borderline lesions was made in 23 patients. The authors encountered difficulties diagnosing a case of MFH that was reported as osteosarcoma and a case of metastasis that was reported as chondrosarcoma.
Conclusion
FNAC of bone lesions is a simple, safe and accurate diagnostic technique for diagnosis of bone lesions especially when other diagnostic modalities are unavailable.
... FNAC was found to have a high sensitivity (93.33%) and specificity (92.86%) as a diagnostic procedure for malignant bone tumors in the present study. In the study by Nnodu et al. 2006, sensitivity and specificity of diagnosing malignancy by FNAC were 95% and 94% respectively. The fact that only one false positive diagnosis of malignancy was rendered is also encouraging. ...
Background:
Though open surgical biopsy is the procedure of choice for the diagnosis of bone tumors, many disadvantages are associated with this approach. The present study was undertaken to evaluate the role of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of bony tumors and tumor-like lesions which may be conducted in centers where facilities for surgical biopsies are inadequate.
Methods:
The study population consisted of 51 cases presenting with a skeletal mass. After clinical evaluation, radiological correlation was done to assess the nature and extent of each lesion. Fine needle aspiration was performed aseptically and smears were prepared. Patients subsequently underwent open surgical biopsy and tissue samples were obtained for histopathological examination. Standard statistical methods were applied for analysis of data.
Results:
Adequate material was not obtained even after repeated aspiration in seven cases, six of which were benign. Among the remaining 44 cases, diagnosis of malignancy was correctly provided in 28 (93.3%) out of 30 cases and categorical diagnosis in 20 (66.67%). Interpretation of cytology was more difficult in cases of benign and tumor-like lesions, with a categorical opinion only possible in seven (50%) cases. Statistical analysis showed FNAC with malignant tumors to have high sensitivity (93.3%), specificity (92.9%) and positive predictive value of 96.6%, whereas the negative predictive value was 86.7%.
Conclusion:
FNAC should be included in the diagnostic workup of a skeletal tumor because of its simplicity and reliability. However, a definitive pathologic diagnosis heavily depends on compatible clinical and radiologic features which can only be accomplished by teamwork. The cytological technique applied in this study could detect many bone tumors and tumor-like conditions and appears particularly suitable as a diagnostic technique for rural regions of India as other developing countries.
... The cytological exam permitted the diagnosis of a malignant mesenchymal tumor highly suggestive of osteosarcoma within a short period of time and even before the biopsy result. In addition, the imprint method permitted Clinical intraoral examination showing tissue proliferation which inverted the fundus of the buccal pouch from the region of tooth 33 to the retromolar triangle the collection of cells of excellent quality for analysis and more refined visualization of cellular aspects than in biopsy material, considering that the cells suffer modifications during the process of decalcification of the material11121314. Cytological analysis was found to be a useful complementary exam for the preoperative diagnosis of osteosarcoma, and was important to reduce the time until referral of the patient for treatment. ...
Osteosarcomas are highly malignant bone-forming neoplasms that account for about 20% of all sarcomas. In light of their aggressive behavior, early diagnosis is crucial for determining adequate treatment. Dental professionals may be the first to detect jaw osteosarcomas in their initial stages. The aim of this case report is to draw attention to the possibility of diagnosing this tumor based on clinical, radiographical and cytological characteristics before confirmation by histology.
A 24-year-old Afro-Brazilian man presented with swelling and pain on the left side of the mandible in the region of the third molar (tooth 38). Radiography showed a poorly delimited intraosseous lesion with radiolucent and radiopaque areas. The cytological aspects were consistent with the diagnosis of osteosarcoma, which was confirmed by biopsy.
Imprint cytology was found to be a reliable, rapid and easy complementary examination. An early diagnosis of osteosarcoma of the jaw is fundamental to the early determination of an adequate treatment.
