Representativeness of Radiologically Guided Fine-NeedleAspiration Biopsy of Bone Lesions

[摘要] The consistency of the cellular yield as obtained by radiologically guided fine-needle aspiration biopsy (FNAB) was investigatedin 29 cases with bone lesions. Aspirates from three different sites of the same lesion were analysed randomly andindependently by two cytologists unaware of the clinical and radiological findings.The series was grouped cytologically intofour categories: (1) benign, (2) sarcoma, (3) other malignancy, (4) non-conclusive. A lesion was considered cytologicallyhomogenous, when all three aspirates were identically categorised. Among 29 lesions, 13 and 12, respectively, were assessedas homogeneous by the two cytologists. In the remaining lesions, heterogeneity almost exclusively pertained to the mixtureof conclusive and non-conclusive aspirates. An alternative diagnosis was suggested in one case by each cytologist.Comparison of the two cytologists' assessments showed that 21 cases were compliant, i.e., no inter-observer difference in63 out of 87 aspirates. In the remaining eight cases (24 aspirates), non-compliance was mainly due to differences betweenthe cytologists in the ratio of conclusive versus non-conclusive aspirates. Only the analysis of one and the same aspirateresulted in two different diagnoses. A correct diagnosis was given by the cytologists in 22 and 23 cases, incorrect in two andnon-conclusive in five and four, respectively.Our cytological study of bone lesions, albeit limited, suggests that true tumour heterogeneity is rare. Thenon-compliance between the two cytologists and the diagnostic difficulties should mainly be attributed to the blind, randomapproach of the study.The main problem of FNAB pertains to the high rate of non-conclusive aspirates.This, however, doesnot entail an increased risk of incorrect diagnosis, but rather prompts repeat FNAB.

[学科分类] 肿瘤学