Cytology as Primary Diagnostic Modality in the Diagnosis and Classification of Neuroendocrine Neoplasms in Various Body Sites: A Nine Year Retrospective Review
I Akhtar, A Siddiqi, R Flowers, D Rugnath, A Matthew, M Baliga. University of Mississippi Medical Center, MS
Background:: A nine year retrospective study was conducted by collecting and analyzing all the neuroendocrine carcinomas (NEC) diagnosed by cytology from various body sites.
Design: The tumors falling into the realm of neuroendocrine (NE) differentiation, whether by morphology or immunohistochemistry were identified by using cytology data base. These included small cell carcinoma (SCC), carcinoid, large cell neuroendocrine carcinoma (LCNEC), neuroblastoma, paraganglioma, pancreatic endocrine neoplasm (PEN), medullary carcinoma of thyroid (MCT), and NEC not otherwise specified (NOS). These cases were followed up by review of medical records.
Results: 148 cases of NEC diagnosed by cytology were identified. These included 110 cases of SCC, 12 cases of carcinoid, four cases of LCNEC, three paragangliomas, five MCT, five neuroblastomas, one PEN and eight NEC, NOS. The common cytological mode of diagnosis were image or bronchoscope guided fine needle aspiration biopsy (FNAB), core biopsy with imprint cytology, FNAB of peripheral palpable lesions and occasionally effusion cytology. In 72 cases (48.6%) additional material related to the primary diagnosis in the form of concurrent surgical biopsy or cytological specimen was available. SCC was by far the most common diagnosis (74.3%), with 65 cases being primary in the lung and 45 cases were metastatic,especially liver. Concurrent biopsy or cytological material was obtained in 52 cases (47.2%) of SCC and in 40 cases (36.3%) it supported the diagnosis. Two of three cases called suspicious for SCC on cytology had corresponding endobronchial biopsies which were positive. Discrepancy was seen in five cases (3.3%). Two cases called LCNEC by cytology had biopsy showing Non-small cell carcinoma, and SCC. Another case diagnosed as SCC, was an olfactory neuroblastoma. Two cases suspicious for MCT were confirmed as hyperplastic goiter by surgical resection. Cytohistologic correlation was almost 100% in carcinoid, paraganglioma and neuroblastoma.
Conclusions: This study emphasizes the utility of cytology as a primary mode of diagnosis of NEC. Cytological approach in the form of FNAB is the most useful technique for a rapid, accurate, less invasive and cost effective approach. Recognizing the NE pattern of tumor and then effectively triaging the specimen for ancillary studies enables rapid diagnosis and prompt treatment.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 69, Wednesday Afternoon