A Comparative Study of the Cytologic and Radiographic Diagnosis of Lesions and Masses of the Kidney, Pancreas, and Liver.
Ashish Barman, Cora Uram-Tuculescu, Lina Liu, Joseph D Jakowski, Celeste N Powers. Virginia Commonwealth University Health Systems, Richmond
Background: Radiographic imaging is excellent in detecting a wide variety of intra-abdominal masses and lesions. Fine needle aspiration (FNA) biopsy has been established as a routine method of choice for the pathologic diagnosis of these abnormalities at our institution. Advances in radiographic technology however, are making it possible to correctly predict the pathologic diagnosis by imaging findings alone. The aim of this study was to establish a baseline comparison of the cytologic diagnosis with the radiographic diagnosis of lesions and masses of the kidney, pancreas, and liver.
Design: FNA cases from the kidney, pancreas, and liver were retrieved using our electronic database between January 2007 and December 2009 with exclusion of unsatisfactory specimens and those with no clinical or radiographic follow-up. The cytologic diagnosis for each case was stratified into one of five categories: neoplastic (CN), benign (CB), atypical (CA), suspicious for neoplasm (CSN), and purely descriptive (CD). The radiology report(s) prior to or at time of FNA biopsy from each case was reviewed and stratified into one of six categories: definitive for neoplasm (RN), definitive for benign process (RB), descriptive-neoplastic (RDN), descriptive-benign (RDB), indeterminate for neoplasm or benign process (RI), and purely descriptive (RD). Neoplasm, for the purposes of this study, included all primary and metastatic malignancies and lymphoma, as well as mucinous cystic neoplasms and endocrine tumors of the pancreas.
Results: 317 FNA (311 patients) from the kidney (26), liver (144), and pancreas (147) were identified that met our study criteria. The most common radiographic diagnosis was RDN (35.3%) followed by RN (30.6%), RD (10.7%), RDB (9.1%), RI (8.5%), and RB (5.7%). The overall positive predictive value (PPV) for a RN and RDN were 89.1% and 85.2%, respectively. The negative predictive values (NPV) for RB and RDB were 94.4% and 93.3%, respectively. CN diagnoses were 61.2% and CB diagnoses were 33.9% of the total FNA with a PPV of 100% and a NPV of 93.1%, respectively. Sampling error was the only observed false negative cytologic diagnosis (8 cases). CA (3.4%), CSN (0.6%), and CD (0.9%) were a minority of cytologic diagnoses.
Conclusions: Our study indicates that a radiographic diagnosis of an intra-abdominal mass or lesion continues to be descriptive more often then being called definitively benign or malignant. FNA continues to have a higher PPV over a radiographic diagnosis alone, however, the NPV for cytology and radiology appear to be identical in our series.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 78, Wednesday Afternoon