VALUE OF IMAGE-GUIDED NEEDLE ASPIRATION CYTOLOGY IN THE ASSESSMENT OFTHORACOLUMBAR AND SACROCOCCYGEAL MASSES

OBJECTIVE: To investigate tumors and nontumorous processes in the thor acolumbar and sacrococcygeal region by the noninvasive method of needl e aspiration cytology (NAG) and whether such preoperative assessment i s useful in deciding between conservative and radical management. STUD Y DESIGN: NAC teas performed under computed tomographic guidance on 22 patients suspected of having a thoracolumbar-sacrococcygeal mass. Cyt ologic examination wits performed on site after staining smears with t he Papanicolaou method. In addition, air-dried smears, fixed smears, f ilter preparations from needle washings and cell blocks were studied. The NAC diagnosis in all cases was supported by examining cell blocks, which illustrated the reliability of histologic architecture; further support was obtained with a tissue biopsy in eight cases. Additionall y, immunoperoxidase and/or histochemical studies were done in cases wi th a NAC diagnosis of chordoma and some cases of metastatic carcinoma. RESULTS: Five cases were diagnosed as inflammatoryl/degenerative lesi ons, and in one case NAC diagnosis of neurofibroma was made. In 14 cas es a variety of metastatic tumors were diagnosed, while in two cases a NAC diagnosis of chordoma was made. Immunohistochemicla staining resu lts were useful in supporting the cytohistologic diagnosis. CONCLUSION : NAG, as the first line of investigation, is not only useful in the d iagnosis of space-occupying les io ns of the thoracolumbar-sacrococcyg eal region but can also save the patient from a radical surgical proce dure to obtain tissue for diagnosis. Also, histologic architecture fro m cell blocks can be correlated with cytology, and such material can b e used for histochemical and immunomarker studies.