IMAGE-DIRECTED PERCUTANEOUS BIOPSY WITH LARGE-CORE NEEDLES - COMPARISON OF CYTOLOGIC AND HISTOLOGIC-FINDINGS

Large biopsy needles (18 and 19 gauge) have been reported to yield hig h-quality tissue ores for reliable histologic diagnosis. In our instit ution, image-directed percutaneous biopsy specimens obtained with thes e needles are processed routinely for simultaneous cytologic and histo logic analysis. For the present study, we reviewed our experience with 82 such biopsies of the thoracoabdominal region. We examined the valu e of cytologic analysis as a supplement to histologic analysis of such biopsies in terms of diagnostic yield and sensitivity for detecting m alignancy. Among the 82 specimens, material was adequate for histologi c diagnoses in 70 (85%) and/or cytologic diagnosis in 63 (77%). Combin ing the histologic and cytologic results increased the diagnostic yiel d to 93% (76 of 82 specimens). Forty-eight lesions were diagnosed as m alignant by either one or both means of analysis. While histologic ana lysis produced 44 of the 48 positive results (92%), cytologic analysis produced 33 (66%) (P < .05, McNemar's test). Because tissue fragments were selected preferentially for histologic processing, histologic ev aluation was more valuable than cytologic evaluation in achieving defi nitive diagnoses of malignancy. In spite of this bias in preparation t echnique, malignancy was diagnosed by cytologic analysis alone in 4 of the 48 positive cases (8%). We conclude that the combined approach of histologic and cytologic examination of large-gauge care needle biops y specimens maximizes the diagnostic yield and sensitivity for detecti ng malignancy.