# I. Introduction eedle aspiration cytology was successfully utilized by Greig and Gutheri as early as 1904 for diagnosis of sleeping sickness from cervical lymphnode aspirates 1 .but for the next 50 years this method of diagnosis was largely ignored due to complications like tissue injury and needle track dessimination 2 . Later on Cardoza (1954), Franzen, Geirtz and Zajicek (1960) etc workers introduced the technique of Author ? ? ? ? ¥ §: Medical college, Kolkata. e-mail: misra_malabika@rediffmail.com FNAC with lesser complications and reasonable success rate 3,4 . Last 4 decades experienced spectacular developments in the field of aspiration cytology and now it has emerged as diagnostic method of preoperative assess -ment any type of swelling. Use of thinner needle has reduced tissue injury to a minimum enabling aspiration from vascular hamartomas or large thyroid lesions 5 . Reported incidence of needle track dissemination after FNAC was also negligible 2 . Even testicular malignancies can now be aspirated safely 6 . FNAC is also a reasonably accurate method of diagnosis. Different workers reported more than 75% accuracy in predicting a definite diagnosis on cytological evaluation 5,7,8,9,10 . This is quite comparable with success rate of modern radiological or serological investigations. FNAC can also be used in tandem with modern radiological procedures like USG, mammography, CT scans with improved diagnostic accuracy in comparison to outcome of any single procedure employed 9 . Principal limiting factor of accurate cytodiagnosis is adequacy of aspirate 11 . In spite of repeated aspirations every worker has reported variable percenttage of failed aspirations in their series 5,9,10 . Radiological guidance often helps in obtaining enhanced amount of aspirates at the cost of increased expenditure 12 . Another major handicap of FNAC is diagnosis of a large lesion with heterogeneous tissue composition. In those cases variability of aspirates from different sites causes considerable confusion 11,13 . Guiding methods can be helpful in choosing appropriate site / sites for aspiration in these cases 9,12,13 . In spite of those two serious drawbacks, FNAC became an important wing of diagnostic medicine because it delivers report with minimum expenditure of money and time in comparison to any other method with comparable safety and accuracy 12 . In our series, a large number of aspirate from all parts of body were evaluated to establish the reliability of this method of diagnosis. Aspirates from head and neck region accounted for almost half of the cases. Our main objectives were: ? To show that interpretation of aspiration in majority of the cases are simple and straight forward. ? To establish that FNAC is a cheap procedure capable of predicting final tissue diagnosis with reasonable accuracy and should be encouraged to be done at grass root level. # II. Material and Methods This method was conducted in the Pathology department of Medical College Hospital, Kolkata for a period of 10 years (1 st January, 2000 to 31 st December 2010). All cases coming to pathology department for FNAC during the mentioned period were included in our study group. FNAC was done using standard procedures and aspirates were stained with May-Grunwald -Giemsa (MGG) stain, Haematoxylin and Eosin (E & O) stain, Papanicolaou stain 12 . Stained slides of each case were evaluated by two separate observers simultan -eously to be categorized into one of the three groups mentioned below: ? Interpretation easy:Two observers reached same definitive diagnosis on initial assessment separately without consultation of any reference material. Lymph nodes were the single most common target of aspiration (28.71%), followed by breast; thyroid, skin etc. intra-abdominal, intra-thoracic sites are the least common. Breast aspirates are easier to interpret (94.64%) but salivary gland aspirates are least easy to interpret (77.8%). Intra-abdominal cases are the most difficult (8.70%) to interpret. IV. # III. Observation # Discussion In the present study, 1774 cases (8.77%) were aspirated under various radiological guidance (CT scan, USG, fluoroscopy). These cases were not included in final analysis because of higher expenditure and poor availability of the guiding techniques at peripheral levels. Among the cases aspirated without guidance (18463), 3.16% (584 cases) could not be reported due to inadequate aspirate. Reported incidence of inadequate aspirate in various studies ranges from 32.2% to 2.5% 7,8,14 . Comparatively lower incidence in our series could be attributable to repeated aspiration attempts by multiple persons in more than one sitting. More than 90% cases (16098 out of 17879) of present group were categorized into easy to interpret, 6.72% cases were moderately difficult and 3.25% were highly difficult demanding highest level of collective expertise -only available at referral centers. Different workers reported incidence of misdiagnosis during cytological evaluation of large number of cases in their series ranging from 0% to as high as 33% 10,9,15,16 . Head and neck lesion accumulated for majority of the cases (47.3%) in our series. Lymph nodes were the commonest target (37.8%) among head and neck aspirates. Similar data was also published by other researchers 10,12 . In our study breast aspirates were comparatively easy with less than 2% cases belonging to highly difficult. Similar results were shared by other workers 8,9 . We faced maximum difficulty during distinction between proliferative breast disease with variable dysplasia and breast carcinoma in situ as also by other researchers 17 . In cases of salivary glands only 77.8% were easy to interpret. Different workers admitted various pitfalls and problems during salivary gland aspiration study 18,19 . 8.7% of abdominal aspirates were highly difficult to interpret. In this study we achieved almost 85% Cytohistological correction. Reported incidences of false positive and false negative malignant cases were 14.93% and 10.48% respectively. Sensitivity, specificity, positive and negative predictive value for detection of malignancy was between 85.07% to 89.52%. These data's quite clearly establish the diagnostic value of aspiration cytology. Comparable results were published by a lot of cytopathologists dealing with large number of cases 7,8,10,16 . # V. Conclusion from the above discussion it is quite clear that FNAC is a reliable method of pathological diagnosis, for lesion of all parts of body including head and neck region. But we want to interpret our results from another angle. During the last 4 decades diagnostic medicine has undergone a sea of changes. Unfortunately all the diagnostic approaches of recent discovery are much costly. But apart from human resources one has to spend less than RS 1000 for FNAC. Butwith routine stains cost is less than Rs 20. FNAC can quickly diagnose malignancy around 90% of cases. In developing countries FNAC is a very useful tool for tissue diagnosis. Cytopathology should not be treated as a highly sophisticated diagnostic procedure but a cheap and efficient measure that can be used routinely by trained persons. Hope this change of approach should come soon from our community to bloom the fullest potentiality of this unique diagnostic tool. ![Volume XIV Issue III Version I© 2014 Global Journals Inc. (US)](image-2.png "N") 1Total cases No. of cases needed%No ofcases without%guidanceguidance20237(100%)17748.771846391.23Out of 20237 cases 1774 (8.77%) needed guided aspiration.Table 2 : adequacy of aspirationNo of cases aspiratedNo. of inadequate%No. of adequatewithout guidanceaspiratesaspirate18463(100%)5843.161787996.84Despite repeated aspiration 584 (3.16%) cases was failed.Table 3 : Categorization of aspiratesNo. of adequateInterpretative categorizationaspirateInterpretation easyInterpretation moderatelyInterpretationdifficulthighly difficult17879 (100%)No%No%No%1609890.0312036.725783.25Moderately difficult interpretation was in 6.72 %( 1203) and highly difficult in 3.25%(578).Table 4 : region wise distribution of casesNo. of casesRegions aspiratedadequatelyaspirationHead andThorax SuperiorInferiorAbdomenMultipleneckextrimityextrimityregion17879(100%)8466411926931911207 (1.10%) 483(2.70%)(47.30%)(23.10%)(15.10%)(10.70%)Maximum no of cases (8466 / 17879) 47.30%were done from head and neck region followed bythorax (23.1%) & superior extremity (15.1%). Out of the8466 head and neck aspirates lymph node biopsy arethe most common (37.8%). Closely followed by thyroid(34.5%). 5Total no. ofOrgan wise distributionaspirates fromhead andLymphThyroid SalivaryNasal, naso &Skin andOrbitalMultipleneck regionnodeglandoropharyngealsoftsitestissueand oral8466 (100%)32052923978439 (5.2%)386 (4.5276 (3.3%) 259 (3.2%)(37.8%)(34.5%)(11.5%)%) 6: organ wise distribution of all cases with interpretation categorizationNo ofSites of aspiration No of cases%Interpretation categorizationadequateEasyModeratelyHighly difficultaspiratesdifficultNo%No%No%17879Lymph node513428.71443386.34027.82995.9(100%)Breast396122.15374994.641433.61691.75(max)(min)(min)Thyroid292316.35264890.62167.38592.02Skin and soft tissue195710.94183693.82854.34361.84Bone and joints11866.63107690.72715.99393.29Salivary glands9785.4776177.818919.32282.88(min)(max)Nasal &4392.4539690.2347.7492.06naso/oropharyngealOrbital2761.5425793.11134.7162.18Intra-abdominal1380.7711784.7896.52128.70(max)Intra-thoracic650.365483.0769.2357.70Multiple sites8224.5977193.79354.26161.95 7No. ofcytodiagnosis No ofHistological diagnosisCases withCases withcasescasescorrectiondisparitywith histologyneoplastic Non-Benign MalignantNo%No%5807Non-neoplastic906752109454923 84.78 884 15.22(100%)Benign2282501943289Malignant2619383532228Table 8 : detection of malignancyNo ofcytodiagNoHistologicFalseFalsesensispecificPrediNegativcasesnosisalpositivenegativetivityityctiveewithdiagnosismalignamalignantvaluepredictihistolont casescasesve valuegyNon maliMali gnaNo%No%gnantnt5807Nonmalig3188 2853343914.334 10.48 85.0759.5286.9687.95(100)nant4193Malignant 2619 391 2228 * notes on the lymphatic glands in sleeping sickness EdmGreig AchGrey Lancet 1 570 1904 * Investigation of tumour spread in conection with aspiration biopsy UEngzell PLEspoti CRubio ASigurdson JZajicek Acta Cytol 10 1971 * PLCardoza 1954. 1980 Loc Cit * cytological diagnosis of prostatic tumor by transrectal aspiration biopsy SFranzen Giertz Brit J Urol 32 193 1960 * Accuracy of fine needle aspirarion of thyroid :a review of 6226 cases and correlation with surgical and clinical outcome MAmrikachi IRamji SRubenfled TMWheeler Arch pathol Lab Med 125 2001 * value of fine needle cytology in the diagnosis of testicular neoplasm KVerma TRRam KKapila Acta Cytol 33 1989 * Thyroid aspiration cytology in Newcastle: a 6 yers cytology/ histology correlation study MATabaqchali JMHanson SJJhonson VWadehra TwjLennard GProud Ann R Coll Surg Engl 82 2000 * Breast fine needle aspiration cytology in a Nigerian tertiary hospital OIAlastice OOLalwal OOOlasode ArkAdesunkami East and Central African Journal of surgery 2006 * the accuracy of one stop diagnosis for 1110 patients presenting to a symptomatic breast clinic AEltahir AJJibril JSquair J R Coll. 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