Role of aspiration cytology in Diagnosis of Bone tumors and tumor like conditions

Dr Pramod Kumar Rai; Dr Shri Prakash Rai

Volume : V, Issue : X, October - 2016

Role of aspiration cytology in Diagnosis of Bone tumors and tumor like conditions

Dr Pramod Kumar Rai, Dr Shri Prakash Rai

Abstract :

Introduction: Diagnosis of bone tumor is based on clinical, radiological and laboratory investigations which includes histological examination. Open biopsy has its own drawbacks such as seeding of tumor cells in an avascular plane and making them resistant to curative radiotherapy and chemotherapy. Placing biopsy incision in area may interfere to final surgical planning, risk of anesthesia, necessity for hospitalization and time involved in prep� paraffin wax block &reporting, as well the cost involved. To avert above problems we banked on newer least invasive ,low cost, quick reporting percutaneous fine needle aspiration cytology(FNAC).Aim and Objective: our aim was to standardarize FNAC, find out its reliability and specificity in relation to basic pathological processes such as inflammatory, benign and malignant bone lesions. Material and method: Fine needle aspiration was performed as OPD procedure, under aseptic condition, without anesthesia by 10ml syringe with 20-22G needle. Aspirated material was spread over 2 to 8 slides. Slides were fixed in absolute Alcohol ,then smear stained in H&E stain. The slides were examined under Microscope and Patients were given cytological report within next day. Diagnosis was based upon cellularity and findings were labeled as diagnosis of bone tumors as definite , indefinite, inflammatory and unsatisfactory smears. Repeat aspiration was done in indefinite and unsatisfactory smears. Observation: A total of 54 patients presenting as skeletal lesion were subjected FNAC. Based on cytological smear final diagnosis was Primary malignant tumor in 14 cases, osseous metastasis in 4, skeletal soft tissue malignancies 8, Primary benign bone tumors including Giant cell lesion 15 cases, primary benign non osseous skeletal tumors 1,inflammatory 6 and unsatisfactory 6 cases. More than70% of primary malignant and benign bone lesions were less than 30 years age. Male to female ratio was 1.8:1,almost twice common in male. Among benign bone tumors ,Giant cell lesions were more predominant. Lower extremity was commonest site for bone tumors.73% long bone tumors were in Femur, Tibia, Fibula, while in flat bones Pelvis was commonest. No significant complication reported with FNAC. Repeat aspiration was done in 6 cases due to their discrepancy in clinical findings and cytological findings or unsatisfactory smears. Discussion: In our series of 54 patients having bony lesion were subjected FNAC. Cytological diagnosis confirmed 14(25.9%) as primary malignant bone tumors, 4(7.4%) metastatic bone tumors, 8(14.8%) soft tissue skeletal tumors,15(27.8%) Primary benign bone tumors,1(1.9%) primary non osseous tumors,6(11.1%) inflammatory and remaining 6(11.1%)diagnosis could not be confirmed. Amongst primary malignant bone tumors, osteosarcoma and Ewing�s tumor were common in first two decades and mostly long bones were involved. Giant cell tumors were predominant in benign lesions of bone and young adults. Overall accuracy of fine needle aspiration cytology was 88.9% as compared of needle biopsy which was 73% only. Summary and conclusion: Fine needle aspiration cytology is performed as OPD procedure with 20-22G needle, tissue immediately stained and reports are provided by the next day. With accuracy of 88.9%, FNAC can be better choice than open Biopsy. Even in doubtful cases or unconfirmed diagnosis it can be repeated without any major problems. This does not interfere with future surgical planning for tumor management. Thus we can conclude FNAC as simple, cost effective, safe ,least time consuming procedure with better reliability in experts hand.