Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 28612

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 758 - 765

Fine Needle Aspiration Cytology of Intra-Abdominal Lesions

SIDHALINGREDDY, SAINATH K. ANDOLA

Department of Pathology, M.R.Medical college, Gulbarga, Karnataka

Correspondence Address :
Dr. Sidhalingreddy
Assistant professor, Department of pathology
S.N.Medical college ,Navanagar, Bagalkot -587102
E-mail: drssreddybenoor@gmail.com
Mobile: 919886689521

Abstract

Background: Intra-abdominal masses always remain as an enigma in surgical practice. A documentary evidence of the nature of the pathology before the institution of therapy and for the prognosis is mandatory. FNAC is a substitute for surgical procedures like diagnostic laparotomy.

Aims: To assess the utility of FNAC in the diagnosis of intraabdominal lesions.

Objectives: To study the cytomorphological features, age and sex distribution of intra-abdominal lesions and to categorize them organwise and as inflammatory, benign and malignant lesions. To classify the malignant lesions according to their cell type. To evaluate the sensitivity, specificity and diagnostic accuracy.

Materials and Methods: The study included 245 intra-abdominal lesions which were detected clinically or radiologically. The lesions were divided clinically into palpable and non-palpablelumps. USG or CT were used for all the non-palpable lesions and for a few palpable lesions and direct in selected palpable lesions. Giemsa’s and Papanicolaou’s stains were used.

Results: The mean age was 45.16 years, with M:F of 1:1.3. The diagnostic yield was 92.1% in USG guided, 100% in CT guided and 95% in direct aspiration. There were 148 (60.3%) malignant, 55 (22.4%) benign, 25 (10.2%) inflammatory and one (0.6%) suspicious lesions and 16 (6.5%) unsatisfactory smears. The liver and the ovary were the most common sites . Adenocarcinomas and hepatocellular carcinomas were the most common malignant lesions. This study showed 94.1% sensitivity, 100% specificity, 100% positive predictive value, 92.3% negative predictive value and 96.5% diagnostic accuracy .

Conclusion: Intra-abdominal FNA is a simple, economical and a safe procedure with high sensitivity, specificity and diagnostic accuracy and it can be utilized as a pre-operative procedure for the management of intra-abdominal lesions.

Keywords

Intra-abdominal, FNA

Intra-abdominal masses always remain as an enigma in surgical practice. A documentary evidence of the nature of the pathology before the institution of therapy and also for prognosis is mandatory. In a majority of cases, the diagnosis which is obtained by FNAC, is the substitute for surgical procedures like diagnostic laparotomy (1),(2). Most of the intra abdominal masses are non – palpable and even if they are palpable, the idea of their size and shape and the extent of the lesion is not possible. Therefore, various imaging modalities like fluoroscopy, CT and USG are used as a guide for fine needle aspiration (2). Most studies have shown it as a highly sensitive, highly specific, accurate and a cost effective diagnostic procedure with a negligible complication rate (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Uncorrectable severe coagulopathy is an absolute contraindication (17).

The FNA cytology was shown to be 100% specific for the diagnosis of malignancy (4),(8). The non –availability of CT, coupled with the higher incidence of advanced malignancy due to public awareness and overburdened surgical units with meagre resources require the USG – guided FNAC procedure for cancer management in developing countries like India (6),(18). The aim of our study was to assess its usefulness as a pre-operative diagnostic procedure in management of intra-abdominal lesions. Our objectives were to assess the cytomorphological features, age and sex distribution of the patients with intra abdominal lesions, to classify the malignant lesions according to their celltype and to evaluate the sensitivity, specificity and the diagnostic accuracy in different lesions wherever possible.

Material and Methods

This study was carried out in the Department of Pathology for a period of three years (36 months) from June–2005 to May 2008. Patients with intra-abdominal lesions which were detected clinically or under radiological guidance, presented to the Department of Cytology.

Intra-abdominal organs including the liver, spleen, pancreas, stomach, gallbladder, the small and large intestines, the omentum, mesentery, the retroperitoneum, kidney, adrenals, lymph nodes, soft tissues and the ovary were included in the study. Parietal swellings arising from the skin and the abdominal wall, the uterus, the cervix, the prostate and the bone were excluded from the study.

After a thorough clinical examination, consent was obtained from the patients after explaining the procedure to them. The cases were divided clinically into palpable and non palpable lumps. The selected palpable lesions were subjected to direct aspiration and USG guidance in case of on palpable and deep seated lesions and in case of a few selected palpable lesions. The puncture site was marked. Under aseptic precautions, a 22–23G needle for superficial lumps and a lumbar puncture needle of the same thickness for deep seated lumps, which was fitted with a 10ml syringe, was introduced immediately under radiological guidance and the aspiration was done under negative pressure. On anaverage, two to three needle passes were made in each case to obtain adequate material. The sample was expelled onto slides, air-dried and stained with Giemsa or it was fixed in 95% ethanol and stained with Papanicolaou’s stain. Special stains were used wherever required.

The cases were analyzed, based on the cytological features. The final diagnosis was arrived at in corroboration with the clinical and the radiological features. The smears were classified as inflammatory, benign, malignant, suspicious of malignancy and unsatisfactory for interpretation.

Results

During the study period, 2624 fine needle aspirations were performed, of which 234 cases were intra abdominal lesions, accounting for 8.9% of the total cases. There were 245 lesions in 234 patients. There were 147 palpable and 98 non-palpable lesions. Histopathological correlation and confirmation was available in 29 cases.

Out of the 234 cases, there were 101 males and 133 females with a male to female ratio of 1:1.3. The youngest patient in the study was 20 days old and the oldest was 88 years old. A majority of the patients i.e. 146 (59.6%) were in the age group of 30-60 years, out of 245 lesions. The mean age was 45.16 years (Standard deviation – 18.48). Among 104 lesions in the male patients, a majority were malignant, accounting for 76 (73.1%) lesions and 12 (11.5%) lesions were inflammatory lesions, eight (7.7%) lesions were benign and one (0.9%) was suspicious for malignancy. In seven (6.8%) cases, the smears were unsatisfactory for evaluation. Among the 141 lesions in the female patients, 72 (51.1%) were malignant, 47 (33.3%) were benign and 13 (9.2%) were inflammatory. In nine (6.4%) cases, the smears were unsatisfactory for evaluation. Out of 245 lesions in the 234 patients, 148 (60.3%) were malignant, 55 (22.4%) were benign, 25 (10.2%) were inflammatory and one (0.6%) was a suspicious lesion. There were about 16 (6.5%) unsatisfactory smears. The benign lesions were more common in females than in males, whereas the malignant lesions had a slight male preponderance. The incidence of the lesions increased in both the sexes after 30 years (Table/Fig 1).

Out of 245 lesions, 164 were aspirated under ultrasonographical guidance and one was aspirated under computed tomographic guidance. Of the 80 cases which were properly selected, the palpable cases were aspirated directly without any guidance. The diagnostic yield of USG was 92.7% i.e. out of 163 USG guided procedures and adequate material was obtained in 152 cases. In the CT guided procedure, the diagnostic yield was 100%. It was95% in the direct unguided procedure, which was higher than that of the USG guided procedure. Overall, the diagnostic yield was 93.5% in the 245 lesions (Table/Fig 2).

In the present study, most of the aspirates were cellular (41.6%) and haemorrhagic cellular (28.6%). It was a fluid aspirate in 11.8% lesions, followed by a necrotic aspirate in 6.5% lesions, a purulent aspirate in 2.9% lesions and a cellular haemorrhagic aspirate in 8.6% lesions. Out of the 21 haemorrhagic and acellular haemorrhagic aspirates, most were (16 cases) unsatisfactory for evaluation and five were interpreted as hemangiomas. Of the 245 lesions, the aspirate was satisfactory in 229 (93.5%) lesions. Unsatisfactory aspirates were obtained in 16 (6.5%) lesions (Table/Fig 3).

A majority of the lesions were located in the liver and most of them were malignant lesions. The most common malignant lesion in the liver was hepatocellular carcinoma (HCC) (34), followed by metastatic carcinoma (25). In seven cases, we could notdifferentiate between primary HCC and the metastatic lesions and these were labeled as poorly differentiated carcinoma. One case was diagnosed as cholangiocarcinoma (Table/Fig 2) in a 50 years old female. The next most common site was the ovary (48), where most of the lesions were benign lesions (33). Other common organs which were involved were the lymph nodes (18), kidney (12), the gallbladder (6) and pancreas (6). There were two cystic lesions in the pancreas and four adenocarcinomas of the pancreas. In the gall bladder, all the lesions were adenocarcinomas.

Abscess constituted the most common inflammatory lesion. Out of eight abscesses, six were located in liver, one in lymph nodes and one in the appendix. There were five tubercular lymphadenitis (Table/Fig 3) and three reactive lymphadenitis cases. Four cases of diffuse parenchymal lesions of the liver were seen.

Most of the benign lesions i.e., 33 lesions were located in the ovary and most of them (11) were diagnosed as cystadenomas. Among the remaining benign lesions, nine (16.5%) lesions were diagnosed as cyst contents, six (10.9%) as serous cystadenomas, three (5.4%) as mucinous cystadenomas, one as a simple serous cyst, one asa twisted ovarian cyst, three (5.4%) as benign teratomas, one as an ovarian fibroma and one as a benign, mixed epithelial stromal tumour (Table/Fig 4). Two cystic lesions were in the pancreas and one was in the liver (calcified cyst content). There were five hemangiomas, all of which were located in the liver, out of 55 cases i.e. 9.1% of the benign lesions. There was one angiomyolipoma, one adrenal cortical adenoma, one benign trophoblastic lesion and one mucinous cyst of the mesentery and the colon each (Table/Fig 5).

Adenocarcinomas (Table/Fig 6) were the most common malignant lesions, followed by hepatocellular carcinomas. Adenocarcinomas were more common in females (23) than in males (16). Hepatocellular carcinomas were more common in males (25) than in females (nine). Lymphomas (Table/Fig 7), renal cell carcinomas (Table/Fig 8), nephroblastomas (Table/Fig 9) and small cell carcinomas were more common in males than in females. Pleomorphic sarcomas were more common in females (three) than in the males (one). Serous cystadenocarcinoma (seven) was the most common malignant lesion in the ovary, followed by one malignant granulosa cell tumour (Table/Fig 10) and one dysgerminoma [Table/Fig-11]and the remaining were metastatic adenocarcinomas. A majority of the adenocarcinomas (25) and the hepatocellular carcinomas (20) were seen in the age group of 41-60 years. The youngest patient who was affected by HCC was an 18 years old female and the oldest one was an 85 years old male. Adenocarcinomas constituted the most common metastatic lesions in the liver, followed by smallcell carcinomas (three). All nephroblastomas, one malignant small round cell tumour and one rhabdomyosarcoma were seen below the 20 years age group. One rhabdomyosarcoma was seen in a 40 years old male (Table/Fig 5).

The HbsAg test was done in nine of the 32 hepatocellular carcinoma cases, of which six were positive and three were negative. 66.7% of HbsAg positivity was seen in hepatocellular carcinomas.

Histopathological correlation and confirmation was available in 29 cases. Out of the 13 benign cases, seven were confirmed by histopathological examination. All mucinous and serous cystadenomas which were diagnosed cytologically were confirmed histopathologically, except one mucinous cystadenoma which was diagnosed as papillary cystadenofibroma. One serous cystadenoma turned out to be serous cystadenocarcinoma by histopathological examination. The benign, mixed epithelial stromal tumour turned out to be a Brenner tumour of the ovary by histopathological examination. One twisted ovarian cyst and one ovarian fibroma were confirmed histologically. One cystadenoma with haemorrhage and one spindle cell tumour turned out to be a twisted ovarian cyst and a leiomyoma of the retroperitoneum respectively.

11 cases were confirmed histologically out of the 16 malignant cases. All serous cystadenocarcinomas of the ovary, one malignant granulosa cell tumour, one clear cell carcinoma of the kidney, two nephroblastomas, one gallbladder adenocarcinoma, one large intestine adenocarcinoma, two adenocarcinomas of the ovary and one ganglioneuroblastoma (Table/Fig 8)(Table/Fig 9)(Table/Fig 10)were confirmed histologically. One case of clear cell carcinoma of the kidney turned out to be adrenocortical carcinoma by histopathological examination. One case of malignant undifferentiated tumour turned out to be malignant, mixed epithelial cell tumour with dysgerminoma and embryonal carcinoma and one case of carcinoma with tuberculosis turned out to be a metastatic adenocarcinoma of the ovary by histopathological examination. One case who presented with a suprapubic abdominal mass was diagnosed to have adenocarcinoma, cytologically. But the histological diagnosis of the cervical biopsy was squamous cell carcinoma. One case of metastatic seminoma of the lymphnodes which was diagnosed cytologically, turned out to be teratocarcinoma by the histopathological examination of the orchidectomy specimen.

Discussion

FNAC is a proven technique for the diagnostic evaluation of intraabdominal lesions. The diagnostic yield which was obtained by USG was 92.7%, by CT it was 100% and for direct aspiration it was 95%. Overall, the diagnostic yield was 93.5%. Nautiyal S., Mishra RK., and Sharma SP,2 in 2004, found a diagnostic yield of 64.81% with direct aspiration of the palpable lumps and a diagnostic yield of 93.06% with USG guided FNAC which was done for both palpable and non-palpable lesions. Nyman et al,(12) in 1995, found a diagnostic yield of 64% with USG guided FNAC. In comparison with previous studies, the present study was found to have more diagnostic yield, irrespective of whether it was direct or guided. In the present study, the diagnostic yield was more with direct aspiration than with USG guided FNAC. This could be due to the careful and proper selection of the cases for direct aspiration and as most of the lesions were superficial and easily palpable. A 100% diagnostic yield which was obtained with CT-guided FNAC, was comparable to that which was obtained by Joseph T. et al (8).

The age incidence in the present study ranged from 20 days to 88 years with a majority of the cases being in the age group of 30-60years (59.6%). The incidence of malignancy increased after the age of 40 years in males and after the age of 30 years in females with a peak incidence between the ages of 40-60 years, which was comparable to the results which were obtained by Zawar MP., et al,(3)and Shamshad et al (14).

The male to female ratio of 1:1.3 was in accordance with the observations which were made by Shamshad et al (14), and Joao Nobrega et al (4). But the observations which were made in the studies by Zawar MP et al (3) , Govind Krishna et al (10), AftabA Khan et al (1), and Ennis and Mac Erlean, (6) showed a male preponderance. This could be due to the inclusion of the ovary in this study, as done by Shamshad et al (14).

The most common organ which was involved in the present study was the liver an observation which was similar to the one made by Zawar M.P. et al (3), and Biradar et al (11). The next most common site in the present study was the ovary. But the ovary was not included in the studies which were done by Zawar M.P. et al (3), and Biradar et al (11). In their studies, thenext most common site was the large intestine. Biradar et al (14), had included the gallbladder, spleen, adrenal, soft tissue, omentum and the mesentery in the unclassified category (Table/Fig 5).

In the present study, malignant lesions constituted the most common diagnostic category, which was in accordance with the observations which were made by Biradar et al (11), Aftab A. Khan et al (1), and Shamshad et al (14) [Table/Fig 14].

In the present study, we observed 6.5% unsatisfactory smears, which was similar to the observations which were made by Shamshad et al (14), and Aftab A. Khan et al (1), who observed 6.5% and 6% unsatisfactory smears. Biradar et al (11), had observed more unsatisfactory smears (14%) as compared to those in our study [Table/Figm 14].

Benign lesions showed a high female preponderance in the present study, because cystic lesions of the ovary were most commonlyseen as benign lesions. There was no age or sex predilection for inflammatory lesions in the present study.

In the present study, adenocarcinomas were the most common malignant cell type (26.3%), followed by hepatocellular carcinoma (23%), renal cell carcinoma (4.7%), serous cystadenocarcinoma (4.7%) and nephroblastoma (2.7%). Poorly differentiated carcinomas constituted 19.6% of the lesions in the present study. This was in accordance with the observations which were made by Shamshad et al (14), and Aftab A. Khan et al (1), who observed 87.1% and 34% poorly differentiated carcinomas respectively. The second most common malignant type in these studies was hepatocellular carcinoma. In the liver, the most common malignant lesion was hepatocellular carcinoma (34), followed by metastatic carcinoma (25). In the western literature, the most common hepatic malignancy was metastasic carcinoma (4),(6),(18),(19),(20). This could be because of the high prevalence of Hepatitis B infection and the consumption of chutney which was made up of groundnuts, which was frequently contaminated with aflatoxins, in this geographical region. The observations of the present study were similar to those of Indian studies, where hepatocellular carcinoma constituted the most common hepatic malignancy (3). Two studies which were conducted in Kashmir showed observations which were similar to that of the western literature (1),(14).

The liver constituted the major site for the malignant lesions, as observed by Aftab A. Khan et al (1), Stewart et al (5), Zawar MP et al (3), Nyman et al (12), Ennis and MacErlean (6), Joao Nobrega et al (4), and Nautiyal et al (2). But in an observation which was made by Shamshad et al (14), and Joseph et al (8), the most common organ sites for the malignant lesions were the gallbladder and the pancreas respectively. Hepatocellular carcinoma was most commonly seen in males, in accordance with previous literature reports (3),(20). Hepatocellular carcinomas and adenocarcinomas had a peak incidence in the age group between 40-60 years, in accordance with the observations made by Shamshad et al (14), and Zawar MP et al (3). Malignant tumours which were seen before 20 years of age, were nephroblastomas and other round cell tumours, Hodgkin’s lymphoma, dysgerminoma and ganglioneuroblastoma. This observation was comparable to that of the previous literature reports (18),(20).

Although few studies have reported complications like mild local pain, bleeding and tumour seeding of the needle tract, a vast amount of literature supports the safety of FNAC. There was no report on complications as a result of FNAC in the 20 papers which amounted to around 20,000 patients, including those of the present study.

The sensitivity of USG guided FNAC ranged from 71.4% to 96.3%. In the present study, it was 94.1%, which was comparable to that of most of the studies. All the studies observed 100% specificity, as was found in the present study also. The diagnostic accuracy in various studies ranged from 83.9% to 100%. The present study found a diagnostic accuracy of 96.5%, which was comparable to that of most of the studies .

Conclusion

Intra-abdominal FNA is a relatively simple, economical, quick and safe procedure for the diagnosis of intra-abdominal lesions. It not only helps in differentiating between inflammatory, benign and malignant lesions, but also in categorizing different malignant lesions. Intra-abdominal FNA is a reliable, sensitive and specific method with a high diagnostic accuracy for the diagnosis ofmalignant lesions. It can be utilized as a pre-operative procedure for the management of all intra-abdominal lesions.

References

1.
Aftab Khan A., Jan GM., Wani NA. Fine Needle Aspiration of Intraabdominal masses for cytodiagnosis. J. Indian Med Assoc 1996; 94(5):167-69.
2.
Nautiyal S., Mishra RK, Sharma SP., Routine and ultrasound guided FNAC of intra abdominal lumps – A comparative study. Journal of Cytology 2004;21(3):129-132.
3.
Dr. Zawar M.P., Dr. Bolde S., Dr. Shete S.S. Correlative study of fine needle aspiration cytology and histology in intra-abdominal lumps. SMJ 2007;4.
4.
Joao Nobrega and Guimaraes dos Santos. Aspirative cytology with fine-needle in the abdomen, retroperitoneum and pelvic cavity: a seven year experience of the Portuguese Institute of Oncology, Centre of Porto. European Journal of Surgical Oncology. 1994;20:37-42.
5.
Stewart CJR, Coldewey J., Stewart IS. Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions. J. Clin. Pathol. 2002;55:93-97.
6.
Mary Ennis G., MacErlean DP. Percutaneous Aspiration Biopsy of Abdomen and Retroperitoneum. Radiology 1980;31:611-16.
7.
Raul Pereiras V., Walter Meiers, et al. Fluoroscopically guided thin needle aspiration biopsy of the abdomen and retroperitoneum. Am J Roentgenol 1978;131:197-202.
8.
Joseph T., Ferrucci Jr. MD., Jack Wittenberg MD. CT Biopsy of Abdominal Tumors: Aids for Lesion Localization. Radiology 1978; 129:739-744.
9.
Vijaya Reddy B., Paolo Gattuso, Kurian Abraham P., Rogelio Moncada, Melanie Castelli J. Computed Tomography-guided fine needle aspiration biopsy of deep-seated lesions – A four-year experience. Acta Cytol. 1991;35(6):753-755.
10.
Govind Krishna SR., Ananthakrishanan N., Narasimhan R., Veliath AJ. Accuracy of Fine Needle Aspiration Cytology of Abdominal Masses without Radiological Guidance. Indian J. Pathol. Microbiol. 1993;36(4): 442-52.
11.
VB. Biradar et al. A study of fine needle aspiration cytology in abdominal lump (dissertation). Gulbarga: University of Gulbarga, 1994.
12.
Nyman RS., Cappelen-Smith J., et al. Yield and complications in ultrasound-guided biopsy of abdominal lesions. Acta Radiologica 1995;36:485-90.
13.
David CC., Darshana Jhala, et al. Endoscpoic Ultrasound-Guided Fine- Needle Aspiration Biopsy. Cancer 2002;96(4):232-239.
14.
S. Shamshad Ahmed, Kafil Akhtar, S. Shakeel Akhtar et al. Ultrasound guided fine needle aspiration biopsy of abdominal masses. JK Science. 2006; 8(4):200-204.
15.
Dilip Das K., Chandra Pant S., et al. Fine needle aspiration diagnosis of intra-thoracic and intra abdominal lesions: Review of experience in the pediatric age group. Diagnostic Cytopathology 2006;9(4):383-93.
16.
Ahmed SS., Akhtar K., Akhtar SS. Nasir A., Khalid M., Mansoor T. Ultrasound Guided Fine Needle Aspiration Biopsy of Retroperitoneal Masses. J of Cytology 2007;24(1):41-45.
17.
Scott Gazelle G., John Haaga R. Guided percutaneous biopsy of intraabdominal lesions. AJR 1989;153:929-35.
18.
Svante R. Orell, Gregory F. Sterrett, Darrel Whitaker. Fine needle aspiration cytology. 4th ed. 2005; Churchill Livingstone.
19.
Barbara A. Centeno. Pathology of liver metastases. Cancer Control. 2006;13(1):13-24.
20.
Juan Rosai, VJ. Desmet, GO. Nelson. Rosai and Ackerman’s surgical pathology. 9th ed. 2005; Mosby.

DOI and Others

JCDR/2011/1455

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com