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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
Original article / research
Full Version
Role of Fine Needle Aspiration Cytology in Evaluation of Bony Lesions
Correspondence Address :
Hemant Jain,
Quarter 4, Medical College Campus, Shastri Nagar, Jodhpur, Rajasthan, India.
E-mail: hemanjainy27@yahoo.com
Introduction: Fine Needle Aspiration Cytology (FNAC) is increasingly being recognised for its diagnostic utility in evaluation of bone tumours. Though open surgical biopsy is the procedure of choice for diagnosis of bony tumours.
Aim: To evaluate the efficacy and reliability of FNAC in diagnosis of bony tumours.
Materials and Methods: This cross-sectional study included 40 patients with bony lesions from July 2018 to December 2019 in tertiary level centre of Rajasthan. The FNAC was performed after clinical and radiological assessment. The smears were stained using standard techniques. Also, open biopsy was performed in the patients who presented with bony lesions of patients and slides prepared for histopathological examination using standard techniques. The data was entered in Excel sheets and the results were evaluated using Statistical Package for Social Sciences (SPSS) software version 20.0.
Results: Adequate material was obtained in FNAC in 29 (72.5%) cases. Out of 29 cases, FNAC results were accurate in 96.5% cases. False Negative report was obtained in one case with no false positives. Sensitivity of FNAC in diagnosing bony lesions comes to be 90% and Specificity was 100%. The Positive Predictive Value (PPV) was 100% and the Negative Predictive Value (NPV) 95.4%.
Conclusion: The FNAC is invaluable tool in primary diagnosis of bony lesions. The technique of obtaining sufficient material though needs to be mastered and will definitely improve with more experience and radiologic correlation.
Biopsy, Bone tumours, Diagnosis
Bone tumours are frequently encountered in orthopaedic practice. Benign neoplasms are 100 times more common than malignant ones (1),(2). The FNAC is increasingly being recognised for its diagnostic utility in evaluation of bone tumours. The FNAC is a simple, cost-effective procedure which is widely used to diagnose lesions in various sites such as breast, thyroid, lymph node, soft tissue, and viscera but has a relatively less utility in bone lesions.
The FNAC of bone lesions are difficult to aspirate due to fibrotic or cystic nature of bone lesions. According to Association of Directors of Anatomic and Surgical Pathology, FNAC is not recommended in bony lesions and open surgical biopsy is the procedure of choice for diagnosis of bony tumours. Open surgical biopsy bears the risk of contamination of adjacent tissue by disruption of compartments, increase the risk of pathological fracture and is also costly (3). Also, in developing countries like India, facilities for open biopsy are not available in rural places and high rate of patients suspected clinicoradiologically of bone tumours are lost to follow-up. In comparison to open biopsy, FNAC is easy to perform, cheap and rapid method which is available even at small centres. The FNAC also gives an early diagnosis with minimal disruption of lesion. Another benefit is that multiple attempts can be done if the specimen is inadequate with very lower incidence of complications. Thus, FNAC is a minimally invasive alternative to open biopsy to achieve diagnosis.
In view of the above facts, this study was conducted to evaluate the efficacy and reliability of FNAC in diagnosis of bony tumours in the institute.
This cross-sectional study was conducted in all patients presenting with bony lesions in Department of Pathology of a tertiary level health care centre of western Rajasthan, India between July 2018 to December 2019 after obtaining ethical clearance (IEC/SNMC/2018/144).
Inclusion criteria: All the patients who presented in the Department of Pathology, SN Medical College, Jodhpur, Rajasthan, during the study time period, had palpable bony lesions, and those who gave detailed informed consent for the study, were included.
Exclusion criteria: All patients with previous surgeries, multiple sites involvement and those who were not willing to give consent, were excluded from the study.
Study Procedure
After detailed history and clinical examination patients were subjected to radiological examination (X-ray and MRI were done in all cases) for assessment of extent and assoiciate. Lesions of bone were discussed with orthopaedic surgeon to select the appropriate site for FNAC keeping in mind, the line of incision for future surgery.
Open Biopsy of the same lesion was also performed by the orthopaedic surgeon in every case. The FNAC was performed by a single pathologist throughout the study maintaining all the aseptic precautions. Twenty two or 23 gauge needles were used for aspiration with 10 cubic centimetres (cc) syringes. The preferred site of FNAC was the area of cortical breach and soft tissue extension of the neoplasm. For some cases with thick intact cortex aspirated by radiologist, cutting needle was first introduced under imaging guidance as leader through which aspiration needle was inserted to obtain the material.
In every case, three attempts were taken. May Gruenwald Giemsa stain was done in air dried smears which were fixed in methanol. Open biopsy was taken by orthopaedic surgeon under anaesthesia. Tissue samples were fixed in 10% formalin, paraffin blocks were prepared and sections were studied using H&E staining. FNAC diagnosis was associated with histological diagnosis made on cell block of subsequently performed surgical biopsies. Special staining was not done in any of the case. Lesions were classified as benign and malignant bony lesions.
Statistical Analysis
The data was entered in MS Excel sheets and the results were evaluated using SPSS 20.0 software using binary classification tests including sensitivity, specificity, PPV and NPV.
Forty patients between the ages of 7-83 years with bony masses with or without pain were included in this study. A total of 28 patients were male and 12 patients were female. Adequate sample was obtained in 29 (72.5%) out of 40 cases (Table/Fig 1). In the remaining 11 cases, adequate material could not be obtained even after more than three attempts (Table/Fig 2). In osteoid osteoma and osteochondroma, the sclerotic peripheral bone prevents collection of adequate tissue material. The other malignant lesions where sample could not be obtained were deeply located and could not be localised well.
On FNAC of these, 19 lesions were benign on both FNAC and biopsy (true negative) and 9 were malignant on both FNAC and biopsy (true positive). One lesion was falsely diagnosed as enchondroma on FNAC which was later proved to be chondrosarcoma on histopathology (false Negative) (Table/Fig 3). Absolute diagnosis could not be obtained in two cases though benign/malignant categorisation was correctly done.
The most common location was femur (11 cases, 37.9%) followed by tibia (7 cases, 24.1%) and humerus (5 cases, 17.2%), metacarpal (2 cases, 6.8%), radius (2 cases, 6.8%), fibula (1 case, 3.4%) and phalanx (1 case, 3.4%).
The most common tumour found in the study was giant cell tumour (Table/Fig 4), (Table/Fig 5) 8 cases followed by osteosarcoma (Table/Fig 6), (Table/Fig 7) -4 cases, aneurysmal bone cyst -4 cases, enchondroma -3 cases and secondaries, osteochondroma, and simple bone cyst -2 case, multiple myeloma (Table/Fig 8), (Table/Fig 9), chondrosarcoma, ewings sarcoma and synovial sarcoma (one case each).
For statistical evaluation 11 cases with insufficient material were excluded. The sensitivity of FNAC in diagnosing bony lesions comes to be 90% and specificity was 100% the PPV comes to be 100% and the NPV is 95.4%. The rate of accuracy for FNAC was 96.5% in this study.
Open surgical biopsy is considered gold standard for diagnosis of bony tumours though FNAC is increasingly being added in diagnostic work-up of such lesions. Its first use in bony lesions was described by Coley BL et al., in 1931 (4).
In a study by Layfield LJ et al., FNAC is found to be 38.5% cheaper compared to open surgical biopsy (5). Though no such study is done in India but FNAC is definitely cheaper compared to open biopsy and more easily available in semi urban areas of India. According to Soderlund V et al., FNAC is of great value in cases of bony lesions as it can reduce risk of false diagnosis to around 1% only (6).
The main problem in using FNAC for bony lesions is to obtain adequate material. In the present study, adequate material could not be obtained in 11 out of 40 cases (27.5%) which is comparable to another study by Layfield LJ et al., rate (33%) (7). Though some studies report low rate of failure in obtaining material like Hand U et al., (18.2%) (8) and Chakrabarti S et al., (13.7%) (8),(9). Technique of obtaining material in bony lesions requires expertise and clinicoradiological correlation to localise exact site. It is easier to obtain material in tumours which are superficially located or when there is soft tissue spread in deeper lesions..
Out of 29 cases where adequate material was obtained rate of accuracy was obtained to be 96.5 which is comparable to study by Kreicbergs A et al., (80%) (10) though less than Chakrabarti S et al., (93.1%) Bommer KK et al., (97.1%), and Wahane RN et al., (90.5%) (9),(11),(12).
In the present study, the sensitivity of FNAC in diagnosing bony lesions was 90%. Though this is slightly lower than Chakarbarti S et al., (93.33%), Nnodu OE et al., (95%) it is still high and encourages the use of FNAC in bony tumours (9),(13). Diagnosis by aspiration depends on the yield of diagnostic material and experience in the interpretation of cytological smears. Lesions surrounded by thick cortical bone or calcified stroma are always difficult to aspirate and obtain sufficient material for FNAC.
The two cases where absolute diagnosis was not possible were osteosarcoma and secondaries from lung but categorisation into benign or malignant was possible. In this study, one of the case was found to be giant cell tumour after open biopsy but was reported to be aneurysmal bone cyst on FNAC. It has been reported in literature in previous study by Murphey MD et al., that secondary aneurysmal bone cyst get formed in 14% giant cell tumours and sample was probably obtained from that part of lesion (14). The another case where diagnosis of benign chondroid tumour on FNAC was changed to low grade chondrosarcoma as both these lesions resemble closely. In previous studies by Layfield LJ et al., (7) and Sanerkin NG (15) also differentiation between low grade chondrosarcoma and enchondroma has been found to be difficult.
All osteosarcoma lesions where sample was adequate were accurately diagnosed on FNAC. This is similar study by Dodd LG et al., where conclusive cytological diagnosis was possible in 65% cases (16). Two of the cases with secondaries were accurately diagnosed on FNAC. Correct diagnosis of metastatic lesion by FNAC aids in appropriate management of these lesions. Early initiation of neoadjuvant chemotherapy or radiotherapy is possible by FNAC of malignant tumours which is important because neoadjuvant chemotherapy has become standard treatment for many malignant bony tumours like osteosarcoma as was very well depicted in study by Bielack S et al., (17). The GCT was most common bone tumour diagnosed in the present study as in study by Vangala N et al., (18). Bone tumours have specific morphological appearances on FNAC, such as multinucleated, osteoclast-like giant cells, along with mononuclear cells in a giant cell tumour of bone , and polygonal cells with intranuclear grooves in a chondroblastoma (19),(20). The FNAC may alleviate the need for an open biopsy for diagnosis and deciding appropriate treatment (21). A similar study in 2019 concluded that FNAC is complimentary to biopsy, for preoperative decisions and triage (22).
Limitation(s)
There was lack of long term follow-up to check if any correlation exists in appearance of lesion with time. Also, In this study, the sample size was limited.
This study concluded that FNAC is invaluable tool in primary diagnosis of bony lesions. The technique of obtaining sufficient material though needs to be mastered and will definitely improve with more experience and radiologic association. If radiologic information is not associating or sufficient material is not obtained than open biopsy can always be obtained later on. The FNAC is easily available at most of the places in India, produces quick results. Future studies with larger sample size are recommended for better generalisation of the results.
10.7860/JCDR/2021/47355.15141
Date of Submission: Oct 23, 2020
Date of Peer Review: Jan 06, 2021
Date of Acceptance: May 20, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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