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Fine needle aspiration (FNA) of enlarged adrenal glands detected by computed tomography is a valuable method for extrathoracic staging of pulmonary carcinomas. This paper presents the case of a middle-aged man with pulmonary adenocarcinoma metastatic to the adrenal glands, the FNA sample of which closely resembled normal adrenal cortical epithelium. Through review of the case and comparison with cytologic preparations from normal adrenal glands, the aspiration cytologic features suggesting carcinoma are described.

Transthoracic fine needle aspiration specimens with abnormal cytology were obtained from 272 patients between 1976 and 1980 at the University of Rochester Medical Center. A comparison was made between the original specific cytologic and final histologic diagnoses on 116 patients; an additional 16 patients with the cytologic diagnosis of small-cell carcinoma were evaluated by clinical criteria. Analysis of the data indicated that malignant neoplasms were identified correctly with an accuracy of 99%. There was a single false-positive diagnosis. Predictive values for a specific morphologic variant of pulmonary neoplasm were 70% for squamous-cell carcinoma, 86% for adenocarcinoma and 95% for small-cell carcinoma. The probable bases for diagnostic error are discussed. Confidence intervals calculated from these data compared favorably with those in recently reported studies. The results reconfirmed the value of fine needle aspiration cytopathology for the diagnosis of pulmonary neoplasms.

Retrospective review of pancreatic fine needle aspiration (FNA) biopsy specimens collected with computed tomographic guidance from 73 patients between 1980 and 1985 at the Medical Center of Delaware was performed to determine the accuracy of the procedure in our hands and to identify possible problem areas for cytologic diagnosis. When compared with clinical data or tissue diagnosis, FNA had a sensitivity for the detection of pancreatic carcinoma of 67.7%. The predictive value of a negative result was only 23.1%. When compared to the cytologic diagnosis made at the time of review, FNA had a sensitivity of 100%, but a single false-positive case was identified. In addition to the majority of probable pancreatic ductal carcinomas, a hepatoma and a lymphoma were detected. Cases of primary pancreatic carcinoma were classified by cytologic features, but all groups had dismal three-to-six-month median survivals, regardless of the degree of tumor differentiation. Survival times were similarly low for patients with negative pancreatic FNAs. The low patient survival times, regardless of FNA diagnosis, support the value of avoiding laparotomy in these patients and confirm the high false-negative rate of the procedure.

In order to define the problems in the interpretation of peritoneal washing cytology specimens, 149 benign cases were examined retrospectively and the cytologies compared with the correlating histologies. There were problems in the cytologic interpretation on blind review in 18 cases (12.1%). Difficulties in interpretation of peritoneal washing cytology included conditions associated with (1) mesothelial reactions and adhesion formation, (2) rupture of cystic structures, (3) fallopian tube epithelium and (4) combinations of these factors. It is anticipated that familiarity with these problems will enhance accuracy in peritoneal washing cytology, particularly in those cases in which a malignancy is present but has not penetrated into the peritoneal cavity.

The peritoneal washings and cul de sac aspirates from 204 patients undergoing 217 procedures for the evaluation of gynecologic disease were examined retrospectively and correlated with the histologic diagnoses. Of the 73 washings from patients with histologically benign genital disease, cytology diagnosed 64 (87.7%) as negative, 6 (8.2%) as inconclusive and 3 as malignant. One malignant washing was a true positive from a nongenital primary. False positives thus occurred in 2.7% of the benign cases on blind review. Of 144 cytologic examinations of washings from patients with histologically confirmed malignant disease of the female genital tract, 38 (26.4%) were considered positive after cytohistologic correlation. Four malignant cases (2.1%) were undercalled on blind review while 3 (2.0%) were considered overcalls. Eleven of 47 cases (23.4%) with biopsy-proven peritoneal disease had negative cytology after histologic correlation. Recurring problems in interpreting peritoneal washings included: (1) the differential diagnosis of the spectrum encompassed by reactive mesothelium, endosalpingiosis, borderline serous tumors and well-differentiated serous cystadenocarcinoma; (2) morphologic similarities between some tumor cells and mesothelial cells associated with treatment effects; and (3) a paucity of malignant cells in some washings, resulting in false-negative interpretations. Ineffective cytopreparation, particularly of bloody specimens, hampered interpretation of some specimens. Correlation with previous histology and cytology enhanced the accuracy of peritoneal washing cytology in this study.