Cytological diagnosis usefulness (PAAF) (Fine needle puncture and Aspiration) in radiotherapy

The discovery of palpable lesions (adenopathy, subcutaneous, breast and thyroid nodes, etc.) in patients with malignancies of various locations referred for radiotherapy, poses diagnostic problems which should be promptly resolved since it may result in changes in the anticipated therapeutic regime. Likewise, the presentation of such lesions in previously irradiated patients raises the differential diagnosis between a progression of the disease and a non-malignant condition. Given the experience and the ease with which fine needle puncture and aspirations is carried out, previding-according to published data a diagnostic accuracy of 76% to 100% in palpable nodules, the usefulness of this procedure was assessed in 35 patients who presented with palpable lesions among a total of 428 new patients seen at the Radiotherapy Department of the Hospital Clinico Universitario, Valencia, in 1985. Out of the 35 lesions, 17 were adenopathies. In 63% of cases, the patients had head and neck malignancies; 14% had breast tumors; 11% had lung cancer and the remaining 11% of patients had malignancies located elsewhere. 43% were discovered before radiotherapy was administered, 14% during the treatment and 43% after this, in routine follow-up visits. Cytological diagnosis was achieved in 89% of cases. An overall clinical and pathological correlation was obtained in 58% of cases. Then out of 20 positive fine needle aspirations determined changes in the therapeutic regime (7 out of 15 prior to radiotherapy and 5 out of 5 during this). After radiotherapy, the clinical and pathological correlation is worse, in 33% of cases, than prior to or during this treatment. In four cases in which fine needle puncture and aspiration was negative but clinical suspicion of tumor involvement was high, open biopsy proved to be negative. (Author). 9 refs