Introduction

Fine needle aspiration cytology which is an important investigation now was started in 19^th century. This procedure began to flourish in the 1950s and 1960s in Europe. Lebert, Kun and Menetrier were the scientists who used needles for obtaining tissue fragments to diagnose conditions like cancer. ^{1, 2}

The technique of fine needle aspiration cytology is minimally invasive, inexpensive and gives quick results. It was initially considered as a means to confirm suspicion of metastasis or local recurrence of a known case of cancer. After this it has been used to diagnose all types of conditions from inflammatory to malignant in any organ of the body. Nowadays fine needle aspiration cytology has become part of service of all sophisticated departments of Pathology. ^{1, 2, 3}

Continuous improvements have taken place in fine needle aspiration cytology along with technical advances in imaging methods of ultrasound and CT. All the imaging techniques have their own advantages and disadvantages. Presence of pathologist in the procedure is known to give better results when compared to radiologist alone. ¹

Ultrasonography is the method in which imaging is possible in any plane. It allows the radiologist to monitor and guide the needle tip throughout the procedure. The easy use of it and the portability makes it favorable and commonly used method for aspiration ¹ .

CT can be used for extremely small lesions like mass of few millimeters in size. Needle tip visualization within the lesion is accurate with CT. Detailed cross-sectional images are available and they are limited to one plane ^{1, 2} .

Material and Methods

Source of data of this study comprised of all ultrasound and computed tomography guided abdominal lesions received at Basaveshwar Teaching and General Hospital attached to MahadevappaRampure Medical College, Kalaburagi.Three-year retrospective study was carried out from June 2015 to May 2018 with sample size of 82 cases. Inclusion criteria for this study included all the abdominal lesions sent for guided fine needle aspiration cytology to Basaveshwar teaching and general hospital/MRMC Kalaburagi. Exclusion criteria of this study was to exclude all the patients with bleeding disorders, patients with uncorrectable severe coagulopathy, patients who do not give consent for the procedure and the patients with abdominal lesions like hydatid cyst.

Results

The 82 cases studied were broadly classified into 5 categories: inflammatory (15 cases), benign (16) cases, malignant (45 cases), Suspicious for malignancy (4 cases) and unsatisfactory for evaluation (2 cases). : The age was from 14 years old to 82 years and majority of them were in the age group of 40 – 60 years. Males were 39 and females 43 (M:F ratio= 1:1.1). Males presented with more malignant cases than females Table 1. The overall diagnostic yield from the FNACs was 95%. Majority of cases were in Liver, 36 cases (43.92%), of which 13 were HCC, 16 were metastasis to liver, 3 inflammatory lesions, 2 suspicious for malignancy and 2 were unsatisfactory for evaluation. HCC on cytology showed large round to oval tumor cells with irregular nuclear borders and prominent nucleoli. One case presented with microfilaria in the smear.Table 2.

Of 15 ovarian FNAC, 14 were benign lesions and 1 malignant (Dysgerminoma). Benign lesions were cyst contents in majority cases: serous cystadenoma 6 cases, mucinous cystadenoma 4 cases and 2 were mature cystic teratoma which showed keratin material on FNAC. 1 case of Brenner showed spindle shaped cells with nuclear grooving. 1 case diagnosed as benign fibroblastic proliferation on histopathology turned out to be fibroma. FNAC of lymph node shows 7 cases of reactive lymphadenitis, 5 cases of tuberculosis, 1 case each of metastatic adenocarcinoma and metastatic squamous cell carcinoma, and 1 case was suspicious for malignancy. 6 cases from kidney showed Renal cell carcinoma of which 3 were clear cell variant. 1 case was diagnosed as papillary renal cell carcinoma which on histopathology was metanephric carcinoma. 2 cases in retroperitoneal region were benign, leiomyoma, and 2 cases were malignant, leiomyosarcoma, which showed pleomorphic spindle cells and high mitotic rate. 3 cases in bowel were adenocarcinoma, of which one was mucin secreting. Showed large round to oval cells with vesicular nucleus, prominent nucleoli and abundant cytoplasm in mucoid and hemorrhagic background. FNAC from spleen lesion was suspicious for malignancy and turned out to be NHL. 1 case from pancreas showed adenocarcinoma, on FNAC pleomorphic malignant cells arranged in acinar pattern. Among the 82 cases 80 smears were good for diagnosis and 2 were unsatisfactory.

Histopathological correlation was available in 60 cases of which only 3 cases differs. Statistically it was highly significant. X²yates = 10.75, p<0.001. The diagnostic accuracy was 95%, sensitivity was 92% and specificity was 100%.

Discussion

Abdominal masses are considered as mystery in clinical practice. All these lesions are visible radiologically but cannot be determined as benign or malignant. Confirmation from the pathologist is essential in these conditions ^{1, 2} . The diagnosis obtained from FNAC guides for the treatment and also is a substitute for few surgical procedures. Eg: diagnostic laparotomy. FNAC is sensitive, easy, less expensive, fast, repeatable procedure. Previous studies and literature have shown that imaging modalities are used as it provides us size, shape and extent of the lesion giving good quality of smears. FNAC plays a major role in diagnostic evaluation of abdominal lesions.In the present study, the total number of cases are 82. Diagnostic yield obtained is 95%. This is higher than study done by T ARiyaz et al in 2016 ⁶ .Age incidence in the present study ranged from 14 years to 82 years with majority of cases i.e 42 cases (51.22%) in the age range of 41 – 60 years which is in accordance to the other studies done by Sidhaling Reddy, S K Andola ⁵ in 2008, IslamT etal ⁷ in 2013 and T A Riyaz et al. ⁶ in 2016. Table 3 There were 39 males and 43 females with male to female ratio of 1:1.1. This was in accordance with the observations done by S Reddy, SK Andola ⁵ . Other studies done by AS Tuladharetal ⁸ , V Ghodasara et al. ⁹ , T A Reyaz et al. ⁶ showed male preponderance .Differentiation into malignant and benign tumors is possible by careful evaluation of cytoarchitecture and background features. In this study, malignant lesions are most common diagnostic category which is in accordance with the observations made by S Shamshad et al. ⁴ , S Reddy, SK Andola ⁵ , BharatiJha et al. ² . This is followed by category of benign lesions in the present study which is in accordance with the observations of the studies done by S Reddy, SK Andola ⁵ and Bharati Jha et al. ² . Most common organ involved was liver which is in accordance with the observations done by S Reddy, S K Andola ⁵ , B S Sumana et al ¹⁰ , J A Glaxon et al. ¹¹ Table 4.HBsAg was done in 10 cases of which 09 cases showed positivity and 01 case was negative. Positive percentage was found to be 90%. Histopathological correlation was available in 6 cases of HCC, diagnostic accuracy was 100%.Table 4.15 cases of ovarian mass subjected to FNAC showed diagnostic accuracy in 93.3%. All cystic lesions showed diagnostic accuracy of 100%. Only one case which was on FNAC diagnosed as benign proliferative lesion turned out to be fibroma.Diagnostic accuracy in FNAC of kidney lesions was 85.7%. It was 100% in retroperitoneal mass, bowel lesions and pancreatic lesion. Diagnostic accuracy was in accordance with S Reddy, SK Andola, BS Sumana et al. and JA Glaxon et al. one case of splenic lesion was lymphoma which on FNAC was given as Suspicious for malignancy.

In the present study out of 82 cases histopathological correlation was available in 60 cases. For these case sensitivity, specificity and diagnostic accuracy were found to be 93.1%, 100% and 95.2% respectively .

Conclusion

Abdominal fine needle aspiration cytology is simple, cost effective, rapid and repeatable procedure for the diagnostic purpose. It helps in categorizing the lesions as inflammatory, benign and malignant. It also helps to know about the categories of malignant lesions and the presence of metastasis.It is easy, reliable, sensitive and specific method with high diagnostic accuracy in malignant conditions.