An interinstitutional review of the value of FNAB in pediatric oncology in resource-limited countries.
Fine-needle aspiration biopsy (FNAB) has been widely accepted as a reliable diagnostic modality in the general pediatric population, but its role in pediatric oncology still remains elusive. With new treatment protocols subscribing to preoperative chemotherapy, the need for a quick, minimally invasive, and accurate diagnostic procedure has arisen. This study assesses the feasibility of FNAB in childhood malignancies to render a specific diagnosis on which treatment can be initiated. An 11-year retrospective study was done on FNABs in patients 19 years and under referred for clinically malignant mass lesions. Cases were confirmed with histology, immunocytochemistry, flow cytometry, or clinical follow-up. Of the 357 patients referred for FNABs, 36 patients were lost to follow-up and 31 FNABS were inadequate. A total of 290 cases were included in the study, of which 68 (23%) cases were benign and 222 (77%) were malignant. The most frequently occurring tumors were nephroblastoma (68), non-Hodgkin's lymphoma (39), rhabdomyosarcoma (22), Hodgkin's lymphoma (22), and neuroblastoma (22). The sensitivity of the procedure for neoplasia was 96.6%, the specificity 97.0%, positive predictive value 99.0%, and negative predictive value 90.1%, with a diagnostic accuracy of 96.7%. The ability of FNAB to enable a specific diagnosis to be made, that is correct and accurate subtyping of the tumor on which chemotherapy or radiotherapy could be commenced was 75.7%. This study shows that FNAB can be used with confidence to confirm malignancy in children. With clinicoradiological correlation and the aid of ancillary techniques, FNAB allows a rapid and accurate preoperative diagnosis for definitive therapy commencement in most cases.
Division of Anatomical Pathology, Stellenbosch University and NHLS Tygerberg, Tygerberg, South Africa. rubina@sun.ac.za
Rubina
R
Razack
Pamela
P
Michelow
Gladwyn
G
Leiman
Anwari
A
Harnekar
Janet
J
Poole
Glynn
G
Wessels
Peter
P
Hesseling
Cristina
C
Stefan
Mercia
M
Louw
Pawel T
PT
Schubert
Herchel
H
Clarke
Colleen A
CA
Wright
D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle / Q000592:standards* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005188:False Negative Reactions; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006295:Health Resources / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods / Q000592:standards; D059012:Lost to Follow-Up; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012923:Social Class; D013019:South Africa / Q000453:epidemiology; D013194:Staining and Labeling / Q000592:standards*; D013383:Suburban Population; D013997:Time Factors; D055815:Young Adult