Ultrasound-guided fine needle cytology of retroperitoneal masses in patients with malignant germ cell tumours: diagnosis and therapeutic impact.

PURPOSE

There are few reports on the use of fine needle cytology (FNC) for the detection of retroperitoneal lymph node metastases from malignant germ cell tumours (MGCT). In order to determine efficiency of the procedure and its impact on therapeutic approaches, this study reviews experience with ultrasound-guided transabdominal FNC in patients with MGCT.

PATIENTS AND METHODS

Twenty-four patients with known malignant germ cell tumour and four patients without previous histology, presented with retroperitoneal masses. They underwent ultrasound-guided fine needle cytology (aspirations were done twice in two patients). Clinical data were retrieved from the medical records and all cytological specimens were reviewed. In metastatic cases, the cytologic findings were correlated with the histology of the primary tumour.

RESULTS

Twenty-one of 30 specimens (70%) were diagnosed as malignant, 6 (20%) were benign, and 3 (10%) were unsatisfactory for the cytologic diagnosis. Five of the 21 malignant lesions were < or =10mm. FNC yielded the correct diagnosis in all four cases of extragonadal malignant germ cell tumours. In four other patients, FNC solved significant staging problems at the diagnosis. In 7 of 11 patients with the suspicion of retroperitoneal recurrence and normal serum tumour markers during follow-up, FNC confirmed the malignant morphology of the lesions.

CONCLUSIONS

In experienced hands, ultrasound-guided FNC can be a valuable method for the morphological diagnosis of retroperitoneal manifestations from MGCT. FNC should be added in follow-up and staging procedures (radiological imaging and serum tumour markers) in selected patients in whom the histological verification of such lesions is critical for the patient's management.