Value of image-guided needle aspiration cytology in the assessment of thoracolumbar and sacrococcygeal masses.

OBJECTIVE

To investigate tumors and nontumorous processes in the thoracolumbar and sacrococcygeal region by the noninvasive method of needle aspiration cytology (NAC) and whether such preoperative assessment is useful in deciding between conservative and radical management.

STUDY DESIGN

NAC was performed under computed tomographic guidance on 22 patients suspected of having a thoracolumbar-sacrococcygeal mass. Cytologic examination was performed on site after staining smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis in all cases was supported by examining cell blocks, which illustrated the reliability of histologic architecture; further support was obtained with a tissue biopsy in eight cases. Additionally, immunoperoxidase and/or histochemical studies were done in cases with a NAC diagnosis of chordoma and some cases of metastatic carcinoma.

RESULTS

Five cases were diagnosed as inflammatory/degenerative lesions, and in one case NAC diagnosis of neurofibroma was made. In 14 cases a variety of metastatic tumors were diagnosed, while in two cases a NAC diagnosis of chordoma was made. Immunohistochemical staining results were useful in supporting the cytohistologic diagnosis.

CONCLUSION

NAC, as the first line of investigation, is not only useful in the diagnosis of space-occupying lesions of the thoracolumbar-sacrococcygeal region but can also save the patient from a radical surgical procedure to obtain tissue for diagnosis. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.