Evaluation of The Role of Transrectal Fine Needle Aspiration As A Diagnostic Modality in The Diseases of Prostate with Review of Literature
DOI:
https://doi.org/10.21276/apalm.2117Keywords:
Transrectal FNAC, Franzen technique, Prostatic carcinomaAbstract
INTRODUCTION: Transrectal fine needle aspiration cytology is feasible, reliable and highly sensitive diagnostic tool for the diagnosis of prostatic diseases. It mostly involves the elderly men, whose population is increasing in our country with the demographic shift of longitude.
AIMS AND OBJECTIVES: To evaluate the sensitivity, specificity and positive productive value of transrectal fine needle aspiration cytology in addition to other advantages so that it could be accepted as a primary screening tool in the selection of the patients for biopsy and treatment of prostatic lesions.
MATERIAL AND METHODS: Transrectal FNAC was performed in 49 patients, in clinically diagnosed cases of prostate diseases. Histomorphology was also carried out.
RESULTS: Satisfactory smears could be obtained in 93.9% cases on first aspiration. The diagnostic accuracy for inflammatory disease was highest (100.0%), followed by malignant (88.8%), and benign lesions (82.9%), with a positive predictive value of 100.0% for malignancy of the prostate. False positivity was seen in 2.09% and false negativity in 11.2% cases.
CONCLUSIONS: Transrectal FNAC is an accurate, sensitive, highly specific procedure with a high positive predictive value with negligible complication with an additional advantage of possible assessment of prognosis.
References
1. Ferguson RS. Prostatic Neoplasms- their diagnosis by the fine needle puncture and aspiration. Am J Surg 1930; 9:507-511.
2. Franzen S, Giertz G, Zajicek J. Cytologic diagnosis of prostatic tomours by Transrectal aspiration biopsy: a preliminary report. Brit J Urol 1960; 32:193-196.
3. Esposti PL. Cytologic diagnosis of prostatic tumours with the aid of transrectal FNAB - A critical review of 1110 cases and report of morphologic and cytochemical studies. Acta Cytol 1996;10:182-188.
4. Zajicek J. Aspiration biopsy cytology: cytology of infra-diaphragmatic organs. Clin Cytol 1979; 7: 129-164.
5. Ekman H, Hedberg K, Pearson PS. Cytological versus histological examination of needle biopsy specimens in the diagnosis of prostatic cancers. BR J Urol 1967; 39: 544-548.
6. Alfthan O, Klintrup HE, Koivuneimi A, Taskinen F. Cytological aspiration biopsy and vim silverman biopsy in the diagnosis of prostate carcinoma. Ann Chirr Gynae Fenn 1970;59: 226-229.
7. Kline TS and Kannan V. Prostatic aspirate: a cytomorphologic analysis with emphasis on well differentiated carcinoma. Diag Cytopathol 1982; 1:13-17.
8. Koss LG. Koss Diagnostic Cytology and its Histologic Basis. 5th Edn, Lippincott Williams and Wilkins Publishers, 2017; pp 912-913.
9. Gawandi A. “Being Mortal†Medicine and what matters in the end. Hamish Hamilton and Penguin Publishers, 1st Edn, 2014: pp1-12.
10. Ingle SP and Ingle RS. The Efficiency of the Serum Prostate Specific Antigen Levels in Diagnosing Prostatic Enlargements. J Clin Diagn Res JCDR 2013; 7(1):82-88.
11. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G et al. ESUR prostate MR guidelines. Eur Radiol 2012; 22(4):746-57.
12. Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L et al. Image-guided prostate biopsy using magnetic resonance imaging–derived targets: a systematic review. Eur Urol 2013; 63(1):125-40.
13. Vargas HA, Hötker AM, Goldman DA, Moskowitz CS, Gondo T, Matsumoto K et al. Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 2016; 26(6):1606-1612.
14. Hermida PJ, Ochoa U, Ramos RA, Acost- Bernad I, Vento RJ, Mesa BD. FNAC in the diagnosis of prostatic cancer. Arch Esp Urol 2001; 54:23-33.
15. Johnson G and Fajers CM. Cancer cells in prostatic secretion. Acta Cher Scand 1950; 90:545-547.
16. Jung KW, Park S, Kong HJ. Cancer statistics in Korea: Incidence, mortality and survival in 2006-2007. J Kor Med Sci 2010; 25:1113-1121.
17. Jung KW, Park S, Won YS. Prediction of cancer incidence and mortality in Korea . Cancer Res Treat 2011; 43:12-18.
18. Mandhani A. Early prostatic cancer- Radical prostatectomy or watchful waiting. The Nat J India 2005;18(4): 23-26.
19. Reddy SD and Rani S. Efficacy of FNAC in early diagnosis of prostatic carcinoma. IAIM 2016; 3(10):100-114.
20. Scadino PT, Weaver R, Hudson MA. Early detection of prostate cancer. Hum Pathol 2011, 23: 231-234.
21. Guinan P, Bush I, Ray V, Rao R, Bhatti R, Veith R. The accuracy of rectal examination in the diagnosis of prostate carcinoma. N Eng J Med 1980; 303: 409-412.
22. Jewitt HJ. Significance of palpable prostatic nodule, JAMA 1956; 160:838-840.
23. Goodwin WE. In Proc. Third Nation Conference. Early case funding of prostate. Ist Ed, Philadephia, Lippincott publishers, 1957; p: 196-199.
24. Mondal C, Ghosh A, Ghosh E. The role of transrectal FNAC in the diagnosis of prostate nodule suspicious of malignancy. Ind J Pathol Microbiol 1990; 33(1): 23-29.
25. Tariq I, Tammana C, Khan KH, Nahar R. Fine needle aspiration cytology of prostatic lesion with histologic correlation. Ibrahim Med Coll J 2007; 1:7-10.
26. Planelles GJ, Beltran AJ, Alonso HS, Tarim PM, Beamud CM, Gil SM. Value of transrectal FNA in the diagnosis of prostatic carcinoma in elderly patients. Acta Urol Esp 2008; 32(5):485-491.
27. Gomez S, Henry H, William JP. Transrectal Prostatic biopsy. Br Med J 2010; 4: 595-597.
28. Suhrland MJ, Dietch D, Schreber K. Assessment of FNAC as a screening tool of occult prostatic cancer. Acta Cytol 1988; 32: 495-498.
29. Kher AV, Gadkari PR, Munshi MM, Grover SV. Trans rectal FNAC of the prostate. J Cytol 1989; 6: 28-38.
30. Hock EF, Wood FW, Kosinski AA. The Cytologic Detection of Prostatic Carcinoma: Its Clinical Application. J Urol 1950; 63:1081-1085.
31. Wahi PN. Cytologic diagnosis of prostate carcinoma. Natl Cancer Inst Monogr 1979;149:7-11.
32. Anderson L, Jonnnson G, Brunk U. Puncture biopsy of the prostate in the diagnosis of prostatic cancers. Scand J Urol Nephrol 1967; 1: 227-234.
33. Puigvert A, Elizalde C, Maltz JA. Perineal implantation of carcinoma of prostate following needle biopsy- A Case Report. J Urol 1972; 107: 821-827.
34. Bissada NK, Rountree GA, Sulaiman JS. Factors affecting accuracy and morbidity of transrectal biopsy of prostate. Surg Gynae Obstet 1977; 145: 185-188.
35. Thomson PM, Pryor JP, Williams JP, Eyers DE, Dulake C, Skully MF. The problem of infection after prostate biopsy via transrectal approach. Br J Urol 1982: 54: 736-743.
36. Volter D and Ziegler H. The cytological detection of prostate carcinoma by transrectal needle aspiration. J Urol 1981; 29(5): 98-101.
37. Eaton AC. The safety of transrectal biopsy of the prostate as an outpatient investigation. Br J Urol 1981; 53:144-148.
38. Hosking DH, Paraskevas M, Hellsten OR, Ramsey EW. The cytological detection of prostate carcinoma by transrectal needle aspiration. J Urol 1983; 129(5): 998-1000.
39. Al-Ababi H. Fine needle aspiration biopsy’s ultrasound guided transrectal random core biopsy of the prostate- comparative investigation in 240 cases. Acta Cytol 1997; 41: 981-986.
40. Narayan P, Jagodia P, Stein R, Tanagho E. A Comparison of FNA and Core biopsy in the diagnosis and preoperative grading of prostatic cancer. J Urol 1989; 141: 560-563.
41. M Cho, Schimizu K, Kajima O, Yamada H. FNAC in Screening of Prostatic Cancer. Hinyokika Kiyo 1995; 41(5):365-368.
42. Ljung B M, Cherrie R, Kauffman JJ. Fine needle aspiration biopsy of the prostate gland. A study of 103 cases with histologic follow up. J Urol 1986; 135: 955-958.
43. Chodak GW, Steinberg GD, Bibi M, Wied G, Strai FS,Vogelzang NJ. The Role of transrectal aspiration biopsy in the diagnosis of prostatic cancer. J Urol 1986; 135 (2): 299-302.
44. Delliveliotis C, Stavropoulos NJ, Macrychoritis C, Koutsokalis G, Kostakopaulos H. Transrectal needle aspiration versus trans-perineal biopsy in the diagnosis of prostatic cancer. Int Urol Nephrol 1995; 27(2):173-177.
45. Carter HB, Richle RA, Koizumi JH, Amberson J, Vaughan ED. Fine needle aspiration of the abnormal prostate- A cyto- histological correlation. J Urol 1986; 138: 294-296.
46. Pantola C, Kala S, Singh PK, Agarwal A, Amit S. A correlative study between transrectal FNAC and histology of the prostate for the detection of prostate carcinoma. J Dent Med 2012; 1:18-20.
47. Saleh AF, Nahar R, Rahman AJ, Salam MA, Islam F. Role of FNAC in the diagnosis of Prostatic lesions with histologic correlation. Bangladesh Med Res Council Bull 2005; 31(3):95-103.
48. William YC, Qu YC, Yang CR, Chang CL, Hwang T. A comparison of transrectal FNAC and biopsy of prostatic lesions. Zhonghus Path J 2002; 50(1):46-51.
49. Qu YC, Yang CR, Tarim PM, Beamud CM. Transrectal FNA in the diagnosis of prostatic carcinoma in elderly patients. Acta Urol Esp 2010; 33(5):485-490.
50. Kaur H, Paul M, Manjari M, Sharma S, Bhasin TS, Mannan R. Ki-67 and p53 immunohistochemical expression in prostate carcinoma: An experience from a tertiary care centre of North India. Ann Path Lab Med 2016; 3(6):509-516.
51. Bentley ME, Mallery WR, Mueller JJ, Anderson MC, Scott AW, Flagel G et al. Acta Cytol 1988; 42(4): 499-503.
52. Melagrana F, Oertel YC, Kwart AM. Prospective controlled assessment of fine needle prostate aspiration. Urol 1982; 19(1): 47-51.
53. Lin B, Davies WE, Harmata PA. Prostatic aspiration cytology.Pathol 1979;11: 607-614.
54. Judith JT., Krishna B, Usha P, Suresh B. Validity of Fine Needle Aspiration Cytology in Diagnosis of Prostatic Lesions and Correlation with Trucut Biopsy. North Am J Med Sci 2014; 7(2): 1-4.
55. Mallik MK and Najma K. Fine needle aspiration cytology of lesions of prostate glands and its correlation with its histopathology. Indian J Sci Res. 2017; 7(2): 97-103.
56. Dhanamjaya RT, Sreelatha V, Hareesh KA. A Study of Prostatic Lesions With Reference To FNAC Evaluation and Histopathology. Dental and Med Sci 2015; 14(2):42-46.
57. Epstein NA. Prostate biopsy- A morphologic correlation of aspiration cytology with needle biopsy. Cancer 1976; 38: 2078-2087.
58. Battaglia S, Barbolini G, Botticelli AR. Early prostate cancer. Morgagni 1974; 7:77-81.
59. Gaetani DCF and Trentini GP. Atypical hyperplasia of the prostate- A pitfall in the cytologic diagnosis of carcinoma. Acta Cytol 1978; 22(6): 483-486.
60. Mohler JL, Erozan YS, Walsh PC, Epstein IJ. FNA biopsy: A new method for diagnosis of prostatic carcinoma. Cancer 1989; 63: 1846-1855.
61. Diana P, Ouzzane A, Ahmed HU, Emberton M, Montironi R, Presti Jr JC et al. Quantitative tissue analyses of prostate cancer foci in an unselected cystoprostatectomy series. Br J Urol 2012; 110(4):517-519.
2. Franzen S, Giertz G, Zajicek J. Cytologic diagnosis of prostatic tomours by Transrectal aspiration biopsy: a preliminary report. Brit J Urol 1960; 32:193-196.
3. Esposti PL. Cytologic diagnosis of prostatic tumours with the aid of transrectal FNAB - A critical review of 1110 cases and report of morphologic and cytochemical studies. Acta Cytol 1996;10:182-188.
4. Zajicek J. Aspiration biopsy cytology: cytology of infra-diaphragmatic organs. Clin Cytol 1979; 7: 129-164.
5. Ekman H, Hedberg K, Pearson PS. Cytological versus histological examination of needle biopsy specimens in the diagnosis of prostatic cancers. BR J Urol 1967; 39: 544-548.
6. Alfthan O, Klintrup HE, Koivuneimi A, Taskinen F. Cytological aspiration biopsy and vim silverman biopsy in the diagnosis of prostate carcinoma. Ann Chirr Gynae Fenn 1970;59: 226-229.
7. Kline TS and Kannan V. Prostatic aspirate: a cytomorphologic analysis with emphasis on well differentiated carcinoma. Diag Cytopathol 1982; 1:13-17.
8. Koss LG. Koss Diagnostic Cytology and its Histologic Basis. 5th Edn, Lippincott Williams and Wilkins Publishers, 2017; pp 912-913.
9. Gawandi A. “Being Mortal†Medicine and what matters in the end. Hamish Hamilton and Penguin Publishers, 1st Edn, 2014: pp1-12.
10. Ingle SP and Ingle RS. The Efficiency of the Serum Prostate Specific Antigen Levels in Diagnosing Prostatic Enlargements. J Clin Diagn Res JCDR 2013; 7(1):82-88.
11. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G et al. ESUR prostate MR guidelines. Eur Radiol 2012; 22(4):746-57.
12. Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L et al. Image-guided prostate biopsy using magnetic resonance imaging–derived targets: a systematic review. Eur Urol 2013; 63(1):125-40.
13. Vargas HA, Hötker AM, Goldman DA, Moskowitz CS, Gondo T, Matsumoto K et al. Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 2016; 26(6):1606-1612.
14. Hermida PJ, Ochoa U, Ramos RA, Acost- Bernad I, Vento RJ, Mesa BD. FNAC in the diagnosis of prostatic cancer. Arch Esp Urol 2001; 54:23-33.
15. Johnson G and Fajers CM. Cancer cells in prostatic secretion. Acta Cher Scand 1950; 90:545-547.
16. Jung KW, Park S, Kong HJ. Cancer statistics in Korea: Incidence, mortality and survival in 2006-2007. J Kor Med Sci 2010; 25:1113-1121.
17. Jung KW, Park S, Won YS. Prediction of cancer incidence and mortality in Korea . Cancer Res Treat 2011; 43:12-18.
18. Mandhani A. Early prostatic cancer- Radical prostatectomy or watchful waiting. The Nat J India 2005;18(4): 23-26.
19. Reddy SD and Rani S. Efficacy of FNAC in early diagnosis of prostatic carcinoma. IAIM 2016; 3(10):100-114.
20. Scadino PT, Weaver R, Hudson MA. Early detection of prostate cancer. Hum Pathol 2011, 23: 231-234.
21. Guinan P, Bush I, Ray V, Rao R, Bhatti R, Veith R. The accuracy of rectal examination in the diagnosis of prostate carcinoma. N Eng J Med 1980; 303: 409-412.
22. Jewitt HJ. Significance of palpable prostatic nodule, JAMA 1956; 160:838-840.
23. Goodwin WE. In Proc. Third Nation Conference. Early case funding of prostate. Ist Ed, Philadephia, Lippincott publishers, 1957; p: 196-199.
24. Mondal C, Ghosh A, Ghosh E. The role of transrectal FNAC in the diagnosis of prostate nodule suspicious of malignancy. Ind J Pathol Microbiol 1990; 33(1): 23-29.
25. Tariq I, Tammana C, Khan KH, Nahar R. Fine needle aspiration cytology of prostatic lesion with histologic correlation. Ibrahim Med Coll J 2007; 1:7-10.
26. Planelles GJ, Beltran AJ, Alonso HS, Tarim PM, Beamud CM, Gil SM. Value of transrectal FNA in the diagnosis of prostatic carcinoma in elderly patients. Acta Urol Esp 2008; 32(5):485-491.
27. Gomez S, Henry H, William JP. Transrectal Prostatic biopsy. Br Med J 2010; 4: 595-597.
28. Suhrland MJ, Dietch D, Schreber K. Assessment of FNAC as a screening tool of occult prostatic cancer. Acta Cytol 1988; 32: 495-498.
29. Kher AV, Gadkari PR, Munshi MM, Grover SV. Trans rectal FNAC of the prostate. J Cytol 1989; 6: 28-38.
30. Hock EF, Wood FW, Kosinski AA. The Cytologic Detection of Prostatic Carcinoma: Its Clinical Application. J Urol 1950; 63:1081-1085.
31. Wahi PN. Cytologic diagnosis of prostate carcinoma. Natl Cancer Inst Monogr 1979;149:7-11.
32. Anderson L, Jonnnson G, Brunk U. Puncture biopsy of the prostate in the diagnosis of prostatic cancers. Scand J Urol Nephrol 1967; 1: 227-234.
33. Puigvert A, Elizalde C, Maltz JA. Perineal implantation of carcinoma of prostate following needle biopsy- A Case Report. J Urol 1972; 107: 821-827.
34. Bissada NK, Rountree GA, Sulaiman JS. Factors affecting accuracy and morbidity of transrectal biopsy of prostate. Surg Gynae Obstet 1977; 145: 185-188.
35. Thomson PM, Pryor JP, Williams JP, Eyers DE, Dulake C, Skully MF. The problem of infection after prostate biopsy via transrectal approach. Br J Urol 1982: 54: 736-743.
36. Volter D and Ziegler H. The cytological detection of prostate carcinoma by transrectal needle aspiration. J Urol 1981; 29(5): 98-101.
37. Eaton AC. The safety of transrectal biopsy of the prostate as an outpatient investigation. Br J Urol 1981; 53:144-148.
38. Hosking DH, Paraskevas M, Hellsten OR, Ramsey EW. The cytological detection of prostate carcinoma by transrectal needle aspiration. J Urol 1983; 129(5): 998-1000.
39. Al-Ababi H. Fine needle aspiration biopsy’s ultrasound guided transrectal random core biopsy of the prostate- comparative investigation in 240 cases. Acta Cytol 1997; 41: 981-986.
40. Narayan P, Jagodia P, Stein R, Tanagho E. A Comparison of FNA and Core biopsy in the diagnosis and preoperative grading of prostatic cancer. J Urol 1989; 141: 560-563.
41. M Cho, Schimizu K, Kajima O, Yamada H. FNAC in Screening of Prostatic Cancer. Hinyokika Kiyo 1995; 41(5):365-368.
42. Ljung B M, Cherrie R, Kauffman JJ. Fine needle aspiration biopsy of the prostate gland. A study of 103 cases with histologic follow up. J Urol 1986; 135: 955-958.
43. Chodak GW, Steinberg GD, Bibi M, Wied G, Strai FS,Vogelzang NJ. The Role of transrectal aspiration biopsy in the diagnosis of prostatic cancer. J Urol 1986; 135 (2): 299-302.
44. Delliveliotis C, Stavropoulos NJ, Macrychoritis C, Koutsokalis G, Kostakopaulos H. Transrectal needle aspiration versus trans-perineal biopsy in the diagnosis of prostatic cancer. Int Urol Nephrol 1995; 27(2):173-177.
45. Carter HB, Richle RA, Koizumi JH, Amberson J, Vaughan ED. Fine needle aspiration of the abnormal prostate- A cyto- histological correlation. J Urol 1986; 138: 294-296.
46. Pantola C, Kala S, Singh PK, Agarwal A, Amit S. A correlative study between transrectal FNAC and histology of the prostate for the detection of prostate carcinoma. J Dent Med 2012; 1:18-20.
47. Saleh AF, Nahar R, Rahman AJ, Salam MA, Islam F. Role of FNAC in the diagnosis of Prostatic lesions with histologic correlation. Bangladesh Med Res Council Bull 2005; 31(3):95-103.
48. William YC, Qu YC, Yang CR, Chang CL, Hwang T. A comparison of transrectal FNAC and biopsy of prostatic lesions. Zhonghus Path J 2002; 50(1):46-51.
49. Qu YC, Yang CR, Tarim PM, Beamud CM. Transrectal FNA in the diagnosis of prostatic carcinoma in elderly patients. Acta Urol Esp 2010; 33(5):485-490.
50. Kaur H, Paul M, Manjari M, Sharma S, Bhasin TS, Mannan R. Ki-67 and p53 immunohistochemical expression in prostate carcinoma: An experience from a tertiary care centre of North India. Ann Path Lab Med 2016; 3(6):509-516.
51. Bentley ME, Mallery WR, Mueller JJ, Anderson MC, Scott AW, Flagel G et al. Acta Cytol 1988; 42(4): 499-503.
52. Melagrana F, Oertel YC, Kwart AM. Prospective controlled assessment of fine needle prostate aspiration. Urol 1982; 19(1): 47-51.
53. Lin B, Davies WE, Harmata PA. Prostatic aspiration cytology.Pathol 1979;11: 607-614.
54. Judith JT., Krishna B, Usha P, Suresh B. Validity of Fine Needle Aspiration Cytology in Diagnosis of Prostatic Lesions and Correlation with Trucut Biopsy. North Am J Med Sci 2014; 7(2): 1-4.
55. Mallik MK and Najma K. Fine needle aspiration cytology of lesions of prostate glands and its correlation with its histopathology. Indian J Sci Res. 2017; 7(2): 97-103.
56. Dhanamjaya RT, Sreelatha V, Hareesh KA. A Study of Prostatic Lesions With Reference To FNAC Evaluation and Histopathology. Dental and Med Sci 2015; 14(2):42-46.
57. Epstein NA. Prostate biopsy- A morphologic correlation of aspiration cytology with needle biopsy. Cancer 1976; 38: 2078-2087.
58. Battaglia S, Barbolini G, Botticelli AR. Early prostate cancer. Morgagni 1974; 7:77-81.
59. Gaetani DCF and Trentini GP. Atypical hyperplasia of the prostate- A pitfall in the cytologic diagnosis of carcinoma. Acta Cytol 1978; 22(6): 483-486.
60. Mohler JL, Erozan YS, Walsh PC, Epstein IJ. FNA biopsy: A new method for diagnosis of prostatic carcinoma. Cancer 1989; 63: 1846-1855.
61. Diana P, Ouzzane A, Ahmed HU, Emberton M, Montironi R, Presti Jr JC et al. Quantitative tissue analyses of prostate cancer foci in an unselected cystoprostatectomy series. Br J Urol 2012; 110(4):517-519.
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Khan AA, Jain PK, Juneja B, Talha M, Mehdi G, Akhtar K, et al. Evaluation of The Role of Transrectal Fine Needle Aspiration As A Diagnostic Modality in The Diseases of Prostate with Review of Literature. Ann of Pathol and Lab Med [Internet]. 2019 Apr. 8 [cited 2024 Nov. 24];6(3):A171-179. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/2117
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Copyright (c) 2019 Ansar A Khan, Prashant K Jain, Binjul Juneja, Mohammad Talha, Ghazala Mehdi, Kafil Akhtar, Ghahlaut YS
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