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Purpose: The aim of this prospective study was to determine the incidence of enlarged supraclavicular lymph nodes by US and the diagnostic yield of US-guided aspiration cytology in the diagnosis of sarcoidosis., Methods: During a 54-month period, all consecutive patients with a clinical suspicion of sarcoidosis underwent supraclavicular US at the Kiljava Hospital, Finland. All patients with enlarged supraclavicular lymph nodes underwent US-guided fine-needle aspiration biopsy (FNAB) of the lymph node., Results: Of a total of 250 patients, 27 (10.8%) had enlarged supraclavicular lymph nodes at US. All these were non-palpable at clinical examination. The cytological specimen was quantitatively sufficient in 25 of the 27 cases (93%). In 22 (88%) of these, the cytological diagnosis was granulomatous inflammation suggestive of sarcoidosis. Three aspirates yielded reactive hyperplasia and 2 specimens were insufficient. No complications occurred. The patients were followed for 2-42 months (mean 19 months), and the diagnosis of sarcoidosis was confirmed clinically in all cases., Conclusion: Supraclavicular US detects non-palpable enlarged lymph nodes in 1/10 of the patients with suspected sarcoidosis. In this subgroup of patients, US combined with aspiration cytology may give cytological evidence of granulomatous disease similar to sarcoidosis and more invasive diagnostic methods can be avoided.

The results of 15 consecutive automated cutting needle (1.2 mm, n = 14; 2.0 mm, n = 1) biopsies of diffuse lung manifestations are presented. Sufficient material for histologic analysis was obtained in 13 of 15 specimens (87%) and a specific diagnosis was obtained in 11 of 14 patients (79%). The tissue specimen confirmed the clinically probable lung disease in 6 patients, gave a new, unsuspected, diagnosis in 2, and resolved a differential diagnostic problem in 3 patients. One pneumothorax after a 2.0-mm needle biopsy necessitated catheter drainage. We conclude that percutaneous lung biopsy with the automated biopsy device mounted with a 1.2-mm needle yields a histologic diagnosis with high accuracy in interstitial and alveolar lung changes, reducing the need for more invasive methods such as open lung biopsy.

Five anterior mediastinal tumors were biopsied with a fine needle under ultrasound guidance. All the tumors were solid, hypoechoic, perivascularly situated masses. Their mean diameter was 7.2 cm. Cytologically there were 2 mediastinal metastatic carcinomas, 1 poorly differentiated carcinoma or non-Hodgkin lymphoma, 1 germ-cell tumor (embryonal cell carcinoma), and 1 malignant lymphoma or thymoma. There were no complications. Ultrasound-guided anterior mediastinal aspiration biopsy is a safe and rapid procedure in the evaluation of anterior mediastinal masses. Biopsy of a mediastinal mass enables simultaneous diagnosis and staging. Mediastinoscopy and diagnostic thoracotomy can be avoided.

Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179 patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C-IV-V) and benign (C-I-II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C-I-II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. US-guided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.

Ultrasound-guided fine needle aspirates from 52 malignant renal tumours and 128 benign expansions taken in 1982-1988 were analyzed retrospectively. There were three suspicious aspirates (class III) suggesting a possibility of malignancy among the cases of benign renal expansions and seven false negative aspirates (C I-II) among the malignancies. The accuracy, sensitivity and specificity of the method for differentiating malignant cases from benign ones were 94.1%, 85.1% and 97.5% respectively. Cytology was correct in 86% of the radiologically equivocal cases and in 63.6% of the small renal neoplasms. Aspiration cytology identifies haemorrhagic cysts and infectious conditions, but is not reliable for the detection of malignancy in a multilocular cyst.