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To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNAB) in the primary diagnosis of lung cancer, we undertook a prospective study of this technique, assessing specimens from 124 patients over a 3-yr period. Cytologic and/or histologic material obtained by an alternate technique was available for 105 (84.7%) of the patients. The diagnostic sensitivity of TBNAB was comparable with that of other bronchoscopic techniques; with the addition of TBNAB, the overall sensitivity of bronchoscopy was increased from 54% to 72% (P less than 0.001). Because of its usefulness for diagnosis of submucosal tumors and its safety, we conclude that TBNAB is a useful addition to current methods for the diagnosis of suspicious pulmonary lesions.

Aspiration of tissue through a fine needle is a feasible way of obtaining material for diagnosis. The value, readability, and specificity of aspiration biopsy cytology is illustrated by a case in which nonpigmented neoplastic cells from an axillary mass were interpretable as metastatic malignant melanoma. That interpretation was later confirmed by conventional and electron microscopy of tissue. A search for the primary lesion led to recognition and excision of a malignant neoplasm with Schwannian features that probably arose in a congenital nevus.

The results of aspiration biopsy from 376 superficial lymph nodes were reviewed. Diagnosis of metastatic carcinoma based on "alien" cells and melanoma was easily made with an accuracy of 95%. The results of aspiration biopsy from lymphoma was much less accurate, and led to retrospective analysis of aspirates from 51 histologically verified cases of benign lymphadenopathy and lymphoma. Features suggestive of lymphoma included large immature lymphocytes, large histiocytes, abundant mitoses, and Reed-Sternberg cells. Thus, this safe office procedure, which immediately differentiates the lymph node from a cyst, inflammatory mass, or mesenchymal tumor, provides an important tool for diagnosis.

In this retrospective evaluation of 72 cases of fine needle aspiration biopsy of the prostate, 25 aspirates from well-differentiated carcinoma were compared with 27 aspirates from benign prostatic enlargement and 20 aspirates from moderately to poorly differentiated carcinoma. Each case was examined by a single observer (V.K.) for multiple parameters including cellularity, dyshesion, nuclear membrane irregularity, anisonucleosis, macronucleoli (major criteria of malignancy), cell and nuclear enlargement, and altered nuclear/cytoplasmic ratio. Cellularity was the most significant indicator, but all major and minor criteria of malignancy were consistently important for distinguishing well-differentiated carcinoma from benign lesions. Systematic use of these meaningful standards enhances diagnostic sensitivity.

Pituitary testicular functions were evaluated in leprosy. Forty-three men with leprosy were studied by basal estimations of plasma LH, FSH, Prolactin, Testosterone, 17-beta estradiol, metoclopramide stimulated prolactin responses and hCG stimulated testosterone responses. Fifteen young healthy men with proven fertility were studied as control subjects. The hormone estimations were related to the histologic changes observed in the testicular biopsies of leprous hypogonadism. In lepromatous leprosy (n:18) the basal plasma gonadotropin levels were significantly increased (FSH 29.5 +/- 2.3 mlU/ml; LH 21.5 +/- 1.9 mlU/ml, mean +/- SE). The plasma gonadotropins were in the normal range in tuberculoid leprosy. In borderline leprosy, the basal mean plasma FSH was normal, whereas LH levels were significantly increased (22.5 +/- 1.2 mlU/ml). The basal plasma testosterone levels were significantly decreased in lepromatous leprosy (1.6 +/- 0.12 ng/ml), tuberculoid leprosy (4.2 +/- 1.7 ng/ml) and borderline leprosy (1.8 +/- 0.18 ng/ml). The basal plasma 17-beta estradiol levels were significantly elevated in all the three types of leprosy. The basal plasma prolactin levels in plasma were significantly increased in lepromatous and tuberculoid leprosy. During hCG stimulation tests, the peak plasma testosterone responses were significantly reduced in both lepromatous leprosy and tuberculoid leprosy subjects. The blunted testosterone responses during hCG stimulation tests in leprosy correlated with the high basal 17-beta estradiol levels (r = 0.58; P less than 0.05). These results strongly suggest that hypogonadism in leprosy results from primary testicular failure. The significant elevation of plasma 17-beta estradiol levels in lepromatous, tuberculoid and borderline leprosy could play a role in hypogonadism of leprosy.

For the past 15 years at Lankenau Hospital, Philadelphia, more than 10,000 breast lesions have been aspirated; the distinctive cytomorphologic features of common carcinomas have been previously reported. This study is a cytomorphologic analysis of eight invasive papillary carcinomas. The parameters include the pattern and morphology of the tumor cells, and their measurements by ocular micrometry. The distinctive features of this unusual neoplasm are its papillary configuration, tall columnar cells, naked nuclei, and blood. The study is especially important because these neoplasms may be misinterpreted as benign tumors.

This work is based on 15 years experience with more than 9000 needle aspiration biopsies from the breast performed by a number of clinicians without syringe guns. From 1981 through 1983, 329 carcinomas were detected with a sensitivity of 90%. A positive or suspicious report was issued in 17 of the 32 minimal carcinomas. There were no false-positive diagnoses. A retrospective comparative study was made on the aspiration biopsy cytology specimens from 65 histologically verified carcinomas: 30 infiltrating ductal, 16 infiltrating lobular, 10 medullary, and 10 colloid carcinomas. Parameters included the pattern, major malignant criteria, and cell measurements by calibrated ocular micrometry. The classic features of each carcinoma and the differential cytomorphology are described.

Aspiration biopsy cytology by fine needle is becoming a popular diagnostic procedure for soft-tissue lesions; it also can be used successfully to diagnose some lesions from bone. The value of this procedure for making the initial diagnosis is illustrated by a case in which a malignant fibrous histiocytoma from a skull bone afflicted with Paget's disease was aspirated and interpreted as a sarcoma. This was later confirmed and subclassified by histology and electron microscopy from the tissue.

Fine needle aspiration biopsy cytology (ABC) has proven to be a valuable tool for diagnosis of metastatic and primary melanoma. The ABC of 28 cases was studied and the findings tabulated. Melanin can be verified by Fontana-Masson stain. Additional salient features include cell isolation, anisocytosis, multinucleation, eosinophilic nucleoli, and intranuclear inclusions. Use of all of these cytomorphologic findings will result in accurate diagnosis of melanoma by ABC.