Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses

Fine needle aspirative cytology is a well-established diagnostic tool for evaluating tumor masses. The goal of the current study was to determine the diagnostic accuracy of direct (nonimaging-guided) fine needle aspiration of palpable abdominal masses excluding the liver.

Direct aspiration of a palpable abdominal mass was performed in 190 patients in order to confirm or to rule out malignancy. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 165 patients, of whom 130 had a malignant abdominal mass and 35 a benign abdominal mass. The cytologic findings were verified by correlation with histologic, cytologic, and clinical findings.

Among the 130 patients with a malignant abdominal mass, the cytologic findings failed to reveal malignancy in 12 patients (9.2%), but did reveal suspected malignancy in five (3.8%) and malignancy in 113 patients (86.9%). Among all 35 patients with a benign abdominal mass, the cytologic findings were reported as nonmalignant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of cytologic findings were 90.8%, 100%, 100%, 74.5%, and 92.7%, respectively. A nonfatal case of bile peritonitis and a case of localized peritonitis that, in retrospective, could have been avoided were the only major complications that followed the fine needle aspirative procedure.

With careful patient selection and meticulous attention to the proper procedure, direct fine needle cytology is a simple, safe, and highly accurate method for diagnosing palpable abdominal masses.