Umbilical metastasis diagnosed by fine needle aspiration

Fine needle aspiration (FNA) is emerging as a useful diagnostic tool in the evaluation of tumor masses, providing high diagnostic yield. Fine needle aspiration for cytologic evaluation was performed on 14 patients suspected of having umbilical metastasis. The site of the primary tumor was known in 12 patients. In nine patients with previously documented malignancy, FNA of the umbilical nodule demonstrated malignant cells compatible with the histologic diagnosis of the primary cancer. In five other patients metastatic umbilical nodule was the first or the only sign for the presence of primary cancer elsewhere and in four of them FNA revealed malignant cells prior to the diagnosis of internal carcinoma. In one case, FNA demonstrated only inflammatory cells while surgery revealed adenocarcinoma associated with inflammation. The sensitivity of FNA in diagnosing malignant umbilical nodule, and the accuracy of FNA findings were 98.2%, while the predictive value of a FNA cytologic finding of malignancy was 100%. It is recommended that an umbilical nodule should alert the clinician to the possibility of malignancy and FNA should be performed as the first diagnostic procedure. This safe, rapid, reliable, and inexpensive method may diagnose malignancy and preclude the need for umbilical biopsy or more complicated diagnostic intervention.