Role of Image-Guided FNAC and Biopsy in Intra-abdominal and Pelvic Masses

Abstract

Introduction: Intra-abdominal masses present as a conundrum to clinicians. It is essential to determine their pathology before therapy can be instituted. The use of minimally invasive procedures like image-guided Fine Needle Aspiration Cytology (FNAC) and biopsy can help to avoid diagnostic laparotomy and is especially important for the diagnosis of impalpable and deep-seated lesions. Aim: To find out the pathological spectrum of abdomino-pelvic masses with use of guided FNAC or biopsy. Materials and Methods: This was a prospective study conducted over a period of January 2018 to June 2019 in a Tertiary Care Hospital in Greater Noida. In patients presenting with intra-abdominal or pelvic masses, detected clinically or radiologically, image-guided FNAC and/or biopsy was performed along with standard radiologic examination, and the slides were examined. Ultrasonography (USG) was used in 56 cases (96.6%) and Computed Tomography (CT) for the remaining 2 cases. The results were analysed using descriptive statistics. Results: The 58 patients presenting with intra-abdomino-pelvic masses had a mean age of 49 years and consisted of 30 (51.7%) males. The most common site involved was liver (19 cases, 32.7%) followed by gastrointestinal tract (7 cases, 12.1%), urinary bladder (6 cases, 10.3%), gall bladder and ovary (5 cases, 8.6% each), kidney, prostate, uterus and lymph node (3 cases, 5.2% each) and miscellaneous abdomino-pelvic masses (4 cases, 6.9%). Malignant and premalignant lesions were detected in 50 (86.2%) patients, of which 29 cases (50%) were primary, 20 (34.5%) were metastatic and 1 (1.72%) was premalignant. Six benign (10.35%) and 2 non-neoplastic (3.45%) lesions were detected. Malignancies were found most commonly in the liver, comprising 31.0% of the study group. Adenocarcinoma was the most commonly detected primary (15 cases, 25.8%) as well as secondary metastatic malignancy (12 cases, 20.7%). Radio-pathological correlation was found to be 79.3% for the study and varied according to the site, from zero in prostatic lesions to 100% in renal and uterine lesions. Radiologic concordance was observed in 100% non-neoplastic, 66.7% benign and 72.4% malignant lesions. Conclusion: Image-guided FNAC and biopsy are simple, rapid and inexpensive methods of arriving at a definite diagnosis, as radiology alone proves to be inadequate or erroneous in most of the cases.

Keywords

• abdominal mass
• fine needle aspiration cytology
• radiologically-guided