Journal of Cytology
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REVIEW ARTICLE
Year : 2001  |  Volume : 18  |  Issue : 1  |  Page : 1-7

Bone FNAC expectations & Limitations - A review - (Part - I)


1 Professor., Department of Pathology, Tata Memorial Hospital, Dr.E.Borges Road, Parel, Mumbai 12, India
2 Senior Registrar, Department of Pathology, Tata Memorial Hospital, Dr.E.Borges Road, Parel, Mumbai 12, India
3 Ex-Registrar, Department of Pathology, Tata Memorial Hospital, Dr.E.Borges Road, Parel, Mumbai 12, India

Correspondence Address:
N A Jambhekar
Dept of Pathology, Tata Memorial Hospital, Dr.E.Borges Road, Parel, Mumbai 12
India
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Source of Support: None, Conflict of Interest: None


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The generally increasing costs of medical care and hospitalization in state run or trust run hospitals is a matter of great concern. Providing quality medical care at an affordable rate, without in any way compromising end results is the buzzword of institutional practice. FNAC is a diagnostic modality, which helps lower the costs of pre-operative work-up and hospitalization, and at the same time provides results with high specificity and sensitivity. The raging popularity of FNAC in general however did not affect or significantly alter the preoperative work-up of skeletal lesions. The reasons for this are two-fold: (i) bone tumours are uncommon, (ii) and more importantly, the stakes involved while dealing with bone tumours are high. Hence, although FNAC of bone was first attempted in the 1930's by Martin & Ellis 1 and later by Stromby and Ackerman (1973)2, neither orthopaedicians nor pathologists were much enthused by skeletal FNAC The ease, simplicity, speed and cost3 of FNAC coupled with the popularity of neoadjuvant chemotherapy and limb sparing procedures for malignant bone tumours, has revived interest in bone FNAC as highlighted by the numerous recent publications on this subject comprising sizeable number of cases4-17. The ensuing comments are based on experience of the past 13 years (since 1987) at a major cancer hospital, which accessions on an average 110 – 180 bone FNAC's per year. The data used in this article is based on an analysis of 518 cases of skeletal FNAC accrued during the period - 1987 to 1990. An element of institutional as well as personal bias is hence, inevitable in this review. The practice of FNAC of bone published from various Indian centers, comprising both series 18-25 as well as case reports 26-38, as well as publications from international centers, has been collated to evaluate the scope and limitations of this procedure. The first part of this article will deal with the technique of bone FNAC, optimization of aspirated material, factors which decide yield and adequacy, evaluation and classification of the smears and a comparison of both Indian and world data on skeletal FNAC. The second part will deal with cytomorphological observations on individual histologic entities together with the expectations and the scope and limitations.


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