https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/2 Sat, 23 Jul 2016 08:17:36 +0000 Abstract Ibrahim Med. Coll. J. 2007; 1(1): 7-10 Key words :  FNAC, Franzen, Papaniculaou Address for Correspondence: Dr. Tariqul Islam, Registrar-Pathology, Department of Pathology & Laboratory Medicine Square Hospital Limited, 18/F West Panthopath, Dhaka-1205 Introduction Fine needle aspiration biopsy of prostate is exclusively used in Scandinavian countries and in recent years it is also widely practiced in United Kingdom and United States of America. This study was undertaken with the aim to evaluate the effectiveness of transrectal fine needle aspiration cytology in the diagnosis of prostatic lesions and to determine the cytomorphological features of prostatic lesions. Materials and Methods         A total of 62 selected patients underwent fine needle aspiration of the enlarged prostate. FNAC was carried out with the help of 10 ml disposable plastic syringe with attached 23-25 gauge spinal needle under guidance of finger cot in all cases. Smears were stained with Papanicolaou’s stain. In only two cases, the smears were inadequate. Biopsy for histopathological examination was available in 58 cases. Table 1: Cytopathological diagnosis of 62 cases of prostatic lesions. Number of patients Benign lesions ( n=36) 58.06 32 Atypical hyperplasia 4.84 1 Malignant tumours (n=21) 33.9 19 Adenosquamous 1.61 1 Suspicious cells 4.84 2 Total 100.00         Histopathological Diagnosis FNA cytological Diagnosis   Nodular Hyperplasia Nodular hyperplasia Atypical Hyperplasia   Carcinoma Atypical hyperplasia Atypical Hyperplasia Carcinoma Carcinoma   Nodular Hyperplasia Total     Fig.4: Photomicrograph shows smear preparation of atypical hyperplasisa Biopsy specimen were available in 58 cases. Of them, 38caseswerediagnosedasnodularhyperplasia,2cases as atypical hyperplasia and 18 cases as carcinoma. Among the 38 benign cases, 34 cases were correctly diagnosed cytologically as nodular hyperplasia but in the remaining 4 cases, 3 cases were diagnosed as carcinoma and one case as atypical hyperplasia. Both cases of atypical hyperplasia were correctly diagnosed by cytology with 100% correlation. The sensitivity of this study is 94% and specificity is 92%. Discussion Prostatic cancer is often localized to the peripheral part of the gland, especially the posterior lobe but also the lateral lobes. It is therefore accessible to transrectal puncture biopsy. The instrument is directed towards the suspected part of the prostate. With experience it is seldom difficult to reach a suspicious area in the posterior part of the prostate by fine needle. On the other hand, if the lesion is central or situated near the floor of the bladder, it may be more readily accessible with a fine needle. In this study of 62 cases, satisfactory smears were obtained in 60 cases (96.77%) and in two cases (3.22%) smears were inadequate. A review of literature revealed that inadequate smears were obtained in many of the studies. In this study, 21 (33.87%) cases were diagnosed cytologically as carcinoma of prostate. Out of these 21 cases, one case as metastatic transitional cell carcinoma, one case as adenosquamous carcinoma and 19 cases were diagnosed as adenocarcinoma. Biopsy was available in 18 cases. Out of these 18 cases, 17 cases were diagnosed as carcinoma histologically and 1 case was diagnosed as nodular hyperplasia. The concordance rate in the present study and the other studies are similar in case of carcinoma of prostate. Cytologic features in this study also agreed with Lin et al.4.   In our country the incidence of prostatic diseases, both carcinoma and nodular hyperplasia, is increasing with the demographic shift to longevity. With increased awareness of the clinical significance of prostate cancer and the advances made in surgical treatment, there is renewed clinical interest in attempting to identify patients with surgically curable disease. FNAC of prostate is of great importance as it helps the urologist to take proper decision about surgery. It is useful in distinguishing between benign and malignant lesions of prostate. No appreciable complications have occurred with this technique except mild discomfort and pain in some cases.   1.  Bruins JL, Lycklama A, Nijeholt AAB, Beekhuis- Brussee JAM. The value of fine needle aspiration biopsy in comparison with core biopsy histology. World J Urol 1989; 7: 2-26. 3. Koss LG. Diagnostic cytology and its Histopathologic bases. 4th ed. Philadelphia 1992. J.B. Lipinncott company; 1001-1002. 5.  Esposti PL. Cytological diagnosis of prostatic tumours with the aid of transrectal aspiration biopsy. A critical review of 11110 cases and a report of morphologic and cytochemical studies. Acta Cytol 1996; 10: 182. 2026 Ibrahim Medical College. All rights reserved.