Cytological Evaluation of the Prostate Gland by Fine Needle Aspiration Biopsy
EARLY REPORTS OF THE USE OF NEEDLES for the purpose of biopsy first appeared in the 19th century. Leydon is mentioned as having aspirated tissue from the lung of a patient with pneumonia in 1883.1 By 1921, Guthrie, at the Johns Hopkins Hospital, reported
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for the purpose of biopsy first appeared in the 19th century. Leydon is mentioned as having aspirated tissue from the lung of a patient with pneumonia in 1883. 1 By 1921, Guthrie, at the Johns Hopkins Hospital, reported on a method of performing fine needle aspiration biopsy in a fashion much as we know it today.2 Its first large scale use was reported by Martin, Ellis, and Stewart from Memorial Hospital (New York) in the 1930s.3-4 Evaluation of the prostate gland by fine needle aspiration biopsy (FNAB) is credited to Russell Ferguson, a urologist from Memorial Hospital in New York. In 1930, beginning with a paper in the American Journal of Surgery: "Prostatic Neoplasms: their diagnosis by needle puncture and aspiration,"5 he described a transperineal aspiration biopsy technique using an 18 gauge needle. Subsequent reports followed from Ferguson and Keyes at New York Address correspondence to: John A. Maksem, M.D., Aspiration Biopsy Laboratory, Inc. Central Medical Arts Bldg. 2475 E22nd St. #B6 Cleveland, Ohio 44115.
Hospital,6 but a group of unfavorable articles in the 1940s temporarily halted interest in the procedure. 7,8,9 It was not until 1960 that FNAB of the prostate was reintroduced by Sixteen Franzen and his associates at Sweden's Karolinska Institute. 1O They devised and popularized a method for obtaining transrectal aspiration biopsies on an outpatient basis. Twenty years later, JanSilvester Willems and Torsten Lowhagen reported that approximately 750 prostatic FNABs were being performed annuallyat the Karolinska Hospital, and that approximately 30% of these were diagnostic of prostatic carcinoma. 11
INDICATIONS FOR FNAB PROSTATE According to Mostofi, 12 the prostate gland is a labile, restless organ with a tremendous potential ranging from seemingly quiescent atrophy to a wide spectrum of growth phenomena from locally. confined benign, but progressive growths, to locally confined and
189 C. M. Fenoglio-Preiser et al. (eds.), Progress in Surgical Pathology © Springer-Verlag Berlin Heidelberg 1989
Maksem et al
190 slowly growing but invasive neoplasms, to very aggressive metastasizing tumors. 12 Enlargement of the prostate gland affects almost every man who reaches the age of 50 years. Nodular hyperplasia is the most common symptomatic tumoral condition in man and carcinoma is the second most frequentcause of death from cancer in the male population in the United States. 12 Latent (clinically stage A) carcinomas of the prostate progressively increase in incidence from about 4% in the third decade to about 80% in the 9th decade. 13 According to Koss,14 the primary purpose of a morphologic examination of prostatic tissue is the diagnosis of carcinoma and the assessment of optimal therapeutic approaches to the disease. DeKemion 's has summarized the raison d'etre of FNAB as follows: " ... more frequent biopsy, if justified on the basis of safety and accuracy, should lead to an increased number of cancers that are diagnosed in the early stages, and potentially de
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