Skip to main content
SpringerLink
Log in

Bone

  • Chapter
  • First Online:
Atlas of Fine Needle Aspiration Cytology

Abstract

Methods for percutaneous sampling such as core needle biopsy (CNB) and drill biopsy have, in recent years, emerged as important diagnostic substitutes for open biopsy of bone neoplasms. In addition, fine-needle aspiration cytology (FNAC) has been used for many years in the diagnosis of bone lesions. As early as 1931, Coley and Ellis applied this sampling method to bone neoplasms. To date, several large series of FNA examination of bone lesions have been published. There are several advantages to skeletal FNAC. The procedure is less traumatic than either CNB or open biopsy and can be used safely in difficult sites such as vertebrae or pelvic bone. FNAC allows rapid triage with coordination of further investigations and planning of anticipated therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg. 1930;92:169–81.

    Article  PubMed  CAS  Google Scholar 

  2. Khalbuss WE, Teot LA, Monaco SE. Diagnostic accuracy and limitations of fine-needle aspiration cytology of bone and soft tissue lesions: a review of 1114 cases with cytological-histological correlation. Cancer Cytopathol. 2010;118:24–32.

    Article  PubMed  Google Scholar 

  3. Layfield LJ. Cytologic diagnosis of osseous lesions: a review with emphasis on the diagnosis of primary neoplasms of bone. Diagn Cytopathol. 2009;37:299–310.

    Article  PubMed  Google Scholar 

  4. Handa U, Bal A, Mohan H, Bhardwaj S. Fine needle aspiration cytology in the diagnosis of bone lesions. Cytopathology. 2005;16:59–64.

    Article  PubMed  CAS  Google Scholar 

  5. Layfield LJ, Dodd LG, Hirschowitz S, Crabtree SN. Fine-needle aspiration of primary osseous lesions: a cost effectiveness study. Diagn Cytopathol. 2010;38:239–43.

    PubMed  Google Scholar 

  6. Willen H. Fine needle aspiration in the diagnosis of bone tumors. Acta Orthop Scand Suppl. 1997;273:47–53.

    PubMed  CAS  Google Scholar 

  7. Bommer KK, Ramzy I, Mody D. Fine-needle aspiration biopsy in the diagnosis and management of bone lesions: a study of 450 cases. Cancer. 1997;81:148–56.

    Article  PubMed  CAS  Google Scholar 

  8. Jayaram G, Gupta M. Fine needle aspiration cytology in the diagnosis of bone tumours. Malays J Pathol. 1994;16:137–44.

    PubMed  CAS  Google Scholar 

  9. Kreicbergs A, Bauer HC, Brosjö O, Lindholm J, Skoog L, Söderlund V. Cytological diagnosis of bone tumours. J Bone Joint Surg Br. 1996;78:258–63.

    PubMed  CAS  Google Scholar 

  10. Akerman M, Berg NO, Persson BM. Fine needle aspiration biopsy in the evaluation of tumor-like lesions of bone. Acta Orthop Scand. 1976;47:129–36.

    Article  PubMed  CAS  Google Scholar 

  11. Akerman M, Killander D, Rydholm A, Rööser B. Aspiration of musculoskeletal tumors for cytodiagnosis and DNA analysis. Acta Orthop Scand. 1987;58:523–8.

    Article  PubMed  CAS  Google Scholar 

  12. Koscick RL, Petersilge CA, Makley JT, Abdul-Karim FW. CT-guided fine needle aspiration and needle core biopsy of skeletal lesions. Complementary diagnostic techniques. Acta Cytol. 1998;42:697–702.

    Article  PubMed  CAS  Google Scholar 

  13. Söderlund V, Tani E, Domanski H, Kreicbergs A. Representativeness of radiologically guided fine-needle aspiration biopsy of bone lesions. Sarcoma. 2002;6:61–8.

    Article  PubMed  Google Scholar 

  14. Soderlund V, Skoog L, Kreicbergs A. Combined radiology and cytology in the diagnosis of bone lesions: a retrospective study of 370 cases. Acta Orthop Scand. 2004;75:492–9.

    Article  PubMed  Google Scholar 

  15. Akerman M, Domanski HA, Jonsson K. Morphological diagnosis of bone tumours. Monogr Clin Cytol. 2010;19:7–12.

    PubMed  Google Scholar 

  16. Akerman M, Domanski HA. Fine needle aspiration (FNA) of bone tumours. With special emphasis on definitive treatment of primary malignant bone tumours based on FNA. Curr Diagn Pathol. 1998;5:82–92.

    Article  Google Scholar 

  17. Jorda M, Rey L, Hanly A, Ganjei-Azar P. Fine-needle aspiration cytology of bone: accuracy and pitfalls of cytodiagnosis. Cancer. 2000;90:47–54.

    Article  PubMed  CAS  Google Scholar 

  18. Agarwal S, Agarwal T, Agarwal R, Agarwal PK, Jain UK. Fine needle aspiration of bone tumors. Cancer Detect Prev. 2000;24:602–9.

    PubMed  CAS  Google Scholar 

  19. Wedin R, Bauer HC, Skoog L, Söderlund V, Tani E. Cytological diagnosis of skeletal lesions. Fine-needle aspiration biopsy in 110 tumours. J Bone Joint Surg Br. 2000;82:673–8.

    Article  PubMed  CAS  Google Scholar 

  20. Kabukçuoğlu F, Kabukçuoğlu Y, Kuzgun U, Evren I. Fine needle aspiration of malignant bone lesions. Acta Cytol. 1998;42:875–82.

    Article  PubMed  Google Scholar 

  21. Aström KG, Sundström JC, Lindgren PG, Ahlström KH. Automatic biopsy instruments used through a coaxial bone biopsy system with an eccentric drill tip. Acta Radiol. 1995;36:237–42.

    Article  PubMed  Google Scholar 

  22. Walther C, Domanski HA, von Steyern FV, Mandahl N, Mertens F. Chromosome banding analysis of cells from fine-needle aspiration biopsy samples from soft tissue and bone tumors: is it clinically meaningful? Cancer Genet. 2011;204:203–6.

    Article  PubMed  CAS  Google Scholar 

  23. Gautam U, Srinivasan R, Rajwanshi A, Bansal D, Marwaha RK, Vasishtha RK. Reverse transcriptase-polymerase chain reaction as an ancillary molecular technique in the diagnosis of small blue round cell tumors by fine-needle aspiration cytology. Am J Clin Pathol. 2010;133:633–45.

    Article  PubMed  CAS  Google Scholar 

  24. Gautam U, Srinivasan R, Rajwanshi A, Bansal D, Marwaha RK. Comparative evaluation of flow-cytometric immunophenotyping and immunocytochemistry in the categorization of malignant small round cell tumors in fine-needle aspiration cytologic specimens. Cancer. 2008;114:494–503.

    Article  PubMed  Google Scholar 

  25. Sanati S, Lu DW, Schmidt E, Perry A, Dehner LP, Pfeifer JD. Cytologic diagnosis of Ewing sarcoma/peripheral neuroectodermal tumor with paired prospective molecular genetic analysis. Cancer. 2007;111:192–9.

    Article  PubMed  CAS  Google Scholar 

  26. Walaas L, Kindblom LG. Light and electron microscopic examination of fine-needle aspirates in the preoperative diagnosis of osteogenic tumors: a study of 21 osteosarcomas and two osteoblastomas. Diagn Cytopathol. 1990;6:27–38.

    Article  PubMed  CAS  Google Scholar 

  27. Domanski HA, Akerman M. Fine-needle aspiration of primary osteosarcoma: a cytological-histological study. Diagn Cytopathol. 2005;32:269–75.

    Article  PubMed  Google Scholar 

  28. McLaughlin RE, Miller WR, Miller CW. Quadriparesis after needle aspiration of the cervical spine. Report of a case. J Bone Joint Surg Am. 1976;58:1167–8.

    PubMed  CAS  Google Scholar 

  29. Rhode MG, Lucas DR, Krueger CH, Pu RT. Fine-needle aspiration of spinal osteoblastoma in a patient with lymphangiomatosis. Diagn Cytopathol. 2006;34:295–7.

    Article  PubMed  Google Scholar 

  30. Mondal A, Misra DK. CT-guided needle aspiration cytology (FNAC) of 112 vertebral lesions. Indian J Pathol Microbiol. 1994;37:255–61.

    PubMed  CAS  Google Scholar 

  31. Sathiyamoorthy S, Ali SZ. Osteoblastic osteosarcoma: cytomorphologic characteristics and differential diagnosis on fine-needle aspiration. Acta Cytol. 2012;56:481–6.

    Article  PubMed  Google Scholar 

  32. Dodd LG, Scully SP, Cothran RL, Harrelson JM. Utility of fine-needle aspiration in the diagnosis of primary osteosarcoma. Diagn Cytopathol. 2002;27:350–3.

    Article  PubMed  Google Scholar 

  33. Dodd LG, Chai C, McAdams HP, Layfield LJ. Fine needle aspiration of osteogenic sarcoma metastatic to the lung. A report of four cases. Acta Cytol. 1998;42:754–8.

    Article  PubMed  CAS  Google Scholar 

  34. Gupta N, Rajwanshi A, Gupta P, Vaiphei K, Gupta AK. Chondroblastic osteosarcoma of the temporal region: a diagnostic dilemma. Diagn Cytopathol. 2011;39:377–9.

    Article  PubMed  Google Scholar 

  35. Klijanienko J, Caillaud JM, Orbach D, Brisse H, Lagacé R, Sastre-Gareau X. Cyto-histological correlations in primary, recurrent, and metastatic bone and soft tissue osteosarcoma. Institut Curie’s experience. Diagn Cytopathol. 2007;35:270–5.

    Article  PubMed  Google Scholar 

  36. Söderlund V, Skoog L, Unni KK, Bertoni F, Brosjö O, Kreicbergs A. Diagnosis of high-grade osteosarcoma by radiology and cytology: a retrospective study of 52 cases. Sarcoma. 2004;8:31–6.

    Article  PubMed  Google Scholar 

  37. Kilpatrick SE, Ward WG, Bos GD, Chauvenet AR, Gold SH. The role of fine needle aspiration biopsy in the diagnosis and management of osteosarcoma. Pediatr Pathol Mol Med. 2001;20:175–87.

    Article  PubMed  CAS  Google Scholar 

  38. Nicol KK, Ward WG, Savage PD, Kilpatrick SE. Fine-needle aspiration biopsy of skeletal versus extraskeletal osteosarcoma. Cancer. 1998;84:176–85.

    Article  PubMed  CAS  Google Scholar 

  39. Bhatia A, Ashokraj G. Cytological diversity of osteosarcoma. Indian J Cancer. 1992;29:56–60.

    PubMed  CAS  Google Scholar 

  40. Mehdi G, Siddiqui F, Maheshwari V, Khan AQ. Imprint smear cytology of chondroblastic osteosarcoma: a case report. Diagn Cytopathol. 2009;37:446–9.

    Article  PubMed  Google Scholar 

  41. Ali RH, Lee CH, Hayes MM. Metastatic small cell osteosarcoma to the liver: a diagnostic pitfall for fine-needle aspiration cytology. Diagn Cytopathol. 2012. [Epub ahead of print]

    Google Scholar 

  42. White VA, Fanning CV, Ayala AG, Raymond AK, Carrasco CH, Murray JA. Osteosarcoma and the role of fine-needle aspiration. A study of 51 cases. Cancer. 1988;62:1238–46.

    Article  PubMed  CAS  Google Scholar 

  43. Cabrera RA, Almeida M, Mendonça ME, Frable WJ. Diagnostic pitfalls in fine-needle aspiration cytology of temporomandibular chondroblastoma: report of two cases. Diagn Cytopathol. 2006;34:424–9.

    Article  PubMed  Google Scholar 

  44. Abdul-Karim FW, Wasman JK, Pitlik D. Needle aspiration cytology of chondrosarcomas. Acta Cytol. 1993;37:655–60.

    PubMed  CAS  Google Scholar 

  45. Dodd LG. Fine-needle aspiration of chondrosarcoma. Diagn Cytopathol. 2006;34:413–8.

    Article  PubMed  Google Scholar 

  46. Lerma E, Tani E, Brosjö O, Bauer H, Söderlund V, Skoog L. Diagnosis and grading of chondrosarcomas on FNA biopsy material. Diagn Cytopathol. 2003;28:13–7.

    Article  PubMed  Google Scholar 

  47. Skoog L, Pereira ST, Tani E. Fine-needle aspiration cytology and immunocytochemistry of soft-tissue tumors and osteo/chondrosarcomas of the head and neck. Diagn Cytopathol. 1999;20:131–6.

    Article  PubMed  CAS  Google Scholar 

  48. Cheim Jr AP, Queiroz TL, Alencar WM, Rezende RM, Vencio EF. Mesenchymal chondrosarcoma in the mandible: report of a case with cytological findings. J Oral Sci. 2011;53:245–7.

    Article  PubMed  Google Scholar 

  49. Handa U, Singhal N, Punia RS, Garg S, Mohan H. Cytologic features and differential diagnosis in a case of extraskeletal mesenchymal chondrosarcoma: a case report. Acta Cytol. 2009;53:704–6.

    Article  PubMed  Google Scholar 

  50. Trembath DG, Dash R, Major NM, Dodd LG. Cytopathology of mesenchymal chondrosarcomas: a report and comparison of four patients. Cancer. 2003;99:211–6.

    Article  PubMed  Google Scholar 

  51. Dahl I, Akerman M, Angervall L. Ewing’s sarcoma of bone. A correlative cytological and histological study of 14 cases. Acta Pathol Microbiol Immunol Scand A. 1986;94:363–9.

    PubMed  CAS  Google Scholar 

  52. Klijanienko J, Couturier J, Bourdeaut F, Fréneaux P, Ballet S, Brisse H, et al. Fine-needle aspiration as a diagnostic technique in 50 cases of primary Ewing sarcoma/peripheral neuroectodermal tumor. Institut Curie’s experience. Diagn Cytopathol. 2012;40:19–25.

    Article  PubMed  Google Scholar 

  53. Pohar-Marinsek Z. Difficulties in diagnosing small round cell tumours of childhood from fine needle aspiration cytology samples. Cytopathology. 2008;19:67–79.

    Article  PubMed  Google Scholar 

  54. Fröstad B, Tani E, Brosjö O, Skoog L, Kogner P. Fine needle aspiration cytology in the diagnosis and management of children and adolescents with Ewing sarcoma and peripheral primitive neuroectodermal tumor. Med Pediatr Oncol. 2002;38:33–40.

    Article  PubMed  Google Scholar 

  55. Sahu K, Pai RR, Khadilkar UN. Fine needle aspiration cytology of the Ewing’s sarcoma family of tumors. Acta Cytol. 2000;44:332–6.

    Article  PubMed  CAS  Google Scholar 

  56. Folpe AL, Hill CE, Parham DM, O’Shea PA, Weiss SW. Immunohistochemical detection of FLI-1 protein expression: a study of 132 round cell tumors with emphasis on CD99-positive mimics of Ewing's sarcoma/primitive neuroectodermal tumor. Am J Surg Pathol. 2000;24:1657–62.

    Article  PubMed  CAS  Google Scholar 

  57. Folpe AL, Goldblum JR, Rubin BP, Shehata BM, Liu W, Dei Tos AP, et al. Morphologic and immunophenotypic diversity in Ewing family tumors: a study of 66 genetically confirmed cases. Am J Surg Pathol. 2005;29:1025–33.

    PubMed  Google Scholar 

  58. Udayakumar AM, Sundareshan TS, Goud TM, Devi MG, Biswas S, Appaji L, et al. Cytogenetic characterization of Ewing tumors using fine needle aspiration samples. A 10-year experience and review of the literature. Cancer Genet Cytogenet. 2001;127:42–8.

    Article  PubMed  CAS  Google Scholar 

  59. Dal Cin P, Qian X, Cibas ES. The marriage of cytology and cytogenetics. Cancer Cytopathol. 2013;44:1165–70.

    Google Scholar 

  60. Layfield LJ. Cytologic differential diagnosis of myxoid and mucinous neoplasms of the sacrum and parasacral soft tissues. Diagn Cytopathol. 2003;28:264–71.

    Article  PubMed  Google Scholar 

  61. Moriki T, Takahashi T, Wada M, Ueda S, Ichien M, Miyazaki E. Chondroid chordoma: fine-needle aspiration cytology with histopathological, immunohistochemical, and ultrastructural study of two cases. Diagn Cytopathol. 1999;21:335–9.

    Article  PubMed  CAS  Google Scholar 

  62. Das DK, Francis IM, AbuZeidan FM. Fine-needle aspiration (FNA) cytology diagnosis of a sacrococcygeal chordoma and its recurrence. Diagn Cytopathol. 1994;10:194–5.

    Article  PubMed  CAS  Google Scholar 

  63. Jo VY, Qian X. Utility of brachyury in distinction of chordoma from cytomorphologic mimics in fine needle aspiration and core needle biopsy. Mod Pathol. 2012;25 Suppl 2:93A.

    Google Scholar 

  64. Söderlund V, Tani E, Skoog L, Bauer HC, Kreicbergs A. Diagnosis of skeletal lymphoma and myeloma by radiology and fine needle aspiration cytology. Cytopathology. 2001;12:157–67.

    Article  PubMed  Google Scholar 

  65. Tani E, Santos GC, Svedmyr E, Skoog L. Fine-needle aspiration cytology and immunocytochemistry of soft-tissue extramedullary plasma-cell neoplasms. Diagn Cytopathol. 1999;20:120–4.

    Article  PubMed  CAS  Google Scholar 

  66. Mondal SK, Bera H, Biswas PK, Mallick MG. High-grade plasmablastic neoplasm of humerus in an HIV-negative patient, which was indeterminate between plasmablastic lymphoma and plasmablastic myeloma. J Cancer Res Ther. 2011;7:214–6.

    Article  PubMed  Google Scholar 

  67. Kumar N, Sayed S, Vinayak S. Diagnosis of Langerhans cell histiocytosis on fine needle aspiration cytology: a case report and review of the cytology literature. Patholog Res Int. 2011;2011:439518.

    PubMed  Google Scholar 

  68. Ramadas PT, Kattoor J, Mathews A, Abraham EK. Fine needle aspiration cytology of Langerhans cell thyroid histiocytosis and its draining lymph nodes. Acta Cytol. 2008;52:396–8.

    Article  PubMed  Google Scholar 

  69. Jayaram N, Ramprasad AV, Sujay RP. Langerhans cell histocytosis—a clinicopathological spectrum. Indian J Pathol Microbiol. 1998;41:331–5.

    PubMed  CAS  Google Scholar 

  70. Elsheikh T, Silverman JF, Wakely Jr PE, Holbrook CT, Joshi VV. Fine-needle aspiration cytology of Langerhans’ cell histiocytosis (eosinophilic granuloma) of bone in children. Diagn Cytopathol. 1991;7:261–6.

    Article  PubMed  CAS  Google Scholar 

  71. Shih LY, Chen TH, Lo WH. Skeletal metastasis from occult carcinoma. J Surg Oncol. 1992;51:109–13.

    Article  PubMed  CAS  Google Scholar 

  72. Katagiri H, Takahashi M, Inagaki J, Sugiura H, Ito S, Iwata H. Determining the site of the primary cancer in patients with skeletal metastasis of unknown origin: a retrospective study. Cancer. 1999;86:533–7.

    Article  PubMed  CAS  Google Scholar 

  73. Treaba D, Assad L, Govil H, Sariya D, Reddy VB, Kluskens L. Diagnostic role of fine-needle aspiration of bone lesions in patients with a previous history of malignancy. Diagn Cytopathol. 2002;26:380–3.

    Article  PubMed  Google Scholar 

  74. Suterwala S, Volk EE, Danforth RD. Aspiration biopsy of osseous metastasis of occult hepatocellular carcinoma: case report, literature review, and differential diagnosis. Diagn Cytopathol. 2001;25:63–7.

    Article  PubMed  CAS  Google Scholar 

  75. Huening MA, Reddy S, Dodd LG. Fine-needle aspiration of fibrous dysplasia of bone: a worthwhile endeavor or not? Diagn Cytopathol. 2008;36:325–30.

    Article  PubMed  Google Scholar 

  76. Logrono R, Kurtycz DF, Wojtowycz M, Inhorn SL. Fine needle aspiration cytology of fibrous dysplasia: a case report. Acta Cytol. 1998;42:1172–6.

    Article  PubMed  CAS  Google Scholar 

  77. Bishop JA, Ali SZ. Primary tibial adamantinoma diagnosed by fine needle aspiration. Diagn Cytopathol. 2010;38:198–201.

    PubMed  Google Scholar 

  78. Schindler S, Cajulis RS, Gokaslan ST, Frias-Hidvegi D, Yu GH. Fine needle aspiration of primary angiosarcoma of bone. Acta Cytol. 1997;41:1225–8.

    Article  PubMed  CAS  Google Scholar 

  79. Jayaram G, Kapoor R, Saha MM. Hemangioendothelioma. Cytologic appearances in two cases presenting with multiple soft tissue and bone lesions. Acta Cytol. 1987;31:497–501.

    PubMed  CAS  Google Scholar 

  80. Mohan H, Palta A, Nada R, Punia RS, Jogai S, Gupta R. Epithelioid haemangioendothelioma of the rib—a case report. Indian J Pathol Microbiol. 2001;44:375–7.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Skåne University Hospital, Sölvegatan 25, 22185, Lund, Sweden

    Henryk A. Domanski MD, PhD

  2. Department of Pathology, Brigham & Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA

    Xiaohua Qian MD, PhD

  3. Department of Pathology, Maine Medical Center, 22 Bramhall St., Portland, ME, 04101, USA

    Donald E. Stanley MD

Authors
  1. Henryk A. Domanski MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaohua Qian MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donald E. Stanley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henryk A. Domanski MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Pathology and Cytology, Skåne University Hospital, Skåne, Sweden

    Henryk A. Domanski

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Domanski, H.A., Qian, X., Stanley, D.E. (2014). Bone. In: Domanski, H. (eds) Atlas of Fine Needle Aspiration Cytology. Springer, London. https://doi.org/10.1007/978-1-4471-2446-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2446-7_15

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2445-0

  • Online ISBN: 978-1-4471-2446-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation