Evaluation of digitally guided fine needle aspiration cytology versus fine needle core biopsy for the diagnosis of recurrent rectal cancer

The clinical value of transrectally digitally guided fine needle aspiration cytology (FNAC) was compared with fine needle core biopsy (FNCB), FNAC was performed with a 21G and FNCB with a 18G needle. No prophylactic antibiotic was given. In the first part of the study 100 patients (20 primary/80 recurrences, 17 benign/83 cancers) were studied by both techniques. In 93% a definite diagnoses was given in FNAC specimen versus 96% of the FNCB cases. There were no false positive cancer diagnoses. The sensitivity of the FNAC was 88% versus 68% of the FNCB specimens. This difference was statistically significant. In a second part of the study 142 specimens of recurrent cases were examined by FNAC including 78 of the patients of the first part. The negative predictive value was around 60% for FNAC versus around 40% for FNCB. Both techniques were without any major complications. For the diagnosis of a palpable recurrent pelvic tumour a digitally guided puncture may be tried before proceeding to CT or US guided examination. In our hands FNAC seems preferable to FNCB.