| Abstract: |
SummaryThis work aims to investigate whether color Doppler ultrasound can detect active spermatogenic foci within azoospermic testis or not. Moreover whether FNAC of the azoospermic testis can provide cytological material for qualitative and quantitative analysis compared with open testicular histopathology of some cases.This work aims also to prove if Doppler guided FNAC can be considered a non invasive diagnostic parameter in male infertility.This study was carried out on 150 azoospermic patients attending the Andrology unit, Dermatology and Venereology Department, Zagazig University.The following were done to every patient:1- Full history taking.2- Clinical examination, general and local, with interest on testicular volume.3- Seminal analysis for at least 2 different occasions.4- Hormonal evaluation of FSH.5- Color Doppler ultrasound for both testis of every patient.6- FNAC from sites detected by Doppler.7- Interpretation of FNAC smear using pattern recognition and differential cell count.8- The results were classified for both FNAC and Open biopsy to normal, hypospermatogenesis, spermatogenic arrest, SCOS, hyalinization / peritubular fibrosis and mixed cells.9- Evaluating results of Doppler and cytology.10-Evaluating results of cytology and open biopsy histopathology.The classification of cytology results were explained for cellularity and pattern of seminiferous tubules.The same group also compared with results of Doppler findings and open biopsy histopathology.A group of 50 patients (selected from the main group), the FNAC was taken from sites detected by Doppler and others away from Doppler then the results were compared, this was to ensure the role of Doppler in detecting active spermatogenic foci.The results of FNAC and +ve Doppler were 38 testes normal spermatogenesis, 36 testes hypospermatogenesis, 70 testes spermatogenic arrest, 16 testes sertoli cell only and 10 testes mixed lesions.The results of FNAC and –ve Doppler findings were 2 hpospermatogenic testes, 49 testes spermatogenic arrest, 62 testes sertoli cell only, 10 testes hyalinization and peritubular fibrosis and 2 testes mixed lesions.The percent of Cytology-Histology correlation (only 100 patients had done open testicular biopsy), were 93.33% in normal spermatogenesis, 70 % in hypospermatogenesis, 42.85% in arrest, 92% in sertoli cell only and 80% in hyalinization and peritubular fibrosis.The results of FNAC from areas detected by Doppler and another away from Doppler finding were quantitatively more in number of cells in Doppler guided FNAC and qualitatively the percent of agreement were 94.7% in normal, 63.6% in hypospermatogenesis, 90% in arrest at late spermatid, 100% in arrest at round spermatid, 88.2% in arrest at 1ry spermatocyte and 100% in sertoli cell only.Doppler guided FNAC of azoospermic testis solve 2 disadvantages of FNAC described before this study:1-The aspirated fragments of seminiferous tubules give account on the state of the basement membrane. It was said that FNAC give no idea about basement membrane.2-The shape of sertoli cells give accounts on the interstitial tissues. Also they believed that FNAC give no information about it.The technique is simple and safe, the cytological identification of the cells was easy and no complications were recorded.FNA cytology as a method of detecting azoospermic testis is a significant, cost-effective and safe method of evaluating male infertility. Because the differential cell counts in FNA smears correlate well with different histologic categories, their use may help in correct classification of the condition and also in quantitation of spermatogenesis, leading to the correct choice of the therapy.
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