Evaluation of precision of guidance techniques in image guided fine needle aspiration cytology of thoracic mass lesions

Abstract

Background:Transthoracic fine needle aspiration cytology (FNAC) is an established and safe technique for diagnosis of thoracic mass lesions. Computed tomography (CT) scan depicts clear anatomical details and provides access to any area of the body. It is, however, expensive and the needle is not passed in real time. Ultrasound is cheaper, radiation free, and allows real time monitoring. Its limitations are obscurement of lesions by aerated lung, smaller, deep seated, and cavitary lesions.Aims:This study aims to compare sensitivity and specificity of CT scan and ultrasonography (USG) in thoracic FNAC.Materials and Methods:The study was conducted on patients who presented with thoracic mass lesions in lungs, mediastinum, hilar lymph nodes, thoracic vertebrae, paraspinal soft tissue, and pleura. One hundred and twenty patients were studied. Only those cases in which sonographic guidance was not possible were taken up for CT guided FNAC. The lesions were assigned to benign and malignant categories and into specific diagnoses where possible. Biopsy correlation was available in 113 cases. Patients were lost to follow-up in five lung and two mediastinal masses.Statistical Analysis:Statistical tests applied included diagnostic tests for sensitivity and specificity.Results:An accuracy of 70.8% was found for image guided FNACs with a sensitivity and specificity of 92.2% and 100%, respectively. CT had a sensitivity of 93.2% and specificity of 100%. For USG guidance, the same was 91.3% and 100%, respectively.Conclusions:Precision of USG and CT scan is comparable for guidance in FNAC from thoracic mass lesions.

Role and Accuracy of Rapid on-Site Evaluation of Ct: Guided Fine Needle Aspiration Cytology of Throracic Lesions

“…In our study, among bronchogenic malignancies prevalence of 'Squamous cell carcinoma' and 'adenocarcinoma' was found to be 44.8% and 31.0 % respectively which is comparable to studies done by Anupam S 11 et al, Basnet et al 14 and Jayashankar 8 et al however preponderance of adenocarcinoma has been seen in studies done by Gangopadhyay, et al 18 and S Kalhan 16 et al…”

“…The incidence of malignancies has been seen in other studies ranging from 62.5% to 96.5%. 16 The prevalence of malignancy in our study is significantly less than the 81.8% found in similar study done by Singh et al 5 In the present study, the benign lesions, studied were of types Acute Inflammatory Lesion (Organized Abscess), Chronic Non Specific Inflammatory Lesion, Tubercular Granulomatous Lesion and Hematoma. CT guided FNAC is useful for diagnosis of pulmonary infections, similar findings are stated by Cones et al 17 and Rangaswamy et al 12 In inflammatory lesions, by integrating other ancillary techniques like special stains such as Grams stain, AFB stain, culture, immunocytochemistry and PCR can help arrive at a specific diagnosis.…”

“…It was comparable similar to the 2.7% and 1.1% of Gupta et al 21 and Mohammad et al 4 The reported diagnostic accuracy of CT -guided lesions in the literature ranged from 64% to 97% 4 , Sensitivity has been found to be in the range of 88% to 97.7 % and Specificity from 84% to 100%. 5,14,16 The present study found a diagnostic accuracy of 94.2%. Sensitivity' of our study is found to be 92.5%, suggesting high usefulness of CT guided FNAC in diagnosis of malignancy of tumors.…”

Computed Tomography Guided Fine Needle Aspiration Cytology of Lung and Mediastinal Lesions

“…3 FNAC of these lesions can differentiate between benign and malignant lesions and also the small cell carcinoma of the lung from non small cell carcinoma of the lung which helps in early initiation of the treatment and avoid more invasive surgeries in maximum number of cases specially in patients with inoperable lesions due to patient's general condition and local factors. [1][2][3][4][5][6][7][8][9][10][11][12][13] Radiologic imaging can very well document the size, shape, contour, edge, density and presence or absence of calcification in the lesion. These features are not of much help in categorizing the lesions as benign or malignant as there is a lot off overlap.…”

Importance of image guided fine needle aspiration in diagnosis of benign and malignant lesions

“…Two vertebral masses (C6, L2) were reported as multiple myeloma and metastatic adenocarcinoma respectively which is in accordance with study by. 20 US guidance is also of great value in aspiration of small and deep seated (intra/ intermuscular) tumour. US/CT can be helpful in finding viable tissue and avoiding cystic and necrotic areas in extensively necrotic /cystic tumors.…”