Image-guided fine needle aspiration cytology of intrathoracic lesions

Abstract

Background:Percutaneous, image-guided transthoracic fine needle aspiration cytology (TTFNAC) is a rapid, yet accurate, and well-established diagnostic method used in the cytological evaluation of intrathoracic lesions. The study was done to determine the utility of image-guided TTFNAC in diagnosis of intrathoracic lesions.Subjects and Methods:A retrospective analysis of all cases who underwent image-guided TTFNAC of a suspected intrathoracic lesion, in a tertiary care hospital was done over a period of 3 years.Results:During the study period, 124 cases of image-guided FNAC of intrathoracic lesions were obtained. The mean age at presentation was 60.5 years with M:F: 3.6:1. Neoplastic lesions (71.5%) outnumbered the nonneoplastic lesions (28.5%). The most common tumor was adenocarcinoma (25%) followed by squamous cell carcinoma (SCC, 11%), and small cell carcinoma (5%). There was one case each of anaplastic carcinoma, plasmacytoma, bronchoalveolar carcinoma, and non-Hodgkin lymphoma (NHL). Most of the lesions were found on the right side and upper lobe. Among the mediastinal lesions, we found two cases of thymoma and one case each of NHL)/primitive neuroectodermal tumor (PNET), NHL, and small cell carcinoma metastasis to lymph node followed by ten cases of inflammatory lesions and seven cases of tuberculosis (TB).Conclusion:Image-guided TTFNAC of intrathoracic lesions is a safe method when done by well-trained medical personnel with lesser rate of complications. An early accurate diagnosis of malignancy can be made based on the cytological features; however, further subtyping of the malignancy may sometimes be difficult due to overlapping cytological features. TTFNAC can be a diagnostic tool for identifying nonneoplastic lesion such as TB. Hence, image-guided FNAC aids in early diagnosis and management of patients with intrathoracic lesions.

Pulmonologist-Performed Ultrasound-Guided Fine-Needle Aspiration of Lung Lesions

“…The diagnostic yield was similar to that for biopsies performed by pulmonologists and radiologists in the literature [12]. The site of the biopsy is not limited to the peripheral lung and pleura, but also includes other intrathoracic areas such as the rib, mediastinum and chest wall in the literature [7,12,15]. From our experience, FNAs of the rib, cervical lymph node and mediastinal lesions were also feasible but not included in this study.…”

Diagnostic value of intraoperative fine‐needle aspiration cytologic diagnosis versus frozen section‐based histopathologic diagnosis in thoracic malignancies: A single institution's experience

“…Within our institution, the sensitivity of intraoperative FNA (88%) is significantly lower than the sensitivity of FS (97%); however, specificity (FS 99%, FNA 99%) and accuracy (FS 97%, FNA 92%) are comparable. Other studies have reported the utility of intra‐procedural FNA in the diagnosis of endobronchial, peripheral, and mediastinal lesions with high specificity 6,11–13 . A study by Biancosino et al 13 reported 94.8% sensitivity, 98.8% specificity, and 99.8% PPV of intraoperative FNA assessment with respect to final histologic diagnosis.…”

“…Other studies have reported the utility of intra-procedural FNA in the diagnosis of endobronchial, peripheral, and mediastinal lesions with high specificity. 6,[11][12][13] A study by Biancosino et al 13 reported 94.8% sensitivity, 98.8% specificity, and 99.8% PPV of intraoperative FNA assessment with respect to final histologic diagnosis. Additionally, based on standardized cytologic criteria, identifying lung cancer type was usually accurate, ranging from 88% PPV in Small cell carcinoma 3 (13%) 0…”

“…3 Frozen section based histologic assessment has been shown to be an accurate method in the diagnosis of pulmonary masses and lymph nodes. 4,5 While a few studies 6,7 have assessed the value of intraoperative FNA as an independent diagnostic procedure, to our knowledge, a direct comparative study of intraoperative FNA and FS based diagnosis in thoracic malignancies within the same clinical practice has not been previously performed. In this study, we compare intraoperative FNA to FS in terms of diagnostic performance, independent of other variables that may partially or completely govern the decision as to which method should be utilized (e.g., tumor resectability, tumor site, patient's fitness for surgery, availability of expertise and resources, etc.…”