Transthoracic Fine Needle Aspiration Cytology Research Articles

Study on Computed Tomography (CT) Guided Transthoracic Fine Needle Aspiration Cytology (FNAC) in the Diagnosis of Intrathoracic Mass Lesions - Not Approachable by USG

Background: Intrathoracic mass is a general issue encountered by the physicians in whole world including Bangladesh. Accurate diagnosis is important for proper management. Percutaneous fine needle aspiration cytology (FNAC) has been extensively utilized and widely accepted as an important means of diagnostic technique. This study was performed to know and justify the computed tomography (CT) guided FNAC as a diagnostic modality for the diagnosis of intrathoracic masses which are non-approachable by ultrasonography (USG). Methods: It was a descriptive type of cross sectional study and conducted among 30 patients having ultrasonologically non approachable intrathoracic masses during the period of Feb 2016 to July 2016 in Combined Military Hospital (CMH), Dhaka considering selection criteria and informed written consent using purposive sampling technique. FNAC was done in all the patients. After further investigation, a definitive diagnosis was made. The analysis of the surgical specimen, the biopsy, the therapeutic response, and the clinical follow-up all contributed to the ultimate diagnosis. A comparison was done between the cytological and final diagnosis for thirty cases. Ethical issues were properly addressed. Results: Initially CT guided FNAC was carried out on all patients. Conclusive cytological diagnosis was possible in 28 patients yielding 93.33% diagnostic accuracy. FNAC diagnosed 24 cases as malignant intrathoracic mass, 04 as benign lesion and 02 undiagnosed due to inadequate tissue material. In final diagnosis 25(75%) diagnosed as malignant and 05(25%) diagnosed as benign. Diagnosis of two patients was impossible by FNAC due to inadequate tissue material. Conclusion: CT guided FNAC of intrathoracic mass allow early diagnosis with lesser trauma and lower cost. This procedure avoided more invasive diagnostic surgery. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 10-16

Respiratory Diseases and Their Diagnosis in Dogs: A Review

Respiratory affections are common in dogs. Very young and older dogs are at greater risk as compared to the adult ones. Constant exposure of the respiratory tract to the infectious agents, reaching the upper and lower respiratory tract aerogenously or hematogenously, makes the respiratory system vulnerable to injury. Clinical signs mainly seen in upper respiratory tract diseases involves nasal discharge (serous, mucopurulent or hemorrhagic), sneezing, facial deformity, stertor, lethargy, inappetence and rarely, central nervous system signs whereas additional signs present in lower tract diseases range from dyspnoea, costal or abdominal respiration, cough, nasal discharge and congestion, edema, consolidation of lungs and weight loss. Advanced tests involved in diagnosis of respiratory problems in veterinary practicpe are rhinoscopy, bronchoscopy, transthoracic fine needle aspiration cytology (FNAC) transtracheal wash and bronchoalveolar lavage fluid cytology and culture. This review discusses the causes of upper and lower respiratory tract disorders of canines and various diagnostic tests involved in their diagnosis.

Pulmonary actinomycosis: cytomorphological features.

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings. Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules.

Image Guided Transthoracic Fine Needle Aspiration Cytology of Mediastinal Masses- An Experience from a Tertiary Care Hospital of Eastern India

Introduction: Image-guided percutaneous transthoracic needle biopsy of mediastinal masses is usually safe and effective technique for obtaining tissue for diagnosis and early decision can be taken for effective management. Aim: The purpose of this study was to know the efficacy of different investigative methods for diagnosis of mediastinal masses and to analyse various cytomorphological forms. Materials and Methods: This was a retrospective observational study conducted at Pandit Raghunath Murmu Medical College, Baripada from January 2019 to June 2020. Retrospective review of all Ultrasonography (USG) and Computed Tomography (CT)- guided percutaneous aspirations of the anterior mediastinum mass. Relevant data regarding patient demographics, imaging characteristics of aspirated masses, presence of complications, and subsequent surgical intervention were collected. Cytology and core biopsy pathology results were recorded. The qualitative data were compared using Chi-square test with Yate’s correction. Results: This study included 35 patients (25 male, 10 female). Highest incidence was noticed in anterior mediastinum (n=26, 74.3%) followed by superior (n=4, 11.4%) and posterior mediastinum (n=3, 8.6%). Most of the cases were malignant (n=28; 80%) and Non Hodgkin Lymphoma (NHL) was most common diagnosis (n=10; 28.6%). Radiology yielded the correct diagnosis in 25 out of 35 patients (71.4%). Core biopsy was obtained in six cases and all the cases were diagnosed cytologically with 100% accuracy. There was statistically significant difference between the radiological and cytological diagnosis. The complication rate was minimal (2/35), both were the case of pneumothorax. Conclusion: Image-guided percutaneous aspiration is a safe diagnostic procedure with high diagnostic accuracy in aspiration cytology than radiology. Highest diagnostic accuracy was seen in non hodgkins lymphoma and it can potentially obviate more invasive procedures.

Role of core-needle biopsies in cases of mediastinal mass lesions as a primary diagnostic modality in comparison with fine-needle aspiration cytology

Introduction: The spectrum of mediastinal masses comprises of lesions of various origins. Although the clinicoradiological findings and the location of these lesions within different mediastinal compartments help narrow down the differentials, tissue diagnosis remains the gold standard for diagnosis. The image-guided percutaneous transthoracic fine-needle aspiration cytology (FNAC) and/or core-needle biopsy (CNB) of the mediastinal lesions are considered to be cost-effective and safe diagnostic procedures. CNB of mediastinal lesions is found to provide better yield with the accuracy of 75%–90% and is more precise as compared to FNAC. In this article, we study the role of CNB in cases of mediastinal masses as a primary diagnostic modality as compared to FNAC. Materials and Methods: A retrospective observational study was conducted at a tertiary care hospital in Mumbai. All cases with mediastinal mass lesions diagnosed by FNAC and/or CNB over a period of 1 year in a tertiary care hospital were analyzed. Cases were divided into FNAC group or CNB group depending on the primary diagnostic procedure undertaken. Comparisons were made between the two groups. Results: CNB group was found to have better diagnostic yield in benign as well as malignant lesions in comparison with the FNAC group. The time taken to reach the definitive diagnosis was found to be shorter in the CNB group as compared to the FNAC group. Conclusion: The use of CNB as a primary diagnostic modality may provide faster and accurate tissue diagnosis in cases of mediastinal masses of both benign and malignant nature as compared to FNAC.

Image-guided Fine Needle Aspiration Cytology of Intrathoracic Lesions.

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.

Role of Rapid On-site Evaluation in CT-guided Fine Needle Aspiration Cytology of Lung Nodules.

Objective:To prospectively investigate the value of rapid on-site evaluation (ROSE) in transthoracic fine needle aspiration cytology (FNAC) of patients with pulmonary nodules. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions and the most common reason for not being able to provide a diagnosis in FNA is inadequacy of samples.Materials and Methods:This was a prospective study conducted in the departments of pathology and radiology of our cancer centre. This study had approval from the institutional review board and ethical committee of our institute. Fifty consecutive cases undergoing CT-guided transthoracic FNAC in our centre were included in the study. The smear submitted for ROSE was stained using toluidine blue stain. The specimen adequacy and diagnosis in ROSE was compared with that of the final cytology report, and the concordance regarding adequacy and diagnosis were noted.Results:Smears were adequate in 34 cases (68%) and inadequate in 16 cases (32%) Out of the 16 inadequate cases, 5 (31%) were converted to adequate due to the application of ROSE, thus increasing the adequate number of cases to 39 (78%). A diagnosis of malignancy was made in all 39 adequate cases. Sensitivity of ROSE in determining adequacy was 92% and specificity was 100%. The most common malignancy was adenocarcinoma in 26 cases. Pnemothorax occurred in 2 cases. No significant complications occurred in other cases.Conclusion:CT-guided FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients. A multidisciplinary approach along with onsite evaluation of adequacy will increase the diagnostic utility of cytology in lung lesions.

English

BACKGROUND Fine needle aspiration cytology (FNAC) is a well-accepted and safe diagnostic procedure for the superficial lesions of the body; however, it can also be used for intrathoracic lesions with or without radiological guidance. The objective is to study the utility of unguided transthoracic FNAC as a diagnostic aid in intrathoracic lesions. MATERIALS AND METHODS This descriptive study of one hundred and fifteen cases of intrathoracic lesions presenting as pulmonary nodules was done by unguided transthoracic fine needle aspiration cytology (TFNAC) to assess the diagnostic accuracy. RESULTS The yield was diagnostic in 76 cases. Among the 76 cases, 64 cases were malignant lesions & 12 were non-neoplastic. There were no false positives; however, 5 cases showed false negative reports. The sensitivity, specificity and positive predictive value were 90.1%, 100% and 100% respectively. Minimal complications were encountered like pain at the punctured site, blood-tinged sputum and pneumothorax in two cases. CONCLUSION Unguided TFNAC is a simple, dependable and economical procedure for the diagnosis of peripheral lung lesions.

English

English

English

Computed tomography guided percutaneous transthoracic fine needle aspiration cytology (FNAC) of thoracic lesions is a widely accepted, simple, rapid, safe and accurate diagnostic tool of relatively low cost. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of the noninvasive method of CT-guided needle aspiration cytology in the assessment of radiologically detected intra thoracic mass lesions, to analyze the results and to know the pathological spectrum of thoracic masses (both benign and malignant) along with the correlation of CT findings with cytopathological reports. SETTINGS AND DESIGN: We conducted an institution based prospective study on patients who presented with thoracic mass lesions in lungs, mediastinum, hilar lymph nodes, thoracic vertebrae, paraspinal soft tissues and pleura. Cytologic examination was performed on site after staining smears with the Hematoxylin and eosin method. It was possible to define the cytologic lineage in 94 percent of the cases and in 3 cases (5.4 percent) the material was insufficient for the cytologic diagnosis. The diagnostic accuracy of percutaneous transthoracic fine needle aspiration cytology was more than 90%.Out of 52 cases, 11 cases were non-neoplastic while 41 cases were neoplastic. Among the non-neoplastic lesions, specific diagnosis were obtained in 10 cases. The diagnostic sensitivity of malignancy was 92.5% and specificity was 100%, positive predictive value of 100 percent and negative of 80 percent. Male to female ratio was 2.9:1. Majority of cases was seen in 5 th to 6 th decade. The most common tumor was squamous cell carcinoma (44.82%) followed by adenocarcinoma (31.03%) Post procedural complications were few. CONCLUSIONS: This study showed that FNAC, under computed tomography guidance, is a simple, rapid, safe, sensitive and specific technique procedure with insignificant rate of complications for the diagnosis of thoracic lesions. It can be used as a first line of investigation and also helps in deciding on appropriate

Diagnostic value of ultrasound guided transthoracic Fine Needle Aspiration Cytology in bronchogenic carcinoma

Background: Transthoracic FNAC is regarded as the most effective of the cytological methods for diagnosing lung cancer, in particular peripherally-located lesions. Notably, it demonstrates high accuracy in distinguishing between small cell lung carcinoma and non-small cell lung carcinoma, a clinically important differentiation. Aims & Objective: To assess the diagnostic value & safety of Ultrasound Guided Transthoracic Fine Needle Aspiration Cytology examination in Bronchogenic Carcinoma. Materials and Methods: Fine needle aspiration Cytology material from lung was obtained by Ultrasound Guided procedure from 31 suspected cases of malignant thoracic mass lesions on clinically & radiological work-up. Smear was made & stained with Hematoxylin & Eosin, Giemsa and Papanicoloua stain. Results: In the present study out of 31 cases, lung carcinoma was diagnosed in 28 cases (90.32 %). Out of 28 patients, 27 cases (96.42 %) were diagnosed to have Non-small cell lung carcinoma category (NSCLC) which was further classified into Adenocarcinoma 9 cases (29.63%) , Squamous cell carcinoma 8 cases (33.34%), Large Cell Carcinoma 3 cases (11.11%), Metastatic Carcinoma 2 cases (7.4%) and 5 cases (18.52 %) were unclassified. While only 1 case (3.58%) of Small Cell lung carcinoma category (SCLC) was diagnosed. In 2 cases inflammatory lesions were found and 1 case was inadequate for assessment. The diagnostic accuracy was 95%, sensitivity 96.55% and specificity 100% considering cytological criteria as the standard. Conclusion: We concluded that Transthoracic Fine Needle aspiration Cytology with Ultrasound guided procedure is simple, safe & cost effective diagnostic technique in Bronchiogenic Carcinoma, with early diagnosis and minimal complications.

Computed tomography guided fine needle aspiration cytology of pulmonary mass lesions in a tertiary care hospital: A two-year prospective study

Background: Percutaneous or transthoracic fine needle aspiration cytology (FNAC) is a rapidly emerging diagnostic modality to assess the nature of radiologically demonstrated lung lesions. Aims: The present study was conducted to evaluate the usefulness of computed tomography (CT)-guided FNAC in the diagnosis of pulmonary mass lesions. Materials and Methods: The present prospective study was carried out on 74 cases of radiologically diagnosed pulmonary mass lesions involving the periphery of the lung parenchyma with strong clinical suspicion of pulmonary neoplasm. CT-guided transthoracic fine needle aspiration was performed and cytology smears were stained with May-Grόnwald-Giemsa (MGG) stain and conventional Papanicolaou (Pap) stain. Smears were broadly categorized into unsatisfactory, benign, suspicious of malignancy and malignant lesion. The cytological diagnosis was compared with subsequent histopathology report where it was necessary. Results: A total of 74 cases of pulmonary mass lesions were included in the present study, of which 58 were males (78.4%). The mean age of the patients was 51.6 years, but the mean age in case of malignant lesions was 62.5 years. Cough was the most common respiratory symptoms (100%) followed by weight loss (91.9%) and fever (62.2%). Maximum cases of benign lesions were chronic non-specific inflammation (10.8%; 8 cases) followed by tuberculosis (8.1%). Regarding the malignant categories, non-small cell carcinoma, not otherwise specified (NOS) (13.5%; 10 cases) was the most common malignancy followed by adenocarcinoma (10.8%; 8 cases), small cell carcinoma (8.1%; 6 cases) and squamous cell carcinoma (6.7%, 5 cases) respectively. All the 38 cases of malignant lesions were confirmed by histopathology. Out of 10 cases of non-small cell carcinoma, NOS 4 cases were diagnosed histopathologically as poorly differentiated adenocarcinoma, 2 cases as high grade squamous cell carcinoma, 2 cases as large cell carcinoma, 1 case as pleomorphic carcinoma and 1 case as adenosquamous carcinoma. Conclusion: CT guided FNAC is a less expensive, simple, fast and reliable method for diagnosis of pulmonary mass lesions.

Computed tomography guided percutaneous transthoracic fine needle aspiration cytology of pulmonary mass lesions: Two years cross sectional study of 61 cases

Background and Objective: A vast spectrum of pathological lesions like neoplastic, inflammatory, congenital and various miscellaneous lesions may present as lung masses. With computed tomography (CT) guidance it is possible to perform a biopsy on almost any portion of lung with high degree of safety and minimal morbidity avoiding more invasive techniques. The objective of present study was to evaluate the diagnostic utility of CT-guided fine needle aspiration cytology (FNAC) in pulmonary mass lesions and to compare with previous similar studies. Materials and Methods: Sixty-one patients presented with undiagnosed pulmonary mass lesions underwent CT-guided FNAC for a period of 18 months. The lesions were localized by CT scan and after the needle tip was confirmed to be in the desired location, aspirations were performed. Smears were fixed with 95% ethyl alcohol stained for Papanicolaou stain and air dried smears were routinely stained with giemsa. Cell blocks were prepared from aspirated materials. Data were analyzed using Epi Info™ version 7. Results: Out of 61 one cases, 56 (91.80%) cases were adequate for evaluation. Considering cell block diagnosis as the standard, sensitivity, specificity, positive predictive value and negative predictive value and diagnostic accuracy of CT-guided FNAC of pulmonary malignant lesions were 95.5%, 84.6%, 94.3%, 91.3% and 91.6% respectively (P < 0.0000096). The mean age of presentation was 65.75 years with male to female ratio of 1.44:1. Squamous cell carcinoma was the most common malignant lesion (35.0%). Hemoptysis and transient pleuritic chest pain were some complications encountered. Conclusion: CT-guided FNAC is simple, safe and has a high sensitivity and diagnostic accuracy with only a few complications.

Quality assurance of rapid on-site evaluation of CT-guided fine-needle aspiration cytology of lung nodules

The methods available for the diagnosis of lung cancer include radiologic, cytologic and pathologic procedures. The aim of this study was to determine the quality assurance of CT guided fine needle aspiration cytology of lung nodules. Cytology results were rated to 4 categories (positive; suspicious; negative; not representative). All cytology reports were compared with the final histology diagnosis. A total of 128 patients underwent CT-guided percutaneous fine-needle aspiration biopsy cytology (63 males; 65 females; mean age 62.8 years). Smears were adequate in 99 cases and inadequate in 29 cases. The average diameter of the nodules was 3.28 cm. Thirty three (25.6%) of the cases were histologically verified and 2 falsely negative and 2 falsely positive cases were detected. The sensitivity and the positive predictive value were 88.8% and 88.8%, respectively. Pneumothorax developed in 7 (5.4%) cases. These results suggest that CT-guided transthoracic fine needle aspiration cytology has a high diagnostic accuracy and an acceptable complication rate. The auditing valves of the results meet the proposed threshold values.

Diagnosis of pulmonary hydatid disease presenting with solid nodule and mimicking malignancy by fine needle aspiration cytology

To the Editor, Hydatid disease (HD) is caused by Echinococcus granulosus, endemic in the cattle- and sheep-raising regions of the underdeveloped and developed world.[1,2] The prevalence is rather high in several countries of the Mediterranean region, mainly in pastoral areas where the dog-sheep cycle of the parasite prevails.[3] It also remains a health problem in Turkey, mainly in the rural areas of the eastern part of the country.[4] Hydatid disease predominantly affects the liver and lungs. The relatively rare anatomic locations are the central nervous system, muscles, subcutaneous tissue, kidneys, bones, and body cavities.[1] Pulmonary HD can be diagnosed by clinical and radiological findings, and serological analysis. However, old, arrested forms of the infection presenting with an organized, solid, atypical pulmonary nodule may mimic lung cancer.[5] Fine needle aspiration cytology (FNAC) can be a useful tool in the differential diagnosis.[6] We report a case of pulmonary hydatid cyst presenting with a solid and solitary nodule, clinically and radiologically suspicious for malignancy, diagnosed by FNAC. A 52-year-old female patient presented with a history of dyspnea and cough. Computed tomography (CT) revealed a solid nodular lesion, with a 2 cm diameter, in the apicoposterior segment of the upper lobe of the left lung [Figure 1]. Figure 1 Computed tomography image showing a nodular lesion (red arrow), 2 cm in diameter, in the apicoposterior segment of the upper lobe of the left lung A clinical and radiological diagnosis of lung malignancy was rendered, and subsequently a CT-guided transthoracic FNAC was done.

Cytopathologic features of pleomorphic carcinoma of the lung: case report

Pleomorphic carcinoma of the lung is a subtype of sarcomatoid carcinoma and essentially classified as a poorly-differentiated, non-small cell lung carcinoma. Being a very rare tumor, it constitutes 0.3-1.3% of all malignancies of the lung. Cytology reveals malignant fusiform and/or giant cells, accompanied by malignant epithelial elements like squamous cell, adeno or large cell carcinoma. Our case, a 76-year-old female patient, presented with chest and back pain. Thoracic CT showed a well-demarcated solid mass of 5x3 cm located peripherally in the left upper lobe of the lung. Trans-thoracic fine needle aspiration cytology showed atypical cells with a biphasic character in a myxoid matrix. It was noted that of these, some were poorly-demarcated fusiform cells with oval nuclei and marked nucleoli, while others were epithelial cells with eccentrically placed nuclei, large cytoplasms and macronucleoli. The patient was diagnosed as pleomorphic carcinoma on the basis of these findings, and the cytological diagnosis was confirmed by histopathology. Pleomorphic carcinoma is a poorly-differentiated non-small cell lung carcinoma, which poses diagnostic difficulties. As it is rare, it lacks decisive diagnostic criteria and has cytological characteristics resembling those of other lung tumors.

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

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.

Study of computed tomography-guided fine needle aspiration cytology of thoracic lesions

Background:Thoracic lesions include a variety of benign and malignant lesions of lung, pleura, chest wall and mediastinum. Transthoracic fine needle aspiration cytology (TFNAC) is a well established technique for work up of thoracic lesions. Computed tomography (CT) has extended the use of FNAC, because it is accurate for localization, needle puncture and above all it permits evaluation of lesions less than 1 cm. This diagnostic modality has a high sensitivity, specificity and is of relatively low cost.Aims:To assess the role of CT-guided FNAC in the diagnosis of thoracic lesions.Materials and Methods:Eighty three patients with various thoracic lesions were evaluated by CT guided FNAC. The cytologic findings were compared with cell blocks whenever available.Results:Conclusive opinion was offered on cytology smears in 80 patients. Lesions of the lung were the most common. Neoplastic lesions in our study accounted for 65% of cases. The sensitivity and specificity of the study were 93.33% and 100%, respectively.Conclusion:CT-guided TFNAC is a low cost, safe, minimally invasive and accurate diagnostic procedure with high sensitivity and specificity and when interpreted in conjunction with clinical and radiological data can prevent some of the pitfalls in diagnosis.

Role and accuracy of rapid on‐site evaluation of CT‐guided fine needle aspiration cytology of lung nodules

To prospectively investigate the role of trans-thoracic fine needle aspiration cytology (FNA) and the value of rapid on-site evaluation (ROSE) in the clinical management of patients with pulmonary nodules/masses. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions although its position in the diagnostic work-up is still a matter of debate. We reviewed 311 patients (211 males and 100 females, mean age 69.5 years) admitted to the University of Padova from 2004 to 2008, correlating the results of cytology with the available histological findings obtained from biopsies, surgery or autopsy. Smears were adequate in 305 cases (98%) and inadequate in six (2%); a diagnosis of malignancy was achieved in 263 cases (86.2%); 39 cases (12.8%) were classified as non-malignant; and three cases (1%) were classified as suspect for malignancy. When correlated with histology, FNA with ROSE discriminated malignant versus non-malignant lesions (Cohen's kappa 0.78), with three false negatives (sensitivity 96.3%, specificity 100%). Moreover, a satisfactory overall agreement of 71.4% was achieved in differentiating the cancer histological types. Pneumothorax occurred in 13 cases, haemoptysis in four, and chest pain in three. A single aspiration was sufficient in 79.6% of patients; two aspirations were needed in 17.4% and three in 3%. The low complication rate was related to the limited number of aspirations needed due to ROSE. FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients, with no contraindications to its use as the first diagnostic procedure for all patients with peripheral lung lesions. FNA with ROSE should be reconsidered in the guidelines for diagnosing and managing lung cancer.

Comparative study of efficacy of brush cytology and transthoracic fine needle aspiration cytology in the diagnosis of bronchogenic carcinoma

Online: 20 July 2010DOI: http://dx.doi.org/10.3329/bmrcb.v36i1.4251 Bangladesh Med Res Counc Bull 2010; 36: 37-39