| Fine
needle aspiration biopsy of the lung.Pathol
Annu.1981;16 Pt 1:159-80.
Fine needle biopsy provides a highly accurate
diagnostic method which can be performed rapidly with minimal risk. It
provides a definitive diagnosis in most patients at low cost with
minimal trauma. Patients at poor surgical risk are saved a thoracotomy
in many instances. Patients who are clinically inoperable can receive
appropriate chemotherapy and radiotherapy without major surgery done
solely for diagnostic purposes. In comparative studies, this technique
has generally been reported to be superior to bronchoscopic biopsy and
sputum cytology in the diagnosis of radiologically evident lung
lesions. In screening patients, sputum cytology remains the method of
choice and is essentially the only method of diagnosing early lesions
not seen radiologically. Bronchial brush biopsy, another technique of
great value, is particularly useful in the diagnosis of central
bronchial lesions. Appropriate utilization of these three cytologic
sampling procedures provides for the highest degree of accuracy in the
diagnosis of pulmonary disease with minimum risk to the patient.
Fine needle
aspiration cytology of lung lesions: a clinicopathological and
cytopathological review of 150 cases with emphasis on the relation
between the number of passes and the incidence of pneumothorax.
Cytopathology. 2007 Feb;18(1):44-51.
OBJECTIVE: The
aim of this study was to review the lung fine needle aspirations (FNA)
that were done in our hospital between January 1998 and April 2004.
Interobserver agreement, sample adequacy and the relation between the
number of passes and the occurrence of pneumothorax are presented.
STUDY DESIGN: One hundred fifty cases of lung FNA from the department
of pathology files were identified and the available specimens and
patient charts were reviewed. The interobserver agreement was
calculated. The relation between the number of passes and the
subsequent development of pneumothorax was tested using Mann-Whitney
U-test. RESULTS: The material of 132 patients (88%) out of 150 were
retrieved and reviewed. There were 85 cases of non-small cell lung
cancer (NSCLC) (64.4%), nine cases of small cell lung cancer (6.8%),
five cases of metastatic cancer (3.8%) and 33 cases were reported
negative for cancer (25%). The NSCLC included 36 cases of
adenocarcinoma (27.3%), 32 cases of squamous cell carcinoma (24.2%),
and 17 cases of large cell undifferentiated carcinoma (12.9%). The
interobserver agreement k was 0.93, (95% CI 0.87-0.98). The majority
of cases (95.5%) were considered adequate for interpretation. The
charts of 138 patients (92%) were reviewed for postprocedure
radiologically confirmed pneumothorax. Sixteen patients (11.6%)
developed pneumothorax only three of whom (2%) required a chest tube
for treatment. The number of passes was identified in 118 patients
(85.5%). The number of passes did not have a statistically significant
association with the development of a pneumothorax (P = 0.747).
CONCLUSION: Fine needle aspirations to diagnose lung lesions is a safe
procedure with a low incidence of pneumothorax. Its findings are
reproducible with high interobserver agreement. Immediate adequacy
evaluation and triage by a pathologist guarantees adequate sample in
most instances. The number of passes was not associated with an
increased incidence of pneumothorax.
Fine needle aspiration cytology of pulmonary lesions: a
reliable diagnostic test.Pathology.
2001 Feb;33(1):13-6.
The objective of this study was to determine the
accuracy of image-guided fine needle aspiration cytology (FNAC) in the
diagnosis of pulmonary lesions. A retrospective study was undertaken
of 286 patients with 288 lesions, who underwent a total of 302
procedures. The FNAC diagnoses were reported as malignant, suspicious,
atypical, benign or non-diagnostic. Subsequently the FNAC diagnoses
were correlated with either the histological or clinical diagnoses. Of
the 288 lesions, 64.6% were reported on FNAC as malignant, 2.1%
suspicious, 2.4% atypical, 20.8% benign and 10.1% nondiagnostic. On
review of the suspicious, atypical, selected benign cases and
non-diagnostic FNAC by an independent pathologist there was agreement
with the original FNAC diagnosis in all cases. All of 186 malignant
FNAC diagnoses were confirmed malignant either clinically or on
subsequent histology. Four of the six suspicious FNAC diagnoses had a
malignant outcome, one patient had organising pneumonia on excision
biopsy and one was lost to follow up. Six of the seven atypical FNAC
diagnoses were confirmed on histology as malignant, while one lesion
resolved spontaneously. Fifty-two of 60 benign FNAC diagnoses were
confirmed benign either clinically or on histology. Seven of the
lesions diagnosed as benign on FNAC were proven to be malignant. One
patient with a benign FNAC diagnosis was lost to follow-up. Ten of the
29 non-diagnostic FNAC group were later shown on clinical or
histological follow up to be malignant. This study shows that image
guided FNAC for the diagnosis of malignant pulmonary lesions has a
sensitivity of at least 92% and a specificity of at least 96%. It is a
reliable diagnostic test although its accuracy is limited by technical
difficulties in obtaining an adequate sample.
Fine needle aspiration biopsy cytology of pulmonary tumors.Rocz
Akad Med Bialymst. 1997;42 Suppl 1:309-13.
Transthoracic
fine needle aspiration specimens of the pulmonary tumors were obtained
from 144 patients. Fine needle aspiration biopsy were performed using
local anaesthesia and ultrasonographic or scopie control. The 20-gauge
needles were used to obtain the specimens. 93 of patients have been
diagnosed as squamous cell carcinomas, 28 as adenoid carcinomas, 18 as
anaplastic carcinomas and 5 as a non neoplastic lesions (tuberculoma
and abscessus). The tumors were typed according to the second WHO
histological classification. Analysis of the date indicated that
malignant neoplasms were identified correctly with an accuracy of
92.0%. There were not false positive diagnoses. There were two false
negative diagnoses (squamous cell carcinoma) and in three cases the
diagnosis were as suspected for malignancy. The results confirmed the
value of fine needle aspiration cytopathology for the diagnosis of
pulmonary tumors.
Immediate assessment of fine needle aspiration cytology of lung.J
Clin Pathol. 1996 Oct;49(10):839-43.
AIMS: To assess
the value of immediate assessment of cytology in percutaneous fine
needle aspiration (FNA) cytology of lung. METHODS: FNA specimens from
75 consecutive patients with suspected pulmonary neoplasms were
subjected to immediate cytology assessment. Direct smears were
prepared in the radiology department and stained using the Diff Quik
method. The cellular content was assessed and, if possible, a
provisional diagnosis offered. A second FNA was requested if the
initial aspirate seemed of doubtful adequacy. The diagnostic accuracy
was examined by review of clinical and radiological data in all
patients, and by correlation with other histological or cytological
material in 25 patients. Complications of the procedure were
identified during the clinical review. RESULTS: Two of 75 specimens
were inadequate for diagnosis. Satisfactory diagnostic material was
obtained in 51 patients on a single aspirate and following a second
FNA in 22 patients. Of the 73 satisfactory aspirates, 58 were
malignant, one highly suspicious of malignancy and 14 reported as
negative for malignancy. All malignant diagnoses were confirmed on
clinical or pathological review. FNA accurately distinguished primary
small cell and large cell carcinomas in those patients with
pathological follow up. There were two false negative reports, one due
to sampling error and the other due to misinterpretation of aspirate
material. The diagnostic specificity was 100% and sensitivity 96.6%.
Complications were recorded in seven (9.3%) patients, five of whom
developed pneumothorax; a chest drain was required in one patient.
CONCLUSIONS: Percutaneous FNA cytology provides safe and accurate
diagnosis in the investigation of pulmonary lesions. Immediate
cytology assessment ensures that aspirate material is handled
optimally, and those patients requiring further sampling or ancillary
investigation identified rapidly. The number of unsatisfactory and
false negative lung FNA are therefore reduced. The complication rate
is minimised by decreasing the number of pleural punctures.
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