| Diagnostic
dilemmas in pulmonary cytology.Cancer.
2001 Dec 25;93(6):364-75. BACKGROUND:
Diagnostic difficulties in pulmonary cytology may be compounded by other
medical problems, lack of pertinent information, and the presence of rare
tumors. In the current study, the authors describe six cases of lower
respiratory tract cytology that presented particular diagnostic challenges
or pitfalls. METHODS: Three lung fine-needle aspiration biopsies (FNAB)
from three patients, four bronchoalveolar lavages from two patients, and
one bronchial washing from one patient, each with histologic confirmation,
were reviewed. Cytologic material included direct smears, ThinPrep slides,
and cell blocks. Cytologic findings were compared with established
cytologic criteria for each final diagnosis. RESULTS: Two cases with
Aspergillus infection that demonstrated reactive atypical cells were
misinterpreted as squamous cell carcinoma and nonsmall cell carcinoma. Two
cases diagnosed as significant atypia and negative, respectively,
subsequently were found to show bronchioloalveolar carcinoma (as well as
lymphangioleiomyomatosis, which was suspected clinically) and bronchogenic
adenocarcinoma, respectively. One lung FNAB from a patient subsequently
confirmed to have bronchiolitis obliterans-organizing pneumonia (BOOP)
showed reactive pneumocytes that initially were misinterpreted as being
suspicious for carcinoid. These reactive pneumocytes were identified
histologically in the area of BOOP. The last case was an FNAB of a well
differentiated fetal-type adenocarcinoma, an unusual variant of
adenocarcinoma that to the authors' knowledge rarely is described in the
cytology literature. CONCLUSIONS: Cytomorphologic features of lower
respiratory tract pathology combined with appropriate clinical information
and diagnostic discretion usually allow accurate diagnoses and should
decrease both false-positive and false-negative result rates. Clinical
information and radiologic findings may be invaluable, but may not always
parallel the cytologic diagnosis.
Small cell
carcinoma versus other lung malignancies: diagnosis by fine-needle
aspiration cytology.Cancer.
2000 Oct 25;90(5):279-85.
BACKGROUND: When
a diagnosis of small cell carcinoma is reached in a patient with a
lung mass, a surgical treatment approach is no longer considered and
chemotherapy becomes the treatment of choice. The aim of this study is
to compare the diagnostic accuracy of fine-needle aspiration cytology
in the diagnosis of small cell carcinoma with the diagnoses of other
lung malignancies. The capacity of this technique to distinguish
between these two categories is assessed. METHODS: Two hundred
fifty-nine consecutive transthoracic fine needle aspirations of lung
tissue from 235 patients with histologic diagnosis of malignancy were
reviewed. The aspirates were performed over a 10-year period at the
University of Miami/Jackson Memorial Medical Center, Miami, Florida.
Two hundred and forty-two fine-needle aspirations from 221 patients
yielded satisfactory smears and were included in the study. Fourteen
patients were excluded. The cytologic diagnoses were classified into 5
categories: 1) small cell carcinoma (18 smears, 7%); 2) other lung
malignancies (158 smears, 65%); 3) suspicious for malignancy (19
smears, 8%); 4) inflammatory process (7 smears, 3%); and 5) negative
for malignancy (40 smears, 17%). RESULTS: The histologic diagnoses
were divided into two groups: small cell carcinomas (29 smears, 12%),
and other lung malignancies (213 smears, 88%). The efficiency of
fine-needle aspiration cytology in the diagnosis of these two groups
was 96% versus 88%, respectively, with an equal specificity of 100%,
and a sensitivity of 67% versus 81%. Once the diagnosis of malignancy
was established, fine-needle aspiration cytology was found to be
highly accurate in distinguishing small cell carcinoma from other
neoplasms. CONCLUSION: We conclude that fine-needle aspiration
cytology of the lung is an accurate diagnostic tool for the diagnosis
of lung malignancies and is an excellent technique for distinguishing
small cell carcinoma from other malignant neoplasms. It can be used
with confidence to select treatment modalities and to avoid
unnecessary surgeries in patients with lung malignancies.
Fine needle aspiration biopsy versus sputum and bronchial material in
the diagnosis of lung cancer. A comparative study of 168 patients.Acta
Cytol. 1988 Sep-Oct;32(5):641-6.
A group of 168
consecutive lung cancer patients in whom a definitive diagnosis of
primary lung cancer was established either in a conventional cytologic
specimen of sputum or bronchial material or in a specimen obtained by
fine needle aspiration (FNA) biopsy was reviewed to compare the
relative accuracies between the modalities of sputum and bronchial
material on one hand versus FNA cytology on the other in the diagnosis
of lung cancer. The patients included in the study were selected from
a total of 1,093 patients who had been diagnosed and treated for lung
cancer at Duke University Medical Center over the five-year period of
January 1, 1980, through December 31, 1984. In 325 (29.8%) of the
1,093 patients, a definitive cancer diagnosis was established from
histopathologic study alone, without any cytologic diagnoses. In 420
patients (38.4%), both histologic and cytologic material had been
interpreted as being conclusively diagnostic for lung cancer. In 348
patients (31.8%), a cytologic diagnosis of lung cancer was made
without a histologic confirmation. Thus, in a total of 768 (70.3%) of
the 1,093 cases, a definitive cytologic diagnosis of cancer had been
made. Of these 768 patients, 168 had been evaluated by both
conventional respiratory cytologic methods (examination of sputum and
bronchial material) and with FNA biopsy cytology. In 9 patients
(5.4%), only conventional respiratory cytologic specimens were
conclusively diagnostic for cancer. In 122 patients (72.6%), only the
FNA biopsy specimen was diagnostic. In 37 patients (22.0%), both
conventional respiratory specimens and FNA specimens yielded a
definitive lung cancer diagnosis. The FNA specimen was the only
positive cytologic specimen in 90.2% of large cell undifferentiated
carcinomas, 79.5% of adenocarcinomas, 66.7% of small cell
undifferentiated carcinomas and 58.2% of squamous cell carcinomas. In
26.5% of the patients, a diagnosis of cancer could have been
established on conventional cytologic specimens, without the necessity
of proceeding to percutaneous FNA biopsy. From this study, it is
concluded that the techniques of conventional respiratory cytology and
FNA biopsy cytology are complementary in the diagnosis of lung cancer.
While the percentage of lung cancers diagnosed by FNA biopsy cytology
alone is much greater than that obtained by conventional respiratory
cytology alone, more than one-fourth of these cancers could be
detected by the less invasive techniques of sputum collection and
bronchoscopy. |
