Diagnostic efficacy and molecular testing by combined fine‐needle aspiration and core needle biopsy in patients with a lung nodule

Abstract

Background Combined image‐guided fine‐needle aspiration biopsy (FNA) and core needle biopsy (CNB) has become the standard of care for diagnosis and/or molecular testing for patients with a solitary lung nodule at our institution. Our purpose was to evaluate the efficacy of this practice. Methods We identified patients who underwent combined lung FNA/CNB during 2012 at our institution. A total of 667 patients who underwent 682 combined lung FNA/CNB procedures were included in the study, including 355 men and 312 women. Combined lung FNA/CNB procedures were performed by a radiologist. The adequacy of FNA specimens was assessed immediately by a cytopathologist. The FNA and CNB specimens were interpreted separately by a cytopathologist and a surgical pathologist, respectively. The diagnostic accuracy of the combined technique was determined. Results The rate of diagnostic consistency between FNA and CNB was 83.4%, and the rate of diagnostic accuracy for malignancy was 98.5% for combined FNA/CNB. Combined FNA/CNB showed a high diagnostic efficacy for malignancy (sensitivity, 97.6%; specificity, 100%). Combined FNA/CNB had a lower false‐negative rate for malignancy (2.2%) than either FNA (7.2%) or CNB (6.2%) alone. FNA contributed to 10.3% of molecular analyses as a complementary tissue source. Conclusions Combined lung FNA/CNB has high diagnostic efficacy for malignancy and a lower false‐negative rate than either procedure alone. FNA was a valuable complement to CNB for molecular testing, potentially reducing patient inconvenience and morbidity associated with repeated lung needle biopsy.

Utility of liquid‐based cytology on residual needle rinses collected from core needle biopsy for lung nodule diagnosis

“…Therefore, combined FNA/CNB has been encouraged in some studies with the advantage of minimizing sampling errors and compensating for the limitations of other methods. 2,14 However, concurrent FNA not only indicates extra cost, but also influences the diagnostic yields of CNB being performed after FNA. 14 Additionally, some institutions, especially in developing countries, lack sufficient facilities and cytologists specializing in rapid on-site evaluation compared with the institutions in developed countries.…”

“…1 Transthoracic computed tomography (CT)-guided core needle biopsy (CNB) is widely used as a tissue sampling modality, especially in the peripheral pulmonary nodules, to meet the increasing clinical demand. 2 Most cases of lung lesions are non-small cell lung cancer (NSCLC), including adenocarcinoma (ADC) and squamous cell carcinoma (SQC). The 2015 World Health Organization Classification of Lung Tumors guidelines indicate that personalized treatment based on molecular testing requires a more precise histopathological subtyping through immunohistochemistry.…”

“…Therefore, the aims of our study were as follows: (1) To evaluate the sensitivity and specificity of cytology of CNB needle rinses (CNR); (2) to determine the superiority of combined CNR/CNB over CNB; and (3) to explore the discordance between CNB and CNR findings.…”

The radiologist’s role in pathologic diagnosis of small lung nodules: radiographic methods of tissue acquisition

“…radiologists preferred single shaft FNA needles (24). With the advent of molecular analysis and personalized medicine, there has been a gradual shift towards using both coaxial and FNA techniques during each biopsy procedure, with some studies demonstrating that combined FNA/core biopsy increases diagnostic accuracy over either FNA or core biopsy alone (25). In a 2017 survey of practice patterns again involving Society of Thoracic Radiology members, about 43% of thoracic radiologists preferred combined FNA/core, 42% preferred core biopsy alone, and 15% preferred FNA alone (26).…”

Diagnostic utility of fine needle aspiration cytology and core biopsy histopathology with or without immunohistochemical staining in the subtyping of the non‐small cell lung carcinomas: Experience from an academic centre in Turkey

“…Some recent publications indicated that sufficient data for targeted molecular therapy may be obtained from cytological samples only (e.g. cell block, stained cytology preparations, and cell‐free supernatant DNA) 8 . However, tumour typing and molecular analysis using cytology samples are not used on a worldwide scale, except for in developed countries 9 .…”