Role and Accuracy of Rapid on-Site Evaluation of Ct: Guided Fine Needle Aspiration Cytology of Throracic Lesions

Abstract

ABSTRACT: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 management.