Diagnstic accuracy of Computed Tomography- guided Fine Needle Aspiration Cytology of thoracic mass lesions-A study of 33 cases
DOI:
https://doi.org/10.7439/ijbar.v8i1.3836Abstract
Aim: The mediastinum harbors a mixed bag of tumors, which may create significant diagnostic dilemmas. These tumors have widely variable therapeutic and prognostic implications. Correct pre-operative cytological diagnosis and trucut biopsy if indicated, may obviate the need of surgical excision of many of these lesions. A stepwise algorithmic approach such as clinical history, radiological localization, salient cytomorphology and ancillary test helps in correct diagnosis of these tumors. This paper discusses the stepwise diagnostic algorithm for fine needle aspiration cytology diagnosis of mediastinal tumors. Materials and methods: Prospectively thirty-three patients were studied over a year (July 2015 to June 2016) for their age, sex, and topographic distribution, cytological diagnosis and histopathological diagnosis on tru cut biopsy specimen. Thereafterthe diagnosis on the basis of Cytology smears and histological sections were evaluated in all patients. Results: Among 33 patients, 27 were male and 6 were female. Most mediastinal neoplasm was identified in 3rd to fifth decade of life. Lymphoma and Germ cell tumor are the most common Mediastinal neoplasm. Adequate tissue material was obtained in 32 of 33 cases by CNB. Of these 32 patients, 26(78.79%) cases were diagnosed correctly by FNAC, whereas 7(21.21%) cases were not diagnosed definitely by FNAC. The sensitivity of CNB for mediastinal neoplasm was 87.88%, significantly higher than FNAC (78.79 %) (P 0.05). Mediastinum is the common site and tissue diagnoses of mediastinal mass are very important for correct therapeutic decision.Downloads
References
Singh HK, Silverman JF, Powers CN, Geisinger KR, Frable WJ. Diagnostic pitfalls in fine -needle aspiration biopsy to the mediastinum. Diagn Cytopathol 1997; 17:121-125.
Linder J, Olsen GA, Johnston WW. Fine needle aspiration biopsy of the mediastinum. Ann Intern Med 1986; 81:1005-8.
Shabb NS, Fahl M, Shabb B, Haswani P, Zaatari G. Fine-needle aspiration of the mediastinum: A clinical, radiologic, cytologic, and histologic study of 42 cases. Diagn Cytopathol 1998; 19:428-36.
Wakely PE Jr. Cytopathology-histopathology of the mediastinum: Epithelial, lymph proliferative, and germ cell neoplasms. Ann Diagn Pathol 2002; 6:30-43.
Geisinger KR. Differential diagnostic considerations and potential pitfalls in fine-needle aspiration biopsies of the mediastinum. Diagn Cytopathol 1995; 13:436-42.
Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol 2007; 35:705-9.
Desai F, Shah M, Patel S, Shukla SN. Fine needle aspiration cytology of anterior mediastinal masses. Indian J Pathol Microbiol 2008; 51:88-90.
Goel D, Prayaga AK, Sundaram C, Raghunadharao D, Rajappa SJ, Rammurti S, et al. Utility of fine needle aspiration cytology in mediastinal lesions: A clinicopathologic study of 1617 cases from a single institution. Acta Cytol 2008; 52:404-11.
Tscheikuna J, Suttinont P. Is cytology necessary in diagnosis of mediastinal mass? J Med Assoc Thai 2009; 92:S24 9.
Shrivastava CP, Devgarha S, Ahlawat V. Mediastinal tumors: A clinicopathological analysis. Asian Cardiovasc Thorac Ann 2006; 14:102 4.
Vaziri M, Pazooki M, Zahedi Shoolami L. Mediastinal Masses: Review of 105 Cases. Acta Med Iran 009; 47:297 300.
Desai F, Shah M, Patel S, Shukla SN. Fine needle aspiration cytology of anterior mediastinal masses. Indian J Pathol Microbiol 2008; 51:88 90.
Karki S, Chalise S. Analysis of mediastinal lesions: A study of 27 cases. Journal of Pathology of Nepal 2011; 1:114 7.
Safavi E, Hosseinian SM, Firoozbakhsh S. The value of percutaneous core needle biopsy in the diagnosis of anterior mediastinal tumors. Tanaffos 2004; 3:7 11.
Fang WT, Xu MY, Chen G, Chen Y, Chen WH. Minimally invasive approaches for histological diagnosis of anterior mediastinal masses. Chin Med J (Engl) 2007; 120:675 9.
Rendina EA, Venuta F, De Giacomo T, Ciccone AM, Moretti MS, Ibrahim M, et al . Biopsy of anterior mediastinal masses under local anesthesia. Ann Thorac Surg 2002; 74:1720 2.
Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung. J Clin Pathol. 1996; 49:839
Salazar AM, Westcott JL. The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer. Clin Chest Med. 1993; 14:99
Sanders C. Transthoracic needle aspiration. Clin Chest Med. 1992; 13:1
Sing JP, Garg L, Setia V. Compared tomography (CT) guided transthoracic needle aspiration cytology in difficult thoracic mass lesions
Van Sonnenberg E, Casola G, Ho M, Neff CC, Varney RR, Wittich GR, et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology. 1988; 167:457
Wallace MJ, Krishnamurthy S, Broemeling LD, Gupta S, Ahrar K, Morello FA, Jr, et al. CT-guided percutaneous fine-needle aspiration biopsy of small (?1-cm) pulmonary lesions. Radiology. 2002; 225: 823
Mullan CP, Kelly BE, Ellis PK, Hughes S, Anderson N, McCluggage WG. CT-guided fine-needle aspiration of lung nodules: Effect on outcome of using coaxial technique and immediate cytological evaluation. Ulster Med J. 2004; 73:32
Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: Variables that affect risk of pneumothorax. Radiology. 1999; 212:165
Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, et al. Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors? Radiology. 2001; 218:491
Shah S, Shukla K, Patel P. Role of fine needle aspiration cytology in diagnosis of lung tumors
Bandyopadhyay A, Laha R, Das TK, Sen S, Mangal S, Mitra PK. CT guided fine needle aspiration cytology of thoracic mass lesions: A prospective study of immediate cytological evaluation. Indian J Pathol Microbiol. 2007; 50:51
Tan KB, Thamboo TP, Wang SC, Nilsson B, Rajwanshi A, Salto-Tellez M. Audit of transthoracic fine needle aspiration of the lung: Cytological sub classification of bronchogenic carcinomas and diagnosis of tuberculosis. Singapore Med J. 2002; 43:570
Abrari A, Aziz M, Haq R. Cytology of lung tumors
Gouliamos AD, Giannopoulos DH, Panagi GM, Fletoridis NK, Deligeorgi-Politi HA, Vlahos LJ. Computed tomography-guided fine needle aspiration of peripheral lung opacities: An initial diagnostic procedure? Acta Cytol. 2000; 44:344
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