title: Sensitivity and cost-effectiveness of fine-needle aspiration with immunocytochemistry in the evaluation of patients with a pulmonary malignancy and a history of cancer.
abstract: OBJECTIVE
  To determine the sensitivity and cost-effectiveness of transthoracic fine-needle aspiration in the separation of primary from metastatic malignancy.
  
  
  METHODS
  Eighty-nine malignant pulmonary fine-needle aspirations in patients with a history of cancer were classified retrospectively by light microscopy, comparison with previous material, and immunocytochemistry. Decision analysis compared the cost-effectiveness of fine-needle aspiration, bronchoscopy, and thoracoscopy.
  
  
  RESULTS
  Fine-needle aspiration classified 87% of the malignancies as primary (n = 7) or metastatic (n = 70) and 13% as indeterminate. By immunocytochemistry alone, 14 of 18 malignancies were subclassified. Decision analysis showed that pulmonary fine-needle aspiration with select use of thoracoscopy was more cost-effective than either bronchoscopy or thoracoscopy alone in many common clinical scenarios.
  
  
  CONCLUSIONS
  Pulmonary fine-needle aspiration with immunocytochemistry is sensitive and cost-effective in subclassifying malignancies in patients with a history of cancer.
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City 52242-1009, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Raab
authors.forename: D D
authors.initials: DD
authors.lastname: Slagel
authors.forename: J H
authors.initials: JH
authors.lastname: Hughes
authors.forename: P A
authors.initials: PA
authors.lastname: Thomas
authors.forename: J F
authors.initials: JF
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000191:economics* / Q000592:standards*; D001999:Bronchoscopy; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013906:Thoracoscopy