Is preoperative percutaneous fine-needle aspiration cytology of intrathoracic lesions advisable in resectable patients?
OBJECTIVE
The study addresses the clinical significance of percutaneous fine-needle aspiration (FNA) cytology in patients with intrathoracic lesions.


METHODS
The diagnoses based on cytology in 101 patients (73 male, 28 female; age 21-78 years) with intrathoracic lesions were compared with a definitive histological diagnosis obtained by thoracotomy. Sixty-one lesions were localized in the right and 31 in the left lung, 5 bilaterally and 4 paramediastinally (maximum diameters: 0.8-12 cm; median: 3.5 cm).


RESULTS
Upon FNA, 69 cases were graded malignant and 17 benign. In the remaining 15 cases the pathologists felt unable to define clearly the cell type or the biological properties, though the material was found representative. Histology yielded 80 malignant and 21 benign lesions, consistent with the cytological diagnosis in 70 cases. In 60 patients accordance between the cellular subtypes suspected after FNA and those found histologically was present. A significantly higher rate of correct FNA diagnoses was made in malignant lesions (chi-square test: p<0.05). The overall diagnostic accuracy of FNA was 0.77, the sensitivity 0.79 and the specificity 0.91 From the surgical point of view, nine resectable lung cancers, three metastases, three other malignancies and three tuberculomas would have been missed by relying on the FNA diagnoses. Eighteen pneumothoraces (nine requiring suction drainage) occurred after FNA.


CONCLUSIONS
The indication for FNA in otherwise resectable patients should be made carefully, keeping in mind the rate of diagnostic errors and of complications, as well as the possibility for diagnostic VATS of peripheral lesions.
Smolle-Juettner
F M
FM
Dept. of Thoracic and Hyperbaric Surgery, University of Graz, Austria.
Woltsche
M
M
Roeger
G
G
Gabor
S
S
Fladerer
H
H
Popper
H
H
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D013896:Thoracic Diseases / Q000473:pathology / Q000601:surgery; D013899:Thoracic Neoplasms / Q000473:pathology* / Q000601:surgery; D013908:Thoracotomy