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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2018; 39(02): 250-253
DOI: 10.4103/ijmpo.ijmpo_86_17
Original Article

CT-guided Lung Fine Needle Aspiration Biopsy: Analysis of Efficacy, Yield and Intricacies

Anirudh V Nair
Department of Radiodiagnosis, Kerala Institute of Medical Science, Trivandrum, Kerala, India
,
Soumya Anirudh
1Department of Pathology, Government Medical College Hospital, Trivandrum, Kerala, India
,
Srikanth Moorthy
Departments of Radiodiagnosis Amrita Institute of Medical Science, Kochi, Kerala, India
,
P Cyril
Departments of Radiodiagnosis Amrita Institute of Medical Science, Kochi, Kerala, India
,
Bindhu Mangalath Rajamma
Departments of Pathology, Amrita Institute of Medical Science, Kochi, Kerala, India
,
PV Ramachandran
Departments of Radiodiagnosis Amrita Institute of Medical Science, Kochi, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aim: This study aims to evaluate various factors that affect the cytological yield while performing computed tomography (CT) guided lung fine needle aspiration biopsy and to determine the complication rate of this procedure. Materials and Methods: In this cross sectional study, we analyzed 70 patients undergoing CT-guided transthoracic lung fine-needle aspiration biopsy (FNAB). 22-gauge spinal needle was used in sixty patients and 20-gauge in ten patients. The presence and absence of an onsite cytopathologist affecting the adequacy of yield for a conclusive cytodiagnosis was compared in groups of 35 patients each. The incidence of complications such as pneumothorax, pulmonary hemorrhage was recorded. Results: Cytological yield was adequate for a conclusive cytodiagnosis in 59 cases (84.2%). Thirty-seven cases (52.8%) were malignant with adenocarcinoma (70.2%) being the most common, 22 cases (31.4%) had benign etiology. Cytological yield was adequate for a conclusive diagnosis in the group (n = 35) with an onsite cytopathologist (100%) compared with those cases without an onsite cytopathologist (68.6%) (P = 0.005). Pneumothorax was observed in 16 cases (22.8%), the incidence of pneumothorax was higher when there was an intervening parenchyma (P = 0.005). Conclusion: CT-guided transthoracic FNAB is an accurate method to rule out malignancy with a reasonable rate of complications. The presence of an onsite-cytopathologist significantly improves the adequacy of yield for a conclusive cytodiagnosis, and should be routinely employed. Pneumothorax and pulmonary hemorrhage are the most common complications as a result of FNAB. The incidence of pneumothorax is higher when there is intervening lung parenchyma.

Keywords

Computed tomography - cytopathologist - fine-needle aspiration biopsy - lung cancer


Publication History

Article published online:
23 June 2021

© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Lourenço R, Camacho R, Barata MJ, Canário D, Gaspar A, Cyrne C. CT-guided percutaneous transthoracic biopsy in the evaluation of undetermined pulmonary lesions. Rev Port Pneumol 2006; 12: 503-24
    CrossrefPubMedGoogle Scholar
  • 2 Swischuk JL, Castaneda F, Patel JC, Li R, Fraser KW, Brady TM. et al. Percutaneous transthoracic needle biopsy of the lung: Review of 612 lesions. J Vasc Interv Radiol 1998; 9: 347-92
    CrossrefPubMedGoogle Scholar
  • 3 Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C. et al. CT-guided transthoracic needle aspiration biopsy of small (<or=20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 2003; 180: 1665-9
    CrossrefPubMedGoogle Scholar
  • 4 Anderson JM, Murchison J, Patel D. CT-guided lung biopsy: Factors influencing diagnostic yield and complication rate. Clin Radiol 2003; 58: 791-7
    CrossrefPubMedGoogle Scholar
  • 5 Haramati LB. CT-guided automated needle biopsy of the chest. AJR Am J Roentgenol 1995; 165: 53-5
    CrossrefPubMedGoogle Scholar
  • 6 Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996; 196: 371-5
    CrossrefPubMedGoogle Scholar
  • 7 Stevens GM, Jackman RJ. Outpatient needle biopsy of the lung: Its safety and utility. Radiology 1984; 151: 301-4
    CrossrefPubMedGoogle Scholar
  • 8 Saji H, Nakamura H, Tsuchida T, Tsuboi M, Kawate N, Konaka C. et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: The angle of the needle trajectory is a novel predictor. Chest 2002; 121: 1521-6
    CrossrefPubMedGoogle Scholar
  • 9 Yeow KM, See LC, Lui KW, Lin MC, Tsao TC, Ng KF. et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001; 12: 1305-12
    CrossrefPubMedGoogle Scholar
  • 10 Voravud N, Shin DM, Dekmezian RH, Dimery I, Lee JS, Hong WK. Implantation metastasis of carcinoma after percutaneous fine-needle aspiration biopsy. Chest 1992; 102: 313-5
    CrossrefPubMedGoogle Scholar
  • 11 Tarver RD, Conces DJJr. Interventional chest radiology. Radiol Clin North Am 1994; 32: 689-709
    CrossrefPubMedGoogle Scholar
  • 12 Greene R, Szyfelbein WM, Isler RJ, Stark P, Janstsch H. Supplementary tissue-core histology from fine-needle transthoracic aspiration biopsy. AJR Am J Roentgenol 1985; 144: 787-92
    CrossrefPubMedGoogle Scholar
  • 13 Stanley JH, Fish GD, Andriole JG, Gobien RP, Betsill WL, Laden SA. et al. Lung lesions: Cytologic diagnosis by fine-needle biopsy. Radiology 1987; 162: 389-91
    CrossrefPubMedGoogle Scholar
  • 14 Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WWJr. et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985; 144: 281-8
    CrossrefPubMedGoogle Scholar
  • 15 Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: Comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996; 167: 105-9
    CrossrefPubMedGoogle Scholar
  • 16 Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169: 593-601
    CrossrefPubMedGoogle Scholar
  • 17 Larscheid RC, Thorpe PE, Scott WJ. Percutaneous transthoracic needle aspiration biopsy: A comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 1998; 114: 704-9
    CrossrefPubMedGoogle Scholar
  • 18 Miller JA, Pramanik BK, Lavenhar MA. Predicting the rates of success and complications of computed tomography-guided percutaneous core-needle biopsies of the thorax from the findings of the preprocedure chest computed tomography scan. J Thorac Imaging 1998; 13: 7-13
    CrossrefPubMedGoogle Scholar
  • 19 Austin JH, Cohen MB. Value of having a cytopathologist present during percutaneous fine-needle aspiration biopsy of lung: Report of 55 cancer patients and metaanalysis of the literature. AJR Am J Roentgenol 1993; 160: 175-7
    CrossrefPubMedGoogle Scholar
  • 20 Madan M, Bannur H. Evaluation of FNAC in lung diseases. Turk J Path 2010; 26: 1-6
    Google Scholar
  • 21 Mohammad GM. CT guided fine needle aspiration cytology in the diagnosis of thoracic lesions. JIMA 2001; 99: 1-5
    Google Scholar
  • 22 Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung. J Clin Pathol 1996; 49: 839-43
    CrossrefPubMedGoogle Scholar
  • 23 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: 51-5
    PubMedGoogle Scholar
  • 24 Santambrogio L, Nosotti M, Bellaviti N, Pavoni G, Radice F, Caputo V. CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: A prospective, randomized study of immediate cytologic evaluation. Chest 1997; 112: 423-5
    CrossrefPubMedGoogle Scholar
  • 25 Saha A, Kumar K, Choudhuri MK. Computed tomography-guided fine needle aspiration cytology of thoracic mass lesions: A study of 57 cases. J Cytol 2009; 26: 55-9
    CrossrefPubMedGoogle Scholar
  • 26 Haramati LB, Austin JH. Complications after CT-guided needle biopsy through aerated versus nonaerated lung. Radiology 1991; 181: 778
    CrossrefPubMedGoogle Scholar
  • 27 Cox JE, Chiles C, McManus MC, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: Variables that affect risk of pneumothorax. Radiology 1999; 212: 165-8
    CrossrefPubMedGoogle Scholar
  • 28 Berquist TH, Bailey PB, Cortese DA, Miller WE. Transthoracic needle biopsy: Accuracy and complications in relation to location and type of lesion. Mayo Clin Proc 1980; 55: 475-81
    PubMedGoogle Scholar
  • 29 Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: A survey of UK practice based on 5444 biopsies. Br J Radiol 2002; 75: 731-5
    CrossrefPubMedGoogle Scholar