Title: Diagnostic Accuracy of CT-Guided FNAC in Evaluation of Various Thoracic Mass Lesions, in Patients Attending Tertiary Care Hospital, At P.M.C.H., Patna

Authors: Dr Uday Shanker Pandey, Dr Satyendu Sagar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.37

Abstract

Objective: The aim of Present study was to establish the utility of CT –guided FNAC in delineating various caused of intrathoracic mass or lesions with cytomorphological features and providing statistical data in documenting their demographic profile.

Materials and Methods: A total of 38 patients Referred to our department for CT guided FNAC with suspected thoracic mass lesion admitted through medical OPD and emergency. After detailed medical and surgical history, clinical examination was done, Routine investigations (CBC, BT, CT, PT and aPTT) were done before the procedure. Recent Plain and contrast CT of chest made available prior to CT guided FNAC. Written consent was taken from each patient. All scans were done using fourth generation spiral CT scanner (16 slices). FNAC was done and five to seven smears were prepared, fixed and stained with May-Grunewald Giemsa stain/papanicolaou, and H&E stain also.

Result: Out of 38 patients with intrathoracic mass 28(73.68%) were male and 10(26.32%) female. Male to female ratio was 2.8:1. Intrathoracic mass lesions were more common in the 51-70 years of age. Lungs was the most common site (68.42%) of the masses. 71.05% patients had cough, 6.52% had weight loss, 34.21% had dyspnea, 28.94% had hemoptysis and 26.31% patients had chest pain. 36.82% patients had elevated total count of WBC and ESR was raised in 50% of cases. Chest radiograph revealed an abnormality in 100% of cases. 63.15% patients had mediastinal lymphadenopathy, 15.78% had subcarinal and 2.63% had peribronchial lymphadenopathy. Out of 38 patients under went CT guided FNAC, 24 (63.16%) patients had malignant intrathrocic mass, 12 (31.58%) cases had benign lesion and 2 (5.26%) patient was undiagnosed due to inadequate tissue materials. Out of 24 cases of malignant lesion Adenocarcinoma (31.58%) was the most prevalent among the cytological diagnosis, followed by Squamous cell carcinoma 15.79%, Small cell carcinoma 7.89%, Large cell carcinoma 5.26% and Metastatic carcinoma was 2.63%.According to location of lesion, 83.33% patients with central lesion had Squamous cell carcinoma and 16.67% had Adenocarcinoma. 83.33% patients with peripheral lesions had Adenocarcinoma and 16.67% patients had Squamous cell carcinoma. In gender distribution 16.67% female patients had squamous cell carcinoma and 75% had Adenocarcinoma. In male patients 83.33% had squamous cell carcinoma and 25% had Adenocarcinoma.

Among the smokers, squamous cell carcinoma was present in 83.33% cases and Adenocarcinoma was 16.67%. In Non-smoker 16.67% had squamous cell carcinoma and 83.33% cases had Adenoncarcinoma. The Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT guided transthoroacic FNAC were 94%, 98.5% ,95.8%,98.5% and 90.67% respectively for malignant lesion and 95%, 99%, 98%,97% and 97% respectively for benign intrathoracic lesion.

Conclusion: Computed Tomography Guided Fine Needle Aspiration cytology is a simple, safe, highly sensitive and specific procedure with high diagnostic accuracy for diagnosis of intrathoracic mass lesions.

Keywords: CT guided, FNAC, Intrathoracic mass, malignant, sensitivity, specificity.

References

  1. Singh MM, Gupta RK, Das DK, Pant S. Ultrasonically guided Fine needle aspiration cytology (FNAC) of intrathoracic lesions. Indian J Chest Dis & All Sci 1987; 29: 82-9.
  2. Wick M.R., The Mediastinum, In Mills S.E., Carter D., Greenson J.K., Reuter V.E., Stoler M.H. (Eds), Strenherg's diagnostic surgical pathology. 5th ed. (Lippincott. William & Wilkins: Wolter Kluwer, 2010) 1120-77.
  3. Duenas V.P., Sanchez ur., Rio F.G., Duran E.V., Plaza B.V., Garcia-Moreno J.M.V., Usefulness CT-guided F.N.A.C. in the Diagnosis of Mediastinal Lesions, Arch Bronconeumol 46(5), 2010,223-229.
  4. David H.H., David A.L., McAdams H.P., Alexander A.B., Basic patterns in lung diseases In Imaging of Diseases of the Chest. 5th ed. (Mosby: Elsevier Ltd, 2010) 83-148.
  5. Menetrier P. Cancer primitive du pounion. Bull SocAnat du Paris 1886:11:643, Cited by: D Veale„. JJ Gilmartin, MD Sumerling, V wadehra & GJ Gibson. Prospective evaluation of fine needle aspiration in the diagnosis of lung cancer.Thorax1988;43:540- 544
  6. Nordenstrom B. A new technique for transthoracic biopsy of lung changes. Br J Radiol, 1965;38:550-3. Cited by: Y Lacasse, E Wong, GH Guyatt and J Cook. Transthoracic needle aspiration biopsy or the diagnosis of localized pulmonary lesions: a meta analysis. Thorax: 1999; 54; 884-893.
  7. Kaur S, Kumar B, Gupta SK. Fine needle aspiration of lymph nodes in leprosy- A study of bactariologycal and morphological indices. Int J Lepr 1997; 45: 369-72.
  8. Gupta SK, Kumar B, Kaur S. Aspiration cytology of lymph nodes in leprosy. Int J Lepr 1981; 49: 9-15.
  9. Suen KC. Atlas and textbook of aspiration biopsy cytology. Baltimore: Williams & Wilkins; 1990. p.1-15.
  10. Orell SR, Sterrett GF, Walters MN, Whitaker D. Manual and atlas of fine needle aspiration cytology. 2nd ed. Edinburgh: Churchill Livingston; 1992. p. 172-216.
  11. Zornoza J, Wallace S, Ordonez N, Lukcman J. Fine needle aspiration cytology of the liver. AJR 1980; 134: 331-4.
  12. Rasmussen, Holm HH, Kristensen JK, Barlebo H. Ulrasonically guided liver biopsy. BMJ 1972; 2: 500.
  13. Hancke S, Holm HH, Koch F. Ultrasound guided transthoracic fine needle aspiration biopsy of pancreas. SurgGynecolObstet 1975; 140: 361.
  14. Kristenscn JK, Holm HH, Rasmussen Sw, Barlebo H. Ultrasound guided transthoracicpuncture of renal masses. Scand J Urol Nephron 1972; 15(suppl): 47.
  15. Singh J.P., Garg L., Setia V, Computed Tomography (CT) Guided Transthoracic Needle Aspiration Cytology In Difficult Thoracic Mass Lesions-Not Approachable By USG, Ind J Radial Imag 14(4), 2004,395-400
  16. Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung.J ClinPathol 1996; 19: 839-43.
  17. Salazar AM, Westcott JL. The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer.Clin Chest Med 1993; 14: 99-110.
  18. Sanders C. Transthoracic needle aspiration. Clin Chest Med 1992; 13 :1-16.
  19. Hagga JR. ed. Image-guided microprocedures: CT and MRI interventional procedure. In: CT and MRI Imaging of the whole body. 4th ed. St.Louis: Mosby; 2003. p. 2123-83.
  20. Gupta S, Wallace MJ, Morello AF, Ahar K, Hicks ME. CT-guided transthoracic needle biopsy of intrathoracic masses by using the transsternal approach: experience in 37 patients. Singapore Med J 2002; 43(11): 573-5.
  21. Gobien RP, Stanley JH, Vujiic I, Gobien BS. Thoracic biopsy: CT guidance of thin-needle aspiration. Proceedings of the 6th congress of the European society of Cardiovascular and Interventional Radiology and the European College of Angiography.August 30th - September 3rd; 1992. Barcelona, Spain.

Corresponding Author

Dr Satyendu Sagar

Assistant Professor, Department of Microbiolology, Nalanda Medical College, Patna, India