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.
