CT-Guided Fine-Needle Aspiration Cytology of Solitary Pulmonary Nodules*: A Prospective, Randomized Study of Immediate Cytologic Evaluation

doi:10.1378/chest.112.2.423

Chest

Volume 112, Issue 2, August 1997, Pages 423-425

https://doi.org/10.1378/chest.112.2.423 Get rights and content

Study objective

To evaluate the immediate cytologic assessment during CT-guided fine-needle aspiration cytology (FNAC) in the diagnosis of operable indeterminate solitary pulmonary nodules (SPNs).

Design

Prospective randomized study.

Patients and methods

Two hundred twenty patients with SPN undergoing CT-guided FNAC were divided into two groups. In the first one (group A, 110 patients), a cytologist assessed the adequacy of the sample obtained immediately, and when the sample was considered inadequate, fine-needle aspiration (FNA) was repeated. In the second group (B, 110 patients), an immediate cytologic examination was not performed, but only a gross assessment by the surgeon. Histologic study of the SPN was possible in 217 cases, whereas three patients were followed up radiologically.

Results

Adequate samples were obtained in 100% of group A and 88% of group B (p< 0.001). The diagnostic accuracy was 99% in group A and 81% in group B (p<0.001). Group A required a mean of 1.22 FNAs compared with 1.10 in group B (p=0.015). The rate of pneumothorax in the whole series was 24%, and statistically significant differences between the two groups were not detected.

Conclusions

Immediate cytologic study significantly increased the adequacy and diagnostic accuracy of CT-guided FNAC of indeterminate SPNs without causing a significant increase of complications.

Section snippets

Materials and Methods

An indeterminate SPN was defined as a solid roundish, peripheral (outer half of parenchyma) lung mass, without evident signs of malignancy (spiculated edges) or benignity (calcifications), measuring between 1 and 3 cm.

From June 1, 1994, to August 6, 1995, 220 consecutive patients with indeterminate SPN underwent CT-guided FNAC. We included all potential candidates for surgery based on age and general condition. The other inclusion criteria were normal sputum cytologic findings and bronchial

Results

The two groups were comparable for age, sex, and smoking habit (group A: average age, 62 years; male/female, 62/48; pack-years, 27.3; group B: average age, 59 years; male/female, 74/36; pack-years, 31.4).

The sensitivity, specificity, predictive value, and efficiency of FNAC with and without immediate cytologic study are reported in Table 1.

At definitive cytologic examination, all the group A samples were adequate, whereas 13 (11.8%) group B samples were not (p<0.001). There were 67 samples

Discussion

Our findings constitute statistically significant evidence that the decision to perform immediate cytologic study during FNA of an indeterminate SPN is a valid one. The most striking result was the significant difference in the number of adequate samples (p<0.001, test power=0.953). The contribution of the cytologists virtually eliminated the problem of inadequate samples, as also reported by others.¹⁰ The certainty of having obtained an adequate sample limits the number of aspirations if the

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There are more references available in the full text version of this article.

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Chest

CT-Guided Fine-Needle Aspiration Cytology of Solitary Pulmonary Nodules*: A Prospective, Randomized Study of Immediate Cytologic Evaluation

Study objective

Design

Patients and methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Ann Thorac Surg

Chest

Prospective evaluation of fine needle aspiration in the diagnosis of lung cancer

Thorax

Fine-needle aspiration biopsy in diagnosis of pulmonary masses

Am Surg

Peripheral mass lesions in the lung

Value of TC-guided fine needle aspiration in solitary pulmonary nodules with negative fiberoptic bronchoscopy

Acta Radiol