DIAGNOSTIC YIELD AND SAFETY OF CT SCAN GUIDED TRANS THORACIC FINE NEEDLE ASPIRATION CYTOLOGY IN PERIPHERAL LUNG LESIONS

Dr. Poonam Salwan*, Dr. Sunil Wadhwa and Dr. Shalini Salwan

ABSTRACT

Aims and Objectives: To obtain a sample of tissue by CT scan guided FNAC for pathological (cytopathological and histopathological) and / or microbiological analysis and to evaluate its efficacy to reach a definitive diagnosis. Material and Methods: 60 patients comprising 48 males and 12 females between 14 to 85 years with lesions in the peripheral lung fields were subjected to CT guided transthoracic fine needle aspiration (FNA) for a definitive diagnosis of benign or malignant lesion or for microbiological analysis to establish the etiologic agent. The procedures were performed using the siemens somatom AR.C CT unit with 18-22 gauge needles. Smears and tissue sections were evaluated simultaneously to reach at a definite diagnosis. An immediate post biopsy scan along with an expiration PA chest radiograph after 2 hours, were obtained to detect the presence of pneumothorax. Results: The commonest lesions diagnosed were inflammatory 41.6% and most of them were non-specific. Among the specific infections, Nocardia was most commonly seen. The post renal transplant – immunocompromised patients were benefited by specific diagnosis in 7 out of 9 patients i.e 77.7%. Primary malignancies were detected in 19/60 patients i.e 31.6% cases. The most common type detected being Non-small cell carcinoma in 17 cases. Secondary deposits were seen in 2 patients. The FNAC showed an overall positivity of 76.6%. In our patients, pneumothorax was seen as a complication in 4 patients i.e. 6.6% only. Conclusion: Fine needle aspiration cytology (FNAC) has a good overall yield for diagnosis of focal radiographic lesions. It is safe, accurate, relatively non invasive and cost effective method of obtaining diagnosis.

Keywords: Fine needle sampling, Fine needle aspiration cytology (FNAC), CT-guided FNAC.