Relative Utilization of Interventional Radiology Guided Fine Needle Aspiration Biopsy and Core Needle Biopsy for the Investigation of Lung Lesions.
Jasreman Dhillon, Marilyn Dawlett, Sanjay Gupta, Kamran Ahrar, Michael Wallace, Ashutosh Lodhi, Savitri Krishnamurthy. MD Anderson Cancer Center, Houston, TX
Background: Initial investigation of lung lesions is generally performed using fluoroscopy or computed tomography guided fine needle aspiration biopsy (FNA) or core needle biopsy (CNB). In a state of the art institution where interventional radiology and pathology support including immediate assessment was available, we undertook this study to evaluate and compare the current utilization and efficacy of FNA and CNB for the investigation of lung lesions.
Design: We searched our pathology files from Jan 2009 to Dec 2009 for patients who underwent investigation of their lung lesion by FNA and CNB or by only FNA or CNB. Pathological parameters reviewed were : size of the lesion, diagnosis on FNA/CNB and ancillary techniques including immunostaining (IHC) and molecular tests (MT) performed using both these techniques. Results were compared with surgical resection and/or clinical follow up and sensitivity of both techniques determined by McNemar's test.
Results: We studied 740 patients who underwent FNA and CNB, 153 FNA only and 84 CNB only. In the former group, using surgical resection and/or clinical follow up as the gold standard, a definite diagnosis was rendered in 651/740 (88%) (Benign-144, Neoplastic-507) by FNA in comparison to 695/740 (94%)(Benign-172, Neoplastic-523) by CNB. A total of 153 patients underwent FNA only which yielded definite results in 143 (93.5%) (Benign-40, Neoplastic-103). All the 84 pateints who had CNB only yielded definite result 100% (Benign-35, Neoplastic-49). Ancillary studies were performed more often using CNB than by FNA; IHC: 40% vs 11%; MT: 16% VS 4%.
Overall, a definite diagnosis was rendered by FNA in 794/893 patients vs 779/824 and their sensitivities, 89% vs 94.5% were not statistically significant. The non-diagnostic rate of FNA was however higher than CNB ;99/893 (11%) vs 45/824.(5.5%).
Conclusions: 1.FNA was utilized more often than CNB for the investigation of lung lesions.
2.The sensitivity of FNA was comparable to that of CNB (89% vs 94.5%).
3. Ancillary studies were performed more often using CNB in comparison to FNA.
4.Non-diagnostic result by FNA was more often encountered than by CNB in this study,
5.Although either technique can be used alone, because of the possibility of discordant results, performance of both techniques if possible can ensure a definite result.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 80, Tuesday Morning