Changing Trends of Fine Needle Aspirate Diagnosis of Lung Neoplasm in the Face of Customized Patient Management Approach. Are We Going to Step Up?
Thamara Jayasinghe, Marcio M Gomes, Harmanjatinder S Sekhon. The Ottawa Hospital, University of Ottawa, ON, Canada
Background: Transthoracic image guided fine-needle aspiration (FNA) is one of the mainstay and utterly useful initial diagnostic modalities for acquiescent focal lung lesions. A large body of literature is available regarding accessibility, yield, sensitivity, specificity and accuracy of lung FNA but recent expectations for profiling classified tumours are becoming an important and desirable diagnosis to tailor tumour specific targeted therapies. The objectives of our study include overall evaluation and efficacy of FNA in the diagnosis of neoplastic lung lesions and to observe the evolvement of diagnostic reporting trends from traditional to more specific classification of tumour and molecular testing phased in at our institution.
Design: Cytology reports of FNA performed on 2206 patients with lung lesions over a 3 year period (2007-2009) were retrieved from the archives of cytopathology of the Ottawa Hospital. During the study period, 517 cases with histologically proven non-small cell carcinoma (NSCLC) diagnoses were identified and evaluated for cytological-histological correlation. Sections of cell blocks of FNA samples of adenocarcinoma cases were tested for EGFR exon 19 and exon 21mutations.
Results: Patients' age ranged from 31 to 90 years with a male: female ratio of 1.69:1 and collectively a diagnosis of neoplasm was rendered for 75.2% for 2206 FNA procedures performed whereas 2.5% were suspicious for malignancy, 4.8% atypical, 14% negative for malignancy and 3% were non-diagnostic. The sensitivity was 100% as all histologically proven non-small cell carcinomas had positive cytology. A specific diagnosis for adenocarcinoma (AdCa) and squamous cell carcinoma (SqCCa) improved from 33% in 2008 to 42% in 2009 in proven NSCLC cases and a diagnosis of atypical cells decreased from 11.4% to 6.7% in all malignant cases. Accuracy rate for SqCCa was 100% and for adenocarcinoma was 98%. 10.3% of adenocarcinoma FNA samples tested for EGFR mutations were positive.
Conclusions: Relatively less invasive, time efficient and cost effective FNA samples obtained by experienced interventionists are optimal to deliver classified tumor diagnosis in a significant number of non-small cell carcinoma cases. In addition, these samples if preserved properly, can be utilized for immunohistochemical studies to further refine the diagnosis and to perform molecular diagnostic techniques to deliver customized oncological chemotherapeutic patient management.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 85, Tuesday Morning