Optimizing Lung Carcinoma Diagnosis: FNA, Core, or Both
Shana M Coley, John P Crapanzano, Anjali Saqi. Columbia University Medical Center, New York
Background: A greater number of minimally-invasive procedures are being performed to diagnose lung cancer. Institutions perform CT-guided fine needle aspirate (FNA), core biopsy (CB), or both (B). Due to the advanced stage of disease at the time of sampling, these procedures may often provide the only diagnosis to guide prognosis and treatment. The aim of this study was to determine which modality (FNA, CB, or B) provides sufficient tissue to render a specific diagnosis and pursue ancillary studies to guide tumor-specific treatment.
Design: A retrospective search was performed for CT-guided lung FNA, CB, or B with on-site assessment by a cytopathologist. All cases positive for carcinoma were grouped by modality and according to whether or not the diagnosis was 'specific', defined as refined enough to subtype a primary carcinoma or to determine the site of origin of a secondary carcinoma, achieved by performing immunostains when necessary. In cases of poorly differentiated carcinomas, where immunostains were extensively performed but a specific diagnosis was not achievable due to the nature of the tumor rather than the limitations of the sample, the diagnosis was considered specific. Cases of primary lung adenocarcinoma were further assessed according to which modality provided sufficient tissue to pursue molecular studies (MS).
Results: Of 125 cases retrieved, 76 were positive for neoplasm. Of the neoplastic diagnoses, 68 were carcinomas.
|FNA, n=40||CB, n=16||B, n=12|
|Specific||35 (88%)||15 (94%)||10 (83%)|
|Non-Specific||5 (12%)||1 (6%)||2 (17%)|
|FNA, n=19||CB, n=7||B, n=8|
|Sufficient||14 (74%)||7 (100%)||5 (62%)|
|Insufficient||1 (5%)||0 (0%)||2 (25%)|
|N/A||4 (21%)||0 (0%)||1 (13%)|