[1979] 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.

Carcinoma: Diagnostic Specificity of FNA, CB, and B

	FNA, n=40	CB, n=16	B, n=12
Specific	35 (88%)	15 (94%)	10 (83%)
Non-Specific	5 (12%)	1 (6%)	2 (17%)

No statistical differences were found in the ability of any of the modalities to reach a specific diagnosis (Fisher's Exact Test, p=0.67).

Primary Lung Adenocarcinoma: MS from FNA, CB, and B

	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%)

Sufficient = sufficient tissue to perform MS for EGFR/KRAS/ALK; Insufficient = insufficient tissue to perform MS; N/A = MS not routine protocol at time of diagnosis; No statistical differences were found in the ability of any of the modalities to provide sufficient tissue for MS (Fisher's Exact Test, p=0.27).


Conclusions: The results of this study suggest that FNA, CB, and B are comparable in reaching a specific diagnosis and in having sufficient tissue for MS, though the study is limited by the number of CB and B cases that met inclusion criteria. However, the results demonstrate that FNA is as capable alone as when combined with a concurrent CB in reaching the diagnostic and prognostic goals of minimally-invasive procedures for lung carcinoma.
Category: Pulmonary

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 294, Monday Morning