CT Guided Transthoracic FNAC of Intrathoracic Lesions-An Institute Experience

Abstract

Introduction: In the management of thoracic lesions, especially malignant lesions, specific pathological diagnosis is considered standard, so obtaining the tissue is essential for diagnosis and treatment. There are complex vascular structures in hila and mediastinum and so precise localization is necessary to avoid unnecessary injury to these structures, which can be achieved by doing image guided procedures. Aim: This study was proposed to analyze the role of CT in guiding the FNAC of the thorax and to understand its scope in improving the diagnostic accuracy and therapeutic outcome, decreasing the patient discomfort, cost and surgical morbidity and also in assessing the types of complications arising out of the same. Materials and Methods: This prospective observational study was conducted at Kidwai Memorial Institute of Oncology Bengaluru, India, from 2012 to 2015 for three years. This study consisted of 420 patients who were referred for TTFNAC. Results: The Study consisted of 420 patients in age group of 18-87 years. Total yield of 85% was achieved, complications were seen in 126 patients (20%)in the form of pneumothorax and hemorrhage. Maximal lesions encountered were seen in the lungs, followed by mediastinum. The sensitivity specificity, positive and negative predictive values are 97%, 66%, 94% and 82% for malignant lesions. However, it was lower for benign lesions. Conclusion: CT-guided Transthoracic (TTFNAC) is a good tool for material procurement in benign and malignant lesions. It helps the clinician to initiate appropriate treatment measures like chemotherapy or radiotherapy at an early pace and is associated with low mortality and morbidity. TTFNAC achieves substantial cost savings, as it can obviate more costly and invasive surgical procedures and is minimally invasive. Fewer complications are caused by TTFNAC that can be avoided, if properly planned by avoiding vessels and bullae. However, if they occur they can be easily managed. This procedure can be used as a safe outpatient procedure for material procurement in lung or mediastinal lesions, not accessible for ultrasound guided FNAC, for lesions situated less than 8 cm from chest wall and size greater than 25 mm and it has good patient tolerance.

Keywords

• lung fnac
• fnac of mediastinal lesions