The Journal of Association of Chest Physicians (Jan 2015)
Diagnostic role of ultra sound and computed tomography guided fine-needle aspiration cytology and Tru-cut biopsy experienced in 50 adult patients of mediastinal diseases
Abstract
Context: Etiology and clinical spectrum of mediastinal diseases are very wide. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, noninvasive approach to these cases sometimes leads to diagnostic dilemma. Aims: We performed a prospective study over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine-needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and noninvasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, need of further detail and patient′s financial status. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Statistical Analysis Used: Statistical analysis was performed using MedCalc ® Version 11.3.3.0 for analysis of data. Results: Among 50 patients TTUS guided FNAC were conducted in 26 (52%) occasions and CT guided FNAC were conducted in 26 (52%) occasions. TTUS guided Tru-cut biopsy were done in eight cases (16%), and CT guided Tru-cut biopsy were done in 32 cases (64%). CT guided Tru-cut biopsy had higher diagnostic yield (96.87%) than TTUS guided Tru-cut biopsy (75%). TTUS guided, and CT guided procedures had similar complication rates. Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and comparable with CT guided invasive procedures in respect to risk and diagnostic yields.
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