Pulmonary Mass Lesions: CT Scan Diagnostic-Impressions and FNAC Diagnoses – A Correlative Study
Abstract
Introduction: Bronchogenic carcinoma, the commonest pulmonary mass lesion, is the leading cause of cancer related death globally. Computed tomography (CT) scan is often used for evaluation of pulmonary mass lesions to have an initial diagnostic impression for deciding on next course of actions in clinical management. So, it becomes highly imperative to study the correlation of CT scan-diagnoses with pathological diagnoses. Till date such correlative studies are very meagre from north-eastern part of India. This study was designed to address this deficiency.
Aim: To correlate CT scan-diagnoses of pulmonary mass lesions with the pathological diagnoses made on fine needle aspiration cytology (FNAC).
Materials and Methods: Ninety subjects with pulmonary mass lesions were included. CT scan evaluation and CT-guided FNAC were performed. Important clinical profiles, radiological diagnostic impressions on nature of the lesions (malignant/benign) and cytological diagnoses were recorded. Finally, a radio-cytological correlation of diagnoses was done.
Results: Out of 90 cases, CT scans diagnosed 81 cases as malignant and nine as benign. On FNAC, there were 73 malignant and nine benign lesions and in eight cases aspirates were unsatisfactory. An overall radio-cytological correlation of 92.6% was observed. The sensitivity and specificity of CT scan for detecting malignancy in pulmonary mass lesions were found to be 94.5% and 55.5% respectively with an overall diagnostic accuracy of 89%.
Conclusion: CT scan study is a very useful non-invasive diagnostic modality in the clinical evaluation of lung masses. CT-guided FNAC is a simple, rapid and safe procedure with high yielding rate of pathological diagnoses.
Downloads
References
Hansel DM, Balkier AA, MacMahon H, McLeod TC, Muller NL, Remy J. Fleischer Society: Glossary of Terms for Thoracic Imaging. Radiology 2008 Mar; 246(3):697-722.doi: https://doi.org/10.1148/radiol.2462070712.
Erasmus TT, Connolly ET, McAdams HP, Page H, Roggli LV. Solitary pulmonary nodule: part 1. Morphologic evaluation for differentiation of benign & malignant lesion. Radiographics. 2000 Jan- Feb; 20(1): 43-55.doi: https://doi.org/10.1148/radiographics.20.1.g00ja0343.
Li F, Sone S, Abe H, Macmahon H, Doi K. Malignant versus benign nodules at CT screening for lung cancer : comparison of thin section CT findings. Radiology 2004 Dec; 233(3) : 793-8.doi: https://doi.org/10.1148/radiol.2333031018.
Mrtin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg.1930 Aug; 92(2):169-81.doi: https://doi.org/10.1097/00000658-193008000-00002.
Mondol KS, Nag D, Das R, Mondol KP, Biswas P, Osta M. Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in eastern India. South asian journal of cancer. 2013 Jan; 2(1):14-18.doi: http://journal.sajc.org/text.asp?2013/2/1/14/105881.
W Richard Webb, Charles B, Higgins. Thoracic imaging. Second edition. Lippincott: Williams & Wilkins 2011: 69-116, 271-3.
Gupta RC, Purohit SD, Sharma MP, Bhardwaj S. Primary bronchogenic carcinoma: Clinical profile of 279 cases from Midwest Rajasthan. Indian J chest dis allied Sci. 1998 Apr-Jun; 40 (2):109-16.
Pandhi N, Malhotra B, Kajal N, Prabhudesai RR, LC Nagaraja, Mahajan N. Clinicopathological profile of patients with lung cancer visiting chest and TB hospital Amritsar. Sch. J. App. Med. Sci. 2015; 3(2D):802-809. https://saspublisher.com/wp-content/uploads/2015/03/SJAMS-32D802-809.pdf.
Rawat J, Sindhwani G, Gaur D, Dua R, Saini S. Clinico-pathological profile of lung cancer in Uttarakhand. Lung India. 2009; 26(3): 74–6.doi: http://www.lungindia.com/text.asp?2009/26/3/74/53229.
Hoque MS, Hashem MA, Hasan S, Siddique AB, Hossain A, Mahbub M et al. Role of CT scan in the evaluation of lung tumor with cytopathological correlation. Faridpur Med. Coll. J. 2014; 9(1):37-41.doi: https://doi.org/10.3329/fmcj.v9i1.23622.
Gopichand N, Praveena S. A study of computed tomography of the chest in bronchogenic carcinoma. Indian journal of applied research. 2015Apr; 5(4): 223-6.doi: https://www.doi.org/10.36106/ijar.
Sengupta M, Saha K. Computed tomography guided fine needle aspiration cytology of pulmonary mass lesions in a tertiary care hospital: A two-year prospective study. Medical Journal of Dr. D.Y. Patil University. 2014 Mar-Apr; 7(2): 177-181.doi: http://www.mjdrdypu.org/text.asp?2014/7/2/177/126333.
Zwirewich CV, Vedal S, Miller RR, Muller NL. Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation. Radiology.1991 May; 179 (2): 469-476.doi: https://doi.org/10.1148/radiology.179.2.2014294.
Ningappa R, Ashwini, John DS, Santosh. Role of MDCT in the evaluation of bronchogenic carcinoma. SSRG International Journal of Medical Science. 2015 Mar; 2(3): 21-23.http://www.internationaljournalssrg.org/IJMS/paper-details?Id=15.
Woodring JH, Fried AM. Significance of wall thickness in solitary cavities of the lung: a follow-up study. AJR Am J Roentgenol.1983 Mar; 140 (3): 473-74.doi: https://doi.org/10.2214/ajr.140.3.473.
Siegelman SS, Khouri NF, Leo FP, Fishman EK, Braverman RM, Zerhouni EA. Solitary pulmonary Nodules: CT assessment. Radiology.1986 Aug; 160(2): 307–12.doi: https://doi.org/10.1148/radiology.160.2.3726105.
Shetty CM, Lashkar BN, Gandadhar VSS, Ramchandran NR. Changing Pattern of bronchogenic carcinoma: A statistical variation or a reality? Ind J Radiol Imag. 2005; 15(1):233-238.doi: http://www.ijri.org/text.asp?2005/15/2/233/28812.
Madan M, Bannur H. Evaluation of fine needle aspiration cytology in the diagnosis of lung lesions. Turk J Path. 2010; 26: 1-6.http://www.turkjpath.org/pdf/pdf_TPD_1403.pdf.
JayaShankar E, Pavani B, Chandra E, Reddy R, Srinivas M, Shah A. Computed tomography guided percutaneous thoracic: Fine needle aspiration cytology in lung and mediastinum. J Cytol Histol. 2010; 107:1–3.doi: https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.4172%2F2157-7099.1000107.
Singh JP, Setia V. Computed tomography (CT) guided transthoracic needle aspiration cytology in difficult thoracic mass lesions-not approachable by USG. Indian J Radiol Imaging. 2004; 14 (4): 395–400.doi: http://www.ijri.org/text.asp?2004/14/4/395/28680.
Datta A. Radio-image guided FNAC: A hospital based study. Indian Medical Journal. 2009 Oct; 103 (10): 331-34.
Konjengbam R, Singh N B, Gatphoh S G. Computed tomography guided percutaneous transthoracic fine needle aspiration cytology of pulmonary mass lesions: Two years cross sectional study of 61 cases. Journal of Medical Society. 2014 May- Aug; 28(2): 112-116.doi: http://www.jmedsoc.org/text.asp?2014/28/2/112/141098.
Baby J, George P. Computed tomography guided fine needle aspiration cytology of thoracic lesions: A retrospective analysis of 114 cases. IOSR Journal of Dental and Medical Sciences. 2014 Jan; 13(1): 47-52.doi: https://doi.org/10.9790/0853-13124752.
Piplani S, Mannan R, Lalit M, Manjari M, Bhasin TS, Bawa J. Cytologic-Radiologic Correlation Using Transthoracic CT-Guided FNA for Lung and Mediastinal Masses: Our Experience. Analytical cellular pathology (Amsterdam). 2014;2014:343461. doi: https://dx.doi.org/10.1155%2F2014%2F343461.
OAI - Open Archives Initiative
