Computed tomography guided fine needle aspiration cytology of thoracic lesions: 10 year experience of an interventional pulmonologist

Varinder Saini, Kranti Garg, Uma Handa, Surabhi Jaggi, Ravi Kumar Garg


Background: Diagnosis of thoracic lesions may be challenging, due to various factors associated with the lesion and subsequent invasive investigations. Computed tomography guided fine needle aspiration cytology (CT-guided FNAC) is a minimally invasive method for thoracic lesions considered non approachable by other modalities.

Methods: Retrospective analysis of patients subjected to CT-guided FNAC during year 2004 to 2014 was done. In these patients, non-invasive and invasive methods like fibre-optic bronchoscopy/ ultrasound guided FNAC were inconclusive/ expected to be inconclusive. Records were statistically analyzed for patient related, lesion related and procedure related factors, and their effect on yield and complications.

Results: 435 patients underwent CT-guided FNAC. Age ranged from 10 to 95 years, with male preponderance. Diagnostic yield was 80.2%. Neoplastic lesions (255/435 (58.6%)) were most commonly diagnosed with majority (206/255 (80.8%)) being non-small cell lung cancer (NSCLC). This was followed by non-neoplastic lesions (94/435 (21.6%)) with Tuberculosis (42/94(44.7%)) being most common in this group. In 227/435 patients, other details like side and size of the lesion, position of patient during the procedure, depth of lesion from skin surface, number of passes undertaken and complications, if any, were also available. They were separately analyzed. Mean size of lesion was 5.7575 X 5.4173cms (maximum vertical X maximum horizontal diameter). Mean depth to which needle was inserted was 5.6663cms. Mean number of passes per patient were 1.98. Right sided lesions were more commonly sampled than left. Supine positioning was most commonly employed. Overall complication rate was 4% (9/227).

Conclusions: CT-guided FNAC for thoracic lesions can serve as early diagnostic tool and guide in planning effective management strategies.


CT-guided FNAC, Thoracic lesion, Pneumothorax

Full Text:



Rangaswamy M, Zacharia T, Krishnamurthy J, Chennakeshaviah G, Sunila, Gubbania M. Study of computed tomography- guided fine needle aspiration cytology of thoracic lesions. J Cytol. 2012;29:30-4.

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 exposure. Anal Cell Pathol. 2014;34346.

Shrestha MK, Ghartimagar D, Ghosh A. Computed tomogram guided fine-needle aspiration cytology of lung and mediastinal masses with cytological correlation: a study of 257 cases in Western region of Nepal. Nepal Med Coll J. 2014;16:80-3.

Pujani M, Jetley S, Jairajpuri Z, Khan S, Hassan MJ, Rana S, et al. A critical appraisal of the spectrum of image guided fine needle aspiration cytology: A three year experience from a tertiary care centre in Delhi. TJ path. 2015;32:27-34.

Arslan S, Yilmaz A, Bayramgurller B, Uzman O, Unver E, Akkaya E. CT guided fine needle aspiration of pulmonary lesions: Accuracy and complications in 294 patients. Med SciMonit. 2002;8CR493-7.

Saha A, Kshitish K, Chodhari M. Computed tomography-guided fine needle aspiration cytology of thoracic mass lesions: A study of 57 cases. J Cytol. 2009;26:55-9.

Koss LG, Zajieek J. Aspiration biopsy in koss. In:Koss L. G, editor. Diagnostic Cytology and Histopathologic basis.4th. JB Lippincott company: Philadelphia, Pa, USA;2005. pp. 643-712.

Mondal SK, Nag D, Das R, Mandal PK, Biswas PK, Osta M. Computed tomogram guided fine needle aspiration cytology of lung mass with histological correlation: A study in Eastern India. South Asian J Cancer. 2013;2:14-8.

Kowalewski J, Sir J, Dancewicz M, Peplinski J. Fine-needle aspiration biopsy under CT-scan guidance- the usefulness in diagnosis of malignant lung tumors. Pneumonologia I Alergologia Polska. 2004;72:177-80.

Wu X, Groves FD, McLaughlin CC, Jemal A, Martin J, Chen VW. Cancer incidence patterns among adolescents and young adults in the United States. Cancer Causes and Control. 2005;16:309-20.

Shah S, Shukla K, Patel P. Role of fine needle aspiration cytology in diagnosis of lung tumors- A study of 100 cases. Indian J Pathol Microbiol. 2007;50:56-8.

Bandyopadhyay A, Laha R, Das TK, Sen S, Mangal S, Mitra PK. CT guded fine needle aspiration cytology of thoracic mass lesions: A prospective study of immediate cytological evaluation. Indian J Pathol Microbiol. 2007;50:51-5.

Tan KB, Thamboo TP, Wang SC, Nilsson B, Rajwanshi A, Salto-Tellez M. Audit of transthoracic fine needle aspiration of the lung: Cytological sub classification of bronchogenic carcinoma and diagnosis of tuberculosis. Singapore Med J. 2002;43:570-5.