IMMEDIATE ASSESSMENT OF FINE-NEEDLE ASPIRATION CYTOLOGY OF LUNG

Aims-To assess the value of immediate assessment of cytology in percut aneous fine needle aspiration (FNA) cytology of lung. Methods-FNA spec imens from 75 consecutive patients with suspected pulmonary neoplasms were subjected to immediate cytology assessment. Direct smears were pr epared in the radiology department and stained using the Diff Quik met hod. The cellular content was assessed and, if possible, a provisional diagnosis offered. A second FNA was requested if the initial aspirate seemed of doubtful adequacy. The diagnostic accuracy was examined by review of clinical and radiological data in all patients, and by corre lation with other histological or cytological material in 25 patients. Complications of the procedure were identified during the clinical re view. Results-Two of 75 specimens were inadequate for diagnosis. Satis factory diagnostic material was obtained in 51 patients on a single as pirate and following a second FNA in 22 patients. Of the 73 satisfacto ry aspirates, 58 were malignant, one highly suspicious of malignancy a nd 14 reported as negative for malignancy. All malignant diagnoses wer e confirmed on clinical or pathological review. FNA accurately disting uished primary small cell and large cell carcinomas in those patients with pathological follow up. There were two false negative reports, on e due to sampling error and the other due to misinterpretation of aspi rate material. The diagnostic specificity was 100% and sensitivity 96. 6%. Complications were recorded in seven (9.3%) patients, five of whom developed pneumothorax; a chest drain was required in one patient. Co nclusions-Percutaneous FNA cytology provides safe and accurate diagnos is in the investigation of pulmonary lesions. Immediate cytology asses sment ensures that aspirate material is handled optimally, and those p atients requiring further sampling or ancillary investigation identifi ed rapidly. The number of unsatisfactory and false negative lung FNA a re therefore reduced. The complication rate is minimised by decreasing the number of pleural punctures.