SENSITIVITY AND COST-EFFECTIVENESS OF FINE-NEEDLE ASPIRATION WITH IMMUNOCYTOCHEMISTRY IN THE EVALUATION OF PATIENTS WITH A PULMONARY MALIGNANCY AND A HISTORY OF CANCER

Objective. - To determine the sensitivity and cost-effectiveness of tr ansthoracic fine-needle aspiration in the separation of primary from m etastatic malignancy. Materials and Methods. - Eighty-nine malignant p ulmonary fine-needle aspirations in patients with a history of cancer were classified retrospectively by light microscopy, comparison with p revious material, and immunocytochemistry. Decision analysis compared the cost-effectiveness of fine-needle aspiration, bronchoscopy, and th oracoscopy. Results. - Fine-needle aspiration classified 87% of the ma lignancies as primary (n = 7) or metastatic (n = 70) and 13% as indete rminate. By immunocytochemistry alone, 14 of 18 malignancies were subc lassified. Decision analysis showed that pulmonary fine-needle aspirat ion with select use of thoracoscopy was more cost-effective than eithe r bronchoscopy or thoracoscopy alone in many common clinical scenarios . Conclusions. - Pulmonary fine-needle aspiration with immunocytochemi stry is sensitive and cost-effective in subclassifying malignancies in patients with a history of cancer.