CT-GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY OF SOLITARY PULMONARY NODULES - A PROSPECTIVE, RANDOMIZED STUDY OF IMMEDIATE CYTOLOGIC EVALUATION

Study objective: To evaluate the immediate cytologic assessment during CT-guided fine-needle aspiration cytology (FNAC) in the diagnosis of operable indeterminate solitary pulmonary nodules (SPNs). Design: Pros pective randomized study. Patients and methods: Two hundred twenty pat ients with SPN undergoing CT-guided FNAC were divided into two groups. In the first one (group A, 110 patients), a cytologist assessed the a dequacy of the sample obtained immediately, and when the sample was co nsidered inadequate, fine-needle aspiration (FNA) was repeated. In the second group (B, 110 patients), an immediate cytologic examination wa s not performed, but only a gross assessment by the surgeon. Histologi c study of the SPN was possible in 217 cases, whereas three patients w ere followed,up radiologically Results: adequate samples were obtained in 100% of group A and 88% of group B (p < 0.001). The diagnostic acc uracy was 99% in group A and 81% in group B (p < 0.001). Group A requi red a mean of 1.22 FNAs compared with 1.10 in group B (p=0.015). The r ate of pneumothorax in the whole series was 24%, and statistically sig nificant differences between;the two groups were not detected. Conclus ions: Immediate cytologic study significantly increased the adequacy a nd diagnostic accuracy of CT-guided FNAC of indeterminate SPNs without causing a significant increase of complications.