Transthoracic fine needle aspiration cytology: a study of 301 aspirations from 221 cases

Our existing cytologic and radiologic service enabled us to introduce transthoracic fine needle aspiration cytology (FNAC). The results of 301 aspirations on 221 patients during the first three years and the histologic, hematologic or clinical correlations are presented. Cytologically, 127 cases were reported positive for malignancy. No false-positive diagnosis was made. Most cases reported as suspicious for or suggestive of malignancy were also found to be malignant. In 23 cases (18%), the cytologic diagnosis of malignancy was made only upon repeated aspiration. Half of the cases reported as "insufficient" or "negative" on the first aspiration attempt were subjected to repeat aspirations, yielding representive samples in 57% of theses cases. FNAC helped to isolate cases of small-cell undifferentiated carcinoma and lymphoma as well as metastases from a group of patients presenting radiologic and clinical symptoms of malignancy and thus was instrumental in establishing proper treatment and preventing contraindicated surgery. It is suggested that in cases considered inoperable, where exfoliative cytology has failed, transthoracic FNAC, rather than bronchoscopy, mediastinoscopy or thoracotomy, should be applied.