Bronchoscopy-guided transtracheal and transbronchial fine-needle aspiration biopsy: a 5-year institutional review of 111 cases.

We reviewed 111 bronchoscopy-guided transtracheal and transbronchial fine-needle aspiration (TT/TBNA) specimens from 97 patients to determine the sensitivity and specificity for diagnosing neoplasia compared to surgical biopsy and clinical follow-up and to determine the optimal number of passes. Fifty were positive for neoplasia, seven were suspicious, one was atypical, 51 were negative, and two were unsatisfactory. Of 57 positive/suspicious cases, 56 were confirmed neoplastic, with one patient lost to follow-up (specificity with follow-up: 100%). A positive diagnosis was rendered on the first pass in 29 cases (58%), second in six (12%), third in five (10%), fourth in three (6%), fifth in four (8%), and sixth, ninth, and eleventh passes in one case each (2% each). Twenty-seven negative cases had confirmed malignancies after their index FNA (sensitivity for neoplasia: 67%). We conclude that TT/TBNA is a highly specific but not always successful diagnostic technique. It appears to be limited by mechanical difficulties that prevent tumor access and cellular uptake in some masses. Little information is gained by procuring more than six samples.

Rare atypical squamous cells of undetermined significance (ASCUS): a clinically significant diagnosis?

To determine the clinical significance of rare atypical squamous cells of undetermined significance (ASCUS) in cervical screening, we studied 748 ASCUS cases prospectively noted to have rare abnormal cells. Comparing the rare ASCUS (RASC) group (defined as five or fewer abnormal cells) statistically to cases diagnosed as within normal limits (WNL), ASCUS unqualified as to number of cells low-grade squamous intraepithelial lesion (LGSIL), and high-grade SIL (HGSIL), we found that the probability of the RASC patients having an abnormal cytology (ASCUS/SIL) or biopsy (dysplasia) result within 1 yr was greater than that of the WNL group, but less than that for ASCUS unqualified, LGSIL, or HGSIL. When only ThinPrep specimens or cases with subsequent definitive SIL/dysplasia were considered, the RASC group was not significantly different from the WNL group. We conclude that RASC increases the risk of a subsequent abnormal cytology/biopsy result in conventional smears, but only when the threshold for abnormality is a subsequent ASCUS. It did not predict dysplasia (SIL/CIN) in those conventional samples. RASC did not have the power to predict any subsequent abnormality and did not appear to be clinically significant in ThinPrep samples.

Radiologically guided percutaneous fine-needle aspiration biopsy of the liver: retrospective study of 119 cases evaluating diagnostic effectiveness and clinical complications.

We reviewed 119 percutaneous, radiologically guided fine-needle aspirations (FNA) from 114 patients with liver masses to evaluate diagnostic effectiveness and complications of this procedure. Satisfactory material was obtained in 118 cases (99%), of which 78 were diagnosed as positive (66%), three suspicious (2%), five atypical (4%), and 32 (27%) as negative for malignancy. Compared to surgical biopsy (48 cases) and clinical data, the sensitivity and specificity of FNA for malignancy was 95.1% and 100%, respectively, yielding a positive predictive value of 100% and a negative predictive value of 88.8%. Four cytology cases (3.4%) were false-negatives (FN); all were interpretive errors. Four FN surgical biopsies (8.3%) were sampling errors. Minor complications occurred in three cases (2.5%). We conclude that FNA is safe and effective for determining the malignant potential of liver masses and should be the procedure of choice. Our experience suggests that having a pathologist present in the radiology suite provides optimal patient care.