Background: Transthoracic fine needle aspiration cytology/biopsy (FNAC) is a well-established and safe technique in evaluating the intrathoracic lesions.
Aim of the work: to evaluate the diagnostic efficacy, safety and complications of computed tomography guided FNAC in difficult to diagnose intrathoracic lesions both neoplastic and non-neoplastic not approachable by other techniques.
Patients and methods: This study involved 66 patients presented with intrathoracic lesions located in the lungs (49 patients), mediastinum (9 patients), hilar lymph nodes (5 patients), thoracic vertebrae mass (one patient), paratracheal soft tissue mass (2 patients). Complete clinical history, examination and details of relevant investigations were obtained and those with non approachable diagnosis were subjected to CT guided FNAC.
Results: 50 out of 66 patients (75.75%) were malignant and 16 patients (24.24%) were benign. Cytological diagnosis was confirmed in 64 out of 66 patients (96.96%) after FNAC. The remaining two patients (3.03%) were diagnosed after thoracotomy (one patient diagnosed as sarcoidosis and one patient as desmoid tumour). Majority of the patients had central bronchogenic carcinoma (46.96%) followed by pulmonary metastatic carcinomas (16.66%). Then granulomatous tuberculous inflammation (12.12%), hodgkin’s lymphoma (4.54%) and non Hodgkin’s (3.03%). Post procedural complications were seen in 14 patients (21.21%); five patients (7.57%) developed pneumothorax, seven patients (10.60%) developed mild haemoptysis and two patients (3.03%) developed local chest pain.
Conclusion: Transthoracic CT-guided FNAC is a simple relatively safe repeatable procedure with minimal complications and high diagnostic accuracy in the evaluation of difficult to diagnose intrathoracic lesions that are not approachable by other techniques. Both malignant and benign non neoplastic lesions like tuberculosis can also be diagnosed with certainty by this technique.