1. CT GUIDED FNAC : A
SIMPLE SOLUTION TO
COMPLEX PROBLEMS
Dr.JOHN JOSEPH
INSTITUTION: Medical College Hospital,
Thiruvananthapuram.
2. History of medicine parallels the quest for correct
diagnosis by least invasive techniques.
The custodian of final diagnosis - pathologist.
How to produce the sample?
Less invasive – FNAC.
Guided FNAC - modality of choice – computed
tomography.
INTRODUCTION
3. INTRODUCTION(cont)
Haaga and Alfidi - reported CT guided
biopsy for pulmonary nodules in 1976.
Geragthy et al - a diagnostic accuracy
benign-80% & malignant-90%.
VanSonnenberg et al - CT guidance permits
biopsy- regardless of size or position.
4. AIMS OF THE STUDY
To evaluate the sensitivity and specificity of
computed tomography (CT) guided
aspiration cytology in lung lesions.
To characterise lung lesions by computed
tomography.
5. Materials and methods
Study period-March 2004 - March 2005.
Sample size-28.
Age – 20-70 yrs.
Males:22(78%), Females:6(22%).
Inclusion criteria: peripheral opacities in
chest X-ray.
7. Materials and methods (contd)
The spiral CT scanner from Toshiba (X- vision)
was used.
Frontal scout view image of thorax.
Axial sections - 10mm,from apex to base.
Sagittal and coronal reconstructions - in selected
cases
Lesions analysed by thin sections(2-5mm).
Plain and CECT taken.
Lesions studied for their characteristics.
9. Technique of FNAC
Done as an OPD procedure.
Relevant investigations.
Informed consent.
After locating the lesion,best
approach(supine,prone and lateral
decubitus) was decided.
Site marked.
Local preparation done.
10. Technique of FNAC (cont)
Needle – disposable spinal needle – 22-23G
& 9cm in length.
Fixatives-wet fixation with 80% isopropyl
alcohol in coplin’s jar.
After anaesthesia needle introduced in
suspended respiration,perpendicularly.
Check CT slice taken.
17. RESULTS
The final diagnosis was determined by
examination of surgical specimen, biopsy
from other sites using tru cut needle and
from clinical follow-up for 18 months.
Malignant: 16 ( 57.14%), Benign: 10
(35.7%), Inconclusive: 2( 7.14%).
18. Results
Of the 28 cases FNAC was done in 24.
In 21 out of 24 patients aspiration yielded
adequate material.
19 out of the 21 yielded aspirations got a
conclusive cytodiagnosis.
23. Complications
Total 3 cases : 12.5%
Pneumothorax: 2 cases(8%).
Patients were observed for 24hrs after which
chest X Ray taken and discharged accordingly.
Pulmonary haemorrhage: 1 case(4%).
As it is self limiting,patient was reassured and
made to lie with biopsy-site down.
All 3 resolved on conservative management.
24. Comparative data for malignancy
References Sensitivity Specificity
Vansonnenberg
1988
82.7 100
Haramati 1995 84 100
Mohammad
2001
95.6 100
Our series 80 100
25. CT GUIDED FNAC
ADVANTAGES
Nodule
densitometry and
biopsy in one sitting
Preprocedure
localisation
Direct visualisation
of intervening
structures
DISADVANTAGES
Longer length
Lack of real time
capability
Complications.
26. Conclusion
CT scan and guided FNAC are effective
diagnostic modalities in patients with
localised pulmonary lesions.
It is a highly sensitive and specific
technique with a good diagnostic accuracy.
It can be used safely as an outpatient
procedure in the diagnosis of lesions that
are not approachable by ultrasound.