Akciğer Lezyonlarının Erken Tanı ve Tedavisinde Bilgisayarlı Tomografi Eşliğinde Transtorasik İnce İğne Aspirasyon Biopsisi/Hücre Bloğu Yönteminin Önemi: 354 Vakada Sitopatolojik Analiz

Amaç Bu çalışmanın amacı, akciğer kitle lezyonlarının tanısında bilgisayarlı tomografi (BT) kılavuzluğunda transtorasik ince iğne aspirasyon biyopsisinin (TTİİAB) etkinliğinideğerlendirmektir. ( Sakarya Tıp Dergisi 2019, 9(3):513-521 ) Gereç veYöntemler Bu çalışmada 354 BT eşliğinde TTİİAB materyalini ve tecrübelerimizi geriye dönük literatür eşliğinde sunmaktayız. Aspirasyonların 348’i direkt akciğer, kalan 6’sı mediastenlokalizasyonlu kitleden yapılmışdı. Lezyonlar BT ile lokalize edildikten sonra göğüs cerrahı tarafından 20ml. 20-22 gauge Chiba iğnesi kullanılarak aspirasyonlar gerçekleştirildi.TTİİAB materyalleri yeterli ise konvansiyonel yayma sitolojisi ve hücre bloğu tekniği için iki eşit bölüme ayrıldı. Sonuçlar, aşağıdaki kategorilerde sınıflandırıldı: 1. Benign /neoplastik olmayan, 2. Neoplazi şüpheli, 3. Neoplastik tanısal, 4. Tanımlama için yetersiz. Bulgular TTİİAB (354 aspirasyon biopsisi) yapılan 220 hastanın 163 (%46.04)'ü tümör, 74 (%20.90)'ü şüpheli lezyon, 71 (%20.05)'i benign lezyon tanısı almış olup, 46 (%12.99) aspiratnondiagnostik özelliktedir. 134 vakadan 140 (%39.54) aspirata hücre bloğu uygulanmış olup bu vakalara immünohistokimyasal ve histokimyasal çalışmalar uygulanabiliptümörlerde tip ayrımı yapılabilmiştir. Neoplazi ve neoplazi şüpheli aspiratlar, 237 (% 66.94) vaka ile ana grubu oluşturdu. Neoplastik 163(46.04%) aspiratın 58’i (35.58%) EC,54 (33,12 %) aspirat NSSC/spesifiye edilemeyen, 23 (14.11%) aspirat AC, 14’ü (8.58%) SCC, 8 aspirat malign tümör, 3 aspirat nöroendokrin tümör, 1 aspirat timoma, 1 aspiratplasmasitom ve 1 aspirat schwannomdu. Sonuç Tecrübeli patologların uzman ellerinde TTİİAB–hücre bloğu incelemesi çoğu akciğer lezyonunun erken tanı ve tedavi planlaması için uygun bir yöntem olarak kabul edilebilir.Pnömotoraks gibi basit ve tedavi edilebilir komplikasyonları olduğundan popülerliği klinisyenler, radyologlar ve patologlar arasında artmaktadır.

The Importance of Computed Tomography GuıdedTransthorasic Fine Needle Aspiration Biopsy / Cell BlockMethod in Early Diagnosis and Treatment of Lung Lesions:Cytopathologic Analysis in 354 Cases

Objective The aim of this study was to evaluated the effectiveness of computed tomography(CT) guided transthorasic fine needle aspiration biopsy in the diagnosis of lung mass lesions. ( Sakarya Med J 2019, 9(3):513-521 ).Materials and MethodsIn this study, we are presenting 354 CT guided TTFNAB materials. The 348 of aspirations were performed from lung directly and 6 of them were performed from masses with mediastinal location. After the lesion was localized by CT, aspiration biopsy was performed by thoracic surgeon with 20-22 gauge Chiba needle by using 20 ml. If TTFNAB material is sufficient, it was divided into two equal parts for conventional smear cytology and the cell block technique.The results were classified in following catogories: 1. Benign/non-neoplastic, 2. suspicious of malignancy, 3. neoplastic-diagnostic, 4. inadequate for interpretation.Results Among the 220 patients who underwent TTFNAB (354 aspiration biopsy), 163 (46.04%) were diagnosed as tumor, 74(20.90%) as suspicious lesion, 71 (20.05) as benign lesion and 46 (12.99%) as aspirate nondiagnostic. 140 (39.54%) aspirata cell blocks were applied to 134 cases. Immunohistochemical and histochemical studies were performed in these cases and type differentiation could be made in tumor. Suspicious for neoplasia and neoplastic cases formed major group with 237 cases (66.94%). Among 163 (46.04%) neoplastic aspirates; there were the diagnoses of EC in 58 (35.58%) aspirates, NSSC/non-specific in 54 (33,12 %) aspirates, AC in 23 (14.11%) aspirates, SCC in 14 (8.58%), malignant tumor in 8 aspirates, neuroedocrine tumor in 3 aspirates, thymoma in 1 aspirate, plasmacytoma in 1 aspirate and schwannoma in 1 aspirate.Conclusion TTFNAB-CB in expert hands and experienced pathologists is fairly accurate for lung masses and can be regarded as an acceptable procedure for early diagnose and treatment planning purposes in most lung lesions.

PDF

___

1. Ferlay J, Shin HR, Bray F, Forman D,Mathers C, Parkin DM. et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917.
2. Ronald S. Winookur, Bradley B. Pua, MD, Brian W. Sullivan, RA, and David C. Madoff . Percutaneous Lung Biopsy: Tecnique, Eff icacy, and Complications. Technique, Eff icacy, and Complications. Semin Intervent Radiol 2013;30:121–127
3. Miller DA, Carrasco CH, Katz RL, Cramer FM,Wallace S,Charnsangavej C. Fine needle aspiration biopsy:the role of immediate cytologic assesment. AJR 1985;144:793-794.
4. Kurıyama T, Masago K, Okada Y, Katakamı N. Computed tomography guided lung biopsy: Association between biopsy needle angle and pneumothorax development. Mol Clin Oncol. 2018; 8(2): 336–341.
5. Silverman FJ, Finley JL, O’Brien KF, Dabbs DJ, Park HK, Larkin EW et al. Diagnostic accuracy and role of immadiate interpretation of fine needle aspiration biopsy specimens from various sites. Acta Cytol 1989;33:791-796.
6. Conces DJ, Schwenk GR Jr, Doering PR, Giant MD.. Th orasic needle biopsy. Improved results utilizing a team approach. Chest 1987;91:813-816.
7. Madan M, Bannur H. Evaluation of fine needle aspiration cytology in the diagnosisof lund lesions. Turk jpath 2010;26:1-6.
8. Charing MJ, Stutley JE, Padley SP, Hansell DMl. Th e value of negative needle biopsy in suspected operable lung cancer. Clin Radiol 1991;44:147-149.
9. Mack MJ, Hazelrigg SR, Landrenau RJ, Acuff TE. Th oracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Th orac Surg 1993;56:825-832.
10. Zarbo RJ, Fenoglio-Preiser CM. Interinstitutional database for comparion of performance in in lung fine-needle aspiration cytology. Arch Pathol Lab Med 1992;116:463-470.
11. Trail ZC, Gleason FV. Delayed pneumothorax aft er CT guided percutaneous fine needle aspiration lung biopsy. Th oax 1997;52:575-576.
12. Gangopadhyay M, Chackrabarti I, Ghosh N, Giri A. Computed tomography guided fine needle aspiration cytology of mass lesions of lung: our experience. Indian J Med Paediatric Oncol 2011;32:192-196.
13. Boskovic T, Stanic J, Pena-Karan S, Zarıgolidis K. Pneumothorax aft er transthorasic needle biopsy of lung lesions under CT guidance. J Th orac Dis 2014;6: 99-107.
14. Davidson MR, Gazdar AF, Clarke BE. Th e pivotal role of pathology in management of lung cancer. J Th orac Dis 2013;5: 463-478.
15. Kocijancic I, Kocijancic K. CT-guided percutaneous transthorasic needle biopsy of lung lesions-2-year experience at the Institute of Radiology in Ljubljana. Radiol Oncol 2007;41: 99-106.
16. Westcott JL. Direct percutaneous needle aspiration of localized lesions results in 422 patients. Radiology1980; 137:31-35.
17. Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthorasic aspiration needle biopsy of the lung. Radiology 1996;198:371-375.
18. Li H, Boiselle PM, Shepared JO, Trotman-Dickenson B,McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung comprasion of small and large pulmonary nodules. AJR Am J Roentgenol 1996;167:105-109.
19. Khouri NF, Stitik FP, Erozan YS. Transthorasic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985;144:281-288.
20. Stanley JH, Fish GD, Andriole JG. Lung lesions cytologic diagnosis by-fine needle biopsy. Radiology 1987;162:389-391.
21. Klein JS, Zarka MA. Transthorasic needle biopsy:an overwiew. J Th orasic Imaging 1997;12:232-249.
22. Gupta S, Krishnamurty S, Bromeling LD, Morello FA Jr, Wallace MJ, Ahrar K et al. Small subpleural pulmonary lesions:short-versus long- needle- path CT-guided Biopsy-- comprasion of diagnostic yields and complications. Radiology 2005;234:631-637.
23. Kline TS. Handbook of Fine Needle Aspiration Biopsy Cytology, 2nd ed. New York:Churchill Livingstone. 1988;492pp.
24. Kowalewski J, Sir J, Dancewicz M, Swiniarska J, Peplinski J. Fine needle aspiration biopsy under CT-guidance-usefulness in diagnosis of malignant lung tumors. Pneumonol Allergol Pol 2004;72:177-180.
25. Wu X, Groves FD, McLaughin CC, J emal A, Martin J, Chen VW. Cancer incidence patterns among adholescents and young adults in the United States. Cancer Causes Control 2005;16:309-320.
26. Mathew EP, Nair V. Role of cell block in cytopathologic evaluation of image–guided fine needle aspiration cytology. J Cytol 2017; 34:133-138.
27. Zemansky AP Jr. Examination of tumour cells; Analysis of 113 cases checked against subsequent examination of tissue. Am J M. Sc 1928;175:489-504.