Güntülü AK, Selma METİNTAŞ, Muzaffer METİNTAŞ, Şenay YILMAZ, Emine DÜNDAR

Evaluation of the contribution of fine-needle non-aspiration cytology to diagnosis in cases with pulmonary malignant lesions

Background/aim: Fine-needle non-aspiration cytology (FNNAC) is an easy-to-apply, minimally invasive diagnostic method that contributes to the diagnosis and staging of lung cancer. FNNAC can be performed from peripheral lymph nodes as well as in peripheral lung lesions. This study aimed to evaluate the contribution of FNNAC performed from peripheral lesions or lymph nodes to diagnosis in patients with pulmonary malignant lesions. Materials and methods: FNNAC was applied from a peripherally located mass in the lung, chest wall lesion, or peripheral lymph node using a needle without an injector or active suction. The collected material was evaluated using the cytoblock method. The FNNAC accuracy was obtained by dividing the true positivity value by a number of needle biopsies performed. The 95% confidence interval of the obtained rate was also calculated. Results: The mean age of 56 patients, two female (3.6%) and 54 male (96.4%), was 63.9 ± 9.1 (38-80) years. FNNAC was performed from the peripheral lymph node in 48 patients, the peripheral pulmonary lesion in four, and the accompanying chest wall lesion in four. While true positivity was present in 42 patients, two patients had true negativity, and 12 had false negativity. In five of the 12 cases reported as false negative, the collected material was evaluated as insufficient, while the malignant diagnoses of the remaining seven cases were confirmed by other diagnostic methods. The diagnostic success of FNNAC was determined as 78.57% (95% CI: 65.56-88.41). FNNAC was more successful in diagnosis when performed from the peripheral lymph node compared to the peripheral pulmonary lesion (p=0.033). Conclusion: In cases with pulmonary lesions, FNNAC performed from the peripheral lymph node is an easy-to-apply, cost-effective, minimally invasive method with a high diagnostic success and low complication rate. It can be preferred for diagnosis, staging, and recurrence in malignant cases not suitable for advanced invasive procedures.

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1. Santos JE, LeimanG. Nonaspiration fine needle cytology. Application of a new technique to nodular thyroid disease. Actacytologica 1988; 32(3): 353-356
2. Kumarasinghe MP, Sheriffdeen AH. Fine needle sampling without aspiration. Pathology 1995; 27(4): 330-332. doi: 10.1080/00313029500169243
3. Zajdela A, Zillhardt P, Voillemot N. Cytological diagnosis by fine needle sampling without aspiration. Cancer 1987;59(6): 1201- 1205. doi: 10.1002/1097-0142(19870315)59:6%3C1201::AIDCNCR2820590628%3E3.0.CO;2-P
4. Pathak SS. Non-aspiration cytology of breast lumps: a comparative study. Annals of Applied Bio-Sciences 2015; 2(3): A60-65
5. Baksh S, Masih K, Singh S, Das S. Diagnostic utility of fine needle non-aspiration cytology versus fine needle aspiration cytology in breast masses. Indian Journal of Pathology&Microbiology 2004; 47(3): 319-321
6. Fagelman D, Chess Q. Non aspiration fine-needle cytology of the liver: a new technique for obtaining diagnostic samples. American Journal of Roentgenology 1990; 155(6): 1217-1219. doi: 10.2214/ ajr.155.6.2122668
7. Zajdela A, Maublanc D, Schlienger P, Haye C. Cytologic diagnosis of orbital and periorbital palpable tumors using fine needle sampling without aspiration. Diagnostic Cytopathology 1986; 2(1): 17-20. doi: 10.1002/dc.2840020105
8. Akhtar SS, Faiz U, Din M, Reyes LM. Efficacy of fine needle capillary biopsy in the assessment of patients with superficial lymphadenopathy. Cancer Cytopathology: Interdisciplinary International Journal of the American Cancer Society 1997; 81(5): 277-280. doi: 10.1002/(SICI)1097-0142 (19971025) 81:5%3C277::AID-CNCR4%3E3.0.CO;2-K
9. Cajulis RS, Sneige N. Objective comparison of cellular yield in fine needle biopsy of lymph nodes with and without aspiration. Diagnostic Cytopathology 1993; 9(1): 43-45. doi: 10.1002/(SICI)1097-0142(19971025)81:5%3C277::AIDCNCR4%3E3.0.CO;2-K
10. Yue XH, Zheng SF. Cytologic diagnosis by transthoracic fine needle sampling without aspiration. Actacytologica 1989; 33(6): 805-808
11. Ramachandra L, Kudva R, Rao BA, Agrawal S. A comparative study of fine needle aspiration cytology (FNAC) and fine needle non-aspiration cytology (FNNAC) technique in lesions of thyroid gland. Indian Journal of Surgery 2011; 73(4): 287- 290. doi: 10.1007/s12262-011-0283-9
12. Malik NP, Jain M, Sharma CV, Verma N, Singh A, et al. Comparison of aspiration versus non-aspiration technique of cytodiagnosis in thyroid lesions. The Journal Indian Academy of Clinical Medicine 2013; 14: 20-22
13. Mc Elvanna K, Pyper PC, Miller K. A comparison of fineneedle aspiration versus non-aspiration cytology of thyroid nodules. The Internet Journal of Surgery 2009; 25(2): 1-6
14. Raghuveer CV, Leekha I, Pai MR, Adhikari P. Fine needle aspiration cytology versus fine needle sampling without aspiration A prospective study of 200 cases. Indian Journal of Medical Sciences 2002; 56(9): 431-439
15. Dey P, Ray R. Comparison of fine needle sampling by capillary action and fine needle aspiration. Cytopathology 1993; 4(5): 299-303. doi: 10.1111/j.1365-2303.1993.tb00105.x
16. Mahajan P, Sharma PR. Fine-needle aspiration versus non aspiration technique of cytodiagnosis in thyroid lesions. JK Science: Journal of Medical Education & Research 2010; 12(3): 120-122
17. Mair S, Dunbar F, Becker PJ, Du Plessis W. Fine needle cytology--is aspiration suction necessary? A study of 100 masses in various sites. Actacytologica 1989; 33(6): 809-813
18. Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung. Journal of Clinical Pathology 1996; 49(10): 839-843. doi: 10.1136/jcp.49.10.839
19. Kumaran M, Benamore RE, Vaidhyanath R, Muller S, Richards CJ, Peake MD, Entwisle JJ. Ultrasound guided cytological aspiration of supraclavicular lymph nodes in patients with suspected lung cancer. Thorax 2005; 60(3): 229-233. doi: 10.1136/thx.2004.029223
20. Gupta RK, Naran S, Lallu, S, Fauck R. The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases. Cytopathology 2003; 14(4): 201-207. doi: 10.1046/j.1365- 2303.2003.00057.x
21. Tian HY, Xu D, Li JP, Mao WM, Chen LY, et al. Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer. Journal of Cancer Research and Therapeutics 2015; 11(8): 234. doi: 10.4103/0973-1482.170544
22. Mitra S, Ray S, Mitra P K. Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period. Journal of Cytology / Indian Academy of Cytologists 2011; 28(3): 108–110. doi: 10.4103/0970-9371.83465
23. Nasuti JF, Mehrotra R, Gupta PK. Diagnostic value of fine needle aspiration in supraclavicular lymphadenopathy: A study of 106 patients and review of literature. Diagnostic Cytopathology 2001; 25(6): 351-355. doi: 10.1002/dc.10002
24. Cagle PT, Kovach M, Ramzy I. Causes of false results in transthoracic fine needle lung aspirates. Actacytologica 1993; 37(1): 16-20
25. Tao LC, Weisbrod GL, Pearson FG, Sanders DE, Donat EE, et al. Cytologic diagnosis of bronchioloalveolar carcinoma by fine needle aspiration biopsy. Cancer 1986; 57(8): 1565- 1570. doi: 10.1002/1097-0142(19860415)57:8%3C1565::AIDCNCR2820570821%3E3.0.CO;2-J