Diagnostic accuracy of image-guided fine needle aspiration cytology in diagnosis of lung tumors
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Background
Lung cancer remains the leading cause of cancer related mortality globally. It is the second most prevalent cancer among women worldwide and ranks third among females in Nepal. Contributing factors include smoking, tobacco use, air pollution, and delayed diagnosis. Image-guided fine needle aspiration cytology(FNAC) and biopsy are widely used, rapid and diagnostic techniques for evaluating lung lesions. As FNAC is minimally invasive procedure with less complications as compared to biopsy, the goal of this study is to examine the histocytologic makeup of lung lesions and link the results.
Materials and Methods
This cross-sectional observational study included 65 patients irrespective of age and sex presenting with lung masses at Chitwan Medical College and Teaching Hospital during the period of eighteen months starting from April 2023 to September 2024. After clinical and radiologic evaluation, all cases underwent image-guided FNAC and biopsy. Only specimens with unequivocal malignant features were classified as positive. Histopathology served as the diagnostic reference standard.
Results
FNAC diagnosed 90.8% as malignant and 9.2% as benign. Biopsy confirmed malignancy in 92.3% of the cases. Taking histopathology as the gold standard, FNAC demonstrated a sensitivity of 98.33%, specificity of 100%, positive predictive value(PPV) of 100%, and negative predictive value (NPV) of 83.33%. Concordance between FNAC and histopathological subtyping was 98.46%. Adenocarcinoma was the most common subtype, followed by squamous cell carcinoma and small cell carcinoma. Smoking was the most common contributing factor associated with malignancy.
Conclusion and implications
Image-guided FNAC is an excellent diagnostic accuracy tool which possess higher level of concordance with biopsy in evaluating lung masses. It should be considered as the frontline diagnostic tool, especially in resource limited settings.
