Objective: This study was planned to evaluate the causes of failure of diagnosis and to determine the route of
diagnosis in patients with pulmonary lesions undiagnosed with Computerized Tomography (CT) guided
Transthoracic Fine Needle Aspiration biopsy (TFNA).
Material and methods: We retrospectively evaluated 673 patients who underwent CT-guided TFNA biopsy between
January 2001 and August 2003.
Results: Diagnosis could not be made in 94 patients with CT guided TFNA biopsy (14%). Diagnosis could be made
in 33 (%35) with thorocotomy, in 11 (%12) with bronchoscopy, in 1(%1) with mediastinoscopy, in 1 (%1) with
biopsy of lymphyadenopathy, in 1(%1) with culture of AFB, and in 39 (%41) with clinical and radiologic follow up.
Diagnosis could not be made 9 (%10) due to lost to follow up. Of the 664 patients, the final diagnosis was
malignant in 597(%90) and benign in 67(%10). Eighty-five patients who had no diagnosis with TFNA were
diagnosed to have malignancy in 49 (58%) malignant and benign lesion in 36 (42%). Eighty-five patients underwent
128 TFNA procedures. The cytology of these procedures included nonspecific blood cells in 86 (67%), reactive cells
in 27(21%), atypical cells in 10 (8%) and benign cells in 5(4%).
Conclusion: Since the 58% of undiagnosed cases was malignant, the diagnosis has to be done in undiagnosed cases,
with clinical suspicion of malignancy. We believe that checking out the adequacy of biopsy specimens during TFNA
procedure will yield higher accuracy and will enable the clinicians to avoid unnecessary thorocotomy procedures for
benign and inoperable pulmonary lesions.
Key Words: CT-Guided, Needle biopsy, Pulmonary lesions, Undiagnosed procedures
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