Role of percutaneous fine-needle aspiration biopsy in suspected intrathoracic malignancy

Percutaneous fine-needle aspiration (PFNA) biopsy is an accepted technique for the diagnosis of suspected intra-thoracic malignancy, but the appropriate indications for its use have not been clearly defined. To help establish guidelines, we performed a retrospective analysis of 188 patients who underwent PFNA biopsy for suspected intrathoracic malignancy. Biopsy led to a diagnosis in 72% ( 135 188) of the patients, but in 27% ( 50 188) samples were inadequate for cytological diagnosis, and in 2% ( 3 188) samples were adequate but failed to yield a diagnosis. Fifty-three patients underwent surgical intervention, thus allowing histological confirmation of the cytological diagnosis. In patients with a diagnosis from PFNA biopsy, operation confirmed malignancy in 97% ( 37 38) and a specific cell type in 79% ( 30 38). In patients without a diagnosis after biopsy, a malignancy was found in 73% ( 11 15) at the time of operation. This suggests a high rate of accuracy when PFNA biopsy provides a diagnosis. However, it also illustrates that a substantial percentage of PFNA biopsy attempts fail to yield a diagnosis in patients ultimately found to have malignancies. This implies that PFNA biopsy might best be reserved for patients who are not surgical candidates.