Value of having a cytopathologist present during percutaneous fine- needle aspiration biopsy of lung: report of 55 cancer patients and metaanalysis of the literature

Percutaneous fine-needle aspiration biopsy is an accepted procedure for diagnosing intrathoracic malignant disease. The value of having a cytopathologist present during the procedure was studied with respect to the number of needle passes, the accuracy of the procedure, and complications. A metaanalysis was performed on the combined results of the present and previous series. We analyzed data from 55 adult patients who underwent percutaneous CT-guided fine-needle (22-gauge) aspiration biopsy of the lung for a lesion that either the biopsy or another subsequent invasive procedure showed to be nonlymphomatous and malignant. A cytopathologist was present for the first 25 procedures and not present for the next 30 procedures. When present, the cytopathologist stained the aspirated material with toluidine blue and gave an immediate opinion on the diagnostic adequacy of the specimen based on microscopic evaluation. If appropriate, the radiologist obtained additional biopsy specimens. When a cytopathologist was not present, the radiologist assessed the adequacy of the specimen by gross examination. A metaanalysis was performed of 211 cases from the present study and two previous series with respect to the effect of the presence of a cytopathologist on the diagnostic accuracy of the procedure. Biopsy specimens showed cancer in 25 (100%) of 25 patients when obtained while the cytopathologist was present, and in 24 (80%) of 30 patients when obtained while the cytopathologist was absent (p < .05, Fisher exact test). No significant differences in the number of needle passes performed or in the frequency of pneumothorax when aerated lung was traversed were noted between the two groups. Although two previous studies showed nonsignificant trends toward increased accuracy of thoracic fine-needle aspiration when a cytopathologist participated in the procedure, metaanalysis revealed significantly increased accuracy when a cytopathologist was present (p < .02, Mantel-Haenszel chi 2-test). An accurate diagnosis from fine-needle aspiration biopsy of intrathoracic cancer was more likely when a cytopathologist was present than when not present during the procedure.