In recent years, F-FNA has been replaced by the more costly and time consuming CT guided FNA (CT-FNA) for the diagnosis of a solitary pulmonary nodule. We report a modified technique for F-FNA performed in a pulmonary fellowship (PF) training program - a technique which provides results comparable if not superior to CT-FNA.
Since 1991, 34 PF have performed 99 F-FNA with attending supervision. The principles of the technique were: (1) an 18-Ga needle (EZEM) was used, (2) the anesthetic needle did not enter the pleural space, (3) under fluoroscopic guidance the needle was inserted into the lesion, (4) respirations were suspended whenever the needle was held or immobilized and respirations allowed when the needle was not immobilized, (5) during a single pass, 5-6 thrusts were made throughout the lesion with constant suction, (6) a cyto-pathologist reviewed smears at time of aspiration. If the smear was not diagnostic, a second pass was made by the attending physician. (7) cores of tissue were embedded for histologic exam.
After appropriate instruction, fifty-one F-FNA were performed by trainees only, 48 by trainees and attending staff and 7 by attending only (total 106). Sixty-two F-FNA were positive for malignant disease (58%). There were 2 false negatives (sensitivity 97%) and no false positives (specificity 100%). A specific diagnosis was made in 19 (44%) of 43 non-malignant lesions. Complications included 13 (12%) pneumothoraces, 3 (2.8%) chest tube insertions, 9 (8.5%) trace hemoptysis and no deaths.
F-FNA is less costly and less time consuming than CT-FNA. It is at least equal to CT-FNA regarding sensitivity, specificity and complications.CLINICAL IMPLICATION: It is a justifiable alternative to CT-FNA for the diagnosis of solitary pulmonary nodules.
A.H. Niden, None.