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Vol. 46. Issue 5.
Pages 223-229 (May 2010)
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Vol. 46. Issue 5.
Pages 223-229 (May 2010)
Original Article
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Usefulness CT-guided F.N.A.C. in the Diagnosis of Mediastinal Lesions
Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas
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Virginia Pérez Dueñasa,
Corresponding author
virpedue@gmail.com

Corresponding author.
, Isabel Torres Sáncheza, Francisco García Ríob, Emilio Valbuena Durána, Blanca Vicandi Plazac, Jose María Viguer García-Morenoc
a Servicios de Radiología, Hospital Universitario La Paz, Madrid, Spain
b Servicios de Neumología, Hospital Universitario La Paz, Madrid, Spain
c Servicios de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
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Abstract
Objective

To evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard.

Patients and Methods

CT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3–10mm image thickness range and low radiation dose (40mAs, 120kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50.

Results

The material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2–97.9%), specificity 84.2% (95%CI: 62.4–94.5%), positive predictive value 97.1% (95%-CI: 91.7–99.0%), negative predictive value 76.2% (95%CI: 54.9–89.4%), likelihoodratio positive 6.03 (95%CI: 2.13–17.05) and accuracy 93.5% (95%CI: 87.7–96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607).

Conclusions

CT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting.

Keywords:
Mediastinal lesions
Computed tomography
Fine needle aspiration
Cytology
Sensitivity
Specificity
Resumen
Objetivos

Evaluar la validez diagnóstica de la punción aspiración con aguja fina (PAAF) percutánea en lesiones mediastínicas considerando la biopsia o el seguimiento clínico como patrón de referencia.

Pacientes y métodos

Se realizó PAAF percutánea guiada por TC a 131 pacientes con lesiones mediastínicas. Se usó un TC helicoidal con cortes de 3–10 mm y baja dosis de radiación (40 mAs, 120 kV). Las muestras fueron examinadas in situ por un citólogo para determinar su validez. Se obtuvo comprobación histológica mediante biopsia o estudio de pieza quirúrgica en 73 pacientes y seguimiento clínico en 50, comparándose los resultados globales y en subgrupos.

Resultados

En 126 pacientes (96,2%) el material fue válido para diagnóstico. Ciento tres lesiones (78,6%) fueron consideradas malignas (62 tumores primarios y 41 metástasis) y 23 (17,6%) benignas. En los 123 pacientes de los que se dispuso de seguimiento clínico o patológico, la PAAF permitió identificar malignidad con una sensibilidad del 95,2% (IC95%: 89,2–97,9%), especificidad 84,2% (IC95%: 62,4–94,5%), valor predictivo positivo 97,1% (IC95%: 91,7–99,0%), valor predictivo negativo 76,2% (IC95%: 54,9–89,4%), razón de verosi- militud positiva 6,03 (IC95%: 2,13–17,05) y exactitud 93,5% (IC95%: 87,7–96,7%). La complicación más frecuente fue el neumotórax (3 casos). La correlación citohistológica fue elevada tanto en las lesiones malignas (kappa 0,641) como en las benignas (kappa 0,607).

Conclusiones

La PAAF percutánea guiada por TC es una técnica segura y eficaz para el diagnóstico de masas mediastínicas con alta rentabilidad para la detección de malignidad.

Palabras clave:
Lesiones mediastínicas
Tomografía computerizada
Punción aspiración con aguja fina
Citología
Sensibilidad
Especificidad
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