CT-Guided Biopsy of Lesions of the Lung, Liver, Pancreas or of Enlarged Lymph Nodes: Value of Additional Fine Needle Aspiration (FNA) to Core Needle Biopsy (CNB) in an Offsite Pathologist Setting

Rationale and Objectives To assess the value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in computed tomography–guided biopsy of lesions of the lung, liver, pancreas, or of enlarged lymph nodes in an offsite cytopathologist setting. Materials and Methods This retrospective Health Insurance Portability and Accountability Act–compliant study was approved by the Institutional Review Board (IRB); informed consent (IC) was waived. Data of 377 patients who underwent computed tomography–guided FNA and CNB of lesions of the lung, liver, pancreas, or enlarged lymph nodes were enrolled. An onsite cytopathologist was not available. Sensitivity and specificity were calculated for FNA, CNB, and combined FNA/CNB. For the purpose of our study, positive diagnoses from CNB specimens or subsequent biopsy or surgical resection specimens or clinical follow-up data were considered as the standard of reference. Results CNB yielded a significantly higher sensitivity than FNA in all sites, except the pancreas, where the difference did not reach statistical significance. Additional FNA to CNB did not significantly increase the sensitivity. Specificity did not significantly differ between FNA, CNB, and combined FNA/CNB in all sites. Malignancies of 1.7% were detected only with FNA, without evidence of malignancy in CNB; for the remaining malignancies, CNB was positive or indeterminate. Conclusion Additional FNA to CNB without an onsite cytopathologist does not yield higher sensitivity or specificity compared to CNB alone.