Abstract：
BACKGROUND: Fine Needle Aspiration cytology (FNAC) and core needle biopsy (CNB) are rapid, minimally invasive and useful techniques to evaluate mediastinal lesions.
OBJECTIVE: To compare cytopathology with histopathology of mediastinal lesions and analyse reasons for discordance.
METHODS: Retrospective analysis was done in a tertiary care centre in North West India over a period of seven and half years from 1stJuly 2016 to 31st December 2023. Only those patients who had undergone FNAC and trucut biopsy of mediastinal masses were included. The cytopathology and histopathology slides were studied to analyse causes of discordance. Sensitivity, specificity, positive and negative predictive values of FNAC were calculated keeping histopathology as gold standard.
RESULTS: Out of 57 cases analysed, eight cases were non diagnostic on cytology. Cytology could effectively classify a lesion as non neoplastic (7) or neoplastic (42). For further subtyping, histopathology and Immunohistochemistry (IHC) were required. Out of 27 cases of cytological - histopathological discordance, 8 cases had sampling error, 15 cases had limited concordance where FNAC could predict possibility of tumor and 4 cases were discordant where subtyping of malignancy varied on CNB. Sensitivity of FNAC to predict definite diagnosis was 90.2 %, specificity was 50 %, positive predictive value of FNAC to give a definite diagnosis was 93.9 %, negative predictive value was 37.5 %.
CONCLUSIONS: Evaluation of mediastinal masses requires combination of cytology, histopathology and ancillary techniques like IHC. FNAC and CNB are complementary modalities and both are essential for rapid, accurate and comprehensive diagnosis.
OBJECTIVE: To compare cytopathology with histopathology of mediastinal lesions and analyse reasons for discordance.
METHODS: Retrospective analysis was done in a tertiary care centre in North West India over a period of seven and half years from 1stJuly 2016 to 31st December 2023. Only those patients who had undergone FNAC and trucut biopsy of mediastinal masses were included. The cytopathology and histopathology slides were studied to analyse causes of discordance. Sensitivity, specificity, positive and negative predictive values of FNAC were calculated keeping histopathology as gold standard.
RESULTS: Out of 57 cases analysed, eight cases were non diagnostic on cytology. Cytology could effectively classify a lesion as non neoplastic (7) or neoplastic (42). For further subtyping, histopathology and Immunohistochemistry (IHC) were required. Out of 27 cases of cytological - histopathological discordance, 8 cases had sampling error, 15 cases had limited concordance where FNAC could predict possibility of tumor and 4 cases were discordant where subtyping of malignancy varied on CNB. Sensitivity of FNAC to predict definite diagnosis was 90.2 %, specificity was 50 %, positive predictive value of FNAC to give a definite diagnosis was 93.9 %, negative predictive value was 37.5 %.
CONCLUSIONS: Evaluation of mediastinal masses requires combination of cytology, histopathology and ancillary techniques like IHC. FNAC and CNB are complementary modalities and both are essential for rapid, accurate and comprehensive diagnosis.
摘要：
背景：细针穿刺细胞学（FNAC）和芯针活检（CNB）是快速的，评估纵隔病变的微创和有用技术。
目的：比较纵隔病变的细胞病理学和组织病理学，分析不一致的原因。
方法：从2016年7月1日至2023年12月31日，在印度西北部的一个三级医疗中心进行了7年半的回顾性分析。仅包括接受FNAC和纵隔肿块活检的患者。研究了细胞病理学和组织病理学切片以分析不一致的原因。灵敏度,特异性，以组织病理学作为金标准计算FNAC的阳性和阴性预测值.
结果：在分析的57例中，8例细胞学检查未诊断。细胞学可以有效地将病变分类为非肿瘤性（7）或肿瘤性（42）。对于进一步的子分型，需要进行组织病理学和免疫组织化学（IHC）。在27例细胞学-组织病理学不一致的病例中，8例存在抽样误差，15例具有有限的一致性，其中FNAC可以预测肿瘤的可能性，4例不一致，其中CNB的恶性肿瘤亚型不同。FNAC预测明确诊断的敏感性为90.2%,特异性为50%，FNAC对明确诊断的阳性预测值为93.9%，阴性预测值为37.5%.
结论：纵隔肿块的评估需要结合细胞学，组织病理学和辅助技术，如IHC。FNAC和CNB是互补的模式，两者都是快速，准确和全面的诊断。
目的：比较纵隔病变的细胞病理学和组织病理学，分析不一致的原因。
方法：从2016年7月1日至2023年12月31日，在印度西北部的一个三级医疗中心进行了7年半的回顾性分析。仅包括接受FNAC和纵隔肿块活检的患者。研究了细胞病理学和组织病理学切片以分析不一致的原因。灵敏度,特异性，以组织病理学作为金标准计算FNAC的阳性和阴性预测值.
结果：在分析的57例中，8例细胞学检查未诊断。细胞学可以有效地将病变分类为非肿瘤性（7）或肿瘤性（42）。对于进一步的子分型，需要进行组织病理学和免疫组织化学（IHC）。在27例细胞学-组织病理学不一致的病例中，8例存在抽样误差，15例具有有限的一致性，其中FNAC可以预测肿瘤的可能性，4例不一致，其中CNB的恶性肿瘤亚型不同。FNAC预测明确诊断的敏感性为90.2%,特异性为50%，FNAC对明确诊断的阳性预测值为93.9%，阴性预测值为37.5%.
结论：纵隔肿块的评估需要结合细胞学，组织病理学和辅助技术，如IHC。FNAC和CNB是互补的模式，两者都是快速，准确和全面的诊断。
