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Is FNAC enough to diagnose lung cancer?

Wednesday, 14 April 2004
Answered by: Dr. Irwin Ziment
Professor of Medicine,
University of California Los Angeles (UCLA),
USA
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Q. If a FNAC test of lung cancer gives no conclusion and the report says that more investigation is needed then what should be the further line of action?

A.  A fine needle aspiration biopsy of a lung nodule could be falsely negative because it failed to sample the nodule adequately or the material was of poor or confusing quality. Such problems arise in the best of hands, and it is known that the procedure is only reliable if a positive diagnosis of malignancy is made by the pathologist. The usual procedure after a 'negative' in a suspicious case varies with the circumstances. The options are: 1. Rebiopsy with a needle 2. Use video-assisted thoracoscopy 3. Bronchoscope to obtain specimens for cytology. Sometimes, several spontaneously expectorated sputum specimens may be adequate. 4. Do other radiologic tests such as MRI to look for more evidence of malignancy 5. Wait for a few weeks to make sure the lesion is not tuberculosis (if cultures have been obtained they take several weeks) and to see how the initial lesion behaves (it may disappear or it may enlarge) 6. Look for evidence of metastatic disease 7. Do a thoracotomy so that the surgeon can remove the lesion or part of the lung.

A.  A fine needle aspiration biopsy of a lung nodule could be falsely negative because it failed to sample the nodule adequately or the material was of poor or confusing quality. Such problems arise in the best of hands, and it is known that the procedure is only reliable if a positive diagnosis of malignancy is made by the pathologist. The usual procedure after a 'negative' in a suspicious case varies with the circumstances. The options are: 1. Rebiopsy with a needle 2. Use video-assisted thoracoscopy 3. Bronchoscope to obtain specimens for cytology. Sometimes, several spontaneously expectorated sputum specimens may be adequate. 4. Do other radiologic tests such as MRI to look for more evidence of malignancy 5. Wait for a few weeks to make sure the lesion is not tuberculosis (if cultures have been obtained they take several weeks) and to see how the initial lesion behaves (it may disappear or it may enlarge) 6. Look for evidence of metastatic disease 7. Do a thoracotomy so that the surgeon can remove the lesion or part of the lung.

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