Sensitivity and cost-effectiveness of fine-needle aspiration with immunocytochemistry in the evaluation of patients with a pulmonary malignancy and a history of cancer.

Abstract

To determine the sensitivity and cost-effectiveness of transthoracic fine-needle aspiration in the separation of primary from metastatic malignancy. Eighty-nine malignant pulmonary fine-needle aspirations in patients with a history of cancer were classified retrospectively by light microscopy, comparison with previous material, and immunocytochemistry. Decision analysis compared the cost-effectiveness of fine-needle aspiration, bronchoscopy, and thoracoscopy. Fine-needle aspiration classified 87% of the malignancies as primary (n = 7) or metastatic (n = 70) and 13% as indeterminate. By immunocytochemistry alone, 14 of 18 malignancies were subclassified. Decision analysis showed that pulmonary fine-needle aspiration with select use of thoracoscopy was more cost-effective than either bronchoscopy or thoracoscopy alone in many common clinical scenarios. Pulmonary fine-needle aspiration with immunocytochemistry is sensitive and cost-effective in subclassifying malignancies in patients with a history of cancer.