Inflammatory and neoplastic processes of the lung: differential diagnosis and pitfalls in FNA biopsies

Our plain-English summary of Inflammatory and neoplastic processes of the lung: differential diagnosis and pitfalls in FNA biopsies, by J.F. Silverman (Diagnostic Cytopathology, 1995).

The study

• Author: J.F. Silverman
• Journal: Diagnostic Cytopathology
• Published: 1995;13(5):448-62
• Type of article: Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This review, from the Department of Pathology and Laboratory Medicine at East Carolina University School of Medicine, discussed sources of diagnostic error in fine-needle aspiration (FNA) biopsy of the lung. The author described the institution's technique. Lung lesions were aspirated percutaneously with a 22-gauge Chiba needle under fluoroscopic, ultrasound or CT guidance, and smears were stained with Papanicolaou and rapid Diff-Quik stains for immediate interpretation.

The review covered benign processes that can mimic malignancy and lead to false-positive diagnoses. These included reactive mesothelial cells, inflammatory atypia, squamous metaplasia, repair in pulmonary infarct, type II pneumocyte hyperplasia in organizing pneumonia, degenerating histiocytes, radiation and chemotherapy effects, inflammatory pseudotumor, vegetable material, inadvertently sampled liver cells, and granulomas. It also described neoplasms that can cause false-negative diagnoses, such as squamous-cell carcinoma with abscess-like necrosis and inflammation.

Four diagnostic challenges among lung neoplasms were discussed:

• small-cell carcinoma versus carcinoid, poorly differentiated squamous-cell carcinoma and lymphoma;
• primary lung carcinoma versus metastasis;
• pleomorphic large-cell malignancies, including sarcoma;
• peripheral adenocarcinoma versus mesothelioma, which the author noted has a very strong association with asbestos exposure.

Tables summarized cytologic, immunocytochemical and electron microscopic features. The author stressed several ways to avoid misdiagnosis: immediate examination of rapid stains, attention to low-power cell architecture, ancillary studies such as immunocytochemistry and electron microscopy, and correlation with clinical and radiologic findings.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a narrative review by a single author on fine-needle aspiration (FNA) biopsy of the lung. It reported no new study of patients and did not study asbestos exposure. The author described hyperplastic, repair, metaplastic and degenerative changes in benign lung conditions that can produce cells mistaken for cancer. The author also described cancers that can be missed when few malignant cells sit among many inflammatory cells, such as squamous-cell carcinoma that looks like a lung abscess. The review then covered difficult distinctions among lung tumors, one of which was peripheral lung adenocarcinoma versus mesothelioma. In that section the author noted, as background, that mesotheliomas show a very strong association with asbestos exposure. The author stated that FNA of solid lesions can be diagnostic. A panel of stains was described in which positive staining favors adenocarcinoma, while long, thin microvilli seen by electron microscopy favor mesothelioma. The author wrote that the correct diagnosis ultimately brings together radiologic evidence of diffuse pleural involvement and clinical history with the cell findings.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of diagnostic pitfalls in lung fine-needle aspiration cytology
• Who was studied: No study population. The article reviews FNA cytology of lung lesions, drawing on published literature and practice at the author's institution (Department of Pathology, East Carolina University School of Medicine, Greenville, NC).
• Exposure: No exposure was studied. Asbestos appears only in a background statement that mesotheliomas show a very strong association with asbestos exposure. No fiber type is named.
• Main results:
  • The review described benign processes (hyperplastic, regenerative or repair, metaplastic, degenerative) that are potential pitfalls for a false-positive diagnosis of cancer in lung FNA.
  • The author described a potential for a false-negative diagnosis of squamous-cell carcinoma when there is severe acute inflammation, as when the tumor resembles a lung abscess.
  • One of the diagnostic challenges discussed was peripheral lung adenocarcinoma versus mesothelioma.
  • When there is no serous effusion, the author stated that FNA sampling of solid lesions can diagnose mesothelioma.
  • The author's group uses a panel of stains (CEA, EMA, Leu-M1, BER-EP4, B72.3). Positive staining for one or more of these favors adenocarcinoma.
  • On electron microscopy, cells with long, thin microvilli favor mesothelioma.
• The authors' conclusion: For mesothelioma, the author wrote that the correct diagnosis ultimately brings together radiologic evidence of diffuse pleural involvement and clinical history to support the cytologic and ancillary studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Differential Diagnosis, Pathology, Fine-Needle Aspiration, Biopsy, Ultrasound, Reactive Mesothelial Cells, Chemotherapy, Granuloma.

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