Utility of intraoperative fine needle aspiration biopsy in the surgical management of patients with pulmonary masses.

Sporadic reports have postulated that intraoperative fine needle aspiration biopsy (FNAB) is a useful adjunct in the surgical management of patients with pulmonary masses. We reviewed 38 consecutive intraoperative pulmonary FNABs performed at our institution in order to assess the efficacy of this technique, as measured by (1) its sensitivity, specificity, predictive values and concordance rates, and (2) the appropriateness of the resultant surgical therapy. Six cases were benign (16%) and 32 malignant (84%); none were small cell carcinomas. Aspirates from the six benign lesions were designated either benign or nondiagnostic; there were no false-positive diagnoses (specificity = 100%). Aspirates from 30 of the 32 malignant neoplasms were diagnosed as malignant, one was considered suspicious for carcinoma, and one was interpreted as benign (sensitivity = 97%). The positive and negative predictive values were 100% and 86%, respectively. The concordance rate for benignancy/malignancy between the intraoperative FNAB interpretation and final diagnosis was 97%. The intraoperative FNAB diagnosis contributed to less-than-optimal surgical therapy in only one case. Thus, we conclude that intraoperative pulmonary FNAB has utility in the proper surgical management of pulmonary masses.