• Immacolata Cozzolino, Andrea Ronchi, Gaetana Messina, Marco Montella, Floriana Morgillo, Giovanni Vicidomini, Virginia Tirino, Anna Grimaldi, Federica Zito Marino, Mario Santini, Salvatore Cappabianca, and Renato Franco.
• From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine "F. Magrassi-A. Lanzara" (Dr Morgillo), the Biotechnology, Medical Histology, and Molecular Biology Unit, Department of Experimental Medicine (Dr Tirino), the Department of Precision Medicine (Dr Grimaldi), and the Department of Radiology (Cappabianca), Università della Campania "Luigi Vanvitelli," Naples, Italy.
• Arch. Pathol. Lab. Med. 2020 Mar 1; 144 (3): 361-369.

Context.—Fine-needle aspiration cytology (FNAC) of pulmonary nodules is usually guided by computed tomography (CT), whereas ultrasonography (US) is generally considered not applicable for such purposes.Objective.—To evaluate the clinical applicability and diagnostic utility of US-guided transthoracic FNAC of peripheral pulmonary nodules.Design.—Ultrasonography-guided transthoracic FNAC was obtained from 40 selected patients with peripheral, subpleural, and paravertebral pulmonary nodules. Air-dried and Diff-Quik-stained smears were used for rapid on-site evaluation; additional smears were alcohol fixed for Papanicolaou staining. Cell blocks were set up for immunocytochemical and molecular studies; in 2 cases, a flow cytometry evaluation was also performed. The series was compared to 40 CT-guided pulmonary FNAC samples from patients with pleural, peripheral, and paravertebral pulmonary nodules, to evaluate differences in terms of diagnostic rate, time of execution, safety, and cost.Results.—The US-guided FNAC samples had results that were adequate and representative in 95% of cases. No significant differences were observed between the 2 groups in terms of diagnostic rate, number of passes, and cellularity of both smears and cell blocks. The mean time needed for the execution of US-guided FNAC was 13.1 minutes, whereas the mean time for CT-guided FNAC was 23.6 minutes. Thus, US-guided FNAC was significantly more rapid than CT-guided pulmonary FNAC. Because pneumothorax occurred in 1 individual who underwent US-guided FNAC and in 9 who underwent CT-guided FNAC, we might conclude that US-guided FNAC is a significantly safer procedure. Finally, comparing the costs of both procedures, US-guided FNAC is less expensive.Conclusions.—Our experience showed an elevated clinical applicability and diagnostic utility of US-guided transthoracic FNAC for selected pulmonary nodules.

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