Cytopathologic analysis of paratracheal masses: A study of 131 cases with clinicoradiologic correlation

Objective: To analyze the cytopathologic findings of a series of paratracheal space (PTS) masses in the context of clinicoradiologic correlation. Study Design: Retrospective review of our cytopathology files revealed 131 cases of PTS lesions in a 14-year period (1991-2005). Cytologic material was obtained under radiologic guidance. Radiologic findings, clinical data and subsequently performed tissue biopsies were reviewed and correlated. Results: Radiologic imaging disclosed masses in the PTS ranging from 1 to 7 cm. Of the 131 cases,, 103 (79%) were deemed diagnostic. Of these, 41 (40%) revealed nonneoplastic lesions, and 62 (60%) yielded malignant neoplasms. Nonneoplastic entities included: 31 (73%) hyperplastic lymph nodes and 10 (24%) sarcoidosis. Of the malignant cases, 45 (73%) were metastatic tumors: adenocarcinoma (ACA) 19, small cell carcinoma 12, squamous cell carcinoma (SQCC) 11 and other tumors, from lung 34, esophagus 4 and other mes. Malignant neoplasms from local spread included lung non-small cell carcinorna 6, SQCC 3 and ACA 3, papillary thyroid carcinoma 3 and other 2. Conclusion: Fine needle aspiration. (FNA) of PTS has a high diagnostic yield (79%) with a sensitivity of 97% and specificity of 100%. The most common diagnosis is a malignant tumor (60%), with metastatic carcinoma (73%) the most common neoplasm (lung ACA the most common primary source). The most common benign entity is a hyperplastic lymph node (24%). Ancillary studies (immunoctyochemistry, fluorescence in situ hybridization and electron microscopy) were helpful and provided definitive dignosis in 30% of the initially nondiagnostic FNA samples.