Mediastinal lesions

Background: Fine needle aspiration cytology has emerged as a minimally invasive, cost-effective diagnostic tool with significant utility in evaluating mediastinal lesions. However, comprehensive data on its diagnostic accuracy, efficacy, and clinical impact on managing these lesions remain limited.Objective: This study aims to assess the diagnostic utility of fine needle aspiration cytology in mediastinal lesions, focussing on its accuracy, safety, and role in guiding the therapeutic approach.Methods: A cross-sectional retrospective analysis was conducted on patients who underwent fine needle aspiration for mediastinal lesions at our tertiary care centre between 2015 and 2024. Demographic data, cytological findings, histopathological correlation, and ancillary studies were reviewed. Diagnostic accuracy was assessed by comparing fine needle aspiration cytology findings with histopathological diagnoses.Results: A cumulative total of 60 cases of mediastinal lesions were evaluated, of which 47 cases were considered suitable for cytological assessment, and subsequent tissue diagnosis was pursued for each case. Among the 47 cases, 38 cases were identified as neoplastic (80.85%), whereas 6 were classified as nonneoplastic (12.76%). Within the spectrum of neoplastic mediastinal lesions, lymphoma was recognised as the principal neoplastic entity, followed by thymic neoplasms and metastatic lesions. The overall diagnostic accuracy achieved through fine needle aspiration cytology in discerning the diverse mediastinal lesions was established at 73.33% in this study, with diagnostic accuracy being exceptionally high in lymphomas, metastatic lesions, germ cell tumours, and in the identification of neuroendocrine tumours.Conclusion: Fine needle aspiration cytology of mediastinal lesions is a highly accurate, safe, and valuable diagnostic tool that significantly influences clinical management and treatment protocols. These findings support the broader adoption of fine needle aspiration cytology in routinely evaluating mediastinal pathologies. Further studies with larger sample sizes and prospective designs are warranted to validate these results and refine procedural protocols.