Utilization of fine-needle aspiration cytology in the diagnosis of neoplastic superior vena caval syndrome

Superior vena caval syndrome often presents as an acute or subacute oncologic emergency that requires immediate action, usually with high-dose radiotherapy. With improved chemotherapeutic regimens for various malignancies, prompt and appropriate treatment of the syndrome is possible. Tissue diagnosis, therefore, is pursued, but invasive procedures are commonly associated with technical difficulties and complications. We find fine-needle aspiration biopsy a rapid, highly reliable, and well-tolerated procedure in selected situations and herein report 17 patients with initial presentation of superior vena caval syndrome efficaciously diagnosed with fine-needle aspiration cytology. The cell types were eight lung small-cell carcinomas, four poorly differentiated adenocarcinomas, two undifferentiated large-cell carcinomas, and one each of malignant large-cell lymphoma, myxoid liposarcoma, and thymic large-cell neuroendocrine carcinoma. Further experience, however, is warranted with this widely available procedure.