Percutaneous transthoracic needle aspiration biopsy of benign and malignant lung lesions

Presentation of over 10 years' experience of percutaneous needle aspiration biopsy in about 200 patients, with special emphasis given to the technique and to the discussion of indications and contraindications, as well as of common problems.     

Transthoracic needle aspiration biopsy: accuracy of cytologic typing of malignant neoplasms

A correlation was made between the cytologic and the histologic diagnoses of 162 patients who underwent transthoracic fine-needle aspiration biopsy in whom histologic proof of the nature of the aspirated lesion was available. Compared to the histologic diagnosis, the specific cell-type cytologic diagnosis was usually in agreement when reported as squamous cell carcinoma (86%), adenocarcinoma (86%), or small cell anaplastic carcinoma(86%). In patients with a known extrapulmonary primary malignant neoplasm, the cytologic specimen was extremely helpful in identifying a new pulmonary lesion as metastatic rather than as a primary lesion in the lung. These results warrant the more extensive use of fine-needle aspiration biopsy in patients with pulmonary neoplasms in whom the specific cell type of the malignant neoplasm has important implications in therapy.     

Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions.

The results of 88 transthoracic needle biopsies of lung lesions using the Rotex biopsy instrument are analyzed. Of 57 malignant lung lesions, 55 were diagnosed correctly. Two patients with false negative biopsies had technically inadequate examinations. All but one of the 28 benign lung lesions were correctly diagnosed as nonmalignant. One false positive diagnosis of malignancy was made. The occurrence of complications was similar to those reported for conventional fine needle aspiration. The high accuracy rate is attributed to the effectiveness of the Rotex instrument in sampling the lesions and to the use of biplane fluoroscopy.     

Transthoracic aspiration biopsy of pulmonary and mediastinal lesions

Thoracic aspiration biopsy (TAB) constitutes a useful technique in establishing a diagnosis in diseases of the lungs and mediastinum. Results obtained from 1046 fluoroscopically-guided TABs are presented with review of the most important aspects of the technique. Diagnostic accuracy in malignancy detection was 93.8% in lung lesions (n = 984) and 74.5% in mediastinal lesions (n = 62). Sensitivity was higher in peripheral than in central lesions (96% vs. 87%, respectively). Specificity was 100% in both groups. Sensitivity in lesions smaller than 2 cm was 70% and 94% in larger lesions. Aspiration biopsies performed with Chiba and Franseen needles showed a similar sensitivity (95%) higher than with other types of needles. A pneumothorax developed in 138 patients (13.2%). Only eight of these required the use of an endothoracic tube (0.8% of all biopsies).     

Percutaneous needle aspiration lung biopsy

A presentation of over ten years' experience with percutaneous needle aspiration biopsy in about 200 patients is provided with special emphasis given to the technique and to the discussion of indications and contraindications as well as to common problems.     

Comparison of bronchial brushing and percutaneous needle aspiration biopsy in the diagnosis of malignant lung lesions.

The results of 100 bronchial brushings and 80 percutaneous needle aspiration biopsies of the lung performed in the same department were analyzed for their accuracy in the diagnosis of pulmonary neoplasms. While both procedures have a high degree of reliability, the aspiration needle biopsy appears to be the procedure of choice in smaller, more peripheral lesions, in Pancoast tumors, and whenever a metastatic neoplasm is suspected.     

Positional precautions in needle aspiration lung biopsy

The authors performed 308 needle aspiration biopsies of parenchymal lung masses. The patients were then placed with the puncture site down for a period of at least 1 hour or until air leakage stopped. Coughing, talking, and activity were restricted. Complications included pneumothorax, at a rate of 25.0%, and chest tube placement, at a rate of 1.6%. In a subgroup of 262 patients who required only one pleural puncture at biopsy, a pneumothorax rate of 17.9% and a chest tube placement rate of 0.4% were encountered. When compared with a similar series of 143 control patients, significant reductions in both pneumothorax rate (P = .0004) and chest tube placement rate (P = .0001) were demonstrated.     

Transthoracic aspiration needle biopsy: value in the diagnosis of pulmonary infections

We reviewed 441 transthoracic needle aspiration biopsies to evaluate the use of the procedure in the diagnosis of pulmonary infections. Sixty-seven (15%) of the biopsies were performed because pulmonary infection was suspected. In these 67 cases, a specific diagnosis was made in 45 (67%). In 46 cases in which infection was ultimately found to be present, aspiration biopsy identified the organism in 35 (76%). Overall, clinically useful information was obtained in 54 (81%) of the 67 biopsies performed for pulmonary infection. In 369 biopsies performed for suspected malignant neoplasm, pulmonary infection was diagnosed in 13. The only significant complication was pneumothorax, which occurred in 18% of the biopsies. Chest tube placement was required in 5% of the biopsies. We conclude that transthoracic aspiration needle biopsy is of value in the diagnosis of suspected pulmonary infections.     

Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.

PURPOSE: To analyze the influence of multiple variables on the rate of pneumothorax and chest tube placement associated with transthoracic needle aspiration biopsy of the lung. MATERIALS AND METHODS: In 346 patients, 331 computed tomographically (CT) guided and 24 fluoroscopically guided lung biopsies were performed. Variables analyzed were lesion size, depth, and location; number of pleural passes; needle size; presence of emphysema; and training level of the person who performed the biopsy. RESULTS: Pneumothorax occurred at 144 (40.4%) of 356 biopsies, including 139 (42.0%) CT-guided and five (21%) fluoroscopically guided biopsies. Chest tube placement was needed in 25 (17.4%) of 144 cases of pneumothorax (7% of all biopsies). An increased rate of pneumothorax was correlated with smaller lesion size (P = .001) and presence of emphysema (P = .01). Patients with emphysema were three times as likely to require chest tube placement. The pneumothorax rate was 15% (16 of 105) if no aerated lung was traversed and approximately 50% if aerated lung was penetrated. Lesion location, needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate. CONCLUSION: Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.     

CT-guided aspiration core needle biopsy of gastrointestinal wall lesions

PURPOSE: The purpose of this work was to examine the accuracy and safety of CT-guided core biopsy of gastrointestinal wall lesions. METHOD: We reviewed over 1,200 CT-guided abdominal core biopsy results from 1989 through 1998. Forty-five were from gastrointestinal wall lesions (16 gastric, 3 duodenal, 7 small intestine, and 19 colon). RESULTS: A definitive histologic diagnosis was obtained from the core biopsy in 41 patients (91%) without complication. The gastric lesion diagnoses were mesenchymal tumor of smooth muscle origin (eight), lymphoma (one), adenocarcinoma (three), and normal (one). Duodenal core biopsy diagnoses were inflammation (one) and normal (one). Small intestinal core biopsy diagnoses were non-Hodgkin lymphoma (four), metastatic leiomyosarcoma (one), carcinoma (one), and tuberculosis (one). Colon core biopsy diagnoses were carcinoma (11), lymphoma (2), actinomycosis (2), granulomatous inflammation (1), metastatic squamous cell carcinoma (1), chronic abscess (1), and mesenchymal tumor of smooth muscle origin (1). CONCLUSION: Percutaneous CT-guided core needle biopsy from gastrointestinal wall lesions is safe and accurate, especially in submucosal lesions, and should be considered in selected cases with negative endoscopic biopsy or in which endoscopic biopsy is not possible.     

Ultrasound guided fine needle aspiration biopsy of splenic lesions

Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infrequently utilized because of the risk of haemorrhage. This study was carried out to evaluate the safety and efficacy of ultrasound guided FNAB of splenic lesions. 35 patients with focal splenic lesions underwent FNAB under real-time ultrasound guidance using a free hand technique. Ultrasound findings were single or multiple focal hypoechoic lesions (n = 33), focal hyperechoic lesion (n = 1) and diffuse heterogeneous echotexture (n = 1). Aspirations were performed with 22 G spinal needles using either the subcostal or the intercostal approach. Definite cytological diagnosis was made in 22 patients (62.8%), including tuberculosis in 10 patients, lymphoma in seven patients, extramedullary haematopoiesis in two patients and aspergillosis, histoplasmosis and bacterial abscess in one patient each. FNAB was negative in 12 patients because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intraabdominal bleeding, which was managed conservatively. In conclusion, splenic FNAB performed under ultrasound guidance is a safe and accurate method in the diagnosis of focal splenic lesions.     

Fine needle aspiration biopsy of osteolytic metastatic lesions.

The use of fine needle aspiration biopsy of solitary osteolytic-type bone metastases in 24 patients is described. A positive diagnosis of malignancy was obtained in 21 patients, as the softness of the osteolytic lesion yielded enough cell material for cytologic examination. No complications were encountered. The procedure can be performed with ease, even on an outpatient basis, without discomfort to the patient.     

Transthoracic needle biopsy of lung masses: a survey of techniques

AIM: In order to assess the range and everyday use of the various techniques for percutaneous transthoracic needle biopsy of lung masses in the USA and Canada, we surveyed thoracic radiologists in academic and community practice on their standard approach to the procedure. MATERIALS AND METHODS: The 300 questionnaires that were mailed to members of the Society of Thoracic Radiology throughout the USA and Canada contained specific questions on their approach to a transthoracic needle biopsy of a routine case of a 3cm lung mass located in the right lower lobe 1cm from the pleural surface. RESULTS: A total of 140 (47%) members responded. Of the 139 responders who performed lung biopsies, 103 (74%) were located at a teaching centre affiliated to a university or medical school, and 36 (26%) were community-based radiologists. In total 97 (70%) replied that they would perform the procedure under CT guidance, 31 (22%) under either CT or fluoroscopy guidance, and 11 (8%) only under fluoroscopy. Fine-needle aspiration was the procedure of choice for the given case by 101 (73%) responders, whereas 20 (14%) preferred doing core biopsy, and 18 (13%) chose both techniques. On-site cytology confirmation for obtaining diagnostic material was available to 101 (73%) responders. Before performing the procedure, 107 (77%) verified coagulation tests whereas 32 (23%) did not. Follow-up imaging for pneumothorax assessment was not routinely performed by 15 (11%) responders. CONCLUSION: The majority of radiologists performed percutaneous transthoracic needle biopsy of a lung mass under CT guidance, by fine-needle aspiration, using repeated pleural puncture technique, and with a cytologist on site. A significant minority did not obtain coagulation screening before the procedure, and a small minority did not routinely assess for pneumothorax by late chest radiography.