Albrandt SA, Domínguez PL, Jiménez FE, Sotelo RR, Arreola R, Hernández BE, Cuica LA, Osorio CG

Language: Spanish
References: 20
Page: 115-120
PDF size: 249.92 Kb.

ABSTRACT

Introduction. The objective of this work is to establish the efficacy of aspiration biopsy of pulmonary nodules with a fine 18 g needle guided by tomography.
Material and method. A total of 67 patients were included (52 women and 15 men) with an age range of 19 to 79 years (median of 52 years) with the presence of pulmonary nodules (lesions smaller than 15 mm) which were biopsied with CT guided fine needle aspiration technique. The largest size of the nodules was 10 x 15 mm, the smallest one measured 2 x 3 mm, with an average of 6 x 6 mm. Fifty-nine of the 67 patients had a history of extrapulmonary primary tumors. Cytopathologic evaluation of the obtained samples was immediate in every patient. The sensitivity and specificity of the procedure was calculated, and in each case the secondary complications were reviewed including pneumothorax and pleural tube placement.
Results. The samples obtained with FNAB were adequate for diagnosis in 63 out of 67 patients (94%). The results reported malignancy in 26 cases (38.8%) of which 24 were metastases and 2 were primary tumor. In 37 cases the report was benign and/or inflammatory (55.2%). The biopsy could not establish the diagnosis in four patients (6%). Follow-up was performed in the 37 patients in whom the diagnosis of the obtained sample was negative for malignancy, and included control Computed Tomography which did not show changes in morphology, size or attenuation values of the nodule suggestive of tumoral activity. Clinical and laboratory tests were also negative.
Discussion. Sensitivity in nodules measuring from 7 to 15 mm was better than in nodules of less than 7 mm, sensitivity is also better in nodules localized in the periphery when compared with central nodules. Six patients presented pneumothorax (9%) and only one of them required pleural tube placement, there was no evidence of other complications.
Conclusions. Based on the previous data we establish that CT guided fine needle biopsy of pulmonary nodules (lesions smaller than 10 mm) represents an excellent and safe diagnostic option, which increases if the lesions are peripheral and measure from 7 to 10 mm.s

REFERENCES

1. Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology 1976;118: 603-607.

2. Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988;169:593-601.

3. VanSonnenberg E, Lin AS, Deutsch AL, Mattrey RF. Percutaneous biopsy of difficult mediastinal, hilar, and pulmonary lesions by computed tomographic guidance and a modified coaxial technique. Radiology 1983;148:300-302.

4. Stanley JH, Fish GD, Andriole JG, et al. Lung lesions: cytologic diagnosis by fine-needle biopsy. Radiology 1987;162:389-391.

5. Khouri NF, Stitik FP, Erozan YS, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985;144: 281-288.

6. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McCloud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996;167:105-109.

7. Larscheid RC, Thorpe PE, Scott WJ. Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 1998;114:704-709.

8. Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 2000; 175:239-243.

9. Perlmutt LM, Johnston WW, Dunnick NR. Percutaneous transthoracic needle aspiration: a review. AJR Am J Roentgenol 1989;152:451-455.

10. Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996; 198:371-375.

11. Cox JE, Chiles C, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999;212:165-168.

12. Laurent F, Michel P, Latrabe V, de Lara MT, Marthan R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique. AJR Am J Roentgenol 1999; 172:1049-1053.

13. Laurent F, Labtrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Intervent Radiol 2000;23:266-272.

14. Yamagami T, Nakamura T, Iida S, et al. Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest 2002;121:1159-1164.

15. Haramati LB, Austin JHM. Complications after CT-guided biopsy through aerated versus nonaerated lung. Radiology 1991;181:778.

16. Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol 1976;17:813-828.

17. Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208:303-318.

18. Klein JS, Salomon G, Stewart EA. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology 1996;198:715-720.

19. Westcott JL, Rao N, Colley DP. Transthoracic needle biopsy of small pulmonary nodules. Radiology 1997;202:97-103.

20. Herman PG, Hessel SJ. The diagnostic accuracy and complications of closed lung biopsies. Radiology 1977;125:11-14.