2004, Number 2
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ABSTRACTIntroduction. 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
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