No abstract

Transbronchial fine needle aspiration (TBNA) is a simple technique for sampling mediastinal lymph nodes and may provide additional information in patients with suspected lung cancer. However, the technique is still under-utilized, and the objective of this study was to evaluate the value of TBNA as part of an integrated pathway for the assessment of patients with suspected lung cancer. All patients referred to the lung cancer services of our institutions were prospectively evaluated. TBNA was performed in all patients with evidence of mediastinal lymphadenopathy. TBNA of one or more lymph node sites were performed in 129 of these patients. TBNA was the sole diagnostic modality in 23% of patients and provided positive staging information for 49% of patients, with adequate sampling in 71% of patients. Among patients with mediastinal adenopathy, the number of patients who required a TBNA performed to diagnose one patient with malignancy in patients suspected with lung cancer (number needed to diagnose) was 1.47 (95% confidence interval, 1.47-1.76). No complications were observed in patients who underwent TBNA. TBNA improves the diagnostic yield and staging of patients with lung cancer. Moreover, it is a simple, low-cost, and safe test, which should be incorporated into the diagnostic pathway of patients with suspected lung cancer.

No abstract

Interventional radiology of the thorax encompasses an expanding variety of procedures, ranging from simple diagnostic pleural fluid aspiration to complex therapeutic procedures such as bronchial artery embolization and radiofrequency ablation of lung tumours. Physicians of many specialties will encounter patients undergoing such procedures and knowledge of possible complications is therefore desirable. We aim to briefly outline the role of the most commonly undertaken radiological thoracic interventions and review the associated complications, their subsequent management and the steps that can be taken to minimize the risk of these complications occurring.

Purpose: A common diagnostic dilemma in the assessment of small pulmonary nodules on computed tomography (CT) is in distinguishing benign intrapulmonary lymph nodes (IPLNs) from small primary pulmonary malignancies. Several CT features have been described of IPLNs, including attachment to a pleural surface. We had observed that IPLNs were often connected to a pulmonary vein and sought to evaluate the utility of this sign in discriminating IPLNs from lung adenocarcinomas. The frequency of other previously described CT signs of IPLNs was also compared with lung adenocarcinomas. Materials and Methods: We retrospectively identified histopathologically proven benign IPLNs (n=62) and small (<15 mm) adenocarcinomas (n=61). CTs were reviewed to assess the number and type of pulmonary blood vessels arising from, or terminating within, these nodules, as well as other CT features of IPLNs (shape, location, and outline). Results: The termination of a pulmonary artery within a nodule was strongly associated with primary lung adenocarcinoma (55.7%), and this was never seen in isolation in IPLNs (0%) (P<0.001). IPLNs were more frequently associated with pulmonary venous connections (93.5%) compared with lung adenocarcinomas (21.3%) (P<0.001). The connection to a pleural surface was observed in both IPLNs (38.7%) and lung adenocarcinomas (37.7%) (P=1.0). Conclusions: We describe a novel imaging marker that can help to differentiate between benign and malignant pulmonary nodules. However, attachment of a nodule to a pleural surface should not be used in isolation to distinguish IPLNs from lung malignancy.