A New Technique for Transthoracic Biopsy of Lung Changes

Nordenström, Björn

doi:10.1259/0007-1285-38-451-550

Cited by 56 publications

(16 citation statements)

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“…Since Nordenström introduced TNAB as it is performed today in 1963, 5 we restricted our Index Medicus search to the 1963-5 period using the following headings: (1) "biopsy" ("needle biopsy" could not be used as a heading since it was introduced in Index Medicus only in 1973); (2) "coin lesion, pulmonary" (introduced in Index Medicus only in 1965); and (3) "lung neoplasms". We searched for additional articles from the reference lists of relevant articles.…”

Section: Literature Searchmentioning

confidence: 99%

See 1 more Smart Citation

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

Lacasse

Wong²,

Guyatt³

et al. 1999

Thorax

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Background-Persisting controversy surrounds the use of transthoracic needle aspiration biopsy (TNAB) stemming from its uncertain diagnostic accuracy. A systematic review and meta-analysis was therefore conducted to evaluate the accuracy of TNAB for the diagnosis of solitary or multiple localised pulmonary lesions. Methods-Searches for English literature papers in Index Medicus (1963)(1964)(1965) and Medline (1966Medline ( -1996 were performed and the bibliographies of the retrieved articles were systematically reviewed. Articles evaluating the accuracy of TNAB in series of consecutive patients presenting with solitary or multiple pulmonary lesions were considered. Only papers in which >90% of patients were given a final diagnosis according to an appropriate reference standard were included in the meta-analysis. Results-A total of 48 studies were included and five meta-analyses were conducted according to four diagnostic thresholds. From the pooled sensitivity and specificity corresponding to each diagnostic threshold, associated likelihood ratios (LRs) were derived for malignant disease as follows: (1) malignant versus all other categories, LR = 72; (2) malignant or suspicious versus all others, LR = 49; (3) suspicious versus all categories but malignant, LR = 15; (4) benign versus all others, LR = 0.07; and (5) specific benign diagnosis versus all others, LR = 0.005. DiVerences in methodological quality of the studies, needle types, or whether a cytopathologist participated in the procedure failed to explain the heterogeneity of the results found in almost every metaanalysis. Given a 50% probability of malignancy prior to the TNAB, post-test probabilities of malignancy upon receiving the results would be malignant, 99%; suspicious, 94%; non-specific benign, 7%; and benign with a specific diagnosis, 0.6%. Conclusions-Given the intermediate pre-test probabilities that would probably lead to performing TNAB, findings of "malignant" or of a specific diagnosis of a benign condition provide definitive results. Findings of "suspicious" markedly increase the probability of malignancy, and "benign" markedly decreases it but may not be considered definitive.

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Section: Literature Searchmentioning

confidence: 99%

“…More than 30 years after the introduction of transthoracic needle aspiration biopsy (TNAB) by Nordenström,5 areas of controversy surrounding its use persist. Part of the controversy stems from the uncertain operating characteristics, especially for the diagnosis of benign pathological processes.…”

mentioning

confidence: 99%

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

Lacasse

Wong²,

Guyatt³

et al. 1999

Thorax

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“…Since the first introduction of transbronchial approach with a curette through a catheter by Tsuboi et al [5], and that of percutaneous approach with a fine-needle technique by Nordenstrom [6], there has been considerable progress and improvement in this area. The arrival of fiberoptic bronchoscope and succeeding new methods of sampling such as flexible transbronchial aspiration needles, generally performed under fluoroscopic guidance [7,8], have increased the diagnostic yield with reduced complications while the safety and effectiveness of percutaneous approach also have been enhanced by ultrasonographic, fluoroscopic or CT guidance [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses

et al. 1998

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CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2–5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third–fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.

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“…Fine-needle aspiration biopsy has been used for the diagnosis of lesions in different organs, especially the lung, breast, and kidney [1][2][3][4][5][6]. More recently, computed tomography (CT) and ultrasonography (US) have been used in conjunction with percutaneous fine-needle biopsy for the diagnosis of both benign and malignant lesions of the pancreas, liver, retroperitoneum, spleen, and other abdominal organs [7][8][9][10][11][12][13][14][15][16][17].…”

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confidence: 99%

Fine-needle biopsy of the pancreas using real-time ultrasonography

Martínez

Velasco

Cáceres

1984

Gastrointest Radiol

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Percutaneous fine-needle biopsy of the pancreas by real-time ultrasonography was performed in 45 patients with suspected pancreatic carcinoma. True-positive diagnoses were obtained in 27 cases, 11 examinations yielded true-negative results, 3 results were false-negative, 2 were equivocal, and 2 samples were inadequate. The overall success rate was 84.4%. No false-positive cytologic diagnoses were made. Complications were not seen in any of the patients. The results confirm the effectiveness, safety, and relatively low cost of this procedure.

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A New Technique for Transthoracic Biopsy of Lung Changes

Cited by 56 publications

References 0 publications

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses

Fine-needle biopsy of the pancreas using real-time ultrasonography

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