Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.

Abstract

Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.

Diagnosis of Lymphoma by Image-Guided Needle Biopsies

“…In this setting we find FC preferable to immunohistochemistry, which is subject to more staining artifact and subjective interpretation. 7,27,28,41 This study confirmed the findings of previous studies 4,10,26,30,37,40 showing a high level of diagnostic accuracy (82%) when using FNAB with adjuvant FC. The addition of core biopsy to FNAB increased the diagnostic accuracy to 93% in our study.…”

“…FNAB, 4,5,10,16,26,30,34,37,40 while others prefer core biopsies obtained by larger needles. 3,8,9,11,13,18,21,24,25,32,36,42,43 Silverman et al compared the results of core biopsies and FNABs and determined that fine needles are as likely as larger needles to obtain diagnostic material.…”

Systemic arterial air embolism and tension pneumothorax: two complications of transthoracic percutaneous thin-needle biopsy in the same patient

“…Biopsy was considered in order to discriminate between the infectious and immunological nature of the disorder. Indeed, there is evidence in the literature that transthoracic needle biopsy can provide or suggest diagnosis of infectious (opportunistic, bacterial) or immunological diseases (hypersensitivity pneumonitis, pulmonary haemorrhage, eosinophilic lung disease) [19,20].Coagulation studies, including prothrombin time, partial thromboplastin time and platelet count, performed the day before the biopsy, were normal. Percutaneous biopsy was performed under CT guidance with a 20-gauge Chiba-type needle.…”

The Pulmonary Nodule After Lung Transplantation

“…Its sensitivity is reported to be 81 % and is increased to 95% with repeat biopsies in a series of 54 patients with a history of malignant lymphoma. 4 In our experience, needle biopsy proved its value in cases with multiple nodules or nodules with a diameter of 1 em or more. In these cases, the underlying disease is often a more "malignant" one, such as PTLD or abscesses (bacterial or fungal) , where a prompt histologic or cultural diagnosis enables immediate therapy and may thus improve the survival rates of L Tx recipients.…”

“…In the two last patients, spiral CT with 8-mm-thick sections was used (Somatom Plus-S, Siemens; Erlangen, Germany). The CT-guided-fine-needle biopsies were performed as described elsewhere 4 From each nodule, about five specimens were taken by using the 18-to 22-gauge (Autovac, Angiomed; Karlsruhe, Germany) or a needle system (Surecut TSK; Tokyo, Japan). Biopsy specimens were fixed in 7.5% buffered formaldehyde solution (Formalin), embedded in paraffin, and sectioned serially at 4 J.I.ID.…”