Diagnostic Yield of Transthoracic Needle Aspiration Biopsy following Negative Fiberoptic Bronchoscopy in 103 Patients with Peripheral Circumscribed Pulmonary Lesions

Abstract

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy (FOB) in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB over a 5-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytologic classification of the tumor type in 72.2% (39 of the 54 patients). Five of the 54 patients (9.3%) presented with small-cell anaplastic bronchogenic carcinoma, diagnosed at TNB, and were referred to chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, 3 benign tumor, 2 infection, and 3 sequelae after pulmonary infarction. The remaining 22 undiagnosed patients were followed up over a long period of time, 5 showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable for the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore no definitive benign diagnosis was made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral localized malignant pulmonary lesions.

Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses

“…Percutaneous fine-needle aspiration (FNA) biopsy is usually recommended for peripheral lesions, whereas bronchoscopy with bronchoalveolar lavage (BAL) with or without transbronchial biopsy is usually performed for endobronchial or central lesions [1]. However, these procedures often fail to lead to a definitive diagnosis [2, 3]. Consequently, open-lung biopsy (OLB) is frequently used to establish the diagnosis for lung lesions [4–10].…”