Transthoracic Needle Aspiration Biopsy following Negative Fiberoptic Bronchoscopy in Solitary Pulmonary Nodules

doi:10.1378/chest.93.6.1152

Chest

Volume 93, Issue 6, June 1988, Pages 1152-1155

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To evaluate the utility of transthoracic needle aspiration biopsy (TTNAB) following negative fiberoptic bronchoscopy (FOB) in a patient with a solitary pulmonary nodule (SPN), we reviewed the records from 262 patients who had undergone TTNAB over an eight-year period. Fifty-eight patients had a SPN and met the criteria for inclusion in this series. Twenty-five of these (43 percent) were diagnosed by TTNAB; 24 had malignant lesions; one had M tuberculosis. Of the remaining 33 patients, 18 went on to definitive diagnostic procedures (surgery, repeat FOB or TTNAB). Nine of these patients had a malignancy. Fifteen patients were followed long-term; one was diagnosed with carcinoma two years after the initial work-up. Carcinoma was not found in any patient under 40 years of age. A benign lesion was diagnosed by TTNAB in only two patients. We conclude that TTNAB is a valuable procedure in the evaluation of patients with a SPN and negative FOB. While a negative FOB and TTNAB do not assure that the lesion is benign, a complex of variables influences the decision regarding thoracotomy vs careful follow-up.

Section snippets

MATERIALS AND METHODS

Between January, 1978 and January, 1986, TTNAB was performed on 262 patients. Case histories of these patients were reviewed. To qualify for inclusion in this series, patients were required to have a solitary pulmonary nodule, have undergone a nondiagnostic fiberoptic bronchoscopy and a TTNAB at this institution, and been followed either to definitive diagnosis or for at least two years beyond TTNAB. Follow-up information was obtained from the medical records, referring physicians or direct

RESULTS

There were 58 patients with a SPN in whom nondiagnostic FOB was followed by TTNAB (Fig 1). TTNAB provided a diagnosis in 25 (43 percent). Twenty-four patients had malignancy diagnosed, and this was confirmed at surgery (Table 1). One patient had the diagnosis of M tuberculosis established by TTNAB and did not have surgery. He received INH chemoprophylaxis and is clinically and radiographically stable five years later. Of these 25 patients, 22 were former² or current²⁰ cigarette smokers (Table 1

DISCUSSION

Our experience with TTNAB indicates that this procedure is a useful adjunct in the evaluation of patients with a solitary nodule. After a negative fiberoptic bronchoscopy, one TTNAB provided a diagnosis in 25 of 58 patients (43 percent). For a procedure which, in our experience, has limited morbidity and no mortality, these results alone make its application worthwhile in such patients. One patient was spared a thoracotomy; in the others, thoracotomy was unequivocally indicated.

Our data also

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Supported in part by NHLBI Pulmonary Training Grant HL-07022.

Manuscript received June 8; revision accepted December 1.

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Chest

Transthoracic Needle Aspiration Biopsy following Negative Fiberoptic Bronchoscopy in Solitary Pulmonary Nodules

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Chest

Differentiation of benign and malignant pulmonary nodules by growth rate.

Radiology

The significance of calcification in pulmonary coin lesions.

Radiology