Chest
Volume 103, Issue 5, May 1993, Pages 1452-1456
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Clinical Investigations
Needle Aspiration Biopsy of Malignant Lung Masses With Necrotic Centers: Improved Sensitivity With Ultrasonic Guidance

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False-negative results from transthoracic needle aspiration biopsy of malignant lung masses may occur if a central necrotic area is present and is the source of the biopsy material. The purpose of this study is to determine if the use of ultrasonic guidance can improve the sensitivity of lung needle biopsies in this circumstance. Sixty patients with malignant lung masses underwent ultrasonic examination in an 18-month period. In 14 cases, ultrasound showed that the mass had a large central necrotic area that was at least half the diameter of the tumor. Under ultrasonic guidance, needle biopsy specimens were taken from the central necrotic area and from the tumor wall in each case. Adequate biopsy specimens were obtained in all 14 patients. In all cases, the mural biopsy material was diagnostic for malignant tumor, while the biopsy specimen from the necrotic center was nondiagnostic in 10 of 14 patients. No complications occurred. We conclude that ultrasonically guided lung biopsy is a useful and safe tool to avoid false-negative needle biopsy specimens in malignant lung tumors with necrotic centers.

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MATERIALS AND METHODS

From January 1990 to July 1991, 60 patients had peripheral lung masses that required ultrasound examination and ultrasound-guided needle aspiration biopsy in National Taiwan University Hospital. Of these 60 patients, 14 (23 percent) had a lung mass with a large central necrotic area as demonstrated by ultraound; they were included in this study. The criteria for patient selection were as follows: (1) mass abutting the visceral pleura; (2) mass with a large central necrotic area manifested as a

RESULTS

A total of 14 patients who had malignant lung mass with a large central necrosis as demonstrated by ultrasound underwent ultrasound-guided aspiration biopsy successfully from both the central portion and peripheral wall portion of the mass. Table 1 summarizes the age and sex of the patients, the mass sizes, wall thicknesses, diameters of the necrotic area, echo patterns of the central necrosis, and the final results of aspiration biopsies. The mass sizes ranged from 4×6 cm to 13 × 15 cm. Their

DISCUSSION

For over a century, after the first report of successful percutaneous needle aspiration in the diagnosis of lung carcinoma by Menetrier in 1886, the needle aspiration technique has been used to obtain tissue proof of lung neoplasms. This technique has been slow to gain widespread usage because of understandable concern regarding potential complications. More recently, because of widespread acceptance of cytologic diagnosis8, 9, 10, 11, 12 and improved radiologic technique permitting a biopsy

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Manuscript received April 30; revision accepted September 15.

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