CT-guided transthoracic fine needle aspiration of pulmonary lesions: accuracy and complications in 134 cases.

The aim of this study was to perform a prospective evaluation of the effectiveness of computed tomography (CT)-guided transthoracic fine needle aspiration (TFNA) in the diagnosis of pulmonary lesions and to determine the complication rate of this procedure. A prospective review was conducted of 134 patients who underwent CT-guided TFNA at our center between December 2003 and August 2005. All fine needle aspirations were performed with a 22-gauge single-pass Chiba needle under CT guidance. The biopsies were performed by one pulmonologist. Two hundred twenty two (91%) malignant lesions and 12 (9%) benign lesions were reviewed in the present study. An accurate diagnosis was made in 107 (88%) of the 122 malignant lung lesions and a specific diagnosis was obtained in 42% of the benign lesions. The sensitivity of TFNAs for the detection of malignancy was 83%, and the overall accuracy of TFNA for diagnosing malignancy was 84%. Pneumothorax occurred in 22 of the 134 patients (16%). Pneumothorax was more frequently observed in centrally located lesions (p= 0.001). Our results suggest that CT-guided TFNA has a high diagnostic accuracy and an acceptable rate of complications. Moreover, we suggest that the most important factor increasing the risk of pneumothorax is an increase in the depth of aerated lung traversed for sampling.

Pleural effusion as the first sign of multiple myeloma.

Multiple myeloma (MM) is a rare disorder that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. A 56-year-old male patient attended our clinic complaining of shortness of breath and fatigue for the past month. A posteroanterior chest radiograph revealed a left pleural effusion, which was subsequently assessed as being exudative in nature. Protein electrophoresis demonstrated hypergammaglobulinemia. Serum and pleural fluid immunofixation electrophoresis showed an increase in the IgG and kappa fractions. The Bence-Jones protein level in the 24-hours urine was high. Pleural biopsy showed plasmocyte infiltration. Bone marrow biopsy revealed atypical plasma cell infiltration, some with immature morphology, carrying IgG/Kappa clonality in a diffuse pattern. The patient was diagnosed with IgG/k type MM and underwent chemotherapy with vincristine, doxorubicin, and prednisolone. Complete regression of the pleural effusion was achieved after one round of chemotherapy, and the patient has been followed for 18 months.

[Value of transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions]. / Endobronsiyal malign lezyonlarin tanisinda transbronsiyal igne aspirasyonunun degeri.

Aim of our study was to investigate the sensitivity of transbronchial needle aspiration (TBNA) and its contributions to conventional diagnostic methods (CDM) in the endobronchial lesions of the patients who underwent TBNA during fiberoptic bronchoscopy (FOB) and had final diagnosis of lung cancer. Bronchoscopy records of 1194 patients, who underwent FOB for uncertain lung cancer in our clinic, were reviewed retrospectively. Eighty-one patients with final histopathological diagnosis of primary lung cancer who underwent TBNA, were included to study. Endobronchial lesions were divided into three groups as endobronchial mass, submucosal lesions and peribronchial diseases. Other CDMs performed during bronchoscopy such as forceps biopsy, bronchial brushing and bronchial lavage were also recorded. Sixty-six (82%) of 81 patients were diagnosed by means of FOB. Remaining 15 (18%) patients were diagnosed by means of other methods than FOB. The diagnostic successes of TBNA and CDMs alone and together, were compared according to the types, locations and histopathological types of the lesions. By the addition of TBNA to CDMs, histopathological diagnosis was made in 17 (21%) additional patients and diagnostic sensitivity of bronchoscopy was increased from 60% to 82% (p= 0.001). By the addition of TBNA to CDMs, a statistically significant increase in the sensitivity in the submucosal lesion group was observed (p= 0.008). By the addition of TBNA to CDMs, diagnostic success was increased from 52% to 76% in the non-small cell lung cancer group and from 81% to 95% in the small cell lung cancer group (p= 0.001 and p= 0.250, respectively). Although the diagnostic success was increased in all localizations by the addition of TBNA to CDMs, statistically significant increase was observed only for the lesions located at trachea and the main bronchi (p= 0.008). Joining TBNA to CDMs, especially for the submucosal lesions, may improve the diagnostic success of bronchoscopy.