No abstract

Over a period of 38 months, diagnostic needle aspiration of 400 (293 malignant and 107 benign) pulmonary lesions was performed with 20-gauge needles. Deep as well as peripheral nodules and masses were routinely biopsied. Positive diagnostic accuracy was 96.5%. There were 9 (2%) incorrect diagnoses with 5 false negatives and 4 false positives. In almost all patients with malignant pulmonary neoplasms, the specific cell type was identifiable. Pneumothorax was a frequent complication, but there were no fatalities, and no episodes of major bleeding or hemoptysis. A new slotted 20-gauge thin wall needle was used in 258 patients which enabled aspiration of larger amounts of material than had been possible with the standard 20-gauge thin wall needle, and in approximately 50% of patients, enough material was obtained to perform tissue sections as well as smears for cytology. In 77 patients with benign lesions and in 114 with unresectable neoplasms, needle aspiration established the diagnosis and made it unnecessary to perform surgery and/or mediastinoscopy.

Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.

The results suggest that the puncture-site-down postbiopsy position may not affect either the incidence of postbiopsy pneumothorax or the incidence of pneumothorax that requires chest tube placement.

Postmortem examination of the lungs of 12 patients with end-stage pulmonary fibrosis revealed the frequent (nine of 12) presence of bronchiectasis. The segmental and subsegmental bronchi were dilated, tortuous, and had a convoluted appearance that resembled a string of pearls. Bronchiectasis was confined to areas of advanced fibrosis. When fibrosis was mild or when it was combined with emphysema, bronchiectasis was absent or mild. Specimen radiographs revealed that bronchiectasis frequently contributed to the radiographic appearance of honeycombing. Retrospective analysis of the plain chest radiographs obtained from five of the patients revealed evidence suggestive of bronchiectasis, but bronchiectasis was difficult to detect unless the surrounding lung was radiopaque. In two living patients with end-stage pulmonary fibrosis, bronchiectasis was much better depicted on computed tomography scans than on plain chest radiographs. In patients with pulmonary fibrosis, the presence of bronchiectasis does not necessarily imply the presence of primary bronchial disease. Rather, bronchiectasis can be a direct result of the fibrotic process.