A comparison between fine-needle biopsy and fiberoptic bronchoscopy in patients with lung lesions

Abstract

1974). Thorax, 29,[352][353][354]. A comparison between fine-needle biopsy and fiberoptic bronchoscopy in patients with lung lesions. We present a series of 40 patients with lung lesions in whom a specific diagnosis was not obtained by conventional methods of examination and in whom tumour was not visualized directly by bronchoscopy with a flexible bronchoscope. Bronchial brushing and blind biopsytaking were performed and the results were compared with those of fine-needle aspiration biopsy. The percentage of diagnoses for the two methods was 30 and 62 respectively. In 40% of cases the diagnosis was obtained solely by fine-needle aspiration biopsy and in 10% alone with the aid of the flexible bronchoscope.In patients with lung tumours it is not always possible to obtain a certain diagnosis with the aid of radiographic examination, bronchoscopy, studies on bronchial secretions, and mediastinoscopy.In a series including some 2,000 thoracotomies 25% were performed without a certain preoperative diagnosis (Jensen, 1965). Among patients with pulmonary carcinoma the percentage was 35.With increasing age of the patient with car. cinoma of the lung (Clemmesen, 1964;Langston, 1972) it is even more important to obtain a certain preoperative diagnosis and as far as possible to avoid exploratory thoracotomy.During the last year the technique of transthoracic fine-needle aspiration biopsy and bronchoscopy with the flexible bronchoscope has developed.The purpose of this paper is to compare the results of the two new methods in patients in whom a tumour was not demonstrated by endoscopy, even with the flexible bronchoscope. Specimens were collected by bronchial brushing, blind biopsy-taking, and suction of bronchial secretions.METHODS

Needle Aspiration Biopsy of Pulmonary Tumors

“…Twice as many were diagnosed by aspiration biopsy as with sputum cytology. 28 In two series, fine-needle aspiration was also found superior to bronchial brushing, most often with tumors not diagnosed by sputum cytology or bronchial washings or not visualized at bronchoscopy even with the popular flexible bronchoscope. 27 ' 28…”

Ultrasonogram–guided Fine Needle Aspiration Cytology in Mediastinum and Lung Lesions

“…Besides the limitation related to size, the efficacy of fibreoptic bronchoscopy depends on the nature of the lesion and its relation to bronchial tree. Borgeskov S. et al 14 concluded that peripheral endobronchial tumour cannot be visualised and FNA may give a diagnostic accuracy of 60%-80%.…”

Needle Aspiration Biopsy in Suspected Pulmonary Carcinoma

“…The diag nostic accuracy in proven pulmonary card-noma was 40%> with FFB and 72°/» with needle aspiration. When the roentgenographic location of the lesion was taken into consideration, central lesions were diag nosed with similar accuracy using either ap proach, but once the lesion was not contig uous to the hilum, the needle proved to have the best yield [11], Hagai a el al. [10] reported 96 cases of proven pulmonary car cinomas and showed that lesions in the lo bar or segmental branches had better accu racy with FFB, but once the lesions were peripheral, FFB had an accuracy at only 61.5%, compared to the needle accuracy of 86.7% [10],…”

“…Borgeskov and Francis [11] performed needle aspiration biopsy on 40 patients with primary lung cancer who had no visible en dobronchial lesion during FFB. The diag nostic accuracy in proven pulmonary card-noma was 40%> with FFB and 72°/» with needle aspiration.…”

“…First, needle aspiration biopsy is indicated in patients with a pulmonary mass or mas ses in whom tissue diagnosis is required be fore other therapy is initiated, but are un suitable for curative surgery because of se vere medical problems or metastatic disease [9,14], Secondly, this procedure is indicat ed in patients with a chest mass that was not seen during a previous FFB, or is assumed to be out of the visual range of the FFB: Pancoast tumors and lesions in the superior segment of either lower lobe [9,11]. Lastly, the present report suggests that needle aspi ration biopsy may be considered the diag nostic procedure of choice when a pulmo nary lesion is against the chest wall.…”