Aspiration biopsy of thoracic lesions

Abstract

We have performed percutaneous needle aspiration biopsy of intrathoracic lesrons under fluoroscopic control on 50 patients. Lesions as small as 1 to 15 cm. in diameter were aspirated. Thirty of the 36 cases of malignant neoplasm were diagnosed by this method. Of the 14 nonneoplastic cases, granuloma was diagnosed in two, and in eight of the remaining 12 the clinical diagnosis was supported by the nature of the aspirated material. Pneumothoraces are to be expected as a complication of the method. Most will be asymptomatic; a small proportion will require treatment. There will also be the occasional haemoptysis. The procedure can be quickly performed and it is well tolerated by the patient. It causes less discomfort than bronchoscopy or scalene lymph node biopsy. The interpretation of the cytological material presents no undue difficulty to the pathologist experienced in conventional pulmonary exfoliative cytology.Aspiration biopsy of pulmonary infiltrates, first practised in the nineteenth century, was primarily used to obtain material for culture in lobar pneumonia (Horder, 1909). The first recorded instance of aspiration biopsy of a pulmonary carcinoma occurred in 1886 (Menetrier, 1886). These early experiences, unassisted by radiographic localization of the lesions, were fairly successful in attaining their purpose; they also proved that needle aspiration was not necessarily complicated by empyema. Now the preciseness of modern radiological techniques makes it possible to aspirate small thoracic masses and infiltrates.Nordenstrom in Sweden pioneered the use of small-bore needles and television x-ray fluoroscopy in the aspiration of thoracic masses (Nordenstr6m, 1965a, b). He used this technique on more than 800 patients; only in two did serious complications occur. Although small pneumothoraces were frequent, the procedure was considered safe enough to be performed on out-patients. We have adopted Nordenstrom's method and we report our results. METHODRoutine radiographic examinations of the chest are used to identify and localize the lesion. The patient is positioned on a horizontal x-ray table equipped with television fluoroscopy, preferably of the C-arm type. Fluoroscopy is used to localize the lesion, plan the approach, and mark the skin for puncture. The chest wall closest to the lesion is chosen, and the patient is positioned so that the direction of thrust of the needle toward the lesion is perpendicular to the floor and parallel to the x-ray beam. Occasionally the skeleton imposes an obstacle, making it necessary to use an oblique course. Such a course is obligatory in lesions confined to the mediastinum.The skin is cleansed, and the soft tissues are anaesthetized down to, and including, the pleura. A sterile No. 18 or No. 20 thin-walled spinal needle, complete with stylet and of sufficient length, usually 8 to 10 in. (20 to 25 cm.), is advanced through the anaesthetized area over the superior aspect of the adjacent rib and into the lung. Occasionally a jabbing motion is necessary to penetrate the mass....