Radiologically guided fine needle lung biopsies in the evaluation of focal pulmonary lesions in allogeneic stem cell transplant recipients

Jantunen, Esa; Piilonen, Anneli; Volin, Liisa; Ruutu, Petri; Parkkali, T; Koukila-Kähkölä, Pirkko; Ruutu, Tapani

doi:10.1038/sj.bmt.1703358

Cited by 15 publications

(13 citation statements)

References 22 publications

(23 reference statements)

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“…The radiologic pattern of the pulmonary involvement also influenced the diagnosis, with malignant diagnoses being more common in patients with focal distribution of lung lesions and in patients with nodular or mass-like lesions. A large proportion of our patients had the above-mentioned clinical and radiologic features that increased the likelihood of obtaining a malignant diagnosis, which could explain the higher incidence of malignant diagnoses in our study than in some of the previously reported studies [6,8,[12][13][14]18,22,27].…”

Section: Discussionmentioning

confidence: 58%

“…Many previous articles evaluating the etiology of pulmonary lesions in immunocompromised patients have reported that infectious causes are more common than malignancy (21-46% vs. 9.3-27%); however, these studies included immunocompromised patients with diverse underlying etiologies such as HIV infection, primary immunodeficiency disease, and solid-organ transplantation, in addition to patients with haematologic malignancies [6,8,[12][13][14]18,22,27]. However, similar to the current study, three previous studies including only patients with haematologic malignancies found that neoplastic lung lesions were at least as common or more common than infections [5,9,19].…”

Section: Discussionmentioning

confidence: 99%

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CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

Gupta¹,

Sultenfuss²,

Romaguera³

et al. 2009

Hematological Oncology

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We searched the electronic patient database at The University of Texas M. D. Anderson Cancer Center for patients who underwent computed tomography (CT)-guided needle biopsy between January 2001 and December 2005. Inclusion criteria were a known history of haematologic malignancy and a newly detected, undiagnosed pulmonary lesion on chest CT that required tissue sampling for diagnosis; 213 met these criteria. We analysed the biopsy results for diagnostic yield, factors affecting diagnostic yield and effect on treatment. Of 213 procedures, 191 (89.7%) yielded sufficient material for pathologic analysis; 130 (60%) yielded specific diagnoses, while 61 (28.6%) yielded nonspecific benign diagnoses. Lesions larger than 1 cm, cavitary lesions and lung masses were more likely to yield a specific diagnosis than were lesions smaller than 1 cm, lung nodules and consolidations. The most common specific diagnoses were malignancy (62.8%) and infection (34.3%). The latter was more common in patients with leukaemia, cavitary lung lesions or consolidations, active underlying malignancy, neutropenia, respiratory signs and symptoms and/or fever, bone marrow transplant recipients, and in patients receiving chemotherapy. Lung lesions discovered upon follow-up imaging in patients who did not have any respiratory signs/symptoms or fever were mostly malignant. Therapeutic changes were more likely after a specific diagnosis than after a nonspecific diagnosis or a nondiagnostic biopsy (88.4% vs. 18.1%; p < 0.0001). CT-guided lung biopsy has a high diagnostic yield in patients with haematologic malignancies that present with unexplained pulmonary lesions and provides a specific diagnosis in a majority of these patients, leading to therapeutic changes.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

Gupta¹,

Sultenfuss²,

Romaguera³

et al. 2009

Hematological Oncology

View full text Add to dashboard Cite

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“…Imaging modalities are fluoroscopy, multidetector computed tomography (MDCT), and ultrasound [7]. Ultrasound is useful only where the tissue mass is in contact with the chest wall since the ultrasound beam does not pass through air and, hence, the aerated lung.…”

Section: Percutaneous Transthoracic Lung Biopsiesmentioning

confidence: 99%

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

Lass‐Flörl

Freund

2009

Aspergillosis: From Diagnosis to Prevention

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The diagnosis of invasive aspergillosis remains challenging and current conventional methods are limited for the diagnosis of invasive fungal infections. The gold-standard for the definite diagnosis of proven invasive pulmonary aspergillosis remains either histopathologic, cytopathologic or direct tissue examination, based on the documentation of typical hyphae and a positive culture of Aspergillus spp. This chapter reviews the yield of invasive procedures in the diagnosis of aspergillosis. Biopsies may be taken percutaneously, bronchoscopically, via open surgery or video-assisted thorascopic surgery. Computed tomography-guided percutaneous, bronchoscopic and open lung biopsies have been performed with a diagnostic yield of 80-100, 51 and 70%, respectively. Bronchoscopy with bronchoalveolar lavage is generally helpful in diagnosing invasive pulmonary aspergillosis, especially in immunocompromised patients with diffuse lung involvement. The sensitivity and specificity of a positive result of bronchoalveolar lavage fluid are ∼50 and 97%, respectively. All specimens obtained via invasive interventions including bronchoalveolar lavage should be processed for microscopy and cytology, fungal cultures and by means of any other available procedure (e.g., Aspergillus PCR and galactomannan). Combining microscopy and culture will increase the diagnostic yield by 15-20%. Combining culture, microscopy, serology, and Aspergillus PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%.

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“…Complications were observed in 18 of 71 patients (25%), with pneumothorax occurring in 14 patients (20%) and 4 patients (6%) requiring chest tube placement. Generally, TTNA in HSCT recipients with focal lung lesions has excellent potential to provide specific diagnosis, especially in IPA [67]. If TTNA is not diagnostic, SLB may be indicated since bronchoscopy is of limited use in evaluating peripheral lesions [32].…”

Section: Transthoracic Needle Aspiration (Ttna)mentioning

confidence: 99%

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

et al. 2005

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Pulmonary complications are a significant cause of morbidity and mortality in hematopoietic stem cell transplant recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates. This review describes the role of the different diagnostic tools available to reach a diagnosis in a timely manner in this patient population. Am.

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Radiologically guided fine needle lung biopsies in the evaluation of focal pulmonary lesions in allogeneic stem cell transplant recipients

Cited by 15 publications

References 22 publications

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

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