Ultrasound assisted transthoracic biopsy: fine needle aspiration or cutting needle biopsy?

¹ Depts of Internal Medicine
² Anatomical Pathology, Tygerberg Academic Hospital and National Health Laboratory Service, University of Stellenbosch, Cape Town, South Africa

^* To whom correspondence should be addressed. E-mail: ahd{at}sun.ac.za.

	Abstract

This study compared the diagnostic yield of ultrasound assisted cutting needle biopsy (CNB) and fine needle aspiration biopsy (FNAB) in chest lesions.

A physician performed ultrasound and FNAB with a 22G spinal needle in all patients directly followed by 14G CNB in patients without contraindication.

We prospectively included 155 consecutive lesions arising from the lung (74%), pleura (12%), mediastinum (11%), or chest wall (3%) in patients with a final diagnosis of lung carcinoma (74%), other malignant tumours (12%), non-neoplastic disease (9%), or unknown (5%). The overall diagnostic yield was 87%. Combined specimens were obtained in 123 lesions (79%). In these, yields of FNAB, CNB and both methods combined were 82%, 76% and 89%, respectively. FNAB was superior to CNB in lung carcinoma (95% versus 81%, p=0.006), but CNB was superior in non-carcinomatous tumours and in benign lesions. On-site cytology was 90% sensitive and 100% specific for predicting a positive FNAB. One patient required drainage for pneumothorax (0.6%).

Ultrasound assisted FNAB performed by chest physicians is an accurate and safe initial diagnostic procedure in patients with a high clinical probability of lung carcinoma. All other patients should undergo concurrent FNAB and CNB.

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