Percutaneous Lung Biopsy in a Patient with a Cavitating Lung Mass: Indications, Technique, and Complications

Abstract

2Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA. Case History A 75-year-old man was admitted to the hospital with an acute myocardial infarction. The patient was a former heavy smoker. A chest radiograph revealed a left apical lung mass (Fig. 1). A CT scan showed a cavitary left upper lobe lung mass measuring 3.5 × 4 cm (Fig. 2A) with an additional 3 × 2 cm mass at the left hilum (Fig. 2B). A wholebody PET scan showed the left upper lobe mass and at the left hilum, increased 18F-FDG uptake that was suggestive of lung neoplasm metastatic to the left hilum (Fig. 3). Therefore, a thoracic radiologist was consulted for biopsy of the left upper lobe lung mass. Dr. Titton. It is interesting to note that a PET scan was obtained for this patient. What is the role of 18F-FDG PET in the evaluation of patients with a pulmonary nodule or lung cancer? Dr. Kalra. In the evaluation of patients with a solitary pulmonary nodule, 18F-FDG PET improves characterization of the nodule by estimating the probability of malignancy. The high positive predictive value for malignancy in nodules greater than 1 cm in diameter suggests that those with positive scan results should undergo either percutaneous biopsy or surgical resection. Histologic examination of PET-positive lesions is necessary because false-positive PET findings can be encountered with granulomatous lesions secondary to sarcoidosis, tuberculosis, or infection [1]. False-negative PET findings are seen in patients with small lesions (< 1 cm) and in selected malignancies, such as bronchioalveolar cell carcinoma or well-differentiated adenocarcinoma or carcinoid tumor. For this reason, regardless of PET findings,