Percutaneous needle aspiration biopsy of the lung

Abstract

Localized pulmonary disease can be safely and accurately diagnosed by means of percutaneous needle aspiration biopsy using image amplifier fluoroscopy for guidance of the needle. This is true whether the lesion is large or small, central or peripheral, or benign or malignant. It is usually performed on an outpatient basis in the x-ray department with local anesthesia being used so that little or no pain will be experienced by the patient. Simple 3 to 6 inch 18 gauge needles holding a stylet are used and the aspirant is sent to the laboratory for cytologic and bacteriologic examination.The procedure is particularly useful for those surgeons using preoperative irradiation in bronchogenic carcinoma since it gives a higher diagnostic yield than any other test short of thoracotomy. Other indications for its use include medical contraindication to or patient refusal of thoracotomy; the presence of metastatic, bilateral, or inoperable disease; unresolved “pneumonia;” and any persistent indeterminate localized lesion which cannot be diagnosed by other means.There were 192 biopsies performed on 100 lesions. Sixty-two of the lesions later proved to be malignant. In this latter group there was an 84 per cent rate of diagnostic accuracy using the needle biopsy technic. False-positive results occurred in 2 per cent and false-negative in 6 per cent. The latter were treated as indeterminate lesions and these patients were operated upon.There were no deaths and no serious complications. Biopsy of 31 per cent of the lesions resulted in pneumothoraxes but in only 7 per cent was closed intercostal drainage required. Six per cent of the patients had brief mild hemoptyses but no alarming bleeding. There was no evidence of tumor dissemination along the needle tract, spread of infection, or air embolism.