Peripheral Pulmonary Masses Research Articles

Application value of coaxial puncture needle (technique) in ultrasound-guided puncture biopsy of peripheral pulmonary masses.

This study aims to investigate the effect of ultrasound (US)-guided coaxial puncture needle in puncture biopsy of peripheral pulmonary masses. In this retrospective analysis, 157 patients who underwent US-guided percutaneous lung biopsy in our hospital were divided into a coaxial biopsy group and a conventional biopsy group (the control group) according to the puncture tools involved, with 73 and 84 patients, respectively. The average puncture time, number of sampling, sampling satisfaction rate, puncture success rate and complication rate between the 2 groups were compared and discussed in detail. One hundred fifty-seven patients underwent puncture biopsy, and 145 patients finally obtained definitive pathological results. The overall puncture success rate was 92.4% ([145/157]; with a puncture success rate of 97.3% [71/73] from the coaxial biopsy group and a puncture success rate of 88.1% [74/84] from the conventional biopsy group (P < .05). For peripheral pulmonary masses ≤3 cm, the average puncture time in the coaxial biopsy group was shorter than that in the conventional biopsy group, and the number of sampling, sampling satisfaction rate and puncture success rate were significantly higher than those in the conventional biopsy group (P < .05). There was no significant difference in the complication rate between the 2 groups (P > .05). For peripheral pulmonary masses >3 cm, the average puncture time in the coaxial biopsy group was still shorter than that in the conventional biopsy group (P < .05). The differences between the 2 groups in the number of sampling, satisfaction rate of the sampling, the success rate of puncture and the incidence of complications were not significant (P > .05). US guided coaxial puncture biopsy could save puncture time, increase the number of sampling, and improve the satisfaction rate of sampling and the success rate of puncture (especially for small lesions) by establishing a biopsy channel on the basis of the coaxial needle sheath. It provided reliable information for the diagnosis, differential diagnosis and individualized accurate treatment of lesions as well.

Respiratory motion-resolved four-dimensional zero echo time (4D ZTE) lung MRI using retrospective soft gating: feasibility and image quality compared with 3D ZTE.

To evaluate the feasibility and image quality of respiratory motion-resolved 4D zero echo time (ZTE) lung MRI compared with that of 3D ZTE. Our institutional review board approved this study. Twenty-one patients underwent lung scans using 3D ZTE and 4D ZTE sequences via prospective and retrospective soft gating techniques, respectively. Image qualities of 3D ZTE and 4D ZTE at end-expiration were compared through objective and subjective assessments. The quality of end-expiratory images of 3D ZTE and 4D ZTE of the two groups with different lung functions was also compared. Images were successfully acquired in all patients without any adverse events. Signal-to-noise ratios (SNRs) of lung parenchyma and thoracic structures were significantly (all p< 0.001) higher in 4D ZTE. Contrast-to-noise ratios (CNRs) of peripheral bronchi, peripheral pulmonary vessels, and nodules or masses were significantly (all p< 0.001) higher in 4D ZTE. The subjective image quality assessed by two independent radiologists showed that intrapulmonary structures, noise and artifacts, and overall acceptability were superior in 4D ZTE (all p< 0.001). Image qualities of groups with normal and low lung functions differed significantly (all p< 0.05) in 3D ZTE, but not in 4D ZTE. The mean acquisition time was 136s (127-143s) in 3D ZTE and 325s (308-352s) in 4D ZTE. Respiratory motion-resolved 4D ZTE lung imaging was feasible as part of routine chest MRI. The 4D ZTE provides motion-robust lung parenchymal images with better SNR and CNR than the 3D ZTE, regardless of patients' lung function. • ZTE MRI captures rapidly decaying transverse magnetization in the lung parenchyma. • 4D ZTE provides motion-robust lung parenchymal images with better SNR and CNR compared with 3D ZTE. • Compared with 3D ZTE, the image quality of 4D ZTE lung MRI was affected less by patients' lung function and respiratory performance.

CT-guided versus ultrasound-guided percutaneous lung puncture biopsy in the diagnosis of peripheral pulmonary masses: a Meta-analysis

Objective To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy. Methods Relevant domestic and foreign related databases such as PubMed, Web of Science, Cochrane Library, OVID, China Biology Medicine, VIP, Wanfang and CNKI databases were searched, the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected. After extracting the relevant data, a Meta-analysis was performed using RevMan 5.2 and Stata softwares. Results Ten studies met the inclusion criteria, with a total sample size of 1 158 cases, of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy. Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant [97.48% (619/635) vs. 96.56% (505/523), RR= 1.01, 95% CI 0.99-1.03, P= 0.360]; the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group, and the difference was statistically significant [92.44% (619/635) vs. 96.56% (505/523), RR= 0.97, 95% CI 0.94-0.99, P= 0.007]. The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [14.49% (92/635) vs. 9.56% (50/523), RR= 1.56, 95% CI 1.11-2.19, P= 0.010]; the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [11.50%(73/635) vs. 6.31% (33/523), RR= 1.77, 95% CI 1.17-2.68, P= 0.007]; the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant [2.99% (19/635) vs. 3.25% (17/523), RR= 1.08, 95% CI 0.59-1.98, P= 0.800]. Conclusions Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value. However, for the intrapulmonary masses shown by ultrasound, the ultrasound-guided lung puncture biopsy has a shorter operation time, lower cost, and higher safety. Key words: Biopsy; Punctures; Ultrasonogrophy; Computed tomography; Peripheral pulmonary masses; Meta-analysis

Combination of free-breathing radial 3D fat-suppressed T1-weighted gradient-echo sequence with diffusion weighted images: Potential for differentiating malignant from benign peripheral solid pulmonary masses

ObjectivesHigh resolution CT is the most commonly used radiological method for differentiating benign from malignant peripheral solid pulmonary masses, however, some of them are not easily diagnosed by morphology alone. Furthermore, due to the radiation dose, it is unsuitable for patients with disorders requiring repeated examinations over prolonged periods. The aims of this study were to evaluate whether a combination of diffusion-weighted images (DWI) and free-breathing radial 3D fat-suppressed T1-weighted gradient echo (radial volumetric interpolated breath-hold examination, radial VIBE) sequence can enable discrimination between benign from malignant peripheral solid pulmonary masses. Materials and methodsBoth chest CT scan and MR imaging with radial VIBE and DWI were obtained from 47 patients; 30 males and 17 females (mean age 64 years old; age range 48–83 years old). Benign and malignant peripheral solid pulmonary masses were conclusively identified by pathology results. Two radiologists independently reviewed all the images and record radiological features including morphological signs on radial VIBE, CT images, and ADC value. Receiver operating characteristic (ROC) was used to analyze the capability of radial VIBE as well as DWI to distinguish malignant from benign peripheral solid pulmonary masses. ResultsIn 77% of patients, malignant peripheral solid pulmonary masses were found. Morphological signs of mediastinal lymph node enlargement and lobulation were more easily found in malignant masses in both radial VIBE (mediastinal lymph node enlargement: p = 0.033, lobulation: p = 0.039) and CT (mediastinal lymph node enlargement: p = 0.004, lobulation: p = 0.012). The ADC value were also significant difference between benign and malignant groups (p = 0.001). Combined ADC value with radial VIBE was a most specific test than routine-dose CT (86.1% vs 75%, p < 0.001), but less sensitive than routine-dose CT (81.8% vs 90.9%; p < 0.001) for malignant peripheral solid pulmonary masses detection. Diagnostic accuracy was 89% for combining ADC value with radial VIBE, and 85% for routine-dose CT. ConclusionsCombination of morphological signs and ADC value seems to improve differentiating malignant from benign peripheral solid pulmonary masses. Especially in patients unable to endure radiation exposure, suspend respiration, radial VIBE provides similar morphological signs displaying to those on routine-dose CT.

Safety and diagnostic yield of thoracic ultrasound-assisted transthoracic biopsy performed by a pulmonologist

BackgroundTransthoracic ultrasonography (US) is still not utilized to its full potential by respiratory physicians, despite being a well-established and validated imaging modality. It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest. This work aims to assess safety and diagnostic yield of thoracic US-assisted transthoracic biopsy performed by a pulmonologist . Patients and methods The present study was conducted upon 75 patients who are referred to the Pulmonary Medicine Department, Ain Shams University Hospitals with radiological assessment that reveals pleural-based mass with or without pleural effusion, anterior mediastinal mass, peripheral lung lesions or chest wall lesions. The present study was conducted upon 75 (67 male and 8 female) patients with mean±SD age 58.8±15.64.ResultsThis study showed that 31 cases were presented by peripheral pulmonary mass, 29 pleural lesions, nine mediastinal and six chest wall lesions, 57 of them diagnosed by sonar guided biopsy, 51 of them were malignant and the remaining six were benign.ConclusionTransthoracic US-assisted cutting-needle biopsy is an excellent first-line diagnostic tool for pleural-based lesions of at least 3 cm in diameter. It is a quick, low-cost, safe and well-tolerated tool in the hands of pulmonologists and has a high sensitivity for pleural-based malignancies.

Feasibility and Safety of the Transbronchial Access Tool for Peripheral Pulmonary Nodule and Mass

Navigational bronchoscopy and other imaging modalities have improved the ability to evaluate pulmonary nodules/mass. Many of these lesions are located outside the bronchial airway and are difficult to access even with these devices. The Transbronchial Access Tool (Medtronic, Minneapolis, MN) allows the bronchoscopist to create a pathway from the bronchial airway, across the lung parenchyma, and into the target lesion. We are reporting the feasibility and safety of this new device. Patients with peripheral pulmonary nodules/mass with an absence of an air bronchogram on thoracic imaging underwent a navigational bronchoscopy in a hybrid operating room under general anesthesia. A navigational system located predetermined areas in the bronchial tree to deploy the Transbronchial Access Tool, and cone beam computed tomography confirmed that the target lesion was accessed. A standard protocol was developed and followed in the last 7patients directing cone beam computed tomography use. The ability to enter the target lesion, diagnostic yield, radiation exposure, and procedural complications were recorded. The Transbronchial Access Tool was used in 14 patients who underwent an electromagnetic navigational bronchoscopy-guided biopsy from September 2015 to January 2016. The overall diagnostic yield was 71% (10 of 14) and 100% (7 of 7) when the standard protocol was instituted. Access was achieved in 75% (9 of 12) of the targeted lesions, with a diagnostic yield of 66% (8 of 12). One complication, a pneumothorax, occurred. The average radiation exposure during the procedure was 4.3mSv (range, 3 to 5 mSv), and fluoroscopic time was 17minutes (range, 2 to 44 minutes). The Transbronchial Access Tool is safe and permits access to pulmonary nodules/masses with navigational bronchoscopy.

Spectrum of Pulmonary Neuroendocrine Proliferations and Neoplasms

Neuroendocrine neoplasms are ubiquitous tumors found throughout the body, most commonly in the gastrointestinal tract followed by the thorax. Neuroendocrine cells occur normally in the bronchial and bronchiolar epithelium and may be solitary or may occur in clusters. Although neuroendocrine cell proliferations may be found in association with chronic lung disease, a broad range of neuroendocrine proliferations and neoplasms may occur and exhibit variable biologic behavior. Diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH) is a diffuse idiopathic form of neuroendocrine cell hyperplasia and is considered a preinvasive lesion that may give rise to carcinoid tumors. Patients with DIPNECH are typically older women who may be asymptomatic or may present with chronic respiratory symptoms. DIPNECH manifests as multifocal bilateral pulmonary micronodules on expiratory high-resolution computed tomographic (CT) images; the air trapping is secondary to constrictive bronchiolitis. Carcinoid tumors are low-grade malignant neoplasms that typically affect symptomatic children and young adults. Carcinoids manifest as well-defined pulmonary nodules or masses that are often closely related to central bronchi. They may exhibit intrinsic calcification and contrast material enhancement at CT, and patients with carcinoids may have postobstructive atelectasis and pneumonia. Although typical carcinoids are indolent neoplasms and patients have a good prognosis, atypical carcinoids are aggressive malignancies with a propensity for metastasis. Both are optimally treated with complete surgical excision. Large cell neuroendocrine carcinoma and small cell lung cancer are highly aggressive neuroendocrine malignancies that usually affect elderly smokers. These tumors manifest with large peripheral or central pulmonary masses. Local invasion, intrathoracic lymphadenopathy, and distant metastases are frequent at presentation. As a result, affected patients may not be candidates for surgical resection, are often treated with chemotherapy with or without radiation, and have a poor prognosis.

Contrast-enhanced ultrasound (CEUS) and CEUS-guided biopsy in the diagnosis of lung abscess in a patient with achalasia: Case report

Primary achalasia is a rare disorder of unknown aetiology characterized by dysfunction of esophageal motility secondary to degeneration of esophageal neurons. Some diseases, in particular neoplastic diseases, can cause symptoms similar to achalasia, and this condition is called pseudoachalasia. Pseudoachalasia can be indistinguishable from primary achalasia, and many investigations are often necessary to detect or exclude an underlying neoplasia. We report a case in which thoracic contrast-enhanced ultrasound (CEUS) and percutaneous CEUS-guided lung biopsy played a central role in differentiating aspiration pneumonia secondary to achalasia and complicated by lung abscess from pseudoachalasia secondary to lung carcinoma, after computed tomography (CT) yielded inconclusive findings. US contrast agent SonoVue® has an exclusively intravascular distribution, and its ability to discriminate between contrast vascular signal and tissue signal is greater than that of CT, making CEUS superior to CT in distinguishing perfused, viable tissues from avascular necrotic tissues. Although its use in pleuropulmonary pathology is still off-label, CEUS can play a useful role in characterizing peripheral pulmonary masses in selected cases.

S40 Early experience of endobronchial ultrasound-miniprobe (EBUS-MP) for investigation of peripheral pulmonary mass lesions

IntroductionPeripheral pulmonary mass lesions are common findings in respiratory medicine. The frequency of detection of such lesions is rising with increasing availability of radiological imaging techniques. Their aetiology may need...

Pulmonary infarction associated with bronchogenic carcinoma

Computed tomography findings of pathologically proven pulmonary infarction associated with bronchogenic carcinoma are reported for two patients. In one case, the infarction was demonstrated as a well-defined pleura-based large nodule in the peripheral portion of the same lobe of the tumor. The nodule had a smooth, convex border and a linear strand from the apex of the lesion toward the hilum. The obstruction of the subsegmental pulmonary artery due to tumor invasion was considered the cause of pulmonary infarction. In the second case, the infarction was demonstrated as a rapidly appeared, pleura-based consolidation in the same lobe of the tumor with a blurred border. Obstruction of the pulmonary vein by a tumor might have played an important role in the development of the pulmonary infarction in association with a large pulmonary artery obstruction. We conclude that pulmonary infarction should be considered as a differential diagnosis when peripheral pulmonary nodules or masses are located in the same lobe as the primary cancer.

Lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone marrow transplant recipient: an emerging infection with fungemia and Crohn disease–like involvement of the gastrointestinal tract

We report the first case of Phialemonium obovatum fungemia with subsequent caseating granulomatas in the lung and Crohn disease-like involvement of the gastrointestinal tract in a bone marrow transplant recipient. This phaeoid fungus has been rarely described as an opportunistic infection in immunosuppressed patients. The patient was diagnosed with chronic myelogenous leukemia and underwent subsequent peripheral bone marrow transplant. After 6 months, he developed graft-versus-host disease of the skin and liver with fever and severe diarrhea. Fecal bacterial cultures and cytomegalovirus serologies were negative. Computed tomographic scan showed a peripheral pulmonary mass. A lung wedge biopsy of the lesion showed septate branching hyphae (4-5 microm in diameter) with terminal globular structures (10 microm in diameter). The hyphae were similar in width to that of an Aspergillus species but had a more moniliform appearance. Blood cultures grew a pure culture of P. obovatum. He was treated with amphotericin B and itraconazole for 6 months without remission of the diarrhea. Biopsies of the stomach, colon, and rectum showed granulomatous inflammation with marked crypt distortion simulating Crohn disease. In retrospect, the fungus was found to be resistant to both of the aforementioned drugs and susceptible to voriconazole and posaconazole. The gastrointestinal findings raise the possibility of further dissemination of a partially treated Phialemonium infection.

Diagnostic Value Of Transthoracic Needle Biopsy In 121 Cases With Peripheral Pulmonary Mass

Transthoracic needle biopsy was performed in 121 cases with peripheral pulmonary mass and presumed diagnosis of pulmonary cancer. Although histologic diagnosis was made in 89 cases (73,5%), obtained tissue was not sufficient for diagnosis in 39 cases. Among the cases diagnosed, 32 (36%) were epidermoid carcinoma, 12 (13%) were adenocarcinoma, 15 (17%) were undifferentiated small cell carcinoma, 8 were (9%) undifferentiated large cell carcinoma, 8 (9%) were metastatic carcinoma and 9 (10%) were undefinable carcinoma. While malignity was detected in 84 (94,4%) of 89 total cases, different benign lesions were seen in the remaining 5 (5,6%) (2 benign teratoma, 1 tuberculosis, 1 giant cell benign tumor, 1 hamartoma). Pneumothorax had developed in 19 patients (15,7%) 4 requiring introduction of a thoracic tube. No significant complications were not seen except for self-limited mild hemoptsy in 8 cases.

Pleural signs of small peripheral pulmonary masses: Pathologic correlation with chest radiographs and diagnostic value

Objective: The current interest in ‘cost-effectiveness’ of medical imagings means that chest radiography is the primary radiological examination of lung diseases. We attempted to investigate the pathological basis of different pleural signs, and determine their usefulness in differentiating small bronchogenic carcinomas from tuberculomas by using chest radiographs. Materials and methods: We prospectively studied 30 small solitary pulmonary masses, including 24 carcinomas and 6 tuberculomas. All 30 resected lobe specimens were investigated with preoperative radiographs, postoperative specimen radiographs, 10–15 μm thick whole-mount sections, and 5 μm thick slices for conventional histological examination. To evaluate the clinical usefulness of these pleural signs, we also retrospectively reviewed 100 chest radiographs and conventional tomographs of 1–3 cm peripheral pulmonary lesions, including 60 bronchogenic carcinomas and 40 tuberculomas. Results: The results confirmed that, besides the previously known interlobular septal fibrosis with pleural retraction, the pathologic basis also included the pleural puckering and adhesion with fluid collection for the ‘tail’ and ‘rabbit ears’ signs, and pleural dimpling with fluid collection and peripheral fibrous hyperplasia for the ‘triangular shadow’ signs. In the retrospective group, the pleural signs with adjacent pleural thickening was significantly more frequent in tuberculomas than in carcinomas ( P < 0.05, x 2-test). Conclusion: Pleural signs associated with adjacent pleural thickening seems to contribute to differentiating granulomas from carcinomas. The pathological basis for this radiological finding includes visceral pleural fibrosis with the inflammatory cell infiltration, and the wide and shallow pleural dimpling filled with reactive pleural fluid.

Vascular manifestations of small solitary pulmonary masses. Angiographic-pathologic correlations and clinical significance.

By performing pulmonary specimen angiographies, the authors attempted to determine the pathologic correlations of the vascular-related radiologic manifestations within, at the edge of, and adjacent to the small solitary pulmonary masses, and to evaluate their usefulness in differentiating small bronchogenic carcinomas from tuberculomas. A total of 29 resected lobe specimens with 1.5- to 3.5-cm solitary pulmonary masses, including 24 carcinomas and 5 tuberculomas, were studied prospectively with preoperative radiographs, postoperative specimen arteriographies (in 19 carcinomas and 5 tuberculomas), and venographies (in 5 carcinomas), 10- to 15 micrograms-thick whole-mount sections, and 5-micrograms-thick slices for the examination of angiographic-pathologic correlation. Another series of chest radiographs and conventional tomographs of 100 patients with 1- to 3-cm peripheral pulmonary masses, including 60 carcinomas and 40 tuberculomas, were reviewed retrospectively and analyzed with the chi-square test. Specimen angiographies showed the intralesion avascularity, small arterial speculation, and lobulation or notch at the mass margin with arterial compression, as well as vascular convergence to the mass, in both carcinoma and tuberculoma groups. The irregular arterial wall (79.2%) and venous dilation distal to the mass (100%) were found in the carcinoma group only. Microscopically, arterial or venous fibrous hyperplasia was observed in both carcinomas and tuberculomas, whereas the arterial erosion by tumor tissue and tumor emboli within the vessels were found in carcinomas only. The retrospective review of the 100 patients showed that two radiologic signs of the vascular convergence to the mass and the vascular dilation distal to the mass occurred at similar frequencies (12%-13%) between the carcinoma and tuberculoma groups. In addition to compression of vessels by tumor and vessel occlusion by tumor embolus, pulmonary vascular fibrotic hyperplasia can cause intramass avascularity. Small vessels running vertically into or from the mass margin can construct the spiculation sign of the tuberculomas. Any evidence of pulmonary vascular irregularity will indicate a bronchogenic carcinoma. The vascular convergence to the mass and the vascular dilation distal to the mass are not specific radiologic signs for small solitary bronchogenic carcinomas.

Pulmonary parenchymal manifestations surrounding small peripheral masses: pathologic correlation with chest radiographs and diagnostic value.

We evaluated pathologic correlations of pulmonary parenchymal manifestations surrounding small peripheral masses and their usefulness in differentiating small peripheral bronchogenic carcinomas from tuberculomas. We evaluated 29 resected lobe specimens with 1.5- to 3.5-cm solitary pulmonary masses, including 24 carcinomas and five tuberculomas. These specimens were prospectively studied with preoperative chest radiographs, postoperative specimen radiographs, 10- to 15-microns-thick wholemount sections, and 5-microns-thick slices. A total of 100 chest X-rays and conventional tomography scans of 1- to 3-cm peripheral pulmonary masses, including 60 carcinomas and 40 tuberculomas, were retrospectively reviewed and analyzed. The pulmonary parenchymal manifestations surrounding the masses presented as small infiltrates and nodular protrusions, thickened strands, and "double track" shadows, which extended from the proximal margin of five tuberculomas (100%, 5 of 5) and from the distal margin of 17 carcinomas (71%, 17 of 24). These pulmonary changes represented caseous material spreading from tuberculomas into the proximal bronchus and alveolar inflammatory exudation distal to the carcinomas. The proximal pulmonary manifestations were significantly more frequent in tuberculomas than in carcinomas (p < .01), whereas the distal pulmonary manifestations were more often found in carcinomas than in tuberculomas (p < .01). The radiologic findings of the pulmonary parenchymal manifestations proximal or distal to the masses may be valuable radiologic signs for distinguishing between tuberculomas and small peripheral bronchogenic carcinomas, even though there is still considerable crossover between the two disease populations in the findings.

Integration of Transbronchial and Percutaneous Approach in the Diagnosis of Peripheral Pulmonary Nodules or Masses: Experience With 1,027 Consecutive Cases

A study to evaluate the usefulness of the integration of the transbronchial and percutaneous approaches in the diagnosis of peripheral pulmonary nodules or masses (PPN/M) was conducted. The authors used both procedures, performed by a single diagnostic team, a pulmonologist, radiologist, and cytopathologist, who were all simultaneously present in the radiologic suite during the maneuvers. From January 1985 to June 1993, under fluoroscopic guidance, the authors performed 557 transbronchial pulmonary biopsies (TBPB), 483 transbronchial needle aspirations (TBNA), and 652 percutaneous needle aspirations (PCNA) on 1,027 consecutive patients referred because of a PPN/M (mean diameter, 3.5 cm; range, 0.8 to 8 cm). The procedure used was as follows: (1) bronchoscopy with exploration of the upper airways and bronchial tree, followed by TBNA and immediate cytologic assessment (ICA); (2) at least three TBPB; (3) if TBNA was diagnostic, the procedure was stopped; if not, a second pass with the needle was performed and then the bronchoscope was removed; (4) if the second TBNA was not diagnostic, PCNA with ICA was performed up to a maximum of three needle passes. Diagnostic sensitivity for malignant lesions was as follows: 53.9% for TBPB, 69.3% for TBNA, 75.4% for TBPB and TBNA together, 93.2% for PCNA, and 95.2% overall. The percentage of benign nodules correctly defined was 41.4% for TBPB, 17.4% for TBNA, 45.8% for PCNA, and 59.5% overall. Examination of the upper airways and bronchial tree was positive for lesions endoscopically visible in 12.6% of cases. The authors' experience shows that transbronchial and percutaneous approaches must be considered complementary and that their integrated use not only increases diagnostic yield but also permits important information to be obtained for disease staging. The creation of teams able to use both approaches with the cytopathologist present for ICA should be encouraged to optimize the diagnostic management of PPN/M with a reduction in diagnostic and hospitalization time and consequent cost saving.

Ultrasound-assisted fiberoptic bronchoscopy utilizing miniature transducer catheters for the diagnosis of peripheral and central pulmonary masses : Robert M. Steiner, J.B. Liu, Barry B. Goldberg, Dan A. Merton, John R. Cohn. Thomas Jefferson University Hospital, Philadelphia, PA 19107

Ultrasound-assisted fiberoptic bronchoscopy utilizing miniature transducer catheters for the diagnosis of peripheral and central pulmonary masses : Robert M. Steiner, J.B. Liu, Barry B. Goldberg, Dan A. Merton, John R. Cohn. Thomas Jefferson University Hospital, Philadelphia, PA 19107

Pulmonary masses: contrast enhancement.

Radiographic studies to discriminate benign from malignant pulmonary masses have previously focused on the morphologic and, more recently, the computed tomographic (CT) attenuation characteristics of the lung mass. Experience with the use of an intravenously administered iodinated contrast medium in examining the enhancement properties of lung masses was reviewed. Distinctive differences in the vascularity, pathophysiologic features, and pharmacodynamics of malignant versus benign pulmonary masses were identified. Forty-five patients with peripheral pulmonary masses were examined. Enhancement was evaluated by means of optical density values measured on trispiral tomograms of the lung masses before and after bolus injection of contrast medium. Results suggest that contrast enhancement of pulmonary masses can be measured on sectional images and that this may become a feasible diagnostic method in the detection of lung cancer. CT offers a simplified technique that is now being explored by the authors.

CT Guided fine needle aspiration biopsy of peripheral pulmonary mass lesions

CT Guided fine needle aspiration biopsy of peripheral pulmonary mass lesions

Fine Needle Aspiration Biopsy of Mediastinal and Peripheral Pulmonary Masses Guided by Real-time Sonography

The value of fine needle aspiration biopsy guided by real-time ultrasonography was assessed in 45 patients referred with an intrathoracic mass adjacent to the chest wall. The mass, as determined by chest x-ray examination, was visualized sonographically and subsequently biopsied in 42 patients. Puncture specimen was diagnostic in 34 patients (81 percent), including nine of 12 patients (75 percent) with previous failure of biopsy under fluoroscopic guidance. The success rate was similar in pulmonary and mediastinal masses, 18 of 23 and 16 of 19 patients, respectively. A diagnostic biopsy was obtained in 26 of 31 patients with a malignant mass. No complications were observed except for a minimal pneumothorax in one patient. Thus, real-time sonographic guidance is a safe, easy, and reliable method in biopsy of pulmonary and mediastinal masses adjacent to the chest wall and may also succeed in patients where fluoroscopically guided biopsy has failed.