Transthoracic Needle Aspiration Research Articles

Staging and operability of primary lung cancer in Western Cape Province, South Africa.

Background Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation. Objectives To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital. Methods A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital’s weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution. Results Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA. Conclusion There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

Comparison of the Effectiveness of the Cell Block Method with Core Tissue Biopsy for Adequate Diagnosis of Lung Malignant

BACKGROUND: An adequate diagnosis of lung malignancy can be detected through examination of pleural fluid and Transthoracic needle aspiration (TTNA) based on the cell block method and tissue core biopsy. The cell block method is an immunocytochemical examination method that is useful for the adequate diagnosis of lung malignancy.
 AIM: This study was to compare the effectiveness of the cell block method with tissue core biopsy on pleural fluid cytology and TTNA cytology to establish the diagnosis of lung malignancy.
 METHODS: This study is a diagnostic test with an analytical cross-sectional approach on 15 respondents suspected of lung cancer at Dr. Moewardi Hospital Surakarta in September 2021. Subjects underwent pleural fluid cytology, TTNA cytology based on the cell block method, and tissue core biopsy examination. Data analysis used the Kappa test and bivariate analysis to calculate the p-value.
 RESULTS: The results of the combined examination of pleural fluid cytology and TTNA cytology based on the cell block method gave a very good level of conformity to the tissue core biopsy with a Kappa value of 0.857 and a p-value of 0.001. The results of the combined examination of pleural fluid cytology and TTNA cytology with cell block method showed the highest percentage for sensitivity (100%), NPV (100%), and accuracy (93%); while the results of the TTNA cytology examination using the cell block method showed the highest percentage of specificity (100%) and PPV (100%) of the tissue core biopsy method.
 CONCLUSION: The cell block method is very effective and significant in assessing the results of combined pleural fluid cytology and TTNA cytology against the tissue core biopsy method so that it is useful for the adequate diagnosis of lung malignant

Efficacy and safety of CT-guided percutaneous fine needle aspiration and biopsy for malignant pulmonary lesions

Background: CT-guided percutaneous transthoracic fine needle aspiration (FNA) and core biopsy (CB) are commonly used to characterise lung lesions. There is conflicting information on which method is superior and wide variation in reported complication rates. Our objectives were to establish the efficacy and safety of percutaneous CT-guided FNA and CB in the diagnosis of malignant lung lesions. Methods: This retrospective study included patients who underwent CT-guided percutaneous FNA and/or CB for lung parenchymal lesions at Kasturba Medical College Mangalore, from January 2013 to December 2020. Ethical clearance was obtained from the Institutional Ethics Committee. Efficacy was determined by the adequacy of samples, sensitivity, specificity and diagnostic accuracy. Safety was assessed using the incidence of complications. Results: A total of 326 patients underwent both FNA and CB, and 49 underwent FNA alone. Adequate samples were obtained in 82.9% of FNA cases and 95.7% of CB cases. Considering biopsy as the gold standard, the sensitivity, specificity and diagnostic accuracy of FNA for malignancy were 95.19%, 80% and 91.27%, respectively. Kappa agreement between the two methods was substantial (0.767). Pneumothorax was the only complication observed, and was seen in 31 patients (8.2%), of which only one required chest tube drainage. The incidence of pneumothorax was significantly higher in patients with pre-existing lung disease such as COPD/emphysema (p value 0.000), patients with smaller lesions (p = 0.009), and deeper lesions from the pleura (p <0.0001). Conclusions: FNA and CB are both safe and effective procedures. In the absence of an onsite cytopathologist, we recommend a combination of both techniques.

Utility and safety of sole electromagnetic navigation bronchoscopy under moderate sedation for lung cancer diagnosis.

BackgroundElectromagnetic navigation bronchoscopy (ENB) is an emerging technique for diagnosing pulmonary lesions. However, limited data is available on its sole utility under a least invasive setting without general anesthesia. We aimed to evaluate the diagnostic performance and safety of sole ENB under moderate sedation for diagnosing pulmonary lesions suspicious for lung cancer and to determine clinical factors associated with a better diagnostic yield.MethodsWe performed a retrospective analysis of consecutive patients who underwent sole ENB under moderate sedation for lung lesion biopsy between August 2016 and June 2021 at Seoul National University Bundang Hospital, a tertiary center in South Korea. Diagnostic yield of the ENB-guided biopsy, safety endpoints defined by the incidence and severity of associated complications, and factors associated with higher diagnostic yield were evaluated.ResultsA total of 94 patients were evaluated. The final diagnostic yield of ENB was 81.5% (75/92), excluding two indeterminate cases. The diagnostic yield ranged from 79.8% to 81.9% assuming all indeterminate cases were false-negatives (79.8%) and true-negatives (81.9%). The sensitivity and specificity for malignancy were 77.6% (ranging from 75.6% to 77.6%) and 100%, respectively. Any-grade pneumothorax occurred in 4.3% of the patients, and 2.1% developed pneumothorax requiring additional intervention. Multivariable analyses identified the presence of a class 2 bronchus sign as the only significant predictor for a higher diagnostic yield (odds ratio =4.83, 95% CI: 1.16–20.12). The diagnostic yield of ENB among those with class 2 bronchus sign was 89.8% (53/59).ConclusionsSole ENB under moderate sedation for diagnosing pulmonary lesions displayed a good diagnostic yield and safety profile, thus confirming its utility in a least-invasive setting. Moreover, sole ENB could be possibly be superior to transthoracic needle aspiration for diagnosing lesions with class 2 bronchus sign accounting for similar yields and lower complication rates.

Innovations in Bronchoscopy: Robotic-assisted Bronchoscopy

Low-dose computed tomography screening for lung cancer has led to the increased detection of peripheral pulmonary nodules (PPN). Bronchoscopic modalities of PPN biopsy (ultrathin bronchoscope, radial endobronchial ultrasound, electromagnetic navigational bronchoscopy) have not consistently shown diagnostic yields as high as ultrasound- or computed tomography-guided transthoracic needle aspiration or surgical lung biopsy. Robotic-assisted bronchoscopy gained US Food and Drug Administration approval in 2018 and 2019, and preliminary data have shown an improvement in the ability to navigate to PPN, obtain a diagnosis and evaluate tissue for molecular markers, all while maintaining a safety profile similar to that of traditional bronchoscopic methods. In this article, we aim to briefly summarize the data available on this novel technology and its potential for future applications.

Pulmonary actinomycosis: cytomorphological features.

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings. Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules.

Lung Adenocarcinoma Metastases to Mediastinal with Malignant Pericardial Effusion

Lung adenocarcinoma with malignant pericardial effusion and also metastases to mediastinum has great impact on morbidity and mortality of patient and it is rare case. Most adenocarcinoma in the mediastinum are metastases from the lung, gastrointestinal tract, pancreas, kidney or even the pituitary gland. Cardiac metastases in lung cancer may occur due to retrograde lymphatic spread or by hematogenous dissemination of tumour cells. Pericardium is frequently involved in direct cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threatening presentation in such cases. A 42-years-old male with superior mediastinal mass has malignant pericardial effusion, cytology shows adenocarcinoma. The patient undergo transthoracic fine needle aspiration biopsy. The result from biopsy is adenocarcinoma. This is a rare case, patient with primary lung adenocarcinoma and malignant pericardial effusion also metastases to mediastinum. To determine the diagnosis requires a comprehensive clinical evaluation and multidisciplinary approach.

CT Guided TTNA and Core Biopsy in Suspected Lung Cancer, Review of Cases in Adam Malik General Hospital, Medan

ounds: The cytological and histopathological findings establish the type of lung cancer cells as the definitive diagnosis of lung cancer. This study aimed to determine the characteristics of lung cancer patients in terms of age, mean age, gender, staging, the proportion of lung cancer cells by cytologic examination of Transthoracic Needle Aspiration (TTNA) and histopathologic evaluation from CT-guided core biopsy. Method: This is a descriptive study involving 42 subjects diagnosed with lung cancer at H. Adam Malik Hospital Medan in 2016-2020 that met the inclusion criteria through consecutive sampling. Data was analysed using descriptive statistics for categorical variables. Results: Of 42 study subjects, the 60–71-year age group had the highest percentage of lung cancer (42.9%). Male (71.4%) was higher than female, the most common lung cancer staging was IVA (57.1%), and adenocarcinoma was found to be the most frequent type of lung cancer in both cytology (33.3%) and histopathology (31.0%). Conclusion: We concluded that core biopsy is superior in diagnosing lung cancer compared to TTNA.

Primary seminoma arising in the posterior mediastinum: a diagnostic challenge

Primary mediastinal germ cell tumors are a rare finding, and one third of them are seminomas. Seminomas are found in the anterior mediastinum, whereas they are extremely rare within the posterior compartment. Most clinicians would not consider a primary seminoma in the differential diagnosis of a posterior mediastinal mass, as only two cases have been reported in literature. Here we present the case of a 57-year-old male with a primary seminoma arising in the left posterior mediastinum. He was asymptomatic and the mass was an incidental finding. Positron emission tomography (PET) revealed a small area with an avid tracer uptake. Transthoracic needle aspiration led to a non-diagnostic result. Due to the strong suspect of malignancy, a surgical excision was chosen to obtain a diagnosis. He underwent complete excision, and pathology report demonstrated a mediastinal seminoma. Subsequent further staging did not reveal any other location of the disease. Given the complete excision of the primary tumor, active surveillance was the treatment of choice. The patient is free of disease 48 months after diagnosis.

A CONFOUNDING CASE OF SUPERIOR VENA CAVA SYNDROME

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Superior Vena Cava Syndrome (SVCS) results from obstruction of blood flow through the superior vena cava (SVC). It can either be due to malignant obstruction caused by direct invasion of tumor into the SVC, or by external compression of the SVC by thoracic or mediastinal structures. Face or neck swelling is one of the commonest findings in SVCS and might be mistaken for an allergic reaction.Here, we present a case of a patient who presented with SVCS due to malignancy which was initially misdiagnosed as angioedema. CASE PRESENTATION: A 72-year-old Caucasian female with a medical history of hyperlipidemia presented to the emergency department (ED) with facial & neck swelling and dyspnea for 6 weeks. The swelling was more prominent in the morning and decreased as the day progressed. Before the presentation, she went to urgent care and was treated with antibiotics for 2-3 weeks. Despite that, her symptoms persisted, and she went to an otolaryngologist, an allergist & an immunologist who treated her with antihistamines and steroids for possible angioedema. Since it was not getting better, she came to the ED. She did not report fever, night sweats, cough, weight loss, or fatigue. She had a 30 pack-year smoking and 10-year vaping history. On presentation, vitals and laboratory investigations were normal. Physical examination was significant for facial edema and erythema in the malar area. There was no swelling in the upper extremities. The chest radiograph was normal. Computed tomography revealed confluent right paratracheal lymphadenopathy measuring 3 x 4 cm in aggregate extending to the right hilum. She underwent endobronchial ultrasound with a transthoracic needle aspiration biopsy. Pathology results were diagnostic for squamous cell carcinoma (SqCC) of the lung positive for P63 and CK5/6. She underwent radiation therapy and chemotherapy with paclitaxel and carboplatin that provided relief to the symptoms. DISCUSSION: SVCS can be challenging to diagnose and can be mistaken as inflammatory, infectious, or allergic conditions (1). Our patient did not have any constitutional symptoms suggestive of malignancy. On physical examination, she had facial swelling but did not have upper extremity swelling. The absence of upper extremity swelling; one of the commonest symptoms, seen in one-third of SVCS patients (2), made the diagnosis difficult. Significant smoking and vaping history prompted us to get further imaging and biopsy which ultimately lead to diagnosis. Evidence suggests that amongst lung cancers, small cell lung cancer is most likely to cause SVCS (3), however, our patient was diagnosed with SqCC which was also unique in our case. CONCLUSIONS: SVCS can be a life-threatening condition and warrants a timely diagnosis. Our case demonstrates that suspicion for SVCS should be high in patients with a significant smoking history presenting with facial swelling unresolved with angioedema treatment. REFERENCE #1: Rochelle Tonkin, Christopher Sladden. What lies downstream? A case of superior vena cava syndrome presenting in the dermatology clinic: A case report. SAGE Open Medical Case Reports. https://doi.org/10.1177/2050313X20919618 REFERENCE #2: Armstrong BA, Perez CA, Simpson JR, Hederman MA. Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys. 1987;13(4):531-539. doi:10.1016/0360-3016(87)90068-x REFERENCE #3: Wei S, Liu J, Li X, et al. A retrospective stenting study on superior vena cava syndrome caused by lung cancer. Thorac Cancer. 2020;11(7):1835-1839. doi:10.1111/1759-7714.13461 DISCLOSURES: No relevant relationships by Ghulam Aftab, source=Web Response No relevant relationships by Sidharth Bhasin, source=Web Response No relevant relationships by Sanya Chandna, source=Web Response No relevant relationships by Monarch Shah, source=Web Response No relevant relationships by Abi Watts, source=Web Response

A rare case: Covid-19 infection diagnosed by transthoracic fine needle aspiration biopsy

Covid 19 is an acute respiratory disease caused by a novel type of Coronavirus (SARS-CoV-2) that was first detected in Wuhan, Hubei Province of China. Its most common symptoms are fever, cough, and weakness; and in the early stages, there may not be findings on chest computed tomography. In pulmonary involvement, peripheral ground-glass areas, a cobblestone appearance, consolidated areas, and interlobular septal thickening, which are usually prominent in the lower lobes may be seen in thorax computed tomography. Consolidation, solid nodules, halo sign, inverted halo sign, vascular enlargement, subpleural line, air bronchograms, and bronchiectasis are other less common findings. In our case, we aimed to present our 69 years old female patient with bilateral nodular densities on thoracic CT and transthoracic fine-needle aspiration biopsy result was reported as lesions compatible with interstitial fibrosis due to Covid-19 inflammation.

The Effectiveness of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients With Undiagnosed Lung Cancer

Objectives: Conventional bronchoscopic techniques and computed tomography-guided transthoracic needle aspiration are widely used in the diagnosis of lung cancer. In some patients diagnosis can be challenging. Endobronchial ultrasound-guided transbronchial needle aspiration can be used in the diagnosis of lung cancer after procedures have failed to provide a diagnosis. We aimed to show the effectiveness of Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer in view of the literature and to share the experience from Turkey.
 Material and Methods: This was a retrospective study conducted between 2014 and 2019. Forty-five patients who were suspected of having lung cancer and underwent Endobronchial ultrasound because diagnosis was not confirmed using methods such as bronchoscopy, computed tomography transthoracic needle aspiration, and peripheral lymph node excision, were included in the study.
 Results: Three hundred sixty-eight Endobronchial ultrasound procedures were performed. Forty-five patients met the inclusion criteria and were included in the study. Using Endobronchial ultrasound, samples were taken from only mass in eight patients (17.8%), lymph nodes in 30 patients (66.7%), and mass + lymph node in seven (15.5%) patients. Minor complications were seen in five (11.1%) patients and no major complications were seen. Definitive diagnosis was obtained in 35 (77.7%) patients with Endobronchial ultrasound guided transbronchial needle aspiration. Non-small cell lung cancer was identified in 16 patients (45.7%), small cell lung cancer was seen in 15 (42.8%) patients. Seven of ten undiagnosed patients underwent surgical procedures.
 Conclusion: Endobronchial ultrasound, is an effective and safe method for diagnosing lung cancer after undiagnosed procedures. In selected cases, it can be the first choice for the diagnosis of lung cancer.

Diagnostic efficacy cell block method of transthoracic fine needle aspiration in diagnosis of lung cancer

BackgroundLung cancer is still the main cause of cancer deaths. The high lung cancer mortality rate is caused by a diagnosis factor or therapy selection. The cell block cytology technique using fine needle aspiration (FNA) samples can provide immunocytochemical material that plays an important role in the differential diagnosis of lung cancer subtypes and in determining immunotherapy administration. This study aimed to determine the sensitivity and specificity of transthoracic FNA (TTFNA) cell block cytology in comparison with bronchial washing smears and TTFNA smears in diagnosing lung cancer. MethodsThis was a cross-sectional diagnostic study involving 26 subjects. All subjects had undergone bronchial washing and CT scan-guided fine needle aspiration followed by cell block preparation. Both direct FNA smears and cell blocks are useful in the diagnostic work-up of patients. Comparative statistical analysis of TTFNA cell block versus bronchial washing smear and TTFNA smear cytology was carried out using the McNemar test. ResultsLung cancer was found in 15 patients (57.7%) using the TTFNA cell block technique. The sensitivity and specificity of the TTFNA cell block technique were 85.7% and 75%, respectively. There was no difference in the positivity value between TTFNA cell block technique of bronchial wash smear technique, and TTFNA smear on lung cancer diagnosis (p>0.05). ConclusionsTransthoracic fine-needle aspiration in combination with the cell block technique has good sensitivity and specificity. The TTFNA can be used for immunocytochemical examinations in lung cancer diagnosis and therapy. This approach is valuable for providing individualized treatment and prognostic evaluations.

Yield of ultrasound guided transthoracic needle aspiration in peripheral intrathoracic mass lesions

In thoracic lesions, early diagnosis and sorting out into malignant- benign is important regarding the therapeutic decisions and prognosis. Ultrasound guided Transthoracic needle aspiration (TTNA) and Corebiopsy (CNB) are described to be safe accurate high yielding means of diagnosis. The study aims to determine the yield and safety of TTNA in peripheral intrathoracic mass lesions. Study was conducted in government teaching institution in Kerala. Patients with intrathoracic peripheral mass lesions which were visualized by USG were subjected to TTNA, and sent for cytopathology. The patients with inconclusive results were subjected to either USG guided or CT guided CNB. The patients were followed up till a conclusive diagnosis obtained. The results were classified as conclusive /definitive or inconclusive. Diagnostic yield and complication rate calculated.USG guided TTNA had an overall diagnostic yield of 65.5%,with 72.15% yield in malignancy. It had high diagnostic yield in lung carcinoma(82.3%) and was a safe procedure with complication rate of 3% only.Combined with USG guided CNB, the overall yield became 86.66% with a cumulative yield of 91.13% in malignancy with no increase in complication rate. Ultrasound guided TTNA is a safe procedure with good yield in peripheral lung malignancies.Ultrasound guided transthoracic needle aspiration and core cut together has a high diagnostic yield in peripheral intrathoracic masses and is accurate in differentiating malignant and benign lesion with a good safety profile.

An Audit of CT Chest Reports and Their Potential Impact on the Workup of Patients with Suspected Lung Cancer.

Background Quality gaps exist in the diagnostic evaluation of lung cancer patients. The initial CT chest guides the workup of patients with suspected lung cancer. We sought to determine how frequently CT reports provided guideline-concordant recommendations with regard to additional imaging studies and/or invasive diagnostic procedures. Methods. This was a retrospective study. The records of patients referred for investigation of suspected lung cancer between January 1, 2015, and June 30, 2016, were reviewed. Patients with confirmed lung cancer, for whom CT scan images and reports were available, are included. CT reports were reviewed, with attention to additional imaging studies and/or invasive diagnostic procedures suggested. These recommendations were examined against current guidelines for lung cancer diagnosis and staging, based on suspected disease stage. Results One hundred forty-six patients are included in the analysis. Most patients were diagnosed with non-small-cell lung cancer (NSCLC), and 63% had advanced disease (stages III and IV). Only 12% of CT reports contained guideline-concordant recommendations for additional imaging studies, with PET scan suggested in only 6% of reports. Potential invasive diagnostic procedures were suggested in one fifth of CT reports, and only 58% of these recommendations were in keeping with current guidelines. In particular, transthoracic needle aspiration (TTNA) was suggested in 26% of patients despite advanced stage disease. Conclusion Guideline-concordant recommendations for investigation of suspected lung cancer are rarely available on CT reports. This is true with respect to both imaging studies and invasive diagnostic procedures. Incorporation of more evidence-based suggestions may reduce quality gaps in lung cancer diagnosis and staging.

Adequacy of small biopsy and cytology specimens for comprehensive genomic profiling of patients with non-small-cell lung cancer to determine eligibility for immune checkpoint inhibitor and targeted therapy

AimsIn advanced-stage non-small-cell lung cancer (NSCLC), incomplete genotyping for guideline-recommended genomic biomarkers poses a significant challenge to making informed and timely clinical decisions. We report our institution’s experience in assessing...

Lung Abscess Carcinomatous

Introduction: Pulmonary malignancies may easily be overlooked and valuable time may be lost. Lung cancer is sometimes diagnosed as a tuberculous cavity or an abscess. Abscess formation can appear in several different ways. Carcinoma that occurs in medium-sized bronchi causes partial bronchial obstruction, atelectasis, and infection due to retention. Inflammation can progress to damage to lung tissue, resulting the formation of multiple suppurative foci or more localized lung abscess. The link between lung abscess and lung cancer has been known, but the presence of malignancy in lung abscesses often undiagnosed. Obstruction from lung cancer can predispose to the development of a lung abscess. Case of a 54 year old man with increased pain at the right chest when breathing in since two months. On physical examination, it was found decreased of fremitus at the right hemithorax, deafness and decreased breath sounds as high as the II - V thoracic right hemithorax. Thorax CT-scan showed a round, homogeneous (HU: 17-30), with a cavity-like image with air fluid level, size: 7,88 cm x 8,2 cm x 9,29 cm and honey comb appearance around it. On the examination of TTNA (Transthoracic Needle Aspiration) results obtained Squamous Cell Carcinoma. A lobectomy is planned for the patient.
 Conclusion: We reported a rare case, a 54 year old male patient, with the diagnosis of Carcinomatous Lung Abscess. This case report was prepared with the aim of increasing awareness of malignancy in patients with a clinical presentation of abscesses, especially in old age.

Lung Abscess Carcinomatous

Introduction: Pulmonary malignancies may easily be overlooked and valuable time may be lost. Lung cancer is sometimes diagnosed as a tuberculous cavity or an abscess. Abscess formation can appear in several different ways. Carcinoma that occurs in medium-sized bronchi causes partial bronchial obstruction, atelectasis, and infection due to retention. Inflammation can progress to damage to lung tissue, resulting the formation of multiple suppurative foci or more localized lung abscess. The link between lung abscess and lung cancer has been known, but the presence of malignancy in lung abscesses often undiagnosed. Obstruction from lung cancer can predispose to the development of a lung abscess. Case of a 54 year old man with increased pain at the right chest when breathing in since two months. On physical examination, it was found decreased of fremitus at the right hemithorax, deafness and decreased breath sounds as high as the II - V thoracic right hemithorax. Thorax CT-scan showed a round, homogeneous (HU: 17-30), with a cavity-like image with air fluid level, size: 7,88 cm x 8,2 cm x 9,29 cm and honey comb appearance around it. On the examination of TTNA (Transthoracic Needle Aspiration) results obtained Squamous Cell Carcinoma. A lobectomy is planned for the patient.
 Conclusion: We reported a rare case, a 54 year old male patient, with the diagnosis of Carcinomatous Lung Abscess. This case report was prepared with the aim of increasing awareness of malignancy in patients with a clinical presentation of abscesses, especially in old age.

Safety and Diagnostic Yield of Transthoracic Needle Aspiration of the Lung in Elderly Patients.

Pulmonary nodules in elderly patients are commonly encountered in clinical practice. Tissue sampling with image guided transthoracic needle aspiration is often performed but may be complicated by pneumothorax or bleeding. To understand the outcomes of transthoracic needle aspiration in the elderly, we retrospectively reviewed outcomes of patients age 75 or greater in a single tertiary center. Four-hundred eleven patients age 75 or greater with a pulmonary nodule identified on computed tomography who underwent needle aspiration of the lung were studied. Diagnostic yield and procedural complications were assessed for each patient and subgroups analysis of those age 85 or greater was performed. Malignancy was confirmed in 70% of subjects and a benign diagnosis identified in 9%. Of the 411 patents, 203 (49.4%) experienced a complication; 150 patients (36.5%) developed a pneumothorax and 79 (19.2%) had bleeding. No patient required transfusion, experienced persistent air leak or massive hemoptysis, air embolism or death. Post procedural hospitalization was required in 36 patients (8.8%) with a median hospital stay of 2 days. No factors were identified to be associated with occurrence of a complication (all p ≥ 0.16) and complications were not increased in those 85 or greater. Our results suggest that in an elderly population, image guided needle aspiration of a pulmonary nodule provides diagnostic findings in most patients. Procedural complications following are not uncommon but the severity and long-term impact are limited. The occurrence of complications is similar in those age 75-84 and age 85 and older.

Lesion characteristics affecting yield of electromagnetic navigational bronchoscopy.

Electromagnetic navigational bronchoscopy (ENB) is an important, minimally invasive diagnostic tool for malignant and benign peripheral lung lesions, offering lower complication risks than transthoracic needle aspirations. As a relatively new technology, the best sampling modality and lesion characteristics for ENB has yet to be determined. We evaluated the sensitivity and diagnostic yield of different sampling modalities (needle aspiration, brush biopsy, transbronchial forceps biopsies) and radiographical lesion characteristics by Tsuboi classification. We also evaluated the difference in yield and sensitivity with the addition of radial probe EBUS to augment ENB. We completed a retrospective chart review of all patients that had ENB performed at our institution since its implementation in 2011. We reviewed the lesion size, location, Tsuboi classification, cytology, pathology results and analyzed biopsy specimen tool types. We included a total of 248 patients who had ENB performed between 2011 and 2018. Average age was 67 years and 50% female. A total of 270 lesions were targeted with a mean size of 24±12mm. Sensitivity for malignancy was 59.2% with a diagnostic yield of 72.3%. Sensitivity and diagnostic accuracy trended higher with combined sampling modalities (brush and transbronchial needle aspiration and forcep biopsy). Lesions with type I and type II Tsuboi classification of bronchus sign had higher sensitivity compared to type III classification (67.9% [n=101 type I], 64.6% [n=65 type II], 37.9% [n=36 type III]), p=0.01 and p=0.04. For navigation bronchoscopy, sensitivity is higher in bronchus sign lesions that end directly into lesion (Tsuboi type I) and travel through malignant lesions (Tsuboi type II) compared to tangentially circumventing the lesion (Tsuboi type III).