Objectives: To evaluate the yield and safety of
transthoracic fine-needle aspiration (FNA) in the diagnosis of
pulmonary disease in patients with hematologic malignancy.
Design: Retrospective chart review.
Setting: Tertiary-care medical center.
Patients: Sixty-seven patients with a hematologic
malignancy or after bone marrow transplantation (BMT) for a hematologic
malignancy who underwent a total of 71 FNAs for diagnosis of an
unexplained parenchymal lung lesion from January 1, 1991, to June 30,
Results: The underlying malignancy was lymphoma
in 42 patients (63%), leukemia in 8 patients (12%), after allogeneic
BMT in 12 patients (18%), after autologous BMT in 3 patients (4%),
and other diseases in 2 patients. Radiographs showed focal
abnormalities in all cases, and were nodules in 37%, masses in 37%,
focal infiltrates in 21%, and cavitary lesions in 5%. The yield of
FNA for a finding specific infection or cancer was 56% (40 of 71
FNAs). The FNA with inflammatory changes was clinically sufficient in
another 11 patients for a total yield of 72% (51 of 71 FNAs). The
yield for lung cancer was 90% (9 of 10 FNAs), for pulmonary lymphoma
was 68% (21 of 31 FNAs), and for infection was 67% (10 of 15 FNAs).
Complications occurred in 18 of 71 FNAs (25%), with pneumothorax in 14
patients (20%) and chest tube placement required in 4 patients (6%).
Bleeding occurred in six patients (8%), including one death in a
patient with abnormal hematologic parameters.
Conclusion: Transthoracic FNA in patients with hematologic
malignancy and focal lung lesions has an excellent yield for detecting
cancer and a yield comparable to bronchoscopy for the diagnosis of
infections. It should be considered a useful diagnostic tool in this