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Clinical Investigations: CANCER |

Role of Fine-Needle Aspirates of Focal Lung Lesions in Patients With Hematologic Malignancies*

Philip W. Wong, MD; Tihomer Štefanec, MD; Karen Brown, MD; Dorothy A. White, MD, FCCP
Author and Funding Information

*From the Departments of Medicine (Drs. Wong, Štefanec, and White) and Radiology (Dr. Brown), Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY.

Correspondence to: Dorothy A. White, MD, FCCP, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Pulmonary Medicine C-678, New York, NY 10021; e-mail: whited@mskcc.org



Chest. 2002;121(2):527-532. doi:10.1378/chest.121.2.527
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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, 1999.

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 setting.


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