PURPOSE: To assess usefulness of commonly available lumbar puncture needle for diagnostic purpose of peripheral lung mass lesion.Increasing cases of lung cancer in developing countries demand rapid, reliable and economically viable diagnostic method.
METHODS: Over a period of 12 months at the Respiratory Clinic, 105 patients having clinically and radiologically suspicious malignant lung mass were enrolled in this study. Patients with pneumothorax, bleeding disorders, unstable respiratory or cardiovascular system were excluded so were pediatric age group and un-co-operative patients. All 105 patients had the lesion in the outer 1\3 of lung field on PA and lateral chest roentgenogram. Patients were subjected for chest sonography to locate the lesion and TTNA(Trans Thoracic Needle Aspiration) performed with 21gauge lumbar puncture needle under sonographic guidance after detailed explanation and consent for the procedure.
RESULTS: Out of 105 patients, 42(40%) had mass size more than 5cm where as 63(60%) had mass size less than 5cm. About zonal distribution, 52(49.5%), 37(35.23%) and 16(15.27%) patients had mass in upper, middle and lower zones respectively. TTNA smears of 97(92.38%) patients reported as satisfactory and 8(7.62%) were not satisfactory. Out of these 97 patients, 85(87.62%) had carcinoma of lung, 11(11.35%) had inflammatory condition, 1(1.03%) had pleural malignancy. In these 85 patients, 71(83.52%) had a conclusive pathological diagnosis and 14(16.48%) were diagnosed as having malignancy but further typing was not possible. Among these 71 subjects, 39(54.93%) had squamous cell carcinoma, 21(29.57%)adenocarcinoma, 8(11.27%)small cell carcinoma and 3(4.23%)large cell carcinoma.Tissue specific diagnostic yield of procedure for malignant lesion was 67.61%. 5 patients suffered complications of the procedure - 2 small pneumothorax and 3 had trivial haemoptysis not needing extra intervention. No procedure related mortality observed.
CONCLUSION: TTNA aided by sonographic guidance is a simple but safe diagnostic procedure with high specificity potential. Commonly available conventional lumbar puncture needle can be used successfully for the purpose.
CLINICAL IMPLICATIONS: Synergistic use of easily available sonography and conventional lumbar puncture needle can facilitate diagnosis of lung cancer at centers with restricted resources.
DISCLOSURE: Varunkumar Patel, No Financial Disclosure Information; No Product/Research Disclosure Information