Pleural based intra-thoracic nodules and masses are frequently encountered by pulmologists. They are a diagnostic challenge as the yield of bronchoscopy and sputum cytology is low for such lesions. CT-scan guided percutaneous biopsy is the most commonly modality used to establish diagnosis. US guided FNAB have been described in the literature 1–3, but they are seldom performed. US guided FNAB can be done in the outpatient setting.We report the yield of US guided FNAB of pleural based intra-thoracic lesions at our center.
25 patients (pts) with pleural based intra-thoracic lesions, underwent US guided FNAB. All pts were considered to have an unresectable malignant process based on clinical evaluation.
A final diagnosis was established in all the pts by US guided FNAB. The results showed: (1) Malignancy in 23/24 (95.8%) pts. (2) Benign lesion in 1/1 pt. Cytology showed pulmonary macrophages. Pt was diagnosed with pneumonia, as after antibiotic therapy repeat CT-scan showed complete resolution of the lesion. (3) 1 non-diagnostic (positive for malignancy by CT-guided FNAB). (4) In 8 pts lesion extended to the chest wall. For diagnosis of malignancy, US guided FNAB had 95.8 % sensitivity, 100 % specificity, 96% diagnostic accuracy, 100% positive predictive value and a 50% negative predictive value. There were no major procedure related complications.
US guided FNAB of pleural based intra-thoracic lesions is a simple and safe procedure with a high yield for malignancy.
US guided FNAB is a portable technique which can be done at the patients bedside. It is safe, with no radiation exposure and can be done in a position comfortable for the patient and clinician. It offers real-time guidance of the biopsy needle. This technique can be easily learned by pulmonologist and become readily available comapred to CT-guided biopsy.
Rahul Khosla, No Financial Disclosure Information; No Product/Research Disclosure Information