Small bronchogenic carcinomas presenting as solitary pulmonary nodules. Bioptic approach guided by CT-positive bronchus sign.
To evaluate the utility of the CT bronchus sign in making a choice between transbronchial biopsy (TBB) and transthoracic needle aspiration (TTNA) as the first diagnostic procedure in a patient with a solitary pulmonary nodule (SPN), we reviewed the results of TBB and TTNA in 26 patients who had a bronchogenic carcinoma less than 3 cm, studied with thin-section CT. The patients were divided into two groups. Group 1 included ten cases with a third- to fifth-order bronchus sign. Group 2 included two cases with a sixth-order bronchus sign and 14 cases with absence of a bronchus sign. TBB was performed in all the patients; conversely, TTNA was carried out in 22 patients. In group 1, TBB gave a diagnostic yield in eight (80 percent) of ten patients, while TTNA was positive in three (42 percent) of seven patients (p > 0.05). Conversely, in group 2, results of TBB were normal in all the patients, while TTNA gave a diagnosis in 10 (66 percent) of 15 patients (p < 0.05). We think that TBB should be considered the method of choice in diagnosing SPNs associated with a third- to fifth-order bronchus sign; conversely, TTNA is more useful than TBB in diagnosing SPNs in the presence of a more peripheral bronchus sign or with the absence of a bronchus sign. In conclusion, we suggest routine evaluation with thin-section CT of each SPN to optimize diagnostic management.
Gaeta
M
M
Service of Diagnostic Imaging, Ospedale Piemonte, Messina, Italy.
Russi
E G
EG
La Spada
F
F
Barone
M
M
Casablanca
G
G
Pandolfo
I
I
D001707:Biopsy, Needle / Q000379:methods; D001995:Bronchography; D002283:Carcinoma, Bronchogenic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed