Role of fine-needle aspirates of focal lung lesions in patients with hematologic malignancies.
OBJECTIVE
To evaluate the yield and safety of transthoracic fine-needle aspiration (FNA) in the diagnosis of pulmonary disease in patients with hematologic malignancy.


METHODS
Retrospective chart review.


METHODS
Tertiary-care medical center.


METHODS
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.


CONCLUSIONS
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.
Wong
Philip W
PW
Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY 10021, USA.
Stefanec
Tihomer
T
Brown
Karen
K
White
Dorothy A
DA
D001707:Biopsy, Needle / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D007239:Infections / Q000473:pathology; D007938:Leukemia / Q000473:pathology* / Q000628:therapy; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008223:Lymphoma / Q000473:pathology* / Q000628:therapy; D008297:Male; D014184:Transplantation, Homologous