title: Ultrasound-assisted transthoracic biopsy: fine-needle aspiration or cutting-needle biopsy?
abstract: The present study compared the diagnostic yield of ultrasound-assisted cutting-needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in chest lesions. A physician performed ultrasound and FNAB with a 22-G spinal needle in all patients, directly followed by a 14-G CNB in patients without contraindication. A total of 155 consecutive lesions arising from the lung (74%), pleura (12%), mediastinum (11%) or chest wall (3%) in patients with a final diagnosis of lung carcinoma (74%), other malignant tumours (12%), non-neoplastic disease (9%) or unknown (5%) were prospectively included. The overall diagnostic yield was 87%. Combined specimens were obtained in 123 lesions (79%). In these, yields of FNAB, CNB and both methods combined were 82, 76 and 89%, respectively. FNAB was significantly better than CNB in lung carcinoma (95 versus 81%) but CNB was superior in noncarcinomatous tumours and in benign lesions. On-site cytology was 90% sensitive and 100% specific for predicting a positive FNAB. One patient required drainage for pneumothorax (0.6%). Ultrasound-assisted fine-needle aspiration biopsy performed by chest physicians is an accurate and safe initial diagnostic procedure in patients with a high clinical probability of lung carcinoma. All other patients should undergo concurrent fine-needle aspiration biopsy and cutting-needle biopsy.
authors.affiliation: Department of Internal Medicine, Tygerberg Academic Hospital, Tygerberg, South Africa. ahd@sun.ac.za
authors.forename: A H
authors.initials: AH
authors.lastname: Diacon
authors.forename: J
authors.initials: J
authors.lastname: Theron
authors.forename: P
authors.initials: P
authors.lastname: Schubert
authors.forename: K
authors.initials: K
authors.lastname: Brundyn
authors.forename: M
authors.initials: M
authors.lastname: Louw
authors.forename: C A
authors.initials: CA
authors.lastname: Wright
authors.forename: C T
authors.initials: CT
authors.lastname: Bolliger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013899:Thoracic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional