title: CT-guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions.
abstract: We searched the electronic patient database at The University of Texas M. D. Anderson Cancer Center for patients who underwent computed tomography (CT)-guided needle biopsy between January 2001 and December 2005. Inclusion criteria were a known history of haematologic malignancy and a newly detected, undiagnosed pulmonary lesion on chest CT that required tissue sampling for diagnosis; 213 met these criteria. We analysed the biopsy results for diagnostic yield, factors affecting diagnostic yield and effect on treatment. Of 213 procedures, 191 (89.7%) yielded sufficient material for pathologic analysis; 130 (60%) yielded specific diagnoses, while 61 (28.6%) yielded nonspecific benign diagnoses. Lesions larger than 1 cm, cavitary lesions and lung masses were more likely to yield a specific diagnosis than were lesions smaller than 1 cm, lung nodules and consolidations. The most common specific diagnoses were malignancy (62.8%) and infection (34.3%). The latter was more common in patients with leukaemia, cavitary lung lesions or consolidations, active underlying malignancy, neutropenia, respiratory signs and symptoms and/or fever, bone marrow transplant recipients, and in patients receiving chemotherapy. Lung lesions discovered upon follow-up imaging in patients who did not have any respiratory signs/symptoms or fever were mostly malignant. Therapeutic changes were more likely after a specific diagnosis than after a nonspecific diagnosis or a nondiagnostic biopsy (88.4% vs. 18.1%; p < 0.0001). CT-guided lung biopsy has a high diagnostic yield in patients with haematologic malignancies that present with unexplained pulmonary lesions and provides a specific diagnosis in a majority of these patients, leading to therapeutic changes.
authors.affiliation: Department of Diagnostic Radiology, The University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA. sgupta@mdanderson.org
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Mark
authors.initials: M
authors.lastname: Sultenfuss
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Romaguera
authors.forename: Joe
authors.initials: J
authors.lastname: Ensor
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahrar
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: Ravi
authors.initials: R
authors.lastname: Murthy
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Hicks
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D018549:Cryptogenic Organizing Pneumonia / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000473:pathology; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D011030:Pneumothorax / Q000209:etiology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000473:pathology