INTEGRATION OF TRANSBRONCHIAL AND PERCUTANEOUS APPROACH IN THE DIAGNOSIS OF PERIPHERAL PULMONARY NODULES OR MASSES - EXPERIENCE WITH 1,027 CONSECUTIVE CASES

A study to evaluate the usefulness of the integration of the transbron chial and percutaneous approaches in the diagnosis of peripheral pulmo nary nodules or masses (PPN/M) was conducted. The authors used both pr ocedures, performed by a single diagnostic team, a pulmonologist, radi ologist, and cytopathologist, who were all simultaneously present in t he radiologic suite during the maneuvers. From January 1985 to June 19 93, under fluoroscopic guidance, the authors performed 557 transbronch ial pulmonary biopsies (TBPB), 483 transbronchial needle aspirations ( TBNA), and 652 percutaneous needle aspirations (PCNA) on 1,027 consecu tive patients referred because of a PPN/M (mean diameter, 3.5 cm; rang e, 0.8 to 8 cm). The procedure used was as follows: (1) bronchoscopy w ith exploration of the upper airways and bronchial tree, followed by T BNA and immediate cytologic assessment (ICA); (2) at least three TBPB; (3) if TBNA was diagnostic, the procedure was stopped; if not, a seco nd pass with the needle was performed and then the bronchoscope was re moved; (4) if the second TBNA was not diagnostic, PCNA with ICA was pe rformed up to a maximum of three needle passes; Diagnostic sensitivity for malignant lesions was as follows: 53.9% for TBPB, 69.3% for TBNA, 75.4% for TBPB and TBNA together, 93.2% for PCNA, and 95.2% overall. The percentage of benign nodules correctly defined was 41.4% for TBPB, 17.4% for TBNA, 45.8% for PCNA, and 59.5% overall. Examination of the upper airways and bronchial tree was positive for lesions endoscopica lly visible in 12.6% of cases. The authors' experience shows that tran sbronchial and percutaneous approaches must be considered complementar y and that their integrated use not only increases diagnostic yield bu t also permits important information to be obtained for disease stagin g. The creation bf teams able to use both approaches with the cytopath ologist present for ICA should be encouraged to optimize the diagnosti c management of PPN/M with a reduction in diagnostic and hospitalizati on time and consequent cost saving.