ADDITIONAL INFORMATION FROM PERCUTANEOUS CUTTING NEEDLE-BIOPSY FOLLOWING FINE-NEEDLE ASPIRATION IN THE DIAGNOSIS OF CHEST LESIONS

Objective: To determine the contribution of percutaneous cutting needl e biopsy (PNB) subsequent to fine-needle aspiration (FNA) in the diagn osis of chest lesions. Design: A retrospective review of 220 patients who underwent CT-guided FNA followed immediately by PNB performed at o ur center between 1988 and 1995 was undertaken. Thirty-eight patients were excluded because FNA and/or PNB specimens were nondiagnostic, yie lding a study group of 182 patients. Results: A diagnosis of malignanc y was made in 141 (77.5%) and nonmalignancy in 41 (22.5%) cases. The y ield of histospecific diagnosis due to FNA was marginally higher than PNB in malignant lesions (86.5% vs 78%, respectively). In contrast, PN B was superior to FNA for the histospecific diagnosis of benign lesion s (87.8% for PNB vs 31.7% for FNA, p<0.00001) and lymphomas (88% for P NB vs 56% for FNA, p<0.05). In 58.8% of the patients with benign lesio ns and in 37.5% of the patients with lymphoma, PNB performances altere d clinical management, either by avoiding further surgery or allowing specific medical treatment. Pneumothorax occurred in 24.7% of the case s but only five patients (2.7%) required hospitalization. Conclusion: PNB is extremely effective for making a specific diagnosis in benign l esions compared with FNA. PNB does not increase the yield of histospec ific diagnosis for malignant lesions except for the subset of lymphoma , where it seems to provide important additional information in many i nstances, We recommend that FNA be performed as the initial procedure, followed by PNB in cases of equivocal diagnosis of carcinoma, for lym phoma and for suspected benign lesions.