Does percutaneous fine-needle aspiration biopsy aid in the diagnosis and surgical management of lung masses?

OBJECTIVES: To evaluate the ability of percutaneous, transthoracic fine-nee dle aspiration biopsy (FNAB) to correctly diagnose intrathoracic masses, to determine what complications were experienced and at what rate they occurr ed and to define more clearly the role of this technique in the surgical ma nagement of lung masses. DESIGN: A chart review. SETTING: Kingston General Hospital, Kingston, Ont., a tertiary care centre and university-affiliated teaching hospital. PATIENTS: One hundred and thirteen patients who underwent 117 percutaneous transthoracic FNABs between Jan. 1, 1991, and July 1, 1996. OUTCOME MEASURES: Patient demographics, size and location of the lesion, di agnostic result of FNAB, complications of the procedure, smoking history, n umber of needle passes made by the radiologist and results of any other ava ilable biopsy (i.e., through bronchoscopy, mediastinoscopy, pleuroscopy) an d of surgical resection, as well clinical information pertaining to the dis ease state in patients with nondiagnostic or negative FNAB. RESULTS: Eighty-six masses (73.5%) were diagnosed as malignant, 31 biopsy s pecimens (26.5%) were either nondiagnostic or negative for malignancy. Of t hese specimens, 15 (48.4%) were subsequently shown to be cancer. In 64 biop sies (54.7%), the patient suffered pneumothorax, requiring hospitalization and chest tube insertion in 35 (29.9%) and 24 (20.5%) cases respectively. T he size of the lesion was related to both the diagnostic accuracy and the i ncidence of pneumothorax. C CONCLUSIONS: Percutaneous transthoracic FNAB should not be used routinely i n the assessment of patients with lung masses who are medically fit to with stand surgery and are free of widespread disease. The results of FNAB do li ttle to modify the course of surgical management in these patients.