Role of Fine-Needle Aspirates of Focal
Lung Lesions in Patients With
Philip W. Wong, MD; Tihomer S
tefanec, MD; Karen Brown, MD; and
Dorothy A. White, MD, FCCP
To evaluate the yield and safety of transthoracic fine-needle aspiration (FNA) in the
diagnosis of pulmonary disease in patients with hematologic malignancy.
Retrospective chart review.
Tertiary-care medical center.
Sixty-seven patients with a hematologic malignancy or after bone marrow transplanta-
tion (BMT) for a hematologic malignancy who underwent a total of 71 FNAs for diagnosis of an
unexplained parenchymal lung lesion from January 1, 1991, to June 30, 1999.
The underlying malignancy was lymphoma in 42 patients (63%), leukemia in 8 patients
(12%), after allogeneic BMT in 12 patients (18%), after autologous BMT in 3 patients (4%), and
other diseases in 2 patients. Radiographs showed focal abnormalities in all cases, and were
nodules in 37%, masses in 37%, focal infiltrates in 21%, and cavitary lesions in 5%. The yield of
FNA for a finding specific infection or cancer was 56% (40 of 71 FNAs). The FNA with
inflammatory changes was clinically sufficient in another 11 patients for a total yield of 72% (51
of 71 FNAs). The yield for lung cancer was 90% (9 of 10 FNAs), for pulmonary lymphoma was 68%
(21 of 31 FNAs), and for infection was 67% (10 of 15 FNAs). Complications occurred in 18 of 71
FNAs (25%), with pneumothorax in 14 patients (20%) and chest tube placement required in 4
patients (6%). Bleeding occurred in six patients (8%), including one death in a patient with
abnormal hematologic parameters.
Transthoracic FNA in patients with hematologic malignancy and focal lung lesions
has an excellent yield for detecting cancer and a yield comparable to bronchoscopy for the
diagnosis of infections. It should be considered a useful diagnostic tool in this setting.
(CHEST 2002; 121:527–532)
fine-needle lung aspirate; immunocompromised patient; invasive radiology; lung cancer; transthoracic
bone marrow transplantation; FNA
fine-needle aspiration; INR
interventional radiology; PT
prothrombin time; PTT
partial thromboplastin time
ransthoracic fine-needle aspiration (FNA) of the
lung is established as a diagnostic tool in the
evaluation of localized pulmonary lesions, particu-
larly nodules and masses. The sensitivity of FNA for
detecting malignancy has been shown to be 84 to
88%, with specificity close to 99%.
The role of FNA
in determining infectious pathogens is less well
studied, although reports of community-acquired
pneumonia and pneumonia in children suggest that
bacterial pathogens can be obtained.
The role of
FNA in the immunocompromised patient where
pulmonary complications are very common and
where opportunistic as well as usual infections, in-
flammatory disorders, and cancers are all found has
not been well studied. Bronchoscopy with BAL is
often the first diagnostic technique employed in this
group of patients, particularly when diffuse infil-
trates are present. However, FNA avoids contami-