Role of Fine-Needle Aspirates of Focal Lung Lesions in Patients With Hematologic Malignancies

Role of Fine-Needle Aspirates of Focal Lung Lesions in Patients With Hematologic Malignancies

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Role of Fine-Needle Aspirates of Focal Lung Lesions in Patients With Hematologic Malignancies* Philip W. Wong, MD; Tihomer S ˇ tefanec, MD; Karen Brown, MD; and Dorothy A. White, MD, FCCP Objectives: To evaluate the yield and safety of transthoracic fine-needle aspiration (FNA) in the diagnosis of pulmonary disease in patients with hematologic malignancy. Design: Retrospective chart review. Setting: Tertiary-care medical center. Patients: 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. Results: 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. Conclusion: 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) Key words: fine-needle lung aspirate; immunocompromised patient; invasive radiology; lung cancer; transthoracic needle aspiration Abbreviations: BMT 5 bone marrow transplantation; FNA 5 fine-needle aspiration; INR 5 international normalized ratio; IR 5 interventional radiology; PT 5 prothrombin time; PTT 5 partial thromboplastin time T 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%. 1 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. 2,3 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-
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Role of Fine-Needle Aspirates of Focal Lung Lesions in Patients With Hematologic Malignancies

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