ULTRATHIN NEEDLE ASPIRATION OF THE LUNG IN INFECTIOUS AND MALIGNANT DISEASE

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Abstract
Patients (50) with malignant (n [number] = 25) or infectious/inflammatory (n = 25) chest lesions had lung aspirations using ultrathin needles, 24-25 gauge. The procedure''s overall sensitivity was 87%, and the specificity was 100%. The diagnostic yield was 90% (9/10) from peripheral malignant coin lesions, 100% (3/3) from malignant cavities and 42% (5/12) from infected, nonmalignant cavities. Antimicrobial therapy probably contributed to poor microbiologic results in the latter group. Of the patients, 22 previously had flexible fiberoptic bronchoscopy with negative results. In this select group, a diagnosis was established in 45% (10/22): 7 had malignant lesions, 2 had anaerobic lung abscesses, and 1 had histoplasmosis. In patients with infectious diseases, a variety of bacterial mycobacterial and fungal infections were confirmed, including the diagnosis of Legionella pneumophila in 2 patients. A definitive diagnosis was obtained in 6 of 8 immunosuppressed patients, who were presented with indeterminate infiltrates on chest radiographs. Complications were minimal, although 21 patients (42%) had COPD [Chronic obstructive pulmonary disease] and 13 patients (26%) had moderate to severe hypoxemia (PaO2 [arterial O2 pressure], 40-60 torr). Mild hemoptysis occurred in 2 patients (4%), and pneumothorax occurred in 4 patients (8%), of whom 2 required chest tube insertion. Compared to other studies using large gauge needles (18-22 gauge), ultrathin needle aspiration of the lung produced fewer complications, while maintaining an exceptionally good diagnostic yield.