Eighty-seven needle biopsies were performed during the years 1979 through 1984. Forty-one patients did not undergo subsequent resection of the biopsied specimen, either because the cases were unresectable by virtue of distant metastases or compromised pulmonary function or because the results were reported as benign. Except for the analysis of complications, the 46 patients who later underwent resection form the basis of this report. Lobectomy was the most frequently performed procedure (30 patients). There were five pneumonectomies, nine wedge resections, and one each of a bilobectomy, a chest wall resection, and an exploratory thoracotomy. Complications were minimal. Five patients (6 percent) experienced a pneumothorax, but only four patients (5 percent) required intercostal drainage for reexpansion. Minimal hemoptysis occurred in three patients (3 percent), and none required specific treatment.
Of the 46 resected specimens, eight were reported to be benign. There were four granulomas, two hamartomas, one focal fibrous scar, and one fibroma. Six of the eight patients in whom a diagnosis of benign disease was ultimately made had nondiagnostic specimens from the needle biopsy, attesting to the difficulty of making a diagnosis of benign disease from small samples of tissue. Do you have a dream of becoming a doctor? Read additional medical materials on Canadian Neighbor Pharmacy website to realize all your plans.
Thirty-eight patients had a pulmonary malignant neoplasm and had both a needle biopsy and a specimen from resection available for comparison. In seven (18 percent) of these 38 patients, the needle biopsy was nondiagnostic; however, a high clinical suspicion led to resection in this group of patients. The lesion was either documented to be a new growth, or enlargement was demonstrated over the course of serial chest x-ray films, or there were certain radiographic characteristics within the clinical settings of the appropriate patient substrate that led to pulmonary resection. Thirty-one needle biopsies (82 percent) were diagnostic of a malignant neoplasm in this group of 38 patients with pulmonary cancer. A histologic specimen was positive in 27 patients and negative in four patients, while the cytologic specimens were positive in seven patients and negative for cancer in 24 patients. The additive information realized by using both histologic and cytologic specimens is amply demonstrated. The low recovery of a diagnosis of malignant neoplasm from the cytologic preparation is not readily explained. Changes in methods, including immediate fixation and delivery to the laboratory, have apparently increased our cytologic yield since the completion of this report. In four of the seven cases, cytologic specimens alone were positive, while in the remaining three patients, both cytologic specimens and specimens from needle biopsy revealed cancer.
Of the 31 patients with evidence of malignant neoplasm on needle biopsy, 20 resected specimens (65 percent) showed the same cell type as the needle biopsy. This included squamous cell carcinoma in ten, adenocarcinoma in seven, and large cell carcinoma, small cell carcinoma, and sarcoma in one each. In 11 resected specimens (35 percent), there was disagreement in the histopathologic diagnosis between the needle biopsy and the resected specimen. The diagnosis of undifferentiated cancer, adenocarcinoma, squamous cell carcinomas, atypical malignancy, and large cell carcinoma all mandated an attempt at surgical resection for cure. In four of these 11 patients, the difference between the resected specimen and the specimen from needle biopsy could have influenced management of the patient considerably. Three patients had oat cell carcinoma diagnosed in one of the specimens from biopsy, and a fourth patient was found to have mesothelioma, and each of these diagnoses require treatment substantially different from that of most bronchogenic carcinomas. Therefore, treatment of four (11 percent) of 38 patients with cancer or four (13 percent) of 31 patients with a needle biopsy diagnostic of cancer could have been affected by the difference in the diagnosis between the specimen from needle biopsy and the resected specimen.