Lung Cancer.pdf

34 F.V. Fossella
The use of flexible fiber-optic bronchoscopy to document the histologic
subtype has the added advantage of providing important staging information
in patients whose disease is potentially operable. For example,
bronchoscopy will document the proximity of the primary lesion to the carina
and may also occasionally reveal a synchronous lesion within the airways,
both important factors for the surgeon to consider in deciding
whether surgery is feasible. In addition, in selected patients, mediastinal
lymph nodes may also be sampled at bronchoscopy with transbronchial
needle aspiration.
Transthoracic Needle Aspiration Biopsy
Peripheral lesions that are inaccessible on flexible fiber-optic bronchoscopy
and mediastinal lymph nodes may be biopsied with transthoracic
needle aspiration (TTNA) under CT or fluoroscopic guidance. TTNA
biopsy is a relatively safe procedure; a severe pneumothorax (i.e., one requiring
chest tube placement) occurs in about 10% to 15% of procedures,
and patients with severe bullous disease are at higher risk. The yield of
TTNA biopsy is more than 90%, but the false-negative rate may be as high
as 20% to 30%. Therefore, if findings on TTNA biopsy are negative in a patient
in whom suspicion of cancer remains high, additional diagnostic
measures should be considered. These might include repeat TTNA biopsy,
fine-needle aspiration of another site of suspected disease (e.g., a liver
mass), open lung biopsy, or, in selected patients with small peripheral
nodules, video-assisted thoracoscopic surgery.
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