Computed tomographic diagnosis of bronchogenic carcinoma in HIV-infected patients

To describe the features of bronchogenic carcinoma (BC) on plain radiography and computed tomography (CT) in human immunodeficiency virus (HIV)-infected patients; to evaluate percutaneous transthoracic needle biopsy (PTNB) in this setting; and to assess outcome.

We reviewed the medical charts, radiographs and chest CT scans in 15 AIDS patients with histologically proven BC. All but one of the patients were young men (mean age 48 years) with a long history of smoking (mean 40 pack-years). Adenocarcinoma was the predominant cell type (46.6%). The stage of the malignancy did not correlate with the CD4 cell count (mean 189 per mm(3)). The diagnosis was obtained by means of PTNB (n=7), bronchoscopy (n=4), thoracotomy (n=2), pleural biopsy (n=1) or extrathoracic biopsy (n=1).

Parenchymal masses and nodules were the most common features (66.6%) on chest radiographs and CT. BC was peripheral in 11 cases (73%) and was located in the upper lobe in ten cases (66.6%). Enlarged lymph nodes were present in 60% of patients and metastases in 30%. PTNB was diagnostic in seven of the eight patients who underwent the procedure; complications included two pneumothoraces and one secondary implantation of tumor cells along the needle tract. Three lobectomies and one pneumonectomy were performed for stage I disease. The mean survival time among the patients who underwent surgery was 14 months. These survivals are more encouraging than some of those previously reported in the literature, furthermore, patients die of competing illnesses.

BC in HIV-infected patients is similar to that in the general population. Early diagnosis can be achieved by means of PTNB. Surgical resection, when feasible, significantly improves survival.