Aspiration biopsy in the diagnosis of pulmonary disease

We reviewed the results of 146 aspiration lung biopsies (ALB) performed on 140 patients over a five-year period. A negative fiberoptic bronchoscopy in patients with a pulmonary mass lesion or infiltrate was the major indication for ALB in this group. Seventy-two patients had various malignant chest lesions, 63 had benign or inflammatory pulmonary disease. A definite diagnosis was not obtained in the remaining five patients. The diagnostic accuracy of ALB was 73.6 percent in malignant disease and 17.5 percent in benign disease with no false positive results. Of 50 patients ultimately proven to have unresectable cancer, 46 (92.6 percent) were spared the necessity of exploratory thoracotomy for diagnosis by prior ALB. Complications included pneumothorax in 30 percent necessitating chest tube drainage in 14.3 percent. Minor hemoptysis occurred in 3.4 percent, hemothorax in 0.68 percent and subcutaneous emphysema in 1.36 percent. There were no deaths directly attributable to the procedure. We conclude that ALB is a valuable procedure in the diagnosis of malignant chest lesions, sparing exploratory thoracotomy for histologic diagnosis in many patients.