Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

Purpose

To investigate predictors of technical success and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of potentially malignant pulmonary tumors.

Material and Methods

From 2008 to 2009, technical success and rate of complications of CT-guided percutaneous transthoracic lung needle biopsies of patients with suspicious pulmonary tumors were retrospectively evaluated. The influence on technical success and rate of complications was assessed for intervention-related predictors (lesion diameter, length of biopsy pathway, number of pleural transgressions, and needle size) and patient-related predictors (age, gender, reduced lung function). In addition, technical success and rate of complications were compared between different interventional radiologists.

Results

One hundred thirty-eight patients underwent biopsies by 15 interventional radiologists. The overall technical success rate was 84.1% and was significantly different between interventional radiologists (range 25%-100%; p<0.01). Intervention-related and patient-related predictors did not influence the technical success rate. The overall complication rate was 59.4% with 39.1% minor complications and 21.0% major complications. The rate of complications was influenced by lesion diameter and distance of biopsy pathway. Interventional radiologist-related rates of complications were not statistically different.

Conclusions

Technical success of percutaneous, transthoracic lung needle biopsies of pulmonary tumors is probably dependent on the interventional radiologist. In addition, lesion diameter and length of biopsy pathway are predictors of the rate of complications.     

CT引导下经皮肺穿刺并发症的高危因素分析

目的:探讨CT引导下经皮肤肺穿刺并发症发生的高危因素.方法:回顾分析93例因肺部肿块行CT引导下经皮肤肺穿刺患者,对其性别、吸烟史、病灶大小、肿块类型、组织学分型、穿刺时体位、进针位置、进针角度和进针深度等因素与穿刺后并发症的相关性进行分析.结果:单因素分析显示吸烟史、病灶大小、肿块类型和进针深度在有并发症患者和无并发症的患者之间存在显著性差异(P＜0.05),多因素分析显示病灶大小、肿块类型和进针深度在两组患者间存在显著性差异(P＜0.05).结论:病灶大小、肿块类型和进针深度为CT引导下经皮肺穿刺并发症出现的高危因素.     

Transthoracic fine needle aspiration and core biopsy of pulmonary lesions. A study of 296 patients

OBJECTIVE: To retrospectively investigate and compare the usefulness of transthoracic fine needle aspiration (FNA), core biopsy and a combination of the two in the diagnosis of pulmonary lesions. STUDY DESIGN: Two hundred ninety-six patients who had undergone FNA, core biopsy or both for lung lesions were divided into malignant and benign groups according to the final diagnoses, which were based on the cytologic and histopathologic findings combined with clinical features. In each group, the diagnostic usefulness of FNA, core biopsy and a combination of the two were evaluated by comparing the results of each with the final diagnoses. RESULTS: In the malignant group, FNA was diagnostically helpful in 188 of 205 patients (91.7%) and core biopsy in 158 of 180 patients (87.8%). The combination of the two methods improved the result to 172 of 178 patients (96.6%). The sensitivities were 94.6%, 88.3% and 97.2%, respectively, for each result. In the benign group, 71.1% (64/90), 70.1% (47/67) and 74.2% (49/66) of cases received specific or nonspecific diagnoses by FNA, core biopsy and their combination, respectively. The rates of specific diagnoses were 20.1%, 21.0% and 31.8%, respectively. CONCLUSION: The combination of FNA and core biopsy markedly improved the diagnostic yields in the malignant group and, to a lesser degree, also in the benign group.     

Percutaneous core needle biopsy vs. fine needle aspiration in diagnosing benign lung lesions.

OBJECTIVE: To determine the diagnostic value of percutaneous core needle biopsy (PCNB) in comparison with fine needle aspiration (FNA) in patients with benign pulmonary lesions. STUDY DESIGN: A retrospective review was undertaken of computed tomography-guided PCNBs and FNAs performed between 1988 and 1997. Both FNA and PCNB biopsies were carried out sequentially at the same visit in every patient. RESULTS: A specific benign diagnosis was made in 10/60 cases (16.7%) by FNA and in 49/60 (81.7%) by PCNB. PCNB findings resulted in significant modification of the diagnosis established by FNA. The only significant complication encountered was pneumothorax, at a rate of 11.7%, which is compatible with that reported in the literature for complications induced by FNA alone. CONCLUSION: Radiologically guided PCNB is a safe procedure, can provide sufficient histologic material for a specific diagnosis of peripheral lung disease and can avoid more-invasive surgical procedures in many cases. Our experience demonstrated that the histologic analysis provided by PCNB can greatly increase the diagnostic accuracy in benign pulmonary diseases as compared with the yield of FNA.     

Fine needle aspiration biopsy in the diagnosis of intrathoracic masses.

During a 3.5-year period (January 1, 1987, to June 30, 1990) 420 percutaneous fine needle aspiration (FNA) biopsies were performed on 390 patients (309 males, 81 females) suffering from one or more intrathoracic, radiologically visible lesions. Aspirations were carried out using 21- or 23-gauge Chiba needles under fluoroscopic or computed tomographic control. The aspirates were used to make minibiopsies and cytologic smears. Diagnosis was possible in 373 cases (95.64%): on the first pass in 344 cases, on the second in 28 cases and on the third in 1. In 17 cases (4.36%) the aspirate was inadequate for diagnosis. There were complications in 10 cases (2.56%) (9 pneumothorax and 1 hemophtysis) requiring intensive care. The 373 percutaneous FNA biopsy diagnoses included 256 malignant tumors (68.63%), of which 234 were primary and 22 were secondary, and 117 benign lesions (31.37%), 5 of them neoplastic and 112 nonneoplastic. Three hundred two of 373 percutaneous FNA biopsy diagnoses were followed (80.96%). One hundred twenty-three follow-ups were histologic (40.73%), including secondary tumors, which could be compared with the primary histotype. Twenty-eight follow-ups were cytologic (9.27%), and 151 were clinical (50.00%), using progression of the disease or the beginning of chemoradiotherapy as a criterion for malignancy and a stable condition or regression of the lesion with nononcologic medical treatment as a criterion for benignity. Percutaneous FNA biopsy diagnoses were confirmed in 288 cases (221 true positives and 67 true negatives) and unconfirmed in 14 (1 false positive and 13 false negatives). Specificity, sensitivity, negative predictive value, positive predictive value and total diagnostic accuracy were, respectively, 98.52, 94.44, 83.75, 99.54 and 95.36%. The histologic typing accuracy of percutaneous FNA biopsy on 70 specimens of surgically removed malignant epithelial neoplasias was 70.00%. These results confirm that percutaneous FNA biopsy is a reliable method of diagnosing intrathoracic masses and reduces the need for diagnostic thoracotomy.     

超声引导下18针与20针穿刺活检对甲状腺结节的诊断效果比较

摘要 目的：比较超声引导下18针与20针穿刺活检对甲状腺结节的诊断效果。方法：选取我院超声科2018.8.6-2020.9.30共收治的167例甲状腺结节患者作为研究对象,将患者分为18针穿刺组（n=86）和20针穿刺组（n=81）,分别对两组患者应用超声引导下18针和20针穿刺活检,比较不确定结果的发生率,包括非诊断性或异型性/滤泡性病变的未确定显著性,恶性肿瘤的诊断性能在最终诊断的结节中进行评估。比较两组并发症发生率及超声引导下的核心针穿刺活检标本产率。结果：对比20针穿刺组和18针穿刺组患者的临床特征发现,两组患者性别、年龄、结节大小、结节形状、方位、回声强度、表现和钙化情况对比无明显差异（P＜0.05）;在20针穿刺组中43个结节和18针穿刺组中46个结节最终确诊。恶性结节的比例在两组之间没有显著差异。在最终诊断分析中,20针穿刺组有38个结节,18针穿刺组中有40个结节。在20针穿刺组,38个结节包括6个非诊断结果、18个不典型/滤泡性病变（未确定显著性）和14个滤泡性肿瘤。在18针穿刺组中,40个结节包括1个非诊断结果,22个不典型/滤泡性病变未确定的显著性,17个滤泡性肿瘤;18针穿刺组的未确诊率（包括非诊断结果和未发现显著性的异型性/滤泡性病变）较低（29.1 % vs 37.0 %）,尽管这一差异在统计学上没有显著性（P＞0.05）。然而,18针穿刺组的非诊断性结果发生率（1.2 % vs 8.6 %;P＜0.05）显著低于20针穿刺组。两组的不典型/滤泡性病变的发生率（27.8 % vs 28.4 %）相似。20针穿刺组的CNB显示出更高的敏感性（75.0 % vs 66.7 %）,更高的阴性预测值（NPV;83.9 % vs 75.9 %）和更高的准确率（78.3 % vs 74.4 %）,虽然结果没有达到统计显著性。两组的特异性（81.8 % vs 80.8 %）和阳性预测值（PPV;两者均为100 %）相似;18针穿刺组和20针穿刺组患者的并发症发生率对比无明显差异（P＞0.05）。结论：18针芯针活检对甲状腺结节的诊断较20针更有效,且不增加并发症情况,安全性好,值得临床应用推广。     

The Role of Percutaneous Lung Biopsy in the Workup of a Solitary Pulmonary Nodule

As the technique of percutaneous lung biopsy continues to evolve, it offers an increasingly accurate method of establishing the malignancy or benignity of a solitary pulmonary nodule. There are relatively few contraindications to the procedure, and the complications—primarily pneumothorax and hemoptysis—generally resolve without therapy. Transthoracic needle aspiration has an important role in the workup for a “coin lesion.” Other elements of the diagnostic workup—particularly the history, a chest roentgenogram, computed tomography, sputum cytology, and transbronchial brush biopsy—may either add to or substitute for a transthoracic needle aspiration biopsy. An algorithm can be used to guide the diagnostic approach to a solitary pulmonary nodule.     

Computed tomography-guided fine needle aspiration of peripheral lung opacities. An initial diagnostic procedure?

OBJECTIVE: To evaluate the results of computed tomography (CT)-guided fine needle aspiration (FNA) cytology following negative fiberoptic bronchoscopy and sputum cytology. STUDY DESIGN: Retrospective study of 64 patients who underwent CT-guided needle aspiration of lung opacities over one year. Following a review of the CT studies, patients were selected according to image characteristics of a primary neoplasm and pleural effusion in cases with pleural lesions. The lesions were classified into three categories--intrapulmonary and peripheral pulmonary, pleuropulmonary and pleural--and were localized and aspirated under CT using a fine needle (22-23 gauge) for obtaining cellular material. Lesions diagnosed as benign on FNA cytology were followed by serial CT scans for a period of two years at six-month intervals. RESULTS: Thirty-nine of 64 (61%) lesions were diagnosed as malignant on FNA cytology and 25 of 64 (39%) as benign. There was one false negative case. There were no serious complications from the procedure. CONCLUSION: FNA under CT guidance may be applied as the initial procedure in the diagnosis of peripheral malignant pulmonary lesions, rendering a high diagnostic yield.     

Percutaneous needle biopsy of the lung.

A total of 160 percutaneous needle biopsies of pulmonary lesions were performed in 149 patients. Cytological and bacteriological examination of the biopsy material yielded clinically useful information in 87% of these patients. False-negative diagnoses were made in 6%, but there were no false-positive diagnoses. In most patients the biopsy obviated the need for a diagnostic thoracotomy. The principal complication of the procedure was pneumothorax, which occurred in 24% of patients; the pneumothorax, however, was usually very small and only two of these patients required treatment with a pleural drain. There were no deaths in the series. It is concluded that percutaneous needle biopsy is an effective and relatively safe method of obtaining diagnostic material from a pulmonary lesion.     

Diagnostic Accuracy of PET/CT-Guided Percutaneous Biopsies for Malignant Peripheral Nerve Sheath Tumors in Neurofibromatosis Type 1 Patients

Background

Malignant peripheral nerve sheath tumors (MPNST) are one of the most frequent causes of death in patients with neurofibromatosis type 1 (NF1). Early detection is crucial because complete surgical resection is the only curative treatment. It has been previously reported that an ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) image with a T/L (Tumor/Liver) SUV_max ratio > 1.5 provides a high negative predictive value; however, it is not specific enough to make a NF1-related MPNST diagnosis. A formal proof of malignant transformation from a histological analysis is necessary before surgical excision because the procedure can cause mutilation. The objective of the present work was to investigate the effectiveness of and complications associated with PET/CT-guided percutaneous biopsies for an NF1-related MPNST diagnosis.

Methods

PET/CT-guided percutaneous biopsy procedures performed on 26 NF1 patients with a clinical suspicion of MPNST and a suspect lesion from a PET/CT scan (T/L SUV_max ratio > 1.5) were retrospectively evaluated. The localization of the suspected malignant site was determined using PET/CT. A stereotactic (ultrasonic and CT control) core biopsy technique was used with a local anesthesia.

Results

The first PET/CT-guided percutaneous biopsies enabled a pathological diagnosis for all of the patients (no "inconclusive " results were obtained), and no secondary procedures were needed. Among the 26 patients, the histopathological results from the biopsy were malignant in 17 cases and benign (BPNST with atypical cells) in nine cases. No complications from the diagnostic procedure were observed. A surgical resection was performed in 18 patients (seven benign and 11 malignant biopsies), removing the fine needle biopsy scar. In addition, six locally advanced/metastatic MPNST were treated with chemo/radiotherapy, and two BPNST had no progression after a follow-up of 14 and 39 months, respectively. The PET/CT-guided percutaneous biopsy gave 25 accurate diagnoses and one false negative (BPNST with atypical cells on the biopsy and MPNST on the operated tumor), resulting in a diagnostic accuracy rate of 96%. This false negative case may be explained by the high heterogeneity of the tumor: benign areas were contiguous with the malignant ones and associated with inflammation.

Conclusions

PET/CT-guided percutaneous biopsies are an effective and relatively non-traumatic procedure for diagnosis of NF1-related MPNST. It is the most reliable approach for early detection of MPNST.     

甲状腺良、恶性结节的临床、超声及细胞学特征分析

目的:研究良、恶性甲状腺结节的相关临床因素、超声特征与甲状腺细针穿刺细胞学检查结果之间的关系。方法:收集2010年1月至2013年12月在上海市第一人民医院因甲状腺结节就诊,并进行超声引导下FNAB检查患者的临床资料,以FNAB细胞学诊断结果为诊断标准,分析和比较不同性质甲状腺结节患者的年龄、性别、甲状腺疾病家族史、临床症状、血清甲状腺激素、甲状腺自身抗体(TPOAb和TRAb)水平,超声检查所发现的结节数量、性状、前后径与横径比(AP/TR)、回声类型、钙化类型、边界状态、血流情况等因素,采用Logistic多因素回归,探讨这些临床和超声特征与甲状腺良、恶性结节之间的关系。结果:根据FNAB结果,1592例患者中,良性结节者1492例,恶性结节者77例,结果不确定者23例。以良性组作为对照,年龄40岁、TPOAb(+)是恶性甲状腺结节的独立危险因素(P0.05);出现钙化点、细小钙化斑、边界不规整的超声表现的恶性甲状腺的风险显著升高(P0.05)。结论:超声检查甲状腺结节出现钙化点、细小钙化斑或边界不规整等与FNAB诊断的甲状腺恶性结节之间存在明显的关联。     

Use of navigation bronchoscopy for biopsy and endobronchial fiducial placement

Electromagnetic navigation bronchoscopy (ENB) is a technique that can be used to biopsy pulmonary lesions beyond areas that are traditionally accessible by bronchoscopy. It can also guide biopsies of peribronchial lymph nodes and guide the placement of fiducial markers for stereotactic radiosurgery. With ENB, the patient is placed in a magnetic field and their anatomy is merged with a 3D reconstructed chest cat scan (CCT). A locatable, steerable probe is used to guide a working channel to the target, usually a peripheral tumor. Biopsies can be taken, and markers can be placed. The accuracy of this system depends largely on a small bronchus leading toward to target. The diagnostic yield is similar to CT-guided biopsies, with a false-negative rate of about 30%, although results may be improved with combined ENB and radial endoscopic ultrasound (EUS). The incidence of pneumothorax is 5% to 8% with ENB-directed biopsies compared with approximately 30% with CT-guided transthoracic biopsy.     

Bronchial submucosal needle aspiration performed through the fiberoptic bronchoscope

Retrospective review of 251 bronchial submucosal needle aspirations obtained from 171 patients with unsuspected pulmonary malignancy showed that adequate cytologic material was obtained in 87.6% of the aspirations. Eighty-one patients were found to have primary bronchogenic carcinomas (with a visible endobronchial tumor in 39), and 21 had secondary pulmonary metastases. The overall diagnostic accuracy of bronchial submucosal aspiration was 81%, with only four definite false-negative and no false-positive results. The diagnostic accuracy was 82% for bronchial brushing, 71% for forceps biopsy, 67% for postbronchoscopy sputum cytology and 46% for bronchial washing. The major advantage of the submucosal aspiration technique was in evaluating mural mucosal lesions, especially those covered with intact mucosa, that were not readily accessible to forceps biopsy or successful brush sampling. Negative results from a needle aspiration must be interpreted with caution because of the small area a single sample represents. Multiple sequential submucosal aspirations may be helpful in assessing the resectability of bronchial neoplasms. No complications have been encountered with this technique.     

肺曲霉病40例的临床分析

目的：探讨肺曲霉病的临床表现、影像学特点、诊断和治疗,以提高对本病的认识。方法：回顾性分析本院2002年1月-2009年4月经病理确诊为肺曲霉病住院患者40例,总结其临床表现、影像学特点、诊断及治疗情况。结果：40例肺曲霉病患者中,曲菌球23例、侵袭性肺曲霉病17例。合并有基础疾病者36例（90．0％）：其中,肺结核15例（37．5％）,支气管扩张6例（15．0％）。肺曲霉病的主要症状为咳嗽32例（80．0％）,咳痰25例（62．5％）,咯血24例（60．0％0。影像学表现多样,肿块结节型23例（57．5％）,渗出型12例（30．0％）空洞样病灶12例（30．0％）,“洞中球征”和“晕征”各8例（20．0％）。所有病例均经过病理检出,手术切除后病理检出26例（65．0％）,纤维支气管镜下活检栓出12例（30．0％）,CT引导下经皮肺穿刺活检检出2例。本组病例中,26倒在病理诊断前被初诊误诊,误诊率高达65．0％,初诊为肺结核13例（32．5％）,肺癌8例（20．0％）,细菌感染3例,支气管扩张并感染2例。26例（65．0％）经外科手术切除,随访均无复发;10例（25．O％）经抗真菌药物治疗,9例痊愈或显效。结论：肺曲霉病多继发于肺部基础疾病,临床表现以咳嗽、咳痰、反复间断咯血为主,缺乏特异性;影像学表现复杂多样。曲菌球和侵袭性肺曲霉病的发病危险因素、临床表现、影像学以及治疗方法均有不同。肺曲霉病误诊率高,确诊有赖于组织病理学;外科治疗和抗真菌药物治疗有较好的疗效。     

Regulation of cell cycle transition and induction of apoptosis in HL-60 leukemia cells by lipoic acid: role in cancer prevention and therapy

 

The most common semiquantitative method of evaluation of pulmonary lesions using ¹⁸F-FDG PET is FDG standardized uptake value (SUV). An SUV cutoff of 2.5 or greater has been used to differentiate between benign and malignant nodules. The goal of our study was to investigate the correlation between the size of pulmonary nodules and the SUV for benign as well as for malignant nodules.

Methods

Retrospectively, 173 patients were selected from 420 referrals for evaluation of pulmonary lesions. All patients selected had a positive CT and PET scans and histopathology biopsy. A linear regression equation was fitted to a scatter plot of size and SUV_max for malignant and benign nodules together. A dot diagram was created to calculate the sensitivity, specificity, and accuracy using an SUV_max cutoff of 2.5.

Results

The linear regression equations and (R²)s as well as the trendlines for malignant and benign nodules demonstrated that the slope of the regression line is greater for malignant than for benign nodules. Twenty-eight nodules of group one (≤ 1.0 cm) are plotted in a dot diagram using an SUV_max cutoff of 2.5. The sensitivity, specificity, and accuracy were calculated to be 85%, 36% and 54% respectively. Similarly, sensitivity, specificity, and accuracy were calculated for an SUV_max cutoff of 2.5 and found to be 91%, 47%, and 79% respectively for group 2 (1.1–2.0 cm); 94%, 23%, and 76%, respectively for group 3 (2.1–3.0 cm); and 100%, 17%, and 82%,, respectively for group 4 (> 3.0 cm). The previous results of the dot diagram indicating that the sensitivity and the accuracy of the test using an SUV_max cutoff of 2.5 are increased with an increase in the diameter of pulmonary nodules.

Conclusion

The slope of the regression line is greater for malignant than for benign nodules. Although, the SUV_max cutoff of 2.5 is a useful tool in the evaluation of large pulmonary nodules (> 1.0 cm), it has no or minimal value in the evaluation of small pulmonary nodules (≤ 1.0 cm).     

Fine needle aspiration biopsy of the liver. A study of 102 consecutive cases

One hundred five CT-guided or ultrasound-guided fine needle aspirations of liver in 102 consecutive patients were reviewed. Adequate histologic confirmation or clinical follow-up of the final diagnosis was available for 86 of the 105 aspirations. A definite diagnosis of malignancy was made in 53 of the 61 aspirations performed on patients with malignant hepatic disease (86.9%). There were no false positives. The most common tumors detected were metastatic adenocarcinomas from an unknown primary or from the colon and rectum. The tumors were typed correctly in nearly all cases. Benign lesions encountered included cysts, abscesses, hemangiomas, cirrhosis and fatty metamorphosis. No serious complications were encountered as a result of aspiration. Guided fine needle aspiration biopsy of focal liver lesions appears to be an accurate, safe and relatively inexpensive method of diagnosis.     

The role of transbronchial lung biopsy in the diagnosis of solitary pulmonary nodule

Transbronchial lung biopsy (TBLB) is a well-recognized diagnostic technique in diffuse interstitial lung diseases, but it is not considered to be the first choice in investigation of solitary pulmonary nodules (SPN). The main idea of this study was to increase the sensitivity of bronchoscopy using multiple techniques, especially TBLB, thus to avoid more aggressive diagnostic procedures. The objective of this prospective study was to evaluate the efficacy and safety of TBLB in the diagnosis of SPN, in comparison with other bronchoscopic techniques. Fifty patients with chest x-ray finding consistent with SPN underwent bronchoscopy with bronchial washing, brushing, bronchoalveolar lavage (BAL) and TBLB were included in this study. Thirty-one patients suffered from malignant tumors, while 19 patients had nonmalignant lesions. TBLB achieved overall diagnostic sensitivity of 62%, BAL of 29%, bronchial brushing of 16% and washing of 6%. Combining all techniques together, bronchoscopy had overall sensitivity of 86%. Concerning malignant lesions, TBLB had a sensitivity of 65%, specificity of 100%, and accuracy of 82%. TBLB had a significantly better yield for lesions with a diameter > or = 25 mm than for lesions of < 25 mm (sensitivity of 82% and 53% respectively, p < 0.05). Diagnostic yield improved significantly with the increasing number of specimens (less than 3 specimens: sensitivity 59%, 3 or more specimens: sensitivity 87%, p < 0.05). Complications of TBLB occurred in 2 (4%) patients: 1 incomplete pneumothorax and 1 hemorrhage. According to the results, we conclude that TBLB is an accurate and safe technique for the diagnosis of pulmonary solitary nodule with a diameter equal or greater than 25 mm.     

FNAB thyroid gland: comparison study between pre- and post-operative histological diagnosis

Fine-needle aspiration biopsy is recommended as the first and most important step in the management of nodular thyroid disease. A retrospective study of 520 patients with nodular thyroid disease was done in the north of Jordan, between January 1998 and August 2001. We compared the results of fine-needle aspiration biopsy (FNAB) of thyroid gland with postoperative histological findings. The results are classified into three groups A)-benign, B)-malignant, and C)-suspicious as shown in table II. The results of the FNAB were benign in 96.4% of the cases which include benign colloid nodules (325 cases), multi-nodular goitre (70 cases), diffuse goitre (40 cases), thyroiditis (23 cases) and thyroid cysts (43 cases). A total of 52 patients underwent surgical management, 49 patients found to be accurate with the FNAB. The accuracy of FNAB was 94% (49 patients out of 52), with a specificity of 99% and a sensitivity of 93%. Ultrasound findings showed that 65% (338 patients) had solid nodules, 15% (78 patients) had cystic lesions and 20% (104 patients) had mixed echogenicity lesions. Histological confirmation of malignancy was 10 out of 11 patients with a 91% accuracy rate. FNAB was found to be a highly effective procedure, which can obviate a lot of unnecessary surgery in case of thyroid lesions, and avoid over treatment of benign disease. Surgery was recommended in all suspicious cases. FNAB under ultrasound guidance increases the sensitivity rate which can reach 100%. FNAB accuracy seems to be similar in cold and in hot nodules. Clinically, most of the patients with benign colloid nodules were having goitres suggesting the role played by iodine deficiency is which a prominent feature in that area in Jordan.     

Transthoracic fine needle aspiration biopsy in pulmonary lesions. Updated results

An investigation was carried out on 271 patients who underwent transthoracic fine needle aspiration biopsy ( FNAB ) for suspected pulmonary lesions in a four-year period; 80% of them had a malignant tumor. The histologic control of the cytologic diagnoses made on the transthoracic FNAB was possible in over 50% of the cases. The sensitivity and predictive value for positive results were, respectively, 0.890 and 0.995, whereas the typing accuracy verified in 58 cases on the surgical specimen was 0.76. The comparison of the data obtained from the most recent case material with that of early observations confirmed the high sensitivity of transthoracic FNAB in the detection and characterization of malignant lesions in the lungs. The sensitivity was almost identical for primary tumors, 0.90, and metastatic disease, 0.88. Furthermore, over the years the data showed an improvement in the results due to the experience gained, the combined use of cytology and histology and the application of histochemical methods. More sophisticated methods, such as immunocytochemistry and electron microscopy, were essential to the final diagnosis in only a few cases.