Transthoracic Image-guided Biopsy of Lung Nodules

When Is Benign Really Benign?

Clare Savage, Eric Walser, Vicki Schnadig, Kenneth J. Woodside, Evren Ustuner, Joseph B. Zwischenberger

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

PURPOSE: A pathologic diagnosis of malignancy by image-guided transthoracic fine needle aspiration (FNA) with or without (±) core biopsy is definitive. However, a benign diagnosis of a lung nodule by FNA ± core biopsy presents a management dilemma of resection for confirmation versus follow-up imaging and/or medical treatment. We propose three separate pathologic categories of benign diagnosis after FNA ± core biopsy: (i) benign specific (ie, aspergillosis); (ii) benign nonspecific (ie, fibrosis); and (iii) nondiagnostic. Our goal was to define when to resect "benign" nodules to avoid an unacceptably high false-negative rate. MATERIALS AND METHODS: All FNA ± core biopsy diagnoses considered nonmalignant at a single institution from 1996 to 2001 were retrospectively reviewed for management and outcomes by radiologic or pathologic follow-up. RESULTS: Ninety-five of 836 total cases with FNA ± core biopsies over the 5-year period were identified as nonmalignant and had complete pathologic or radiologic follow-up. Twenty-one of 95 had a benign specific diagnosis; all were true-negative for malignancy on radiologic (n = 17) or surgical (n = 4) follow-up. The remaining 74 had either benign nonspecific (n = 53) or nondiagnostic (n = 21) diagnoses. Seven of 53 benign nonspecific specimens (13%) and six of 21 nondiagnostic specimens (29%) were malignant at excisional biopsy or radiologic follow-up. Sixteen of 95 (17%) had a postprocedural pneumothorax requiring a chest tube. CONCLUSION: Transthoracic FNA ± core biopsy may yield a nonmalignant diagnosis as (i) benign specific, (ii) benign nonspecific, or (iii) nondiagnostic. Diagnosis-directed medical management is recommended for a benign specific diagnosis. Additional diagnostic studies, repeat biopsy, or resection is necessary for benign nonspecific and nondiagnostic biopsy results as a result of an unacceptably high rate of malignancy.

Original languageEnglish (US)
Pages (from-to)161-164
Number of pages4
JournalJournal of Vascular and Interventional Radiology
Volume15
Issue number2 I
StatePublished - Feb 2004

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Image-Guided Biopsy
Fine Needle Biopsy
Lung
Biopsy
Chest Tubes
Neoplasms
Aspergillosis
Pneumothorax
Diagnostic Imaging
Fibrosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Savage, C., Walser, E., Schnadig, V., Woodside, K. J., Ustuner, E., & Zwischenberger, J. B. (2004). Transthoracic Image-guided Biopsy of Lung Nodules: When Is Benign Really Benign? Journal of Vascular and Interventional Radiology, 15(2 I), 161-164.

Transthoracic Image-guided Biopsy of Lung Nodules : When Is Benign Really Benign? / Savage, Clare; Walser, Eric; Schnadig, Vicki; Woodside, Kenneth J.; Ustuner, Evren; Zwischenberger, Joseph B.

In: Journal of Vascular and Interventional Radiology, Vol. 15, No. 2 I, 02.2004, p. 161-164.

Research output: Contribution to journalArticle

Savage, C, Walser, E, Schnadig, V, Woodside, KJ, Ustuner, E & Zwischenberger, JB 2004, 'Transthoracic Image-guided Biopsy of Lung Nodules: When Is Benign Really Benign?', Journal of Vascular and Interventional Radiology, vol. 15, no. 2 I, pp. 161-164.
Savage C, Walser E, Schnadig V, Woodside KJ, Ustuner E, Zwischenberger JB. Transthoracic Image-guided Biopsy of Lung Nodules: When Is Benign Really Benign? Journal of Vascular and Interventional Radiology. 2004 Feb;15(2 I):161-164.
Savage, Clare ; Walser, Eric ; Schnadig, Vicki ; Woodside, Kenneth J. ; Ustuner, Evren ; Zwischenberger, Joseph B. / Transthoracic Image-guided Biopsy of Lung Nodules : When Is Benign Really Benign?. In: Journal of Vascular and Interventional Radiology. 2004 ; Vol. 15, No. 2 I. pp. 161-164.
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abstract = "PURPOSE: A pathologic diagnosis of malignancy by image-guided transthoracic fine needle aspiration (FNA) with or without (±) core biopsy is definitive. However, a benign diagnosis of a lung nodule by FNA ± core biopsy presents a management dilemma of resection for confirmation versus follow-up imaging and/or medical treatment. We propose three separate pathologic categories of benign diagnosis after FNA ± core biopsy: (i) benign specific (ie, aspergillosis); (ii) benign nonspecific (ie, fibrosis); and (iii) nondiagnostic. Our goal was to define when to resect {"}benign{"} nodules to avoid an unacceptably high false-negative rate. MATERIALS AND METHODS: All FNA ± core biopsy diagnoses considered nonmalignant at a single institution from 1996 to 2001 were retrospectively reviewed for management and outcomes by radiologic or pathologic follow-up. RESULTS: Ninety-five of 836 total cases with FNA ± core biopsies over the 5-year period were identified as nonmalignant and had complete pathologic or radiologic follow-up. Twenty-one of 95 had a benign specific diagnosis; all were true-negative for malignancy on radiologic (n = 17) or surgical (n = 4) follow-up. The remaining 74 had either benign nonspecific (n = 53) or nondiagnostic (n = 21) diagnoses. Seven of 53 benign nonspecific specimens (13{\%}) and six of 21 nondiagnostic specimens (29{\%}) were malignant at excisional biopsy or radiologic follow-up. Sixteen of 95 (17{\%}) had a postprocedural pneumothorax requiring a chest tube. CONCLUSION: Transthoracic FNA ± core biopsy may yield a nonmalignant diagnosis as (i) benign specific, (ii) benign nonspecific, or (iii) nondiagnostic. Diagnosis-directed medical management is recommended for a benign specific diagnosis. Additional diagnostic studies, repeat biopsy, or resection is necessary for benign nonspecific and nondiagnostic biopsy results as a result of an unacceptably high rate of malignancy.",
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T2 - When Is Benign Really Benign?

AU - Savage, Clare

AU - Walser, Eric

AU - Schnadig, Vicki

AU - Woodside, Kenneth J.

AU - Ustuner, Evren

AU - Zwischenberger, Joseph B.

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N2 - PURPOSE: A pathologic diagnosis of malignancy by image-guided transthoracic fine needle aspiration (FNA) with or without (±) core biopsy is definitive. However, a benign diagnosis of a lung nodule by FNA ± core biopsy presents a management dilemma of resection for confirmation versus follow-up imaging and/or medical treatment. We propose three separate pathologic categories of benign diagnosis after FNA ± core biopsy: (i) benign specific (ie, aspergillosis); (ii) benign nonspecific (ie, fibrosis); and (iii) nondiagnostic. Our goal was to define when to resect "benign" nodules to avoid an unacceptably high false-negative rate. MATERIALS AND METHODS: All FNA ± core biopsy diagnoses considered nonmalignant at a single institution from 1996 to 2001 were retrospectively reviewed for management and outcomes by radiologic or pathologic follow-up. RESULTS: Ninety-five of 836 total cases with FNA ± core biopsies over the 5-year period were identified as nonmalignant and had complete pathologic or radiologic follow-up. Twenty-one of 95 had a benign specific diagnosis; all were true-negative for malignancy on radiologic (n = 17) or surgical (n = 4) follow-up. The remaining 74 had either benign nonspecific (n = 53) or nondiagnostic (n = 21) diagnoses. Seven of 53 benign nonspecific specimens (13%) and six of 21 nondiagnostic specimens (29%) were malignant at excisional biopsy or radiologic follow-up. Sixteen of 95 (17%) had a postprocedural pneumothorax requiring a chest tube. CONCLUSION: Transthoracic FNA ± core biopsy may yield a nonmalignant diagnosis as (i) benign specific, (ii) benign nonspecific, or (iii) nondiagnostic. Diagnosis-directed medical management is recommended for a benign specific diagnosis. Additional diagnostic studies, repeat biopsy, or resection is necessary for benign nonspecific and nondiagnostic biopsy results as a result of an unacceptably high rate of malignancy.

AB - PURPOSE: A pathologic diagnosis of malignancy by image-guided transthoracic fine needle aspiration (FNA) with or without (±) core biopsy is definitive. However, a benign diagnosis of a lung nodule by FNA ± core biopsy presents a management dilemma of resection for confirmation versus follow-up imaging and/or medical treatment. We propose three separate pathologic categories of benign diagnosis after FNA ± core biopsy: (i) benign specific (ie, aspergillosis); (ii) benign nonspecific (ie, fibrosis); and (iii) nondiagnostic. Our goal was to define when to resect "benign" nodules to avoid an unacceptably high false-negative rate. MATERIALS AND METHODS: All FNA ± core biopsy diagnoses considered nonmalignant at a single institution from 1996 to 2001 were retrospectively reviewed for management and outcomes by radiologic or pathologic follow-up. RESULTS: Ninety-five of 836 total cases with FNA ± core biopsies over the 5-year period were identified as nonmalignant and had complete pathologic or radiologic follow-up. Twenty-one of 95 had a benign specific diagnosis; all were true-negative for malignancy on radiologic (n = 17) or surgical (n = 4) follow-up. The remaining 74 had either benign nonspecific (n = 53) or nondiagnostic (n = 21) diagnoses. Seven of 53 benign nonspecific specimens (13%) and six of 21 nondiagnostic specimens (29%) were malignant at excisional biopsy or radiologic follow-up. Sixteen of 95 (17%) had a postprocedural pneumothorax requiring a chest tube. CONCLUSION: Transthoracic FNA ± core biopsy may yield a nonmalignant diagnosis as (i) benign specific, (ii) benign nonspecific, or (iii) nondiagnostic. Diagnosis-directed medical management is recommended for a benign specific diagnosis. Additional diagnostic studies, repeat biopsy, or resection is necessary for benign nonspecific and nondiagnostic biopsy results as a result of an unacceptably high rate of malignancy.

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