Correct!
2. Percutaneous fine needle aspiration / core biopsy
While it may seem that all three tissue sampling procedures may again be equally appropriate, and the risk / benefit ratio is probably similar for all, percutaneous transthoracic fine needle aspiration / core biopsy is probably the best choice at this point. While surgical lung biopsy provides the largest tissue sample, and this benefit is often equated with optimal diagnostic accuracy, it generally provides tissue from the more peripheral aspects of the lung. Therefore, if the areas requiring targeting are located in deeper ling tissue, a surgical lung biopsy may not offer the best opportunity for diagnosis. In this patient, and adequate pulmonary parenchymal tissue sample was already obtained from the let lower lobe, and significant histopathologic abnormalities were seen, but none adequately explained the patient’s complaints and progressive scan abnormalities. On the thoracic CTs shown previously, several nodular lesions, most notably in the right upper lobe, have shown progression, and would provide good targets for tissue sampling. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy has the potential to provide a diagnosis in this patient, particularly given the bronchiolocentric nature of the dominant right upper lobe lesion(see panels C and D, Figure 9), but percutaneous fine needle aspiration / core biopsy can provide a larger amount of tissue sample for diagnosis than a transbronchial biopsy and allows direct visualization of the lesion to be targeted- these advantages of percutaneous fine needle aspiration / core biopsy make the best choice for a tissue diagnosis for this patient.
Further clinical course: The patient subsequently percutaneous fine needle aspiration / core biopsy (Figure 10), with the material retrieved showing B cell lymphocytes staining positive for CD 20, CD 3, CD 43, and CD 5, and absent staining for cyclin D1, all consistent with small lymphocytic lymphoma.
Diagnosis: Small lymphocytic lymphoma non-Hodgkin lymphoma, recurrent in the lung
References