Correct!
4. Percutaneous transthoracic fine needle aspiration and core biopsy
Given the peripheral nature of this lesion and the lack of an associated airway, flexible fiberoptic bronchoscopy is not the best method for obtaining a tissue diagnosis for the lesion in this patient. Mediastinoscopy cannot access the inferior thorax caudal to the posterior aspect of the subcarinal space, and the lesion in this patient has no mediastinal extension. Similarly, the lesion does not have contact with, and is not in proximity to, the esophagus, and therefore endoscopic ultrasound would not be a good choice for obtaining a tissue diagnosis in this patient. Video-assisted thoracoscopic surgery would be a useful procedure for obtaining a tissue diagnosis for this patient, but a tissue diagnosis could also be achieved less invasively using percutaneous transthoracic fine needle aspiration and core biopsy; the latter is the best method among those listed for obtaining a diagnosis for this patient.
Further clinical course: The patient underwent percutaneous transthoracic fine needle aspiration and core biopsy which showed a small spindle cell neoplastic process associated with areas of collagen, but no evidence of necrosis. Immunoperoxidase staining showed positivity for CD34, BCL2, CD99 and rarely faintly positive estrogen receptors, and pancytokeratin staining was negative. The histopathologic features are consistent with solitary fibrous tumor of the pleura.
Diagnosis: Solitary fibrous tumor of the pleura.
References