Correct!
4. Percutaneous transthoracic fine needle aspiration biopsy
Bronchoscopy with transbronchial biopsy is unlikely to provide a tissue sample adequate for diagnosis for a lesion located as peripherally as this lesion, particularly when no connection to the airways is evident. Serial thoracic CT for growth is often an appropriate strategy for the evaluation of small indeterminate nodules or when opacities of undetermined significance for which biopsy would be difficult are present. However, for this patient, a large, mass readily accessible to percutaneous fine needle aspiration biopsy is present and the patient has symptoms referable to this lesion; therefore, an observational strategy is not appropriate in this circumstance. 18FFDG-PET scanning is unlikely to provide management-altering information in this circumstance. If 18FFDG-PET shows hypermetabolism within the mass, a tissue diagnosis would be warranted. However, the lack of tracer utilization within the lesion would not allow a non-invasive approach given the large size of the lesion and the fact that symptoms are referable to the lesion’s location. Finally, surgical lung biopsy could be considered, preferably using a thoracoscopic approach rather than an open one, but a surgical procedure is needlessly invasive when the lesion is so clearly amenable to a percutaneous approach.)
The patient subsequently underwent percutaneous transthoracic needle biopsy (Figure 3).
Figure 3. Prone thoracic CT image shows percutaneous needle biopsy of the left lower thoracic mass.
Based on the appearance of the lesion, which of the choices that follow is the most likely finding from the percutaneous biopsy procedure?