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• W2037193295 abstract "To the Editor:I read with great interest in the October 1990 issue of Chest the excellent paper by Dr Torres and colleagues1Torres A Jimenez P Puig de la Bellacasa J Celis R Gonzalez J Gea J Diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia..Chest. 1990; 98: 840-844Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar on the subject of percutaneous lung needle aspiration (PLNA) in patients with pneumonia. However, the authors' interpretation of our published data on this subject2Berger R Arango L Etiologic diagnosis of bacterial pneumonia in seriously ill patients..Crit Care Med. 1985; 13: 833-836Crossref PubMed Scopus (27) Google Scholar was not entirely correct. In that article, we reported a study on the diagnostic adequacy of tracheobronchial secretions for establishing the cause of nosocomial pneumonias in critically ill patients. In order to do this, we purposely studied only patients in whom a “gold standard” culture had firmly established the cause of the pulmonary infection. Thus, by definition, our study included only patients who had a positive PLNA result, since those with a negative result were automatically excluded from the final analysis. Obviously, under these circumstances, our report that 11 of 11 PLNAs were positive should not be construed to mean that the sensitivity of the procedure was 100 percent.Torres and colleagues found a diagnostic sensitivity of 37.5 percent for PLNA in their patients. Reported sensitivities for PLNA in the context of pulmonary infections have varied widely, ranging from less than 40 percent to over 75 to 90 percent.3Tobin MJ Diagnosis of pneumonia: techniques and problems..Clin Chest Med. 1987; 8: 513-527PubMed Google Scholar, 4Castellino RA Blank N Etiologic diagnosis of focal pulmonary infiltrates in immunocompromised patients by fluoroscopically guided percutaneous needle aspiration..Radiology. 1979; 132: 563-567Crossref PubMed Scopus (54) Google Scholar, 5Moser KM Mauer J Jassy L Kremsdorf R Konopka R Shure D et al.Sensitivity, specificity, and risk of diagnostic procedures in a canine model of Streptococcus pneumonia..Am Rev Respir Dis. 1982; 125: 436-442PubMed Google Scholar, 6Mimica I Donoso E Howard JE Ledermann GW Lung puncture in the etiologic diagnosis of pneumonia: a study of 543 infants and children..Am J Dis Child. 1971; 122: 278-282Crossref PubMed Scopus (91) Google Scholar Such variability in diagnostic yield is most likely due to such factors as differences in patient characteristics, type of infection being investigated, and technique used for obtaining and processing the aspirated samples. In addition, we have previously reported7Berger R Arango L The value and safety of percutaneous lung aspiration for children with serious pulmonary infections..Pediatr Pulmonol. 1985; 1: 309-313Crossref Scopus (5) Google Scholar that prior antimicrobial therapy has a definitive and significant negative impact on the diagnostic yield of PLNA in patients with pneumonia. Indeed, the possibility that prior antimicrobial therapy negatively affected diagnostic yield in their study was included by the authors in the discussion of their findings. I would suggest that another potential contributing factor for decreased diagnostic yield is that without fluoroscopic guidance, as used by Torres and co-workers, one cannot be absolutely certain that optimal needle placement within a significantly infiltrated or consolidated lung area is achieved in all cases. To the Editor: I read with great interest in the October 1990 issue of Chest the excellent paper by Dr Torres and colleagues1Torres A Jimenez P Puig de la Bellacasa J Celis R Gonzalez J Gea J Diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia..Chest. 1990; 98: 840-844Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar on the subject of percutaneous lung needle aspiration (PLNA) in patients with pneumonia. However, the authors' interpretation of our published data on this subject2Berger R Arango L Etiologic diagnosis of bacterial pneumonia in seriously ill patients..Crit Care Med. 1985; 13: 833-836Crossref PubMed Scopus (27) Google Scholar was not entirely correct. In that article, we reported a study on the diagnostic adequacy of tracheobronchial secretions for establishing the cause of nosocomial pneumonias in critically ill patients. In order to do this, we purposely studied only patients in whom a “gold standard” culture had firmly established the cause of the pulmonary infection. Thus, by definition, our study included only patients who had a positive PLNA result, since those with a negative result were automatically excluded from the final analysis. Obviously, under these circumstances, our report that 11 of 11 PLNAs were positive should not be construed to mean that the sensitivity of the procedure was 100 percent. Torres and colleagues found a diagnostic sensitivity of 37.5 percent for PLNA in their patients. Reported sensitivities for PLNA in the context of pulmonary infections have varied widely, ranging from less than 40 percent to over 75 to 90 percent.3Tobin MJ Diagnosis of pneumonia: techniques and problems..Clin Chest Med. 1987; 8: 513-527PubMed Google Scholar, 4Castellino RA Blank N Etiologic diagnosis of focal pulmonary infiltrates in immunocompromised patients by fluoroscopically guided percutaneous needle aspiration..Radiology. 1979; 132: 563-567Crossref PubMed Scopus (54) Google Scholar, 5Moser KM Mauer J Jassy L Kremsdorf R Konopka R Shure D et al.Sensitivity, specificity, and risk of diagnostic procedures in a canine model of Streptococcus pneumonia..Am Rev Respir Dis. 1982; 125: 436-442PubMed Google Scholar, 6Mimica I Donoso E Howard JE Ledermann GW Lung puncture in the etiologic diagnosis of pneumonia: a study of 543 infants and children..Am J Dis Child. 1971; 122: 278-282Crossref PubMed Scopus (91) Google Scholar Such variability in diagnostic yield is most likely due to such factors as differences in patient characteristics, type of infection being investigated, and technique used for obtaining and processing the aspirated samples. In addition, we have previously reported7Berger R Arango L The value and safety of percutaneous lung aspiration for children with serious pulmonary infections..Pediatr Pulmonol. 1985; 1: 309-313Crossref Scopus (5) Google Scholar that prior antimicrobial therapy has a definitive and significant negative impact on the diagnostic yield of PLNA in patients with pneumonia. Indeed, the possibility that prior antimicrobial therapy negatively affected diagnostic yield in their study was included by the authors in the discussion of their findings. I would suggest that another potential contributing factor for decreased diagnostic yield is that without fluoroscopic guidance, as used by Torres and co-workers, one cannot be absolutely certain that optimal needle placement within a significantly infiltrated or consolidated lung area is achieved in all cases." @default.
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• W2037193295 title "Lung Needle Aspiration for Diagnosis of Pneumonia" @default.
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