Rheumatology 2000; 39: 776-782
© 2000 British Society for Rheumatology
Percutaneous image-guided biopsy of lung nodules in the assessment of disease activity in Wegener's granulomatosis
Departments of Rheumatology,
1 Radiology and
2 Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TT, UK
Objective. In patients with known Wegener's granulomatosis (WG) and persistent chest radiographic abnormalities, assessment for disease activity is often difficult, prompting the need for histological diagnosis to determine appropriate treatment. Here we report the use of automated image-guided core needle biopsy of pulmonary lesions for the assessment of disease activity in WG, rather than for primary diagnosis.
Methods. Image-guided percutaneous core needle biopsy was performed on five occasions in four patients with thoracic WG and persistent radiographic abnormalities of the chest. Clinical features, indication for biopsy, radiographic abnormalities and pathological findings were recorded.
Results. Adequate pathological specimens were obtained, allowing exclusion of infection and tumour. Active chronic inflammation with or without vasculitis was demonstrated in each case, indicating the need for further immunosuppressive therapy. A small pneumothorax following biopsy in one case required no treatment. Follow-up chest imaging revealed a reduction in the extent of thoracic disease following therapy in all cases.
Conclusions. The safety and diagnostic accuracy of image-guided core biopsy of thoracic lesions makes it a useful tool in the assessment of disease activity in WG patients with persistent chest radiographic lesions.
KEY WORDS: Wegener's granulomatosis, Pulmonary nodule, Biopsy.
Correspondence to: D. M. Carruthers, Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.