Tumors arising from the lung, pleura, or chest wall are a frequent problem in clinical
pulmonary medicine. Most lesions are either infectious, neoplastic or granulomatous in
nature, but a variety of other differential diagnoses must be considered. An accurate diagnosis
is important because the available treatments differ substantially, and because any delay will
impair the prognosis in potentially curable patients with lung carcinoma. The investigations
involve the disciplines of radiology, pulmonology, surgery, microbiology, and anatomical
pathology and consume a respectable amount of resources. The aim of the work covered in
this thesis was to optimize the available diagnostic methods for the routine use in a health
care setting with limited resources.
The general idea of this work was to identify conventional sampling methods that could be
developed further to become more useful for the diagnosis of chest tumors in a low resource
health care setting. The key method was research performed: a) to revise and expand the
indication for a sampling method, b) to technically improve the sampling process, and c) to
optimize sample transport, preparation and analysis in collaboration with the analytical
A list of invasive diagnostic procedures, imaging methods and analytical processes were
developed, evaluated and integrated into clinical practice. A) transbronchial needle
aspiration, B) transthoracic cutting needle biopsy, C) transthoracic fine needle aspiration, D)
transthoracic ultrasound, and E) rapid on-site evaluation of needle aspirates by a
cytopathologist. Five studies pertaining to this thesis were published in international peerreviewed
â ¢ Safety and yield of ultrasound-assisted transthoracic biopsy performed by
pulmonologists (Respiration 2004;71:519-22) This paper established that ultrasound-assisted transthoracic biopsy performed by
pulmonologists is feasible, safe, practical, low-cost and has a high yield.
â ¢ Utility of rapid on-site evaluation of transbronchial needle aspirates (Respiration
This paper demonstrated the economical advantages of on-site evaluation of transbronchial
specimens in a low-resource setting.
â ¢ Transbronchial needle aspirates: comparison of two preparation methods (Chest
This paper demonstrated that preparing smears on-site has a far better yield than pooling
samples into a vial. This means that the yield is improved over the current standard at no
â ¢ Transbronchial needle aspirates: how many passes per target site? (European
Respiratory Journal 2007;29:112-6)
This paper investigated the most economical and effective approach to serial sampling with
transbronchial needle aspiration during flexible bronchoscopy.
â ¢ Ultrasound assisted transthoracic biopsy: fine needle aspiration or cutting needle
biopsy? (European Respiratory Journal 2007;29:357-62)
This paper compared two common methods of sampling and demonstrates that the less
expensive method is sufficient in the majority of cases.
This work has impacted on current practice in multiple ways. Conventional methods have
been optimized by improving technical factors and with the integration of interdisciplinary
collaboration. The initiated research is ongoing with the aim to achieve continued technical
and economical improvements in the diagnosis of chest tumors.||en_ZA