The Journal of the Arkansas Medical Society Issue 9 Vol 114 | Page 21

5. McWilliams A, Tammemagi MC, Mayo JR,
Roberts H, Liu G, Soghrati K, et al. Probability
of cancer in pulmonary nodules detected on
first screening CT. N. Engl. J. Med. 2013; 369:
910–9.
6. Centers for Disease Control and Preven-
tion (CDC) - Indicator Definition - Disability
and Health Data System (DHDS) - NCBDDD
[Internet]. Updated: November 30, 2015.
Available from: http://dhds.cdc.gov/guides/
healthtopics/indicator?I=smokingstatus Ac-
cessed: December 20, 2015.
7. Henschke CI, Yankelevitz DF, Naidich DP, Mc-
Cauley DI, McGuinness G, Libby DM, et al. CT
screening for lung cancer: suspiciousness of
nodules according to size on baseline scans.
Radiology 2004; 231: 164–8.
Figure 1c. Solitary fibrous tumor: One 20x field shows the classic “patternless pattern” architecture. There
are alternating hypocellular and hypercellular areas formed by bland and uniform oval to spindle cells in
haphazard storiform –like arrangements. On low power (4x) the classic “staghorn-shaped” vessels (arrow
heads) are scattered throughout the bland, fibroblastic cells which are intermixed with thick, hyalinized,
brightly eosinophilic collagen bands (arrow). [H&E]
support a trial of antifungal therapy for “granulo-
matous inflammation without a definitive diagno-
sis” despite absence of fungal elements on staining
and culture. 
Several limitations of our study need to be
acknowledged. Being a single-center retrospective
analysis, our data and power was limited; possi-
bly undermining few CT features that might also
predict an increased risk of malignancy in a mass.
The data available to us was only from transtho-
racic or EBUS guided needle aspirations. Finally, our
center is in the endemic area for fungal infections
such as histoplasmosis and blastomycosis, which
can explain a higher rate of infectious processes.
However, it is important to note that HIV prevalence
is lower in Arkansas compared to the national aver-
age, and no lung mass in our study was caused by
an opportunistic infection. 
Conclusion and future directions
Our study indicates that even though lung
cancer is the most common pathology found in
lung masses, its prevalence among such masses is
considerably lower now as compared to the stud-
ies from the past. Certain CT features can predict
an increased risk of lung cancer in a mass. Future
studies should be aimed at developing evidence-
based guidelines to improve accuracy of sampling
techniques and minimizing repeat sampling proce-
dures whenever possible. This study underscores
a need for a large-scale reevaluation of the state-
ment “a lung mass is almost always malignant,”
given that one of the major causal factors (smok-
ing) is declining in prevalence.
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Contact AMS for a complete list of references.
LIST OF ABBREVIATIONS
CT: computed tomography
SPN: solitary pulmonary nodule
IRB: Institutional Review Board
TTNA: transthoracic needle aspiration
EBUS-TBNA: endobronchial ultrasound-guided
transbronchial needle aspiration
IQR: Interquartile range
CI: confidence interval
HIV: human immunodeficiency virus
FNA: fine needle aspiration
PET: positron emission tomography
NPV: negative predictive value
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