Safety and Yield of Ultrasound-Assisted Transthoracic Biopsy Performed by Pulmonologists

Abstract

Background: Transthoracic ultrasound (US) has gained popularity as a tool for visualizing pleural effusions and assisting thoracentesis or chest drain placement. In the absence of effusion, US just as well demonstrates solid masses involving or abutting the pleura, yet biopsy of such lesions is not widely performed by chest physicians. Objective: To assess the feasibility and the safety of US-assisted cutting needle biopsy performed by chest physicians in routine practice. Methods: Lesions involving or abutting the pleura ≧20 mm in diameter on US were sampled with a 14-gauge cutting needle under local anesthesia. Biopsy site, needle direction and depth of penetration were determined with US. The procedure was performed without direct US guidance in ‘free-hand’ technique. Results: Ninety-one patients underwent 96 cutting-needle biopsies for suspected peripheral lung tumors (n = 44, 46%), pleural-based (n = 39, 41%), mediastinal (n = 10, 10%), or chest wall lesions (n = 3, 3%), which were single in 71%, multiple in 6% and diffuse in 23%. Sensitivity for malignant neoplasms (n = 65) was 85.5% and 100% for mesothelioma (n = 10). Pneumothorax occurred in 4%. Conclusions: US-assisted cutting-needle biopsy of lesions ≧20 mm in diameter is safe in the hands of pulmonologists. The yield for neoplastic disease including mesothelioma is high.

Diagnostic yield and safety of ultrasound-assisted biopsies in superior vena cava syndrome

“…No pneumothoraces or major haemorrhage was caused, and only mild haemorrhage occurred in 4% of needle aspirations and 18.8% of biopsies. These findings are comparable to case series not limited to SVC syndrome [13,14].…”

“…US-assisted biopsy performed by clinicians on peripheral pulmonary and mediastinal mass lesions in the absence of SVC syndrome is a well-established practice [7,10,13,14,[16][17][18][19][20][21][22][23][24]. SAITO et al [16] described US-guided mediastinal biopsies .20 yrs ago.…”

“…Intrathoracic mass lesions abutting or invading the chest wall are visible at US [7][8][9]. Recent studies on US-guided transthoracic fine needle aspirations (TTFNA) utilising rapid on-site evaluation (ROSE) and US-assisted cutting needle biopsies (CNB) of mass lesions involving or abutting the pleura have shown that these procedures are not only safe but also have a high diagnostic sensitivity [13,14].…”

Intrathoracic tumors in contact with the chest wall – ultrasonographic and computed tomography guided biopsy comparative evaluation

“…In our series, we found three cases in which post-procedual CT showed a thin blood layer around the lesion. Adequacy rate of peripheral pulmonary or pleural lesion biopsy performed with a non fine needle is reported to be between 89.5% and 97% with CT guidance (6,9,10,23) and between 76%and 96 % with US guidance (17,19,20). Our values are comparable with those reported in the literature.…”

“…However, US has been described as a useful tool in the characterization of undetermined pleural or sub-pleural pulmonary nodules (13,16) when no aerated lung is interposed in between . Also, US can be used as a safe and effective method with which to guide biopsies of masses abutting the chest wall (5,(17)(18)(19)(20). Major advantages of this imaging modality are that US enables real time multiplanar monitoring of the procedure and can be performed at the patient bedside, without the use of ionizing radiation .…”