Safety maximization of percutaneous transthoracic needle biopsy with ultrasound guide in subpleural lesions in the evaluation of pulmonary consolidation

Abstract

The study by Kiranantawat et al. “Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation” highlights how “pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy”. Even if we agree about the role of CT guidance, we would like to point out how Thoracic Ultrasound could be better than CT for biopsy of subpleural lesions that could easily be detected and reached with this “real-time” and quicker technique.

Transthoracic Ultrasound and Intraoperative Lung Ultrasound

“…Transthoracic Ultrasound (TUS) is a well-established imaging technique, mainly used for pleural and subpleural diseases adherent to the 70% of pleural surface visible by ultrasound [1]. The TUS role in thoracentesis, in pleural drainage guidance and in US-guided pleural and subpleural lesions biopsies has been clearly established also in the British Thoracic Society (BTS) guidelines [2,3]. However, a deep knowledge of ultrasound basic physics principles and a proper training are crucial in order to avoid images misinterpretation [4].…”

Recommendations for Operation, Measurement, Reporting and Application of Pediatric Lung Ultrasound: Chinese Experts Consensus

“…For neoplastic diseases, lung ultrasound can identify nodules and metastatic lesions in the pleural cavity and subpleural areas [11]. In interventional surgery, guiding the biopsy of sub-pleural lung parenchyma or lung nodules in real time is another application of lung ultrasound [12]. Sine there are no contraindications for pediatric lung ultrasound, it could be safely carried out in pediatric patient population [13,14].…”

“…Ultrasound-guided thoracentesis biopsy, aspiration, or catheter drainage increase the accuracy and safety of clinical procedures in pediatric [12].…”

Commentary: Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs

“…US-guided lung biopsy has success rate similar to CT-guided biopsies (which is the gold standard) in the assessment of the cyto-histological diagnosis of peripheral lung lesions, but offers lower complications, less time, and less cost without radiation exposure (Frongillo et al, 2018;Sperandeo et al, 2019). A new US contrast agent, SonoVue, (Bracco SpA), has emerged in recent years for USguided biopsy of lesions of the liver (D'Onofrio et al, 2015), thyroid (Zhan and Ding, 2018), and mediastinal cancers (Fu et al, 2016), but it has also been proposed, off label, for the study of peripheral lung lesions in contact with the pleural surface (Cao et al, 2011;Dong et al, 2015;Sidhu et al, 2018).…”

“…The needle (18 gauge) is labeled with a centimeter scale to have the highest precision level. (Sperandeo et al, 2019) (Figure 1). Also, the pathologist's experience with pulmonary lesions is crucial for a satisfactory diagnosis.…”