Should We Perform Transthoracic Trucut Lung Biopsies of Pleural-Based Lung Masses Under Ultrasound Guidance or Computed Tomography Guidance?

Abstract

We aimed to emphasize which method should be prioritized by comparing the ultrasound and computed tomography (CT) guidance for percutaneous transthoracic biopsy of pleural-based lung lesions in terms of comorbidity, diagnostic success, time, and costs. Approximately 700 biopsy procedures performed between 2014 and 2018 were retrospectively reviewed. The files of these patients and picture archiving and communication system were scanned. Size and localization of the lesion, pathological diagnosis, comorbidity status, pneumothorax complications at the end of the procedure, and whether or not a thoracic tube was placed due to pneumothorax were recorded. Fisher exact test and Pearson χ2 test were used for statistical analysis. A total of 181 patients who underwent the pleural-based biopsy procedure, the subject of study, were included in the study. One hundred (55.2%) of the biopsy procedures of these patients were performed under the guidance of tomography, and 81 (44.8%) were performed under the guidance of ultrasound (US). Median size of the lesions is 38 mm (25%–75%, 33–55 mm). Pneumothorax complications were observed in 6 patients (6%) who had CT-guided procedures and 4 patients (4.9%) who had US-guided procedures. Of the patients who developed pneumothorax, 2.8% were inserted thoracic tubes owing to the complication. Diagnostic efficacy of our procedures is 99.8% in US-guided procedures and 97% in CT-guided transthoracic biopsy. The average duration of US-guided transthoracic biopsy procedures is 17 minutes, and the average duration of CT-guided biopsy procedures is 35 minutes.

Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention

“…Percutaneous biopsy under CT guidance is often used for peripheral lung lesions nearby or adjacent to the chest wall, and percutaneous biopsy for peripheral lung lesions adjacent to the chest wall can be performed under both CT and ultrasound guidance. Compared with CT-guided biopsy, ultrasound-guided biopsy for peripheral lung lesions was simple, safe, realtime visualization, fewer complications, lower cost and no radiation exposure, the diagnosis rate similar to that of CT (5)(6)(7)(8). The defect of ultrasound guidance is easy to be affected by aerated lung tissue, narrow scope of application (only suitable for peripheral lung lesions adjacent to the chest wall), in addition, mastering ultrasound-guided puncture biopsy requires a long training period, which may be the reason why CT guidance is currently preferred more than ultrasound guidance in lung lesions puncture biopsy in many countries (9,10).…”

“…With the wide application of high-resolution CT and the established role of low-dose helical computed tomography (CT) screening for lung cancer, pulmonary lesions are increasingly detected (1,2). Image-guided biopsy is still required for lesions that cannot be determined by CT or malignant lesions diagnosed by CT need to be clarified histopathologically or genetic types before radiotherapy or chemotherapy (3)(4)(5). Percutaneous biopsy under CT guidance is often used for peripheral lung lesions nearby or adjacent to the chest wall, and percutaneous biopsy for peripheral lung lesions adjacent to the chest wall can be performed under both CT and ultrasound guidance.…”

Ultrasound-Guided Percutaneous Core Needle Biopsy of Peripheral Pulmonary Nodules ≤ 2 cm: Diagnostic Performance, Safety and Influence Factors

“…Currently, percutaneous US-guided core needle biopsy plays an increasingly important role in the management of PPLs (8). Some published studies had shown the feasibility and efficacy of US-guided percutaneous biopsy for PPLs (2,5,6,(9)(10)(11). It was reported that US-guided procedures could achieve a high success rate of 84%~96% (2), a pneumothorax rate of 1%~6%, and a hemorrhage rate of 3.3%~5.1% (2,6,12).…”

Efficacy and Safety of Ultrasound-guided Percutaneous Transthoracic Needle Biopsy for Peripheral Pulmonary Lesions: Comparison Between 16-gauge and 18-gauge Core Biopsy Needle- a Propensity Score Matching Analysis

“…On the other hand, US-guided percutaneous needle biopsy for PPLs was more advantageous than CT-guided procedure, such as radiation-free, convenient and cost-effective, real-time and dynamic [15][16][17]. Therefore, US-guided biopsy for PPLs that were adjacent to visceral pleura was a potentially feasible and reliable technique [18].…”

“…Some previous studies that focused on US-guided biopsy for PPLs have veri ed the e cacy and safety of this technique [16,18,19]. However, the procedures were almost performed with 18-gauge or 20-gauge core biopsy needle.…”