Thoracic lesions: Diagnosis by ultrasound-guided biopsy

Abstract

We reviewed the results of US-guided fine-needle biopsies of peripheral pulmonary, pleural, mediastinal and chest wall lesions in 200 patients. Sufficient material for cytological analysis was obtained in 95%, 92%, 96% and 100%, respectively. Sensitivity was 88%, 94%, 96%, 100% and specificity 89%, 100% and 100%, respectively. The ratio of false-negative results was 7%. A cutting needle biopsy was additionally performed in 24 patients. All but two of the histological samples (92%) were adequate for diagnostic purposes and a correct diagnosis was established in 86% (19/22) of these. 8 patients (4%) with pleural or pulmonary targets had minor complications (5 pneumothorax, 3 haemoptysis), which did not require treatment. Cutting needle biopsies and biopsy of mediastinal lesions proved safe. Due to the many advantages US may be considered for guidance in peripheral larger-sized pulmonary lesions, particularly those abutting the pleura, and also in pleural, thoracic wall and mediastinal masses.

Pleuro-Pulmonary Aspergillosis

“…Using minimally invasive US-guided fine-needle aspiration as a diagnostic tool contamination from the upper airways can be avoided and the target and the needle tip can be continuously monitored during the needle insertion and aspiration, which is not possible in CT-guided biopsies. There were no complications in this study, supporting our previous 4% (8/200) rate of minor complications in USguided transthoracic FNABs (9). Drawbacks of US are that only lesions abutted to the chest wall can be seen and that it is very operator-dependent.…”

“…Aspergillosis usually affects the apex of the lung and re- sembles tuberculosis (4), and apical and pleural lesions are good targets for US-guided biopsy (7,9). Using minimally invasive US-guided fine-needle aspiration as a diagnostic tool contamination from the upper airways can be avoided and the target and the needle tip can be continuously monitored during the needle insertion and aspiration, which is not possible in CT-guided biopsies.…”

“…contrast enhancement (100 ml iopromide 300 mg II ml). The US-guided procedures (9) were carried out with a 3.75 or 5 MHz sector or convex transducer using a freehand technique. All imaging and clinical data were reviewed prior to FNAB.…”

“…FNAB has been used to diagnose both bacterial abscesses in the lung and pulmonary tuberculosis (9,12,13). Previous studies concerning biopsy of pulmonary fungal infections advocate fluoroscopic guidance for consolidations, coin and cavitating lesions (5), CTguidance for mycetomas (6) and cutting needle biopsy for consolidations (10).…”

Ultrasound-guided percutaneous thoracoabdominal biopsy. Efficacy, cost-effectiveness and safety

“…Although results from the first US‐guided thoracic FNAB was published as early as 1976, CT is still the most widely used guidance method for thoracic lesions (54). CT is used for deep‐seated, small and central pulmonary and mediastinal masses.…”