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

Abstract

Background: To investigate puncture skills and complications prevention in ultrasound-guided percutaneous needle biopsy for peripheral lung lesions. Methods: Ninety-two peripheral lung lesions in 92 patients, detected via computed tomography (CT) and also visible on ultrasound, were retrospectively analyzed. All patients underwent percutaneous peripheral lung lesion needle biopsy under traditional ultrasound or contrast enhanced ultrasound (CEUS) guidance paying attention to avoiding necrotic areas and large blood vessels. All the specimens were examined histopathologically. Preprocedure all 92 lesions were performed by traditional ultrasonography to evaluate the size, the echogenecity, liquefaction areas and blood flow on color Doppler imaging, some of which were performed by CEUS for evaluating non-enhanced necrosis areas, contrast agent arrival time (AT) and characteristics of blood perfusion. Results: The histopathologic results of all 92 lesions were as follows: 67 malignant tumors (including 28 adenocarcinomas, 19 squamous cell carcinomas, 6 bronchoalveolar carcinomas, 5 small cell carcinomas, 5 metastatic cancers, 3 poorly differentiated cancers and 1 malignant mesothelioma), 20 benign lesions (including 9 pneumonia, 6 inflammatory pseudotumors and 5 tuberculomas), 5 undetermined lesions. Of 52 lesions by CEUS guidance, 7 lesions showed enhancement in the pulmonary arterial-phase (including 6 pneumonia and 1 malignant tumors), 45 lesions showed enhancement in the bronchial artery phase (including 37 malignant tumors, 3 inflammatory pseudotumors, 4 tuberculomas and 1 undetermined lesion).According to needle insertion angle along linear path, a total of 92 lesions were divided into two groups, 49 lesions at an angle of 70°-80° needle insertion and 43 lesions at an angle of 80°-90° needle insertion. In the study, linear and non-linear two puncture paths were used, we first tried to puncture along linear path in all lesions, if an attempt to insert into the lesions failed due to be blocked by the ribs and then changed to puncture along non-linear path instead. The success rate of biopsy procedure along linear puncture was significantly higher at an angle of 80°-90°group (93.0% vs. 20.4%, P<0.01), and the adoption rate of nonlinear path biopsy for solving the puncture needle blocked by the ribs was significantly higher at angle of 70°-80°group ( 79.6% vs. 7.0%, P<0.01). Of 52 lesions by CEUS guidance, 27 (51.9%) showed non enhanced necrosis areas on CEUS, only 5 showed liquefaction necrosis areas on gray-scale ultrasound. Of 40 lesions by traditional ultrasound guidance, 4 showed necrosis areas on gray-scale ultrasound. There were no significant differences in lesion size, the average number of biopsy attempts and complication rates between CEUS guidance group and traditional ultrasound guidance group (P>0.05), the pathological confirmation rate in CEUS guidance group was higher than that in traditional ultrasound guidance group, but without significant difference (98.1% vs. 90.0%, P>0.05). Of all 92 cases, 3 c...

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

“…There were no mortalities in all procedures. The results were comparable to previous studies that included various lesion size and reported rates of pneumothorax and hemorrhage ranging from 1%~6% and 3.3%~5.1%, respectively (2,6,12). Influence factors regarding patient characteristics, tumor profiles, needle size and needle passage were analysed.…”

“…In China, US-guided biopsy is usually preferred for PPLs, while CT-guided procedures are mainly recommended for lesions that cannot be displayed by ultrasound (6). Although CT-guided procedures have been well established in a previous study with a similar diagnostic rate compared with US-guided procedures for PPLs, a higher incidence of postprocedural pneumothorax were observed (7).…”

“…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).…”

“…To the best of our knowledge, data about diagnostic performance and safety of US-guided biopsy for small PPLs are still deficient. Most previous studies included cases with medium or large PPLs and did not systematically provide detailed analysis on small PPLs due to limited sample size, nor the procedures were performed under CT-guidance (2,5,6,9). To find out the influence factors of efficacy and safety would provide critical information to improve the diagnostic yield and lower the complication rate in biopsy for small PPLs.…”

Diagnostic yield of percutaneous computed tomography guided core needle biopsy of lung lesion and its complications in tertiary hospital

“…Computed Tomography (CT) offers the most accurate method of localizing the lung lesions regardless of its distance from skin and provides relevant information on needle trajectory within the lung as well. 1 Commonly described complication of lung biopsy is pulmonary haemorrhage leading to haemoptysis or hemothorax. 2 Risk of various complications is affected by different parameters such as biopsy needle size, lesion size, lesion depth from pleura, number of pleural punctures during biopsy, needle traversing through fissure and emphysema in the path of the biopsy.…”