Ultrasound Versus Computed Tomographic Guidance for Percutaneous Biopsy of Chest Lesions

Abstract

Objectives To compare ultrasound (US) versus computed tomography (CT) for primary guidance during needle biopsy of chest lesions. Methods Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act–compliant retrospective study, and the need for informed consent was waived. All US‐ and CT‐guided chest biopsy procedures performed between January 1, 2012, and October 15, 2014, at our institution were reviewed, and all procedures targeting peripheral intrathoracic and chest wall lesions were included. Axillary lesions, lung lesions without peripheral pleural contact, and mediastinal lesions without a transcutaneous US window were excluded. Radiologic, pathologic, and clinical records were reviewed. Results Fifty‐five procedures with primary US guidance (23 lung, 6 pleural, 2 mediastinal, and 24 chest wall) and 130 CT procedures (88 lung, 10 pleural, 7 mediastinal, and 25 chest wall) were performed. Diagnostic samples were obtained in 98% (54 of 55) of US procedures and 87% (113 of 130) of CT procedures (P = .02). Pneumothorax requiring treatment occurred in 2% (1 of 55) of US procedures and 5% (7 of 130) of CT procedures (P = .25). Computed tomographic localization was used in 29% (16 of 55) of US procedures. Nevertheless, the average patient radiation dose was significantly less in US procedures (182 mGy‐cm) versus CT procedures (718 mGy‐cm; P< .01). The average procedure time was 40 minutes for US and 38 minutes for CT (P = .39). The average lesion size was 4.5 cm for US and 4.9 cm for CT (P = .14). Conclusions During biopsy of peripheral intrathoracic lesions and chest wall lesions, primary US guidance resulted in a higher likelihood of a diagnostic sample and a decreased patient radiation dose compared with CT guidance.

Curriculum for the Performance of Ultrasound‐Guided Procedures

“…Essentially not seen before ultrasound guidance introduction, these procedures are now taught routinely to trainees. A short list of references, which are available at the time of publication, has been supplied to support the use of ultrasound guidance for procedures …”

“…A short list of references, which are available at the time of publication, has been supplied to support the use of ultrasound guidance for procedures. [1][2][3][4][5][6][7][8] The aim of this task force was to create a standardized and broadly applicable ultrasound curriculum that can be used by any health care provider with appropriate education to incorporate ultrasound for procedural guidance into the provider's practice. During the past year, the task force developed this document through conference calls, a collaborative writing platform, and one in-person meeting.…”

Pengaruh Karakteristik Lesi Terhadap Adekuasi Ambilan Sampel Sitologi Pada Tindakan Biopsi Jarum Halus Transtorakal-Tuntunan Usg

“…Modalitas ini memberikan kombinasi tampilan anatomi cross sectional (termasuk menggambarkan anatomi vascular dengan USG color Doppler dan evaluasi internal echostruktur) dan visualisas ireal-time . 4,5 Penggunaan USG dalam mengambil contoh jaringan di regio toraks memiliki tantangan tersendiri. Hasil tampilan USG tidak dapat memberikan gambaran toraks yang utuh.…”

“…juga menunjukkan keberhasilan pengambilan sampel dengan ukuran kecil < 2cm pada biopsi tuntunan USG. 5 Rekomendasi dari British Thoracic Society menyebutkan sebisa mungkin biopsi paru transtorakal perkutan menggunakan tuntunan USG sebagai modalitas yang paling aman, cepat dan lebih murah. 4 Penggunaan jarum halus dalam penelitian ini juga memiliki hasil yang baik, sesuai dengan penelitian oleh Diacon dkk.…”

Chest wall – a structure underestimated in ultrasonography. Part III: Neoplastic lesions

“…A simultaneous use of color Doppler imaging allows to avoid damage to larger vessels( 3 – 7 , 9 – 11 , 31 , 32 ). Furthermore, compared to CT-guided procedures, this method is more effective in obtaining diagnostic material for assessment and does not involve patient exposure to the negative effects of ionizing radiation( 32 ).…”