Ultrasound- Versus CT-Guided Subpleural Lung and Pleural Biopsy: An Analysis of Wait Times, Procedure Time, Safety, and Diagnostic Adequacy

Abstract

Purpose: To compare the wait times, safety, and diagnostic adequacy of computed tomography (CT)–guided percutaneous lung biopsies with ultrasound (US) guidance for subpleural lung and pleural lesions. Methods: Consecutive CT- and US-guided biopsies performed at our institution between January 2018 and January 2019 were retrospectively reviewed. Biopsy wait times, lesion size, degree of pleural contact, procedure duration, number of needle passes, complications, and pathologic diagnosis were recorded and compared. Results: A total of 158 biopsies of subpleural or pleural-based lesions were reviewed. Forty-three cases utilized US guidance, while 115 cases used CT, 41 with conventional CT (CCT), and 74 with cone-beam CT guidance (CBCT). Overall, the mean lesion maximum axial diameter and length of pleural contact for US-guided biopsies was greater than for CT (4.8 ± 2.6 cm vs 3.2 ± 1.9 cm and 4.0 ± 2.5 cm vs 2.6 ± 1.7 cm, respectively, P < .001). Wait times for US-guided biopsies were significantly shorter than CCT by 10.9 days on average while being equivalent to CBCT. Procedure time was shorter for lesions localized with US than CT (29.5 ± 16.4 minutes vs 37.6 ± 19.5 minutes, P = .007) despite CT using less needle passes per lesion (3.5 ± 1.1 vs 3.1 ± 0.8, P = .034). Sample adequacy was equivalent for both modalities (88% for US and 92% for CT). The frequency of pneumothoraces was similar between US (12%) and CT (15%). Conclusion: Ultrasound and CT guidance have similar safety and diagnostic adequacy for subpleural lung and pleural biopsies. Ultrasound guidance has shorter wait and procedure times.

Marked safety and high diagnostic yield of freehand ultrasound‐guided core‐needle biopsies performed by pulmonologists

“…The overall success rate for ultrasound‐guided biopsies in this study was 91.1%, which is a highly diagnostic value that correlates with similar reports on CT guided biopsies 8–10,14–16 . In our study, the average lesion size was 51.6 mm, with the largest lesion in the mediastinum measuring 97.7 mm and the smallest was a supraclavicular lymph node measuring 27.3 mm.…”

“…The overall success rate for ultrasound-guided biopsies in this study was 91.1%, which is a highly diagnostic value that correlates with similar reports on CT guided biopsies. [8][9][10][14][15][16] In our study, the average lesion size was 51.6 mm, with the largest lesion in the mediastinum measuring 97.7 mm and the smallest was a supraclavicular lymph node measuring 27.3 mm. We achieved a very high diagnostic yield of 95.7% in the lung mass group, which is in the top tier of previous reported US and CT guided lung biopsies using GNB.…”

“…Notwithstanding, our complication rate is lower than previous studies which report 2.7%-12.8% using US guided percutaneous biopsy (UG-PNB). [13][14][15][16][17] Moreover, in previous studies comparing US-and CT guided biopsies of lung and pleural lesions, US was associated with a lower complication rate and improved safety. 14,17 Although these data are compelling, our study had several limitations.…”

“…[13][14][15][16][17] Moreover, in previous studies comparing US-and CT guided biopsies of lung and pleural lesions, US was associated with a lower complication rate and improved safety. 14,17 Although these data are compelling, our study had several limitations. First, the inherent limitations of a retrospective data analysis study design with small sample sizes across the subgroups weaken our statistical analysis power.…”

“…We achieved a very high diagnostic yield of 95.7% in the lung mass group, which is in the top tier of previous reported US and CT guided lung biopsies using GNB. [13][14][15][16] The average lesion size was 59.5 mm, and the average pleural contact length was 80 mm. Previous studies presented a mean size of lesions ranging from 41.5-70 mm.…”