Abstract
ObjectiveTo evaluate the accuracy and safety of contrast-enhanced ultrasound (CEUS) guided biopsy in the diagnosis of radiologically determined pleural based lesions.MethodA prospective study was conducted on patients with radiologically determined pleural based lesions. Patients who met the inclusion criteria received pleural biopsy guided by CEUS to obtain specimens, followed by histomathological and microbiological examinations. After treatment and follow-up, surgical thoracoscopy was performed on cases with undefinite diagnosis.ResultA total of 460 patients were finally included. CEUS showed internal necrosis in 72.17% cases and obvious peripheral vessels in 55.43% cases, both of which were significantly higher than the conventional ultrasound imaged (p < 0.05). The diagnostic accuracy through CEUS guided biopsy sampling was 98.91% (455/460). The microbiological diagnostic yield achieved 71.88% (225/313) in infectious lesions. In 330 cases combined pleural effusion, CEUS guided biopsy increased the diagnostic yield from 60.30% (199 /330) to 98.36% (325 /330) in all cases (p < 0.05), from 15.56% (14/90) to 94.44% (85/90) in malignant lesions (p < 0.01) and from 77.08% (185/240) to 100% (240/240) in infectious lesions (p < 0.05). No serious adverse events occurred.ConclusionCEUS guided biopsy provides a minimally invasive, effective and safe diagnostic biopsy method for pleural lesions.Clinical Trials Registration: Chinese Clinical Trial Registry ChiCTR2000029749 (ChiCTR, www.chictr.org.cn).
Highlights
Pleural lesion is a chest imaging manifestation of a variety of diseases, of which the diagnosis covers multidisciplinary areas regarding surgery, histopathology, microbiology and imaging, etc [1]
In 330 cases combined pleural effusion, Contrast-enhanced ultrasound (CEUS) guided biopsy increased the diagnostic yield from 60.30% (199 /330) to 98.36% (325 /330) in all cases (p < 0.05), from 15.56% (14/90) to 94.44% (85/90) in malignant lesions (p < 0.01) and from 77.08% (185/240) to 100% (240/240) in infectious lesions (p < 0.05)
Sun et al BMC Pulm Med (2021) 21:224 pleural biopsy was considered to be the best method for the diagnosis of pleural effusion of unknown causes and was useful in the diagnosis of malignant pleural disease with the diagnostic rate of 90–95% [2,3,4]
Summary
Pleural lesion is a chest imaging manifestation of a variety of diseases, of which the diagnosis covers multidisciplinary areas regarding surgery, histopathology, microbiology and imaging, etc [1]. The best specimen for the diagnosis of pleural disease is pleural tissue rather than pleural effusion [1]. It is well known that thoracoscopic biopsy is an invasive procedure which may not be the first choice in source-limited countries, especially in areas with high TB burdens. Ultrasound-guided closed biopsy (USCB), as a minimally invasive method, was advocated as a firstline initial diagnostic procedure for undiagnosed pleural effusion, especially in areas with high TB burdens [5, 6]. CEUS guided biopsy can conduct real-time guided and accurate targeted puncture biopsy, so as to avoid injury to adjacent organs and large blood vessels, which has the advantages of accurate guidance and fast access to high-quality specimens [8]
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