Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations.

Marco Sperandeo,Antonio Varriale,Paolo Graziano,Concetta Di Micco,Gianmaria Ferretti,Marco Taurchini,Annalisa Simeone,Lucia Dimitri,Donato Lacedonia,Maria Arcangela Grimaldi,Elio Perrone,Evaristo Maiello,Carla Maria Irene Quarato,Antonio Mirijello,Salvatore De Cosmo

doi:10.3390/diagnostics11091641

Abstract

(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies.

Highlights

Pulmonary consolidations are the most common radiological findings encountered in outpatient and inpatient clinical care
In patients with multiple pulmonary lesions at chest CT scan, the one that was most clearly seen at transthoracic ultrasound (TUS) was selected as the main target for biopsy
TUS is an imaging method that has numerous limitations related to the presence of air in the lung and to the obstacle constituted by the bone structures of the rib cage

Summary

Introduction

Pulmonary consolidations are the most common radiological findings encountered in outpatient and inpatient clinical care. If in a patient with a fever and cough, newonset radiological infiltrates suggest the diagnosis of pneumonia, the investigation of patients with chronic lung lesions may be challenging It must be determined whether the lesion is likely to be benign or malign, secondly it is crucial to determine the histology and the correct stage if lung cancer is confirmed. If lung cancer is the most likely diagnosis and curative resectability is in doubt or lung function testing reveals that the patient is not candidate for surgical resection, the histological diagnosis should be confirmed by the least invasive procedure prior to introduce the appropriate chemotherapy or radiotherapy [1,4,5] In this context, percutaneous biopsy (PNB) of peripheral lung lesions is a less invasive technique that may play a critical role in obtaining pathologic proof of malignancy, guiding staging, and planning treatment with less complications. PNB under CT guidance is regarded as the gold standard for peripheral lesions, which cannot be diagnosed with bronchoscopy [6]

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