High diagnostic yield of ultrasound-guided percutaneous needle biopsy of peripheral lung and pleural lesions, lymph nodes, and other sites performed by respiratory physicians

Abstract

<b>Introduction:</b> Ultrasound-guided percutaneous needle biopsy (US-PNB) is typically performed by interventional radiologists to diagnose benign and malignant pulmonary pathologies. Emerging evidence suggests that accessible lesions can be sampled by respiratory physicians experienced in thoracic ultrasound. <b>Aims/Objectives:</b> To examine the diagnostic yield (DY) and safety of US-PNB of peripheral lung and pleural lesions, lymph nodes, and other accessible sites performed by respiratory physicians. <b>Methods:</b> Data was prospectively collected for consecutive US-PNBs in patients referred to an Australian respiratory physician-led outpatient service over three years (2016-2019). US-PNB was performed under local anaesthetic using real-time ultrasound guidance and rapid onsite cytology when available. Final diagnosis was determined in a lung oncology MDM, and 12-month follow-up data was available for all patients. <b>Results:</b> 162 US-PNBs were performed on 151 patients, with 11 patients undergoing an additional biopsy. The final diagnosis was malignant in 83% of cases. US-PNB was diagnostic in 135 cases, with an overall DY of 83% (95% CI 77-88). DY for pleural lesions was significantly lower than for non-pleural lesions (66% v 89%, p&lt;0.001). Sensitivity and specificity for detection of malignancy was 82% (95% CI 76-88) and 100% (95% CI 84-100) respectively. Pneumothorax occurred in four patients (2.5%), with one patient requiring ICC insertion. <b>Conclusion:</b> US-PNB of accessible thoracic lesions may be performed by respiratory physicians with a similar diagnostic yield and safety profile to interventional radiologists.