Abstract
BackgroundDefinitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.Materials and methodsIn total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.ResultsThe overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).ConclusionHigher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.
Highlights
Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample
The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively
The realtime ultrasound (US)-guided percutaneous needle biopsy for PPLs is more beneficial in terms of being radiationfree, convenient, economical and dynamic than the CTguided procedure [15,16,17]
Summary
Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. We compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications. Diagnosing peripheral pulmonary lesions (PPLs), defined as nodules directly in contact with the chest wall without an intervening aerated lung [1], continues to be a challenge [2,3,4]. Bronchoscopy, and percutaneous biopsy are frequently used to diagnose PPLs [5]. The realtime ultrasound (US)-guided percutaneous needle biopsy for PPLs is more beneficial in terms of being radiationfree, convenient, economical and dynamic than the CTguided procedure [15,16,17]. The US-guided biopsy for PPLs is considered a potentially feasible and reliable technique [18]
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