Abstract
Tissue pathology is integral for the diagnosis of various conditions, especially malignancy. Traditionally, biopsy procedures, including core needle biopsy (CNB), are performed by surgeons or radiologists. With the increasing utilization of point of care ultrasound (POCUS) skills and competence in bedside procedures by general internists, CNB can be safely moved to the patient’s bedside with maintained accuracy and increased cost savings compared to traditional procedural methods. We aim to review the experience of our hospitalist-run medical procedure service in performing these ultrasound-guided procedures at the bedside.
Highlights
Biopsy of a nodule, mass or lymph node is the gold standard for diagnosis of a variety of conditions, especially malignancy
core needle biopsy (CNB) is less prone to sampling errors and allows for better characterization of the target lesion compared to fine needle aspiration (FNA), often requiring less follow-up procedures [5,11,12]
Our medical procedure service (MPS) is comprised of five attending hospitalists and one nurse clinician trained in point-of-care ultrasound and basic bedside medical procedures
Summary
Mass or lymph node is the gold standard for diagnosis of a variety of conditions, especially malignancy. Pathology from open biopsy has historically provided better diagnostic yield, but FNA and CNB have gained traction as reasonable alternatives without sacrificing diagnostic outcomes [1,4,5,6,7]. Across a range of pathologies, the yield of CNB (81-95% sensitivity, 80-100% specificity, 93-95% accuracy) compared to FNA (63-80% sensitivity, 70-80% specificity, 80% accuracy) has made it a more preferable initial test of choice [8,9,10]. CNB is less prone to sampling errors and allows for better characterization of the target lesion compared to FNA, often requiring less follow-up procedures [5,11,12]. The addition of procedural ultrasound guidance provides safety benefit along with characterization of target lesions, contributing more pre-procedural bedside clinical information than other biopsy modalities [13,14]
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