Abstract
In this study, a total of 58 patients with single subpleural pulmonary lesions (males: 36, females: 22, mean age: 63 ± 16.2 years) who underwent contrast-enhanced ultrasonography (CEUS) and had a definite diagnosis (benign lesions:25, malignant lesions:33) were enrolled. The number of biopsies, diagnostic accuracy rate, and the incidence of complications were recorded. The nodules were divided into two size subgroups: ≥5 cm (group 1), and <5 cm (group 2). The display rate of internal necrosis and change of pre-scheduled puncture paths were compared between subgroups. Also, the arrival times, intensity and uniformity of enhancement after the contrast agent injection, as well as the display rate of internal necrosis were recorded and compared between malignant and benign lesions. Finally, the average number of punctures was 2.9 ± 0.7 times. The total diagnosis rate was 98.3%. Local pneumothorax occurred in 2 patients. Hemoptysis occurred in 1 patient. No serious complications occurred. Internal necrosis was demonstrated in 20 of 58 lesions (34.5%). Sixteen of them had changed the planned puncture path due to the large necrosis area (80%, 16/20). For lesions in group 1, necrosis was found in 15 lesions and there was a statistically significant difference in the necrosis rate between the two subgroups (15/26 vs 5/32, p = 0.001). The change in the pre-scheduled puncture path occurred in 12 patients in group 1 while 4 patients in group 2 exhibited a change in the planned puncture path (p = 0.004). There was a statistically significant difference in the arrival times and intensity of enhancement between benign and malignant lesions (p < 0.05). In conclusion, CEUS guided biopsy is an effective, sensitive, and safe method for the diagnosis of pleural-based pulmonary lesions by facilitating a distinction between necrosis and active tissue. The current findings indicated that CEUS before a biopsy may be especially vital in lesions ≥5 cm.
Highlights
Lung cancer is a primary cancer that has become a major public health concern
A total of 58 patients with peripheral pulmonary lesions diagnosed by chest computed tomography (CT) and confirmed by pathological assessments between May 2016 and May 2018 were selected for the study
A contrast-enhanced ultrasonography (CEUS) examination was performed, and the size of the lesion, the target puncture region, and the presence or absence of perfusion defects as well as their range were confirmed on the basis of lesion perfusion
Summary
Lung cancer is a primary cancer that has become a major public health concern It is the most frequent cause of cancer-related mortality in men, and lung cancer-related morbidity and mortality are both increasing (Ferlay et al, 2015). Ultrasound-guided percutaneous lung biopsy has a success rate similar to that obtained with CT guidance, a lower complication rate, and a shorter operation time; it is more economical, does not involve radiation, and offers a more convenient puncture guidance method. This technique has gained wide acceptance in clinical conditions and shows satisfactory puncture results (Khosla et al, 2016). Conventional ultrasonography cannot distinguish between atelectatic lung tissue and necrotic lesions, which often results in false-negative biopsy results that can confound clinical diagnosis and treatment and cause complications (Wang et al, 2015)
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