US-guided Percutaneous Needle Biopsy Research Articles

Ultrasound versus computed tomography guided percutaneous needle biopsy for subpleural pulmonary lesions

BackgroundSub-pleural pulmonary lesions (SPLs) can be diagnosed by percutaneous needle biopsy (PNB) guided by both computed tomography (CT) and ultrasound (US). This investigation aims to compare the diagnostic accuracy and safety between US- and CT-guided PNB for SPLs.MethodsThis retrospective study analyzed SPL patients who underwent CT- or US-guided PNB in our hospital between January 2022 to January 2023. Furthermore, the technical success rates, duration of procedure, diagnostic yield, diagnostic accuracy, pneumothorax rates, and hemoptysis rates were compared between the 2 groups. Pneumothorax risk factors were assessed via the univariate and multivariate logistic regression tests.ResultsThe data indicated that 213 patients who underwent CT- (n = 108) or US-guided (n = 105) PNB diagnosis had SPLs at the final diagnosis. Furthermore, both groups indicated similar operation times (20.1 ± 8.1 min vs. 19.9 ± 6.9 min, p = 0.793). The diagnostic accuracy and yield of the US group were 100% and 64.8%, respectively, whereas those of the CT group were 99.1% and 72.2%, respectively. Moreover, no significant differences were observed in diagnostic accuracy (p = 1.000) and diagnostic yield (p = 0.561) between the 2 groups. The CT group indicated markedly higher rates of chest tube insertion (6.5% vs. 0.0%, p = 0.014) and pneumothorax (24.1% vs. 1.9%, p = 0.001) than the US group. However, the hemoptysis rates were comparable between the 2 groups (2.7% vs. 2.9%, p = 1.000). In addition, CT guidance was the independent risk factor of pneumothorax (p = 0.003).ConclusionsIn summary, this research indicated that both US- and CT-guided PNB have high diagnostic accuracy for SPLs. However, US guidance may provide better safety than CT guidance.

Transthoracic Ultrasound in Infectious Organizing Pneumonia: A Useful Guide for Percutaneous Needle Biopsy.

In patients presenting with classical features of CAP (i.e., new peripheral pulmonary consolidations and symptoms including fever, cough, and dyspnea), a clinical response to the appropriate therapy occurs in few days. When clinical improvement has not occurred and chest imaging findings are unchanged or worse, a more aggressive approach is needed in order to exclude other non-infective lesions (including neoplasms). International guidelines do not currently recommend the use of transthoracic ultrasound (TUS) as an alternative to chest X-ray (CXR) or chest computed tomography (CT) scan for the diagnosis of CAP. However, a fundamental role for TUS has been established as a guide for percutaneous needle biopsy (US-PNB) in pleural and subpleural lesions. In this retrospective study, we included 36 consecutive patients whose final diagnosis, made by a US-guided percutaneous needle biopsy (US-PTNB), was infectious organizing pneumonia (OP). Infective etiology was confirmed by additional information from microbiological and cultural studies or with a clinical follow-up of 6–12 months after a second-line antibiotic therapy plus corticosteroids. All patients have been subjected to a chest CT and a systematic TUS examination before biopsy. This gave us the opportunity to explore TUS performance in assessing CT findings of infective OP. TUS sensitivity and specificity in detecting air bronchogram and necrotic areas were far lower than those of CT scan. Conversely, TUS showed superiority in the detection of pleural effusion. Although ultrasound findings did not allow the characterization of chronic subpleural lesions, TUS confirmed to be a valid diagnostic aid for guiding percutaneous needle biopsy of subpleural consolidations.

Diagnostic yield of ultrasound-guided transthoracic biopsy in peripheral lung lesions

BackgroundUltrasonography (US) guidance of transthoracic needle biopsy of peripheral lung lesions is a useful diagnostic technique. It is a relatively easy and safe procedure under real-time US guidance and may give enough tissue sampling of lesions for histopathological examination. The aim of this study was to determine the diagnostic accuracy and safety of this technique in the diagnosis of peripheral lung lesions.Patients and methodsA total of 60 patients underwent US-guided percutaneous needle biopsy of peripheral lung lesions from November 2017 to October 2018 in the Chest Department. The age of patients ranged from 27 to 79 years, with mean age of 58.4 years. Overall, 48 (80%) patients of the studied group were males, whereas 12 (20%) patients were females.ResultsAccording to the final diagnoses, 48 (80%) cases were malignant and 12 (20%) cases were benign. Diagnostic accuracy was 90%, sensitivity was 96%, both specificity and positive predictive value were 100%, and the negative predictive value was 60%. Pneumothorax and hemoptysis occurred in two (3.33%) patients each.ConclusionChest US-guided biopsy in the diagnosis of peripheral lung lesions is a safe and fast procedure with high diagnostic yield and fewer complications.

Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy.

Ultrasound (US)-guided percutaneous needle biopsy is a useful diagnostic technique with short examination time and real-time monitoring at the bedside. However, there are only a few studies that report on thoracic lesions, whereas the computed tomography (CT)-guided biopsy is well established. There is also limited data comparing US- and CT-guided biopsy. We aimed to clarify the efficacy and safety of US-guided biopsy for thoracic lesions adjacent to the chest wall. We retrospectively enrolled consecutive patients who underwent US- or CT-guided percutaneous biopsies for thoracic lesions adjacent to the chest wall between April 2012 and December 2017. Clinical characteristics, lesion size, lesion-pleura contact arc length (LPCAL), diagnostic rate, and complications were compared between the 2 groups. This study enrolled 61 US-guided and 70 CT-guided biopsies. No significant difference was found in age or sex. The lesion size and LPCAL in the US-guided group were significantly larger than those in the CT-guided group (P<0.0001). The diagnostic rate was marginally higher in the US-guided group (93.4%) than in the CT-guided group (84.3%) (P=0.101). When the median cut-off of the LPCAL was defined as 40 mm in all cases, the diagnostic rate for lesion size >40 mm was significantly higher in the US-guided group than in the CT-guided group (P=0.009). Complication rates were significantly lower in the US-guided group (3.3%) than in the CT-guided group (24.3%) (P<0.001). US-guided percutaneous needle biopsy for thoracic lesions adjacent to the chest wall is a feasible technique compared with CT-guided biopsy because of its higher diagnostic rate with a longer LPCAL and reduced complications.

Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging.

Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n=122) and IGM (n=48) were included in the final study group. There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19m/s (minimum-maximum 2.49-5.82) and 5.05m/s (minimum-maximum 2.09-8.46), respectively (p<0.001). The median internal velocity for IGM and malignant lesions was 2.76m/s (minimum-maximum 1.14-4.12) and 4.79m/s (minimum-maximum 2.12-8.02), respectively (p<0.001). The combination of VTI and VTQ as a complement to conventional US provides viscoelastic properties of tissues, and thus has the potential to increase the specificity of US.

Value of Ultrasound (US)-Guided Percutaneous Needle Biopsy of Detected Pathological Gastrointestinal (GI) Tract Lesions but Negative or Incomplete Endoscopy

The study aim was to investigate the diagnostic value of US-guided percutaneous needle biopsy in the case of suspicious tumor lesion of the GI tract revealed by abdominal US but without detection with endoscopy or with incomplete or no possible endoscopy. Over a defined time period, all consecutive patients with no appropriate endoscopic diagnostic specimen or finding were registered. The patient, diagnostic, and periinterventional characteristics were documented. In total, 16 patients (7 males; mean age, 63.2 [range, 43 - 90] years) were enrolled in this study representing a rare but possible constellation from endoscopic practice characterized by no detectable intraluminal tumor growth and a suspicious tumor lesion revealed with abdominal US as found in each case (n = 16) from 01 / 01 / 2003 - 12 / 31 / 2006. The main indications for needle biopsy were pathological colonic cockades (n = 7) and tumor lesions of the stomach and small intestine (n = 9). The first needle biopsy attempt was successful in all subjects (technical success rate: 100 %) using the color-coded US mode in each case (100 %). There were no postinterventional complications (rate: 0 %). Percutaneous US-guided needle biopsy can be considered a safe diagnostic tool for clarifying the differential diagnosis of suspicious tumor lesions of the GI tract (revealed originally only by abdominal US) as the next favorable diagnostic step in the rare situation that endoscopy cannot provide appropriate information, in order to shorten the diagnostic course, to achieve a therapeutic decision and to decrease effort and costs.

Hepatocellular carcinoma mimicking cavernous hemangioma on angiography and contrast enhanced harmonic ultrasonography. A case report

A 73-year-old man with chronic hepatitis due to hepatitis C virus was referred to our hospital for close examination of hepatic nodule. An abdominal ultrasonography revealed a mosaic pattern nodule with 3.7 cm in diameter. Arterial phase of dynamic CT revealed the small caudal part and marginal area of cranial part of the tumor were enhanced. The enhancement of marginal area of cranial part of the tumor continued up to portal phase and equilibrium phase and enhanced area was gradually filling in to the central area. On the other hand, the caudal part of the tumor was less enhanced compared with surrounding normal hepatic area in portal phase and equilibrium phase. An abdominal angiography revealed spotty tumor staining mimicking cotton-wool appearance, which is a typical finding for cavernous hemangioma. Contrast enhanced harmonic ultrasonography also showed hemangioma like finding (peripheral globular enhancing pattern). Because of these discrepancies on imagings, it was difficult to make final diagnosis of this tumor to be hepatocellular carcinoma since cavernous hemangioma cannot be completely ruled out. The pathological study of the specimen taken by US-guided percutaneous needle biopsy finally confirmed this nodule as hepatocellular carcinoma. In conclusion, we must keep in mind that some hepatocellular carcinomas could mimic hemangioma due to peliotic change or large acinar formation, therefore, needle liver biopsy may be essential for correct diagnosis if there is a discrepancy in several imaging findings.

The pump maneuver: an atraumatic adjunct to enhance US needle tip localization.

Real-time ultrasound (US)-guided biopsies and drainage procedures require constant visualization of the needle tip. Ensuring optimum needle tip visualization is paramount to the success of these procedures. The authors have found that pumping the stylet in and out of a stationary needle shaft increases the echo-genicity of the needle shaft and tip, thereby facilitating needle localization. This technique, which we have termed "the pump maneuver," is a quick, useful, and atraumatic adjunct to be considered during US-guided percutaneous needle biopsy and drainage procedures.