Pleural and Peripheral Lung Lesions: Comparison of US- and CT-guided Biopsy

Published Online:https://doi.org/10.1148/radiol.12112077

When dealing with pleural or peripheral lung lesions, US guidance is comparable to CT in terms of technical success rate, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.

Purpose

To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions.

Materials and Methods

Institutional review board approval was obtained, and the informed consent requirement was waived. From January 2000 to August 2011, 711 thoracic biopsies were performed at two institutions. Among these, 273 lesions in 273 patients (115 men, 158 women; mean age, 65 years ± 11 [standard deviation]; 86 pleural lesions; 187 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (170 patients; mean age, 64 years ± 12; 55 pleural lesions, 115 peripheral pulmonary lesions) or US (103 patients; mean age, 67 years ± 10; 31 pleural lesions, 72 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.

Results

No significant difference was found for patient age (P = .741), sex (P = .900), lesion size (P = .206), or lesion origin (P = .788). Median time was 556 seconds for CT-guided biopsy (25th percentile, 408 seconds; 75th percentile, 704 seconds) and 321 seconds for US-guided biopsy (25th percentile, 157 seconds; 75th percentile, 485 seconds) (P < .001). Postprocedural pneumothorax was observed in 25 of 170 (14.7%) CT-guided procedures and in six of 103 (5.8%) US-guided procedures (P = .025); hemorrhage occurred in two of 170 (1.2%) CT-guided procedures and in one of 103 (1.0%) US-guided procedures (P = .875). Technical success was achieved in 100 of 103 US-guided procedures (97.1%) and in 164 of 170 CT-guided procedures (96.5%) (P = .999).

Conclusion

With pleural or peripheral lung lesions, US guidance is comparable to CT guidance in terms of sample accuracy, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.

© RSNA, 2012

References

  • 1 Gupta S, Madoff DC. Image-guided percutaneous needle biopsy in cancer diagnosis and staging. Tech Vasc Interv Radiol 2007;10(2):88–101. Crossref, MedlineGoogle Scholar
  • 2 Schubert P, Wright CA, Louw Met al.. Ultrasound-assisted transthoracic biopsy: cells or sections? Diagn Cytopathol 2005;33(4):233–237. Crossref, MedlineGoogle Scholar
  • 3 Kim GR, Hur J, Lee SMet al.. CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 2011;21(2):232–239. Crossref, MedlineGoogle Scholar
  • 4 Carrafiello G, Laganà D, Nosari AMet al.. Utility of computed tomography (CT) and of fine needle aspiration biopsy (FNAB) in early diagnosis of fungal pulmonary infections: study of infections from filamentous fungi in haematologically immunodeficient patients. Radiol Med (Torino) 2006;111(1):33–41. Crossref, MedlineGoogle Scholar
  • 5 Cheung YC, Chang JW, Hsieh JJ, Lin G, Tsai YH. Adequacy and complications of computed tomography–guided core needle biopsy on non–small cell lung cancers for epidermal growth factor receptor mutations demonstration: 18-gauge or 20-gauge biopsy needle. Lung Cancer 2010;67(2):166–169. Crossref, MedlineGoogle Scholar
  • 6 Solomon SB, Zakowski MF, Pao Wet al.. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. AJR Am J Roentgenol 2010;194(1):266–269. Crossref, MedlineGoogle Scholar
  • 7 Tsai IC, Tsai WL, Chen MCet al.. CT-guided core biopsy of lung lesions: a primer. AJR Am J Roentgenol 2009;193(5):1228–1235. Crossref, MedlineGoogle Scholar
  • 8 Rossi UG, Seitun S, Ferro C. MDCT-guided transthoracic needle aspiration biopsy of the lung using the transscapular approach. Cardiovasc Intervent Radiol 2011;34(1):184–187. Crossref, MedlineGoogle Scholar
  • 9 Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol 2006;16(6):1387–1392. Crossref, MedlineGoogle Scholar
  • 10 Hiraki T, Mimura H, Gobara Het al.. CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 2009;136(6):1612–1617. Crossref, MedlineGoogle Scholar
  • 11 Carlson SK, Felmlee JP, Bender CEet al.. CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: a prospective randomized controlled clinical trial. Radiology 2005;237(2):701–708. LinkGoogle Scholar
  • 12 Yamao Y, Yamakado K, Takaki Het al.. Optimal scan parameters for CT fluoroscopy in lung interventional radiologic procedures: relationship between radiation dose and image quality. Radiology 2010;255(1):233–241. LinkGoogle Scholar
  • 13 Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. AJR Am J Roentgenol 2007;188(1):37–41. Crossref, MedlineGoogle Scholar
  • 14 Josephson T, Nordenskjold CA, Larsson J, Rosenberg LU, Kaijser M. Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol 2009;50(1):42–47. Crossref, MedlineGoogle Scholar
  • 15 Chung MJ, Goo JM, Im JG, Cho JM, Cho SB, Kim SJ. Value of high-resolution ultrasound in detecting a pneumothorax. Eur Radiol 2005;15(5):930–935. Crossref, MedlineGoogle Scholar
  • 16 Rednic N, Orasan O. Subpleural lung tumors ultrasonography. Med Ultrasound 2010;12(1):81–87. Google Scholar
  • 17 Diacon AH, Schuurmans MM, Theron J, Schubert PT, Wright CA, Bolliger CT. Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists. Respiration 2004;71(5):519–522. Crossref, MedlineGoogle Scholar
  • 18 Ikezoe J, Morimoto S, Arisawa J, Takashima S, Kozuka T, Nakahara K. Percutaneous biopsy of thoracic lesions: value of sonography for needle guidance. AJR Am J Roentgenol 1990;154(6):1181–1185. Crossref, MedlineGoogle Scholar
  • 19 Liao WY, Chen MZ, Chang YLet al.. US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter. Radiology 2000;217(3):685–691. LinkGoogle Scholar
  • 20 Sheth S, Hamper UM, Stanley DB, Wheeler JH, Smith PA. US guidance for thoracic biopsy: a valuable alternative to CT. Radiology 1999;210(3):721–726. LinkGoogle Scholar
  • 21 Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology. World J Radiol 2010;2(2):83–90. Crossref, MedlineGoogle Scholar
  • 22 Rizzo S, Preda L, Raimondi Set al.. Risk factors for complications of CT-guided lung biopsies. Radiol Med (Torino) 2011;116(4):548–563. Crossref, MedlineGoogle Scholar
  • 23 Ohno Y, Hatabu H, Takenaka D, Imai M, Ohbayashi C, Sugimura K. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules. Eur J Radiol 2004;51(2):160–168. Crossref, MedlineGoogle Scholar

Article History

Received October 7, 2011; revision requested November 22, 2012; revision received May 9; accepted July 10; final version accepted August 23.
Published online: Mar 2013
Published in print: Mar 2013