Background The current gold standard method for sampling intrathoracic lesions is via a CT-guided approach. However, most parietal-attached intrathoracic lesions can be visualised with ultrasound and sampled.
Aims A prospective audit of consecutive patients with CT-identified intrathoracic parietal-attached lesions, sampled percutaneously by an ultrasound-guided approach, was carried out to assess efficacy and safety. The lung MDT was instrumental in selecting patients.
Materials and Methods Seventeen consecutive patients were audited over a span of 8 months. This cohort included 12 males and 5 females with an age range from 42 to 84 years (median 63 years). The biopsies were performed by 4 skilled investigators assisted by a specialist nurse, using an 18 gauge single-trochar puncture under standard aseptic conditions. A Toshiba Applio ultrasound unit, with Doppler-flow map capabilities was used to avoid vessel puncture. Patients recovered in the radiology department observation ward.
Results Interpretable specimens were obtained in 16 patients. A single patient needed a repeat, successful, US-guided procedure. The median duration for the procedure was 26 minutes, with a median observation time before discharge of a further 40 minutes. Two patients developed small pneumothoraces and one patient suffered minor haemoptysis, none of which required admission.
Conclusion Where applicable, this technique is safe, fast, avoids radiation and may result in fewer complications compared to the CT-guided approach. Fewer personnel are required and CT scanner time is freed for other uses. Moreover, in the hands of an ultrasound-skilled respiratory physician, this method correctly applied would provide an earlier route to diagnosis for the Lung MDT.
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