Introduction Transthoracic ultrasound is important tool in assessing pleural effusions and guiding placement of chest drains. It also demonstrates pleural-based masses and lung tumours abutting the pleura.1 Such lesions are suitable for ultrasound guided full core needle biopsy.1 Percutaneous transthoracic lung biopsy with ultrasound guidance is not widely performed by respiratory physicians.1
Objective To assess safety and yield of ultrasound guided transthoracic biopsy performed by respiratory physicians.
Methods The procedures were carried out in an outpatient or bed side setting between April 2014 and Jun 2015. Apart from checking clotting and omitting antiplatelet/anticoagulants no special prior preparations were undertaken. Under real time transthoracic ultrasound, lesions involving pleura or abutting the pleura which were >1.5 cm were sampled 2–3 times with a full core biopsy needle (Biopince 18G). Repeat thoracic ultrasound was done after 10 min to check for pneumothorax. Patients were discharged home around 30 min post procedure.
Results 51 patients underwent full core biopsy for suspected peripheral lung (44), pleural based (6) and Mediastinal tumours (1). The biopsies were considered adequate in 47 cases (94%). Diagnosis was achieved in 43 patients with an overall yield of 84% (Table 1) whilst the yield for malignancy was 82% (36/44). Of the 8 patients with a negative biopsy, malignancy was diagnosed at surgery in 2 patients and CTGB (CT guided biopsy) in 6 patients. Complications were minimal with one patient developing a small pneumothorax (2%) and another had a small subcutaneous hematoma. After the introduction of the service the waiting list for CT guided biopsies in our hospital has been eliminated.
Conclusion Ultrasound guided peripheral lung/pleural mass biopsy can be performed by trained respiratory physicians with excellent yield and very low complication rate. Used appropriately it reduces the waiting list for CTGB.
Reference 1 Diacon AH, Schuurmans MM, Theron J, et al. Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists. Respiration 2004;71(5):519–22
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