Role of Ultrasound-Guided Tru-cut Biopsy in the Diagnosis of Peripheral Lung and Pleural Lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Wagih ◽  
Nehad Mohammed Osman ◽  
walid Heta ◽  
Fatma El-Zahraa Abdellatif
Keyword(s):  
Diagnostic Yield ◽  
Tube Placement ◽  
Consecutive Series ◽  
University Hospitals ◽  
Transthoracic Needle Biopsy ◽  
Lung Lesions ◽  
Pulmonary Lesions ◽  
Guided Biopsy ◽  
High Flow Oxygen ◽  
Peripheral Lung

Abstract Background Transthoracic needle biopsy is a well-established technique for diagnosing pulmonary lesions. Computed tomography (CT) is usually used as guidance. Ultrasound (US)-guided biopsy is a relatively affordable modality for diagnosis of peripheral lung lesions (PLLs; also known as peripheral pulmonary lesions [PPLs]) and peripheral pleural lesions. Objectives The purpose of this study was to study the diagnostic yield of US guidance sampling a consecutive series of peripheral lung and pleural lesions and potential factors influencing the diagnostic yield with recording the occurrence of any complications. Patients and Methods This was a prospective study that was conducted at Ain Shams University Hospitals upon a population of 60 patients, during the period from September 2018 to August 2019. A special puncture transducer is used to perform US-guided biopsy with visualization of the biopsy needle and the lesion; facilitating the sampling procedure. Results The use of US-guided transthoracic needle biopsies across 60 patients was shown to have a yield of 75% which found the occurrence of 45 conclusive and 15 non-conclusive results From this study population, 70% (n = 42/45) were found to have malignant manifestations, of which 26 were undifferentiated high grade adenocarcinoma, and 9 were moderately differentiated adenocarcinoma. As for complications arising from the biopsy procedure, twenty percent 20% (n = 12) of patients suffered from complications in the form of hemoptysis in 8 which was controlled by hemostatic measures and 4 patients acquired pneumothorax, three (¾) of them received high flow oxygen and conservative treatment and only one (1/4) patient had intercostal tube placement. Diagnostic yield was significantly increased with the presence of Wedge shaped hypoechoic lesions(p < 0.001), hard Mass consistency was significantly highly associated with conclusive results (p < 0.001), as well as a significant link between the longitudinal diameter of masses that had a mean length of 45.05mm ±12.93mm (#x0003D; 0.029).It also showed that more biopsies taken were highly significant correlation with conclusive outcomes (p < 0.001). Conclusion US-guided biopsy is a robust and accurate procedure to effectively diagnose peripheral lung lesions, with a low incidence of complications and gradually improving results with the mastery of the procedure.

Multimodale Bronchoskopie in der Rundherddiagnostik: Gewinnbringende Kombinationen ausloten

2021 ◽  
pp. 1-3
Author(s):  
Axel Tobias Kempa
Keyword(s):  
Diagnostic Yield ◽  
Target Lesion ◽  
Endobronchial Ultrasound ◽  
External Diameter ◽  
Pulmonary Lesions ◽  
Diagnostic Bronchoscopy ◽  
Peripheral Lung ◽  
Visible Lesion ◽  
Median Diameter ◽  
Pulmonary Tumors

There are cases of peripheral lung nodules that are difficult to approach despite using ancillary diagnostic devices during multimodal bronchoscopy. The use of ultrathin bronchoscopes has shown superiority over standard thin bronchoscopes. We retrospectively evaluated whether substitution of the thin-bronchoscope by the ultrathin device during multimodal bronchoscopy improves lesion ultrasound visualization and diagnostic yield in patients with difficult-to-approach pulmonary lesions. The study comprised 44 out of 338 patients that underwent multimodal bronchoscopy at Matsusaka Municipal Hospital. The thin-bronchoscope with an external diameter of 4 mm was substituted by the ultrathin-bronchoscope with an external diameter of 3 mm when the radial endobronchial ultrasound showed that the probe position was not within the target lesion. The median diameter of the pulmonary tumors was 17.5 mm (range: 6.0–5.2.0 mm). The endobronchial ultrasound showed the probe’s position adjacent to the lesion in 12 cases and no visible lesion in 32 cases using a thin-bronchoscope. However, the endobronchial ultrasound views changed from adjacent to the lesion to within the lesion in nine cases, from no visible lesion to within the lesion in 17 cases, and from no visible lesion to adjacent to the lesion in nine cases after bronchoscope substitution. After substitution, the diagnostic yield was 80.8% in cases with the radial probe within the target lesion, 72.7% in cases with the probe adjacent to the target lesion, and 0% in cases with no visible lesion. The overall diagnostic yield was 65.9% after bronchoscope substitution. The substitution of the thin bronchoscope by the ultrathin device on a need basis improves the position of the radial endobronchial ultrasound probe and diagnostic yield of pulmonary lesions during multimodal diagnostic bronchoscopy.

scholarly journals Factors Related to Diagnostic Yield of Flexible Bronchoscopy Without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 1012A
Author(s):  
Jongmin Lee ◽  
Hye Seon Kang ◽  
Wooho Ban ◽  
Sung Bae Cho ◽  
Myung Sook Kim ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Flexible Bronchoscopy ◽  
Lung Lesions ◽  
Peripheral Lung

scholarly journals Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist

2019 ◽  
Vol 8 (6) ◽  
pp. 821 ◽  
Author(s):  
June Hong Ahn ◽  
Jong Geol Jang
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Safe Procedure ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions ◽  
Percutaneous Transthoracic Needle Biopsy

In the diagnosis of lung lesions, computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) has a high diagnostic yield and a low complication rate. The procedure is usually performed by interventional radiologists, but the diagnostic yield and safety of CT-guided PTNB when performed by pulmonologists have not been evaluated. A retrospective study of 239 patients who underwent CT-guided PTNB at Yeungnam University Hospital between March 2017 and April 2018 was conducted. A pulmonologist performed the procedure using a co-axial technique with a 20-gauge needle. Then diagnostic yield and safety were assessed. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 96.1% (171/178), 100% (46/46), 100% (171/171), and 86.8% (46/53), respectively. The diagnostic accuracy was 96.9% (217/224) and the overall complication rate was 33.1% (82/248). Pneumothorax, hemoptysis, and hemothorax occurred in 27.0% (67/248), 5.2% (13/248), and 0.8% (2/248) of the patients, respectively. Univariate analyses revealed that pneumothorax requiring chest tube insertion was a significant risk factor (odds ratio, 25.0; p < 0.001) for diagnostic failure. CT-guided PTNB is a safe procedure with a high diagnostic accuracy, even when performed by an inexperienced pulmonologist. The results were similar to those achieved by interventional radiologists as reported in previously published studies.

scholarly journals Factors Related to the Diagnostic Yield of Flexible Bronchoscopy without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions

2017 ◽  
Vol 80 (3) ◽  
pp. 284 ◽  
Author(s):  
Hye Seon Kang ◽  
Jick Hwan Ha ◽  
Hyeon Hui Kang ◽  
Chang Dong Yeo ◽  
Chin Kook Rhee ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Flexible Bronchoscopy ◽  
Lung Lesions ◽  
Peripheral Lung

scholarly journals CT-guided percutaneous lung biopsy: Correlation between diagnostic yield, lung lesion size, and lobar distribution

2021 ◽  
Vol 5 ◽  
pp. 14
Author(s):  
Matthew Wilson ◽  
Adib R. Karam ◽  
Grayson L. Baird ◽  
Michael S. Furman ◽  
David J. Grand
Keyword(s):  
Retrospective Study ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Lesion Size ◽  
Lung Lesion ◽  
Target Size ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions ◽  
Significant Difference

Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations (P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.

scholarly journals CT guided lung biopsy complications: a single centre prospective study

2018 ◽  
Vol 6 (9) ◽  
pp. 2943
Author(s):  
Mohd Farooq Mir ◽  
Muzafar Ahmed Naik ◽  
Javid Ahmed Malik
Keyword(s):  
Prospective Study ◽  
Needle Biopsy ◽  
Lung Biopsy ◽  
Pulmonary Haemorrhage ◽  
Complication Rates ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions ◽  
Peripheral Lung ◽  
Percutaneous Transthoracic Needle Biopsy

Background: Computed tomography (CT) guided percutaneous transthoracic needle biopsy of lung is a routine procedure in patients with suspected malignant lung lesions which are either peripheral or not amenable to biopsy on fibreoptic bronchoscopy.Methods: This prospective study was conducted to obtain complication rates based on patient and physician experience after CT guided lung biopsy of central and peripheral lung lesions.Results: In our study 96 patients were included with 78 patients with peripheral and 18 patients having central lung lesions. The reported post procedural complication rates of CT guided lung biopsy were pulmonary haemorrhage 33.3 %, pneumothorax 21.9%, haemoptysis 15.6%, cough 6.3%, haemothorax 3.1% and fever 3.1%. Two patients required inter costal tube drainage. There was no reported mortality of CT guided lung biopsy in our centre.Conclusions: Pulmonary haemorrhage and pneumothorax are the most common complications of percutaneous transthoracic needle biopsy of the lung, the former one is common with central and the latter one with peripheral lung lesions.

scholarly journals Diagnostic Performance of Electromagnetic Navigation Bronchoscopy-Guided Biopsy for Lung Nodules in the Era of Molecular Testing

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1432
Author(s):  
Ju Hyun Oh ◽  
Chang-Min Choi ◽  
Seulgi Kim ◽  
Se Jin Jang ◽  
Sang Young Oh ◽  
...  
Keyword(s):  
Safety Profile ◽  
Diagnostic Yield ◽  
Growth Factor Receptor ◽  
Pulmonary Nodules ◽  
Molecular Testing ◽  
Nsclc Tissue ◽  
Transthoracic Needle Biopsy ◽  
Electromagnetic Navigation ◽  
Anaplastic Lymphoma ◽  
Guided Biopsy

Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited patients with peripheral pulmonary nodules that were not suitable for biopsy via percutaneous transthoracic needle biopsy methods. The possibility of molecular testing, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and programmed death ligand 1 (PD-L1), was identified with non-small cell lung cancer (NSCLC) tissue obtained using ENB. ENB-guided biopsy was performed on 30 pulmonary nodules in 30 patients. ENB-guided biopsy was successfully performed in 96.6% (29/30) of cases, but one case failed to approach the target lesion. The diagnostic accuracy of ENB-guided biopsy was 68.0% (17/25). Biopsy-related pneumothorax occurred in one patient and there was no major bleeding or deaths related to the procedure. Among 13 patients diagnosed with NSCLC, molecular testing was successfully performed in 92.3% (12/13). ENB-guided biopsy demonstrated acceptable accuracy and excellent sample adequacy, with a high possibility of achieving molecular testing and a good safety profile to evaluate peripheral pulmonary nodules, even when the percutaneous approach was difficult and/or dangerous.

Safety and Diagnostic Yield of Radial Probe Endobronchial Ultrasound-Guided Biopsy for Peripheral Lung Lesions in Patients with Idiopathic Pulmonary Fibrosis: A Multicenter Cross-Sectional Study

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Jaemin Lee ◽  
Changhwan Kim ◽  
Hee Yun Seol ◽  
Hyeon Sung Chung ◽  
Jeongha Mok ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Diagnostic Yield ◽  
Usual Interstitial Pneumonia ◽  
Endobronchial Ultrasound ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Cross Sectional ◽  
Lung Lesions ◽  
Peripheral Lung

<b><i>Background:</i></b> Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used for diagnosis of peripheral lung lesions (PLLs). To date, there have been no reports regarding the clinical outcomes of RP-EBUS-TBLB for PLLs in patients with idiopathic pulmonary fibrosis (IPF). <b><i>Objectives:</i></b> This study was performed between October 2017 and December 2019 to identify the safety and diagnostic performance of RP-EBUS-TBLB in IPF patients. <b><i>Methods:</i></b> Patients were divided into the usual interstitial pneumonia (UIP) group (<i>n</i> = 39, 4%), the probable UIP group (<i>n</i> = 12, 1%), and the noninterstitial lung disease (non-ILD) group (<i>n</i> = 903, 95%). <b><i>Results:</i></b> The diagnostic yield was significantly lower in the UIP group than in the non-ILD group (62% vs. 76%; <i>p</i> = 0.042), but there were no significant differences between the UIP and probable UIP groups (62% vs. 83%; <i>p</i> = 0.293) or the probable UIP and non-ILD groups (83% vs. 76%; <i>p</i> = 0.741). Multivariate logistic analysis showed that the mean diameter of PLLs, positive bronchus sign on CT, and “within the lesion” status on EBUS were independently associated with success of the procedure. Especially, the presence of the UIP pattern on CT (OR, 0.385; 95% CI: 0.172–0.863; <i>p</i> = 0.020) was independently associated with failed diagnosis. Among patients with UIP, “within the lesion” status on EBUS (OR, 25.432; 95% CI: 2.321–278.666; <i>p</i> = 0.008) was shown to be a factor contributing to a successful diagnosis. Overall, there were no significant differences in complication rates among the 3 study groups. <b><i>Conclusion:</i></b> RP-EBUS-TBLB can be performed safely with an acceptable diagnostic yield, even in patients with IPF.

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