Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists.
BACKGROUND
Transthoracic ultrasound (US) has gained popularity as a tool for visualizing pleural effusions and assisting thoracentesis or chest drain placement. In the absence of effusion, US just as well demonstrates solid masses involving or abutting the pleura, yet biopsy of such lesions is not widely performed by chest physicians.


OBJECTIVE
To assess the feasibility and the safety of US-assisted cutting needle biopsy performed by chest physicians in routine practice.


METHODS
Lesions involving or abutting the pleura > or =20 mm in diameter on US were sampled with a 14-gauge cutting needle under local anesthesia. Biopsy site, needle direction and depth of penetration were determined with US. The procedure was performed without direct US guidance in 'free-hand' technique.


RESULTS
Ninety-one patients underwent 96 cutting-needle biopsies for suspected peripheral lung tumors (n = 44, 46%), pleural-based (n = 39, 41%), mediastinal (n = 10, 10%), or chest wall lesions (n = 3, 3%), which were single in 71%, multiple in 6% and diffuse in 23%. Sensitivity for malignant neoplasms (n = 65) was 85.5% and 100% for mesothelioma (n = 10). Pneumothorax occurred in 4%.


CONCLUSIONS
US-assisted cutting-needle biopsy of lesions > or =20 mm in diameter is safe in the hands of pulmonologists. The yield for neoplastic disease including mesothelioma is high.
Department of Internal Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa. ahd@sun.ac.za
A H
AH
Diacon
M M
MM
Schuurmans
J
J
Theron
P T
PT
Schubert
C A
CA
Wright
C T
CT
Bolliger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000473:pathology; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000379:methods*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted; D014463:Ultrasonography