title: Percutaneous ultrasound-guided biopsies in the evaluation of thoracic tumours after PET-CT: a prospective diagnostic study.
abstract: BACKGROUND
  Lesions detected by positron emission tomography-computed tomography (PET-CT) during the analysis of thoracic tumours are often impalpable at physical examination, and subsequent ultrasound (US) may aid in finding these lesions for pathologic evaluation.
  
  
  OBJECTIVE
  The success rate of percutaneous US-guided biopsies of palpable and non-palpable lesions and the impact on tumour stage were studied prospectively.
  
  
  METHODS
  Lesions, significant for diagnosis and disease stage, with metabolic activity on PET-CT and presumed appropriate for percutaneous approach under US guidance were selected for cytologic aspiration or tissue core biopsies.
  
  
  RESULTS
  In 127 patients, 134 lesions (subdivided into 24 local thoracic, 74 supraclavicular and 36 distant metastatic lesions) were biopsied percutaneously under US guidance. Malignancy, benign disease and inadequate biopsies were found in 80% (106/134), 14% (19/134) and 7% (9/134), respectively. In 55% (56/102) of patients, biopsies confirmed the disease stage. Fifty-one percent (18/35) of distant lesions and 54% (43/68) of supraclavicular lesions were impalpable on physical examination.
  
  
  CONCLUSIONS
  US-guided biopsies in patients with suspected thoracic malignancy on PET-CT provide an excellent tool for obtaining a pathological diagnosis, leading to a definitive disease stage in over half of the patients.
authors.affiliation: Department of Pulmonology, Isala Klinieken, Zwolle, The Netherlands. j.a.stigt@isala.nl
authors.forename: Jos A
authors.initials: JA
authors.lastname: Stigt
authors.forename: Ad H
authors.initials: AH
authors.lastname: Oostdijk
authors.forename: James E
authors.initials: JE
authors.lastname: Boers
authors.forename: Jan Willem K
authors.initials: JW
authors.lastname: van den Berg
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods*; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D015203:Reproducibility of Results; D013899:Thoracic Neoplasms / Q000175:diagnosis*; D013909:Thorax / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography