title: Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy.
abstract: OBJECTIVE
  To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions.
  
  
  METHODS
  Institutional review board approval was obtained, and the informed consent requirement was waived. From January 2000 to August 2011, 711 thoracic biopsies were performed at two institutions. Among these, 273 lesions in 273 patients (115 men, 158 women; mean age, 65 years ± 11 [standard deviation]; 86 pleural lesions; 187 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (170 patients; mean age, 64 years ± 12; 55 pleural lesions, 115 peripheral pulmonary lesions) or US (103 patients; mean age, 67 years ± 10; 31 pleural lesions, 72 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.
  
  
  RESULTS
  No significant difference was found for patient age (P = .741), sex (P = .900), lesion size (P = .206), or lesion origin (P = .788). Median time was 556 seconds for CT-guided biopsy (25th percentile, 408 seconds; 75th percentile, 704 seconds) and 321 seconds for US-guided biopsy (25th percentile, 157 seconds; 75th percentile, 485 seconds) (P < .001). Postprocedural pneumothorax was observed in 25 of 170 (14.7%) CT-guided procedures and in six of 103 (5.8%) US-guided procedures (P = .025); hemorrhage occurred in two of 170 (1.2%) CT-guided procedures and in one of 103 (1.0%) US-guided procedures (P = .875). Technical success was achieved in 100 of 103 US-guided procedures (97.1%) and in 164 of 170 CT-guided procedures (96.5%) (P = .999).
  
  
  CONCLUSIONS
  With pleural or peripheral lung lesions, US guidance is comparable to CT guidance in terms of sample accuracy, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.
authors.affiliation: Servizio di Radiologia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy. io@lucasconfienza.it
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
authors.forename: Mauro
authors.initials: M
authors.lastname: Truini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.forename: Carmelina
authors.initials: C
authors.lastname: Murolo
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*