title: Do respiratory comorbidities limit the diagnostic usefulness of ultrasound-guided needle aspiration for subpleural lesions?
abstract: BACKGROUND
  The usefulness of ultrasound-guided needle aspiration for subpleural lesions has been reported. However, no reports have evaluated its usefulness and safety in patients with respiratory comorbidities such as chronic obstructive pulmonary disease (COPD) and interstitial pneumonia (IP), which can increase the risk of iatrogenic pneumothorax. In this study, we evaluated the influence of chronic respiratory diseases (CRDs) on the usefulness and safety of ultrasound-guided needle aspiration for subpleural lesions.
  
  
  METHODS
  Between January 2000 and September 2011, we examined 144 patients with intrapulmonary subpleural lesions. We retrospectively reviewed clinical data, including lesion size on thoracic computed tomography (CT), ultrasound findings, pathological findings obtained by ultrasound-guided needle aspiration, final diagnosis, and complications.
  
  
  RESULTS
  A positive definitive diagnosis was obtained in 74.3% of all 144 patients; 84.7% patients with malignant diseases, including lung cancer; and 26.9% patients with benign diseases. Of the 144 patients, 64 belonged to the CRD group and 80 to the non-CRD group. The former included 31 patients with COPD, six with emphysematous changes on thoracic CT, 17 with IP, and 10 with other diseases. The positive rate of diagnosis for malignant diseases was 84.7% in the CRD group, which was the same as that in the non-CRD group. With regard to complications related to ultrasound-guided aspiration, there were only two cases of pneumothorax in the CRD group and one in the non-CRD group.
  
  
  CONCLUSIONS
  Ultrasound-guided aspiration is safe and useful for subpleural lesions, particularly malignant lesions, even in patients with respiratory comorbidities such as COPD and IP.
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: msekiya@juntendo.ac.jp.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sekiya
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: kyoshimi@juntendo.ac.jp.
authors.forename: Kaku
authors.initials: K
authors.lastname: Yoshimi
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: k-muraki@juntendo.ac.jp.
authors.forename: Keiko
authors.initials: K
authors.lastname: Muraki
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: siwakami@juntendo.ac.jp.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Iwakami
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: Shinsaku@juntendo.ac.jp.
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Togo
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: tmk@estate.ocn.ne.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tamaki
authors.affiliation: Department of General Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: tdambara@juntendo.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Dambara
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. Electronic address: kztakaha@juntendo.ac.jp.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D061705:Image-Guided Biopsy; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D012449:Safety; D014463:Ultrasonography; D055815:Young Adult
keywords: Computed tomography-guided needle biopsy; Subpleural lesions; Ultrasound-guided needle aspiration