title: Utility of contrast-enhanced ultrasound with SonoVue in biopsy of small subpleural nodules.
abstract: OBJECTIVE
  This study aimed to evaluate the diagnostic accuracy and complication rates of contrast-enhanced ultrasound (CEUS)-guided biopsy of small subpleural nodules with SonoVue.
  
  
  METHODS
  CEUS-guided biopsies with SonoVue and conventional ultrasound were performed to determine nodule size, texture and biopsy route. After baseline ultrasonography, all patients received an intravenous injection of 4 mL of SonoVue, followed by 5 mL of saline flush. CEUS was obtained using a convex probe and contrast-specific imaging software. The lesion was observed using a contrast agent. Biopsies were performed during real-time visualisation of the target lesion.
  
  
  RESULTS
  A total of 51 patients (34 males and 17 females; average age, 54.8 ± 5.8 years) with subpleural nodules were enrolled. The median nodule size was 1.92 ± 0.75 cm (0.9-2.5 cm). Forty-eight of 51 procedures (94.1%) provided adequate material for histological analysis. Thirty patients (62.5%) were malignant and 18 patients (37.5%) were benign at the definitive diagnosis. The true positive and true negative result were 28 (58.3%) and 18 (37.5%), no false positive result was seen and two (4.2%) provided a false negative result. The sensitivity, specificity, positive and negative predictive values for the malignant diagnosis were 93.3, 100, 100 and 90%, respectively. The diagnostic accuracy was 95.8% (46/48), the standard error and the 95% CI were 2.8% and 86%-99%. An asymptomatic pneumothorax was present in one patient with no chest tube placement required. A small amount of hemoptysis was observed in another patient, which stopped spontaneously without treatment.
  
  
  CONCLUSIONS
  CEUS-guided biopsy with SonoVue exhibits high diagnostic accuracy and low complication rates. It is especially advantageous for biopsies of small subpleural nodules.
authors.affiliation: The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120, Guangdong Province, China.
authors.forename: Jinlin
authors.initials: J
authors.lastname: Wang
authors.affiliation: First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120, Guangdong Province, China.
authors.forename: Dazhi
authors.initials: D
authors.lastname: Zhou
authors.affiliation: The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120, Guangdong Province, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Xie
authors.affiliation: The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120, Guangdong Province, China.
authors.forename: Panxiao
authors.initials: P
authors.lastname: Shen
authors.affiliation: The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120, Guangdong Province, China.
authors.forename: Yunxiang
authors.initials: Y
authors.lastname: Zeng
keywords: Contrast-enhanced ultrasound; SonoVue; biopsy; subpleural nodules