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US Guidance for Thoracic Biopsy: A Valuable Alternative to CT

¹ Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287.

PURPOSE: To determine the role, accuracy, and selection criteria of ultrasonographic (US) guidance for biopsy of thoracic lesions.

MATERIALS AND METHODS: Imaging-guided thoracic biopsies (n = 86) were performed in 84 consecutive patients. US guidance was used for lesions abutting the chest wall; computed tomographic (CT) guidance was used for all masses surrounded by aerated lung. Mass location and size, guidance modality, histologic results, procedure time, and complications were recorded.

RESULTS: Thirty-four lesions (19 parenchymal, six pleural, six chest wall, three mediastinal) were amenable to US-guided biopsy. The mean mass diameter was 4.3 cm, the mean number of passes was 3.2, and the mean procedure time was 31.4 minutes. A histologic diagnosis was achieved in 31 (91%) patients, including all with small (<2-cm) masses (n = 9). There was one case of pneumothorax. CT guidance was used in 52 (60%) of 86 cases. Lesions were parenchymal (n = 41), pleural (n = 1), and mediastinal and hilar (n = 10). The mean diameter was 2.9 cm, the mean number of passes was 2.3, and the mean procedure time was 45.2 minutes. A histologic diagnosis was achieved in 37 (71%) patients, including 18 of 27 with a small mass. Complications included pneumothorax (n = 21) and parenchymal hemorrhage (n = 2).

CONCLUSION: US is an effective and safe alternative to CT for guidance at biopsy of masses abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, and performance in debilitated and less cooperative patients.

Index terms: Lung, biopsy, 60.126, 60.12985 • Mediastinum, biopsy, 67.12985 • Thorax, biopsy, 60.126, 60.12985 • Thorax, CT, 60.1211 • Thorax, US, 60.12981, 60.12982, 60.12985 • Ultrasound (US), comparative studies, 60.1211, 60.12985

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