A pictorial review of the utility of CEUS in thoracic biopsies

Abstract

Lung cancer is one of the commonest malignancies worldwide and necessitates both early and personalised treatment. A key requirement is histological sampling with immunohistochemistry obtained usually from percutaneous biopsy. Conventionally thoracic biopsies are performed using CT guidance, but more recently, there has been development of physician led ultrasound biopsy for pleural lesions. Contrast-enhanced ultrasound (CEUS) has been increasingly used in interventional procedures and is able to offer benefits for thoracic biopsies including improving lesional visualisation and characterisation, targeting viable tissue and avoiding critical vascular structures as well as evaluating for the presence of post-procedural complications. This educational review aims to benefits of the role of CEUS in thoracic biopsies.

Role of Contrast-Enhanced Ultrasound in Pulmonary Lesions: 5-Year Experience at a Single Center

“…Based on the dual vascular supply to pulmonary arterial and bronchial arterial patterns of enhancement, CEUS was theoretically deemed appropriate for the differential diagnosis of lung lesions (G€ org and Bert 2004). However, the majority of previous studies have focused on increasing the diagnostic yield of guided percutaneous biopsy (Cao et al 2013;Wang et al 2015;Laursen et al 2016;Fu et al 2019;Yusuf et al 2021). Debate occurs over the actual role of CEUS in discriminating between pulmonary benignancy and malignancy (G€ org et al 2006a;Hong-Xia et al 2016;Sperandeo et al 2017).…”

WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung

“…CEUS should be performed in patients with peripheral pleural-based neoplastic lesions only if specific clinically relevant questions arise: (i) diagnosis and exclusion of chest wall infiltration; (ii) visualization of a central tumor in the case of obstructive atelectasis for possible biopsy (Fig. 16); and (iii) evaluation of the tumor tissue with safe visualization of nonperfused (necrotic) areas on CEUS in the tumorous lung tissue, before performing a US-guided core needle biopsy (Cao et al 2011;Dong et al 2015;Mathis 2016Mathis , 2017Findeisen et al 2019Findeisen et al , 2020Liang et al 2020;Yusuf et al 2021).…”

“…Tumor necrosis is a common occurrence in pleural and lung tumors (Cao et al 2011;Dong et al 2015;Fu et al 2019;Liang et al 2020;Wang et al 2020;Yusuf et al 2021). To avoid false-negative biopsies, biopsies should be performed under CEUS guidance from perfused tumor tissue whenever possible (Dong et al 2015;Yusuf et al 2021).…”

“…Tumor necrosis is a common occurrence in pleural and lung tumors (Cao et al 2011;Dong et al 2015;Fu et al 2019;Liang et al 2020;Wang et al 2020;Yusuf et al 2021). To avoid false-negative biopsies, biopsies should be performed under CEUS guidance from perfused tumor tissue whenever possible (Dong et al 2015;Yusuf et al 2021). CEUS guidance of thoracic biopsies has been found not only to increase diagnostic yield, but also to improve safety and early detection of complications (Cao et al 2011;Dong et al 2015;Fu et al, 2019;Jacobsen et al, 2020;Liang et al 2020;Wang et al 2020;Yusuf et al 2021).…”

“…To avoid false-negative biopsies, biopsies should be performed under CEUS guidance from perfused tumor tissue whenever possible (Dong et al 2015;Yusuf et al 2021). CEUS guidance of thoracic biopsies has been found not only to increase diagnostic yield, but also to improve safety and early detection of complications (Cao et al 2011;Dong et al 2015;Fu et al, 2019;Jacobsen et al, 2020;Liang et al 2020;Wang et al 2020;Yusuf et al 2021). Sometimes, after initial CEUS evaluation of the lesion, a second injection of the ultrasound contrast agent is necessary to directly guide biopsy (Yusuf et al 2021).…”