Percutaneous Ultrasound-Guided Biopsies in the Evaluation of Thoracic Tumours after PET-CT: A Prospective Diagnostic Study

Abstract

Background: Lesions detected by positron emission tomography-computed tomography (PET-CT) during the analysis of thoracic tumours are often impalpable at physical examination, and subsequent ultrasound (US) may aid in finding these lesions for pathologic evaluation. Objectives: The success rate of percutaneous US-guided biopsies of palpable and non-palpable lesions and the impact on tumour stage were studied prospectively. Methods: Lesions, significant for diagnosis and disease stage, with metabolic activity on PET-CT and presumed appropriate for percutaneous approach under US guidance were selected for cytologic aspiration or tissue core biopsies. Results: In 127 patients, 134 lesions (subdivided into 24 local thoracic, 74 supraclavicular and 36 distant metastatic lesions) were biopsied percutaneously under US guidance. Malignancy, benign disease and inadequate biopsies were found in 80% (106/134), 14% (19/134) and 7% (9/134), respectively. In 55% (56/102) of patients, biopsies confirmed the disease stage. Fifty-one percent (18/35) of distant lesions and 54% (43/68) of supraclavicular lesions were impalpable on physical examination. Conclusions: US-guided biopsies in patients with suspected thoracic malignancy on PET-CT provide an excellent tool for obtaining a pathological diagnosis, leading to a definitive disease stage in over half of the patients.

Percutaneous Ultrasonography as Imaging Modality and Sampling Guide for Pulmonologists

“…FNA performed better in patients with lung cancer (95 vs. 81%) but TCB was better in diagnosing benign lesions and non-carcinomatous tumours [29]. In our own series, 22-gauge spinal needles were used for aspiration because of their longitude [30]. Compared to injection needles, for example, there is more freedom to move in the US plane when guided by the attachment device.…”

“…In our own experience, the diagnostic success rate of PET-detected supraclavicular nodes is very high (96%). Less than half the nodes were found on palpation, obviously presenting a strong argument for the use of image guidance for pathologic sampling [30]. …”

“…In our own series of 36 patients with suspected distant metastatic disease based on PET-CT imaging, US-guided biopsies failed just once. The great value of US was emphasized by the observation that half of these lesions were impalpable on physical examination [30]. …”

“…Malignant lesions approached percutaneously for US-guided sampling are indeed often metastatic in cases of lung cancer. In 55% of our own patients, diagnosed after PET-CT and subsequent US-guided sampling, US-guided biopsies determined the disease stage and so precluded further invasive investigations [30]. …”

Emergency Ultrasound of the Chest

“…In this context, diagnostic or therapeutic puncture should be guided by sonography [20]. Especially in the diagnosis of hemothorax (hematocrit >50% in the effusion) or empyema (pH value), ultrasound is most helpful.…”