The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Fine-Needle Aspiration of Drowned Lung

Koegelenberg, Coenraad F.N.; Bolliger, Chris T.; Irusen, Elvis; Wright, Colleen A.; Louw, Mercia; Schubert, Pawel; Diacon, Andreas H.

doi:10.1159/000319576

Cited by 22 publications

(28 citation statements)

References 33 publications

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“…Transthoracic ultrasound (US) has become a valuable guide for interventional procedures [7,8], and plays an increasing role in biopsies of the chest wall, pleura and peripheral lung [9,10,11,12,13]. US-assisted biopsies of mediastinal masses were first described by Saito et al [14] two decades ago, enabling them to diagnose 87% of all malignant tumours and 67% of benign masses.…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

et al. 2010

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Background: Ultrasound (US)-assisted transthoracic biopsy offers a less invasive alternative to surgical biopsy in the setting of mediastinal masses. Objectives: The aim of this 1-year prospective study was to assess the diagnostic yield and safety of a novel single-session sequential approach of US-assisted transthoracic fine-needle aspirations (TTFNA) with rapid on-site evaluation (ROSE) followed by cutting needle biopsies (CNB) performed by physicians on patients with anterosuperior mediastinal masses. Methods: US-assisted TTFNA with ROSE was performed on 45 consecutive patients (49.5 ± 27.7 years, 24 males), immediately followed by CNB where a provisional diagnosis of epithelial carcinoma or tuberculosis could not be established, provided a safety range could be assured. Results: TTFNA alone was deemed adequate by means of ROSE in 27 (60%) patients. CNB could be performed in 17 of the remaining 18. The on-site diagnosis corresponded to the final diagnosis in 26/45 (57.8%). An accurate cytological diagnosis was made in 33 (73.3%), and was more likely to be diagnostic in epithelial carcinoma and tuberculosis (28/30) than all other pathologies (5/15, p < 0.001). CNB yielded a diagnosis in 15/17 (88.2%). Overall, 42/45 patients were diagnosed by the single-session approach (93.3%). The final diagnoses included 41 neoplasms, with small cell lung cancer (n = 13) the commonest diagnosis. We observed no pneumothorax or major haemorrhage. Conclusions: A single-session sequential approach of US-assisted TTFNA with ROSE followed by CNB, where indicated, has a high diagnostic yield for anterosuperior mediastinal masses, is safe and offers an alternative to surgical biopsy.

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Section: Introductionmentioning

confidence: 99%

The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

et al. 2010

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“…Drowned lung is considered to represent accumulated secretions and is typified on US by fluid bronchograms, provided it extends to the pleura (8). USassisted TTFNA of a drowned lung can be diagnostic in almost 75% of cases, and it may represent a viable alternative to bronchoscopy in selected cases (53,54).…”

Section: Transthoracic Biopsy Of Chest Wall and Pulmonary Tumorsmentioning

confidence: 99%

“…The same investigators pioneered the supraclavicular approach for US-guided biopsies of superior mediastinal tumors (56). However, US-assisted mediastinal biopsy has not gained popularity among clinicians, presumably because investigators generally utilized only CNB and were almost exclusively interventional radiologists (57). The complication rates of the various studies range from 1% to 6%, with pneumothoraces, hemothoraces, and hemoptysis the most common serious complications.…”

Section: Transthoracic Biopsy Of Mediastinal Massesmentioning

confidence: 99%

“…When US-assisted TTFNA is combined with CNB, close to 94% of patients are diagnosed (combined yield) by this sequential single-session approach without the aid of a radiologist or thoracic surgeon (54). US-assisted biopsy of mediastinal masses appears to be safe even in the setting of superior vena cava (SVC) syndrome, with minor hemorrhage seen in <5% of patients following TTFNA and 19% following CNB (58).…”

Section: Transthoracic Biopsy Of Mediastinal Massesmentioning

confidence: 99%

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Transthoracic ultrasonography for the clinician

Vorster¹,

Allwood²,

Koegelenberg³

2015

Eurasian J Pulmonol

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Transthoracic ultrasonography (US) has become an essential tool for respiratory, emergency, and critical care physicians. It can be performed with basic equipment and by personnel with minimum training as a modality for the evaluation of a wide range of thoracic pathologies. Its advantages include immediate application at the point of care, low cost, and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumors. Transthoracic US is also useful in visualizing pulmonary pathologies that abut the pleura, such as pneumonic consolidation and interstitial syndromes, including pulmonary edema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and it is useful in diagnosing skeletal abnormalities such as rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, transthoracic US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. Transthoracic US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes and lesions arising from the chest wall, pleura, peripheral lung, and mediastinum are safe to perform and have a high yield in the of hands of experienced clinicians. Transthoracic US can also potentially guide the aspiration and biopsy of diffuse pulmonary infiltrates, consolidations, and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism.

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“…A diagnostic yield under these circumstances of 74.2% in a series of 31 patients was described without any complication [43]. Optimization of results of US guidance is theoretically possible with contrast enhancement.…”

Section: Us As a Sampling Guidementioning

confidence: 99%

Percutaneous Ultrasonography as Imaging Modality and Sampling Guide for Pulmonologists

Stigt

Groen

2014

Respiration

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Ultrasound (US) imaging is gradually progressing into common practice in contemporary pulmonology. Its main applications are to determine the presence and amount of pleural effusions and to guide subsequent treatment interventions. Guidelines recommend the use of US for these indications. Training programs are organized and competency levels are formulated. Image guidance with US to obtain specimens for pathologic and/or microbiological analysis is less extensively practiced by pulmonologists but it is an important tool for tumour staging and diagnosing diseases. Lung tumours in contact with the pleural surface, pleural thickenings, mediastinal tumours and chest wall tumours are conceivable indications for pulmonologists to approach with the help of US visualization. Moreover, sampling of chest disease-related extrathoracal lesions may also be regarded as the working field of the pulmonologist. For example, supraclavicular and axillar lymph node metastasis, and also soft tissue and bone metastases, are lesions encountered during dissemination tests. US-guided biopsy provides not only a diagnosis, but also gives information on the stage of disease in sometimes inaccessible primary lesions. US-guided sampling increases diagnostic efficacy and safety and enables very precise performance of fine-needle aspirations as well as tissue core biopsies.

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The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Fine-Needle Aspiration of Drowned Lung

Cited by 22 publications

References 33 publications

The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

Transthoracic ultrasonography for the clinician

Percutaneous Ultrasonography as Imaging Modality and Sampling Guide for Pulmonologists

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