Ultrasound-assisted transthoracic biopsy: fine-needle aspiration or cutting-needle biopsy?

Abstract

The present study compared the diagnostic yield of ultrasound-assisted cuttingneedle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in chest lesions.A physician performed ultrasound and FNAB with a 22-G spinal needle in all patients, directly followed by a 14-G CNB in patients without contraindication.A total of 155 consecutive lesions arising from the lung (74%), pleura (12%), mediastinum (11%) or chest wall (3%) in patients with a final diagnosis of lung carcinoma (74%), other malignant tumours (12%), non-neoplastic disease (9%) or unknown (5%) were prospectively included. The overall diagnostic yield was 87%. Combined specimens were obtained in 123 lesions (79%). In these, yields of FNAB, CNB and both methods combined were 82, 76 and 89%, respectively. FNAB was significantly better than CNB in lung carcinoma (95 versus 81%) but CNB was superior in noncarcinomatous tumours and in benign lesions. On-site cytology was 90% sensitive and 100% specific for predicting a positive FNAB. One patient required drainage for pneumothorax (0.6%).Ultrasound-assisted fine-needle aspiration biopsy performed by chest physicians is an accurate and safe initial diagnostic procedure in patients with a high clinical probability of lung carcinoma. All other patients should undergo concurrent fine-needle aspiration biopsy and cutting-needle biopsy.

Diagnostic yield and safety of ultrasound-assisted biopsies in superior vena cava syndrome

“…No pneumothoraces or major haemorrhage was caused, and only mild haemorrhage occurred in 4% of needle aspirations and 18.8% of biopsies. These findings are comparable to case series not limited to SVC syndrome [13,14].…”

“…Numerous subsequent studies firmly established transthoracic mediastinal FNA and CNB as investigations with a diagnostic sensitivity ranging 80-90% [19][20][21][22] and as feasible alternatives to mediastinoscopy or diagnostic thoracotomy [23,24]. The present authors previously reported a combined diagnostic yield for US-assisted TTFNA and CNB of 89% in 155 consecutive patients with mass lesions that abutted the chest wall [14]. In that study, TTFNA had a significantly higher sensitivity than CNB in diagnosing bronchogenic carcinoma (95 versus 81%; p50.006), but CNB was superior in noncarcinomatous tumours and in benign lesions.…”

“…More errors in typing may have been made by inexperienced personnel. It should therefore be stressed that the main purpose of ROSE is to ascertain the presence of diagnostically useful material and not to make final diagnoses per se [14,16]. Vital decisions on patient management should therefore never be solely based on the ROSE diagnosis.…”

“…US-assisted biopsy performed by clinicians on peripheral pulmonary and mediastinal mass lesions in the absence of SVC syndrome is a well-established practice [7,10,13,14,[16][17][18][19][20][21][22][23][24]. SAITO et al [16] described US-guided mediastinal biopsies .20 yrs ago.…”

“…Intrathoracic mass lesions abutting or invading the chest wall are visible at US [7][8][9]. Recent studies on US-guided transthoracic fine needle aspirations (TTFNA) utilising rapid on-site evaluation (ROSE) and US-assisted cutting needle biopsies (CNB) of mass lesions involving or abutting the pleura have shown that these procedures are not only safe but also have a high diagnostic sensitivity [13,14].…”