The diagnostic value of ultrasound-guided percutaneous transthoracic core-needle biopsy versus computed tomography-guided biopsy in peripheral intrathoracic lesions

Transthoracic ultrasound has become an important diagnostic tool in peripheral intrathoracic lesions. Transthoracic needle biopsy is a relatively safe and easy procedure under real-time ultrasound (US) guidance, and may provide adequate tissue sampling of lesions for cytological, histological, or microbiological analysis. The aim of the present study was to compare the diagnostic yield, accuracy, and complications of thoracic US-guided core-needle biopsy versus computed tomography (CT)-guided biopsy in peripheral intrathoracic lesions, including pleural, peripheral pulmonary, and mediastinal lesions. US-guided biopsy and CT-guided biopsy were performed in Chest and Radiology Departments during the period from February 2011 to June 2014 on 100 patients (50 patients for each group) using core-biopsy needle, with needle size (16–18–20 G), needle length (20 cm), and core length (1–1.5–2 cm) according to the size and type of lesion. The histopathological examination and complications were reported. The diagnostic value of chest US was compared with CT; chest US had sensitivity 91.7%, specificity 89.4%, positive predictive value 73.3%, negative predictive value 97.1%, and accuracy 90% in detecting pleural lesions; 90.7, 91.4, 95.1, 84.2, and 91%, respectively, in detecting pulmonary lesions; and 72.7, 88.7, 44.4, 96.3, and 87%, respectively, in detecting mediastinal lesions compared with chest CT. After taking transthoracic biopsy, chest US-guided biopsy revealed four benign (8%), 30 malignant (60%), 10 inflammatory(20%), and six undiagnosed (12%) cases, whereas CT group revealed two (4%), 33 (66%), 10 (20%), and five (10%) cases, respectively, with a complication rate [pneumothorax: two (4%) cases for US group and three (6%) cases for CT group and pulmonary hemorrhage: two (4%) cases and three (6%) cases respectively]. Chest US-guided biopsy is safe, reliable, and a fast procedure with lower cost and fewer complications than is CT-guided biopsy, provided that the lesions have favorable acoustic window and abut the visceral pleura.