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Sperandeo M, Maiello E, Graziano P, Simeone A, De Cosmo S, Dimitri L, Di Micco C, Perrone E, Taurchini M, Ferretti G, Mirijello A, Varriale A, Grimaldi MA, Lacedonia D, Quarato CMI. Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations. Diagnostics (Basel) 2021; 11:diagnostics11091641. [PMID: 34573981 PMCID: PMC8468729 DOI: 10.3390/diagnostics11091641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022] Open
Abstract
(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies.
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Affiliation(s)
- Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy;
| | - Evaristo Maiello
- Unit of Oncology, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (E.M.); (C.D.M.)
| | - Paolo Graziano
- Unit of Patology, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (P.G.); (L.D.)
| | - Annalisa Simeone
- Unit of Radiology, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy;
| | - Salvatore De Cosmo
- Department of Internal of Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (S.D.C.); (A.M.); (A.V.); (M.A.G.)
| | - Lucia Dimitri
- Unit of Patology, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (P.G.); (L.D.)
| | - Concetta Di Micco
- Unit of Oncology, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (E.M.); (C.D.M.)
| | - Elio Perrone
- Unit of Nuclear Medicine and PET/TC, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy;
| | - Marco Taurchini
- Unit of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (M.T.); (G.F.)
| | - Gianmaria Ferretti
- Unit of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (M.T.); (G.F.)
| | - Antonio Mirijello
- Department of Internal of Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (S.D.C.); (A.M.); (A.V.); (M.A.G.)
| | - Antonio Varriale
- Department of Internal of Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (S.D.C.); (A.M.); (A.V.); (M.A.G.)
| | - Maria Arcangela Grimaldi
- Department of Internal of Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy; (S.D.C.); (A.M.); (A.V.); (M.A.G.)
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, FG, Italy;
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, FG, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, FG, Italy;
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, FG, Italy
- Correspondence:
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Sperandeo M, Filabozzi P, Varriale A, Carnevale V, Piattelli ML, Sperandeo G, Brunetti E, Decuzzi M. Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases. J Ultrasound 2008; 11:39-46. [PMID: 23396553 DOI: 10.1016/j.jus.2008.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Although numerous studies have been conducted on the use of ultrasonography (US) for the examination of thoracic structures, this procedure is not as widely accepted as abdominal US. The newer portable scanners can be used at the bedside to detect pleural malignancies and effusions, as well as peripheral lung nodules of the lung, even in seriously ill patients. Focal thickening of the pleura can be easily detected with US and further investigated with a US-guided biopsy. US guidance can also be used during percutaneous drainage of pleural effusion or transthoracic biopsy of peripheral lung lesions, thus reducing the incidence of procedure-related pneumothorax to almost zero. We review the current literature on thoracic US and present our clinical experience with the technique in large groups of patients with pleural and peripheral lung diseases.
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Affiliation(s)
- M Sperandeo
- Department of Internal Medicine, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (FG), Italy
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