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Wang XY, Yuan ZF, Gan KH, Zhong Y, Huang JX, Huang WJ, Xie YH, Pei XQ. Contrast-enhanced Imaging in Peripheral Pulmonary Lesions: The Role in US-guided Biopsies. Radiol Cardiothorac Imaging 2024; 6:e230234. [PMID: 38695742 PMCID: PMC11211938 DOI: 10.1148/ryct.230234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/07/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
Purpose To compare the tissue adequacy and diagnostic accuracy of US-guided biopsies of peripheral pulmonary lesions (PPLs) with and without contrast agents. Materials and Methods A retrospective study was conducted at four medical centers in patients with PPLs who underwent US-guided percutaneous transthoracic needle biopsy (PTNB) between January 2017 and October 2022. The patients were divided into contrast-enhanced US (CEUS) and US groups based on whether prebiopsy CEUS evaluation was performed. Tissue adequacy and the diagnostic accuracy of PTNB, stratified by lesion size, were analyzed and compared between groups. A propensity score matching (PSM) analysis was conducted using the nearest-neighbor matching method. Results A total of 1027 lesions were analyzed, with 634 patients (mean age, 59.4 years ± 13.0 [SD]; 413 male) in the US group and 393 patients (mean age, 61.2 years ± 12.5; 270 male) in the CEUS group. The CEUS group produced more acceptable samples than the US group (98.2% vs 95.7%; P = .03) and achieved higher diagnostic accuracy (96.9% vs 94.2%; P = .04), with no evidence of a difference in sensitivity (96.7% vs 94.0%; P = .06). PSM and stratified analyses (n = 358 per group) indicated higher tissue adequacy (99.0% vs 95.7%; P = .04) and diagnostic accuracy (98.5% vs 92.9%; P = .006) in the CEUS group compared with the US group for 2-7-cm PPLs but not for lesions larger than 7 cm. Conclusion PTNB with prebiopsy CEUS evaluation demonstrated significantly better tissue adequacy and diagnostic accuracy compared with US guidance alone for PPLs ranging from 2 to 7 cm, with similar biopsy performance achieved between groups for lesions larger than 7 cm. Keywords: Contrast Material, Thoracic Diseases, Ultrasonography, Image-Guided Biopsy © RSNA, 2024.
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Affiliation(s)
| | | | - Ke-Hong Gan
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yuan Zhong
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Jia-Xin Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Wei-Jun Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yu-Huan Xie
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Xiao-Qing Pei
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
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Argirov D, Yavorov B, Aleksiev V, Chapkunov A, Shterev F, Kartev S, Uchikov P, Vazhev Z. Complications due to ultrasound transthoracic cutting biopsy of peripheral pulmonary lesions and lesions in the chest wall and mediastinum. Folia Med (Plovdiv) 2024; 66:179-187. [PMID: 38690812 DOI: 10.3897/folmed.66.e114030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/09/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Evaluation of patients with peripheral lung lesions and lesions of the chest wall and mediastinum is challenging. The nature of the lesion identified by imaging studies can be determined by histological evaluation of biopsies. An important place in this direction is the ever-increasing popularity among thoracic surgeons of the transthoracic biopsy with a cutting needle under ultrasound control (US-TTCNB).
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Li Q, Nie F, Yang D, Dong T, Liu T. Contrast-enhanced ultrasound (CEUS) - A new tool for evaluating blood supply in primary peripheral lung cancer. Clin Hemorheol Microcirc 2022; 83:61-68. [PMID: 36031889 DOI: 10.3233/ch-221484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore the feasibility of contrast-enhanced ultrasound (CEUS) as a new tool for characterizing vascularization of primary peripheral lung cancer. METHODS 315 consecutive patients with definite primary peripheral lung cancers underwent CEUS examination from November 2016 to March 2022. CEUS parameters including time to enhancement (TE), time to peak (TP), time to wash-out (TW), distribution of vessels (DV), extent of enhancement (EE) and homogeneity of enhancement (HE) were obtained. RESULTS The lesions were grouped on the basis of TE which reflects tumor vascularization: early enhancement (pulmonary arterial vascularization) (n = 91) and delayed enhancement group (bronchial arterial vascularization) (n = 224). Overall, lung tumors commonly (71.1%) manifested a delayed enhancement which indicating blood supply originated from bronchial arteries, while an early enhancement was present in less than a third of the cases. Tumors with bronchial vascularization tended to show a delayed, reduced and heterogeneous enhancement. Correspondingly, it is characterized by a shorter TE, marked EE and a relatively infrequent occurrence of necrosis in tumors with pulmonary vascularization. CONCLUSIONS Providing micro-perfusion information, CEUS is a potentially imaging tool for evaluating blood supply in primary peripheral lung cancer.
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Affiliation(s)
- Qi Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Gansu, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Gansu, China
| | - Dan Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Gansu, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Gansu, China
| | - Ting Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Gansu, China
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You QQ, Peng SY, Zhou ZY, Tan XL, Miao XS. Comparison of the Value of Conventional Ultrasound and Contrast-Enhanced Ultrasound-Guided Puncture Biopsy in Different Sizes of Peripheral Pulmonary Lesions. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6425145. [PMID: 35615730 PMCID: PMC9110189 DOI: 10.1155/2022/6425145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
Objective To compare the clinical value of contrast-enhanced ultrasound and conventional ultrasound-guided puncture biopsy in peripulmonary lesions of different sizes. Materials and Methods 110 patients with peripulmonary lesions were randomly divided into two groups: the conventional ultrasound-guided group and the contrast-enhanced ultrasound-guided group. The lesions in the two groups were further divided into two groups according to the size of the lesions, and the tissues taken after puncture biopsy were sent for pathological examination. The pathological results were compared with the postoperative pathological results and other examination results, and the complications were recorded at the same time. Results In the conventional ultrasound group, the success rate of single puncture was 72.7% and the success rate of puncture was 80.0%; in the contrast group, the success rate of single puncture was 90.9% and the success rate of puncture was 94.6%. The difference between the two groups was statistically significant. There was no significant difference in needle bleeding and pneumothorax between the two groups. In the <30 mm group, there was no significant difference in the success rate of single puncture and the success rate of puncture between the two groups according to the size of the lesions. In the ≥30 mm group, the success rate of single puncture (97.1%) and puncture success rate (97.1%) in the contrast guidance group were higher than those in the conventional ultrasound guidance group (70.3%, 78.4%) and the difference was statistically significant (p < 0.05). Conclusion Compared with conventional ultrasound, for peripheral pulmonary lesions guided by contrast-enhanced ultrasonography, especially when the maximum diameter of the lesion is ≥ 30 mm, needle biopsy has better guiding significance; for peripheral lung lesions with a maximum diameter of <30 mm, contrast-enhanced ultrasonography is compared with conventional ultrasound guidance. The puncture success rate was not significantly different.
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Affiliation(s)
- Qi-Qin You
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, No. 1158 East Park Road, Shanghai 201700, China
| | - Shi-Yi Peng
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, No. 1158 East Park Road, Shanghai 201700, China
| | - Zhi-Ying Zhou
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, No. 1158 East Park Road, Shanghai 201700, China
| | - Xing-Li Tan
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, No. 1158 East Park Road, Shanghai 201700, China
| | - Xian-Sheng Miao
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, No. 1158 East Park Road, Shanghai 201700, China
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Del Cura JL, Del Cura G, Zabala R, Korta I. Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures. RADIOLOGIA 2022; 64:277-288. [PMID: 35676061 DOI: 10.1016/j.rxeng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.
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Affiliation(s)
- J L Del Cura
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
| | - G Del Cura
- Servicio de Radiodiagnóstico, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R Zabala
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
| | - I Korta
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
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Safai Zadeh E, Görg C, Prosch H, Jenssen C, Blaivas M, Laursen CB, Jacobsen N, Dietrich CF. WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:598-616. [PMID: 35067423 DOI: 10.1016/j.ultrasmedbio.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 05/09/2023]
Abstract
The use of ultrasound has revolutionized the evaluation of pulmonary complaints and pathology. Historically, most lung ultrasound uses described are limited to B-mode, M-mode and occasionally color Doppler. However, the use of contrast can significantly expand the diagnostic capabilities of lung ultrasound. Ultrasound contrast enables significant expansion of therapeutic and intervention capabilities. We provide a detailed description of contrast administration, phases and uses in lung ultrasound. Additionally provided are example contrast use cases and illustrative examples of contrast use in a wide range of lung ultrasound applications including pneumonia, atelectasis, pulmonary embolism and neoplasms. Clinical practice examples will help providers incorporate contrast use into their lung ultrasound practice.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Michael Blaivas
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland.
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Jacobsen N, Pietersen PI, Nolsoe C, Konge L, Graumann O, Laursen CB. Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:72-81. [PMID: 32259873 DOI: 10.1055/a-1143-3141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Contrast-enhanced ultrasound is utilized in an increasing array of medical fields, including thoracic medicine. However, the technique is still relatively new and only sporadically mentioned in current guidelines and recommendations. The aim of this systematic review is to provide a literature overview and to critically appraise the current clinical applications of contrast-enhanced thoracic ultrasound (CETUS). MATERIALS AND METHODS A systematic literature search using major electronic databases and in accordance with PRISMA guidelines was performed. Studies with a primary focus on CETUS of thoracic disorders compared to a standard reference test were included. The QUADAS-2 tool was used for quality assessment of the studies. RESULTS The search identified 43 articles: 1 randomized controlled study, 6 non-randomized controlled studies, 16 non-randomized non-controlled studies, 5 case series, 10 single case reports, and 5 animal studies. The overall risk of bias was judged to be high. Diagnostic accuracy measurements of noninvasive applications of CETUS were only reported in a few studies and they were too dissimilar for meta-analysis. Six studies compared CETUS-guided versus ultrasound-guided transthoracic needle biopsy of thoracic masses. They individually reported a significant increase in diagnostic accuracy in favor of CETUS guidance but were too heterogeneous for meta-analysis. CONCLUSION The current literature on CETUS is overall heterogeneous with a few high evidence level studies, small study populations and a high risk of bias. CETUS-guided biopsy is the most frequent clinical application and increases diagnostic accuracy compared to ultrasound guidance by an average of 14.6 percentage points.
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Affiliation(s)
- Niels Jacobsen
- Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Pia Iben Pietersen
- Regional Center for Technical Simulation (TechSim), Odense University Hospital, Odense C, Denmark
| | - Christian Nolsoe
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense C, Denmark
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Safai Zadeh E, Weide J, Dietrich CF, Trenker C, Koczulla AR, Görg C. Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions. Diagnostics (Basel) 2021; 11:diagnostics11071293. [PMID: 34359376 PMCID: PMC8305637 DOI: 10.3390/diagnostics11071293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose: To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs). Methods: From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined. Results: With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy (p < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy. Conclusion: The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
| | - Johanna Weide
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany;
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), 35033 Marburg, Germany;
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), 35033 Marburg, Germany;
- Correspondence: ; Tel.: +49-6421-58-61538; Fax: +49-6421-58-62825
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Barr RG, Wilson SR, Lyshchik A, McCarville B, Darge K, Grant E, Robbin M, Wilmann JK, Chong WK, Fleischer A, Paltiel HJ. Contrast -Enhanced Ultrasound: State of the Art in North America. Ultrasound Q 2021; 36:206-217. [PMID: 32890323 DOI: 10.1097/ruq.0000000000000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to produce a white paper on noncardiac CEUS in North America. The panel met in Chicago, Illinois, on October 24 and 25, 2017. The recommendations are based on analysis of current literature and common practice strategies and are thought to represent a reasonable approach to introduce the advantages of this safe and noninvasive technique for the benefit of our patients. Characterization of liver nodules, and pediatric vascular and intravesicular applications comprise the approved indications for CEUS in the United States. They, along with the very successful off-label use of CEUS for the kidney, are included in this publication.Other off-label uses are presented with emphasis on their value and literature support in the online version.
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Affiliation(s)
| | | | | | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Edward Grant
- University of Southern California, Los Angeles, CA
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10
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Xu W, Wen Q, Zhang X, Pan M, Liu C, Zha L, Huang P. The Application of Contrast Enhanced Ultrasound for Core Needle Biopsy of Subpleural Pulmonary Lesions: Retrospective Analysis in 92 Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1253-1260. [PMID: 33546923 DOI: 10.1016/j.ultrasmedbio.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to investigate the role of contrast-enhanced ultrasound (CEUS) in determining the viable target area in patients with subpleural pulmonary lesions before ultrasound-guided transthoracic core biopsy. In this retrospective study, we analyzed 92 patients with subpleural pulmonary lesions (63 males and 29 females; mean age: 65.17 ± 11.72 y). All patients underwent B-mode ultrasound, color Doppler and CEUS. Color Doppler was performed to identify the major vessels. The time to enhancement of the contrast agents, homogeneity of enhancement and the presence of areas without enhancement were recorded after administration of the contrast agents. The viable target areas were defined as regions showing enhancement relative to those without enhancement and regions showing delayed enhancement in reference to peripheral lung tissues showing early enhancement. Afterward, real-time ultrasound-guided transthoracic core needle (18 gauge) biopsies were performed and the complication rate, success rate and diagnostic accuracy were calculated. With CEUS, the needle pathways of these lesions were readjusted the biopsy strategy in 40/92 patients (43.5%). It was determined that the satisfactory rate of the subsequent biopsy specimen was 100%. The histologic diagnostic accuracy of the biopsy was 97.83%. No serious complications occurred during the biopsy. In conclusion, the application of CEUS before biopsy was able to depict the viable target areas of the lesion to readjust the biopsy routes. With the help of CEUS, ultrasound-guided core biopsy could obtain adequate samples, improve the diagnostic accuracy and reduce the complication rates of biopsies.
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Affiliation(s)
- Wen Xu
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qing Wen
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinjian Zhang
- Department of Vascular Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - MinQiang Pan
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chunmei Liu
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lijing Zha
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Ackman JB, Chung JH, Walker CM, Bang TJ, Carter BW, Hobbs SB, Kandathil A, Lanuti M, Madan R, Moore WH, Shah SD, Verde F, Kanne JP. ACR Appropriateness Criteria® Imaging of Mediastinal Masses. J Am Coll Radiol 2021; 18:S37-S51. [PMID: 33958117 DOI: 10.1016/j.jacr.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | | | - Tami J Bang
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen B Hobbs
- University of Kentucky, Lexington, Kentucky, Councilor, ACR Kentucky Chapter, Vice Chair, Informatics and Integrated Clinical Operations, University of Kentucky
| | | | - Michael Lanuti
- Massachusetts General Hospital, Boston, Massachusetts, The Society of Thoracic Surgeons, Director, Thoracic Oncology, Division of Thoracic Surgery, Massachusetts General Hospital
| | - Rachna Madan
- Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- University of Chicago, Chicago, Illinois, Primary care physician. Associate Chief Medical Information Officer, University of Chicago Medicine
| | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland, Director, Diagnostic Imaging, Johns Hopkins Bayview Medical Center
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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12
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Del Cura JL, Del Cura G, Zabala R, Korta I. Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures. RADIOLOGIA 2021; 64:S0033-8338(21)00067-9. [PMID: 33773773 DOI: 10.1016/j.rx.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.
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Affiliation(s)
- J L Del Cura
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, España.
| | - G Del Cura
- Servicio de Radiodiagnóstico, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - R Zabala
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, España
| | - I Korta
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, España
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13
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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14
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Yusuf GT, Fang C, Tran S, Rao D, Bartlett-Pestell S, Stefanidis K, Huang DY, Sidhu PS. A pictorial review of the utility of CEUS in thoracic biopsies. Insights Imaging 2021; 12:9. [PMID: 33506348 PMCID: PMC7840822 DOI: 10.1186/s13244-020-00944-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022] Open
Abstract
Lung cancer is one of the commonest malignancies worldwide and necessitates both early and personalised treatment. A key requirement is histological sampling with immunohistochemistry obtained usually from percutaneous biopsy. Conventionally thoracic biopsies are performed using CT guidance, but more recently, there has been development of physician led ultrasound biopsy for pleural lesions. Contrast-enhanced ultrasound (CEUS) has been increasingly used in interventional procedures and is able to offer benefits for thoracic biopsies including improving lesional visualisation and characterisation, targeting viable tissue and avoiding critical vascular structures as well as evaluating for the presence of post-procedural complications. This educational review aims to benefits of the role of CEUS in thoracic biopsies.
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Affiliation(s)
- Gibran T Yusuf
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE59RS, UK.
| | - Cheng Fang
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE59RS, UK
| | - Sa Tran
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE59RS, UK
| | - Deepak Rao
- Department of Respiratory Medicine, Princess Royal University Hospital, Farnborough, Kent, BR68ND, UK
| | - Sam Bartlett-Pestell
- Department of Respiratory Medicine, Princess Royal University Hospital, Farnborough, Kent, BR68ND, UK
| | | | - Dean Y Huang
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE59RS, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE59RS, UK
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15
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16
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Quarato CMI, De Cosmo S, D'Agostino F, Gaudiuso G, Sperandeo M. Commentary: Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs. Front Pharmacol 2020; 11:365. [PMID: 32346365 PMCID: PMC7171447 DOI: 10.3389/fphar.2020.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
| | - Federica D'Agostino
- Department of Internal Medicine, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
| | - Giulia Gaudiuso
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Bari, Bary, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Unit of Interventional and Diagnostic Ultrasound, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
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17
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Han J, Feng XL, Xu TY, Feng WQ, Liu MJ, Wang B, Qiu TL, Wang Y. Clinical value of contrast-enhanced ultrasound in transthoracic biopsy of malignant anterior mediastinal masses. J Thorac Dis 2019; 11:5290-5299. [PMID: 32030246 DOI: 10.21037/jtd.2019.11.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Given low incidence and high heterogeneity, the treatment strategies of anterior mediastinal masses (AMMs) are diverse based on pathology. The purpose of the study is to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of malignant AMMs when compared with that of ultrasound (US) alone and to screen lesions that are more suitable for CEUS evaluation and guidance. Methods We reviewed all the US- and CEUS-guided transthoracic core needle biopsy (CNB) of AMMs performed in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between July 2013 and April 2019. A total of 68 patients (mean age 36 years; male-female ration 1.6:1) who were suspected with malignant AMMs were enrolled in the study. Among them, 20 patients received pre-biopsy CEUS examination (CEUS group); 48 patients underwent conventional US examination and guidance (US group). Demographic, radiologic, pathologic, medical records, and biopsy procedure details were retrospectively reviewed and compared between the two groups. Results The display of internal necrosis areas was significantly improved when compared with that of the conventional US (70%, 30%; P=0.008). Specifically, CEUS improved the diagnostic accuracy of US-guided transthoracic biopsy (95.0%, 79.2%; P=0.210) and especially for AMMs exceeding 10 cm (100%, 68.2%; P=0.040) and carcinoma (100%, 0%; P=0.048). The number of punctures in US group and CEUS group was 2.6 and 4.4 times, respectively (P<0.001). In case of similar number of punctures (1 to 3 times), CEUS improved diagnostic accuracy when compared to that of the conventional US (100%, 75%; P=0.486). The technical success rate was 100% (68/68). In both groups, patients did not exhibit symptomatic complications such as bleeding, pneumothorax, or hemoptysis after the biopsy. Conclusions The application of CEUS in transthoracic biopsy of malignant AMMs improved diagnostic accuracy when compared with conventional US and especially played more important role in lesions exceeding 10 cm and presumptive clinical carcinoma.
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Affiliation(s)
- Jie Han
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Li Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tian-Yu Xu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wen-Qi Feng
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Meng-Jia Liu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bo Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ting-Lin Qiu
- Cancer Quality Control Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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18
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Kawshty FH, Abd Elradi AA, Ahmed AM. Diagnostic yield of ultrasound-guided transthoracic biopsy in peripheral lung lesions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_25_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Wang Y, Xu Z, Huang H, Zhou X, Xian M. Application of quantitative contrast-enhanced ultrasound for evaluation and guiding biopsy of peripheral pulmonary lesions: a preliminary study. Clin Radiol 2019; 75:79.e19-79.e24. [PMID: 31706568 DOI: 10.1016/j.crad.2019.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in differentiating malignant from benign peripheral pulmonary lesions, and to evaluate the feasibility, accuracy, and utility of CEUS-guided biopsy for peripheral pulmonary lesions. MATERIALS AND METHODS Thirty-three patients with histopathologically confirmed peripheral pulmonary lesions (22 malignant, 11 benign) were enrolled in this retrospective study. Conventional ultrasound (US) was first performed and then CEUS with a contrast-specific mode and sulfur hexafluoride-filled microbubble contrast agent. CEUS indices-time of enhancement (TE), time to peak (TP), extent of peak (EP), mean transit time (MTT), area under curve (AUC), and slope-were recorded and compared between the groups. The ability of CEUS and US to detect necrotic areas within lesions was also compared and the accuracy of CEUS-guided biopsy was calculated. RESULTS On CEUS, TE was significantly shorter in acute pneumonia lesions than in other types of lesions (p=0.03). Other indices were not significantly different between benign and malignant lesions. Detection of necrosis within lesions was significantly higher with CEUS than with US (51.5% versus 27.3%; p=0.04). The accuracy of CEUS-guided biopsy was 96.9% (32/33). CONCLUSION The study findings suggest that CEUS can identify necrotic areas within lesions, and thereby, play a useful role in imaging-guided biopsy. The present pilot study indicates that CEUS may help to identify acute pneumonia lesions from other types of pulmonary lesions. CEUS might be a useful additional technique for the diagnosis of lung lesions.
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Affiliation(s)
- Y Wang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58 Zhongshan Er Road, 510080, PR China
| | - Z Xu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The Seventh Affiliated Hospital, Sun-yat Sen University, No.628, Zhenyuan Road, Xinhu Street, Guangming New District, Shenzhen, 200090, PR China.
| | - H Huang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The Eastern Hospital of The First Affiliated Hospital, Sun-yat Sen University, No. 183 Huangpu East Road, Huangpu District, Guangzhou, 510700, PR China
| | - X Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58 Zhongshan Er Road, 510080, PR China
| | - M Xian
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The Eastern Hospital of The First Affiliated Hospital, Sun-yat Sen University, No. 183 Huangpu East Road, Huangpu District, Guangzhou, 510700, PR China
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20
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Fu Y, Zhang YY, Cui LG, Tan S, Sun Y. Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs. Front Pharmacol 2019; 10:960. [PMID: 31551773 PMCID: PMC6733953 DOI: 10.3389/fphar.2019.00960] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/29/2019] [Indexed: 12/26/2022] Open
Abstract
In this study, a total of 58 patients with single subpleural pulmonary lesions (males: 36, females: 22, mean age: 63 ± 16.2 years) who underwent contrast-enhanced ultrasonography (CEUS) and had a definite diagnosis (benign lesions:25, malignant lesions:33) were enrolled. The number of biopsies, diagnostic accuracy rate, and the incidence of complications were recorded. The nodules were divided into two size subgroups: ≥5 cm (group 1), and <5 cm (group 2). The display rate of internal necrosis and change of pre-scheduled puncture paths were compared between subgroups. Also, the arrival times, intensity and uniformity of enhancement after the contrast agent injection, as well as the display rate of internal necrosis were recorded and compared between malignant and benign lesions. Finally, the average number of punctures was 2.9 ± 0.7 times. The total diagnosis rate was 98.3%. Local pneumothorax occurred in 2 patients. Hemoptysis occurred in 1 patient. No serious complications occurred. Internal necrosis was demonstrated in 20 of 58 lesions (34.5%). Sixteen of them had changed the planned puncture path due to the large necrosis area (80%, 16/20). For lesions in group 1, necrosis was found in 15 lesions and there was a statistically significant difference in the necrosis rate between the two subgroups (15/26 vs 5/32, p = 0.001). The change in the pre-scheduled puncture path occurred in 12 patients in group 1 while 4 patients in group 2 exhibited a change in the planned puncture path (p = 0.004). There was a statistically significant difference in the arrival times and intensity of enhancement between benign and malignant lesions (p < 0.05). In conclusion, CEUS guided biopsy is an effective, sensitive, and safe method for the diagnosis of pleural-based pulmonary lesions by facilitating a distinction between necrosis and active tissue. The current findings indicated that CEUS before a biopsy may be especially vital in lesions ≥5 cm.
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Affiliation(s)
- Ying Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yuan-Yuan Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
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21
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Abstract
Contrast-enhanced ultrasound (CEUS) has evolved from the use of agitated saline to second generation bioengineered microbubbles designed to withstand insonation with limited destruction. While only one of these newer agents is approved by the Food and Drug Administration for use outside echocardiography, interventional radiologists are increasingly finding off-label uses for ultrasound contrast agents. Notably, these agents have an extremely benign safety profile with no hepatic or renal toxicities and no radiation exposure. Alongside diagnostic applications, CEUS has begun to develop its own niche within the realm of interventional oncology. Certainly, the characterization of focal solid organ lesions (such as hepatic and renal lesions) by CEUS has been an important development. However, interventional oncologists are finding that the dynamic and real-time information afforded by CEUS can improve biopsy guidance, ablation therapy, and provide early evidence of tumor viability after locoregional therapy. Even more novel uses of CEUS include lymph node mapping and sentinel lymph node localization. Critical areas of research still exist. The purpose of this article is to provide a narrative review of the emerging roles of CEUS in interventional oncology.
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22
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Guo Z, Shi H, Li W, Lin D, Wang C, Liu C, Yuan M, Wu X, Xiong B, He X, Duan F, Han J, Yang X, Yu H, Si T, Xu L, Xing W, Jinhua H, Wang Y, Xie H, Cui L, Gao W, He D, Liu C, Liu Z, Ma C, Pan J, Shao H, Tu Q, Yong L, Xu Y, Weihao Z, Qiang Z, Wang S. Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy. Thorac Cancer 2018; 9:1530-1543. [PMID: 30221455 PMCID: PMC6209790 DOI: 10.1111/1759-7714.12849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.
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Affiliation(s)
- Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Committee of Chinese Society of Interventional Oncology, China Anti-Cancer Association, Tianjin, China
| | - Hong Shi
- Chinese Medical Association Publishing House, Beijing, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Changli Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chen Liu
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Min Yuan
- Department of Interventional Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xia Wu
- Department of Interventional Radiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xiong
- Department of Interventional Radiology, Huazhong University of Science and Technology Affiliated with Union Hospital of Tongji Medical College, Wuhan, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Feng Duan
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Jianjun Han
- Department of Interventional Therapy, Shandong Cancer Hospital, Jinan, China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haipeng Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tongguo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Linfeng Xu
- Department of Interventional Therapy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenge Xing
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Huang Jinhua
- Department of Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yingjuan Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hui Xie
- Department of Interventional Therapy, 302 Military Hospital of China, Beijing, China
| | - Li Cui
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Wei Gao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dongfeng He
- The Affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | - Changfu Liu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhou Liu
- Department of Interventional Therapy, Shenzhen Cancer Hospital, Shenzhen, China
| | - Chunhua Ma
- Department of Interventional Therapy, Tianjin Huanhu Hospital, Tianjin, China
| | - Jie Pan
- Department of Interventional Therapy, Peking Union Medical College Hospital, Beijing, China
| | - Haibo Shao
- Department of Interventional Therapy, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qiang Tu
- Department of Interventional Therapy, Jiangxi Cancer Hospital, Nanchang, China
| | - Li Yong
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yan Xu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhang Weihao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zou Qiang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Sen Wang
- Department of Interventional Therapy, Tianjin Third Central Hospital, Tianjin, China
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Nolsøe CP, Nolsøe AB, Klubien J, Pommergaard HC, Rosenberg J, Meloni MF, Lorentzen T. Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1305-1324. [PMID: 29230842 DOI: 10.1002/jum.14498] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
The aim of this article is to provide an inventory of the use of contrast-enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS-guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best-evidenced indications for CEUS-guided interventions are biopsy and ablation of inconspicuous or B-mode-invisible tumors, intraprocedural ablation control and follow-up, as well as percutaneous transhepatic cholangiography and drainage procedures.
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Affiliation(s)
- Christian Pállson Nolsøe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Alexander Bjørneboe Nolsøe
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Jeanett Klubien
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Maria Franca Meloni
- Interventional Ultrasound Section, Department of Radiology, Institute of Care Igea, Milan, Italy
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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24
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Laursen CB, Graumann O, Møller TV, Davidsen JR. Contrast-enhanced Ultrasound-guided Transthoracic Lung Biopsy. Am J Respir Crit Care Med 2017; 194:e5-6. [PMID: 27351775 DOI: 10.1164/rccm.201603-0500im] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christian B Laursen
- 1 Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,2 Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,3 Centre for Thoracic Oncology and.,4 South Danish Center of Interstitial Lung Diseases, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- 5 Radiology Department, Aarhus University Hospital, Skejby, Aarhus, Denmark; and.,6 Center of Clinical Ultrasound, Aarhus University, Aarhus, Denmark
| | - Thøger V Møller
- 1 Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper R Davidsen
- 1 Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,2 Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,4 South Danish Center of Interstitial Lung Diseases, Odense University Hospital, Odense, Denmark
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Lei Z, Lou J, Bao L, Lv Z. Contrast-enhanced ultrasound for needle biopsy of central lung cancer with atelectasis. J Med Ultrason (2001) 2017; 45:461-467. [PMID: 29243129 DOI: 10.1007/s10396-017-0851-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/10/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) can distinguish between central lung cancer and atelectatic lung tissue. The aim of this study was to explore the clinical value of CEUS for biopsy in patients with central lung cancer with obstructive atelectasis. METHODS One hundred and twelve patients were selected and CEUS was performed to display central lung cancer and atelectatic lung tissue. The front edge of central lung cancer was punctured with a needle, avoiding the necrotic area, under the guidance of CEUS. RESULTS All of the 112 lesions were diagnosed with a clear central lung cancer mass and atelectatic lung tissue. In 104 cases, the central lung cancer mass presented with a "slow-in and fast-out" pattern compared to atelectatic lung tissue. In eight cases, the central lung cancer mass presented with a "fast-in and fast-out" pattern compared to atelectatic lung tissue. The mean number of punctures was 2.6, and the success rate of puncture biopsy was 98%. Of the 112 patients, six cases had hemoptysis during the procedure and 10 patients had bloody sputum in the postoperative period. No complications were found in the other cases. CONCLUSION CEUS has important clinical value for needle biopsy of central lung cancer with atelectasis.
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Affiliation(s)
- Zhikai Lei
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
| | - Jun Lou
- Department of Ultrasound, Hangzhou Tumor Hospital, Hangzhou, China
| | - Lingyun Bao
- Department of Ultrasound, Hangzhou First People's Hospital, Hangzhou, China
| | - Zhuying Lv
- Department of Ultrasound, Hangzhou Tumor Hospital, Hangzhou, China
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Hafez MR, Sobh ES, Elsawy SB, Abo-Elkheir OI. The usefulness of thoracic ultrasonography in diagnosis and staging of bronchogenic carcinoma. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2017; 25:200-212. [PMID: 29163656 DOI: 10.1177/1742271x17721264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 06/25/2017] [Indexed: 01/31/2023]
Abstract
Aim To evaluate (1) the usefulness of thoracic ultrasound in diagnosis and staging of bronchogenic carcinoma by comparing lesion detectability between thoracic- ultrasound and computed tomography and (2) the outcome of thoracic-ultrasound-guided biopsy in diagnosing bronchogenic carcinoma. Methods We conducted a cross-sectional study on 53 patients of confirmed bronchogenic carcinoma. All patients had been investigated by thoracic-ultrasound and chest-computed tomography; data regarding the presence of mass (its size, necrosis), lymph nodes invasion, peritumoural atelectasis, consolidations, pleural effusion, chest wall invasion, and paralysis of the diaphragm were recorded. Thoracic-ultrasound-guided biopsy was done for 41 patients. Results Thoracic-ultrasound had significantly higher detection rate of peritumoural atelectasis, paralysis of the diaphragm, and supraclavicular lymph nodes invasion, while it has significantly lower detection rate of pulmonary masses and mediastinal lymph nodes invasion than computed tomography. It has nonsignificant higher detection rate of pleural effusion, consolidations, chest wall invasion and necrosis within mass than computed tomography. Thoracic-ultrasound detects static air-bronchogram and/or fluid bronchogram in 53.3% of bronchogenic carcinoma-associated consolidation. Thoracic-ultrasound-guided biopsy revealed positive yield in 78.0% (32/41) of patients. All patients with negative thoracic-ultrasound biopsy had mass size >5 cm with necrosis within the mass. Self-limited complications occurred in 26.8% after thoracic-ultrasound-guided biopsy (haemoptysis 22.0%, pneumothorax 2.4% and subcutaneous emphysema 2.4%). Conclusion Thoracic-ultrasound has a significant complementary role to computed tomography in diagnosis and staging of bronchogenic carcinoma. Thoracic-ultrasound-guided biopsy revealed good positive yield (78%), its yield was negatively affected by mass size and necrosis. It is a simple, practical and accurate procedure without significant patients' risks.
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Yi D, Feng M, Wen Ping W, Zheng Biao J, Fan PL. Contrast-enhanced US-guided percutaneous biopsy of anterior mediastinal lesions. Diagn Interv Radiol 2017; 23:43-48. [PMID: 27911263 DOI: 10.5152/dir.2016.15590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE We aimed to explore the value of contrast-enhanced ultrasonography (CEUS) in guidance of percutaneous biopsy of anterior mediastinal lesions. METHODS Ninety patients with solitary anterior mediastinal lesions (55 males, 35 females; mean age, 46±4 years) were included. Patients were randomly divided into CEUS group (n=45) and conventional ultrasonography (US) group (n=45). Real-time US-guided core needle (16 G) percutaneous biopsies were performed in all lesions. The display of internal mammary arteries, internal necrosis, and active areas were recorded and compared. Biopsy success rate and diagnostic accuracy were compared between the two groups. RESULTS Display rate of unenhanced internal necrosis was higher in the CEUS group than in the US group (88.9% vs. 46.7%, P = 0.041). With real-time CEUS guidance, internal mammary arteries were effectively displayed and avoided during biopsies in 68.9% of the lesions (31/45). Of the lesions, 88.9% (80/90) were histologically proven, including 13 benign lesions and 67 malignancies. There was a significant difference in the rate of successful puncture attempts between the two groups (P = 0.041). CEUS group had a higher biopsy success rate (100% vs. 95.5%, P = 0.045) and higher diagnostic accuracy (97.8% vs. 82.2%, P = 0.035) compared with the US group (P = 0.035). CONCLUSION CEUS guidance is a promising technique in depicting internal necrotic areas, viable areas, and internal mammary arteries during percutaneous biopsy of anterior mediastinal lesion, with satisfying safety, accuracy, and success rates.
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Affiliation(s)
- Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
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28
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Linta N, Baron Toaldo M, Bettini G, Cordella A, Quinci M, Pey P, Galli V, Cipone M, Diana A. The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats. BMC Vet Res 2017; 13:141. [PMID: 28545570 PMCID: PMC5445396 DOI: 10.1186/s12917-017-1061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures. RESULTS Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions. CONCLUSIONS CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.
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Affiliation(s)
- N. Linta
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - G. Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Cordella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Quinci
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - P. Pey
- ANTECH Imaging Services, 17672-B Cowan Avenue, Irvine, CA 92614 USA
| | - V. Galli
- Freelance sonographer, Rome, Italy
| | - M. Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
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Corcoran JP, Tazi-Mezalek R, Maldonado F, Yarmus LB, Annema JT, Koegelenberg CFN, St Noble V, Rahman NM. State of the art thoracic ultrasound: intervention and therapeutics. Thorax 2017; 72:840-849. [PMID: 28411248 DOI: 10.1136/thoraxjnl-2016-209340] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/14/2017] [Accepted: 03/23/2017] [Indexed: 12/25/2022]
Abstract
The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will be in its use as an adjunct to pleural and thoracic interventions, owing to the widely recognised benefits for patient safety and risk reduction. However, as clinicians become increasingly familiar with the capabilities of thoracic ultrasound, new directions for its use are being sought which might enhance practice and patient care. This article reviews the ways in which the advent of thoracic ultrasound is changing the approach to the investigation and treatment of respiratory disease from an interventional perspective. This will include the impact of thoracic ultrasound on areas including patient safety, diagnostic and therapeutic procedures, and outcome prediction; and will also consider potential future research and clinical directions.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Rachid Tazi-Mezalek
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Jouke T Annema
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.,Tygerberg Academic Hospital, Cape Town, South Africa
| | - Victoria St Noble
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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30
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Ultrasound-guided Lung Biopsy in the Hands of Respiratory Physicians: Diagnostic Yield and Complications in 215 Consecutive Patients in 3 Centers. J Bronchology Interv Pulmonol 2017; 23:220-8. [PMID: 27454475 DOI: 10.1097/lbr.0000000000000297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to determine the diagnostic yield and prevalence of complications of ultrasound-guided transthoracic needle aspiration biopsies (US-TTNAB) performed by respiratory physicians after implementation of the procedure in an everyday clinical setting at 3 different centers. METHODS Patients were included if they during the period from January 2012 to August 2014 had a registered US-TTNAB procedure code or if a US biopsy registration form had been filled out at either of the participating centers. Histology or cytology results were used as a reference test for diagnoses that could be made based on these results. Reference test for the remaining diagnoses was clinical follow-up. The diagnostic yield of US-TTNAB was defined as the proportion of patients in which the result of the US-TTNAB was consistent with the reference test. RESULTS A total of 215 patients in which a primary US-TTNAB had been performed were identified. The most common biopsy sites were lungs and pleurae with a total of 164 (76.3%) patients and 31 patients (14.4%), respectively. US-TTNAB diagnostic yield was 76.9% (95% CI, 70.3%-83.4%) for malignant diagnoses and 47.6% (95% CI, 31.9%-63.4%) for nonmalignant diagnoses. The most common complications of US-TTNAB were pneumothorax (2.5%; 95% CI, 0.03%-4.6%) and pain at the biopsy site (2%; 95% CI, 0.04%-3.9%). No fatalities related to US-TTNAB were observed. CONCLUSION US-TTNAB performed by respiratory physicians is a safe procedure with a low risk of complications and the diagnostic yield to establish a malignant diagnosis is acceptable.
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Hong-Xia Z, Wen H, Ling-Gang C, Wen-Jia C, Shuo L, Li-Juan D, Hai-Man S, Yang Z. A New Method for Discriminating between Bronchial and Pulmonary Arterial Phases using Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1441-1449. [PMID: 27067416 DOI: 10.1016/j.ultrasmedbio.2016.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/10/2016] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
This study aimed to explore the value of a real-time comparative observation method using contrast-enhanced ultrasound (CEUS) for discriminating between bronchial and pulmonary arterial phases in diagnosing lung diseases. Forty-nine patients with 50 pulmonary lesions (45 peripheral lesions and five central lesions with obstructive atelectasis, including 36 malignant tumors, five tuberculomas, four inflammatory pseudotumors and five pneumonia lesions) detected via computed tomography and visible on ultrasonography were enrolled in this study. The arterial phases were determined by comparing contrast agent arrival time (AT) in the peripheral lung lesion with that in adjacent lung tissue, referred to as a real-time comparative observation method. Detection rates of this observation method were 100% (50/50) for pulmonary arterial phase and 88% (44/50) for bronchial arterial phase. Using the instrument's built-in graphing and analysis software, a time-intensity curve was constructed based on a chosen region of interest within the lesion where enhancement was the most obvious. Commonly used perfusion indicators in CEUS, such as AT, time-to-peak and peak intensity, were obtained from the time-intensity curve. Percutaneous puncture biopsies were performed under ultrasound guidance, and specimens of all 50 lesions were examined pathologically. AT was significantly shorter in patients with pneumonia than in those with malignant tumors or chronic inflammation (p < 0.05), whereas no difference was seen between those with malignant tumors and those with chronic inflammation. No significant differences in time-to-peak or peak intensity were seen among those with various lung diseases (p > 0.05). This is the first description of a real-time comparative observation method using CEUS for determining the arterial phases in the lungs. This method is accurate, simple to perform and provides a direct display. It is expected to become a practical and feasible tool for diagnosing lung diseases.
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Affiliation(s)
- Zhang Hong-Xia
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - He Wen
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Cheng Ling-Gang
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cai Wen-Jia
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Shuo
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Du Li-Juan
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Hai-Man
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhao Yang
- Ultrasonography Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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García-Ortega A, Briones-Gómez A, Fabregat S, Martínez-Tomás R, Martínez-García MÁ, Cases E. Benefit of Chest Ultrasonography in the Diagnosis of Peripheral Thoracic Lesions in an Interventional Pulmonology Unit. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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El-Shimy WS, El-Emery FA, Abd El-Zaher AH, El-Badry AM, El-Sharawy DE. The diagnostic value of ultrasound-guided percutaneous transthoracic core-needle biopsy versus computed tomography-guided biopsy in peripheral intrathoracic lesions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.176660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fu J, Yang W, Wang S, Bai J, Wu H, Wang H, Yan K, Chen M. Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anterior-medial mediastinal lesions. Chin J Cancer Res 2016; 28:617-625. [PMID: 28174490 PMCID: PMC5242449 DOI: 10.21147/j.issn.1000-9604.2016.06.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of anterior-medial mediastinal lesions. Methods A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy (CEUS group). During the same period, 51 patients received biopsy without CEUS examination (US group). The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups. Results A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group (P>0.001). For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound (62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023). The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively (P>0.05). The diagnostic accuracy rate of biopsy in CEUS group (96.9%, 62/64) was significantly higher than that in US group (84.3%, 43/51) (P=0.022). In US group, 2 patients suffered from mediastinal bleeding (3.9%), while no major complications occurred in CEUS group.
Conclusions CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.
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Affiliation(s)
- Jingjing Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Jing Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Haiyue Wang
- Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Minhua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
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Value of Contrast-Enhanced Ultrasound in Guidance of Percutaneous Biopsy in Peripheral Pulmonary Lesions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:531507. [PMID: 26576426 PMCID: PMC4630371 DOI: 10.1155/2015/531507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022]
Abstract
Objectives. To investigate the value of contrast-enhanced ultrasound (CEUS) in guidance of percutaneous biopsy in peripheral pulmonary lesions. Methods. This study focused on 53 patients (male: 38, female: 15, and mean age: 55.7 years ± 10.7) with 53 single peripheral pulmonary lesions. Before core needle (16-gauge) percutaneous biopsy, CEUS were performed in all lesions, with injection of 2.4 mL SonoVue (Bracco, Italy). The contrast-enhancement pattern, display rate of internal necrosis (nonenhanced) and active (obviously enhanced) areas, biopsy success rate, and pathological diagnosis rate were recorded. Results. All the peripheral pulmonary lesions were proved pathologically as benign lesions (n = 7), primary malignancies (n = 41), or metastasis (n = 5). Forty (86.9%) malignant lesions and 4 (57.1%) benign lesions showed internal necrosis areas on CEUS. The detection rate and average size of internal necrosis areas had been significantly improved compared to conventional ultrasound (P < 0.05). After CEUS, core needle percutaneous biopsies were performed successfully in the active areas of all lesions. The sampling success rate and pathological diagnosis rate were 100% and 98.1%. Conclusions. CEUS before biopsy provided useful diagnostic information about peripheral pulmonary lesions. By depicting internal necrotic and active areas, it is a promising technique for guaranteeing the accuracy, success, and safety of core needle biopsy.
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36
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García-Ortega A, Briones-Gómez A, Fabregat S, Martínez-Tomás R, Martínez-García MÁ, Cases E. Benefit of Chest Ultrasonography in the Diagnosis of Peripheral Thoracic Lesions in an Interventional Pulmonology Unit. Arch Bronconeumol 2015; 52:244-9. [PMID: 26411258 DOI: 10.1016/j.arbres.2015.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The use of ultrasound in peripheral thoracic lesions offers advantages over other radiological guiding methods. This diagnostic procedure has been applied in most studies published by radiologists. Our aim was to determine the diagnostic efficacy of percutaneous ultrasound-guided punctures and biopsies of peripheral thoracic lesions performed by pulmonologists. METHODOLOGY A retrospective analysis of 58 patients who underwent real-time ultrasound-guided transthoracic punctures and biopsy of peripheral thoracic lesions between March 2011 and September 2014 in the pulmonology department of our hospital. Cases were classified into the following diagnostic categories: malignant, benign and non-diagnostic (non-specific benign without evidence of malignancy and insufficient specimen). RESULTS A conclusive diagnosis was obtained in 47 procedures (81%), of which 13 (22.4%) were specific benign lesions and 34 (58.6%) cancers. In the remaining 11 (19%) patients, a non-diagnostic result was obtained [non-specific benign in 5 cases (8.6%) and insufficient specimen in 6 (10.3%)]. Sensitivity was 75.6%, negative predictive value was 54.2%, specificity and positive predictive value were 100%, and diagnostic accuracy was 81%. Excluding procedures with insufficient specimens, the results were 87.2%, 72.3%, 100%, 100% and 90.4% respectively. There were no serious complications. CONCLUSIONS Percutaneous ultrasound-guided puncture and biopsy in the diagnosis of peripheral thoracic lesions performed by pulmonologists is a safe procedure with high diagnostic accuracy. We achieved similar results to those previously obtained by radiologists.
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Affiliation(s)
- Alberto García-Ortega
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - Andrés Briones-Gómez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Sandra Fabregat
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Raquel Martínez-Tomás
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Enrique Cases
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
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The Role of Contrast-Enhanced Ultrasound in Selection Indication and Improveing Diagnosis for Transthoracic Biopsy in Peripheral Pulmonary and Mediastinal Lesions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:231782. [PMID: 26090391 PMCID: PMC4450237 DOI: 10.1155/2015/231782] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/02/2014] [Indexed: 11/23/2022]
Abstract
Objective. To investigate the value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of peripheral lung and mediastinal lesions. Methods. Of 142 patients, 82 patients received CEUS before biopsy and were defined as CEUS group. The remaining 60 patients only underwent conventional ultrasound (US) before biopsy and were served as US group. The information of CEUS was used for selecting indication and instructing biopsy. The imaging features, number of punctures, diagnostic successful rate, and complication rate between the two groups were compared. Results. Necrosis was demonstrated in 43.9% of the lesions in CEUS group and in 6.7% of US group (P < 0.001). Detection rate of lesion hidden in pulmonary atelectasis in CEUS group was 13.4%, which was statistically higher than 1.7% of US group (P = 0.013). The diagnostic success rate was 96.3% for CEUS group and 80% for US group, respectively (P = 0.002). The average number of punctures was 2.5 ± 0.7 and 2.6 ± 0.6, respectively. There was no significant difference in complications between CEUS group and US group. Conclusions. CEUS could play an important role in selecting proper indication and improving diagnostic accuracy rate of lung biopsy.
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Di Vece F, Tombesi P, Ermili F, Sartori S. Contrast-enhanced ultrasound (CEUS) and CEUS-guided biopsy in the diagnosis of lung abscess in a patient with achalasia: Case report. Interv Med Appl Sci 2013; 5:31-3. [PMID: 24265886 DOI: 10.1556/imas.5.2013.1.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/08/2012] [Indexed: 12/12/2022] Open
Abstract
Primary achalasia is a rare disorder of unknown aetiology characterized by dysfunction of esophageal motility secondary to degeneration of esophageal neurons. Some diseases, in particular neoplastic diseases, can cause symptoms similar to achalasia, and this condition is called pseudoachalasia. Pseudoachalasia can be indistinguishable from primary achalasia, and many investigations are often necessary to detect or exclude an underlying neoplasia. We report a case in which thoracic contrast-enhanced ultrasound (CEUS) and percutaneous CEUS-guided lung biopsy played a central role in differentiating aspiration pneumonia secondary to achalasia and complicated by lung abscess from pseudoachalasia secondary to lung carcinoma, after computed tomography (CT) yielded inconclusive findings. US contrast agent SonoVue® has an exclusively intravascular distribution, and its ability to discriminate between contrast vascular signal and tissue signal is greater than that of CT, making CEUS superior to CT in distinguishing perfused, viable tissues from avascular necrotic tissues. Although its use in pleuropulmonary pathology is still off-label, CEUS can play a useful role in characterizing peripheral pulmonary masses in selected cases.
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Affiliation(s)
- Francesca Di Vece
- Section of Interventional Ultrasound, Department of Internal Medicine, St. Anna Hospital Ferrara Italy
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