Safety and Diagnostic Yield of Thoracic Ultrasound–Assisted Transthoracic Biopsy Performed by a Pulmonologist

Abstract

Transthoracic ultrasonography is still not utilized to its full potential by respiratory physicians, despite being a well-established and validated imaging modality. It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest.

The present study was conducted upon 75 patients (67 male and 8 female) with mean age 58.8 (SD ± 15.64) and (51) of patients were smokers who are referred to the pulmonary medicine department; Ain Shams University Hospitals with radiological assessment that reveals pleural-based mass with or without pleural effusion, anterior mediastinal mass, peripheral lung lesions or chest wall lesions. From the present study, the following results were obtained: Our study showed that 31 cases were presented by peripheral pulmonary mass divided as 25 diagnosed by transthoracic US, 4 diagnosed by other methods (including fiberoptic bronchoscopy, CT guided biopsy and surgery) and 2 cases were still undiagnosed although those methods used. Twenty nine pleural lesions divided as 17 diagnosed by transthoracic US, 9 diagnosed by other methods (thoracoscopic) and 3 cases were still undiagnosed although other invasive methods; the other 9 mediastinal and the 6 chest wall lesions, were all diagnosed by transthoracic US. According to the final diagnoses of the 57 diagnosed lesions, 51 lesions (89.4%) were malignant mostly non small cell lung cancer and mesothelioma and 6 lesions (10.6%) were benign. Their lesion size range 2.5-15 cm with Mean±SD 5.21±1.92 while undiagnosed lesion size rang 2-4cm with Mean±SD 2.75±0.49.

In the current study, diagnosis of peripheral lung masses had a sensitivity of 80.6% and a specificity of 66%, with a positive and negative predictive value of 92 and 40%, respectively. While diagnosis of pleural lesions showed a sensitivity of 58.6% and a specificity of 75%, with a positive and negative predictive value of 85% and 42.8%, respectively.