Ultrasound guidance for transthoracic fine needle biopsy

Primarily a method to by pass the long waiting lists for CT guided diagnostic procedures, nowadays, after more than 15 years of experience, ultrasound (US) has become an essential tool in detection of peripheral lung changes at the Department of Interventional Pulmology at the Pulmology and Allergy Clinic in Skopje. In order to position the value of ultrasound versus fluoroscopy (FS) for detection of solitary pulmonary nodules, we conducted a retrospective study evaluating the period from January 2009 to December 2011. A total of 720 patients consulted for diagnosis of peripheral pulmonary nodules, larger than 2cm. Ultrasound detection of the nodules was succeeded in a total of 518 (71.9%) patients, and US guided transthoracic needle aspiration (TTNA) or biopsy (TTNB) was performed for either cytology or histological specimen. In the remaining 202 patients the nodule was not detected either because of superimposing lung tissue or bone, or insufficient visualization because of large BMI, and they were referred for fluoroscopy. Results were compared for both methods of guidance. Overall diagnostic yield for FS versus US guidance was as follows: TTNA for cytology specimens was diagnostic in 58.4% (118 patients) for FL versus 61.9% (321 patients) with US; by including biopsy with a histological needle, positive diagnosis was obtained in 78.2%(159 patients) and 81.1% (420 subjects) respectfully. In 28 (18.8%) versus 57 (16.2%) of cases conclusive results were not obtained with cytology and it was necessary to repeat the biopsy for histological specimen. Statistical analysis did not show a significant difference for both methods. We recommend US is a reliable method for TTNA or TTNB guidance for peripheral lesions, larger than 2 cm, and close to the thoracic wall, as a low radiation, low cost, easily applicable and repeatable method.