Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention

Our plain-English summary of Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention, by H. Zhang, Y. Guang, W. He, et al (Journal of Thoracic Disease, 2020).

The study

• Authors: H. Zhang, Y. Guang, W. He, L. Cheng, T. Yu, Y. Tang, H. Song, X. Liu, Y. Zhang
• Journal: Journal of Thoracic Disease
• Published: 2020;12(7):3697-3705
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: To investigate puncture skills and complications prevention in ultrasound-guided percutaneous needle biopsy for peripheral lung lesions.

Methods: Ninety-two peripheral lung lesions in 92 patients, detected via computed tomography (CT) and also visible on ultrasound, were retrospectively analyzed. All patients underwent percutaneous peripheral lung lesion needle biopsy under traditional ultrasound or contrast enhanced ultrasound (CEUS) guidance paying attention to avoiding necrotic areas and large blood vessels. All the specimens were examined histopathologically. Preprocedure all 92 lesions were performed by traditional ultrasonography to evaluate the size, the echogenecity, liquefaction areas and blood flow on color Doppler imaging, some of which were performed by CEUS for evaluating non-enhanced necrosis areas, contrast agent arrival time (AT) and characteristics of blood perfusion.

Results: The histopathologic results of all 92 lesions were as follows: 67 malignant tumors (including 28 adenocarcinomas, 19 squamous cell carcinomas, 6 bronchoalveolar carcinomas, 5 small cell carcinomas, 5 metastatic cancers, 3 poorly differentiated cancers and 1 malignant mesothelioma), 20 benign lesions (including 9 pneumonia, 6 inflammatory pseudotumors and 5 tuberculomas), 5 undetermined lesions. Of 52 lesions by CEUS guidance, 7 lesions showed enhancement in the pulmonary arterial-phase (including 6 pneumonia and 1 malignant tumors), 45 lesions showed enhancement in the bronchial artery phase (including 37 malignant tumors, 3 inflammatory pseudotumors, 4 tuberculomas and 1 undetermined lesion). According to needle insertion angle along linear path, a total of 92 lesions were divided into two groups, 49 lesions at an angle of 70°-80° needle insertion and 43 lesions at an angle of 80°-90° needle insertion. In the study, linear and non-linear two puncture paths were used, we first tried to puncture along linear path in all lesions, if an attempt to insert into the lesions failed due to be blocked by the ribs and then changed to puncture along non-linear path instead. The success rate of biopsy procedure along linear puncture was significantly higher at an angle of 80°-90°group (93.0% vs. 20.4%, P<0.01), and the adoption rate of non-linear path biopsy for solving the puncture needle blocked by the ribs was significantly higher at angle of 70°-80°group (79.6% vs. 7.0%, P<0.01). Of 52 lesions by CEUS guidance, 27 (51.9%) showed non enhanced necrosis areas on CEUS, only 5 showed liquefaction necrosis areas on gray-scale ultrasound. Of 40 lesions by traditional ultrasound guidance, 4 showed necrosis areas on gray-scale ultrasound. There were no significant differences in lesion size, the average number of biopsy attempts and complication rates between CEUS guidance group and traditional ultrasound guidance group (P>0.05), the pathological confirmation rate in CEUS guidance group was higher than that in traditional ultrasound guidance group, but without significant difference (98.1% vs. 90.0%, P>0.05). Of all 92 cases, 3 cases (3.3%) had mild pneumothorax and 4 cases (4.3%) had hemoptysis.

Conclusions: In ultrasound-guided needle biopsy for peripheral lung lesions, using a combination of linear and non-linear puncture techniques and keeping away from necrotic areas and large blood vessels, may help to increase the success rate and reduce the incidence of complications further.

2020 Journal of Thoracic Disease. All rights reserved.

In plain English

This retrospective study from the Department of Ultrasound at Beijing Tiantan Hospital, China, reviewed needle biopsies of 92 peripheral lung lesions in 92 patients. The lesions had been found on CT and were also visible on ultrasound. The study did not examine asbestos exposure; one of the 92 lesions was a malignant mesothelioma. Biopsies were guided by traditional ultrasound (40 lesions) or contrast-enhanced ultrasound, called CEUS (52 lesions). A straight needle path was tried first, and a non-linear path was used when ribs blocked the needle. The straight path succeeded in 93.0% of lesions with an insertion angle of 80° to 90°, compared with 20.4% at 70° to 80° (P less than 0.01). Overall, the non-linear path was used in 42 of 92 lesions. CEUS showed areas of dead tissue (necrosis) in 27 of 52 lesions, while ordinary ultrasound showed them in only 5 of those. Tissue diagnosis was confirmed in 98.1% with CEUS and 90.0% with traditional ultrasound, a difference that was not statistically significant. Mild pneumothorax (air leaking around the lung) occurred in 3 patients and coughing up blood in 4. The authors concluded that combining both needle paths and avoiding dead tissue and large blood vessels may improve success and reduce complications.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of ultrasound-guided needle biopsies (single-centre case series comparing biopsy techniques)
• Who was studied: 92 patients (56 males, 36 females; mean age 66.4 years, range 52 to 82) with 92 peripheral lung lesions, at Beijing Tiantan Hospital, China. Mean lesion diameter was 3.2 cm (range 1.2 to 9.2 cm). Study dates are not given.
• Exposure: No asbestos or other fiber exposure was studied. The study compared biopsy guidance by CEUS (52 patients) with traditional ultrasound (40 patients), and linear with non-linear needle paths.
• Main results:
  • Across all 92 lesions, tissue examination found 67 malignant tumors, including 1 malignant mesothelioma. It also found 20 benign lesions and 5 undetermined lesions.
  • The straight (linear) path succeeded in 93.0% of the 43 lesions in the 80° to 90° insertion-angle group, compared with 20.4% of the 49 lesions in the 70° to 80° group (P less than 0.01).
  • The non-linear path, used when ribs blocked the needle, was needed in 79.6% of the 70° to 80° group and 7.0% of the 80° to 90° group (P less than 0.01). Overall, it was used in 45.7% of lesions (42 of 92).
  • Of 52 lesions examined with CEUS, 27 (51.9%) showed non-enhanced necrosis areas on CEUS, and only 5 of these showed liquefaction necrosis on gray-scale ultrasound. Of the 40 traditional-ultrasound lesions, 4 showed liquefaction necrosis.
  • The pathological confirmation rate was 98.1% in the CEUS group and 90.0% in the traditional ultrasound group. This difference was not statistically significant (P greater than 0.05). Lesion size, number of biopsy attempts and complication rates also did not differ significantly between the two groups.
  • Among all 92 cases, mild pneumothorax occurred in 3 (3.3%). Hemoptysis occurred in 4 (4.3%): massive hemoptysis in 1 case during the procedure and bloody sputum in 3 cases afterwards.
  • On CEUS, 7 lesions enhanced in the pulmonary arterial phase (6 pneumonia, 1 malignant tumor). Another 45 enhanced in the bronchial artery phase, including 37 malignant tumors.
• The authors' conclusion: The authors concluded that, in ultrasound-guided needle biopsy of peripheral lung lesions, combining linear and non-linear puncture techniques and keeping away from necrotic areas and large blood vessels may help increase the success rate and reduce complications.
• Limitations the authors state:
  • The authors suggested that the lack of a significant difference in confirmation rate between CEUS and traditional ultrasound may be due to multiple puncture attempts and small numbers.
  • The 16G needle cases (10 patients) were not analysed statistically because there were few cases and they were not randomly selected.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Needle Biopsy, Necrosis, Adenocarcinoma, Squamous Cell Carcinoma, Carcinoma, Mesothelioma, Biopsy.

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