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Abstract Peripheral intrathoracic lesions have broad differential diagnosis including malignant, benign and inflammatory lesion. These lesions can be in parenchyma, pleural or mediastinal. Tissue diagnosis is gold standard for all of these lesions that used to be obtained either by open lung biopsy, mediastinoscopy or video assisted thoracic surgery. Image guided percutaneous transthoracic biopsy has become a widely accepted, effective, and safe minimally invasive technique with which to obtain tissue specimens from a number of different intrathoracic lesions. Computed tomography (CT) is among the more commonly used imaging investigations in patients with chest disease. Modern CT scanners can acquire images of the thorax in a single breath-hold and provide morphological details. CT provides also excellent resolution and a good acoustic window. But it has the disadvantages of high cost and exposure to ionizing radiation; in addition, it lacks the bedside availability and needs considerable patient cooperation at certain positions. The role of US is emerging in the pulmonology and now being used in assessment of various Pulmonary diseases. The USguided transthoracic biopsy has become a valuable tool for pulmonologists. Ultrasound (US) also is a safe and effective method for percutaneous guided biopsies from lesions with chest wall contact with real time guidance, free of ionizing radiation. In addition, US equipment is less expensive than CT machines and is generally more widely available. Portable US machines can also be moved to the patients bedside. The aim of this study was to assess and compare the diagnostic yield and complications of ultrasound-guided transthoracic biopsy versus computed tomography (CT)-guided biopsy in peripheral intrathoracic lesions. This compartive study included 100 patients with undiagnosed peripheral intrathoracic lesions and divided into 2 groups. group I included 50 patients with peripheral intrathoracic lesions on whom transthoracic core-needle biopsy (CNB) was carried out guided by ultrasongraphy. group II included 50 patients with peripheral intrathoracic lesions on whom CNB was carried out guided by chest computed tomography. We excluded from the study patients with intrathoracic lesions away from chest wall by more than 2 cm, patients with bleeding diathesis ( international normalized ratio (INR) of more than 1.3 or platelet count of less than 100,000/mm3), hemodynamic instability, cardiovascular instability for example, unstable angina, recent myocardial infarction, or uncontrolled severe hypertension, severe chronic obstructive pulmonary disease (FEV1 < 1L or < 35% predicted). hypervascular lesion or aneurysm, patient on positive pressure ventilation, severely limited function of contralateral lung or contralateral pneumonectomy and suspicion of hydatid cyst. An informed written consent was taken from each patient. All procedures were performed safely with local anesthesia alone. The procedure was done while the patients were placed supine, prone or lateral decubitus, according to the position which gave greater access with the best safety profile. The biopsy was performed by using semiautomated true cut needle. Transthoracic core-needle biopsy (CNB) was carried out guided by ultrasongraphy in group I. The affected region was scanned using US (HITACHI EUB-7000 Jaban) with a 3.5-MHz convex probe parallel to the ribs in the intercostal spaces.The biopsy was performed by using semi-automated spring loaded true cut needle GTA [Quistello (MN), Italy] having a size of , 18-G needle, length of 10, 15 or 20 mm was chosen according to the size and distanse of the lesion. The samples were sent for histopathological examination and diagnosis. Transthoracic core-needle biopsy (CNB) was carried out guided by chest computed tomography in group II using CT scanner (Toshiba, Alexion, 16 detectors). The slice thickness should be less than half the diameter of the targeted lesion to be certain that a single CT image contains the lesion. With the use of the gantry laser light to delineate the Z-axis position, and radiopaque skin marker to determin the X-axis position, the needle entry site was marked on the patient’s skin. The same core-biopsy needles (GTA) were used. Anew axial slices were made to confrm the correct location.The samples were sent for histopathological examination and diagnosis. Chest radiograph was performed after 30 minutes and after 3 hours to rule out any complications including pneumothorax, hemothorax, and soft tissue hematoma. The patient is observed for 6 hours and then discharged. The present study reported a success rate of 100% of US guided core biopsies in pleural lesions and their histopathology was (pleural fibroma 2 patients (4%) and mesothelioma in 4 patients (8%) and also the a success rate of 100% of CT guided core biopsy in pleural lesions (mesothelioma in 4 patients (8%) of cases. The present study showed diagnostic yield of (94.8%) of US as guidance for core biopsies in peripheral parenchymal lesions ( Inflammatory in 2 patients (4%), adenocarcinoma in 21 patients (42%), large cell lung cancer in 2 patients (4%) small cell lung cancer in 8 patients (16%) squamous cell carcinoma in 2 patients (4%) undifferentiated malignant neoplasm in 2 patients (4%) and undiagnosed in 2 patients (4%)). While the diagnostic yield of 100% of CT guided biopsy parenchymal lesions ( Inflammatory in one patient (2%), adenocarcinoma in 23 patients (46%), large cell lung cancer in one patient (2%), small cell lung cancer in 11 patients (22%), squamous cell carcinoma in 4 patients (8%) and undifferentiated malignant neoplasm in 2 patients (4%)). Our results showed adiagnostic yield of (80%) of US guided core biopsies in mediastinal lesions (lymphoma in 2 patients (4%) malignant thymoma in 2 patients (4%) and undiagnosed in 1 patients (2%)). The diagnostic yield of CT guided mediastinal biopsy revealed a diagnostic yield of 75% (lymphoma in 2 patients (4%) malignant thymoma in 1 patients (2%) and undiagnosed in 1 patients (2%)). The sensitivity of ultrasound-guided transthoracic biopsy in diagnosis of peripheral intrathoracic lesions was 94% , while the sensitivity CT-guided transthoracic biopsy was 98% and there was no difference exist between CT and US guidance in the terms of safety and diagnostic yield. On comparing the complications of biopsy between the studied two groups. In group I there was no complications, while in group II pneumothorax was detected in 1 patients (2%), mild perilesion contusion was detected in 1 patients (2%) and hemoptysis was detected in 1 patient (2%). So ultrasound-guided transthoracic biopsy is a safe and effective method in diagnosis of peripheral intrathoracic lesions as CT-guided transthoracic biopsy. |