الفهرس 
Chest UltrasonographyOnly 14 pages are availabe for public view
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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.