Thoracic core needle biopsy using ultrasound guidance

Complications due to ultrasound transthoracic cutting biopsy of peripheral pulmonary lesions and lesions in the chest wall and mediastinum

INTRODUCTION

Evaluation of patients with peripheral lung lesions and lesions of the chest wall and mediastinum is challenging. The nature of the lesion identified by imaging studies can be determined by histological evaluation of biopsies. An important place in this direction is the ever-increasing popularity among thoracic surgeons of the transthoracic biopsy with a cutting needle under ultrasound control (US-TTCNB).

Should We Perform Transthoracic Trucut Lung Biopsies of Pleural-Based Lung Masses Under Ultrasound Guidance or Computed Tomography Guidance?

We aimed to emphasize which method should be prioritized by comparing the ultrasound and computed tomography (CT) guidance for percutaneous transthoracic biopsy of pleural-based lung lesions in terms of comorbidity, diagnostic success, time, and costs.Approximately 700 biopsy procedures performed between 2014 and 2018 were retrospectively reviewed. The files of these patients and picture archiving and communication system were scanned.Size and localization of the lesion, pathological diagnosis, comorbidity status, pneumothorax complications at the end of the procedure, and whether or not a thoracic tube was placed due to pneumothorax were recorded. Fisher exact test and Pearson χ test were used for statistical analysis.A total of 181 patients who underwent the pleural-based biopsy procedure, the subject of study, were included in the study. One hundred (55.2%) of the biopsy procedures of these patients were performed under the guidance of tomography, and 81 (44.8%) were performed under the guidance of ultrasound (US). Median size of the lesions is 38 mm (25%-75%, 33-55 mm). Pneumothorax complications were observed in 6 patients (6%) who had CT-guided procedures and 4 patients (4.9%) who had US-guided procedures. Of the patients who developed pneumothorax, 2.8% were inserted thoracic tubes owing to the complication. Diagnostic efficacy of our procedures is 99.8% in US-guided procedures and 97% in CT-guided transthoracic biopsy. The average duration of US-guided transthoracic biopsy procedures is 17 minutes, and the average duration of CT-guided biopsy procedures is 35 minutes.

The impact of imaging speed of MR-guided punctures and interventions in static organs--a phantom study

PURPOSE

Verification of MR-guidance with image acquisitions slower than 1 image per second as it is inevitable for some interventions. Therefore, we quantified solely the effect of acquisition-time on the efficiency of MR-guided interventions in a static phantom study.

MATERIALS AND METHODS

We measured the duration, accuracy and error rate of simulated interventions for different acquisition-times using a simplified interventional setup. All measurements were performed in a 1.0 T open MRI scanner. Imaging was performed with a gradient-echo sequence (flipangle=20°; TR/TE=12/6 ms; voxelsize=1 mm×1 mm; slicethickness=5 mm; FOV=230 mm×200 mm; acquisition-time=1 s). Variable acquisition times were simulated with intermediate pauses of 0, 1, 2, 3, 4 and 5 s. The interventions were performed by a total of 20 volunteers including 7 experienced interventionalists.

RESULTS

The mean duration of the intervention was 2 min. Significant differences between experienced and unexperienced volunteers were limited to the localization of the image plane and corrections made. The mean accuracy was 5.6 mm. The time to localize the image plane increased with deceleration of imaging from 24 s to 49 s. A similar increase was observed for the intervention time (55-108 s). A significant influence of the acquisition-time on durations and corrections was only found with acquisition-times greater than 4s per image.

CONCLUSION

Even image rates of several seconds per image are sufficient enough for efficient interventions in static organs. Thus, the main attention has to be turned on the visibility of the needle when sequences are optimized for MR-guidance. The minimization of imaging speed is rather of secondary interest.