ULTRASOUND-GUIDED TRANSTHORACIC BIOPSY OF THE CHEST - 06/09/11

Advances in technology have greatly improved the imaging capabilities of ultrasound (US). This article summarizes the current applications of US as a diagnostic tool in chest diseases. By scanning through the acoustic window, US is a very reliable and efficient tool for evaluating lesions of the chest wall, pleural cavity, peridiaphragm, mediastinum, hilum, and peripheral lungs. A precise puncture transducer can be used to perform US-guided transthoracic needle biopsy (TNB) with real-time visualization of the biopsy needle and the lesion. The accuracy of US-guided TNB for peripheral pulmonary nodules, chest wall lesions, and mediastinal tumors is 88% to 100%. US-guided TNB is also useful for histologic diagnosis of tumors causing superior vena cava (SVC) syndrome, Pancoast's tumors, pulmonary consolidation of unknown etiology, and tumors with obstructive pneumonitis. Moreover, transthoracic needle aspiration under US guidance can provide adequate specimens for microbiologic diagnosis of lung abscesses, necrotizing pneumonia, and parapneumonic effusions. Color Doppler imaging further extends the diagnostic spectrum of US, allowing the hemodynamics and neovascularization of a pulmonary lesion to be assessed noninvasively. Pulmonary arteriovenous malformations, pulmonary sequestration, and pulmonary infarctions can be diagnosed easily with color Doppler US. The color Doppler US puncture guiding device can improve the safety of US-guided TNB by simultaneously displaying blood vessel information, the needle shaft, and the puncture route. US examination and US-guided TNB have become indispensable diagnostic techniques for various chest diseases.

TNB with imaging guidance is a well-established technique for the diagnosis of focal pulmonary lesions.<sup>6 Klein J.S., Zarka M.A. Transthoracic needle biopsy: An overview J Thorac Imaging 1997 ;  12 : 232-249  [cross-ref]

Cliquez ici pour aller à la section Références, 22 Westcott J.L. Percutaneous transthoracic needle biopsy Radiology 1988 ;  169 : 593-601

Cliquez ici pour aller à la section Références</sup> CT and biplane fluoroscopy are the most common imaging modalities used to guide TNB. With advances in imaging capabilities, biopsy techniques, and cytopathology, CT- and fluoroscopy-guided TNB can now provide extremely high diagnostic yields (sensitivity 80% to 95%) and are relatively safe.<sup>6 Klein J.S., Zarka M.A. Transthoracic needle biopsy: An overview J Thorac Imaging 1997 ;  12 : 232-249  [cross-ref]

Cliquez ici pour aller à la section Références, 21 Westcott J. Direct percutaneous needle aspiration of localized pulmonary lesions: Results in 422 patients Radiology 1980 ;  137 : 31-35

Cliquez ici pour aller à la section Références</sup> These diagnostic modalities may be time-consuming, however, especially for small peripheral pulmonary lesions, and carry the risk of excessive exposure to radiation.

Recently, rapid advances in transducer design, signal processing, and Doppler technology have greatly improved the imaging quality of US. With the development of a precise puncture-guiding device, US has proved to be a reliable, efficient, and informative imaging modality for evaluation of a wide variety of complicated clinical problems associated with chest diseases.<sup>12 Mathis G. Thorax sonography—part II: Peripheral pulmonary consolidation Ultrasound Med Biol 1997 ;  23 : 1141-1153  [cross-ref]

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Cliquez ici pour aller à la section Références</sup> It can also be used effectively to guide TNB and other interventional procedures in the thorax.<sup>1 Chang D.B., Yang P.C., Luh K.T. , et al. Ultrasound-guided pleural biopsy with Tru-cut needle Chest 1991 ;  100 : 1328-1333  [cross-ref]

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Cliquez ici pour aller à la section Références</sup> This article presents an overview of the state-of-art applications of US-guided transthoracic biopsy in chest diseases including indications and contraindications, imaging techniques, biopsy procedures, diagnostic spectrum and sensitivity, potential complications, and advantages and limitations.