Diagnostic Accuracy and Complication Rates of Fusion Images Created Using Real-Time Ultrasound with CT for Identification of Peripheral Lung Lesions in Patients Undergoing Biopsy

Several investigators have described the utility and safety of ultrasound (US)-guided transthoracic cutting needle biopsy and fine needle aspiration in chest lesions. However, these studies were conducted only in the conventional B mode, and thus occurrence of mis-targeting is possible.

Recently, fusion image with real-time US and computed tomography (CT) has been introduced in interventional radiology. In the chest, fusion image can be used to assist in detecting the pleural-lesion contact area in extremely small solid nodules. Moreover, the fusion image of the pleural membrane associated with solid component of part-solid ground-glass nodule (GGN), results in localization of the lesion.

In this paper, the authors described the clinical benefit of US-guided lung biopsy using fusion image and aimed to retrospectively compare the diagnostic accuracy and complication rates of US-guided lung biopsy with B-mode alone and those of a fusion image created using real-time US and computed tomography (CT). 

This retrospective study was conducted at a single institution. Between September, 2013 and September, 2016, 50 peripheral lung lesions in 50 patients (40 males, 10 females; median, 74 years old) were performed by US-guided percutaneous cutting needle biopsy using the B-mode alone or fusion image. Final diagnoses were based on surgical outcomes or clinical follow-up results for at least 12 months after biopsy. To assess prebiopsy characteristics, all lesions were divided into two groups: group 1 (identification on B-mode) and group 2 (identification on fusion image). 

The results showed that of 50 peripheral lesions, 40 lesions (80%) were detected by means of B-mode alone (group 1), and 10 lesions (20%) were identified by fusion image (group 2). The diagnostic accuracy of group 1 was 90% (36/40 lesions), and the diagnostic accuracy of group 2 was 100% (10/10 lesions). Nodule type and the size of the lesions showed significant group wise differences (p < 0.001 and p = 0.02, respectively). Pneumothorax occurred immediately after the first puncture in five of 50 (10%) lesions, with no symptom development in all patients. 

In conclusion, fusion images created using real-time US and CT may be useful for identification of the minimal size of potential target lung lesions and may be more suitable for improved yields with US-guided lung biopsy.

Article by Rinpei Imamine, et al, from Japan.

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