Ultrasound-guided percutaneous core biopsy of thoracic lesions: Diagnostic yield and site-specific safety

Abstract

Background: Ultrasound (US)-guided percutaneous biopsy is increasingly being used for thoracic lesions abutting the chest wall; however, its comparative safety according to puncture site remains unclear. We assessed the diagnostic yield and complications of bedside US-guided core needle biopsy.

Methods: We retrospectively reviewed the medical records of 168 consecutive patients who underwent pulmonologist-performed bedside core biopsy using an 18-gauge needle under real-time US guidance without a coaxial system between April 2011 and July 2022 at a single center. Typically, two to three passes were performed. Lesions were prospectively classified ultrasonographically as solid or heterogeneous. Diagnostic yield and complications were graded using the Clavien-Dindo system and compared according to puncture site and lesion morphology.

Results: Adequate tissue was obtained in 159 (94.6 %) patients. The final diagnosis was malignancy, infection, and other benign conditions in 81.8 %, 13.8 %, and 4.4 % patients, respectively. Complications occurred in 7.1 % of patients, and pneumothorax was the most frequent complication (4.7 %). All complications were managed conservatively. Grade IV-V adverse events occurred in three (1.5 %) patients undergoing lung parenchymal biopsies. Of these, one patient died during follow-up due to pleural dissemination along the biopsy tract. No adverse events ≥ Grade III occurred after chest-wall, pleural, or mediastinal biopsies. No adverse events occurred in 156 patients.

Conclusions: US-guided percutaneous core biopsy has a high diagnostic accuracy and low complication rate. However, safety varies according to site, with serious adverse events limited to patients with lung parenchymal targets. US-guided core biopsy is a feasible first-line approach for accessible extrapulmonary thoracic lesions; however, careful consideration is required for intrapulmonary targets.

Keywords: Complications; Diagnostic yield; Percutaneous biopsy; Pneumothorax; Thoracic ultrasonography.