High Diagnostic Yield of Ultrasound-Guided Percutaneous Needle Biopsy of Peripheral Lung and Pleural Lesions, Lymph Nodes, and Other Sites Performed by Respiratory Physicians

Background: Ultrasound-guided percutaneous needle biopsy (US-PNB) represents an efficacious, safe, and cost-effective alternative to CT-guided biopsy for accessible thoracic lesions. Emerging evidence suggests that respiratory physicians experienced in thoracic ultrasound may achieve comparable diagnostic yield and safety outcomes to interventional radiologists. This study aimed to determine the diagnostic yield and safety of US-PNB of accessible thoracic lesions as performed by respiratory physicians, in an Australasian context. Methods: Demographic, clinical, and procedural information was prospectively collected at a single Australian tertiary centre for patients undergoing US-PNB of peripheral lung and pleural lesions, lymph nodes, and other accessible thoracic lesions in an outpatient setting between October 3, 2016 and December 20, 2019. The final diagnosis was determined following a discussion in a lung oncology multidisciplinary meeting. Twelve-month follow-up data was reviewed. Results: One hundred and fifty-one patients underwent 162 US-PNB procedures. This included 3 patients who underwent US-PNB of separate sites, and 8 patients who underwent repeat US-PNB procedures of the same site. Overall, the diagnostic yield of US-PNB was 83% (95% CI: 76-88). Diagnostic yield varied by procedural site, with yields highest in lymph node biopsy (91%, 95% CI: 79-97) and lowest in pleural biopsy (66%, 95% CI: 50-79). Complications occurred during 23 procedures (14%) and were largely minor. Pneumothorax occurred in 4 patients (2.5%), with 1 patient requiring intercostal catheter insertion. Conclusion: US-PNB of peripheral lung and pleural lesions, lymph nodes, and other accessible thoracic lesions performed by respiratory physicians is safe with high diagnostic yield.