Thoracoscopic biopsy versus ultrasound guided biopsy to diagnose peripheral intrathoracic lesions

ABSTRACT

Now, thoracoscopy is a well-defined technique of proven value in the investigation, diagnosis and staging of different intrathoracic lesions. Also, ultrasound guided biopsy is a new diagnostic modality in this field. To document the feasibility, safety and reproducibility of thoracoscopic biopsy and compare its results with the ultrasound-guided biopsy to diagnose peripheral intrathoracic lesions. This prospective study included all patients admitted with undiagnosed intrathoracic mass lesion during the period between March 2003 to April 2005. Group A included 45 patients for whom 56 biopsy samples were taken as ultrasound- guided biopsy [11 repeated procedures]. Group B included 30 patients for whom 30 samples were taken thoracoscopically, these included 7 patients from group A who had failed ultrasound-guided biopsy. The results were compared. Group A 45 patients, 21 males and 24 females the age ranged between 23 and 67 years, mean age was 45+6.14 years ultrasound-guided biopsy was done but repeated for 9 patients then repeated for two of the last group the diagnosis was confirmed in each case by the postoperative pathological examination of the whole resected mass. Ultrasound-guided biopsy showed sensitivity of 57%, it yielded diagnosis in 80% of the patients. The yield increased when more than one attempt was made. Also, pneumothorax occurred in 9% of cases [5 patients], heamoptysis in 3 patients and hemothorax in only one patient. Group B 30 patients 18 males and 12 females, mean age was 42+3.12 years 7 of them had previously failed ultrasound-guided biopsy. The diagnostic yield was 100%, sensitivity 100% and specificity was 100% as well. The only complication was prolonged air leak [in 2 patients] and one case converted into thoracotomy for excessive bleeding. Thoracoscopy is highly feasible, safe and having a high diagnostic yield. Both the sensitivity and specificity of thoracoscopy are much higher than those of the ultrasound-guided biopsy. Recent technologic advances including specially designed ultrasound needles will allow more precise needle placement and will lead to a higher diagnostic lead when recent equipments become available to us. In most of the cases, both ultrasound-scanning, CT-scanning and thoracoscopy are complementary to each other to diagnose peripheral intrathoracic masses