Repeated ultrasonically guided needle biopsy of small subpleural nodules

Study objective: To detect the significance of repeated ultrasonically guid ed needle biopsy (UGNB) for the diagnosis of nodular lesions less than or e qual to 2 cm in diameter, Design: Retrospective study to evaluate the diagnostic yield of UGNB. Setting: University hospital, outpatients, and inpatients of time respirato ry department, Patients: One hundred seven cases with small nodular lesions less than or e qual to 2 cm in diameter in contact with the pleura, Sixty-two of 107 cases were malignant, and the others were benign diseases, Results: Initial UGNB identified 56% (35/62) of the malignant lesions and 1 6% (7/45) of the benign lesions, ie, 39% (42/107) of the total. In 35 of 65 cases that were not diagnosed by the initial UGNB, it was repeated. Diagno stic;yields of the second UGNB were 68% (13/19) of the malignant cases, 25% (4/16) of the benign cases, yielding a total of 49% (17/35) in those reexa mined. Furthermore, 51 of 65 patients with negative findings on the initial UGNB underwent fiberoptic bronchoscopy. The resulting diagnostic yields we re 22% (5/23) from the malignant lesions and 18% (5/28) from the benign les ions, 20% (10/51) in total. Thus, among the malignant cases, the repetition of UGNB increased the definitive diagnostic yield from 56% (the initial UG NB) to 77%. In these small tumors, no serious complications were caused by the procedure. Conclusions: UGNB should be performed twice for a definitive diagnosis of s mall subpleural nodules before deciding on surgical biopsy or follow-up.