US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter

PURPOSE: To evaluate the safety and accuracy of ultrasonography (US)-guided transthoracic cutting biopsy for diagnosing peripheral thoracic lesions (< 3 cm). MATERIALS AND METHODS: Fifty consecutive patients with peripheral thoracic lesions less than 3 cm in diameter underwent US-guided percutaneous transth oracic cutting biopsy with a modified technique. Fifty lesions (43 parenchy mal lung, two pleural, two chest wall, and three anterior mediastinal lesio ns) were sampled for biopsy. The final diagnosis was based on histopatholog ic analysis of surgical specimens (n = 18) or clinical follow-up (n = 32). RESULTS: The histology recovery rate was 98% (49 lesions), and the correct diagnosis was obtained in 48 lesions (96%). Twenty-four (48%) lesions were malignant and 26 (52%) were benign. The diagnostic accuracy for malignant l esions was 92% (22 of 24 lesions). A specific benign diagnosis was made in 17 (65%) of the 26 benign lesions, and the negative predictive value for ma lignancy was 93% (26 of 28 lesions). Only two patients (4%) developed postb iopsy pneumothorax, and three (6%) developed postbiopsy hemoptysis. Biopsy helped prevent surgery or thoracoscopy in 32 patients (64%): 18 patients wi th benign disease and 14 with multiple metastases or inoperable cancer. CONCLUSION: US-guided transthoracic cutting biopsy appears to be a safe and effective method for diagnosing peripheral thoracic lesions less than 3 cm in diameter. The high diagnostic accuracy for benign lesions and metastati c lung cancer can help prevent surgery in many cases.