Diagnostic Yield of Ultrasound-Guided Tru-Cut Biopsies of Peripheral Lesions by the Pulmonologist

Background: Lung parenchyma lesions have multiple differential diagnoses and needs extensive workup for proper treatment but tissue histopathology or culture remain the gold standard. We calculated whether ultrasound guided Tru-cut biopsy is safe when performed by pulmonologist. Material and methods: Patient with peripheral lesion on CT chest were underwent tru-cut biopsies performed with Fine-core needle (16 G) under ultrasound guidance by pulmonologist. A curvi-linear 2-5 MHz probe was used for localization and real time guidance during procedure. Minimum 4 biopsies were performed. Definitive diagnosis was labeled if clear cut diagnosis was made on provided tissue by pathologist. Diagnostic yield was calculated by SPSS 16.0. Results: Fifty patients (M: 28(56%), F: 22(44%)) had tru-cut biopsies with mean age 55+ 9.4. The sites of the lesions were pulmonary in 44 cases (88%), Mediastinal in 4 cases (8%), pleuro-parietal in 1 case (2%) supraclavicular in 1 case (2%). Mean size was 9.09+1.65 cm in maximum dimension. No major complication like pneumothorax was noted. Minor hemoptysis after procedure was noted in two patients 4% (n= 2) that stopped spontaneously while procedural pain was reported in 20 % (n=10) of cases. In 98% (n=49) procedures we obtained a concluding diagnostic, 4% (n=2) with organizing pneumonia and 94% (n= 47) with cancers. Remaining 2% (n=1) patient; we obtained a non-diagnostic result due to inadequate tissue it was a sub-clavicular lesion. The sensitivity was 98 % and the overall diagnostic yield was 98%. Conclusions: Pulmonologists can efficiently perform ultrasound-guided biopsies in peripheral lesions with limited complications. It is comparable to biopsies performed by radiologist (91%).