Safety and efficacy of ultrasound-guided lung biopsies in an outpatient physician-led service

Abstract

Introduction: Transthoracic ultrasound is an important tool in assessing pleural effusions and placement of chest drains. It also demonstrates pleural-based masses and lung tumours abutting the pleura, lesions usually suitable for US-guided biopsy (USGB). This procedure is not being widely performed by chest physicians.

Objective: To assess safety and efficacy of USGB performed by chest physicians in outpatient setting.

Methods: The procedures were carried out in outpatient setting between August 2015-January 2016. Apart from informed written consent, checking clotting and omitting antiplatelet/anticoagulants, no special preparations were undertaken. Under real-time US, lesions involving/abutting the pleura which were >15mm were sampled 1-3 times with a full-core biopsy needle (Biopince® 18G). Repeat US was done 10 minutes and 30 minutes post-biopsy, ruling-out pneumothorax. Patients were discharged home 30 minutes post-biopsy.

Results: 48 patients had USGB for lung/mediastinal tumours. Biopsies were histologically deemed adequate in 97.9%, with overall yield 97.9% and yield for malignancy 91.6% (44/48), all in accordance with The Royal College of Radiologists. In 1 patient with a negative biopsy, malignancy was diagnosed at surgery. Complications were minimal with one case of minor haemoptysis (2%) and one case of small subcutaneous hematoma (2%). We had no pneumothoraces and no deaths (0%). After the introduction of the service the waiting list for tissue diagnosis has disappeared.

Conclusion: USGB can be performed by trained chest physicians with excellent yield and very low complication rate in outpatients. When used appropriately, it reduces the waiting list for tissue diagnosis.