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Ultrasound-assisted transthoracic biopsy: fine-needle aspiration or cutting-needle biopsy?

¹ Depts of Internal Medicine and ² Anatomical Pathology, Tygerberg Academic Hospital and National Health Laboratory Service, University of Stellenbosch, Cape Town, South Africa.

CORRESPONDENCE: A. H. Diacon, Dept of Internal Medicine, PO Box 19063, 7505 Tygerberg, South Africa. Fax: 27 219317442. E-mail: ahd{at}sun.ac.za

Keywords: Cutting-needle biopsy, fine-needle aspiration, lung biopsy, lung carcinoma, pleural biopsy, ultrasound

Received: June 14, 2006
Accepted October 22, 2006

The present study compared the diagnostic yield of ultrasound-assisted cutting-needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in chest lesions.

A physician performed ultrasound and FNAB with a 22-G spinal needle in all patients, directly followed by a 14-G CNB in patients without contraindication.

A total of 155 consecutive lesions arising from the lung (74%), pleura (12%), mediastinum (11%) or chest wall (3%) in patients with a final diagnosis of lung carcinoma (74%), other malignant tumours (12%), non-neoplastic disease (9%) or unknown (5%) were prospectively included. The overall diagnostic yield was 87%. Combined specimens were obtained in 123 lesions (79%). In these, yields of FNAB, CNB and both methods combined were 82, 76 and 89%, respectively. FNAB was significantly better than CNB in lung carcinoma (95 versus 81%) but CNB was superior in noncarcinomatous tumours and in benign lesions. On-site cytology was 90% sensitive and 100% specific for predicting a positive FNAB. One patient required drainage for pneumothorax (0.6%).

Ultrasound-assisted fine-needle aspiration biopsy performed by chest physicians is an accurate and safe initial diagnostic procedure in patients with a high clinical probability of lung carcinoma. All other patients should undergo concurrent fine-needle aspiration biopsy and cutting-needle biopsy.

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