PURPOSE: This study analyses our experience of ultrasound-guided percutaneous lung aspiration for diagnosis of peripheral pulmonary lesions.
METHODS: Prospective study was performed on 25 patients showing lesion at least of 1 cm in diameter in chest radiographs, having inconclusive investigations of sputum, blood and fiberoptic-bronchoscopy. Ultrasonically-guided 22G (0.65mm) lumbar-puncture needle was introduced into the lesion under 2% lidocaine infiltrated upto parietal pleura. Aspiration was done using 10-20ml disposable syringe attached to a syringe-holder.
RESULTS: Maximum number of patients were above the 40 years age group. Male:Female ratio in the study was 2.13:1.0. Most of the patients had symptoms of cough with hemoptysis, loss of appetite, dry cough, loss of weight, hoarseness of voice, dysphagia, headache, backache and swelling over scalp in decreasing order of frequency. Most commonly encountered sign was consolidation (48%) & lympadenopathy (24%). Chest roentgenograms revealed homogenous opacity (48%), tumour mass (36%), collapse (12%), pleural effusion (8%), rib erosion (8%) and cavitatory lesion (8%). Out of 64% proved to be malignant or suspicious of malignancy, 56.25% were having adenocarcinoma, 18.75% squamous cell carcinoma and 12.5% suggestive of malignancy. One case each of malignant plasmacytoma and lymphoma was found. Out of 3 benign lesions, 2 proved to be tubercular and one suppurative. The only complications encountered were blood streaked sputum (4%) and chest pain (4%).
CONCLUSION: This clearly indicates that USG-guided percutaneous lung aspiration is a inexpensive and safe procedure which can invariably be performed on an outpatients basis and gives as good, if not better results as percutaneous cutting needle biopsy but is accompanied with a much lower incidence of morbidity and no mortality.
CLINICAL IMPLICATIONS: Transthoracic needle aspiration is especially helpful for lesions inaccessible to bronchoscopy or when bronchoscopy is non diagnostic. Ultrasound guidance is promising in lesions abutting the pleural surface. With smaller needle (18-22 gauge), complications are less frequent and sensitivity for diagnosis of malignancy in peripheral lesions is greater than 85%. The specific yield in benign lesions, however, ranges from 12% to 68%.
DISCLOSURE: Somesh Thakur, No Financial Disclosure Information; No Product/Research Disclosure Information