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Advantages of Thoracic Ultrasound-Guided Fine-Needle Aspiration Biopsy in Lung Cancer and MesotheliomaFine-Needle Aspiration Biopsy in Lung Cancer FREE TO VIEW

Marco Sperandeo, MD; Lucia Dimitri, MD; Clara Pirri, MD; Francesca M. Trovato, MD; Daniela Catalano, MD; Guglielmo M. Trovato, MD
Author and Funding Information

From the Department of Internal Medicine, Section of Interventional and Diagnostic Ultrasound (Dr Sperandeo), IRCCS, and Department of Pathology (Dr Dimitri), Casa Sollievo della Sofferenza; and the Department of Medical and Pediatric Sciences (Drs Pirri, F. M. Trovato, Catalano, and G. M. Trovato), University of Catania.

CORRESPONDENCE TO: Guglielmo M. Trovato, MD, School of Medicine and Policlinico University Hospital, Department Medical and Pediatric Sciences, via Santa Sofia 78, University of Catania, 9511 Catania, Italy; e-mail: guglielmotrovato@unict.it


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):e178-e179. doi:10.1378/chest.14-1557
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To the Editor:

In a recent issue of CHEST (October 2014), Hallifax et al1 describe their experience in achieving definitive diagnosis of pleural disease by pleural biopsy or pleural fluid cytology. Image-guided sampling is now standard practice, and physician-based, ultrasound-guided, cutting-needle pleural biopsy obtains pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.1

Differently, without awaiting the failure of thoracoscopy, we use thoracic ultrasound (TUS) and TUS-guided fine-needle aspiration biopsy (FNAB) as a primary intervention procedure. These tools, quite neglected, are complementary to CT imaging in patients with malignant pleural mesothelioma (MPM) or lung cancer (LC), are less traumatic, and are equally or more successful, with minimal discomfort for the patient.2-5

TUS imaging, diagnostic yield, and complications of TUS-guided FNAB were reassessed. The records of 133 patients with MPM and 801 patients with LC were analyzed. In 55 of the patients with MPM and in all 801 of those with LC (2008-2013), TUS-guided FNAB was performed using 20-gauge needles and US transducers with a central hole for needle passage.3 Such thin needles provided specimens of adequate size (length: 1.0-2.5 cm). In 20 patients, the procedure was repeated for insufficient sampling. Four patients had partial, self-limited pneumothorax; no severe complication was observed. The TUS signs observed in histologically confirmed MPM were irregular thickening of the pleural line (> 5.0 mm) and associated micronodules (5-10 mm); a lower percentage showed plaque nodulations (5-10 mm), all with slight or relevant pleural effusion. We emphasize that the concordance of CT images and TUS is greater in patients with MPM than in patients with LC, probably due to the strictly pleural-subpleural position of the tumor mass (Fig 1). Moreover, the FNAB-dedicated probes3 enable reaching the lesion to be biopsied under the coaxial view (Fig 1C), getting specimens of length, thickness, and quality adequate for pathology assessment.

Figure Jump LinkFigure 1 –  A, High-resolution CT (HRCT) imaging of two mesothelioma nodes (arrows). B, This is confirmed by calretinin histochemistry (ie, the specimen is stained with antibody to calretinin) (original magnification × 20). The cells exhibit nuclear and cytoplasmic immunoreactivity. C, Using a probe with a central hole and dedicated to fine-needle aspiration biopsy (FNAB), the lesion to be biopsied is shown under coaxial view within the node (arrow) detected by thoracic ultrasound. The ultrasound imaging is nonspecific for mesothelioma: It is not the HRCT image but only the histologic FNAB assessment that confirms the diagnosis.Grahic Jump Location

CT scanning remains the primary imaging modality in these settings, but researchers continue to strive to understand the limitations of CT imaging while simultaneously seeking to advance the utility of this modality. For the same reasons, we find that the use of TUS is a valuable complementary imaging modality and the primary diagnostic intervention procedure. It allows us to perform a step-by-step TUS-guidance FNAB with more ease and advantages in comparison with blind or CT scan-guided biopsies.3,4 Information derived from different TUS imaging features and modalities,5 CT imaging, and histology could contribute also to more articulated noninvasive screening approaches for those subjects exposed to environmental and occupational risk for MPM and LC.

References

Hallifax RJ, Corcoran JP, Ahmed A, et al. Physician-based ultrasound-guided biopsy for diagnosing pleural disease. Chest. 2014;146(4):1001-1006. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Optimization of thoracic US guidance for lung nodule biopsy. Radiology. 2014;270(1):308. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Thoracic ultrasound guidance for access to pleural, peritoneal, and pericardial space. Chest. 2013;144(5):1735-1736. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Computed tomography screening for lung cancer. Ann Intern Med. 2013;159(2):155. [CrossRef] [PubMed]
 
Sperandeo M, Sperandeo G, Varriale A, et al. Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. Ultrasound Med Biol. 2006;32(10):1467-1472. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  A, High-resolution CT (HRCT) imaging of two mesothelioma nodes (arrows). B, This is confirmed by calretinin histochemistry (ie, the specimen is stained with antibody to calretinin) (original magnification × 20). The cells exhibit nuclear and cytoplasmic immunoreactivity. C, Using a probe with a central hole and dedicated to fine-needle aspiration biopsy (FNAB), the lesion to be biopsied is shown under coaxial view within the node (arrow) detected by thoracic ultrasound. The ultrasound imaging is nonspecific for mesothelioma: It is not the HRCT image but only the histologic FNAB assessment that confirms the diagnosis.Grahic Jump Location

Tables

References

Hallifax RJ, Corcoran JP, Ahmed A, et al. Physician-based ultrasound-guided biopsy for diagnosing pleural disease. Chest. 2014;146(4):1001-1006. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Optimization of thoracic US guidance for lung nodule biopsy. Radiology. 2014;270(1):308. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Thoracic ultrasound guidance for access to pleural, peritoneal, and pericardial space. Chest. 2013;144(5):1735-1736. [CrossRef] [PubMed]
 
Trovato GM, Sperandeo M, Catalano D. Computed tomography screening for lung cancer. Ann Intern Med. 2013;159(2):155. [CrossRef] [PubMed]
 
Sperandeo M, Sperandeo G, Varriale A, et al. Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. Ultrasound Med Biol. 2006;32(10):1467-1472. [CrossRef] [PubMed]
 
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