Diagnosis Value Between Ultrasound And CT In Guidance Of Percutaneous Biopsy Of Peripheral Pulmonary Lesions

Objectives:To compare the diagnosis value between CT and ultrasound in guidance of percutaneous biopsy of peripheral pulmonary lesions.By comparing these two methods,we hope to find a suitable puncture biopsy for the patients.Methods:83 patients with peripheral pulmonary lesions required ultrasound-guided transthoracic lung biopsy for pathological diagnosis.Among them,50 patients received CEUS examinations before biopsy(CEUS group).During the same period,33 patients received biopsy without CEUS examination(US group).The ultrasonography characteristics were recorded and compared between the two groups.A total of 485 patients with pulmonary lesions underwent CT-guided transthoracic lung biopsy,screening of 84 cases of chest CT images showed lesions close to the lung pleura patients with CT group.83 patients with pulmonary lesions were guided by ultrasound for biopsy.Comparison of the success rate,the positive rate of pathological diagnosis and the incidence of complications between the two groups.Results:The internal necrosis detection rate(60%)in the CEUS group was higher than that in the US group(12.1%).In particular,for the peripheral pulmonary nodules with diameter>5 cm,the detection rate of internal necrosis was higher(77.8% vs 16.7%,P <0.001).For the squamous cell carcinoma and adenocarcinoma,the detection rate of internal necrosis(76.9% vs 15.4%,P = 0.001;70.6% vs 17.6%,P = 0.005)was significantly improved compared with conventional ultrasound.The success rates of puncture in the CT group and ultrasound group were 96.4% and 95.1%,respectively.The positive rate of pathological diagnosis of CT group was 90.5%,and the positive rate of pathological diagnosis was 86.7% in US group(P> 0.05).The correct rate of pathological diagnosis of CT group was 97.6%,and the correct rate of pathological diagnosis was 97.6% in US group(P> 0.05).There were 24 cases of complications in the CT group(28.6%),including12 cases of pneumothorax(14.3%);4 cases of hemoptysis(4.8%);2 cases of bleeding(2.4%);3 cases of chest pain(3.6%);3 cases cough(3.6%).There were 8 cases of complication in the ultrasound group,the total incidence rate was 9.6%,including 3 cases pneumothorax(3.61%);4 cases small hemoptysis(4.82%);1 case chest pain(1.20%).Conclusions:1.The puncture success rate,the higher correct rate of pathological diagnosis between ultrasound-guided(US)group and CT-guided group of lung biopsy are both high,indicating that both the methods have clinical value.2.Compared with CT-guided lung biopsy,ultrasound-guided lung biopsy is more convenient,low cost,no radiation,the incidence of complications is low Etc.3.This study found that ultrasound guided percutaneous lung biopsy is the first choice for the diagnosis of pulmonary nodules in visible peripheral lesions with ultrasound.4.Contrast-enhanced ultrasound(CEUS)can provide the best puncture site and puncture path than conventional ultrasound,and avoid to injury intercostal artery.