Ultrasound-Guided Percutaneous Needle Biopsy For Peripheral Pulmonary Lesions:Diagnostic Accuracy And Influciening Factors

Objective : To evaluate the diagnostic accuracy and the factors influencing the diagnostic accuracy of 648 procedures of ultrasound-guided percutaneous needle biopsy(PNB)for peripheral pulmonary lesions(PPLs).Methods and Materials: We reviewed the histopathology results,the clinical records and the procedure reports of these 648 biopsies and the final diagnoses of 637 PPLs to determine the diagnostic accuracy of ultrasound-guided PNB.Factors that influenced the diagnostic accuracy were assessed by analysis of the biopsy procedures,which were classified as diagnostic cases(true-positive and true-negative)and non-diagnostic cases(false-positive,false-negative and indeterminate).Statistical analyses of factors that related to patient demographics,lesion characteristics,and biopsy details were performed to determine possible effects on diagnostic accuracy.Results: Biopsies were successfully performed in all cases and 11 patients underwent second biopsies for the same lesions.Among the 637 PPLs,there were 326(51.2%)malignant lesions,272(42.7%)benign lesions,and 39(6.1%)indeterminate lesions.Of the 272 benign lesions,114(41.9%)were found to be tuberculous.The overall diagnostic accuracy was 81.8% and the rates of hemoptysis,symptomatic pneumothorax,and chest-tube insertion were 8.0%,1.7%,and 0.9%,respectively.Lesions sizes were divided into three groups according to the measurement by ultrasound.For lesions that measured ?20mm,21-49 mm,and ?50mm,the diagnostic accuracy was72.0%,86.8% and 79.7%,while sensitivity and specificity were 54.3%-79.2%,88.3%-90.7%,79.4%-89.5% and 77.3%-100%,96.8%-100%,58.6%-100%,respectively.Diagnostic accuracy was significantly affected by lesion size when lesion size was measured by ultrasound(P =0.006)and computer-tomography(CT)(P =0.001).In the three lesion groups of ?20mm,21-49 mm,or?50mm,diagnostic accuracy among each group was significantly different(P<0.001).When lesion size was measured by ultrasound(P<0.001)and CT(P<0.001)and the three groups were analyzed(P<0.001),there was a statistically significant relationship between lesion size and the presence of necrosis.The rates of the presence of necrosis in lesions that measured ?20mm,21-49 mm,or?50mm were3.9%,11.7% and 28.8%,respectively.No significance was found for age(P =0.119),sex(P =0.25),lesion location(P =0.55),the presence of necrosis(P =0.226),patient position(P =0.25),needle size(P =0.26),puncture angle(P =0.34),and needle passes(P =0.21).Conclusions: Ultrasound-guided PNB is an effective and safe diagnostic method for PPLs,and the diagnostic accuracy is significantly affected by lesion size,and it decreases in smaller(?20mm)and larger(?50mm)lesions.