Comparison of the novel simultaneous biplane versus in-plane imaging technique in ultrasound-guided biopsy: a...

To evaluate and compare the in-plane and novel biplane imaging techniques in ultrasound-guided biopsies (USBx). USBx are effective for obtaining tissue samples in suspected malignancy or infection. The in-plane technique is the gold standard, offering continuous needle visualization. The biplane technique enables simultaneous in-plane and out-of-plane visualization, potentially improving biopsy outcomes. A study was conducted using gel phantoms to simulate USBx, with the goal of determining whether one technique offers distinct advantages over the other.

A total of 30 participants (mean age: 30 ± 7 years; 20 men) were recruited, primarily consisting of physicians in training with varying levels of experience. Each participant performed biopsies on gel phantoms using both the in-plane and biplane techniques in a randomized order after watching a standardized tutorial video. Procedure-related parameters were analyzed, and post-intervention questionnaires, including the NASA task load index (NASA-TLX), were collected to assess cognitive workload and personal preferences.

All participants achieved successful biopsies with both techniques. The first-puncture success rate was significantly higher with the biplane technique (83% vs. 63%; P = 0.01). The biplane technique required significantly fewer biopsy attempts than the in-plane approach (37 vs. 43; P = 0.03). Although the biplane technique had a longer "mean time to first successful biopsy" (120 seconds vs. 72 seconds), this difference was not statistically significant (P = 0.09), likely due to high variability. No significant differences were found in safety-related parameters, including the number of skin punctures, needle retractions, percentage of time the needle tip was visible, and the number of biopsy attempts without needle tip visualization. The NASA-TLX indicated higher mental demand with the biplane technique (P = 0.013), but other dimensions showed no significant differences. Overall, 83% of participants, including 88% of more experienced operators, preferred the biplane technique, citing enhanced visualization and perceived safety.

In this study, the biplane technique in USBx was substantially superior in terms of total biopsy attempts and first-puncture success rate compared with the in-plane approach. It may offer safety and efficiency advantages, particularly for less-experienced operators. Further studies with larger sample sizes and experienced operators, especially in clinical settings, are needed to determine clear superiority.

These findings suggest that biplane imaging may be especially beneficial for training less-experienced operators and in cases with elevated complication risk.