Thoracic ultrasonography-guided biopsy: Radiological and radiometabolic factors affecting diagnostic success

Investigate radiologic and radiometabolic features affecting the diagnostic success of transthoracic biopsy (TTB) procedures guided by Thoracic Ultrasonography (TUS).

The electronic medical records of all patients who underwent TUS-guided TTB procedures (TUS-TBB) were retrospectively reviewed. Patients with a final diagnosis of primary lung cancer (LC), established via TUS-TBB or other diagnostic modalities, were included in the study. The cohort was stratified into two groups: those in whom the TUS-TBB procedure was diagnostic and those in whom it was non-diagnostic. Clinical, demographic, radiological [Chest Computed Tomography (CT)], and radiometabolic (PET-CT) characteristics were compared between the two groups.

A total of 107 patients with a final diagnosis of lung cancer were included in the study. Of these, 91 (85%) were male, with a mean age of 67.8±11.4 years. The mean maximum diameter of the mass lesion on chest CT was 68.2±31 millimeters (mm), and the mean maximum standardized uptake value (SUV_max) on PET-CT was 14.1±6.9. A necrotic component/ametabolic area within the lesion on PET-CT was present in 43 (40.2%) patients and absent in 64 (59.8%). The most frequent histopathological subtype was adenocarcinoma, observed in 46 (42.9%) cases. While 41 (38.3%) patients underwent transthoracic fine-needle aspiration biopsy (TTFNAB) under TUS guidance, 66 (61.7%) patients underwent tru-cut biopsy (TCB). The TUS-TBB procedure was diagnostically successful in 87 (81.3%) of the cases. The presence of a necrotic component within the lesion on PET-CT was identified as the sole independent risk factor significantly impacting the diagnostic success of the procedure (p=0.010).

TUS-TBB procedures demonstrate high diagnostic success. In carefully selected patients, pre-procedural evaluation of lesion metabolic activity using PET-CT may enhance the diagnostic success of the biopsy.