Influencing factors and diagnostic yield of second-look ultrasound-guided pleural biopsy based on CT characteristics:...

Ultrasound-guided pleural biopsy (USPB) is a minimally invasive technique for diagnosing pleural diseases; however, the factors influencing its diagnostic performance in routine clinical practice remain incompletely characterized. This real-world study aimed to analyze the influence of demographic, radiological [pleural computed tomography (CT) characteristics], and technical factors on the diagnostic performance of USPB.

We retrospectively analyzed 1,022 patients who underwent USPB between January 2020 and January 2024. The overall success rate and diagnostic positive rate were calculated. Binary logistic regression identified factors influencing outcomes, including demographics, CT findings (effusion, thickening, nodules), and technical details (operator seniority, needle gauge, number of cores).

The success rate was 93.3% [95% confidence interval (CI): 91.8-94.9%] and the diagnostic rate was 92.4% (95% CI: 90.7-94.0%) among 1,022 patients (mean age 59.8±16.9 years). Pleural nodules, more tissue cores, and use of a 16G (vs. 18G) needle were associated with a higher success rate (P<0.05). For diagnostic yield, only the 16G needle were positive factor (P<0.05). Pleural effusion showed no significant impact on a success rate.

USPB showed favorable technical success and diagnostic yield in this single-center retrospective study. Obtaining a greater number of tissue cores and using larger-caliber needles may be associated with improved diagnostic performance. Given its real-time guidance and lack of ionizing radiation, USPB may represent a practical diagnostic option in selected patients. Further prospective multicenter studies are needed to validate these findings.