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Malignancy risk and contrast-enhanced ultrasound guidance in non-diagnostic biopsies of peripheral lung lesions: a
Qi Li1,2, Xueliang Yan1,2, Fang Nie3,4
1Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China.
Objectives:
To assess the malignancy risk of peripheral lung lesions with non-diagnostic percutaneous transthoracic needle biopsy (PTNB) findings and to evaluate contrast-enhanced ultrasound (CEUS) guidance for reducing non-diagnostic outcomes.
Materials And Methods:
This retrospective study included patients who underwent PTNB at three institutions between October 2018 and March 2023. PTNB results were categorized as diagnostic (malignancy or specific benignity) or non-diagnostic (nonspecific benignity, atypical epithelia, insufficient samples, or sampling failure). The risk factors for malignancy and the effectiveness of CEUS for guiding PTNB were analyzed.
Results:
This study included 1591 peripheral lung lesions from 1558 patients (median age: 63 y; range: 18-87 y). Among these patients, 1072 were male, and 486 were female. Approximately 40% of PTNBs yielded non-diagnostic results. Malignancy risk increased with increasing lesion size (p < 0.001). Granulomatous inflammation/organizing pneumonia was a protective factor. Compared with atypical cells of undetermined significance, atypical cells suspicious of malignancy conferred a higher malignancy risk (p < 0.001). No significant difference in malignancy rates was observed between insufficient samples and sampling failures (p > 0.05). Compared with non‑contrast enhanced US guidance, CEUS guidance demonstrated a significantly greater sampling success rate, higher diagnostic accuracy, and higher sensitivity, particularly for lesions measuring 3.1-5.0 cm (all p < 0.05).
Conclusion:
In terms of non-diagnostic PTNB results, lesions with atypical epithelia have the highest malignancy risk, whereas nonspecific benign lesions have the lowest risk. This study suggests that CEUS-guided PTNB is significantly effective for diagnosing lesions ranging from 3.1 to 5.0 cm in size, aiding the selection of imaging guidance.
Key Points:
Question What is the malignancy risk in peripheral lung lesions of non-diagnostic PTNB results, and can CEUS guidance effectively improve diagnostic accuracy and reduce inconclusive outcomes? Findings Malignancy risk varies significantly across different non-diagnostic pathological categories, while CEUS guidance demonstrated improved overall diagnostic performance, particularly for lesions measuring 3.1 to 5.0 cm. Clinical relevance This study provides a risk-stratification framework for managing non-diagnostic biopsies and demonstrates that integrating CEUS can optimize sampling success, reduce repeated procedures, and ensure timely, accurate diagnosis for patients with peripheral lung lesions.
