Title : Ultrasound guided cutting needle biopsy of subpleural pulmonary lesions: Predictors of non diagnostic results
Abstract:
Background: Although ultrasound-guided cutting needle biopsy (US-CNB) demonstrates high diagnostic accuracy for subpleural pulmonary lesions (SPLs), a certain number of cases may yield non-specific findings or insufficient material. This study aimed to investigate the specific diagnostic value of US-CNB for SPLs and analyze variables influencing non-diagnostic results.
Methods: This retrospective study analyzed 902 patients with SPLs who underwent a total of 907 US-CNB procedures. Patient clinical, radiological, and pathological data were analyzed. Biopsy results were categorized as diagnostic or non-diagnostic, and variables associated with these two outcome groups were identified.
Results: 832 biopsies (91.7%) yielded diagnostic results, comprising 674 (81.0%) malignancies and 158 (19.0%) definitive benign lesions. 75 biopsies (8.3%) were non-diagnostic. Among these 75 non-diagnostic cases, 45 (60.0%) were ultimately diagnosed as malignant, and 30 (40.0%) as benign. Multivariate analysis revealed that lesions located in the lower lobe (OR=1.781, 95% CI [1.090, 2.910], p=0.021), non-round shape (OR=1.763, 95% CI [1.034, 3.008], p=0.037), moderate to rich blood supply (OR=1.711, 95% CI [1.034, 2.833], p=0.037), acquisition of only one biopsy sample (OR=3.243, 95% CI [1.407, 7.474], p=0.006), and a final benign diagnosis (OR=2.330, 95% CI [1.393, 3.895], p=0.001) were associated with an increased risk of non-diagnostic results.
Conclusion: US-CNB is an effective method for establishing a definitive diagnosis of SPLs, with a relatively low proportion of non-diagnostic cases. Independent risk factors for diagnostic failure include lesion location in the lower lobe, non-round shape, moderate to rich blood supply, acquisition of only one biopsy sample, and a final benign diagnosis.
Keywords: Ultrasound-guided cutting biopsy; Subpleural pulmonary lesion; Non-diagnostic result
