Ultrasound Guidance Versus CT Guidance for Peripheral Lung Biopsy: Performance According to Lesion Size and Pleural Contact

The purpose of this study was to compare efficacy and safety of biopsy guided by ultrasound (US) versus CT for lung lesions with pleural contact. Among 1269 image-guided thoracic biopsies obtained at our institution between 2004 and 2016, 150 were US-guided for lung lesions with pleural contact (78 men, 72 women; mean age, 67 years). Of those, 94 were performed using US only; 56 had initial CT localization. A comparison cohort of 100 consecutive CT-guided biopsies for lung lesions with pleural contact was identified (60 men, 40 women; mean age, 65 years). Biopsy type, number of passes, sample adequacy, final pathologic results, complications, procedural time, lesion diameter, and pleural contact were recorded. Fisher exact and t tests were used for statistical analysis. US-guided biopsy was associated with fewer complications (7%) than CT-guided procedures (24%; p < 0.001). Mean procedure times (± SD) were shorter with US only (31 ± 16 min) than with CT only (45 ± 26 min; p < 0.001) or US with CT localization (45 ± 18 min; p < 0.001). Procedural times were longer for patients with small lesions and those with lesser pleural contact. Sample adequacy was best when core biopsy was performed with US and CT. Fewer passes were performed with US guidance than with CT guidance (mean, 3.1 ± 1.8 vs 4.4 ± 1.9, respectively, p < 0.001), with a trend toward improved pathologic adequacy (98% vs 93%, respectively, p = 0.122). Subgroup analysis showed fewer complications for lesions 31-50 mm (p = 0.029), improved sample adequacy for lesions 10-30 mm (p = 0.0032), and shorter procedural times for lesions 10-30 mm (p = 0.0001) with US than with CT. US guidance should be considered for biopsy of peripheral lung and pleural lesions larger than 10 mm, because it is safer, faster, and possibly more accurate than CT guidance.