Ultrasound-assisted transthoracic diagnostic techniques

[摘要] ENGLISH ABSTRACT: Although transthoracic ultrasonography is a well established modality, it is stillunderutilised by chest physicians. The aim of this research project was toinvestigate the feasibility, diagnostic yield and safety of ultrasound(US)-assistedtransthoracic biopsies performed by clinicians in various settings relevant to dailypractice of respiratory medicine. We conducted four clinical trials which aresummarised below: 1. In a prospective study on the feasibility of US-assisted transthoracic fineneedle aspiration (TTFNA) of drowned lung secondary to a proximal masslesion, a novel indication for US-assisted TTFNA was described. TTFNApasses >20mm from the visceral pleura had a sensitivity of 74.2% andwere also more likely to contain malignant cells than more superficialpasses. The surprisingly high yield and the fact that no seriouscomplications were observed validated this approach, which may be analternative to bronchoscopy.2. In the largest single-centre study on US-assisted TTFNA with rapid on-siteevaluation (ROSE) and cutting needle biopsy (CNB) in the setting ofsuperior vena cava (SVC) syndrome ever reported, we were able toaccurately diagnose 96% of all patients who presented with an associatedmass lesion that abutted or infiltrated the chest wall. No pneumothoracesor major haemorrhage was caused. We also validated the single-session approach, and were able to conclude that US-assisted TTFNA (withROSE) is the initial investigation of choice in suspected bronchogeniccarcinoma, whereas both TTFNA and CNB need to be performed in allother cases.3. We continued to validate the novel single-session sequential approach ina study on anterosuperior mediastinal masses. US-assisted TTFNA withROSE was performed on 45 consecutive patients, immediately followedby CNB where a provisional diagnosis of epithelial carcinoma or probabletuberculosis (TB) could not be established. An accurate cytologicaldiagnosis was made in 73.3%, and was more likely to be diagnostic inepithelial carcinoma and TB than all other pathology (p<0.001). CNByielded a diagnosis in 88.2%. Overall 93.3% of patients were diagnosedby the single-session approach. No pneumothorax or major haemorrhagewas observed.4. In a prospective study, we compared US-assisted Abrams and Tru-Cutneedle biopsies with regard to their yield for pleural TB. Pleural biopsyspecimens obtained with Abrams needles contained pleural tissue in91.0% of cases and were diagnostic in 81.8%, whereas Tru-Cut needlebiopsy specimens only contained pleural tissue in 78.7% (p=0.015) andwere diagnostic in 65.2% (p=0.022).In conclusion, we investigated the feasibility of US-assisted biopsies performedby respiratory physicians in various settings, and consistently found acceptableto very high diagnostic yields with minimal complications. Furthermore, we wereable to validate a novel indication for US-assisted TTFNA (US-assisted TTFNA ofdrowned lung), validate the use of a single-session sequential approach (USassistedTTFNA with ROSE followed by CNB where indicated) in at least twoclinical settings (SVC syndrome and anterosuperior mediastinal masses) and wewere able to show that US-assisted Abrams needle biopsy is superior to Tru-Cutneedles biopsy when histological confirmation of TB pleuritis is required.

[发布机构] Stellenbosch University