Ultrasound/ CT guided biopsy of lung /pleural lesions

Ultrasound-guided or CT-guided biopsy of lung and pleural lesions is a minimally invasive procedure used to obtain tissue samples for diagnostic evaluation.

Indications

1. Lung Lesions: Suspicious lung nodules or masses detected on imaging studies (X-ray, CT scan, PET scan) that require further evaluation for diagnosis.
2. Pleural Lesions: Abnormalities in the pleura, such as pleural thickening, nodules, or effusions, that are suspected to be malignant or require characterization.

Pre-procedure Preparation

1. Patient Assessment:
   • History taking, physical examination, and review of imaging studies to confirm the location, size, and characteristics of the lesion(s) requiring biopsy.
   • Evaluation of coagulation profile and correction of any bleeding disorders if present.
2. Informed Consent:
   • Explanation of the procedure, its purpose, risks, benefits, and alternatives to the patient or their caregivers. Informed consent is obtained.
3. Imaging Studies:
   • CT scan or ultrasound imaging is performed to precisely localize the lesion and plan the biopsy approach.
4. Medications:
   • Depending on the patient’s medical history and the planned procedure, medications such as antibiotics or sedatives may be administered.

Ultrasound-Guided Biopsy

1. Patient Positioning:
   • The patient is positioned comfortably, either lying down or sitting upright, depending on the location of the lesion.
2. Ultrasound Localization:
   • The ultrasound probe is placed on the chest wall or the skin surface near the lesion to visualize the target area in real time.
   • The radiologist or interventionalist identifies the optimal biopsy site, avoiding critical structures and ensuring adequate tissue sampling.
3. Local Anesthesia:
   • Local anesthesia is administered to numb the skin and underlying tissues at the biopsy site to minimize discomfort during the procedure.
4. Biopsy Needle Insertion:
   • A biopsy needle is inserted through the skin and guided into the target lesion under continuous ultrasound visualization.
   • Multiple tissue samples (core biopsy or fine needle aspiration) may be obtained using the biopsy needle to ensure diagnostic accuracy.
5. Sample Collection:
   • The collected tissue samples are retrieved from the biopsy needle and sent to the laboratory for histological and cytological analysis.

CT-Guided Biopsy

1. Patient Positioning:
   • The patient is positioned on the CT scanner table in the appropriate position based on the location of the lesion within the lung or pleura.
2. CT Localization:
   • CT imaging is performed to precisely localize the lesion in three dimensions and plan the optimal needle insertion trajectory.
3. Skin Marking and Anesthesia:
   • The skin surface overlying the biopsy site is marked, and local anesthesia is administered to numb the area.
4. Biopsy Needle Insertion:
   • Using CT guidance, a biopsy needle is inserted through the skin and advanced into the target lesion with real-time imaging feedback.
   • The needle position is adjusted as necessary to ensure accurate sampling of the lesion.
5. Sample Collection:
   • Tissue samples (core biopsy or fine needle aspiration) are obtained using the biopsy needle under CT guidance.
   • The collected samples are sent to the laboratory for pathological analysis, including histology and cytology.

Post-procedure Care

1. Monitoring:
   • The patient is monitored for a brief period after the procedure for any immediate complications such as bleeding, pneumothorax, or respiratory distress.
   • Vital signs, oxygen saturation, and respiratory status are assessed regularly.
2. Pain Management:
   • Pain or discomfort at the biopsy site is managed with appropriate analgesics as needed.
3. Observation and Discharge:
   • Patients are observed for a few hours post-procedure to ensure stability before discharge.
   • Post-biopsy instructions, including follow-up appointments and contact information for any concerns or complications, are provided.

Benefits of Ultrasound/CT-Guided Biopsy

• Precision: Allows for precise localization and targeting of lesions within the lung or pleura, enhancing diagnostic accuracy.
• Minimally Invasive: A less invasive alternative to surgical biopsies, with reduced risks, shorter recovery times, and minimal discomfort for the patient.
• Real-Time Imaging: Provides real-time imaging feedback during needle insertion, ensuring optimal sampling and avoiding injury to adjacent structures.
• Diagnostic Yield: Typically provides sufficient tissue samples for histological and cytological analysis, aiding in definitive diagnosis and treatment planning.

Risks and Considerations

• Bleeding: Risk of bleeding at the biopsy site, particularly in patients with bleeding disorders or anticoagulant therapy.
• Pneumothorax: Risk of pneumothorax (lung collapse) due to needle insertion, especially in lung biopsies.
• Infection: Although rare, there is a risk of infection at the biopsy site or within the sampled tissues.
• Pain and Discomfort: Patients may experience mild pain, discomfort, or bruising at the biopsy site, which usually resolves quickly.

Conclusion

Ultrasound-guided or CT-guided biopsy of lung and pleural lesions is a safe, effective, and minimally invasive procedure for obtaining tissue samples for diagnostic evaluation. It provides accurate localization, precise targeting, and high diagnostic yield, contributing to optimal patient management and treatment decisions for lung and pleural diseases. Close monitoring and adherence to sterile techniques are essential to minimize risks and complications associated with the procedure.