According to an open-access article in the American Journal of Roentgenology, ultrasound-guided percutaneous pleural needle biopsy (PCPNB) has excellent diagnostic accuracy for small pleural lesions.

“Ultrasound-guided PCPNB is highly likely to be diagnostic for small pleural lesions with nodular morphology on CT or ultrasound, or with pleural thickness ≥ 4.5 mm,” explains Jongmin Park and colleagues from South Korea’s Kyungpook National University.

To determine the diagnostic yield of ultrasound-guided PCPNB for small (≤ 2 cm) pleural lesions and the impact of CT and ultrasound morphologic and technical factors, Park’s team retrospectively studied 103 patients (73 men, 30 women; mean age, 60.8) who underwent ultrasound-guided PCPNB of a small pleural lesion by a single experienced operator from July 2013 to December 2019.

Histopathological results established final diagnosis, including from repeat ultrasound-guided and CT-guided biopsies, as well as imaging and clinical follow-up. CT and ultrasound assessed pleural morphology and thickness, while ultrasound measured needle pathway length throughout the pleura.

Summarizing their results, Park and colleagues note: “[Ultrasound-guided PCPNB] of small pleural lesions had a diagnostic accuracy of 85.4%. The yield was 96.4% for nodular CT lesions, 95.0% for diffuse CT lesions with thickness ≥ 4.5 mm, 55.6% for diffuse CT lesions with thickness.” Repeating their assessments on both CT and ultrasound two weeks later yielded representative measurements.

“In multivariable analysis,” the authors of this article conclude, “pleural morphology on ultrasound and needle pathway length through the pleura independently predicted diagnostic yield,” adding that if the pleura is nodular or thicker than 4.5 mm on CT, ultrasound-guided PCPNB is justifiable as an initial or repeat diagnostic test.