Objective: Tissue diagnosis through a variety of interventional approaches guides thoracic cancer management, but often introduces delay to definitive treatment and can be resource intensive. We introduced a thoracic surgeon-led, point-of-care ultrasound-guided biopsy program to provide rapid diagnosis for patients with thoracic cancers. We assessed the diagnostic yield and adverse events with this approach.
Methods: A prospective cohort study was performed of consecutive patients undergoing ultrasound-guided biopsies performed by 5 thoracic surgeons from June 2021 to April 2024 at a tertiary Canadian thoracic surgery institution. Using a bedside ultrasound, 20-gauge tissue cores were obtained using multiple passes with a standard spinal needle. Descriptive univariable statistics were used.
Results: 160 patients underwent bedside biopsy for lung (n=101), liver (n=20), chest wall/pleural (n=20), mediastinal (n=18), or other (n=1) lesions. Tissue diagnosis was obtained in 86.3% of patients (n=138), and diagnostic yield was similar for high and low-volume providers and over time. All liver biopsies were diagnostic. Non-diagnostic biopsies were more likely to occur with benign pathology, chest wall/pleural lesions, or extensive necrosis; diagnosis was achieved with other modalities in most cases. There was 1 post-procedure pneumothorax (adverse event rate 0.6%).
Conclusion: Thoracic surgeon-led ultrasound-guided biopsies are safe in an outpatient clinic setting, and have high diagnostic accuracy. This results in reduced time to diagnosis by an estimated 28-35 days, and frees up endoscopic and radiology resources for other patients. This low-cost procedure can be adopted as part of comprehensive thoracic malignancy assessment, and can accelerate patient access to cancer treatment.
Keywords: Thoracic cancer; biopsy; point-of-care ultrasound.
Copyright © 2024. Published by Elsevier Inc.