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(Chest. 1999;116:1320-1324.)
© 1999 American College of Chest Physicians

Repeated Ultrasonically Guided Needle Biopsy of Small Subpleural Nodules*

Ken’ichi Obata, MD; Jun Ueki, MD; Takashi Dambara, MD, FCCP and Yoshinosuke Fukuchi, MD, FCCP

* From the Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan.

Correspondence to: Ken’ichi Obata, MD, Department of Internal Medicine, Juntendo Urayasu Hospital, 2–1-1 Tomioka, Urayasu City, Chiba Prefecture, 279-0021, Japan

Study objective: To detect the significance of repeated ultrasonically guided needle biopsy (UGNB) for the diagnosis of nodular lesions <= 2 cm in diameter.

Design: Retrospective study to evaluate the diagnostic yield of UGNB.

Setting: University hospital, outpatients, and inpatients of the respiratory department. Patients: One hundred seven cases with small nodular lesions <= 2 cm in diameter in contact with the pleura. Sixty-two of 107 cases were malignant, and the others were benign diseases.

Results: Initial UGNB identified 56% (35/62) of the malignant lesions and 16% (7/45) of the benign lesions, ie, 39% (42/107) of the total. In 35 of 65 cases that were not diagnosed by the initial UGNB, it was repeated. Diagnostic yields of the second UGNB were 68% (13/19) of the malignant cases, 25% (4/16) of the benign cases, yielding a total of 49% (17/35) in those reexamined. Furthermore, 51 of 65 patients with negative findings on the initial UGNB underwent fiberoptic bronchoscopy. The resulting diagnostic yields were 22% (5/23) from the malignant lesions and 18% (5/28) from the benign lesions, 20% (10/51) in total. Thus, among the malignant cases, the repetition of UGNB increased the definitive diagnostic yield from 56% (the initial UGNB) to 77%. In these small tumors, no serious complications were caused by the procedure.

Conclusions: UGNB should be performed twice for a definitive diagnosis of small subpleural nodules before deciding on surgical biopsy or follow-up.

Key Words: small pulmonary nodule • transthoracic needle biopsy • ultrasound






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