Ultrasound- Versus CT-Guided Subpleural Lung and Pleural Biopsy: An Analysis of Wait Times, Procedure Time, Safety, and Diagnostic Adequacy

Purpose: To compare the wait times, safety, and diagnostic adequacy of computed tomography (CT)-guided percutaneous lung biopsies with ultrasound (US) guidance for subpleural lung and pleural lesions. Methods: Consecutive CT- and US-guided biopsies performed at our institution between January 2018 and January 2019 were retrospectively reviewed. Biopsy wait times, lesion size, degree of pleural contact, procedure duration, number of needle passes, complications, and pathologic diagnosis were recorded and compared. Results: A total of 158 biopsies of subpleural or pleural-based lesions were reviewed. Forty-three cases utilized US guidance, while 115 cases used CT, 41 with conventional CT (CCT), and 74 with cone-beam CT guidance (CBCT). Overall, the mean lesion maximum axial diameter and length of pleural contact for US-guided biopsies was greater than for CT (4.8 +/- 2.6 cm vs 3.2 +/- 1.9 cm and 4.0 +/- 2.5 cm vs 2.6 +/- 1.7 cm, respectively, P < .001). Wait times for US-guided biopsies were significantly shorter than CCT by 10.9 days on average while being equivalent to CBCT. Procedure time was shorter for lesions localized with US than CT (29.5 +/- 16.4 minutes vs 37.6 +/- 19.5 minutes, P = .007) despite CT using less needle passes per lesion (3.5 +/- 1.1 vs 3.1 +/- 0.8, P = .034). Sample adequacy was equivalent for both modalities (88% for US and 92% for CT). The frequency of pneumothoraces was similar between US (12%) and CT (15%). Conclusion: Ultrasound and CT guidance have similar safety and diagnostic adequacy for subpleural lung and pleural biopsies. Ultrasound guidance has shorter wait and procedure times.