- Design
- Prospective multicentre randomised controlled trial, three guidance methods
- Population
- 2,485 patients undergoing biopsy of subpleural lung lesions
- Primary outcome
- Diagnostic yield and disease-specific sensitivity
- Effect
- Yield 88.8% (CEUS) vs 78.9% (CT) vs 76.0% (US); complications 4.6% vs 15.8% (CT)
A multicentre randomised trial assigned 2,485 patients needing percutaneous biopsy of a subpleural lung lesion to ultrasound-, contrast-enhanced ultrasound (CEUS)- or CT-guided biopsy, with diagnostic yield and disease-specific sensitivity as dual primary outcomes.
CEUS guidance gave the highest diagnostic yield (88.8% vs 78.9% for CT and 76.0% for standard ultrasound) and the highest sensitivity, including for malignant subtypes (91.8%). It also had the lowest overall complication rate (4.6% vs 7.5% for ultrasound and 15.8% for CT), the last reflecting CT's radiation-free but needle-path trade-offs.
For lesions that touch the pleura, this supports CEUS-guided biopsy as the preferred first approach where the equipment and expertise exist: it finds the diagnosis more often and with fewer complications, and avoids CT radiation. It is a single-country trial and CEUS needs contrast and operator skill, so applicability depends on local capability.
- CEUS-guided biopsy of subpleural lesions gave the highest diagnostic yield (88.8%).
- It was most sensitive for malignant subtypes (91.8%).
- It had the lowest complication rate (4.6% vs 7.5% ultrasound, 15.8% CT).
- Prefer CEUS guidance for pleura-touching lesions where equipment and skill allow.
- It needs contrast and operator expertise, so local capability determines use.
Why it matters
It challenges CT as the default for pleura-adjacent lesions, offering more diagnoses with fewer complications and no radiation.
Don't overread it
Single-country trial; CEUS depends on contrast availability and operator skill, so the advantage may not transfer to centres without that expertise.
The statistics, in plain English
A yield of 88.8% versus 78.9% is a meaningful absolute gain in actionable diagnoses, and the much lower complication rate strengthens the case; as a single-country trial, results depend on comparable operator expertise.
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