Contrast-enhanced ultrasound beat CT and plain ultrasound for subpleural lung biopsy

Design

Prospective, multicentre, three-arm randomised trial

Population

2,485 patients undergoing percutaneous 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% vs 7.5%

This Chinese multicentre trial randomised 2,485 patients needing percutaneous needle biopsy of a subpleural lung lesion to guidance by contrast-enhanced ultrasound (CEUS), conventional ultrasound or CT.

CEUS gave the highest diagnostic yield (88.8% vs 78.9% with CT and 76.0% with ultrasound) and the highest sensitivity (86.1% vs 74.3% and 68.7%). The advantage held for malignancy (91.8% vs 83.2% and 75.2%) and was larger for specific benign diagnoses (69.9% vs 46.8% and 47.1%). Complications were least common with CEUS (4.6%) against 7.5% with ultrasound and 15.8% with CT.

Contrast is thought to help the operator avoid necrotic areas and sample viable tissue, and ultrasound avoids radiation and allows real-time needle tracking. For lesions abutting the pleura, this supports ultrasound-based guidance, preferably with contrast where available, over CT.

• For lesions touching the pleura, consider ultrasound-guided biopsy before CT-guided biopsy.
• Contrast enhancement improved yield, particularly for benign diagnoses.
• Complications were about a third as common with CEUS as with CT guidance.
• Check whether your centre offers CEUS-guided lung biopsy and refer accordingly.
• Deep lesions not abutting the pleura were not studied and still need CT guidance.

Why it matters

It is a large randomised comparison showing that the most accessible technique, with contrast, is both more accurate and safer.

Don't overread it

All centres were in China with experienced ultrasound operators; results may not transfer to less experienced units.

The statistics, in plain English

Diagnostic yield here used the strict ATS/ACCP definition — a result that actually allows treatment to be decided — so the 10-point gain over CT reflects real clinical usefulness, not just a sample being obtained.

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