- Design
- Prospective, multicentre, three-arm randomised trial
- Population
- 2,485 patients undergoing biopsy of subpleural lung lesions, China
- 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 multicentre Chinese trial, published in CHEST on 3 October, randomised 2,485 patients needing percutaneous needle biopsy of a subpleural lung lesion to guidance by plain ultrasound, contrast-enhanced ultrasound (CEUS) or CT, roughly 830 in each arm.
CEUS guidance had the highest diagnostic yield by the strict ATS/ACCP definition: 88.8%, against 78.9% with CT and 76.0% with plain ultrasound. Sensitivity was also highest with CEUS, both for malignancy (91.8% vs 83.2% and 75.2%) and for specific benign diagnoses (69.9% vs 46.8% and 47.1%). Complications were lowest with CEUS at 4.6%, against 7.5% with ultrasound and 15.8% with CT.
Contrast shows which parts of a lesion are viable and which are necrotic, so the needle can be aimed at tissue likely to be diagnostic. The trial applies only to lesions touching the pleura, and operators were experienced in a high-volume system. CEUS needs an ultrasound contrast agent and training, both less widely available in India than CT.
- For subpleural lesions, consider ultrasound-guided biopsy before CT guidance; it avoids radiation and, in this trial, had fewer complications.
- Where available, contrast-enhanced ultrasound can target viable tissue in necrotic lesions.
- CT guidance remains necessary for lesions not abutting the pleura.
- A non-diagnostic biopsy should prompt a repeat or alternative sampling rather than reassurance.
Why it matters
It suggests a radiation-free method can beat CT on both yield and safety for a common biopsy.
Don't overread it
The result applies to subpleural lesions in experienced hands; it does not cover deeper lesions.
The statistics, in plain English
The differences are large and in a big trial, so chance is an unlikely explanation. The comparison was not blinded, and results from expert centres may be higher than in routine practice.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pulmonology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free