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Ultraschall Med 2009; 30(4): 390-395
DOI: 10.1055/s-0028-1109442
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Transthoracic Ultrasonography-Guided Core Needle Biopsy of Pleural-Based Lung Lesions: Prospective Randomized Comparison Between a Tru-Cut-Type Needle And a Modified Menghini-Type Needle

Transthorakale ultraschallgesteuerte Stanzbiopsie pleuraler Läsionen der Lunge: prospektiv randomisierter Vergleich von Tru-Cut und modifizierten Menghini-NadelnP. Tombesi1 , I. Nielsen2 , D. Tassinari3 , L. Trevisani2 , V. Abbasciano2 , S. Sartori1
  • 1Internal Medicine – Section of Interventional Ultrasound, St. Anna Hospital
  • 2Internal Medicine, St. Anna Hospital, Ferrara, Italy
  • 3Oncology, City Hospital, Rimini, Italy
Further Information

Publication History

received: 17.12.2008

accepted: 6.4.2009

Publication Date:
18 June 2009 (online)

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Zusammenfassung

Ziel: Der diagnostische Wert der bei transthorakalen Biopsienetnahmen verwendeten Punktionsnadeln ist bisher kaum untersucht worden. Das Ziel der Studie war es, die Nadel vom Tru-cut-Typ (TCT) mit der modifizierten Menghini-Typ-Nadel (MMT-Nadel) bei ultraschallgesteuerten (US-gesteuerten) Biopsien von pulmonalen Raumforderungen zu vergleichen. Material und Methoden: 307 Probanden (191 Männer und 116 Frauen, Durchschnittsalter 58 Jahre) mit peripheren Läsionen der Lunge, denen eine US-gesteuerte Biopsieentnahme bevorstand, wurden zur Punktion mit einer 18-Gauge-TCT- oder MMT-Nadel randomisiert ausgesucht. Die Gewebeproben wurden auf 2 – 3 Objektträger zur zytologischen Untersuchung aufgetragen und anschließend zur Histologie in einer Formalinlösung fixiert. Sensitivität, Spezifität, positiver prognostischer Wert (PPW), negativer prognostischer Wert (NPW) sowie die allgemeine Genauigkeit wurden jeweils berechnet. Der HRR- Wert (histology recovery rate-Wert), die diagnostische Genauigkeit und der diagnostische Ertragswert der Kombination von Zytologie und Histologie im Vergleich zur Zytologie oder Histologie für sich allein wurde anhand des Exakten Tests nach Fischer berechnet. Ergebnisse: 155 Biopsien wurden mit einer MMT-Nadel, 152 mithilfe einer TCT-Nadel durchgeführt. Der HRR-Wert betrug 112 / 152 (72,3 %) bzw. 144 / 152 (94,7 %) (p < 0,0001). Sensitivität, Spezifität, PPW und NPW betrugen jeweils 81,6 %, 100 %, 100 % und 62 % für Ersteres und jeweils 93,6 %, 100 %, 100 % und 86 % für Letzteres. Bei 133 / 155 Biopsien (85,8 %) wurde bei Verwendung einer MMT-Nadel und in 145 / 152 der Fälle (95,4 %) bei verwendeter TCT-Nadel (p = 0,0041) eine zutreffende Diagnose gestellt. Die Kombination von Zytologie und Histologie hatte einen höheren diagnostischen Ertragswert als nur die Zytologie (p < 0,001) oder die Histologie (p < 0,001) für sich allein. Schlussfolgerung: Die TCT-Nadel schneidet mit besserem Ergebnis ab als die MMT-Nadel und erhöht damit die diagnostische Genauigkeit der US-gesteuerten transthorakalen Biopsie von peripher gelegenen Läsionen der Lunge.

Abstract

Purpose: The diagnostic yield of the different types of cutting needles used to perform transthoracic biopsy is scarcely investigated. Aim of the study was to compare a Tru-cut-type (TCT) needle and a modified Menghini-type needle (MMT) in ultrasonography (US)-guided biopsy of pulmonary lesions.Materials and Methods: 307 subjects (191 males and 116 females, mean age 58 years) with peripheral lung lesions selected to undergo US-guided biopsy were randomized to undergo biopsy by using an 18-gauge TCT or MMT needle. The specimens were imprinted on two to three slides for cytology and then put into a formalin solution for histology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Fisher’s exact test was used to compare histology recovery rate (HRR), diagnostic accuracy, and diagnostic yield of the combination of cytology and histology in comparison with cytology alone and histology alone. Results: 155 biopsies were performed using the MMT needle, 152 using the TCT needle. HRR was 112 / 155 (72.3 %) and 144 / 152 (94.7 %), respectively (p < 0.0001). Sensitivity, specificity, PPV, and NPV were 81.6 %, 100 %, 100 %, and 62 % for the former, respectively, and 93.6 %, 100 %, 100 %, and 86 % for the latter. A correct diagnosis was achieved in 133 / 155 biopsies (85.8 %) performed with the MMT needle, and in 145 / 152 biopsies (95.4 %) performed with the TCT needle (p = 0.0041). The combination of cytology and histology had a higher diagnostic yield than cytology alone (p < 0.001) and histology alone (p < 0.001). Conclusion: The TCT needle performs better than the MMT needle, and improves the diagnostic accuracy of US-guided transthoracic biopsy of superficial lung lesions.

Key words

thorax - biopsy - interventional procedures - ultrasound - tumor

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Dr. Sergio Sartori

Internal Medicine – Section of Interventional Ultrasound, St. Anna Hospital

corso Giovecca 203

44100 Ferrara

Phone: ++ 39/5 32/23 67 41

Fax: ++ 39/5 32/23 66 22

Email: srs@unife.it

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