CT-Guided Percutaneous Trans-scapular Lung Biopsy in the Diagnosis of Peripheral Pulmonary Lesion Nodules of the Superior Lobes Using Large Needles

摘要

Abstract Purpose CT-guided percutaneous transthoracic lung needle biopsy (PLB) is an effective procedure for obtaining cyto-histological diagnoses of peripheral lesions. However, upper postero-lateral lung nodules (UPLN) may be difficult to reach using a standard intercostal either anterior or lateral approach or when the nodule is just behind a rib or scapula. We evaluated the feasibility and effectiveness of trans-scapular approach (tPLB) in these patients using large-core needles. Methods We retrospectively collected the data of 11 consecutive patients (mean age 74.6?years, SD 5.9) among those scheduled to undergo CT-guided PLB over the period February 2015 to February 2017. In these patients, the presence of a UPLN required a tPLB using a co-axial technique and large full-core needles (15G for the scapular piercing and 18–19G for tissue sampling). All patients were assessed by telephone at 24?h, 78?h and at an office visit at 30?days after the procedure to evaluate post-procedural pain (VAS score) and shoulder mobility. Results Ten of the eleven samples were diagnostic. No major complications were encountered. Three patients developed a pneumothorax, but none required pleural drainage. All the patients confirmed the absence of pain at 24–72?h and 30?days, reporting a VAS score less than 1, without any shoulder mobility limitation. Conclusion tPLB seems to be an effective and feasible procedure, accompanied by a low risk of pneumothorax in UPLN cases.