Surgeon-led Point-of-care Ultrasound-guided Thoracic Biopsy: A new paradigm in efficient diagnosis and resource-sparing care.

Abstract

Tissue diagnosis through a variety of interventional approaches guides thoracic cancer management, but often introduces delay to definitive treatment and can be resource intensive. We introduced a thoracic surgeon-led, point-of-care ultrasound-guided biopsy program to provide rapid diagnosis for patients with thoracic cancers. We assessed the diagnostic yield and adverse events with this approach. A prospective cohort study was performed of consecutive patients undergoing ultrasound-guided biopsies performed by 5 thoracic surgeons from June 2021 to April 2024 at a tertiary Canadian thoracic surgery institution. By using a bedside ultrasound, 20-gauge tissue cores were obtained using multiple passes with a standard spinal needle. Descriptive univariable statistics were used. A total of 160 patients underwent bedside biopsy for lung (n = 101), liver (n = 20), chest wall/pleural (n = 20), mediastinal (n = 18), or other (n = 1) lesions. Tissue diagnosis was obtained in 86.3% of patients (n = 138), and diagnostic yield was similar for high- and low-volume providers and over time. All liver biopsies were diagnostic. Nondiagnostic biopsies were more likely to occur with benign pathology, chest wall/pleural lesions, or extensive necrosis; diagnosis was achieved with other modalities in most cases. There was 1 postprocedure pneumothorax (adverse event rate 0.6%). Thoracic surgeon-led ultrasound-guided biopsies are safe in an outpatient clinic setting and have high diagnostic accuracy. This results in reduced time to diagnosis by an estimated 28 to 35 days and frees up endoscopic and radiology resources for other patients. This low-cost procedure can be adopted as part of comprehensive thoracic malignancy assessment and can accelerate patient access to cancer treatment.