الفهرس 
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Abstract
The aim of this study was to compare the efficiency and safety of biopsy guided by ultrasound versus CT for lung lesions with pleural contact. A hypothesis was set; that US may be superior to CT in efficacy and safety. This study will be conducted on 50 patients presented with thoracic mass lesions in CT chest and referred to the radiology department at Diagnostic & Interventional Radiology and Imaging Department at Tanta University hospitals for imaging-guided biopsy and histopathology. The duration of the study will be two years from December 2021 to November 2023 and may be extended if indicated. All cases were biopsied under local anesthesia, except two cases who needed general anesthesia. No technique failure happened in any of the cases, and none of the cases was needed to be repeated. No biopsy specimens were rejected by the pathology laboratory, and a reasonable final pathological diagnosis was reached for every biopsy, assuming similar adequacy of the biopsied samples for both US-guidance and CT-guidance. True-cut 18 G x 20 cm (GTA®, Medilab; Italy) core biopsy needles were used in the two study groups. US-guidance was done with an (Apleo 500, TOSHIBA, Japan) system, while CT-guidance was done on an (Aquillion One, TOSHIBA, Japan) system. Only lung lesions with pleural contact were included in the study, while deep lung lesions that had no degree of pleural contact were excluded along with chest wall lesions; even if had any intra-thoracic components. Lesions’ size was referred to as the maximal diameter in axial plane and was measured in millimeters, the length of pleural contact was measured in millimeters too, the exact locations of the lesions were described in terms of lobes and segments, the position of the patient was documented either supine, prone or on a lateral decubitus. Number of needle passes, and number of soft tissue cores obtained, as well as final pathological results were all included in the statistical analysis of the data. The procedural times were calculated from patient’s entery into the room of CT or US till his/her ambulation to the observatory suite as documented on patient’s Personal hospital charts. The times consumed in the study of the patients previous investigations (imaging and laboratory) were not included in the study times. Any complications were documented as well as their management procedures. The results of the current study show that; Fewer passes were performed with US-guidance than with CT-guidance (mean 2.7 passes ±0.8 versus 3.4 passes ± 1.2, respectively, P = 0.04). This decreased number of needle passes was linked to faster procedural times with US-guidance than with CT-guidance (mean 6.3 minutes +2.2 versus 21.8 minutes +5.7, respectively, P = 0.0001). In addition, fewer complication rates were achieved with US-guidance than CT-guidance (15% versus 40%, respectively, p > 0.05). Subgroup analysis of the pleural contact revealed that US-guidance was faster and safer than CT-guidance more significantly in the 10-50 mm pleural-contact length subgroups (P= 0.036). Overall, 16 patients out of 50 (32%) had minor complications; mainly mild self-limiting pneumothorax (73%), no major complications happened, nor procedural-related mortalities occurred during or after the procedures. There was a tendency for increased complication rates with prone position 30.5%, more than supine position 20%, more than setting position with supported back 0%, (P = 0.683), also a trend was detected for increased number of malignant pathologies with tobacco smoking (P = 0.167). Malignant pathologies were more commonly encountered than benign pathologies (90% and 10%, respectively), across both study groups, with adenocarcinoma as the most commonly diagnosed lung cancer (42.5%). In conclusion, the current study found US guidance to be safer and faster than and at least as accurate as CT guidance for peripheral thoracic biopsy of lesions contacting the pleura. US-guidance should be considered as a first priority for peripheral lesions with pleural contact length of 10 -50 mm, and it should be considered for lesions with smaller and larger pleural contact length with safety profile comparable to CT-guidance, yet with faster procedural times and no ionizing radiation hazards. These reasons offer a compelling rationale for radiologists who perform thoracic interventions to consider implementing or expanding US-guided thoracic interventional services in their daily practice.